The NMIH Study Is Fascinating

Apparently, the study lasted 7 years and included more than 3,000 people with Bipolar disorder in addition to co-morbid disorders which no other study had ever done. All other studies had focused on Bipolar exclusively which did not give a really good “real” life cross section of people with Bipolar disorder as it commonly occurs with other disorders like PTSD, Panic Disorder, Agoraphobia, etc. 

Even with the amount of research that I have done over the years on Bipolar disorder among others, I am learning quite a bit about treatment outcomes. They had groups who received no psychosocial intervention, groups who received one of four different types of therapy, and all groups were on some form of mood stabilizing medication. The groups with the best outcomes were those who received intensive therapy (3 times per month over a 9 month period) and were on mood stabilizing medications. Which is no real surprise to me, however, for clinicians planning treatment plans for their bipolar patients, this study could be of real help. 

Even if you are currently relatively stable on your treatment plan, this study is really interesting, and there are links to other studies, as well. Since, I want to know all that I can about how to remain symptom “free” (not likely), I would highly recommend reading this for your own edification.

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.

 

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.

Can't Really Tell Where My Head Is At

Divorce Cakes a_006 (Photo credit: DrJohnBullas)

I have received the divorce papers. It is official; I am divorced after approximately 4 years of marriage. I do not really know how I feel about it now that it is a reality that I can read as many times as I want on page two of the Divorce Decree. And, believe me, I have been doing just that. That cannot be healthy. My anti-anxiety medication refuses to work, the mood stabilizers are on holiday to Jamaica (or where ever that postcard came from “Wish you were here!”). I am alternately very quickly through mania and depression. Mostly at the same time.

I mailed the required copies to my ex-husband as New Mexico law and I would presume most states, if not all, has this clause. He found out that the divorce was final, I think on Thursday. I found out about a week earlier. It was surreal to read those papers. I think in my mind that it was going to take longer to process the divorce packet. It took two days from the date of filing. It was so fast. My mom and I finalized the papers on a Tuesday, filed Wednesday, and by Friday I was divorced.

I really do not know how I feel about this. I have been waiting for him to change his “habit” for two or more years now. I thought I had worked out the abandonment and neglect that was part and parcel of this marriage. I have been alone with someone for so long that I thought living alone would be easy, and I would just drop into my old routines. That hasn’t happened. I feel sad and depressed. I feel like a complete failure. I have done everything right in my life’; with a few notable exceptions. Why couldn’t I get this right? Why couldn’t he get it right? Its not like he hasn’t had practice. He’s been married three times, and divorced three times. Although, I have noticed a pattern, he stays married for about 3-4 years and then gets divorced. Is he leaving them? Or, are his “habits” so odious that they leave him? He doesn’t need a wife; he needs a friend with benefits and a maid.

I didn’t expect to feel loss. i thought I had been through that already, too. Apparently not. I feel loss, I feel grief, and I feel relief and elation. I feel like I have been having a mixed episode for about three weeks. If I am manic with not too much depression, I can get things done, if I am depressed and slightly manic. I sit and mourn.

I have no more access to a car, so it is looking like my Buddhist activities are going to cease as they are on Sunday, and the Sunday buses rune every hour at inconvenient times. So, that’s not an option. As this spiritual philosophy has kept me grounded for almost 5 years, I do not know what I am going to do with out it. I cannot in all good conscience keep asking people for rides to meetings and events as it may be years before I can get a car, and that is a serious imposition. 

I am scared.

An Open Letter To One Who Denies Me

Disease? (Photo credit: armigeress)

This is an open and ongoing dialogue I have with myself. Some days it is quiet on the frontlines, other days, the frontline has shifted. It is like trench warfare; no one side advances very far before the retreat. Today the trench belongs to the other side so I write. 

An Open Letter To One Who Denies Me

Hello,

I would like to introduce myself. I am the part of you that you will not acknowledge. Half of my DNA is the result of you. I possess 23 pairs of your chromosomes. I look like you. I have the same coloring as you, freckled and fair and strawberry blonde. I have inherited your intelligence, your thirst for knowledge, your seeking ways, your search for an elusive “truth.” I have the gene that causes you to deny me. I am like your mother, yet I am nothing like her. Yes, I paint, yes, I love to travel, yes, I enjoy conversation with interesting people, yes, I am fascinated by all things in this world. But, I lack the storminess of her. Yes, I used to be a person of stormy and unpredictable moods, but unlike her, I live in this century where they have almost figured out how to medicate the storminess so it no longer wreaks havoc on the world around it.

