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.

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.

Yet Another Doctor's Appointment

English: Wavelength for sine wave (Photo credit: Wikipedia)

Quite possibly, the one single thing that has really begun to bug me about this having Bipolar Disorder thing that causes me to have to put caustic chemicals in my body and ultimately my brain, is the constant stream of doctor’s appointments to assess how I am doing. If it isn’t the psychiatrist (today) checking to see how well a dosage change is affecting mania or depression, it is the therapist next Tuesday to assess my emotional status. I mean, do not get me wrong, I owe a deep debt of gratitude to both them and my parents for paying for them, but sometimes I just like to be left alone to ride my sine wave, and have a good or bad day without it becoming part of a medical chart, or part of my diagnosis. If I am having a sort of bad day when I see the psychiatrist, I get labeled Bipolar Type 1 ~ “low mood”. Of course it is “low”, I am having a bad day. That doesn’t mean I am depressed or about to jump off a bridge! It means I having a bad day, not week, not month, but one single day.  If I am happy and effusive then I am Bipolar Type 1 ~ “manic”. No, not manic, just happy and content. It once again is a one day thing. 

I just get tired of all the notes taking down every word I say for further review. All the writing and prescriptions that have created a medical chart that is thicker than a PhD. thesis. Or my therapist listening for “key” words in our sessions that might be significant in some way that I do not know about. I have no idea when one thing I say prompts a flurry of handwriting or something that I consider to be pretty significant does not. It’s like I just do not know the rules of the game that I am playing and the Doctors all have the upper hand. And then there are the appointments that I go to where I have nothing to report or just do not feel like talking. Those are the most fun. I do not feel like talking and yet, there they are, pens poised in anticipation of the next “great” thing to come out of my mouth/brain. Quite honestly, I do not have something to say all the time. Sometimes, I have no thought pattern whatsoever, yet, there they sit waiting for me to say I am depressed, I feel manic, I feel suicidal….all those things they are expecting.

Most of the time I just feel pretty normal, except I do not handle stress or irritation well. But that is something that is common to a lot of people, not just those of us blessed with Bipolar Disorder. And, I do mean blessed. I would not be as strong as I am without this disorder. If I were one of those people who seem like they just glide through life, I would be at a serious loss as to what to do when the glider came to a screeching halt. I would fly due to forward momentum straight into a crisis that I would not be able to handle. People who have been tested by life seem to handle things better than those who have not. Life is not “Leave it to Beaver” land. It is difficult, testy, irritable, irrational. It is not a Toll House cookie. And, I am sick of being poked and prodded. The meds work. I am fine. I am surfing my own little sine wave, and enjoying it. If you want to knock me off, make me an appointment with a doctor so I can be poked and prodded at. My cage doesn’t even have a Hamster wheel. One of those might be nice. At least I would get some exercise. 

Maybe I just do not want to go out and drive a 70 mile round trip because it has been incredibly hot here, and even though our air conditioner is set to cycle down during the hottest part of the day, it is still at least 20 degrees cooler inside. Heat makes me chappy. I am a Fall/Winter person. I like cold. I hate hot. Now, a nice 70 degrees would be blissful. But, alas, where I live that doesn’t happen until November, and we aren’t even out of June. That’s definitely it. I do not want to drive 70 miles today. I have to attend a meeting after the appointment so I won’t even be home until 9:30 or 10:00. I just do not want to go. I am being peevish. 

Life Used To Be Simpler

My life used to be simple. I woke up, had some coffee then grabbed my bike and headed off for school. During the time when only my fiancé was working and I

mountain bike in downhill race in forest ski trail (Photo credit: Wikipedia)

was going to school, I used to mountain bike every morning without fail. I always went out between 9 am and 11 am (I am fair skinned, and the sun is still low enough in the sky that you won’t get burned as badly). Nothing beats the thrill of coming down that bitch of a hill that killed your legs going up. Especially if it is winding. It seems that I have always felt better on a bike.

I remember one ride where I actually hit the “zone” that athletes are always talking about. My then fiancé and I were up in the mountains and it started to storm quite seriously. I am talking about lightning and thunder at the same time. That’s how close the lightning was to us, and all I could think about was getting the heck out of there because my bike is made of carbon fiber. Carbon fiber is an electrical super conductor. So, I just started to haul ass out of there. I wasn’t into getting fried that day. It was the most amazing ride. I was one with the bike (which never happened),  I was not thinking about how I was going to make a turn or over a log, I just found a way, and it worked. All I was really thinking about was, OMG mountain storm! Get out now! I think it was my favorite ride ever. I wish it were possible to use words to describe the experience of riding your bike through the mountains with all this lightning and thunder and hail and rain. It is one of the most exhilarating thing ever, And yes, it even beat sex.

Life was just so much simpler in those times. I was happy, I was in school and doing well, I was in love, and I had a great best friend that I used to go to the mountains with after school was out. He and I were like little kids, we explored everything that looked like it might be a trail. We were joined at the hip. If one of us showed up somewhere, it was a safe bet the other was not far behind. The sun is coming up, and the sky is turning pink. It is beautiful.

