Sunrise in My Socks

The Crystal Method ~ Slipstream (on Divided By Night)

English: The Crystal Method Logo (Photo credit: Wikipedia)

I am not sure where the Slipstream is but I am pretty sure I have been in it.

Fall

I love the fall. It marks the beginning of the cycle of renewal. For me the seasons do not start to revive in the Spring, but in the Winter when the snow falls to provide the water for the plants and flowers of Spring, and in the Fall everything becomes dormant as it helps Winter to prepare for the coming Spring. That and there is something cozy and magical about fall; the turning of the leaves green to yellow, gold, and red to finally fall brown to the ground, the animals going into hibernation for the year to awaken again in the Spring. Everything about fall the way I see it is about death and renewal.

My Cat Thinks I Am Depressed

Cat Conspiracy (Photo credit: Tjflex2)

 

My cat will not leave me alone. She has to be on me, or touching me with a paw. She runs her head into my body because she wants to be petted. We took a nap today, and she spread herself down my entire stomach and happily slept there until I woke up and rolled over her. She didn’t like that at all. I got a very nasty look, and the cat equivalent of hhhhmmpphhh. She only does this when I am sick or not feeling well for some other reason. Since, I am not sick, nor am I feeling physically icky in any other way, I have to assume that she is picking up on something I am not completely aware of. She thinks I am depressed and she is going to purr and be all cute and sweet until she thinks I am okay again. She may be right. I believe that animals can sense all manner of things that people themselves don’t or won’t pick up on their own. People are consummate liars when it comes to their emotions, and as there is a tear rolling down my cheek, I am going to have to say that, no, it hasn’t been a good week. I am feeling loss and pain, and I do not like those two emotions. However, they could be gone tomorrow unless it rains because I have no car so I ride the bus, and I can’t find my umbrella. What that has to do with anything is anybody’s guess.

 

What Exactly Is Bipolar Disorder? Part Three

This is my summation of my research, and some personal opinions gleaned from a lifetime of mental illness:

Part Three:

Due to the length of this treatise, I am skipping the different types of psychotherapy and just saying that your therapist and your psychiatrist should communicate and be on the same page. As for the patient. Complying with treatment including psychotherapy is key to recovery or management, whichever you prefer. Also, if you are going through a tough life event, it is a good time to talk to your doctors about your medication needs and you therapy needs. You may need to add a medication or increase you already take, and you may need to see your therapist more frequently until you feel that you are safe, and can handle the situation.

In closing, Bipolar Disorder in all its various forms, manifestations and severity of symptoms is a rollercoaster ride. I tend to compare calm times to being on a long frequency sine wave where you rock gently through the ups and downs, and episodes both depressed and manic as being on the Richter scale. Then you are like an earthquake, and you never know what devastation you will leave in your wake. Hopefully, you never go higher than a 2.0 earthquake because then real damage can be done. Having Bipolar Disorder, in my opinion, requires a level of inner strength that is difficult to achieve because you will lose friends, you will lose husbands and wives, lovers and partners, jobs, and a sense of who you once were. You will question your self-worth, and your worth to other people. It is a devastating disease. It takes and takes, but will never give back. That you have to learn how to do on your own. It is a very needy disease that wears out everyone including the afflicted person. Even if you have the best doctors, and you have the disorder mostly managed, it is usually at a great cost to a lot of people including you. It can be a very lonely illness. But, this is not to say that it is a hopeless situation. You can manage it, you can find friends who will understand or will be willing to learn about it, you can find partners that are understanding that it’s not you that is acting out of sorts, it is the disorder. It is possible to rebuild your life with sympathetic people who will be there when you really need them, and they will understand that you are going through a rough patch, and need help. So, all is not lost as I once thought, and I would imagine other people have felt upon being diagnosed. If you choose to educate yourself about the whole thing, medication, therapy, mood swings, etc. you will know what you are fighting, and you can get the better of it.