Granted, I choose to take the least amount of medication that will keep my madness stable. I choose to do so because I still want to feel that storminess that drives my writing, my painting, my dabbles in computer graphics. In other words, the stormy weather that makes me a person distinguishable from others. I manifest the storm in a way that is completely different than she did. I am not her, therefore, I do not understand why you would deny that which is part of you.

Let me tell you about myself. First and foremost, I am a distinct person. I am not my illnesses. I have my illnesses, and to tell the truth, I would not have it any other way. My experience of the world is rich with emotion and appreciation and gratitude (even though some would disagree with that statement). I am not like the other that is also part of you. I have opinions that are based on my experience of what I read and find to be the correct belief. Maybe I am wrong in some of my beliefs and perceptions, but you have to take into account that all I experience is filtered through the somewhat crooked lens of my perception. The important thing is that they are uniquely mine.

Secondly, I am just as flawed as you are. Maybe that is why you deny me. You see flaws in me that you have seen in another. But, once again, I am not her. I am her on atypical anti-psychotics, anti-anxiety medication, and a little stimulant to control my racing mind. She was untreated and, therefore, ran rampant when the episodes hit. At least this is what I am guessing because no one will tell me anything about her except that she was “odd,” and that I remind relatives of her. I have heard this since I was a child, and since I remind people of her, I can only assume she struggled with the same ailments that I do. She must have been “mad” as well from what little I can gather. Which is not much because you have chosen to deny my existence in your world.

Why would you do that? Am I really that much of a disappointment to you? Did I fail in some way to live up to your exceptionally high standards (mine are higher than yours, by the way)? What have I done to cause you to deny a part of yourself? Or, is it guilt for passing on the predisposition to madness? You know, as an intelligent researcher, that only the predisposition is passed down. Some external stressor is thought to activate the “disease.” Or, perhaps, you look at me as being “diseased,” and since all of your research has focussed on eradicating disease from cells, I am unacceptable because you cannot separate me from the “disease.”

For whatever reason you choose to deny me, you are choosing to deny a part of you. I would have thought that by now, you would have learned to accept yourself as you are. Some of us have been forced to do exactly that due to being considered “different” than…….

 

Anxiety And Manic Depression ~ Symptom or Separate Diagnosis?

English: signs and symptoms ptsd (Photo credit: Wikipedia)

English: Emil Kraepelin (Photo credit: Wikipedia)

Since I suffer from both Manic-Depression and a couple of anxiety disorders (PTSD and Panic disorder with and without Agoraphobia), I was curious as to whether anxiety is a symptom of Manic-Depression or if it is a completely separate diagnosis. What I found were conflicting opinions on this subject. Most of my research on this subject came from the Journal of Affective Disorders v. 68, issue 1.

In 1921, Dr. Emil Kraeplin originally described the illness Bipolar depression, and declared that anxiety is a symptom of the illness. He described it as an “anxious mania” or an “excited depression.” However, he described anxiety as a specific symptom of Manic-Depression. All of this needed qualifying as anxiety is not generally thought to be one of the symptoms of Manic-Depression.

However, as reported by Freeman, Freeman & McElroy in a study done at the University of Cincinnati, Biological Psychiatry Department, Department of Psychiatry, anxiety is found both as a symptom of Manic-Depression and as a separate disorder. They state that “symptoms of anxiety as well as Anxiety disorders commonly occur in patients with Bipolar disorder. However, the pathophysiologic, theoretical and clinical significance has not been widely studied.” 

Their methods were to study the existing literature on the subject compiling information as they went. They examined the epidemiological and clinical studies that have been done on the overlap of Bipolar disorder and Anxiety disorders with their main emphasis being on Panic disorder and Obsessive Compulsive disorder or OCD , and to a lesser degree Social Phobia and PTSD. Data on potential neural mechanisms and treatment response were also reviewed.