Anyway, this was long before the “diagnosis” and the medication-go-round that I ended up on. This was long before I got married which I am still trying to decide if that was big mistake or not. I love my husband, please do not get me wrong, it is just sometimes he can be incredibly difficult to deal with. He doesn’t seem to want to learn about what bipolar really is; he’d prefer to rely on his past 2 experiences with bipolar women, and both were total tramps. One was a “I’ll try anything once” type, the other one just cheated on him a lot. And neither one of them would stay on their medication so they were constantly going up and down. I, on the other hand, am medication compliant, and actually start to freak out when I have run out of medication because I know what happens when I do. It is simple, take your meds, and the mood swings will be closer to those that normal people have. It really isn’t rocket science nor does it require an advanced degree in physics.

What I think is that he cannot face his own depression. He has never received treatment for it until now when we finally reach a point where marriage counseling has become necessary, and they have a treatment plan that has us doing marriage counseling every two weeks and him doing one on one therapy every two weeks. He says that he has looked at himself and knows who and what he is. Therapy will fix that. Therapy forces you to look at yourself in a new light. He is going to finally have to confront the ugly in his nature. At least he will if he is honest with himself and the therapist. If he isn’t then therapy will do him no good. Therapy can be very scary. You will have to talk about things that you have buried so deeply it can take years to work your way through the maze of emotions surrounding the issue. I do not think he gets that. I have been in therapy for about 8 1/2 years, but I had some very dark things I had to take care of. I remember one session where I spent the entire session in a fetal ball (this was a few years ago). Something had triggered me. That’s another thing he needs to learn about: triggers. Once you can recognize them, you can control how you react to them, or at the very least manage not to let them set you off.

I swear life used to be so simple.

Treatment of and Medications for Bipolar Disorder

To date, there are no known cures for Manic Depression, but there are a large number of medical and alternative treatments. Because this is a chronic and recurring illness, most people with the disorder are going to require long term, possibly lifetime treatment. Treatment typically consists of medication and psychotherapy or talk therapy. Most talk therapy is of the Cognitive Behavioral type which aims to change the patient’s way of thinking and behaviors. However, I would like to add that I believe a firm faith or spiritual grounding in a religion that suits you personally is equally as important as the medication and therapy. It has been my experience that practicing Nichiren Buddhism in addition to medication and psychotherapy has helped me to remain stable for a lot longer than previous to my becoming Buddhist about 3 1/2 years ago. 

Medication: Usually prescribed by a psychiatrist. Also very tricky to find the right combination of medications for each individual case. What works very well for me may turn out to be your worst nightmare, and vice versa. Medication is very individual and specific. It is important to find a psychiatrist that is good with medication, and is not into over-medicating.

“Mood Stabilizers” are usually the first drugs of choice. Patients will typically stay on mood stabilizers for years.

1. Lithium (also known as Eskalith or Lithobid) was the first of the mood stabilizers to be approved by the FDA in the 1970’s, and is still very common today as a first line medication for stabilizing mood. It is generally prescribed for preventing mania, but also works on depression. It is highly effective at preventing recurrences of manic and depressive episodes. The only drawback is the monthly blood level checks to make sure you are in between about a 0.6 and 0.9. Any higher than 1.0, and your body will become toxic, and any lower than 0.6, and you might as well take a sugar pill. It is also important to have renal system functioning tested monthly. Side effects of Lithium can include: Restlessness, Dry Mouth, Bloating/Indigestion, Acne, Unusual Discomfort to Cold Temperatures, Joint or muscle pain, Brittle hair and nails. If you have these or any other extremely bothersome side effects, contact your doctor immediately.
2. Depakote (Valproic Acid or divalproex sodium) is the other first line mood stabilizer. It was approved in 1995 for the treatment of mania. It is an alternative for those who cannot take Lithium. In my experience, Depakote just sucks as a mood stabilizer. I gained 40 pounds in the two months I was on it, and I slept all day, lost two jobs to being late constantly. No wonder my mood was stable: I was comatose.
3. Anti-convulsants: Although designed to treat seizure disorders, many in this class of medication are used as mood stabilizers. They include gabapentin (Neurotin), topiramate (Topamax), oxcarbazepine (Trileptal). Most recently, the FDA approved lamotrigine (Lamictal) for the treatment of Bipolar Disorder.

Depakote, Lamictal and other anticonvulsant medications tend to increase suicidal ideation in some patients so it is important to closely monitor people on these medications for any changes in thought or behavior, new or worsening symptoms of depression, suicidal thoughts or behavior,  or any unusual changes in mood or behavior. People taking Lamictal are also cautioned against the development of a rash that may become life threatening (Steven-Johnson’s Syndrome).

Lithium also can affect thyroid functioning especially in rapid cycling women. Both low and high levels af thyroid hormone can change energy and mood , it is important to monitor these levels as well. This may lead to taking Thyroid medication in addition to the bipolar medications.

“Atypical Antipsychotics” are also sometimes used in the treatment of Bipolar Disorder. They are often combined with other medications. They are called “Atypical” to set them apart from the earlier medications in this class which are called “first generation” or “conventional” antipsychotics.

