Questions And Answers About Bipolar Disorder Medication

By Jerry Kennard, Health Guide Saturday, July 10, 2010

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There are medications and there are medications for bipolar disorder. Unlike an infection, or headaches, where popping a few pills can alleviate the problem, the outlook for most people with bipolar is very different. In this Sharepost I've touched on some of the recurring questions asked about medic...

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Managing Bipolar Disorder: How to Chart Your Mood

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Donna-1

7/10/10 12:02pm

I was diagnosed first as having bipolar disorder, so I feel I can post at this particular site. My medication causes two unwanted side effects: somnolence and weight gain. The problem is that when I am "fat" (my weight doubled in a few months) I would rather be thin and risk relapsing. But when I relapse, I would rather be fat. So I go back and forth. Have for years. My doctor doesn't understand, but then he's not the one experiencing the illness or the medications.

Donna

Suzanne

7/10/10 12:56pm

I would definitely search for a new provider if at all possible. My meds provider (nurse pracitioner who specializes in bipolar) works WITH me in a collaborative way. I was on Abilify for about 15 yrs. & gained 50 lbs. Abilify at first said it was "weight neutral" but everyone except one person in my DBSA support group have gained weight on Abilify. Now the patient insert does list weight gain & metabolic syndrome (which is what I have) as side effects.

So now I take meds for high cholesterol & blood pressure & am taking a diabetes educ. class to try to lower my blood sugar which is now in the diabetic range. Plus my self-esteem is in the gutter due to weight gain.

I NEEDED the Abilify to help me get to thinking "straight" or rationally & thus be able to benefit from therapy (also take Lamictal, Provigil & Concerta for ADHD). I tried Lithium & did great on it mood-wise but had kidney malfunction & had to get off it in 2 mos. Geodon caused me extreme dizziness & tiredness so much so that I had to lie down on the floor at work as the room was spinning (& I worked in a public place--not very professional) & I fell asleep while driving on Geodon. Luckily, when my tires hit the shoulder of the road as I was veering off the road the sound of the gravel on the shoulder woke me up.

When I was first dxed I was in a mixed episode & put on Depakote which helped w/the agitation but not the depression. When I told the pdoc that I was still depressed, he asked me if the radio was "giving me special messages" (never one of my symptoms!) & I said, "No" so he told me to stay on Depakote & this was "as good as it was going to get." I wouldn't accept that extremely low quality of life.

I "fired" him & got another meds provider who actually listened to me (this pdoc maybe had me confused with someone else whose radio gave them special messages!). The n.p. spends 45 min. - 1 hr. w/ me & charges LESS than 10 min. w/the pdoc! She knows me, details about my life & can talk to me about my energy level, relationships, ability to do things I want to do, anxiety, etc. & then knows best how to adjust my meds as needed.

She even wrote 30 min. of aerobic exercise on a script for me when writing my scripts for other meds as she says exercise is as important as taking your medication & gave me her cell ph. #.

I am working w/her to get off or decrease dosages of meds now that my DBT & indiv. therapy w/therapist who leads DBT group have proven so beneficial to me. The neuroplasticity of the brain is true. With a lot of education & practice you can change your cognitive distortions that lead to erratic behaviors & over-emotional reactions so your family & friends don't have to "walk on eggshells" around you all the time (as my husband did me).

I also take advatnage of all resources I can find like WRAP (Wellness & Recovery Action Plan--I think that is the correct name!); IMR (Illness Management & Recovery), Peer-to-Peer classes (all have been offered by NAMI (National Alliance on Mental Health) free of charge & attend a DBSA (Depression & Bipolar Support Alliance) support group.

I have been off Abilify for about 1 1/2 yrs. & am decreasing my dosage of Lamictal w/the approval of my meds provider & the understanding that if symptoms return I may need to up the dosage (which I did for the Lamictal for about a month when a depression hit) & be agreeable to take or add medications if my symptoms warrant it. But that is the best thing--to be an equal partner w/your provider. I trust her & she in no way wants me to be a "zoombie" or have a lower quality of life. Now that I have been correctly dxed & being treated life should get BETTER (though I do miss the hypo-manias, I admit).

