Living in Chaos: Survival

What defines Stability in MI....?

Recently I was asked to define stability with regard to Bipolar illness:

When did we know he was stable?
How long did it take to reach?
How many medication trials did it take to get there?
What medications worked?

Stability is relative. I don't think there is any one way to measure what is stabile and what is not. It is a range of behavior, a range of treatment, a range of function, a lack of change.

For Dalton, I don't remember exactly how many medication trials we had to go through to reach the place when I began to consider the world stable as being a part of my vocabulary. I remember counting once, and I believe he had been on somewhere around 32 different medications. Some of these were tried in more than one combination, and when we finally began to see some levelling off of his symptomology, he was on five psychotoppic mediations and two non-psychotropic medications. Of the 32 or so medications he tied, over 1/3 resulted in severe adverse reactions, another third did almost nothing, and he ended up on many in combination, just to function... it has taken a combination of seven to eight prescription medcations from December 1998 until just recently, to maintain what we consider stability. He is still on three psychotropic meds and two others. We hope to be able to eliminate another of the psychotropic meds this summer.

The final piece of the puzzle to reach "Stability" for Dalton was adding Seroquel to his medications in December 1998. Prior to this, he was on Eskalith, Zyprexa, Tenex, Topamax and Synthyroid. Even so the one remaining issue which kept making his life a living hell, day to day was the severe level of psychotic anxiety. he would scream and rage, cry and fight, every single night for 45 minutes to over two hours at bedtime. I think this was a combination of night terrors, PTSD, and who knows what all... He would freak out if I touched and tried to hold to comfort him, then freaked out more if I tried to leave the room. Severe separation axniety, but even more severe fear of me. We played "Don't touch me...Don't leave me..." every night for over two years.

Seroquel stopped this behavior in it's tracks within less than two weeks. It was from this point that Dalton was able to sleep, at times, alone in his room, all night. He began to go poop on the toilet occasionally for the first time ever. He began to slowly begin to show the ability to think in advance of actions. He even managed to begin to ask to go to bed, to tell us he was tired, and would we tuck him in?

Dalton still has certain symptoms which will never disappear. He is impulsive, oppositional, defiant, mouthy, hyperactive, and appears to exist in an almost perpetual state of hypomania. These symtoms wax and wane depending on the time of year, the stress and transitions in his life, and ebb and flow like the waves at sea. However, as time has continued to pass, the severity of his mood swings has lessened dramatically each year, and we know how to manage his medications, making adjustments to his Seroquel and Lithium as needed. Up and down, back and forth, it is a dance. Spring, summer and Fall and Christmas are the forseeable times when we know he will have fluctuations in his functioning. As time has moved on, we have become knowledgeable of his illness and medications so that we can usually minimize his more difficult times to a period of a few weeks.