Combating the side-effects of bipolar medication that affects your appearance

This post turned out to be a bit longer than I planned, so if you just want the advice, scroll down and read the italic bits. If you want to understand better, can relate or generally enjoy my self-deprecating humour, please continue. 

It seems that the side-effects of psychiatric medication is something that isn’t discussed enough by medical professionals. In my younger, more naive years I thought that if the doctor didn’t say anything about side-effects, it meant that there weren’t any. Until weird things started happening to my body and I eventually had to take to Google. What you learn very quickly is that everyone experiences side-effects differently, and something that I can’t possibly imagine is true, happens to you.

There are a few side-effects that are relatively common across most psychiatric meds: weight gain, serious fatigue, skin conditions, nausea, gastrointestinal issues to name a few. For some people, most if not all of these symptoms disappear after a while, but weight gain and fatigue usually lasts (especially with anti-psychotics). When I started Lithium almost exactly a year ago, my family couldn’t understand why my doctor hadn’t put me on it a long time ago. Neither could I really, until my doctor warned me about possible kidney failure, thyroid disease, blood tests, dehydration, balancing my salt intake and possible Lithium toxicity. She left out the ‘smaller, less important’ side-effects that I first thought was in my head until it became completely abnormal: hair loss and acne. Along with weight gain, these are the side-effects I want to talk about.

I guess that doctors don’t consider discussing the side-effects that affect your physical appearance as important since they don’t happen to everyone, and aren’t life threatening, but they definitely have a big impact on your already fragile and depressed self-confidence.

1. Weight gain

Of the three, this side-effect is the most common, and caused by most anti-psychotics (except Geodon), some anti-depressants, and most mood stabilisers (like Lithium) except for Lamotrigine. For more info about specific meds and weight gain, go check out Mayo clinic.

Get support

I can only tell you what worked and didn’t work for me. When I was first put on Seroquel (anti-psychotic), I picked up 8kg in a very short time. I didn’t even realise how much I’d picked up before it was too late. I tried going off Seroquel but I could feel myself slipping badly. Later I tried switching to Geodon, but it was extremely expensive and my dose was probably not high enough, so I had the most wonderful hypomanic episode followed by and epic crash that landed me in the hospital again with a new psychiatrist. I had to accept that Seroquel was here to stay. I joined a weigh-loss programme that conveniently had a branch at my offices. It took me a YEAR of mostly being hangry and wanting to cry when I walked past chocolates, but I lost 10kg. I did cheat over weekends, otherwise I would have died. So I was finally on my goal weight; not skinny, but not overweight. I should have continued with the programme but didn’t, and so picked up 5kg again. It was okay though, I had learned a lot and could monitor my eating better.

So my advice is, join some sort of weight support group where someone can help you plan meals, where people keep each other accountable, where you are forced to weigh yourself once a week, and where people keep each other motivated. You don’t have to tell your bipolar story to everyone, but at least tell the person leading the group what medication you are on and how it causes (in my case) sugar and carb cravings and makes you feel like you are ALWAYS hungry. And STICK with it once you’ve reached your goal weight to stay there. 

Consider a possible medical intervention

And NO, I am not talking about diet pills. That shit is bad for you. I am talking about the anti-depressant Wellbutrin. Wellbutrin is also sold as Zyban and helps people to quit smoking. It is also known for making people lose weight. Lithium causes weight gain too, but I started Wellbutrin at the same time and since then I have lost, and kept off, about 6kg in a relatively short time without consciously trying. It is only now that I have lost the weight and am back on my goal weight, that I am making an effort to keep it off. I’ve experienced it as pretty miraculous. Word of warning though, Wellburin doesn’t work for everyone. It either works or it doesn’t. It is also known to bring on (hypo)mania, which is why I am currently only on 150mg and not 300mg. It is also pretty expensive and not all health insurances cover it. Unfortunately there also isn’t a generic at the moment. So seriously discuss it with your doctor first, especially if your are taking a combination of other stuff. To me and others I know it’s been well worth it.