Donna-1

7/10/10 2:25pm

Thank you so much for your suggestions and the long post. It's good to know someone out there has found a good listener. Although I don't agree with my psychiatrist on some issues, he has given me a fair chance with many, many medications. Any time something new comes out or something old sounds promising, he is more than willing to let me try it. But nothing helps except Zyprexa. Absolutely nothing. What I would like to do is get professional counseling on how to wean myself off the Zyprexa and get through the withdrawal period. My pdoc says it is not withdrawal, it is return of symptoms, and that therefore I have no option but to take the Zyprexa. But...I am beginning to wonder. After I have stopped taking it for a few days, I get these buzzing thoughts flying through my brain like an angry bumblebee. And the sensation that I'm going to faint. And constant music phrases playing over and over in my head. None of these were among my original symptoms.

I use a nurse practitioner for my general medical needs and find her delightful. But she doesn't want to step on the toes of my pdoc by taking over my mental healthcare. I say, who cares? Shouldn't I as the patient be the one to decide? With our new healthcare laws in the works, I hesitate to change pdocs, though. I have been seeing this one since 1997 and finally stablized under his care.

Donna

Anonymous

7/10/10 5:42pm

Donna: Your n.p. may not feel comfortable dealing w/psych meds. The n.p. I go to specializes in bipolar & is in charge of the psych ward of the local hospital. This is her area of expertise. She, however, does not want to prescribe for my high blood pressure, etc. She knows what her speciality & what her limits are. I see an internal med doc for blood pressure & cholesterol & thyroid & pernicious anemia & blood sugar, etc.

But I DID interview the internal med doc before I "signed on" as her patient & also gave her the opportunity to not accept me as a patient as I also have acute anxiety (esp. around docs) so I almost always cry! I just wanted to lay it down on the line for her as to what to expect from me as I am a "complicated" case! I don't want to feel all the anxiety before an appt. as then I tend to cancel appts. & I need to address my physical health issues. So I just told her about all my difficulties & let her know what she was in for! She spent about 1 1/2 hrs. w/me just talking & said she considers the emotional component as important as the physical so she talked to me for that lengthy time & I came back for the actual physical part (she gave me the choice as I was exhausted just from explaining my background & current difficuties).

Donna-1

7/10/10 6:17pm

Yes, I can see where a PCP might be hesitant to prescribe meds for schizophrenia or bipolar...or any other mental illness. And it is worth noting that my psychiatrist is equally as hesitant to discuss my other physical dysfunctions. And I guess that is the way it will stay because there are so many things to learn and keep up with in each specialty. Not like the old days when the family doc made house calls and ordered a mustard plaster.

Donna

Tabby

7/14/10 5:01pm

My thoughts and comments:

By the way, DO YOU take any of these medications? I'm not being funny nor meaning to be disrespectful, honest. I'm serious. Do you actually take the medications yourself?

I ask because many times you get this answer from professional folks who look upon those with mental illness as "patients" and not connect with them as "people". They do this because they do not "live" through the illness they are prescribing the meds for and do not first hand experience the meds themselves.

In my personal experience, with meds, my relationships did not get better. If anything, I lost relationships because I could barely move and react and was more sedated and less "light hearted, spontaneous, and fun".

I sat, most of the day and could barely hold a conversation. Most days I was just a big fat lump sitting and staring. Granted, the multitude of meds I was on at one time was most likely too heavy but don't tell the docs that.

I take 1 med now. It doubles as mood stabilizer and anti-seizure because I have both conditions. I really have no mood stability in as such as the seizure control BUT, I've not been quite so bad as I've been known to be... except when highly triggered by an outside environmental factor.

I am highly med sensitive in that my system does not tolerate meds so what is way low for most might be too high for me. Most of the docs I've seen, do not try to get this. They label me med non-compliant when truth is; my eyes swell shut, my body breaks out into hives, my muscles jerk and twitch, or I get so dizzy I can not stand up even on some of the lowest doses around.

Let's not even talk about the worsening or presentation of brand new psychiatric symptoms because many of the meds have adverse psychiatric reactions.

Also, the "standing a better chance of holding down work" is just sorta giggling.

You see, the majority of those diagnosed with Bipolar never ever return to the working world of employment. Folks may have worked for years on years before diagnosis; bouncing here and there but working.. working working working. Then they are diagnosed, placed on 4-6 meds, and suddenly the majority run - don't walk - to their nearest social security office to never work again.

