News Day Tuesday: Bipolar Awareness Day!

a cure for what ails you, explanations, major depression, medication, mood diary, News Day Tuesday, ptsd, rapid-cycle bipolar disorder, stigma, therapy

Happy Tuesday, readers! Today (October 4th) is Bipolar Awareness Day, so I wanted to share an article with you that outlines the basic symptoms (for the uninitiated, as I know there are some new readers here) as well as what’s on the horizon in terms of treatment.

First of all, let’s hear about what bipolar disorder actually is. I’m referencing bt.com for the purposes of this tidbit, as the article I found gives a really great Reader’s Digest condensed version of the illness.

National charity Bipolar UK characterise the condition as “a severe mental health illness characterised by significant mood swings, including manic highs and depressive lows”, and note that, “the majority of individuals with bipolar experience alternating episodes of mania and depression”.

According to this article, it takes 10.5 years on average (in the UK) for people with bipolar disorder to be properly diagnosed. The National Depressive and Manic Depressive Association (NDMD) paints a similarly grim picture: it can take ten years or more for a diagnosis to be reached, and 69% of cases are misdiagnosed.

What are the symptoms?

There are two sides to bipolar: mania and depression.

During a bout of depression, it is possible to feel: grumpy, without hope, guilty, self-doubting, suicidal, pessimistic, worthless, lacking curiosity and concentration.

And with mania: elation, full of energy, ideas and plans, easily distracted, feeling invincible, risky behaviour including spending huge amounts of money.

Both can feature: lack of appetite, insomnia and delusions.

-bt.com

My experience began very early. I remember fits of agitation and depression as early as eight years old, which at the time was chalked up to the incredibly rough hand I was dealt–a broken home, a mother who struggled with bipolar disorder herself as well as alcoholism, extreme bullying, and persistent nightmares (which were later diagnosed as a feature of PTSD). NAMI states that rapid-cycling bipolar disorder, the most severe form of the illness, seems to be more common in individuals who begin exhibiting symptoms early in life.

From NAMI.org:

Early Warning Signs of Bipolar Disorder In Children and Teens

Children may experience severe temper tantrums when told “no.” Tantrums can last for hours while the child continues to become more violent. They may also show odd displays of happy or silly moods and behaviors. A new diagnosis, Disruptive Mood Dysregulation Disorder (DMDD), was added to the DSM-5 in 2014.

– See more at: http://www.nami.org/Learn-More/Mental-Health-Conditions/Bipolar-Disorder/Overview#sthash.l0XKtkSy.dpuf

When I was eighteen, I decided to see a therapist and psychiatrist for the intense mood swings that had plagued me for most of my life. I was initially told that my deep depressions were the result of PTSD. I was prescribed fluoxetine (brand name Prozac), which only made the agitation worse. And I was still depressed.

At 22, I relocated to Wisconsin and began the search for something, anything, that would finally help me feel “normal.” The misdiagnoses continued: major depressive disorder, for which I was prescribed Abilify and trazodone. I felt amazing on Abilify for about two weeks, and then I crashed. Trazodone made me a zombie. (Note: It is not atypical for antipsychotics to be prescribed to treat both MDD and bipolar disorder.)

Bipolar disorder is most often misdiagnosed in its early stages, which is frequently during the teenage years. When it is diagnosed as something else, symptoms of bipolar disorder can get worse. This usually occurs because the wrong treatment is provided. Other factors of a misdiagnosis are inconsistency in the timeline of episodes and behavior.

-healthline.com

When I was 24 and in my first “adult job” with health insurance, I found a wonderful psychiatrist who, over the course of several sessions, examined my family history and asked very specific questions to find the root of my illness. At first, I didn’t even think to mention my “up” periods, because even with the agitation and sleeplessness, I actually felt good–and no one goes to the doctor when they’re feeling well. But upon deeper probing, he came to a conclusion: first bipolar II, then, after further investigation and a few weeks of mood tracking in a journal, rapid-cycling bipolar I.

