Am I a Fraud?
At my most recent mental health appointment last month, my psychiatric mental health nurse practitioner (PMHNP) asked me her routine questions in order to gain insight about my mental state: Am I depressed, am I manic, am I stable? Ever since I began seeing her – which has been some months now – my moods have been stable. One could say that I am euthymic: I am neither manic nor depressed. Euthymia is a bipolar mood state that probably does not get as much attention as depressed and (hypo)manic states.
Somehow, about 60 days in, I ran out of what should have been a 90-day supply of my antidepressant medication and did not have any refills. That is to say that, perhaps due to a pharmacy error, I had been off of Zoloft for about a month. When I shared this with my PMHNP, we decided that I could discontinue the Zoloft at this point. This was music to my ears, as I would ideally like to come off of all my medications, including my antipsychotic (under the supervision of a mental health professional, of course). Why? 1) I’m stable and have been for a while. 2) My husband and I would like to start a family, and there is not sufficient research on how psychotropic medications affect babies in utero. Rather, the research largely focuses on how stopping medication negatively affects the mother’s mental health. For instance, she may sink into depression or ascend into mania, causing her to unintentionally harm herself and/or her unborn child. Right now I am still taking my antipsychotic. My PMHNP gave me a 90-day supply with two refills because she thinks that I need to continue that medication indefinitely. She also thinks that I don’t need to come back for six months. At this six-month follow-up appointment, I will be seeing a new PMHNP, as my current one is resigning from the practice. It will be interesting to compare and contrast these two professionals’ approaches to my mental health treatment.
While I am pleased with how I am doing and how I feel, it’s kind of got me thinking: Am I even bipolar at all? Maybe the psychosis I experienced, and even the manic weeks or months leading up to that, was just a one-and-done type episode that has resolved and will never happen again. Essentially, I am experiencing imposter syndrome. In other words, I feel like a fraud. After doing some searches on YouTube, I realize that I am not alone. And in fact, this is one reason people with mental health diagnoses come off of their medication. They are so stable that they cannot relate to or have emotionally distanced themselves from who they were when they were unstable. Some people even go so far as thinking that they must have faked the whole thing, that they did it for attention. It’s easier to feel this way about hypomania. Full-blown, psychotic mania, however, cannot be faked in my opinion. I am not saying that one can’t pretend to be psychotic, but I am saying that if you have truly experienced psychosis, you know that you didn’t make that stuff up. It was real. But, at the same time, it wasn’t. The delusions, the hallucinations, the paranoia…stable me doesn’t recognize that person anymore. I don’t even recognize my hypomanic or depressed self.
My psychotic episode was triggered by extreme stress and poor self-care. Do I need medication? The science says that I do for my lifetime, but it doesn’t mean that I can’t stop and start the medication. But there is a caveat: A future episode will be more difficult to treat if you have been off of your meds for too long because those future episodes occur in shorter periods of time and have less extreme triggers. This kindling effect is why it is important to know your triggers and to pay attention to your moods even if you are stable and think that maybe nothing is wrong with you after all.