I did say, the majority. There are a few of us who do still work, even while battling the disorder, and yes work is triggering, stress producing, and de-stabilizing... but we still work - even while taking the meds.

We, may end up hospitalized quite a bit and have to take repeated leaves of absence.. and quite often are eventually fired if we don't resign ourselves... but, we still work - even while taking the meds.

It's not to strike against those who do not work or choose to not continue employment... it's just fact that the majority of those diagnosed with Bipolar, placed on several medications, no longer continue employed working.

If one finds that the side effects are intolerable or makes their daily lives more dysfunctioning, then you don't have to tolerate it. Talk with your doc.

The beauty of it is; there are many many meds out there and you can tell the doc that you simply won't tolerate the side effect(s) you are experiencing and ask for something else or advisement on how to reduce or prevent it from occuring. You don't have to live with side effects that you find are intolerable and dysfunctioning/disabling.

Many meds cause over sedation, inability to think clearly, twitches and jerks, blood sugar spikes, onset of diabetes and cardiovascular problems, psychotic symptoms, increased psychaitric symptoms, dermatological reactions, thryoid and kidney malfunctioning, excessive weight gain (in majority), joint issues, GI problems, dizziness, blurriness, pins and needles in fingers and toes... migraine headaches and the like. Not to mention the common everyday nausea, vomiting, and/or diarrhea, and many cause death of libidio or near death.

If any of these are troublesome, disabling, causing dysfunctioning of daily life activities and needs... talk with your doc.

The meds are supposed to help you obtain a better "quality" of life than you've experienced by balancing out mood swings.

If the meds are causing you the inability to drive and you have to work, it is not helping you. If the meds are causing blurry vision so bad that you can not see and you have to focus, then the med is not helping you. If it causes your mind to process through thick sludge and your reaction and response time is greatly diminished and all you want to do is lay down and can barely get up, and you care for your (or other's children) children... the med is not helping you.

Talk with your doc.

Finally, "Taking the right medication will almost certainly reduce your chances of relapse. Stability in your life usually reflects on the lives of significant others."

See, the statement is "will almost". He did not say "will" certainly reduce.

See, the meds do not completely erase the mania, depression, and/or impulse to suicide. You still get them, even while taking all the meds, you will just more than likely not have them AS STRONG or as high. This then gives you a better means of management in order to try and prevent any extreme levels from occuring.

In being "stable", stability has no specific description, no "picture" of what is right. Stability means different things to different people.

The meds help keep you managed for those around you to deal with you, while at the same time hoping to help you manage yourself and cope with life's ups and downs to your benefit.

You can choose to take the meds or you can choose not to take the meds. It is up to you. If your life is filled with chaos, confusion, dysfunctioning, drama, constant battles with everyone around you, and internally/eternally a battle within yourself... then meds are a most likely answer. They are not however, the only component.

Meds treat the symptoms of the illness, meds do not treat the psychological and emotional aspect of the disorder. You can drug yourself into a pharmaceutical stupor and block all feelings and emotions you or someone else deems as inappropriate or dangerous or disabling... but, until you deal with how to go about coping with life and life's everyday challenges and stressors... it's not going to give you a really good 'quality" of life and the symptoms keep returning.

You really do need to consider therapy and/or therapeutic treatment to coincide with your medication.

Therapy will assist you and give you the tools to see, rationalize, analyze, and perhaps cope with that which will trigger you and thus trigger your emotional behavior and mis-management. It's not a cure all neither and you have to practice what you learn all the time, day by day, 24/7.

It takes considerable time and considerable effort but, if you find a good supportive therapist or program... it helps speed up the obtainment of periods of stability much moreso and longer. Longer periods of stability is what each really should aim for and want.

Anonymous

7/14/10 7:43pm

I cannot imagine anyone staying w/a meds provider who would consider those kinds of side effects acceptable. I've "fired" pdocs who have not given me a good enough quality of life. And just because you are on certain meds doesn't mean you are on them for life (like I was on an anti-psychotic for a period of time & it was very helpful in allowing me to think more rationally & apply what I was learning in indiv. therapy & DBT so that I was then able to get off the anti-psychotic w/the agreement of my meds provider).