That first year was rough. I cycled so frequently that the days were exhausting. One day, I bounced between depression and mixed episodes several times in a single 24-hour period. Slowly but surely, the medications my doctor had prescribed (venlafaxine/Effexor, lamotrigine, and lithium) began to take effect. I began to stabilize. There were no more florid creative periods, but I was also able to sleep for more than an hour a night for the first time in weeks. My misery began to ebb, and though it didn’t disappear completely (a dysfunctional marriage contributed, among other things), I began to feel like a person again instead of a defective thing that needed to be turned off and fixed.

Aside from pharmaceuticals, NAMI’s website mentions cognitive-behavioral therapy, psychotherapy that focuses on self-care and stress management, and, in rare cases, electro-convulsive therapy (ECT). Learning to recognize the triggers for each type of episode is key; one suggestion offered by the numerous therapists I’ve seen over the years is mood tracking/journaling.

However, I had to stop at one point because, in the heyday of my illness, I began to obsess over the cycles, sometimes tracking up to ten or eleven times a day. Instead of the journaling soothing my mind, I began to worry that I was untreatable. I found my mood journal during a recent move and it was difficult reading, to say the least. But it was also a reminder of how far I’ve come and how much my quality of life has improved since receiving a proper diagnosis.

These days, I’m doing much better. My medications have been adjusted slightly to accommodate the deep depressive episodes I’m prone to during the fall and winter months, but I am proud of myself for being able to recognize that the winter storm was a-comin’. Three years ago, I would not have been able to see the symptoms for what they are: a warning sign and a signal that I need to not only keep up with my medications, but to practice good self-care. In the past, I saw fall and winter as something awful that I had to endure. Now, I realize that I can still enjoy life even when the days begin to get longer and darker. The seasons are no longer a metaphor for the overall “climate” in my head.

How long did it take for you to receive a proper diagnosis, readers? Are you taking care of yourselves as winter approaches? I hope you’re all doing well and staying healthy and safe. And spread the word–this illness is massively misunderstood, even by mental health professionals, so it’s our job to reach out and counter-strike against the misinformation and discrimination.


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News Day Tuesday: Local Mental Health Resources

a cure for what ails you, abuse, anxiety, medication, News Day Tuesday, ptsd, therapy, three hopeful thoughts

Good afternoon, readers! This time, let’s talk local resources for mental health care.

I saw a wonderful counselor through the Johns Hopkins Student Assistance Program (which I’m eligible for because my significant other is currently a student). I’ll share more of the personal details in a post later this week, but the counselor I met with gave me some information about local resources I had no idea existed, and I’d like to pass those on to you. I feel they’ll be particularly useful to anyone in the Baltimore area, but I’m sure there are similar programs throughout the country.

First is Sheppard Pratt. Being new to the area, I was unfamiliar with this hospital, but they have a program specifically designed to help people dealing with all sorts of trauma.

The Trauma Disorders program at Sheppard Pratt specializes in dissociative disorders and CPTSD, which is exciting because I had no idea these types of programs existed anywhere. They certainly weren’t a thing in the Midwest, where I’m from. It’s an inpatient program, which isn’t a good fit for me for a number of reasons, but I plan to reach out to see if they know of any good outpatient therapists who are well-versed in these issues.

It’s comforting to know that there are facilities that offer support specifically tailored to complex post-traumatic stress disorder, which can present challenges to many therapists. I found one therapist during my time in Madison who seemed to know quite a bit about PTSD, including my dissociative symptoms, but she went on maternity leave shortly after I began seeing her. My subsequent searches for therapists was largely unsuccessful, which is not a negative reflection on any particular counselor–as I said, it can be a tricky affliction to effectively treat. I’ve been told that because of the depth of my dissociative symptoms, I’m not a great candidate for EMDR, which eliminates one of the most widely-used techniques for treating PTSD.

