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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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?

Return of the Dark Core

major depression, ptsd, rapid-cycle bipolar disorder, self-harm

About ten minutes ago, I was standing in the kitchen trying to eat a bowl of strawberry ice cream. My hands were shaking so badly, I could barely even hold the spoon, and then the dark core started its shit again. I’ve been feeling anxious, guilty, and extremely depressed lately—I shouldn’t have to add this qualifier, but I feel sad for no reason. Or rather, no reason that others can see; my brain chemistry has decided to take a dive again and I think I’m in the beginning stages of a major depressive episode.

We’re struggling financially right now and I’m still feeling a lot of guilt and self-loathing for not being able to work; I know those things don’t help. My meds aren’t quite right but I can’t go see my psychiatrist until I get my lithium checked. He fucked up the lab sheet again and the clinic I go to won’t take it without a time written on it along with the date, so I’m not sure when I can have those levels done. I’ve stopped going to therapy for the forseeable future because our deductible just reset and we can’t afford it.

In short, things are not going that well these days.

My cycles have been getting longer, which I was told is a sign that I’m getting better. But while it’s okay to have a two-week-long hypomanic, or even manic, episode, the major depressive ones frighten me, not because I don’t know what I might do but because I know exactly the sort of things I’m capable of doing.

I’ve been feeling out-of-sorts for several days, but things started their usual downward slide this afternoon. I put myself to bed for a few hours in hopes that I could sleep it off, and I did feel a little better when I woke up…but it’s back. The worst part is feeling helpless to stop it. Oh, I know some ableist scum would argue that I could do all sorts of things to “cure” it, but the fact is, it’s a simple matter of brain chemistry that’s not quite right. And unfortunately, type I bipolar tends to be very tricky to treat even if it’s not rapid-cycle (mine is).

I’m counting the time until D. gets home so we can talk about a safety plan. It’s important to discuss that before things get really bad up in my head. For now, I think I’ll indulge in my usual anti-self-harm strategy of hugging a cat and listening to music. If I fall asleep again, so much the better. Anything to get away from these thoughts.

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.

A brief update.

authoress in motion, major depression, medication, rapid-cycle bipolar disorder, three hopeful thoughts

This is just a brief update on my current meds, treatment plan, and moods. If you’re into videos and want to see the authoress in motion, check it out. 🙂

Capturing moods.

major depression, medication, ptsd, rapid-cycle bipolar disorder, self-harm, suicidal ideation

My psychiatrist is teaching me how to handle my episodes. Lamictal twice a day, 200 in the morning and 250 at night. Seroquel for mixed episodes; never, never take lorazepam for a mixed, because it’ll do nothing but heighten the sense of detachment. The only problem is, I find it difficult, if not impossible, to differentiate between anxiety and a mixed episode. Both make me feel jittery, anxious, prone to sobbing uncontrollably and fighting so hard to hold back the urge to self-injure or finally do myself in that it takes all of my energy. I guess the solution is to take a benzo when I feel it coming on, and if that doesn’t work, the antipsychotics might. He’s instructed me to take the Seroquel 50 mg at a time, and I can take up to 200 mg a day if necessary.

I am trying very hard to stay off the Seroquel. I’ve read terrible things about antipsychotics—uncontrollable weight gain, tardive dyskinesia—and I am terrified of having them happen to me. I know it’s just my hypochondria kicking into overdrive, but I’m so unlucky, so prone to having bad things happen to me, that my fears about the worst coming to fruition actually don’t seem that silly or off-base.

And my memory is getting worse. I’ll tell the same story three times and not remember any of it. We went to Teslacon this weekend and had a lovely time, but by the time we left on Friday night I was unable to remember any of the panels we’d gone to that morning. I can’t focus on anything for longer than perhaps 20 minutes, which is disturbing because I used to be able to read or write or play the piano for hours on end. My psychiatrist thinks it’s ADD brought on by the concussion I suffered in July, but he can’t prescribe anything to help until my cycling stops and my moods are finally under control. Considering 450 is a higher than usual dose of lamotrigine (so high that I now have to undergo blood tests periodically), it seems like the manic depression is fighting hard to keep its grip on me, just as hard as I’m fighting to get rid of it.

Relief is always just within reach, but miles away.

*

I feel guilty and hate myself every single day. My husband works 40 hours a week as the shift lead at a drug store and is taking six credits at a local community college. He hopes to transfer to a large state university within five years. My inability to work full-time so he can go to school full-time upsets me so much that sometimes I wonder if he wouldn’t be better off without me. I feel as if I’m holding him back from his dreams—having to care for an invalid wife surely isn’t what he set out to do with his life.

Meanwhile, I stay home every day, reading books and watching movies and trying not to give in to the nasty little voices that whisper to me: I’m useless, I’m a drain on everyone’s energy and resources, I’ll never amount to anything because I am so sick and seemingly unable to recover.

I’m afraid to go back to work until this is under control because I’ve lost two jobs this year; I can’t handle getting fired again. D. agrees that a break from it all, time off so I can rest and work on my memoir, is the best plan. I made a budget; we can easily afford it if we cut out all luxuries. But I want to spoil him, want to give him everything he wants because I feel so awful and guilty, and then I feel bad because the money’s gone faster than we expected, and the whole cycle starts all over again.

We’ve applied for food stamps. I’ve applied for disability. Each day, I commit myself to two hours of research (reading books on dissociation, manic depression, PTSD, and anything else I feel might be applicable), jotting down quotes on note cards with obsessive precision—a purple heading for dissociation, green for bipolar. Most of the time, these quotes help me remember anecdotes, pieces of the puzzle that I can use when I actually begin to write this thing. I am determined to be as organized as humanly possible, despite all the things that are going on inside my head, because I want to finish this book. I want to keep going on this project and not give up; I’ve tried to write a memoir three times before and got stuck after the first chapter. How can I not know what happened to me? I’ve realized the failures were probably because I didn’t have everything laid out just-so: and then, and then, and then.

I know the cycles will make things difficult. I need to make the most of the mania and hypomania and try not to hate myself too much when I crash and can’t do anything but lie in bed and sob.

Jesus Christ, I just want to be okay and make something of myself, be able to provide for our little family again. I want to be good and successful and not feel like I’m wasting my life, like I’m already useless and dead at 24.

I want to make it to 25, and then 30…

*

I feel like I need to give myself some credit for staying out of the hospital through all the years of misery. Two suicide attempts, eight months of intense cutting, and that’s just this year. 2013 has sucked, and I’m ready for it to be over. I want a fresh start. I want someone to turn me off and fix me.

I want to not be me. I want to feel like it’s okay to be me.

I want my husband to always see me as interesting and pretty, not as a sad, pathetic mess.

I want my family to stop seeing me as a disappointment (they probably don’t, but I worry that they do) : If only I tried harder, I could go back to work. Mind over matter, J.

I’m seeing my therapist on Thursday, and I feel like that’s a very good thing. What I need most right now is for a neutral third party to reassure me, to comfort me and tell me I’m doing exactly what I need to be doing, that I’m right where I’m supposed to be at this point in my life.

I hope I’m going to be okay.