1. Zyprexa when given with an anti-depressant medication can be effective in relieving symptoms of severe mania or psychosis. It is also available in injectable form which will put a quick stop to a manic episode or psychosis. People taking Zyprexa may gain weight and increase their risk of diabetes and heart disease. These side effects are more common than with the other “atypicals”.
2. Abilify is approved for the treatment of manic or mixed episodes. It is also used as a maintenance drug following a severe or sudden episode. It can also be injected to quickly control the symptoms of a manic or mixed episode.
3. Seroquel also relieves the symptoms of severe and sudden manic episodes. In 2006, the FDA approved its use for depressive episodes as well.

Risperidone and Geodon are examples of other “atypical ” antipsychotics that may be prescribed for a Bipolar patient.

“Anti-depressants” are sometimes used in combination with a mood stabilizer to control to treat symptoms of depression in bipolar disorder. Generally, this is because anti-depressants alone can often cause “switching” in which the patient becomes manic or hypomanic or rapid cycling.  A recent NIMH study found that adding an anti-depressant is sometimes no more effective than a mood stabilizer alone. Prozac, Paxil, and Wellbutrin are examples of anti-depressants that may be prescribed for Bipolar patients.

People taking medications for Bipolar Disorder should not suddenly stop taking their medication. This can lead to a worsening of symptoms and potentially uncomfortable or dangerous withdrawal effects. Patients taking anti-depressants should be monitored for the first few weeks of treatment. Potential side effects include worsening of depression, suicidal thoughts or behavior, trouble sleeping, agitation or withdrawal from normal activities. Generally, anti-depressants are not prescribed for people under the age of 18. 

Side-Effects

1. Mood Stabilizers: Drowsiness, Dizziness, Headache, Diarrhea, Constipation, Heartburn, Mood Swings, Stuffed or runny nose, other Cold-like symptoms
2. Antipsychotics: Drowsiness, Dizziness when changing position, Blurred Vision, Rapid Heart Beat, Sun Sensitivity, Skin Rashes, Menstrual Problems in women. People taking antipsychotics are prone to weight gain which may increase the chance of developing diabetes and high cholesterol. Patients on these medications should be monitored for lipid levels, weight and glucose levels. In rare cases, long term us is associated with a condition known as Tardive Dyskinesia which causes uncontrollable muscle movements most commonly affecting the mouth. These symptoms may be permanent, or they may improve once the patient is taken off the medication.
3. Anti-depressants : Headache, Nausea, Sleep problems, Agitation, Sexual problems (men and women) including decreased drive and enjoyment of sex. These side effects generally go away after a few weeks. Some of these medications cause more problems than others, however your doctor or pharmacist should be able to explain the differences in medications.

The Best Books about Bipolar Disorder And 10 Subtle Symptoms ~ Updated

Okay, so this post is going to be dry and boring, but if you or someone you know has been diagnosed with Bipolar, these are among the best books about the subject. I will probably add more as I run across them. The important thing here is to know you are not crazy, nuts or anything else. You have a chemical imbalance in your brain that affects your moods, and it is important to know that you are not alone, and that you can live a functional and productive life with this illness. Each of these links will take you to that book’s site on Amazon where you can purchase new and used copies. My other current favorite online bookstore is half.com where you can purchase books for a little under $5.00 per book. Some of these titles may be available there as well:

1.  An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison (I cannot recommend this book more highly). It was the first I read on the subject and the fact that she not only has Bipolar Illness, but is a Doctor and researcher at Johns Hopkins gave me more hope that I could lead a “normal” life than any other book I have read. She researches mood disorders when she is not busy being a practicing psychiatrist. Of all the books written by Bipolar’s, I think this one is most important because it gives and honest accounting of what it is like to live with the illness while at the same time being a functioning, productive member of society. It is personal and it also offers clinical advice.
2. Madness: A Bipolar Life by Marya Hornbacher ~ I took a look at this book, and it details very accurately the life of a Bipolar even the early years when the author was a child. As I read the first few pages on Amazon, I had this very eerie feeling come over me, and I realized that was me as a child. Hyperactive, convinced that strange things lived under my bed (Dracula, Frankenstein, and the Werewolf), and that I would die if I were not completely covered from head to toe; not even a finger could stick out. I stayed awake as long as I could to be sure they wouldn’t get me or something would become uncovered.  This book is deeply personal while the same time offering clinical information on medications, side effects of those medications and a whole host of links to Bipolar or other Mental Illness sites; one of my favorites has always been http://www.crazymeds.com . This site has a lot of information on various medications used to treat many different illnesses, but Bipolar Illness is in there. The guy who maintains the site recounts his experience with different medications with a dry humor, but his information is really good. He explains in laymen’s terms what you can expect from various medications.
3. Touched with Fire: Manic Depressive Illness and the “Artistic Temperament”  by Kay Redfield Jamison ~ Examines the relationship between creativity and Bipolar illness. While not all artists are Bipolar, some form of “madness” does seem to be pervasive in the artistic community both now and historically. I have this book and have started to read it. It is a very interesting look at the connection between mental illness and the “artistic temperament.”
4. Manic: A Memoir by Terri Cheney ~ I have not read this book outside of the few pages that Amazon tempts you with to get you to buy the book, but what I read described a mixed episode that resonated so realistically with me that I remembered my early experiences as a clinically diagnosed Bipolar. I had days where I was so high and so low all at the same time, the only choice to stop the “ride” was to end my life, at least in my eyes. But, I was riding a manic high at the same time. I would be cleaning furiously and crying my eyes out at the same time.  This book would appear to be a very personal and not clinical look at what it is truly like to live with Manic Depression.
5. The Bipolar Survival Guide by David J. Miklowitz, PhD. ~ This one I have as well, and it offers up a plethora of ways to “survive” Bipolar disorder from medication and staying on it to things you can do to help yourself when you are having episodes to ways you can keep episodes from being so debilitating. He covers subjects like when you are just having a good or bad day, or if it your symptoms “talking.” He also offers up advice on not to let our illness run your life, and how you can be productive at work, and  function in personal relationships. It is a must have for all Bipolars that want to be as “normal” as possible.
6. To Walk on Eggshells by Jean Johnston ~ For those on the other side of mental illness. It is a book about what it is like to care for a mentally ill person. A good thing to have if your loved one is mentally ill. 
7. The Dark Side of Innocence: Growing Up Bipolar by Terrie Cheney ~ Chronicles what it is like to be a Bipolar child. Although there is a lot of controversy in the Psychiatric circles about whether Bipolar Illness can manifest as early as childhood, I have read way too many books where the person writing seems to be writing my life’s story. The violent, out of the blue outbursts, the absolutely bone-crushing depressions (no child should be attempting suicide at the age of twelve,  and that was just the first attempt, there were many more), the problems at school, the difficulty relating to people, the absolute certainty I had that everyone was against me (I still suffer from paranoia), the just wanting to isolate myself because then I was “safe” from other people, the bullying I experienced lets me know I was not a “normal” child. I was different somehow. most people called me “hypersensitive”. I do not think so. I think that I had a mood disorder that was not diagnosed because I never gave the psychologists and psychiatrists that my parents took me to a chance to even glimpse inside my head. Hell, I didn’t want to glimpse inside my head; it was a scary, dark place I just didn’t want to go. I escaped by reading voraciously.
8. Surviving Manic Depression ~ A Manual on Bipolar Disorder for Patients, Families, and Providers  By E. Fuller Torrey, M.D and Michael B. Knable, D.O ~ is the most comprehensive, up-to-date book on a disorder that affects more than 2 million people in the United States alone. Based on the latest research, it provides detailed coverage on every aspect of the disorder ~ from understanding its causes and treatments to choosing doctors and managing relapses.
9. The Bipolar Disorder Survival Guide ~ What You and Your Family Need To Know By David J. Miklowitz, PhD ~ How can you distinguish between early warning signs of bipolar mood swings and normal ups and downs? What medications are available, and what are their side effects? What you should do when you find yourself escalating into mania or descending into depression? how you can get the help and support you need from family members and friends? How can you tell your coworkers about your illness without endangering your career?  Filled with information and practical advice, this comprehensive guide offers straight talk that can help you tackle these and related questions, take charge of illness, and reclaim your life.
10. loving someone with bipolar disorder ~ Understanding & Helping Your Partner By Julie A. Fast and John D. Preston, Psy. D. ~ written specifically for the partner of a person with bipolar disorder. If you have a loved one with bipolar, you know how disruptive and straining this disorder can be to your relationship.You may experience feelings of fear, loss, and anxiety as well as a constant uncertainty about your loved one’s ever-changing moods. This book is designed to help you overcome the unique challenges of loving someone with bipolar disorder. With the supportive and helpful information, strategies, and real-life examples, you’ll have all the tools you need to create a loving, healthy and close relationship. (Julie Fast herself has bipolar illness as does her partner, John D. Preston, Psy. D. has received the Mental Health Association’s President’s award). This is an excellent book for somebody who is close to or loves a bipolar, it is also an excellent resource for bipolar people as it allows them a different perspective on their illness and it’s effects on those around them.
11. Bipolar Symptoms: By Tammy Worth ~ 10 signs that mood problems may be due to more than a quirky or difficult personality
    1. Great Mood ~ Bipolar disorder is characterized by up-and-down episodes of mania and depression. During a manic phase, some patients can have a total break from reality.
       But hypomania, which is also a symptom of the disorder, is a high-energy state in which a person feels exuberant but hasn’t lost his or her grip on reality. 
       “Hypomania can be a pretty enjoyable state, really,” Dr. Bearden says. A person’s mood can be elevated, they may have a lot of energy and creativity, and they may experience euphoria. This is the “up” side of bipolar disorder that some people with the condition actually enjoy—while it lasts.
    2. Inability to Complete Tasks ~ Having a house full of half-completed projects is a hallmark of bipolar disorder. People who can harness their energy when they are in a hypomanic phase can be really productive. 
       Those who can’t often go from task to task, planning grand, unrealistic projects that are never finished before moving on to something else.
       They can be quite distractible and may start a million things and never finish them, says Don Malone, MD, the director of the Center for Behavioral Health and chair of the Department of Psychiatry at Cleveland Clinic, in Ohio.
    3. Depression ~ A person who is in a bipolar depressive state is going to look just like someone who has regular depression. They have the same problems with energy, appetite, sleep, and focus as others who have plain old depression, Dr. Malone says. 
       Unfortunately, typical antidepressants alone don’t work well in patients who are bipolar. They can even make people cycle more frequently, worsening their condition, or send someone into a break-with-reality episode. 
       Antidepressants can be downright dangerous in people with bipolar because they can send them into mania, he says.
    4. Irritability ~ Some people with this condition suffer from “mixed mania,” where they experience symptoms of mania and depression at the same time. During this state, they are often extremely irritable. 
       Everyone has bad days, which is one reason this kind of bipolarity is much harder to recognize. 
       “We are all irritable or moody sometimes,” Dr. Bearden says. “But in people with bipolar disorder it often becomes so severe that it interferes with their relationships—especially if the person is saying, ‘I don’t know why I’m so irritable.I can’t control it.”
    5. Rapid Speech ~ Some people are naturally talkative; we all know a motormouth or Chatty Cathy. But “pressured speech” is one of the most common symptoms of bipolar disorder. 
       This kind of speech occurs when someone is really not in a two-way conversation, Dr. Bearden says. The person will talk rapidly and if you try to speak, they will likely just talk over you. 
       They will also sometimes jump around to different topics. “What’s kind of a red flag is when it is atypical for the person to talk like this,” doing it only when they are in a manic cycle but not at other times, she says.
    6. Trouble at Work ~ People with this disorder often have difficulty in the workplace because so many of their symptoms can interfere with their ability to show up for work, do their job, and interact productively with others.
       In addition to having problems completing tasks, they may have difficulty sleeping, irritability, and an inflated ego during a manic phase, and depression at other times, which causes excessive sleeping and additional mood problems. 
       A lot of the workplace problems can be interpersonal ones, Dr. Malone says.
    7. Alcohol or Drug Abuse ~ (See post on “Self-Medication”) : About 50% of people with bipolar disorder also have a substance abuse problem, particularly alcohol use, Dr. Bearden says. 
       Many people will drink when they are in a manic phase to slow themselves down, and use alcohol to improve their mood when they are depressed.
    8. Erratic Behavior ~ When they are in a manic phase, people with bipolar disorder can have an inflated self-esteem. 
       “They feel grandiose and don’t consider consequences; everything sounds good to them,” Dr. Malone says. 
       Two of the most common types of behavior that can result from this are spending sprees and unusual sexual behavior. “I have had a number of patients who have had affairs who never would have done that if they weren’t in a manic episode…during this episode they exhibited behavior that is not consistent with what they would do normally,” he says.
    9. Sleep Problems ~ People with this condition often have sleep problems. During a depression phase, they may sleep too much, and feel tired all the time. 
       During a manic phase, they may not sleep enough—but still never feel tired.
       Even with just a few hours of sleep each night, they may feel great and have lots of energy.
       Dr. Bearden says staying on a regular sleep schedule is one of the first things she recommends for bipolar patients.
    10. Flight of Ideas ~ This symptom may be something that is hard to recognize, but it occurs frequently when someone is in a manic phase. People feel like their mind is racing and that they can’t control or slow down their thoughts. 
        This flight of ideas sometimes occurs with pressured speech.
        People with bipolar may not recognize or admit that their mind is racing out of control, says Dr. Bearden.