The second resource I learned about last Friday is the Baltimore County Crisis Response, which offers not only crisis intervention (as the name suggests), but also a 24-hour hotline and–this is the most exciting part–one-time psychologist and psychiatrist consults, which are particularly useful for people who are in a transitional period and looking for providers in the area but need refills of medication or therapy. That’s right, readers; there’s actually a place you can go for those all-important refills you can’t get anywhere else, which means no more rationing of medication to make it through.

The counselor at JHSAP was also kind enough to email me a long list of references for therapists in the area. Admittedly, I’ve been procrastinating a bit and haven’t gotten around to checking them out, but it’s on the list for this week.

Are you aware of resources and programs in your area, readers? Are they easy to locate, or do they require a bit of digging?


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Recovery is a verb: It’s what you do!

a cure for what ails you, anxiety, call for submissions, medication, rapid-cycle bipolar disorder, relationships, three hopeful thoughts, Uncategorized

I’m not going to lie–moving to Baltimore has been a bit of an adjustment for me. The whole new city, new places, new people thing doesn’t faze me, partly because I’m here with someone I love and care for deeply and can lean on, and partly because I was so desperate to get away from the Midwest, to start fresh and re-invent myself again.

The part that’s scary is not having much of a support system yet. I’ll admit it; I’m frightened because right now I don’t know many people and the ones I’ve met (and like immensely!) are my fella’s classmates. I’m in that awkward transitional phase where an introvert suddenly has to start over and find friends in the area to hang out with, and as someone who’s generally a homebody, it’s tough. It’s especially hard right now because I’m taking a gap semester to adjust, work on the blog and CTL, and find a grad school down here to continue my work toward a Master’s in Counseling Psychology. What that translates into is a lot of long days where I have to figure out what to do with myself.

I’ve had a rough few days. It always seems to hit around this time of year–I love autumn and it’s always been my favorite season, but as someone with relatively severe bipolar disorder, my brain chemistry doesn’t like the changing of the seasons so much. I’m hopeful that this year it won’t be so bad, as I’ve heard the seasons are a lot milder here in the Southeast. Still, I came to the realization last night that I need to change my meds a little bit, which is nothing unusual for me. (I have some beef with the texture of my uncoated lamotrigine tabs, which makes snapping them in half to add a half-dose for nighttime a little unpleasant texturally-speaking, but that seems pretty minor in the grand scheme of things.)

Important side note and disclaimer: I don’t recommend anyone tweaking their meds without the express permission and guidance of a psychiatrist–luckily, mine helped me develop a seasons guide to use in situations like this, where I’m unable to get in to see a doctor to make adjustments. I’m still within the prescribed dose range and am only doing this to get myself through until I’m able to start seeing a psychiatrist down here.

The other night, I finally opened up. My last relationship–a five-year marriage–was somewhat disastrous and left a ton of emotional damage. As some of you may remember, I was out of work for thirteen months because I was simply too ill to hold down a job with regular hours, and staying inside most of the time with little to do means I got a lot worse before I started getting better. I don’t want to become a dependent. I don’t want to be needy. I want to be a partner, a strong woman who is capable of supporting herself and living her own life and not feeling sad and lonely and, perhaps worst of all, soul-crushingly bored when I’m alone during the day.

To counter this, I’ve been making myself a little “schedule” for each day, just little things I can do to keep myself busy so that at the end of the day, I feel like I’ve accomplished something. It helps a little; I don’t feel as melancholy and like I wasted the day. But it’s still very much a process. Recovery is not something you either have or you don’t. It’s not like you either are or aren’t “recovered.”

Each of us has natural ups and downs in life, regardless of how well-medicated we are. We can take our pills every day and go to therapy and exercise and be social and do everything right, and we will still have low periods. It’s the nature of the illness. It doesn’t mean that we’ve failed on any level or that, as I believed for years, that we’re unsuitable partners, sons, daughters, friends. It just means that we have an illness and we’re doing everything we can to fight it. Despite our best intentions, it is always going to be there, and I’ve found that accepting that fact has it a lot easier to live with.