Exercise

I put it here because I feel I have to, not because I practise what I preach. Personally I am not a fan and apart from occasionally walking my dog a block or 2, I haven’t exercised in months. BUT it does help with weigh-loss and general health etc. There is loads of info out there if this is your thing. Just remember weight-loss is more diet than exercise and just because you exercise doesn’t mean you can eat what you want if you want to lose weight.

2. Acne 

I had problems with my skin all through my younger years, so I was pretty happy to grow up and have that stop, mostly. And then it just flared up like crazy! Especially along my jaw line where I never use to get spots before. I couldn’t understand it. I’d been on birth control to help me with moods and hormones for many years, but even on that my skin looked like crap. So I changed brands, and changed again. It was only after a few months that I looked at Lithium side-effects again, and there it was. Acne.

I didn’t want to go on antibiotics unnecessarily and there was NO WAY I was going on Accutane. Not that I can now that I have a mental illness diagnosis anyway, but that shit is BAD. Thinking about it, no medication side-effects has ever been as bad as that. So anyway, no matter how desperate you are, don’t use Accutane.

Once I moved back to my sleepy town, my mom suggested that I go for a chemical peel. She did it when she was in her 30s and swears that’s why she looks younger than all her friends who are younger than her, and it is much cheaper here than in the city. Problem was I really hate facials. The minute they put a warm cloth or steam machine over your face I  feel like I’m drowning. I was also scared that it was going to look like someone threw acid in my face. But desperate times… I wasn’t going out because even thick make-up couldn’t cover up how hideous I looked. Something had to be done.

Luckily the girl that now does my chemical peels is really sweet and professional and the whole process is not at all what I expected. They start you off with a very light peel and increase the intensity as your face gets more use to it. She also told me to switch to dermatologically recommended wash and cream with no perfumes or funny things as my skin is crazy dry. And it’s working! I’ve gone for 3 peals every 4 weeks and I look like myself again! I’ve always been vigilant about my skin routine, but now I’m SUPER vigilant and will continue to go for the treatments as long as I can afford it. The place I go to uses Placecol products, but I’m sure there are other good products out there too.

My doctor also lowered my Lithium dose a bit because my blood levels were too high, and that probably helped too.

3. Hair loss

I’m sure you could gather that the acne situation was really bad. And it was horrible. But the hair loss! Nothing could have prepared me for that.

I’ve had a beautiful, glossy, wavy mane of hair for the largest part of my life. I love my hair. It has been every colour and style under the sun (except blue and pink), but now that I qualify as an adult, I’ve kept it pretty long. I don’t have to style or use product or even blow dry my hair, and I barely comb or was it. I LOVE my hair.

Obviously long hair falls out a lot, so I’m use to that, but then I started noticing that the hairballs from my brush and the shower were getting larger and larger. I thought it was all in my head at first (no pun intended), but it got worse and worse. Making a ponytail I could actually feel a marked difference. It made no sense, this sudden hair loss problem. And then I went back to the Lithium booklet. It was the only thing that made sense and it pissed me off severely. The worse part is, there isn’t really anything you can do about it, except lower you Lithium dose and cross your fingers that it stops.

And luckily it did. Surprisingly, it also started growing back! The only stupid thing now is that I have these little Alfalfa hairs sticking up all over my head, and what my hairdresser recently referred to as ‘bum fluff’ (ridiculous little corkscrew curls) that are frizzing on either side of my forehead.

I haven’t been to hairdresser in almost a year, because I didn’t want to explain why it looks like a child got to my hair with a razor, but then I made friends with a friend of my brother’s who I didn’t mind telling the bipolar Lithium hair loss story to. Once you’ve gotten your hair to grow back, there isn’t much you can do about it, but she basically recommends:

• Don’t touch your hair at all, because the baby hair is fine and by trying to get it flat or uncurled you just pull the hair out again.
• After you’ve blow dried your hair, you can set it with cold air (didn’t last long for me).
• Don’t straighten the baby hair (in my case my bum fluff) because the flat iron will also damage it and pull it out.

