Month: August 2014

4 Comments Posted on Posts

Impulsivity is a symptom of mania or hypomania!

DSCN0192

One very important reason to take the correct dose of the correct medication is shown below from the article: “Impulsivity and Risk Taking in Bipolar Disorder and Schizophrenia” published in Neuropsychpharmacology in September 2013. Here is the reference if anyone would like to read the whole article: http://www.nature.com/npp/journal/v39/n2/full/npp2013218a.html

Basically what this article is saying is that impulsiveness, which is defined as risky decision making, high risk attitudes, acting without planning, poor inhibition of risky actions, high risk attitudes, and rapid decision making (which basically means making decisions without thinking them through). Please understand that these are symptoms of mania. Once you are in a manic phase, you are going to do this. In a hypomanic phase, you are also going to do this but to a much lesser degree, your actions will not be as risky to your life or health. Please also understand that the only way to stop this from happening is to NOT go into a manic or hypomanic phase. The way to do that is to take the right amounts of the right medication as you doctor had prescribed. And if you feel like your mood is slipping towards mania or depression, to call your doctor and let them know. This is a BIOCHEMICAL disease involving levels or metabolism of neurotransmitters. All these neurotransmitters have certain effects on the brain. When their activity or levels of these neurotransmitters are high, we become impulsive. So, just take the right dose of your medication and head these problems off at the pass, nip them in the bud, stop them before they happen. If you don’t, this disease WILL ruin your life, it will destroy your peace of mind, it will destroy your relationships, it will destroy your friendships, it may even take your life. That is as bluntly as I can put it. I am definitely on the therapeutic dose of lithium and I’m staying on it for the rest of my life, I am not allowing this mood disorder to control my life or take days away from me or most importantly take my family or beloved friends away from me.

Not me, not now, not ever again! I hope you too will make a commitment to your health and sanity and your life, and follow your doctor’s advice to the letter.

Below in quotes are passages from the above mentioned article.

“Impulsiveness is a clinical feature of bipolar disorder. Broadly, impulsivity refers to a predisposition toward unplanned reactions without consideration of consequences and can include risky decision making, self-reported high-risk attitudes, poor response inhibition, and rapid decision making. 

Bipolar disorder is often characterized by impulsive behavior and increased tendency to work toward a reward, often without sufficient planning. Although risky-impulsive behavior is a diagnostic criterion for mania and bipolar patients consistently show abnormalities on self-report measures of impulsivity, they do not consistently show deficits on behavioral tasks that require planning and forethought. These differences may reflect the multi-faceted nature of impulsivity, or the measurement tools used to assess the construct.

Finally, some of the mixed findings in bipolar disorder and schizophrenia regarding impulsivity and risk taking may be attributable to the types of medications patients are taking. The neurochemical basis of impulsivity and risk taking involves dopaminergic, serotonergic, and other neurotransmitter systems, and these systems are affected by antipsychotic (AP) medications. Some studies find a reduction in impulsiveness associated with AP medications, whereas others find no such effect in psychotic samples. Thus, it is important to consider the role of AP medications on measures of impulsivity and risk taking.

This is one of the first studies to examine both self-report and behavioral measures of impulsivity in bipolar disorder and schizophrenia. The study had two goals. The primary goal was to conduct a careful analysis of impulsivity using multiple approaches across three groups: bipolar disorder patients, schizophrenia patients, and healthy controls. The secondary goal was to compare subgroups of bipolar disorder patients who differed in terms of AP medications and history of psychosis on measures of impulsivity and risk taking.”

 

 

Leave a comment Posted on Posts

People with bipolar d/o don’t want to take the correct dose of medicine :(

 