I’m trying to make friends with my brain again. I’m trying to make friends with the ugly voice in the back of my mind that tells me I’m not enough. It’s the same one that brings up such tiny, insignificant things from decades ago and nags me about how these events, most of which I had little control over, make me bad or less-than in some way. I talk to the negative thoughts. I tell them to shut up if I’m feeling peevish or overwhelmed, but I also try to be sympathetic. I try to rationalize with the parts of me that are still trying to drag me down.

I still externalize what I’m feeling and pretend I’m a therapist and my client is me-but-not-me, a person who has the exact same concerns and emotions and neuroses that I do. If I separate myself from the negative feelings and thoughts, it’s easier to cope. I feel a sense of power over the thoughts. I counter them with the A-B-C-D-E method of learned optimism, which, thankfully, is effective more often than not.

And most of all, I am still working hard to be kind to myself every day. When I’m feeling bad, I try to remind myself of everything I’ve accomplished so far in spite of these huge obstacles and the weight I’m still carrying around.

On a happier note, I found out that Johns Hopkins offers free counseling to students as well as family members and significant others, so I’ve put in an appointment request for short-term counseling to get me through until my Medicaid (ugh) paperwork is finished and I can find a long-term therapist and psychiatrist again.

In the meantime, I’m trying to practice good self-care and take pride and enjoyment in the little things in life, whether it’s nailing a tough piano piece or simply tidying up the apartment. I don’t want to go back to my life being all about pain. I want to keep moving forward, to keep doing more. I have huge goals for myself in life, and I refuse to let this illness keep me from accomplishing them. My stubbornness has kept me alive for 27 years, and I need to harness that and use it as a recovery tool.

Where are you in your recovery, readers? Do you have any helpful tips to share?

As always, stay safe and lovely and well. I’ll see you all again next Tuesday for another exciting News Day! And keep those submissions coming–I want as many unique voices and stories on the blog as possible!

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News Day Tuesday: New drug for PTSD!

a cure for what ails you, medication, News Day Tuesday, ptsd, three hopeful thoughts

News on mental illness (aside from the usual stories about police brutality and the fact that mental illness physically alters your brain) has been somewhat scarce lately, readers. However, I did manage to scare up an article about a new drug for PTSD called TNX 102 SL, which is absorbed sublingually (under the tongue, like lorazepam and other anti-anxiety meds) and reportedly helps with some of the more disruptive symptoms of PTSD, like arousal/startle response, anxiety, and negative thoughts.

The drug is related to a muscle relaxant called Flexeril. I’ve heard of muscle relaxants being used to treat startle response in the past, but I’ve never tried anything of the sort before. I typically rely on lorazepam to control acute symptoms, like when I’m out in a crowded public space and begin to feel the good old irritability and hypersensitivity to sound kick in.

I’m pretty excited that new treatments are even being tested for PTSD, honestly. The startle response is definitely the worst symptom for me–any sudden noise, no matter how small, can provoke an ear-piercing shriek and a huge bump in my heart rate. And because I have chronic pelvic pain that’s partially caused by trigger points, the instinctive tensing makes the pain multiply, which makes me more miserable, and it becomes this whole endless cycle that’s really hard to break.

I’m also hopeful that some new treatments that help with sleep but don’t leave me a groggy mess the next day will pop up. I sleep very lightly now and have a hard time falling asleep. I usually use either lorazepam (if the insomnia’s not too bad, though I need at least two milligrams to get a good night’s rest) or quetiapine/Seroquel if I’m really sleep-deprived. However, even though those drugs work in the short-term, I end up sleeping way longer than intended and am basically a zombie the next day.

Readers, what do you think of this drug, given what limited information we have so far? Would you try it? What do you use to cope, either medically or psychologically?