I have experienced every one of these symptoms. There have been times when by brain was racing so fast it could not keep up with itself, or I felt the absolute NEED to talk about nothing and everything. I have had episodes where I didn’t sleep for 5 days or I only slept an hour or two (do not let anyone tell you that warm milk will help. It won’t and it is gross). I have experienced “erratic behavior” although this particular symptom began when I was in my teens ( I was diagnosed at 33). I have abused alcohol and just about every drug that is out there, and done huge amounts of damage to my relationships with people because of it. I have lost jobs due to this illness, and problems at work caused by either manic episodes, or in my case, depressive ones where I just couldn’t face the idea of going to work. I remember this particular symptom from the time I was in grade school. Basically, I have experienced lately or within the last twenty years every single, last one of these symptoms. Any one who read my blog post yesterday would have seen irritability, lingering depression from the hospital visit, suicidal ideation to alleviate the depression, but definitely not great mood. At this point, i would give at least one arm and a leg for a manic or hypomanic episode. I  have just about had it with the paranoid depressions that I find myself in. Not all of them require hospitalization, but the very fact that I am even putting myself “out there” like this tells me, I am trying my damnedest to understand what has been wrong with me quite possibly since birth, but did not rear its ugly head until I was in my early 20s, and quite possibly, even earlier than that as I do recall mood swings happening since I was a child. One minute I could be your best friend, the next I was beating the tar out of you for saying something that I would now view as totally benign, but back then was the worst possible thing to tell me.