 

What Exactly Is Bipolar Disorder? Part Two

This section covers diagnosis and treatments:

Part Two:

Diagnosis

Bipolar disorder operates on a spectrum that includes four types. To be diagnosed with any form of Bipolar disorder, one must meet the criteria set out in the Diagnostic and Statistical Manual of Mental Disorder (the DSM).

1. Bipolar I Disorder ~ defined by manic or mixed episodes that last for more than a week, or by manic symptoms so severe hospitalization is required. There is usually a depressive episode lasting longer than 2 weeks. This is the “classic” form of the illness
2. Bipolar II Disorder ~ characterized by a pattern of depressive episodes and hypomanic episodes, but no full-blown manic or mixed episodes.
3. Bipolar Disorder Not Otherwise Specified (BP-NOS) ~ used when symptoms of  Type I or Type II are not present, but the behavior is clearly not within the normal range for that person.
4. Cyclothymic Disorder, or Cyclothymia ~ a mild form of Bipolar Disorder (there has been some talk as to whether to include this in the Bipolar Spectrum). It is used when the person has episodes of hypomania as well as mild depression for at least 2 years. The symptoms do not meet the criteria for Bipolar Disorder as laid out in the DSM.

Since people are more likely to seek out treatment when depressed, the diagnosing clinician should take a very specific medical history to avoid a misdiagnosis of Major Depressive Disorder. People who what they refer to as Unipolar Depression do not have manic or hypomanic episodes.

Bipolar Disorder can get worse with time if left untreated. Episodes may be more frequent or more intense. In addition, delays in getting the correct diagnosis can lead to significant personal, social and work-related problems (oh, how well I know that having been fired from 2 jobs before being correctly diagnosed with Type I Bipolar). Proper treatment of the illness can help reduce the frequency and intensity of the episodes making it possible for a person with manic-depresseive illness able to lead a full and productive life.

Substance abuse is high among Bipolars although the reasons for the connection are not clear. The working hypothesis is that people are self-medicating. Taking CNS inhibitors like alcohol or certain groups of pills to bring themselves down, and using stimulants when feeling depressed.

Anxiety Disorders such as PTSD, social phobia and generalized anxiety often co-occur in people with Bipolar Disorder. Bipolar Disorder is also co-morbid with ADHD/ADD which both mimic some of the symptoms of Bipolar like restlessness or an inability to focus. I am one such lucky individual to have the PTSD, Social Phobias, and ADD. Makes for an interesting ride sometimes.

Treatments

Now we get into the fun stuff: medication, or the “med-go-round” as I have named it. Bipolar Disorder cannot be cured but it can be effectively managed. Proper treatment can help many people ~even those with the most severe forms ~ manage their mood swings and the resulting behavior. As it is a lifelong illness, treatment is an ongoing long-term process and even those who have most successfully recovered may have continued albeit not as intense mood swing and changes in behavior. The NIMH funded “Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD)” is the largest study ever conducted on Bipolar Disorder. It found that almost half of those who had recovered still had lingering symptoms, and having additional mental disorders increased the chance of relapse (no wonder I cannot hold down a job).

Treatment is most effective when the patient works closely with his or her doctor and there is open and honest communication about medication and how the patient feels they are doing on it. The most effective treatment plan usually includes medication and psychotherapy.

Medication

This is where the patient gets turned into a guinea pig. I am really not kidding. Finding the right medications to stabilize a person’s mood and therefore their behavior is a really un-fun (yes, I know that’s not a word) proposition. There are many different types of medication used for the treatment of Bipolar Disorder. One suggestion for the early phases of medicating a person is to have the patient log their moods, sleep patterns, and “life events”/stress/anxiety and tell the psychiatrist about side effects, especially if they become intolerable, or if your moods change for the worst. That will give the clinician an idea of what’s working and what’s not working. Although, my experience with the first go at medication had me on 6 different medications. How could they tell what worked and what didn’t? I eventually found a psychiatrist who thinks the way I do about medication. The fewer to accomplish the goal, the better.