IMG_0140

Many people with bipolar disorder (BPD) refuse to take medication. Even if they do go on meds, they may reduce the dose or not take enough to control their symptoms. This can be for a few reasons, 1) The side effects may be so bad that the meds may be intolerable. For example I have had literally half my hair fall out with Depakote and Trileptal. I have also had debilitating migraines with Latuda, unbelievable anxiety with Wellbutryn SR, and other pretty bad side effects from a plethora of other drugs. 2) Some patients may be sort of addicted to the ups of mania and don’t want to take any medication that will bring them down to normal. Although I don’t really have ups, I have mixed episodes, for some reason I didn’t want to take the full 900 mg of Lithium, so I used to suffer through major mood upheaval every year. I don’t know why I didn’t take the recommended dose, I told myself that I didn’t need that high a dose, that my body couldn’t handle that high a dose, that I was fine taking 1/3 the recommended dose. And it is true, a 900 mg dose was a lot for me at first, but now after about 2 months of being on 900 mg of Lithium, the side effects have abated a bit and it is actually not too bad. So what I’ve realized now is that I’ve been sabotaging myself as far as taking the correct dosage is concerned. Yes I am dismayed that I caused so much suffering for my self and my loved ones, however, I am starting from now and changing what I can. I can not go back to the past and undo what happened, if I could I certainly would. Ugh… I don’t know why I didn’t just take 900 mg, it is really foolhardy that I didn’t. I suffered a lot and lost days and days of my life. Also, a recent experience in my life has taught me that I need to take full responsibility for my illness and my mood, so I am now doing that, starting with taking the correct dosage of the correct medicine.

I am going to have a Lithium level done on Monday, and the optimal dose is 0.6-0.75 mmol/L. Hopefully mine level is there, if not, I may try to increase the dose in conjunction with my doctor.

I am very hopeful that this dose will stop the cycling allowing me to be normal and productive and happy and healthy :)) Also, this will stop me from being a burden to my amazing and lovely family and friends who have always been there for me.

Wish me luck in this endeavor!

6 Comments Posted on Posts

Lithium, the miracle drug for people with mood disorders!!!

Lithobid

Lithium is a naturally occurring element. It is the same element that is used in batteries. But it is a Godsend for people with bipolar d/o. It stabilizes our moods. It stops the swings altogether or at least stops them from being too extreme. In areas where the concentration of lithium in drinking water is high, the incidence of mood disorders is lower!!! It is a calming mineral that helps with mania and, to a lesser degree, with depression. The general dose is 900 mg per day. I was on 300 mg because of the few side effects I had (fine muscle tremors, frequent urination, hair loss, acne, weight gain, GI problems.) But that was not enough to control my mood swings, so I went up to 600 mg/day, and that was better, but my swings were still not controlled. Now I am on 900 mg per day. Even though my right hand shakes a LOT, more of my hair is falling out, and I may get acne now and then, however to be stable mood wise is very, VERY important to me. So I am taking hair skin and nails vitamins, using benzoyl peroxide and living with fine muscle tremors. I am confident that the 900 mg dose of lithium is going to keep me in the normal phase, without swings that are too extreme in either the depressive or manic direction.

Lithium possesses unique anti-suicidal properties that set it apart from other agents. With respect to cognition, studies suggest that lithium may reduce cognitive decline in patients. It is seen to have a protective effect on people’s brains. The neuronal cell death that is seen in people with bipolar disorder is decreased when they are on Li+. As neurons die, venticles in the brain increase, this is also seen to lessen in patients who take Li+!!! It even has been hypothesized that Li+ causes neuronal cell growth, thereby reversing the damage that bipolar d/o inflicts upon its victims. So I am very happy, thrilled in fact, to know that the Li+ I take is not only preventing this disease from having an effect on me, but it is also protecting and regenerating my neurons. :)))))

The molecular mechanism of lithium (Li+) seems to be related to its similarity to sodium (Na++). It is taken up by neurons through the same pump that pumps in Na+ (Yes there are pumps that pump ions, such as calcium (Ca++) potassium (K+), in and pumps that pump ions out of all cells, including neurons. Pretty amazing hunh?) 

Evidence from both in vitro and in vivo studies has demonstrated that lithium exerts multiple effects on neurotransmitter/receptor-mediated signaling, ion transport, signal transduction cascades, hormonal and circadian regulation, and profoundly alters gene expression patterns.