I do recommend reading as many legitimate books on the subject as possible from both points of view. It will go a long way toward helping you understand the illness on an intellectual basis. Acceptance is something that will come with time. But, the more you know, the safer you are from yourself.

Bipolar Gets Worse with Time ~ Why An Early Diagnosis is Important

Bipolar tends to be a lifelong illness. Very few people are ever considered “cured” which is one reason why early diagnosis and treatment are so vital. Most people with the disorder will continue to experience high and low episodes with periods that are nearly symptom free in between, although some people will continue to display some symptoms of the disorder. There are four types of Bipolar that are recognized in  the Diagnostic and Statistical Manual or DSM.

• Bipolar Type I: mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.
• Bipolar Type II:  mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.
• Bipolar Not Otherwise Specified: is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.
• Cyclothymia:  a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Bipolar illness tends to get worse over time. Time lost in getting the correct diagnosis and treatment can lead to more severe and more frequent episodes than in someone treated earlier in the disorder. The more frequent episodes tend to lead to significant impairment in social, work related and personal relationships.  


Believe me, I know all about the social, work related and personal relationship malfunctions. I know for a fact that I have lost at least one job solely because I was not diagnosed or treated yet, and when I found out what was going on with me, I filed all my appeals and grievances on time. However, the bureaucratic jerks I was working for seemed to have no sense of their own policies and procedures. They filed their responses weeks late. I had all types of documentation pointing out their inconsistencies, but they brushed it off with a statement like “well, it was  last year when that happened.” Do not go after a lawyer’s daughter if you do not have your ducks in a row. Especially not one whose mother was an attorney for 27 years. You learn things about documenting everything down to the very last detail. I had my ducks in several rows, but they were all dismissed with a nonchalant, ‘Well, that’s not how we remember it.” They were wrong, I knew I was right, but without an attorney, and not having filed a complaint with the EEOC, there wasn’t much I could do except watch my beloved job slip away because I could not “fulfill the essential functions of the job.” I was covered by the Americans with Disabilities Act, but they found their way around that too. They were too powerful for me at that time. I had been diagnosed/hit by a Mack truck, and really was in no position to fight the way they were. They had attorneys. I did not. I did not have the strength to fight them. They were too strong and too evil, and I do not know how to battle hate.




I know for a fact that before my diagnosis, the illness contributed greatly to the loss of my first fiance. There were times I jut went off on him for no reason, and I was beginning to drink heavily to try and cope with the stress of being a full time student, employee, and “housewife.” He did absolutely nothing around the apartment. He worked full time as a bike mechanic. I had three full time jobs; school, my paying job, and him. It was too much. I quit my job as a waitress. Probably one of the sanest things I ever did, and I focused on school and him. but, in the end, the fighting got too bad, and it got too personal. We were not even fighting about anything in particular, we just fought. So, I am pretty sure illness cost me that relationship, and I can honestly say there are times that I wonder why my husband hangs around because I have been known to use him as a punching bag, or go into one of my paranoid phases and decide that he doesn’t love me any more. But, there is more to that story than I am willing to write; it is not completely my fault I feel that way sometimes. He has some less than desirable habits that really just offend me to the core of my moral being.


As for social relationships, they stayed more or less intact although they have cooled a bit. However, many of my friends are married, they have children, and normal lives.


So, in order to avoid all the misery I have put myself through and/or been put through, if you feel something is not right with you, you do not feel like your self, and the feelings last for more than two or three weeks and you aren’t “coming out of it” or “getting over it,” it is time to consider seeking help before you wreck your life like I did, and am constantly on the verge of doing. I just cannot help myself sometimes. I get these thoughts that just do not go away. If you are having the same issue, go get help. If you feel you fit any of the criteria above, by all means get thee to a therapist with all haste before everything you’ve built for yourself comes crashing down before your eyes, and you can not do a damn thing to stop it. It freaking sucks to have that happen, because then you have to start all over again, and sometimes there just isn’t a whole lot of time to do that.

Hospitals, When Should You Go and What To Expect

The psychiatric or “behavioral health” unit of a hospital can be your best friend and your worst enemy. First of all, you need to know or be aware of when it is appropriate to check yourself in. Not everything is an emergency. If you have been in a manic mood for more than five days and have been incredibly energetic, not sleeping, maxing out the credit cards or spending money that is needed for something else like rent, for example, you should definitely consider the hospital,or, at the very least, an emergency appointment with your psychiatrist. If you do not have a psychiatrist, go to the hospital Emergency Room and tell them what is happening to you. If you are feeling depressed for more than about two weeks or are feeling suicidal, you need to go to the hospital. 