There are a few basic types of medication used to treat Bipolar Disorder. They include mood stabilizers like Lithium, atypical antipsychotics like Abilify, and anti-depressants although one has to be careful with that class of medication as it can provoke a manic episode and/or increase mood cycling.

Lithium is the mood stabilizer of choice when a person first steps on the med-go-round. Lithium is a trace element that everyone needs to live, but in much higher doses, it is an effective mood stabilizer. Unless you are allergic to it as I am. Then, it does nothing for your mood because you are feeling like you have the flu all the time. Essentially, you are being poisoned. But, it does work for a lot of people. It was the first of the mood stabilizers to be approved for use by the FDA in the 1970’s for treating both mania and depression.

Anti-convulsants are also used as mood stabilizers although their primary purpose is to treat seizures associated with Epilepsy or other seizure disorders. The ones most commonly used are Depakote, which was approved in 1995 although there are special risk factors for younger women, Lamictal which can be effective in treating depression but comes with a “black box” warning that it may have serious side effects such as Steven-Johnson Disease which can be fatal. The anti-convulsant category comes with the FDA warning that use may increase suicidal ideation and behavior. Tried both of the above and side effects were intolerable, and didn’t need to be more suicidal than I already was. Doctors and patients need to closely monitor the effects of the anti-convulsants for any mood changes for the worse, and suicidal thoughts and/or behavior.

All of the medications in the category “mood stabilizer” have lengthy lists of side effects including dry mouth, bloating, restlessness, joint or muscle pain, and others. Other common side effects include drowsiness, dizziness, headaches, mood swings and cold-like symptoms. Medication is fun!

Atypical anti-psychotics (the new breed of Thorazine without the drooling) are sometimes used to stabilize mood and behavior. The most prominent are Zyprexa usually used with an antidepressant to control mania and psychosis, Abilify used for manic or mixed episodes, and Seroquel, Resperidal, and Geodon also used to treat mania.

I currently take 30 mg of Abilify each morning, with Welbutrin and Klonopin (for anxiety), and 500 mg of Seroquel at night as it knocks me out cold for a good 9 hours (see post on Waking up On Seroquel). Geodon is worse. Won’t take it, don’t even try.

The side effects of atypical antipsychotics are not nearly as bad as their predecessors. First of all, don’t drive until you know how they affect you (I once had the world tilt 90 degrees while at the grocery store, and I had driven my car there. That was not cool). The list of side effects for the atypicals is fairly short: drowsiness, dizziness upon standing, blurred vision, rapid heartbeat, sun sensitivity, and a couple of others.

I am going to skip the anti-depressant category because most people have either taken one of  them personally or know someone who does. The only problem with using them for Bipolar depression is mood switching and rapid cycling of moods.

 

One Thing I have Never Blogged About: What Exactly Is Bipolar Disorder?

I have never actually blogged on the subject of Bipolar Disorder in and of itself. I have written numerous posts about how I feel about it, or how it is affecting me and others on any given day. So, here goes. Most of this information comes from the National Institute for Mental Health. I am going to break this into pieces as it became something of a dissertation on Bipolar Disorder in all of its lovely forms.

Part One:

What exactly is Bipolar Disorder?

Also known as manic-depressive illness, Bipolar disorder is mental disorder belonging to the DSM category Mood Disorders. It is characterized by unusual shifts in mood, energy levels, activity levels, and the ability to carry out day to day tasks. The symptoms of Bipolar can range from mild to severe. The symptoms of Bipolar Disorder vary greatly from the experience of “normal” moods. They are far different than the usual ups and downs that most people experience from time to time. The symptoms of Bipolar Disorder can interfere with relationships causing sometimes irreparable damage; they can cause poor school or work performance, and even, at its most extreme, suicide. People with Bipolar have a high rate of death by suicide. I do not know the exact statistics, but they are higher than those of Major Depressive Disorder and other mood disorders, and even Schizophrenia. The good news is that Bipolar disorder can be successfully treated so that people who have the disorder can lead full and productive lives. This is not to say that a “treated” bipolar is not going to experience the world the same way as a person without the disorder, they will still experience “bipolar moments” from time to time. However, the episodes tend not to last as long, and seem to be less detrimental. Many people with manic-depressive illness may go for months without an episode if properly treated with a combination of medication and therapy. It is important to remember this is a lifelong illness. It may go into a “remission” of sorts, but it is still there, and people will still experience episodes from time to time.