What Freeman, Freeman, & McElroy found was that an increasing number of epidemiological studies have determined that Bipolar disorder significantly co-occurs with Anxiety disorders at a higher rate than in the general population. Clinical studies have also demonstrated a high comorbidity between Bipolar disorder and Panic disorder, OCD, Social phobia, and PTSD. They state that psychobiological mechanisms that may account for the higher rates of Anxiety disorders in patients with Bipolar disorder, and that they like involve a “complicated interplay among various neurotransmitter systems. particularly Norepinephrine, Dopamine, Gamma-aminobutyric acid (GABA), and Serotonin, The studies further theorize that secondary messenger system, Inositol, may also be involved. Not knowing what inositol is, I did some further research. Okay, that was fascinating, however, I did not realize that I would be delving into some very complex neural chemistry involving molecules, cell membranes, and what not. The researcher, Earl Wilbur Sutherland, jr.,  who discovered the “secondary messenger” system in the brain won the Nobel Prize in Medicine in 1971, and the two researchers, Martin Redbell and Alfred G. Gilman, who discovered the mechanisms for the secondary messenger system won the Nobel Prize in 1994. So, having been raised by a man who spent his entire research and teaching career investigating the nature of cells or “histology,” I can sort of get what they are talking about with the cellular stuff, but the chemistry is beyond me. All of the following is from Wikipedia with notations of the researchers where possible.

So, I’ll start with Inositol. Inositol is a carbohydrate though not in the classical sense of a sugar. It reportedly has a taste about half that of table sugar. “Myo”-inositol plays a very important role as the structural basis for a number of “secondary messenger” systems in eukaryotic cells (an organism with a nucleus and other structures contained within a membrane; they first developed about 1.6-2.1 billion years ago).

Now, I am going to try to explain what a “secondary messenger” system is. First of all, the neurotransmitters Dopamine, Serotonin, Norepinephrine, etc. constitute the “primary messenger” system. The “secondary messenger” system is composed of molecules that convey signals from receptors on the cell surface to target molecules within the cell generally located within the cytoplasm or nucleus of the target cell. They relay the signals of hormones such as epinephrine (adrenaline), growth factor and others, and cause some type of change within the target cell. These molecules also greatly amplify the strength of the initial signal. There are several different secondary messenger systems, however, they are all very similar in mechanism. In all cases, a neurotransmitter binds itself to a membrane-spanning receptor protein molecule (in other words, the neurotransmitter has locked itself into a receptor cell much like a lock and key. The receptor cell is membrane-spanning in that there can be transference between the neurotransmitter and the receptor). The binding of the neurotransmitter to the receptor changes the receptor and cause it to open a binding site for a g-protein (don’t ask me) which is a transducer, or a “signal” molecule that operates much like a switch does. The g-protein is either GDP or GTP which are respectively, guanosine diphosphate and guanosine triphosphate. Now we are into the chemistry, and I really have no clue, but this is how it works. Once the g-protein is bound to the inner membrane of the cell, it creates three subunits: alpha, beta, and gamma. It is then able to exchange a GDP molecule for a GTP molecule. Once this has occurred, the alpha subunit breaks free from the beta and gamma subunits and is free to travel around the inner membrane of the cell it has bound to; the remaining beta and gamma subunits remain membrane bound. The alpha subunit eventually contacts with another membrane bound protein (the primary effector) and this produces an action that creates a signal that can diffuse a cell or, in other words move across the membrane. This signal is called the secondary messenger system. Now that we are all confused (remember the scientists who worked all of this out won Nobel Prizes) let’s go back to inositol and its potential psychiatric uses.

Medication

I am tired of taking medication to keep other people sane.

sigh. (Photo credit: jessdamen)

 

Yet More Pink Floyd

This song has a particular resonance with me as I have been to this place, and feel like I am headed there now.

I Learned Something About Myself Yesterday….

Bipolar Affective Disorder (Photo credit: tamahaji)

and I wish I had not come to this piece of enlightenment or wisdom, whichever you prefer. While I think I have been in an emotionally and verbally abusive relationship for a while now (my husband has a tendency to speak in a condescending manner to me, he does not really support the things and activities that I am involved in, he gives me the silent treatment when I have done something that displeased him rather than talk it out, basically anything to demean or degrade me), I came to the realization yesterday that I am no different. I am emotionally and verbally abusive as well. And I became that way before he did. I do think there are reasons why. I have never had a good grip on my temper, or my moods. Medication and therapy do help, but there is no “magic pill” that will make it all go away. Bipolar is always managed; it is never controlled. I have been subject to fits of anger all my life, and I have generally taken it out on the people around me, but not the person that I am angry with. Clearly, it is something that I need to work on. 