Li+ reduces excitatory (dopamine and glutamate) but increases inhibitory (GABA) neurotransmission; however, these broad effects are underpinned by complex neurotransmitter systems that strive to achieve homeostasis by way of compensatory changes. For example, at an intracellular and molecular level, lithium targets second-messenger systems that further modulate neurotransmission. For instance, the effects of lithium on the adenyl cyclase and phospho-inositide pathways, as well as protein kinase C, may serve to dampen excessive excitatory neurotransmission. All this means is that Li+ affects molecules that are called second messengers (the neurotransmitter being the first messenger) and that normally transmit the signal, well Li+ stops the excitatory signals. Makes sense, as it a cracker jack mania buster!

Li+ also has inhibitory actions on inositol monophosphatase, inositol polyphosphate 1-phosphatase, glycogen synthase kinase-3, fructose 1,6-bisphosphatase, bisphosphate nucleotidase, and phosphoglucomutase enzymes. Some of these enzymes are involved in increasing activity of neurons in response to neurotransmitters, such as dopamine, serotonin, epinephrine, norepinephrine, and GABA. So again, Li+ stops excitatory signals from being passed from one neuron to another, thereby decreasing neuronal activity. This is good, because in mania your brain is working like gangbusters! And it needs to be slowed down. So Li+ does that. 

If your doctor has prescribed Lithium for you, please take it. It is a wonderful medication, which will save your neurons, your brain, your relationships, and maybe even your life.

 

Leave a comment Posted on Posts

A little boy on a plane.

image

I saw a family on the plane from Nantucket to JFK, yesterday. It was a young mom and dad, in their thirties, with a baby girl and a 5 or so year old son. Our plane was late, and the couple was very upset they were going to miss their connection to Cincinnati. They tried to speak to the flight attendant to get them to hold the plane for them, but no dice. The mom was holding the baby girl, who was all smiles and coos. The little boy however was very upset because he “wanted his mama!” The dad kept deriding the boy for crying and being a ninny. He told the boy, who was sobbing, to stop making things hard for all of them. And the boy literally implored him, saying “Please don’t say that.” The mother was just ignoring this little boy and the father was being extremely negative and angry with him. And the little boy just kept saying “But I want my mama!” It was plain for me to see that he was in emotional distress, for whatever reason. His parents were doing nothing to help him, in fact their actions were hurting him more. They were annoyed at the possibility of missing their flight and had no time to address this little boy’s emotional needs. I just wanted to say “Mom, hand the baby to your husband, and comfort your son.” That’s all it would have taken. Instead, they did nothing, and the little boy cried heart rendingly. It was hard for me to listen to him. Is this the way mood disorders begin, by needs that are unmet and perhaps, repeatedly remain unmet? Was this little boy simply more sensitive, his genetic makeup, and simply felt things at a much greater depth than the rest of his family? I know that sensitivity is a key feature of mood disorders. Also, his parents inability to soothe his upset mood, does this then lead to the inability to self soothe for the little boy, leading to anxiety and possibly even depression in the future? Just something I saw that upset me a lot. It just wasn’t right for the parents to ignore this beautiful, little boy’s pleas. It also made me think of how much parents affect our life, how empathy and love would make any situation you find yourself in better. Especially empathy and love from your parents when you are little and need them to have a healthy, happy life. 

Also, it made me think of how these kinds of traumatic events affect the grown up men into which these little boys grow up. 

And what is the relationship of these types of things to people developing mood disorders.

Leave a comment Posted on Posts

Whether One Takes Medication or Not Affects Outcome of Having bipolar disorder.

Some people with Bipolar disorder are very high functioning. The main thing that distinguishes people who do well from people who don’t is the ability to accept that one has a disease and take medication.

Often, people who have mental illnesses refuse to accept that they have an illness. They refuse to see a doctor and often refuse to take their medication. This obviously makes for a very negative outcome with the illness getting worse and worse and finally hospitalization after hospitalization and maybe even worse. With bipolar symptoms getting worse and worse due to not taking their medication, many people also have problems with the law as in arrests and legal trouble.

As was so tragically illustrated with the death of Robin Williams just recently, mental illness can be a terminal illness.

The best outcomes occur for people who go to their doctor regularly and take the recommended medications at the proper doses. I have found thinking about it in terms of the molecular mechanisms of the disease helps me understand the illness as something totally molecular which is helped by taking medication.