Also, the majority of my friends in my support group (in fact, the leader--a volunteer position--of the support group is a therapist in private practice who is dxed w/bipolar & takes meds for bipolar including Abilify & Lamictal) & in the IOP I went through at the local hospital when I was first dxed w/bipolar was filled w/people who were working & that was why we met evenings (most worked full-time; I only work part-time by choice) so statistically can you back up the claim that the majority of people who have been dxed w/bipolar can't work?

tabby

7/14/10 11:27pm

can you statistically state that the majority of ones with bipolar work?

i did say that it was "my thoughts and comments"

i've worked within the MH system for several years now.. I also am a fixture on not only this website but on another.. have been for several years now. A vast majority of those with Bipolar, are not currently employed via choice and/or disability.

I did say the majority, meaning not all, but most. There are many folks, awaiting judgment from SSDI but are in legal limbo awaiting their hearings.

Then there are many more out there who have families who support them financially and resourcefully who do not collect any disability.. and yet also, do not work outside their living homes under employment with another.

This does not make those who do not work bad people, nor are the ones who work more capable of dealing with the illness than ones who do not. If you found a group, that meets in the evening so that the members, who all work, can meet... then great.

Not many community state funded mh agencies, for those of low income - no insurance - and/or indigent status, offer mh groups and/or programs during the evenings for those who actually work. At least, not many in the state of which I reside in. This, of course, may be completely different everywhere else.

Anonymous

7/15/10 8:58am

Sorry, I misinterpreted your statement: "...it's just FACT (caps mine--your choice of the word "fact" rather than "opinion" or "thought" confused this feeble bipolar mind of mine!) that the majority of those diagnosed with Bipolar, placed on several medications, no longer continue employed working."

I think your post is very articulate, informative & I was merely commenting on that reference as it seemed you were stating a FACT & I was asking where you learned that fact. However, you explained that it is not a fact, but a thought of yours. So sorry I misunderstood. Yes, I guess I'm "lucky" that I had the ability to go to an IOP in the evening. I have no idea how many states have that option or if it is state-wide here. I do know NAMI has given the state I live a D or D- grade for its mental health treatment so I doubt we are offering anything special. I volunteer a lot for NAMI & was on their Board & was actually given their award of Consumer of the Year last year at the state conference (which was a complete surprise; if I had known I would have definitely dressed better as I had to walk up to the podium in front of everyone!!).

I speak to community groups like the Kiwaniis or at the hospital for patients in the psych wards who are being discharged or half-way houses or abnormal psych classes at the university (I'm the "abnormal" one), teach classes through NAMI to mental health professionals (Provider Ed. Classes); teach & coordinate the Peer-to-Peer classes (for consumers), volunteer in the local jail co-leading a support group w/a therapist for the women there (many have undiagnosed mental health issues that finally get dxed & treatment there) & am "on call" for those who call NAMI looking for someone to talk to (who just want a friend who understands)...

I am 56-years-old & have been through a lot & just have a heart for those who are starting their journey towards wellness & so want people to have hope & the goal of a good quality of life. My mother committed suicide when I was young (bipolar) & I had my 1st suicide attempt at 15. Both my children had awful bouts of depression in their late teens or early 20's & are now in their 30's & are doing very well.

I've fought so hard against the insurance co. that my husband's work had for mental health coverage that was such a joke that finally through all my documenting the hours & hours of my trying to get the insurance co. to cover the therapy that I should have coverage for but they kept denying, my husband's company "fired" them & got a great new company to provide mental health coverage that now gives us PARITY & covers the claims with no problems. Since then we found out so many other people were having problems getting claims paid for by this insurance co. but they just didn't have the time, energy or patience to pursue it as I did so they just quit getting mental health treatment. I must admit I spent many of my therapy visits talking about my frustration w/this insurance co. & I only had 30 therapy visits allowed per year!! Here I was wasting them talking about the insurance problems!! My therapist did not charge me for some of those visits (bless her) as she realized I didn't really get any therapy!!

I take "webinars" for lawyers (my daughter is a law prof) & professionals who deal w/this subject but they have had no problem "letting me in" that focus on disability law & all the new laws coming into effect so I can help others apply for disability or advise them if they are being discriminated against with the new laws concerning "hidden disabilities." They are free & excellent w/lawyers who specialize in the field & present all the recent cases & are interactive. You can ask questions & then they provide all the case notes afterwards. To find out info. & register, I believe the site is ada-audio.org

The next webinar is Aug. 4th. They run 1 1/2 hours, 1:00-2:30 (Eastern time, I think!! I'm going to be doing it on Pacific time as I will be out-of-state so I may be a little confused on the time in other zones).