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This week has an been a wild ride!

a cure for what ails you, medication, ptsd, rapid-cycle bipolar disorder, three hopeful thoughts

This story actually starts at the beginning of July, about a week after we moved to Baltimore. I applied for Medicaid through the healthcare marketplace, as did my fella. Since we listed each other on our applications (not knowing any better) and he filed after me, his app bumped mine out. I was never informed (oops), so I sat around for over a month wondering why I couldn’t get coverage and going through the frustration of weekly phone calls to check on my application, to no avail.

So that brings us to this week, when I finally ran out of my carefully-rationed venlafaxine. I’m supposed to take 75 mg a day, and had been taking 32.5 every other day to make sure I could stretch it because I had no other options. I took my last dose on Monday, and it took about a day and a half for the symptoms to start up. And man, did they come back with a vengeance.

I had two nearly-sleepless nights because of the brain zaps and headaches. My application had been received, Medicaid promised on Tuesday, but I had to give them more time to get me an ID number. Meanwhile, the depressive symptoms, combined with the stress of the whole unfortunate situation, snowballed into something truly awful.

The little sleep I did get this week was plagued by night terrors, involuntary twitching, and (so I’ve been told) a lot of whimpering in my sleep, some of which woke me up. I finally got my scripts filled today, after a bit of a fight regarding the dates on the prescriptions, then came home and promptly collapsed after taking one of my newly-procured venlafaxine.

Moral of the story: Withdrawal is exhausting. It’s hard on the patient, and it’s hard on the patient’s loved ones. Fortunately, my brain immediately grabbed that medication and held onto it ferociously, and I woke up feeling much better (perhaps because I slept like the dead for two hours).

This week was a test of my will to fight and my mindfulness skills. I didn’t cope as well as I had hoped–little things sent me into tears, and I was generally irritable the entire time. I didn’t like being around myself. I was plagued by guilt. I felt, for the first time in years, trapped in my body and helpless to fight my invisible tormentor–the bipolar disorder that had, once again, taken hold despite my best efforts to fix the situation.

The good news is that I’m on the mend. I now have insurance, so I can start shopping for a good psychiatrist/therapist/every other kind of doctor I have to see because my body’s kind of a wreck and I have a bunch of chronic illnesses that tend to require a lot of maintenance.

Have any of you had to detox against your will? I hope not, but from what I’ve been reading, it’s frighteningly common. Stay safe, readers. Hang in there–it’s finally the weekend, and I hope all have a lovely one. 🙂

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Anxiety blues.

a cure for what ails you, anxiety, medication, ptsd, rapid-cycle bipolar disorder, relationships

The last few days, I feel like I’ve fallen down a sort of anxiety-hole, and it’s really bugging me.

Yesterday was wonderful–we went to Canton and had delicious pie with a friend of Paul’s from college and her lovely fiancee, then took a walk in a nearby park. There was a hiccup where he snuck up on me and startled me a bit, which in addition to a ton of people being around (it was, after all, a beautiful day) kind of made my PTSD-radar go “ping!” I think that’s what set it off.

When we got home, I had a minor annoyance/setback when I learned that my venlafaxine, which I’m almost out of, was ready–but my new insurance, for some reason, was still pending and the Rx was pretty far out of my price range. After waiting in a crowded pharmacy for close to an hour, my brain didn’t take the news particularly well and my anxiety went up a few more notches.

I had taken a couple of lorazepam throughout the day, which I normally don’t have to do, and while I was nice and chilled out by that evening, I woke up this afternoon (after fourteen hours of sleep, which is highly unusual these days) feeling groggy and depressed.

Days like these, I feel the old blues and hopelessness creeping back in. I am in a gorgeous city and a new apartment with someone I love, yet I still get sad and anxious. I’ve come to realize that it’s part of the illnesses and that these things will be with me for the rest of my life. I suppose I’ve taken the good days for granted, so this one blindsided me a little.

I took another nap, woke up, finished my Theories paper, and am feeling quite a bit better. Still, it’s something I’m going to mention to my new psychiatrist (once I find one in the area, haha). The lorazepam does wonders for me in terms of calming my anxiety and the irritability that comes with it, but I often feel a little down the day after taking it and I’m wondering if there are other things I could try.