Neurotransmitters such as Serotonin, Epinephrine, Norepinenephrine, and Gamma Amino Butyric Acid (GABA), are the molecules that carry information from one neuron to another. This information may be thoughts, emotions, or feelings.

image

Again remember the presynaptic neuron (yellow) and the space which is the synapse, and the post synaptic neuron? Well the presynaptic neuron, upon firing, empties it’s vesicles into the synapse, thereby releasing its supplies of neurotransmitters, eg. Serotonin. The Serotonin then binds to a receptor on the post synaptic neuron and exerts its effect via proteins that are in close proximity to the receptor. How long the Serotonon stays active depends on how fast the post synaptic neuron reuptakes it. If the reuptake is too fast then Serotonin cannot exert its effect. This reuptake is blocked by drugs such as Zoloft, Prozac, Wellbutryn (this actually blocks reuptake of dopamine and norepinephrine.) That is how they are hypothesized to alleviate depression.

SSRI stands for selective Serotonon reuptake inhibitor.

SNRI stands for serotonin norepinephrine reuptake inviter.

DRI stands for dopamine reuptake inhibitor.

Soon to come: mechanism of lithium action :-))

Leave a comment Posted on Posts

Happy Living :-))

imageimage

My son Aral ❤

Being grateful for all the good in my life :-))

Spending time with my loved ones.

Sending love to my family and friends :-))

Good conversation.

Singing and acting! Yikes, I have to learn my lines!!!

Puppies/dogs and kittens/cats :-))

Knowledge.

 Music.

Flowers.

Dancing.

Reading.

Zumba.

Yoga.

Meditation.

Walks in beautiful green places.

Writing poetry and prose.

Taking photographs.

Baking. 

Traveling.

 

 

Leave a comment Posted on Posts

FYI: Phases in Bipolar disorder.

 image

Different phases of Bipolar disorder.

Full blown manic phase: No sleeping, weight loss, talking a lot, flight of ideas (switching from none topic to another,) shopping sprees, excessive involvement in pleasurable activities, such as sex, inflated self esteem, grandiosity, distractability, anxiety, if left untreated leads to psychosis ( loss of touch with reality.) Once at the psychotic point, major tranquilizers have to be administered.

Depression: Sleeping too much, depressed mood, weight gain, loss of interest in normal activities, anhedonia, (loss of positive feelings), agitation, thoughts or attempts of suicide, if left untreated, can also lead to psychosis.

Hypomania: Talking a lot, little sleep, grandiosity, excessive involvement in pleasurable activity, such as sex, irritability, weightless. This is the phase that precedes the full blown manic phase. If treated with mood stabilizers such as lithium, won’t progress to full blown mania. 

Mixed Phase: Unfortunately taking antidepressants for people who have bipolar disorder causes them to have mixed phases. This phase has elements of both depression and mania, and enormous amounts of anxiety. The phases can alternate many times in a day, such as manic, normal, and depressed. This is called rapid cycling. Or the phases can alternate in longer cycles, which may be days or weeks. This can lead to full blown mania or depression if not treated with mood stabilizers such as lithium, Depakote, Seroquel, and others. 

And the most coveted is the Normal phase 🙂

Also anything that helps stabilize mood like meditation, yoga, exercise, good nutrition, all this helps the symptoms of bipolar d/o.

Leave a comment Posted on Posts

Robin Williams.

image

A mood disorder has struck again. Robin Williams is gone. How sad, how unbelievably sad! He was a comic, he made us laugh. Oh the awful irony of it! I remember him as Mork in “Mork and Mindy.” He was hilarious, his high energy exploits, the funny words he made up and used, how sad now. I remember seeing him on late night TV, his off the wall comedy, his boundless energy, he made us laugh. The last time I watched him was on a video on Facebook. He was with Koko the gorilla. Link here: http://www.youtube.com/watch?v=GorgFtCqPEs

Koko wanted to tickle him and did, then he tickled Koko, and they both laughed, it was so funny and infectious and adorable.

I didn’t know that he, with his boundless energy, his hilarious stories, his crazy antics, was so severely depressed. I had no idea that he suffered from depression at all.