Causes

While there is no general consensus on what causes Bipolar disorder, scientists do believe there are a number of factors that work together to produce the illness or increase the chances that a person will develop the disorder. First, we will look at role that genetics plays in the onset of the illness.

Genetics

It has been determined through self-report and the organizing of family mental health “pedigrees” (a chart of all relatives who either have problems with depression or have the illness itself), that Bipolar disorder has a strong genetic tie. Some research has determined that people with a certain gene are more at risk for developing the disorder than others. The NMIH literature states that children with a parent or sibling with the illness are more likely to develop manic-depression than those who do not have a close relative with the disorder. However, most children with a close relative with the disorder will not develop it.

An aside on the genetics model, I believe that Bipolar disorder can skip generations as long as one or both parents carry the gene predisposing one to manic-depression. The reason for my hypothesis is that my Father’s mother (my paternal grandmother) had untreated Bipolar disorder (Lithium didn’t come into play until the 1970’s). As far as I know there are no other close or immediate family members on his side of the family that have Bipolar disorder although I know very little about that side of my family.

Researchers are also pursuing illnesses with similar symptoms such as depression and schizophrenia to identify possible genetic differences that may increase the risk of a person developing Bipolar disorder. However, genetics may not be the only cause. A combination of predisposition and environment has been posited as creating a risk factor. Scientists do not fully understand the duality of genetics and environment in the risk for developing the disorder.

Brain Structure and Functioning

Some imaging studies using MRI’s and PET images have shown possible differences in the actual structure of the bipolar brain. One MRI study found that the pre-frontal cortex in people with Bipolar disorder may be smaller than that of people without the disorder. This is the “decision” making and problem-solving part of the brain. It is linked to other parts of the brain which come to full development in adolescence which may be why most people will present with manic-depression in their teens or early 20’s. Scientists are still working on how these brain structures combined with genetics may predispose a person to develop Bipolar. With more research, scientists may be able to better “predict” what types of treatment will be most successful.

Signs and Symptoms

People with manic-depression experience intense emotional states that are called “episodes.” An episode has to be a drastic change in the person’s normal mood and/or behavior. A “depressive” episode is pretty self-explanatory if you have ever experienced any form of depression. It is just a more intense form of depression and can last a very long time with detrimental effect. A “manic” episode is a different animal altogether. Manic episodes are characterized by abnormally high energy levels, lack of a need to sleep or no sleep at all, “flight of ideas” (a state where your mind is so active, even the Bipolar can’t keep up, it’s like ADD on steroids), pressured speech (an extreme need to speak), and eventually irritability and even psychosis due to the lack of sleep. There is also the “mixed state” which is what I usually present with. It isn’t exactly depression in the classical sense nor is it mania in the classic sense. It is both at the same time. I describe it as being the most unmotivated manic person, and the most motivated depressed person. It sucks. People with manic-depression can be very irritable and explosive while experiencing an episode be it depressive, manic, or mixed (which I have heard is the most dangerous of the mood episodes). Psychosis can appear in all mood episodes which frequently leads to a misdiagnosis of schizophrenia. I, myself have Bipolar disorder Type I with Psychotic Features which means I periodically (usually while depressed experience a break from reality). I do not think I will go into all of the symptoms and resulting behaviors because I have pretty much covered them.