If this is your first manic episode, you may be reluctant to let it go, but in reality, mania is just as destructive as a depressive episode. Symptoms of mania include mood and behavioral changes: Mood Changes ~ 1) long period of feeling “high” or an overly happy/outgoing mood, 2) extremely irritable mood, agitation, feeling “jumpy” or “wired”, Behavioral Changes ~ 1) Talking very fast, having racing thoughts, 2) being easily distracted, 3) increase in goal-oriented behaviors, 4) being restless, 5) sleeping very little or not at all, 6) having an unrealistic belief in one’s abilities, and 7) taking part in impulsive, high risk activities. If you are experiencing any of these symptoms, you need to go to the hospital to have your medication adjusted or, perhaps, to be diagnosed as a Bipolar if you have not already. In young men and men, a manic episode is often the first manifestation of Bipolar disorder. Manias are often followed by gut-wrenching depressive episodes so it is important to get help immediately.

Depressive episodes present in the following ways: Mood Changes ~ 1)long period of feeling worried or empty 2) loss of interest in previously enjoyed activities including sex , Behavioral Changes ~ 1) feeling tired or “slowed down”, 2) Having problems concentrating, remembering, or making decisions, 3) being restless or irritable, 4) changing eating, sleeping or other habits such as personal hygiene, 5) Thinking of death or suicide, or attempting suicide. If you are experiencing thoughts of death or suicide, get yourself to the Emergency Room ASAP by whatever means possible. Call a friend to take you if you think you can’t doe it yourself, call 911, do whatever it takes to get there. Your life really is in the balance. I know this both from my own experiences with trying to end my own life (more than once, and the last time I came very close to succeeding), and with my best friend nearly killing herself, and my former fiance’s sister succeeding. Since some symptoms of mania overlap depression, you may think you will come out of it on your own which is possible, but there is no reason to suffer from a depressive episode if it can be managed with medication and talk therapy. Most young women and women will present with depression as their first manifestation of Bipolar, but it is difficult to distinguish from Unipolar depression. You have to have had a manic episode and a depressive episode to “qualify” for a diagnosis of Bipolar.

Like I said, the hospital or “behavioral health” unit of the hospital can be your best friend and/or your worst enemy. You will see a psychiatrist, perhaps for the first time which can be difficult. It is extremely difficult to admit that you are having problems handling your life if you are depressed, and you will not want to give up the rush that comes from mania. Sometimes, if you have already been diagnosed, but not yet stabilized, they will try several medications on you, and that can be uncomfortable since many of them have some strange side effects. Lithium is probably the most commonly used medication for mood stabilization, but you have to be aware that as it builds in your system, you will need to drink a lot of fluids, and you will more than likely develop a fine to moderate trembling. Or, you may be completely allergic to it the way I am, and you will become quite ill physically from it. In that case, they  may try the atypical anti-psychotics like Abilify, Seroquel, Zyprexa (especially if you are manic), and there are a few others they may try in addition to an anti-depressant or they may put you on any combination of drugs they think might work. I call it the “med go round.” Since the doctors do not know what will work for you (they are not mind readers unfortunately), you may feel like a guinea pig initially. This can last for several years as you cycle through the various medications and see how they work for you. Everyone is different. What works wonders for me (Abilify, Klonopin, Adderall, and Seroquel) may not be the right “cocktail” for you.

Another way the hospital can be challenging is that there are many different people with different illnesses all together on a locked ward. From my experiences with the psych ward, you will usually have various levels of people with Bipolar Illness of many different types and manifestations, Borderline Personality Disorder, Schizophrenia, and Schizo- Affective Disorder. Many people will have multiple diagnoses. So, you have a range of behaviors and moods to deal with. It is not easy to deal with. If you just cannot take it, spend your time in your room. I tend to want to write when I am having trouble dealing with everyone. But, it can be helpful to talk to the other patients. It also helps to build a hasty wall (if you can) around you to guard against other patients’ moods affecting you. This ability usually comes from repeated trips to the psych hospital. It is not necessarily a good thing, but it does help, but it also means you have become a “frequent flyer.” I do not know how many times I have been to the hospital prior to the most recent last week, but it had been about 2.5 years since I had been there, and it took me a while to get used to not being able to do what I wanted when I wanted. It is a highly regimented place, and that may piss you off at first. Then, you get used to it, and not feeling out of control, and the idea of leaving becomes a little nerve rattling. It really is a strange experience, and not one you ever want to become accustomed to.

If you do find it is necessary to check yourself in, remember that they will take away anything with wires, laces, ribbons, etc that may be used to hurt either yourself or someone else so do not take any valuables or anything you w0uldn’t want to lose. You don’t always get all your stuff back. You can take shampoo, conditioner, lotion, face soap, body wash and clothes provided they have no laces. They do allow underwire bras for some reason….. don’t ask me, I do not know. The wires can be taken out. Do not take that a suggestion, it is merely an observation.

 Expect to stay at the very least one week if you have a regular doctor and therapist. If you have been feeling “weird” or not like yourself, but have no doctor or diagnosis, plan on a two or even three week stay while they diagnose and dope you up. Also, remember, you are in charge and have a say in your medical care so if a drug is really not helping or you feel really weird when you are on it, you do have the right to not take it, and request they try something else. Advocate for yourself. Do not let them release you on 6 or 7 different medications the way I did. But, don’t refuse all treatment, a lot of side effects go away, and you may find they work to control what you cannot: your mood fluctuations. You may find that you can work your medication regimen down to two or three medications. The point of all of this is to not let them over medicate you. That’s just as bad as the mood swings. 