Oh Robin, why? Why didn’t you fight? Fight harder? Why didn’t you tell someone? Why didn’t you reach out to someone? Anyone, even a stranger? You didn’t have to go like this. Depressions don’t last forever, they too pass…

I feel like it is a strike against all of us who suffer from mood disorders. It’s personal. It’s a personal defeat. God if I could have saved him, I, as sure as I live and breathe, I would have. It seems that if a person such as Robin Williams, who had everything at his disposal, the best doctors, the best medication, therapy, if he could go down, then what chance is there for the rest of us?

Suicide is a momentary decision, if someone is there at that moment and can talk you out of it, you are invariably grateful that they did. It is really a matter of a weak moment. I wish so much that someone had held his hand and walked him through that moment.

I am beyond sad. Of course my heart and my thoughts go out to his family and friends. I hope they remember the wonderful times and the love he had for them. 

Mood disorder, be not proud. You have taken a beautiful, energetic, funny, intelligent man from us. But we will never forget him.

Leave a comment Posted on Posts

Bipolar d/o does not define me!

IMG_0280

Yes I have this disease. Yes it is a part of my life and messes with it periodically. But it does not define who I am. I am so much more than this illness that I have had the misfortune to have in my genes. I have two Master’s degrees, one I got in 1985 in Molecular Biology and one I got in 2008 in Education/ School Counseling, both, ironically in the throes of this illness. I did not let this disease stop me from getting these degrees. I have been married for 26 years. Yes we have had our ups and downs, major ups and downs, but we are still together. I have a brilliant son who is in Law School, whom I am so, incredibly proud of and love indescribably much. I have amazing friends, some from middle school, some from high school and college and they have always known about my illness and have never given up on me. I love animals, dogs, horses, cats, all of them. I love flowers and photography. I love to do Zumba, yoga and I really love to dance.

In a way, perhaps, this disease has given me the capacity to feel very deeply. I think people who have mood disorders, such as bipolar, feel things much more deeply than ones who don’t. In some ways, this sensitivity is good, but in sick times, it can be very painful, because the depth of feeling good and especially bad, is so extreme that it can be unbearable.

What am I trying to say here? Well, that I am much more than my disease. I am a person with feelings, desires, loves, dislikes, shortcomings, and strengths just like anyone else. I do recognize, of course, that this illness can complicate my life a lot, and it has done that sometimes. But I am much greater than this illness. In fact I am stronger than it is. And I will never let it beat me. When I get sick, and I realize I am sick, then I increase my medication dose and I get over it.

I just want my new friends, old friends, all my loved ones to know that I value all of you incredibly, and by the same token, I am also a valuable person, who, admittedly, has a disease. But please also know that I am not destructive, malicious, bad or negative. I love you all with all my heart and do wish all of you incredibly well and I hope we will be in each other’s lives forever and ever!!! :-))

Leave a comment Posted on Posts

Some reasons for bipolar d/o.

image

Why do people get bipolar disorder? There are many theories abound. One of them of course, is neurotransmitter levels. We have epinephrine, norepinephrine, dopamine, serotonin and GABA (gamma a mini butyric acid.) Neurotransmitters are either derivatives of amino acids, or small peptides. Some of these are excitatory neurotransmitters and some are inhibitory. They are released by presynaptic neurons (yellow). The excitatory ones bind to the post synaptic neuron (green) across the synaptic cleft and make it easier for that neuron to fire thereby passing the nerve impulse and information along. The inhibitory ones make it harder for the next neuron to fire thereby stopping the nerve impulse.

It has been postulated that levels or metabolism of these neurotransmitters may be involved in mood disorders such as bipolar disorder or depression. It’s easy to imagine how a deficit in neurotransmitters may cause depression and possibly an overproduction or over activity of neurotransmitters may lead to mania.

There is also evidence that the Na+ (Sodium) pump that is involved in pumping Na+ out of neurons may be involved in mania. Lithium works at the site of the Na+ pump. Lithium is so similar to Na+, that when it given to patients, their intracellular Na+ concentration decreases. And that may be exactly how lithium exerts it’s mood stabilizing effect. The decrease in Na+ concentrations inside neurons leads to less firing of neurons. The less the firing, the less the signal, or information, or thought is propagated. The less activity in the brain, the less mania. That’s how I explain it to myself.