 

Just Finished a New Book About How To Manage Bipolar Symptoms

BiPolar – What’s Up? – Dunno, I’m kinda Down (Photo credit: Creativity+ Timothy K Hamilton)

I am sure that most people in the Bipolar world have heard of Julie Fast. She has been living with Ultra Rapid Cycling Bipolar II with psychotic features for about 15 + years. It’s not that far away from my own diagnosis of Bipolar I with psychotic features except i am usually in a mixed state which is just the worst. You are the most motivated depressed person and the least motivated manic person. They sort of bleed into one another.

Anyway, the book is Bipolar Happens! and it has a very unique outlook on managing Bipolar symptoms such as anxiety (I knew there was a connection), depression, mania, paranoia, and other subtle symptoms of Bipolar.

She starts the book with that familiar saying and complaint: “I just want to be normal.” She states that people are often taken aback by that statement. People often ask “What is normal?” or “is anyone really normal?” which personally I would find somewhat offensive because there is such a thing as “not normal.” She states it is not normal to not be able to hold a job for more than two years (hmmm, been there), or taking 8 years to finish college (hmmm, been there too). She says it is not normal to hear voices that tell you that you are worthless and you should just die.

She states in return to these statements that everyone is abnormal to some degree, but there are normal people out there. She knows that because she knows what it means to be NOT normal as I suspect many people with mental interestingness would attest to. She points out that “normal” people think about one or two thoughts at a time, not twenty (flight of ideas) whirling around inside your brain. Ms. Fast writes that it is not normal to break down every behaviour looking for the negative meaning. It isn’t about hearing voices that tell you that you’ll never amount to anything so why bother trying (I have experienced those voices for many, many years, and I would dare say that most people with Bipolar have also to some degree). 

One thing that really resonated with me is her writing that normal people live day-to-day while Bipolar people have a tendency to live in the past and feel that there is no hope for the future. I am guilty of that. Especially of reliving my childhood where I was a weird kid, but not a Bipolar person, yet.

She writes a great deal on depression and how to combat it in the book (maybe because women are more likely than men to have depressive episodes). One thing that she talks about that I had already discovered on my own is how truly beautiful this world is. Instead of walking with your head down looking at all the garbage this world produces, look at the sky, the bees collecting nectar, the unsual arrangement of pots that make up a planter; of course it helps if you don’t have a car, but I have seen more beautiful things that I would have missed had I been driving. I have met some very interesting people as well.

She asks the question: are you looking up and seeing the beauty of the world and feeling better, or are you looking down and letting depression get you? I know it is hard when you are in the throes of depression to see any beauty in anything, however I have found that getting outside and walking can be very spirit lifting. Basically, she says you have to tell the depression NO! and fight it like an enemy. She suggests writing down the symptoms of your depression so you will know it is the illness talking and not something else. Basically, you have to learn your behaviours so well that you can feel them coming, and you can take action to stop them.

Another topic she writes on, which I think is terribly important, is for your friends and family to be educated about the illness so they can see when you are ill, and take steps to help you rather than as one person I know put it when I asked them to take me to the hospital, “I am so sick and tired of all of your drama and chaos!” That wasn’t what I needed to hear from that person. If a Bipolar is asking to go to the hospital, just take them. They know what condition their condition is in, and they are asking for help not being screamed at. At the time of the above occurrence, I had all my meds lined up in a row an the counter in the bathroom, and I was wondering if I had enough to kill myself. So, yes, I think it is extremely important for those who care about you and whom you care about to be educated about this sometimes fatal illness. 

She writes on how to recognize the early stages of a manic episode and how to stop them. Of course, this is very personal in how the mania manifests itself. The are a myriad of ways that mania can insidiously crawl into your life. And, it can be a very destructive force in relationships, financial matters, work place etiquette, etc. It is important to know what triggers your manic episodes. 

