The Subtlety of Moods

Over the years I have slowly discovered some things about moods.  The first is that moods color every part of your thinking.  How you remember the past, what you predict for the future, how you feel right now.  They change your understanding of the motivations of others.  They change how you relate to others.  They change your motivation, your hopes, your dreams, your fears, who you think you are.

The thing about moods is that often you don't realize that you are in one.  Your behavior seems to you to be entirely reasonable based on the situation, and because moods affect how you view the past and the future it feels as though things have always been like this.  This can be true even in very extreme moods, like depression or euphoria.  When you are depressed it feels like there is no hope for the future, and your past is a tale of woe.  If you are euphoric then everything is beautiful and wonderful and nothing matters but right now.  I find this difference in time scale both interesting and informative, misery is about the future and the past while happiness is about right now.

I come to this subject from perhaps a weird direction.  I have been taking effective medication for my bipolar disorder since late July of last year.  While my mood has not been monotonal, it has been within a particular range, wobbling gently between a calm happiness and a mildly ruffled mundanity.  Sometime in December this went down a bit, so that I asked my psychiatrist for an increase in dose in order to get back to consistent calm happiness.  Unfortunately, at the same time the drug company decided to end their payment assistance program, meaning that the new dosage would cost me about $150 a month as a co-pay (after insurance).  There is a generic medication, and the co-pay for the same dosage is about $3, and so I naturally wanted to switch.

My psychiatrist had previously said that "generics don't work" and explained the situation with generic medications in the USA as he understood them.  For a start the requirements were set by a group of three men in Washington.  The requirements set by the FDA are essentially that there must be the same active ingredient released into the bloodstream within 80-125 percent of the original amount.  For my dose of 300mg this means that the range of legal dosage is between 240mg and 375mg, a range of nearly half the actual dosage.  According to the FDA the actual variation is usually far smaller than this, and I see no reason to think they are lying.  However, according to my psychiatrist, the actual number of people in the FDA checking to see if the standards are maintained is pitifully small, not enough to actually ensure this is true.  Moreover, the penalties if caught are not an adequate incentive to ensure standards are maintained.  Just in January of this year a company found to have not only not checked dosages themselves, but also used illegal production techniques and lied to the FDA about their actions.  Their penalty?  A suspension of production until standards were met, and the establishment of an outside auditor to ensure this happened.  According to my psychiatrist a study was performed that found the average dosage in generics was 40% of the brand name medication.

Anyway, with this generic drug, in an increased dosage (from 200 to 300mg), my symptoms have worsened.  I have had times of increased tiredness, an afternoon of twitchy excitement, and today I realized that I had a sense of world-weariness.  The 300mg of the generic is working less well than 200mg of the brand name, but it is still working.  I have an appointment next week and will ask for the greatest increase in dosage the psychiatrist will allow.  Apparently my experience with this drug (lamotrigine) is not unique.

Now I need to tie all of this together.  I had not really noticed a large change in mood during the last three months.  I knew there were some more symptoms, and I knew I wasn't at my happiest, but I thought that was about it.  After today's realization I started reviewing the last three months and started noticing some things.  I realize that I had felt that I was under a curse living in Texas, basically that anything that could go wrong would go wrong.  I realized that three months ago I was writing regular blogs, studying spanish for an hour a day, and playing music regularly.  13 posts in both November and December, 8 in January, 4 in February.  I now force myself just to study spanish a bit, think that I haven't learned anything, and often go several days between actually studying.  I have played music twice in three weeks.

Clearly there has been a pattern here of reduced mood, reduced motivation, reduced energy.  The thing is that I did not notice.  Mood is the most immediate thing in our consciousness.  It colors everything, informs everything.  However, its very omnipresence means that it can be invisible.  Slow changes are unnoticed.  Sudden changes are attributed automatically to circumstances.  I believe that our moods are the most important things in our lives, but they are subtle and hide in plain sight.