Needless to say, I also have to find a therapist to help me with quite a few things–after all, I just went through a huge move and am dealing with all sorts of new feelings and worries about being so far from home for the first time in my life.

What helps you unwind, readers? How do you shake off the blues?

Fabulous Las Vegas.

major depression, medication, rapid-cycle bipolar disorder, stigma

Paul took me to Las Vegas for our anniversary this weekend, which I loved! What I didn’t love, however, was the continued downward slide of my emotions into a Deep Depression.

Let me explain.

On Thursday night, when we landed and walked the Strip a bit, I said to him, “I feel like it would be impossible to be depressed in this town.” (Ha!)

I felt okay on Friday. Then Saturday happened, though it might be more accurate to say that nothing happened at all–externally, at least. I woke up early on Saturday (thanks, jet lag and associated temporal shenanigans!) and felt a little off but was fairly certain I could shake it off. It was a beautiful, sunny day, which ironically has always been the toughest kind of day for me. Sometimes, I feel as though I’m genetically hardwired to hate sunny days, because they tend to make my moods worse. (More on that in another post.)

I took a bath in the fantastic tub in our suite at the Cosmopolitan, all the while ruminating on how the world was just going on around us. We spent lots of time talking and cuddling. I went back to sleep around 10 AM until almost 1 in the afternoon and didn’t feel any better.

We went out and explored a little, which distracted me enough to lift my spirits a little. Then we went back to the room for a few hours to rest up before going to Zombie Burlesque–which, by the way, was fantastic!

My fella napped peacefully for about an hour and a half. I, meanwhile, was miserable. I cried for a while, then went out on the balcony to smoke, then cried out on the balcony, then cried when he was in the shower, then tried not to cry while we were out and ran into a snafu with the tickets.

The show was wonderful and made me feel better because it was a very welcome distraction. The rest of the night was wonderful and I thought to myself, “Maybe I’m getting better. Maybe it was one of my weird one-offs.”

We woke early on Sunday morning to catch our flight and I felt strange and out-of-sorts in a way that I knew was a warning but stubbornly ignored. I cried on the first plane. I cried on the second plane. I cried in the car on the way home. I cried when we got home. I cried in the tub that night. I cried before bed. And this morning, I really cried.

I found out that not only was my psychiatrist unwilling to refill my meds, it was that, despite reassurances two weeks ago that it would be taken care of, my chart had been closed due to my inability to pay because, hey, divorce and unemployment and not being able to pay for insurance on your own can really mess things up.

I managed to fork over the almost $400 required to even find out if my doctor had a same-day available–thankfully, he did–which means my Chapter 7 filing is now even further away. My little nest-egg of over $1,000, which I had so carefully saved up and budgeted for, will be completely gone after rent this month. I will be back to where I was a year ago.

I took an Ativan and another bubble bath, Paul and one of the cats at my side to make sure I was okay, and am now calm enough to blog about this. I plan on doing some research this week on how temporal changes and jet lag can mess with bipolar symptoms, but now all I’m doing is biding my time until 6:00 when I can finally get in to see my psychiatrist and get my medications refilled.

I’m left with an overwhelming dread, however, and a fundamental disappointment in how the healthcare system is run. I’m not sure how it’s even legal to deny someone access to what is, quite frankly, life-saving medication on the basis that they are unable to pay due to a whole bunch of awful circumstances that are completely beyond their control. Even if it is, it’s definitely not ethical.

But it appears that, for now, it’s just one of those things. Wisconsin, where I currently live (but hopefully not for long–my fella is applying to grad schools around the country and I plan to follow) is definitely not a progressive state when it comes to mental healthcare. It’s like the entire government is violently allergic to even the idea of reform. And unfortunately, it looks like I, and many others like me, are going to be stuck in this (leaky, shoddily built) boat until it finally sinks. I’m just hoping I can jump ship and move away before it gets really bad.

