Hormones got me like…

a cure for what ails you, bipolar disorder, endometriosis, medication, rapid-cycle bipolar disorder, Uncategorized

I had laparoscopic excision surgery earlier this month for endometriosis. It was loooong overdue and my surgeon was excellent, which means no more pain! Seriously, I haven’t had a single day without some form of pelvic pain or muscle tension in years, so this is incredible.

Anyway, he popped the hood and did a bunch of stuff. In addition to removing sheets of scar tissue that had formed after my last (unsuccessful) surgery seven years ago, he placed a Mirena IUD. I was always scared of having one placed because I’d heard it was so painful, but he assured me that he could do it while I was 100% out. And readers, I feel great and am so glad I did it!

I’d been on a pretty heavy dose of Megace for about a year and a half. Megace is a heavy hitter and is one of the strongest progesterone medications out there. It’s not really meant to be taken long-term, but the gynecologist who prescribed it back in the day didn’t tell me that. She also failed to mention that it wouldn’t actually treat my endometriosis–it just stopped my periods. I mean, that’s great and all, but I was under the illusion that I was actually treating it. Instead, I was just building up some heckin’ heavy uterine lining that my surgeon had to scrape out. Ew.

I stopped the Megace cold-turkey a few days before my surgery, with the blessing of my endocrinologist. (I have a lot of health stuff going on in addition to the bipolar disorder.) He ran a fasting cortisol panel to make sure the Megace wasn’t destroying my adrenal glands. Everything came back totally normal, so boom, no more Megace. And hello, Mirena!

But, as we all know, hormonal shifts can have huge implications for people with mood disorders. My bipolar disorder has been amazingly stable for years–you all may recall way back in the day when I was first diagnosed (2013!). I’d been on more or less the exact same doses of medication since then, with minor adjustments to my lithium and a change in the type of antidepressant (from SSRI to SNRI) when I first started taking meds. It’s pretty rare for a patient to not have adjustments within a five-year period, but I was one of the lucky ones.

I saw my psychiatrist yesterday and mentioned a few things I’ve noticed–tiny bits of hypomania peeking through and depression where it shouldn’t be. Fortunately, I’ve been very tuned-in to my body and my moods for years because I have to be in order to stay healthy and sane. Being in the mental health field has also helped, because I now have more precise language to describe what’s going on with my moods. My psychiatrist, who I initially had doubts about, has been pretty awesome the last few times and worked with me to determine what meds to adjust and how much. She seems to get that she has the medical knowledge and I have the experiential knowledge, so together, we’re a treatment powerhouse.

I’ve been sleeping a lot more than usual lately and my appetite has been really weird–up one day, then down for a couple days, and so on. I slept thirteen hours the other night and eleven-and-a-half last night. I would have slept later today, but the cats were staring at me when I woke up from my third alarm and I needed to get up and feed them. Groan.

Here are my current meds, for anyone who’s interested. Please bear in mind that these are my doses and that your needs may be different (either a little or a lot!). As always, work with your doctors and make sure everyone’s in the know, especially if you see a few different specialists regularly like I do. They’re part of your wellness team, so make sure they’re up to date!

I’ve dropped the 60mg of Megace and also my 5mcg of liothyronine (a T3 thyroid medication) so far this year! My current regimen sounds like a lot, but it’s actually the smallest amount of meds I’ve taken in years. Here we go!

  • 400mg lamotrigine/Lamictal
  • 88mcg levothyroxine (T4 thyroid medication)
  • 600mg lithium
  • 112.5mg venlafaxine/Effexor

And that’s it! No more birth control pills because Mirena’s got my back. Now that I’ve more or less adjusted (a few aches and pains similar to what I remember PMS being like) to it, I’m feeling pretty good. I still have some residual pelvic achiness from time to time, but my surgery was less than a month ago and things are still healing internally.

How are your meds going, readers? Or are some of you fighting the good fight without them? Summer can be rough for a lot of us mood-wise–hypomania and mania tend to spike, so we have to be extra vigilant. Let me know how you’re doing in the comments!

 

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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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