I also can provide the web site to download a 50-pager Disability Law Handbook written for the layman that describes the process & really is appalling as it says how the gov't routinely will deny the person the 1st, 2nd & even 3rd time so get a lawyer as it "won't cost you anything"--like the person may be disabled but that doesn't mean the person is stupid! Yeah, the lawyer is doing it for free!! Except for the portion he/she takes out of your rightfully deserved check when you are finally accepted for disability! And it says even though your doc says in his medical opinion you are disabled that doesn't mean we (the gov't) think you are disabled because we have our own definition of what a disability is & then it proceeds to tell you what the gov't says a disability is! Quite informative.

I've had to report inadequate mental health services to the Div. of Mental Health. I'm one person, but I have a voice & can use it & sometimes others don't have the ability or strength to use their voice. I know for many, many years I didn't so in the remaining years I have (which I'm not too sure of since I'm being tested for a genetic neurological disorder that my younger brother has due to my chronic pain--Spinocerebellar Ataxia Type 8--which doesn't have any treatment or cure & my younger brother is already in a wheelchair & losing his vision; I am "lucky" in that I'm only in intense pain that has landed me in the ER several times, but "unlucky" in that the pain meds don't seem to be working).

I applaud all that YOU are doing. You seem to be a "go-getter" & a "giver" & that is great. Keep it up. I didn't mean to offend & you seemed to be offended by my question as you seemed defensive. I simply misinterpreted it due to that word "fact."

All my best to you.

GeekStyle59

7/15/10 6:13pm

RIGHT ON TABBY!! WISH THE PROFESSIONALS WOULD GET IT, TOO!!!!

Tabby

7/15/10 9:27pm

I too apologize for perhaps misleading by using "fact". I can see where that would cause some inquiry.

I also can tell that you are a passionate advocate and for that, I am thankful.

At first, I was going to post again and ask you why you stated that you choose to work part-time rather than say.. full time? In that employment while mentally ill was a "flare" for both of us.

Yet, I can see... that in your working part-time, you are very engulfed in advocating and educating those surrounding you and truthfully... if you worked full time, say 40+ hours a week.. you'd likely not be able to do all that you do. So, I see why you'd chose to work part-time.

In my state, my mental health grade is also a D- and my state has further slashed our mental health budget to the gristle. So many services and service providers, especially to the very poorest of us, are simply not able to sustain on the very meager scraps the state will pay in reimbursement. So, many of the mentally ill population in my state simply go without or do not receive adequate services to fill their needs.

I work in MH agencies as an administrative and I have an inner passion to try and see whatever agency I'm employed with succeed. The agencies I've worked with are primarly for those of indigent and poverty stricken status and so... I ardently try to work the state authorities to approve and allow what funds there are to be paid to us.. so we can keep the doors and lights on for so many we service.

It really taxes my mental agility and ability most days and well.. my mind is not what it once was. I struggle daily with the war within my mind. My current employer does not know of the Bipolar... I dare not disclose. In times past, disclosing never accomplished anything positive... not in my experience anyway.

I'd kinda like to think I was making some miniscule difference somewhere and in some fashion to make someone's life a little brighter.. somehow. I always feel like I come so way short.

I guess I'm rambling and well... went off track somewhere.

Again, I do apologize for the perhaps misleading wording. I can see where that could be misconstrued and perceived as offending. I do apologize.

diane

7/18/10 9:47pm

Could you please send the link you spoke of? Also, how do we find out about the webinar? Thanks, going through alot of this myself.

Anonymous

7/18/10 10:43pm

Law webinar: ada-audio.org

Next one is Aug. 4th. They are free, but you do need to register beforehand.

DISABILIITY LAW HANDBOOK AVAILABLE

The Southwest Disability and Business Technical Assistance Center (DBTAC) - funded by the National Institute on Disability and Rehabilitation Research recently announced that the Disability Law Handbook is now available on our website at: http://www.swdbtac.org/html/publications/dlh/index.html. The book will also be translated into Spanish and will be available soon.