Remission?

abuse, Authoress, endometriosis, medication, ptsd, rapid-cycle bipolar disorder, three hopeful thoughts

 

Also pictured: Beast-baby Dorian T. Catsby on his king-of-the-house perch

I can’t remember the last time I was sad. Granted, my memory’s not great, and there was a lot of crying last week because of all the trauma that was suddenly dragged to the surface, but now that I’ve made my peace with that—or at least, beaten the beast back into its cage, tucked safely away deep underground—I feel good. Not hypomanic- or manic-good, but balanced, settled. Things aren’t going the greatest right now, but at least I have the concrete knowledge that they’re going to get better sooner rather than later.

Current medications:

  • 200 mg lamotrigine (Lamictal) taken twice a day, once in the morning and once in the afternoon/at night (usually around 6:00 or so).
  • 1 mg tabs of lorazepam (Ativan), as needed. Since the myoclonic jerks I began experiencing when my Effexor dose was too high have begun to subside, I’m finding that I don’t need this as often.
  • 300 mg lithium taken three times a day, two in the morning and one at night
  • 125 mg venlafaxine (Effexor), taken in the morning
  • 50 mg hydroxizine for sleep, one to two capsules as needed

This regimen seems to be working well for me. I’m sort of scared that it’ll just stop working, which is what I’ve experienced in the past with psych meds as well as endometriosis treatments, but I’m trying to stay positive.

Speaking of endometriosis, I met my new pain doctor on Thursday; he and his PA are both excellent. She spent some time asking about the nature of my PTSD and then informed him, and he actually asked if it was okay if he examined me before inviting me to hop up on the table. That was a whole new experience for me, and while I don’t really like being treated that gingerly, it was obvious that he was making an effort to make me feel comfortable, and I appreciated that.

I had some trigger point injections done yesterday morning; the knot of muscle was located very low, well below the bikini line in my general pubic area, but I didn’t feel nervous about him touching the spot or doing the injections. Because of my initial impression of him, I found it very easy to trust him implicitly. First impressions matter.

Right now, I’m in quite a bit of pain…about a level 7, which isn’t fun but is something I can tough out. As D. has told me, I’m “a tough old broad, a bad motherfucker.” Several people have suggested I buy the Pulp Fiction wallet and after everything I’ve been through with the pain in the last few years, I just might. It feels like a cautery knife is running back and forth through my lower abdomen, but my mother assures me that this will subside in a few days.

In the meantime, I’m keeping busy—cross-stitching, reading Ruth Reichel’s food/bipolar mother memoirs, and bothering the beast-babies, as usual.

Readers, what do you use to distract yourselves?

Informational post: panic attacks versus mixed episodes.

a cure for what ails you, explanations, medication, ptsd, rapid-cycle bipolar disorder, self-harm, stigma, suicidal ideation

In May, I woke up feeling rather odd—jittery, teary, completely unable to calm down. I’d felt this way before, but it had never been that bad. After about an hour of trying (and failing) to steady myself, I asked my husband to take me to the emergency room because I was afraid for my safety.

I thought I was having a severe panic attack and spent four and a half hours confined to a bed in the ER on suicide watch; after demonstrating that I really was okay and didn’t need to be committed to the psych ward upstairs, I was released with a prescription for lorazepam. At the time, we thought panic attacks were a reasonable explanation, given that I have C-PTSD and a couple of dissociative disorders as a result.

I continued taking lorazepam whenever I felt that way, even after I’d learned I was having mixed episodes and not panic attacks. I needed a couple of milligrams before I started feeling okay again, but that much knocked me out for a couple of hours…not really the most productive way to handle the situation. I talked to my psychiatrist and learned that benzos are pretty much the worst thing to take during a mixed episode because they heighten the feeling of detachment, which can lead to more anxiety and make things worse. He prescribed quetiapine (Seroquel) and so far, it’s worked; I usually don’t need a very high dose, about 50 mg, whenever I feel a severe mixed episode coming on.

