The Marriage Plot - Jeffrey Eugenides [150]
Leonard understood why psychiatrists did what they did. Their imperative, when confronted with a manic-depressive patient, was to nuke the symptoms out of existence. Given the high suicidality of manic-depressives, that was the prudent course of action. Leonard agreed with it. Where he differed was in managing the illness. Doctors counseled patience. They insisted that the body would adjust. And, to an extent, it did. After a while, you’d been on the drugs so long that you couldn’t remember what it felt like to be normal. That was how you adjusted.
A better way to treat manic depression, it seemed to Leonard, was to find the sweet spot in the lower reaches of mania where side effects were nil and energy went through the roof. You wanted to enjoy the fruits of mania without flipping out. It was like keeping an engine operating at maximum efficiency, all pistons firing, perfect combustion generating maximum speed, without overheating or breaking down.
What had ever happened to Dr. Feelgood? Where had he gone? Now all you got was Dr. Feel-O.K. Dr. Feel-So-So. Doctors didn’t want to push the envelope, because it was too dangerous and difficult. What was required was somebody daring, desperate, and intelligent enough to experiment with dosages outside clinical recommendations, someone, that is, like Leonard himself.
At first, he just took fewer pills. But then, needing to reduce in smaller increments than 300 milligrams, he began cutting his pills with an X-acto blade. This worked well enough, but sometimes sent pills shooting onto the floor, where he couldn’t find them. Finally, Leonard bought a pill cutter at the P-town pharmacy. The oblong 300-milligram lithium tablets were easily halved, but less easily quartered. Leonard had to place the pill between spongy prongs inside the cutter, closing the lid to bring down the blade. When dividing a pill into fifths or sixths, Leonard had to guesstimate. He took things slowly, dropping his daily dose to 1,600 milligrams for a week and then to 1,400. Since this was what Perlmann promised to do in another six months, Leonard told himself he was just speeding things along a bit. But then he took his dose down to 1,200 milligrams. And then down to 1,000. And finally all the way down to 500.
In a Moleskine notebook, Leonard kept a precise record of his daily dosages, along with notes on his physical and mental state throughout the day.
Nov. 30: Morning: 600 mg. Evening: 600 mg.
Cotton-mouth. Cotton-head. Tremor worse, if anything. Strong metal taste to saliva.
Dec. 3: Morning: 400 mg. Evening: 600 mg.
Good period this morning. Like a window opened in my Tower of London head and I could see out for a few minutes. Pretty out there. Although the gallows are possibly under construction.
Tremor possibly less, too.
Dec. 6: Morning: 300 mg. Evening: 600 mg.
Down four pounds. Good mental energy most of day. Tremor about the same. Not as thirsty.
Dec. 8: Morning: 300 mg. Evening: 500 mg.
Made it through the night without having to use the bathroom.
Alert all day. Read 150 pp. of Ballard without coming up for air.
No dry mouth.
Dec. 10: Morning: 200 mg. Evening: 300 mg.
Little bit overexuberant at dinner. M. moved my wineglass out of reach, thinking I was drinking too much. Will increase doses for next two days up to 300 mg to stabilize.
Hypothesis: Possible that kidney function not as good as Dr. P. thinks? Or that there are fluctuations? If lithium not flushed from body, can it be assumed that excess lithium remains in system, doing its evil business? If so, might this be cause of dead brain, GI trouble, torpor, etc.? Daily dose may therefore