There is a positive to this realization, however. I think it may be the first time I have really tried to look at my self from someone else’s viewpoint. Where I see someone who really tried hard to please people, someone else may see a person who is manipulative, and tries to please people for their own gain. What I view as sarcasm may be interpreted by another as just plain mean ( I do have this problem with stupid questions: ask a stupid question, you’ll probably be met with scathing sarcasm. It is not a part of me that I like). I cannot tell at this point whether being emotionally abusive is reactionary ( I am feeling attacked, and I have to fight back), or if I actually start fights just to start them. However, in my defense, I rarely call people names. or speak to them in way as to belittle them. I just throw temper tantrums or I become very quiet (that’s when you have to look out because a storm is gathering).

I have always failed to take the role of the other which is what happened yesterday. I finally began to see my behavior through someone else’s eyes, and I was appalled at what I saw. What I saw was a brat who threw temper tantrums to get her way.

How much of my lack of control is due to having Bipolar Disorder, I do not know. I just know that I am destructive and not terribly constructive, that I have a hair trigger when it comes to tones of voice, inflections, and perceived attacks. I do know that Bipolar is a chemical or organic versus situational disease. The depressions and the manias are not typically brought on by things in my environment, they just seem to come and go as they please. I also know my brain does not process information the same way as a non-Bipolar person. I have seen PET scans and MRI’s of the Bipolar versus Non-Bipolar brain, and they are chemically different. Whether or not this chemical difference causes my mood swings, and my tendency toward hurting those that I love, I do not know either. 

I just know that somehow I am going to have to learn how not to hurt the people that I love even when I feel like they are hurting me. The perception may or may not be correct. It’s very difficult when you can’t trust your own judgement.

Just Because I Am Quiet

English: WPA era Roosevelt Park in Southeast Albuquerque, New Mexico (Photo credit: Wikipedia)

I am quiet does NOT mean I am depressed. It does NOT mean I am even getting depressed. Sometimes I am just quiet.

And, I really wish my husband would stop assuming that I have taken something or that I have been drinking just because my words are slurred. I had major dental surgery about 2 months ago, and have not yet healed enough to create the dental appliance. I have no F&*&^%$ front teeth! Of course my words are going to come out a little funny sounding. He needs to stop with all of his “pop” psychology and thinking that he understands this disorder. It is beginning to really, really, really piss me off.

It may mean I am having a bad day. I have my medication doses set so I can have bad days and good days just like everyone else. I do not want to be a medication junkie, or a walking zombie. I WANT to be able to feel like a normal person, and that means that, yes, I am going to have a bad day every now and then! Just like every other person including him.

And, I am really tired of him telling me that I complain all the time about everything. Maybe I am being quiet because I do not feel like putting up with his Buddhist shit about not complaining about anything and every thing. He has been complaining non-stop about the moving crews that moved our whole house full of stuff from Los Lunas back to Albuquerque. It is only a 45 minute drive, and they unloaded everything where they could find space. So, upstairs stuff ended up downstairs and vice versa. He hasn’t shut up about that for three days now. And, I am tired of listening to his whining.

Perhaps I am quiet because I do not want him to speak to me like a small child or in a condescending manner. Maybe I just do not want him to talk to me at all. Maybe I just do not want to hear about how many times he’s been “around the block.” Maybe I just do not feel like being pissed off by something he said, so I do not talk to avoid arguments.

Not everything is about Bipolar, and he just doesn’t get that. I am not always sick. It comes and goes like a cold or the flu. I know when I am sick. I have been sick for the last two or three weeks. However, because of moving and getting rid of most of my pets, I did not have time to be sick. And, now, he won’t even let me recuperate. He won’t let me wind down from the manic state I had to be in to accomplish this move. He won’t let me mourn my lost friends.

I do not know if he is just a cold person, or if he really just doesn’t get it. Mania sucks after a few days, and anyone who has had a pet for a period of time would understand what it is like to have it die in your arms, or to take it to Animal Control (which is a near certain death sentence). He thinks I am getting depressed and “we have only been in this house for 3 day. Why are you depressed?” Exact words. I am NOT depressed; just really tired both mentally and physically. All of which makes me quiet. Quiet does not equal depressed. Quiet equals quiet.

I wonder if he’s ever considered that I am not speaking because I am content in that particular moment and happy about it? It doesn’t always have to be about the illness.