Having learned more about panic attacks, it seems strange to me that the ER staff didn’t recognize my mixed episode for what it was. While panic attacks tend to produce more physical symptoms (racing heartbeat, shortness of breath, chills, hot flashes, nausea, trembling, sweating), mixed episodes (also called mixed mania) tend to produce more mental symptoms, such as the highs of mania with the lows and despair of major depression, urge to self-harm or attempt suicide, and uncontrollable swings between moods and thoughts.

I think the reason the two were confused that day was because of the mental symptoms present during a panic attack—fear of loss of control and a sense of impending doom, which is how my fear of self-injuring or attempting suicide was interpreted. I was having cold sweats and my heart was racing, but as I’ve started paying closer attention to my moods and symptoms, I’ve found that those, along with an overall feeling of panic or being out of control, generally accompany my mixed states.

There are many great resources online about how to help and what not to do when someone is having a panic disorder, so I won’t touch on those. Below are a list of things that I find particularly helpful when I’m going through a mixed episode (and what to avoid doing). Feel free to chime in with your suggestions in the comment section!

  • I really dislike being touched in general, so touching me is likely to make things worse. However, I’ve found that if my husband holds me in a particularly tight embrace, the compression is soothing and helps me calm down and feel safe and loved. During a mixed episode, I tend to feel very guilty and my self-worth plummets, so the physical contact from a loved one helps reassure me that I am worthy and do not need to harm myself as “penance” (the main reason I used to self-injure) or “eliminate my own map” to relieve loved ones of the burden.
  • Obviously, confiscating my sharps prevents me from hurting myself and is very helpful.
  • If I’m too far gone to realize I have medication that will help me calm down, being brought a Seroquel (which is an antipsychotic) and a glass of water with tons of ice cubes in it (which I love) is very helpful. It takes a few minutes for it to kick in, but when it does, the noise in my head quiets down, the psychomotor agitation goes away, and I’m able to focus again. The worst case scenario is that it knocks me out for a few hours if I’m given too much, but at least I’m not in danger of harming myself.
  • Saying comforting things that are not in the form of absolutes is very helpful. For example, saying specific things such as “You are worth something because you’re spreading the word about mental illness” is much more helpful than saying “Stop it, you’re not a bad person.” If you reference specific things, my brain can recognize those as true—I am writing about mental illness in the interest of raising awareness and fighting the stigma—I will not be able to argue with it, whereas I could go in circles all day long with all the reasons I think I’m a bad person.
  • Playing music or doing something over-the-top to make me laugh has been a good way to “break” the episode in the past. It’s important to note that not everything works as a distraction, but if you can get me laughing (which is not difficult because I have an entire folder of gifs/images/text posts that have made me laugh hard enough to cry in the past; also, my sense of humor runs extremely dark, so saying something really fucked-up is likely to make me lose it), there’s a good chance it’ll shorten the duration of the episode by giving me something else to think about.
  • I cannot stress enough how important it is to avoid saying the things I mentioned above: “It’s going to be okay,” “You’re not a bad person,” “Stop getting down on yourself,” “Just try to calm down,” etc. They’re not helpful, they just make me feel worse, and they usually cause the situation to escalate.

I’ll put together a post like this on C-PTSD and what my specific triggers are, what people can do to avoid triggering me, etc. I’d really like to hear from my readers, though—I want to hear about your coping techniques and how people can avoid triggering you.

Love and antipsychotics,

J.

Manic Depression: A Brief Explanation

authoress in motion, explanations, major depression, medication, rapid-cycle bipolar disorder, self-harm, stigma

I finally got around to editing the explanation video on bipolar disorder/manic depression (I prefer the latter term as I feel it’s more descriptive).

In the video, I talk about the different categories of bipolar disorder, what each phase (from depression to mania and mixed states) is and what it feels like, and tips for dealing with a mixed episode.