This Disability Law Handbook is a 50-page guide to the basics of the Americans with Disabilities Act and other disability related laws. Written in an FAQ format, The Disability Law Handbook answers questions about the Americans with Disabilities Act, the ADA Amendments Act, the Rehabilitation Act, Social Security, the Air Carrier Access Act, the Individuals with Disabilities Education Act, the Civil Rights of Institutionalized Persons Act, and the Fair Housing Act Amendments

Questions re this Handbook should be directed to the Southwest DBTAC, web site www.swdbtac.org.

Want information on Federal mental health grants, publications, meetings,

policies, programs and other useful material for mental health consumers? Join

the CMHS Consumer Affairs Listserv at: http://mentalhealth.samhsa.gov/listserv/

###

Want information on Federal mental health grants, publications, meetings, policies, programs and other useful material for mental health consumers? Join the CMHS Consumer Affairs Listserv at: http://mentalhealth.samhsa.gov/listserv/

Anonymous

7/18/10 11:03pm

As usual when I try to cut & paste from somewhere else even when using the window provided here I get a lot of junk. Sorry! The ADA Legal Webinar Series is put on by the DBTAC--Great Lakes ADA center. Ph. # 877-232-1990. I believe I get logged in for the webinars at ada-audio.org, but I'm not sure if you can get info. or register there. If you call them, I'm sure you can get all the info. you need.

mumzy30

8/ 4/10 11:35pm

HI Tabby...

I agree with you 100%. I did have a question for you...I am also epileptic and would like to know what med you are taking and the dose.

TMH

Blake

7/15/10 7:48pm

I had two rotten experiences with bipolar meds. On lamotrigine, I got The Rash, the deadly one. Too bad, I felt great and very creative. Then came Lithium, one long nightmare, tasting of metal. I was scared and stayed off meds for about a year after those terrible three years on Lithium, which changed my personality.

But the third time was a charm. I took all the supplements I could, including fish oil and N-Acetyl-Cysteine (NAC) and obtained a service dog. My common sense increased, but my rage and anxiety did not subside. Then one day nearly broke my leg fallng off a mountain. That's when I decided that the metabolic risks were an even trade for the manic risks. I am now dong well on Abilify, a small dose for someone with bipolar I but it's doing the trick. I think it has saved my marriage, too.

Anonymous

7/15/10 9:52pm

Hi Tabby! I think I am fortunate that I was ABLE TO CHOSE to work part-time & did not reveal to my employer why I wanted to reduce my hours. I had worked there for 15 yrs. by that time & had hid my illness the best I could & it was getting harder & harder so I just requested reduced hours & for my job to not entail dealing w/the public & having to be there at a certain time (so I could work on my own schedule & work at home) & he complied as I was a valuable employee--worked way harded than anyone else; had that perfectionistic thing going on; felt like I was never good enough; of course bosses love that!

And I do have the luxury of having a loving husband who has a good job & does not begrudge me the expenses of the treatments my mental illness require though I don't go out-of-network (except for the exceptionally good & reasonably priced psychiatric nurse practictioner) or outrageously costly stuff.

I do take attend the free things NAMI & other organizations provide (DBSA support group) & WRAP & IMR, etc.

The therapist who leads the support group (DBSA & is free of charge) gets grants for us from the state to attend many seminars which has been great. It is wonderful to have a caring advocate like that.

But as you have already noticed I am a terrible rambler. Apologize for that. take care, All.

vinnie78

7/16/10 11:52am

I've been diagnosed with bipolar since 1996, which also happened to be my senior year of high school. If there was a worse time to be dealing with meds, please let me know. I know about the "zombie" feeling and can gladly say those days are behind me. I take my meds far more regularly now because I would love to continue my run of being out of the hospital. It is my fear of winding up back there that helps my stick to a regular dosing schedule. I have finally gotten to the point where I don't like either extreme I'm capable of experiencing and know that meds help me avoid just that.

sunnyday1982

7/20/10 2:23pm

I have to disagree w/ everthing this guy has to say...when doctors go through med school and have their psych rotation, they should have to have some sort of simulated way of knowing what it's like to being on the meds that they are prescribing or have to take them theirselves...it's BS to make people take meds that are gonna mess up their lives and expect them to be happy about it...and not know what it's like themselves, because alot of doctors really don't care as long as you taking something and not being a bother to them...because we do lose our independence, stay on meds forever, and we are zombies, and it's awful!

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