Someone also recommended that I use horse shampoo, but I haven’t found any yet, and I have also started using folic acid but not long enough to know if it makes any difference.

 

I hope that there is someone somewhere who has looked long and hard for some answers on how to just look like yourself again and who will find them here. If you have any other tips on psych med weight, acne and hair loss PLEASE share. The struggle is real people and I don’t want to have to choose between looking good and feeling good, because that’s just not fair!

*Please discuss any and all medication adjustments with your doctor. Don’t be stupid and make things worse for yourself. NEVER just stop your meds cold turkey on your own. You think taking meds have bad side-effects? You don’t want to go through withdrawal!

Big wave, little wave

*trigger warning* This post contains mentions of suicide.

Greetings  blogosphere and interwebs in general. I’ve delayed writing a bit because you see, a lot can happen in a year. Also because bipolar folk are notoriously unreliable when we hit an episode. It’s really not our fault.

As for me, I won’t share all the details because it will be much too long and I don’t think it will necessarily be helpful to anyone. So just in short, in the past roughly 10 months, I did a stint in clinic because I was suicidal, then thought I was fine. Then, mostly unbeknown to myself, depression became a mixed episode and my life and my brain became all kinds of fucked-up (I will gladly share details if someone wants to PM me), then I did actually try to commit suicide, failed/was stopped, spent 5 days in ICU, went through the aftermath with the people in my life (this was by far worse than anything else). If you want to kill yourself you better make damn sure you die. That being said, now I’m kinda glad I didn’t. Most of the time.

Anyway, then my life fell apart. I had to take unpaid leave from work and left the city to stay with my parents in my home town and receive intense therapy. My doc also put me, and here is the important part of the post, Lithium. It took some time and a whole lot of blood tests to get the dose right, but it pulled me out of my very deep hole. I won’t lie, Lithium has its stigma for a reason and its side effects are horrendous. Apart from the common shakes and dry mouth, there is hair loss, stomach cramps, vertigo, unbearable thirst, acne, possibility of kidney and thyroid problems and probably some others. But how does it look on a practical level? It means if I don’t carry water with me all the time, I get incredibly agitated from thirst. I can’t apply eyeliner or do any detailed kind of work with my hands. My writing is even worse than it was. Some days my stomach cramps so much or I get such bad vertigo that I have to lie down. No matter what I do, my skin looks terrible. But to me the worse is probably the hair loss. I have thick and long hair and it’s EVERYWHERE. I shed worse than my cats and it frustrates me to no end. These side effects make me feel very sorry for myself.

So why take it if it’s so horrible? Because the 1 pro far outweighs the many cons: It keeps me from wanting to kill myself. It’s as simple as that, and the no. 1 reasons doctors prescribe Lithium despite its side effects. I’m still not on ‘normal’ between hypomanic and depressed, but I’ve only have little waves, not big waves. And this has been with a whole bunch of crap happening in between. I quit my job, left the city to move back home, had to find my own place, my father passed away and I’m starting my own business. It hasn’t always been easy, and there has been plenty of days spent in bed or in front of the TV, but I’m managing.

While most of this is largely thanks to Lithium, I am also on Wellbutrin, Venlor and a very small dose of Seroquel. I’ve also basically stopped drinking and have a good exercise routine. I’m not under big city stress (like traffic), and I am not in an extremely deadline driven industry. I try to at least do one big task/errand a day. All these things help too. I still need to get into a better routine and do something about my diet (currently I have only bread, cheese and a bunch of sauces in my fridge).

I curse the fact that I have to live with these side-effects every single day. I get very angry that people don’t see it and therefore don’t know what I’m going through. I feel embarrassed when someone sees my food fall off my fork because my tremour is so bad. But then I get over it and remember where I could have been. How I almost drowned in the storm of my own mind. And I ride my little waves, that no one even sees, like a pro.

 

*If you or someone you know need support, please call the suicide prevention hotline in your area immediately, or reach out to someone you trust. Threats of suicide should ALWAYS be take seriously.*