The First Signs of Trouble

Trouble began in the form of an extremely stressful work environment that had been created by the Manager of Financial Services at the University I worked at. They had suddenly put my trainer in Payroll and Personnel and my Accounting Manager (who had hired me two months earlier) on paid leave pending an overtime “scandal.” They thought that another employee in another department had been having my trainer falsify her time sheets to make it appear she had worked hours she had not.

Well, needless to say, these employees were there one minute and gone the next. This left me on my own to learn their Payroll procedures, develop my own, and figure out the complex process of Personnel. Add to this a narcissistic and micromanaging Manager, and work became very tense. I had only been there maybe three months, and already this drama was happening. I thought I had left that behind at my last position. Apparently not. They appointed our senior accountant as acting Accounting Manager because he had the most seniority. Now, if the powers that were had only left him alone to manage the department, everything might have been okay for us. But, they didn’t trust him to run the department, and that was a huge mistake on their part. He was more than qualified.

Anyway, the situation began to stretch out into the summer and the fall. By the fall, I was becoming a basket case. I was drinking after work to try to relieve the stress, but like everything else, I do not drink half-assed. I do everything to the extreme (or I used to). So, my drinking began to go out of control as the stress increased in the office. The Manager of Accounting was constantly in the office, and like I said she had some problems with narcissism. Everyone around her had to make her look good because in reality, she was not all that good at what she did. Although none of us knew exactly what she did, we all knew she wasn’t good at her job and relied on her subordinates to make her look good.

Well, at some point, I started to feel really depressed. And I mean, depressed like I had not been since High School and that had been about 15 years with no symptoms. Yes, I started my mental illness career with uni-polar depression for the majority of my life. It wasn’t until I was about 32 that i was officially diagnosed, first with BiPolar II, and then BiPolar I with psychotic features. Sounds cool, doesn’t it? Psychotic features. What the hell did that mean? So, anyway, I go into a deep funk and go on a drinking binge for about a week and a half. Obviously, I am not going to work, so I am putting even more pressure on an already stressed out office. That wasn’t very cool of me, but I wasn’t really thinking about that at the time, just that I had to escape for a while.

Well, needless to say, my superior, The Manager from Hell was not amused with my 10 day absence, so I was required to call in directly to her or to my “other boss” when I was going to be out. Well, one thing about the first episode of BiPolar disorder leaves you avoiding people, so calling in and talking to someone was impossible for me, and I did not adhere to that part of my “return to work” conditions. In the meantime, during all of this I made an extremely good friend in another department, and if it weren’t for him, I would have imploded long before I did.

I knew I was having problems due to the experience that I had in High School so I looked up a few therapists in my provider directory and emailed the list to my Doctor, and asked for a recommendation. He recommended my current therapist as someone he had worked with, and whom he felt would be a good fit with me. I may look fairly conservative, but I am actually quite eccentric. The conservative thing is a disguise 🙂 Anyway, I made an appointment with her, and went to see her. I told her everything about me from the HS depression to the attack I experienced at 16 years of age. She was just one of those people you could really open up to. So, I began seeing her, and received the dubious distinction of being diagnosed as uni-polarly depressed which is what I thought it was. I didn’t feel any extremes of emotion, I did have problems sleeping but I had always had problems with that.

During the course of the first few months of therapy as I gradually began to open up, I discussed the various activities that my friend, now lover, had been engaging in. Apparently, BiPolar’s are risk takers without thinking about the consequences of their actions. Well, my friend and I had taken to having sex in public places around campus where the risk of being caught was quite high. Apparently, this is a symptom of BiPolar depression. I did not know that at the time. So, as I talked and she listened, I began to reveal myself as a BiPolar Type II which is BiPolar, but not really full blown BiPolar Disorder. The more I talked, and the more she listened and had me take the Minnesota Multiphasic Personality Inventory, I became a BiPolar Type I with psychotic features. I was progressing up the diagnosis ladder. Hooray for me. This information hit me like a Mack truck. I was floored. Was I really this sick? Apparently so. The doctor said so.

I continued to have problems at work. The only bright spot for me was my buddy/lover in the other department. Otherwise, I would have rather stayed home drinking. I was finally suspended for failure to follow the call-in stipulation, but I just could not talk to a live person sometimes. I kept my diagnosis to myself. Eventually, the untreated Disorder became too much to handle, and after another series of absences, i was given a Letter of Intent to Terminate. There is a whole involved story surrounding this, but let’s just say it is really hard to just fire someone from a University. The process takes about two to three months or longer if you can afford an attorney. So, there it was. I had been hit with the Mack truck of mood disorder diagnoses. and I was being fired. Life was good, not so much.

I was untreated meaning not medicated, so I was still self medicating with alcohol and other substances as available. The next installment will include the initial attempts at stabilizing me. I am what they call “treatment resistant,” meaning I am very sensitive to the medications that are commonly used to stabilize a BiPolar person. Oh, and I did get fired. That helped. A lot.