Basically, this is a fast read, and many of the techniques she describes are ones I have tried and been successful with. If you had asked me 5 + years ago how I was doing, I would have had to lie, and say fine. And, since I am really good at hiding my illness from others, people believe me, and are then rather shocked when I become so depressed I can’t get dressed or bathe. However, I find that sticking to a regular sleep cycle, always taking my meds, trying to eat right and exercise, and doing things I enjoy seem to help. All are mentioned in her book. I guess when you have been an untreated bipolar for 15 years and treated for 11 years, you sort of work out your own “health” plan. I do, however, recommend this book. It is short, simple and to the point. And, it makes a lot of sense. She does not claim to be “cured” just very well managed.

OMG!!

I was watching “The Metal Show” on VH1, and now they are doing the 80’s thing. The 80’s do not bring back warm fuzzy memories for me. I have to go to change the channel before I go nuts. And I already am nuts!!!!

So I Am All Tranced Out On House Music And Thinking…..

This is a “thought bubble”. It is an illustration depicting thought. (Photo credit: Wikipedia)

 

I am thinking about the impossible to know with a reasonable level of certainty. What do two people have to do or not do to make a marriage work or die a flaming death much like mine? AC/DC’s song “Shot Down in Flames” comes to mind. While I admit that the world is probably a safer place for all involved if I live alone, I wonder what it was that I obviously did or did not do. I know what my problem with the whole grown-ups behaving badly thing is/was. No need to cover old ground, or extremely tainted water under a falling bridge.

 

I realize that having a diagnosis such as Bipolar tends to knock you a little sideways, and your perceptions of yourself in relation to the world changes a bit (maybe more than a bit). However, once you have recovered your senses, and you happen to be a highly functional mentally interesting person, shouldn’t things get easier not more tedious? Yes, I flew off the handle one too many times, but once again, I wasn’t the one who could not leave my computer sometimes for days on end. I tried to communicate, but how do you communicate with someone who does not know how to communicate with you? It’s like clapping with one hand (thanks to Anthrax for that analogy).

 

What are you supposed to do with someone who has no desire to really get to know who you are apart from your interestingness, and does not seem to have any desire to learn anything substantial about Bipolar? I, upon receiving said diagnosis, went out and read everything that seemed legitimate. How can you battle that which you do not understand fully? Answer: you cannot effectively deal with any illness unless you know what you are dealing with. 

 

This was supposed to be forever, but I guess that’s a big fairy tale society tells little girls: your knight in shining armor will come and all will be sparkly and shiny and smiley and happily ever after. They lied. I think I met my knight in shining armor, and ditched him to get married to a man who turned out to be a far cry from the “face” he put on during the courtship. I am sure he feels the same about me, but I really do not know how to be anything but myself. He knew my moods weren’t completely handled, but he said, no problem, he could handle it. Apparently not. 

 

So, now I am in my early 40’s looking at starting all over again. Dating in my 30’s was not a problem because of said knight in shining armor. I never had to worry about someone to go drink beer and listen to blues bands with. He was always there for me, in all ways. What the hell was I thinking? Now, I am left to pick up the wreckage that used to be a perfectly satisfying life. I did not have self-worth problems, I did not have problems with how I looked, I did not have a problem with how feminine I was or was not. I didn’t have a problem with a lot of things. As I imagine he didn’t either. But, I wasn’t shattering his masculinity every single day. 

 

i think that I took him very much by surprise when I actually did file for divorce. I had mentioned it several times over the past couple of years, but he never thought I would actually take any action. He said everything I said was just talk and more talk, no action. Well, I guess you shouldn’t threaten me physically. I don’t cotton to that very well. I just wish I could pinpoint where it all went wrong. When I became unhappy with him and he with me. I play it over in my mind, and nothing seems to just pop out at me. I think I became upset with myself when I stopped getting mad about his Internet activities. There was no point. i was just wasting breath. I do not know, but I do not think I will try it again anytime soon. Talk about a learning experience. Never again will I allow myself to be treated like that. I am surprised I didn’t see it until the very end. After all, I grew up in an emotionally abusive family. I should have seen it for what it was and left much sooner. Maybe then I wouldn’t feel so scarred. Again.