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 :-))

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.

 

 

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.

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.

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!!! :-))

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.

Thank goodness for Lithium!

crocus 1

The treatments for bipolar disorder were initially discovered serendipitously. Lithium for example remains one of the most frequently used and effective treatments for bipolar disorder, but lithium has a number of different targets in the brain and so we haven’t learned very much specific information from lithium’s effect. Some of the things that lithium does are now targets for a great deal of research. One of those things is that lithium will decrease the function or change the function of some second messenger systems. And so it will give a way that you could have multiple neurotransmitter systems affected or damped-down by just the one effect of lithium. Another thing that lithium does is that it has very robust neuroprotective and neurotrophic effects. It’s thought that lithium may partly have its effect in the brain by restoring the structure, some of these structural abnormalities that occur in bipolar disorder. For example, the reductions in grey matter volume that exist in the hippocampus and the medial prefrontal cortex, there is now some evidence that suggests lithium can actually reverse those changes. Similarly in those experimental animal models where you’ve got repeated stress causing atrophy in the same structures, lithium has the capability of reversing those atrophic changes. So, one impact of lithium might be on the neuroplasticity of the brain.

http://www.dnalc.org/view/2085-Lithium-how-it-might-protect-the-brain.html

At 25 years of age, bipolar disorder got me.

IMG_0004

1984, My brother was diagnosed with this wretched disease. None of my family knew whether we were coming or going. My poor mother was devastated. This was her favorite child, her precious baby Farooq, who was 20 at the time. We were all under so much stress, that my mother went into a severe depression and I too, started slipping into a depression. My depression became so severe that I felt like I had completely lost myself. There was nothing of Samina left. Not her laughter, not her interest in life, not her love of music or books, nothing at all. I didn’t know what was happening to me and I kept thinking “How do I live without myself?” I started thinking about swallowing a whole bottle of my mother’s tranquilizers which I had hidden in my room. I thought about it daily for weeks. No one was paying any attention to me, we were all totally involved in the disaster that my brother’s life had become. He did not want to see psychiatrists, he did not want to take any medication. He went into a full blown manic phase, so much so that he was out of touch with reality. He had to be hospitalized with a 3PC (a three physician certificate, used to hospitalize a mentally ill patient by force.) In the hospital, they gave him lithium and major tranquilizers and he became totally his normal self. Once he was discharged, he threw away all his medication and of course started to get sick again. He went to my step dad’s office and told his secretary to tell him to “call off the dogs.” Classic paranoia in the psychotic (out of touch with reality) phase of mania. Again he had to be hospitalized. His doctors worked with him, trying to explain to him that he could not control his own brain. He must stay on his meds. As soon as he was released, he again threw away all his meds, insisting he could control his own brain and didn’t need any medication. We all tried to tell him he needed to keep taking lithium and other meds his doctor prescribed. But he wouldn’t listen. I was steadily going downhill, and one day told my mother and step dad that no one was looking out for me and that I didn’t feel well. I was put on antidepressants (without lithium) because no one knew at that point that I too had bipolar disorder. I had, at any rate, decided never to attempt to take my life. It was amazingly because of a song I’d heard on the radio by Wilson Phillip, called “Hold On For One More Day!” I literally took that song to heart and in a way it stopped me from doing anything to myself I would later regret. Once on the antidepressants, without lithium, I started to become manicky. Talking a lot, listening to music very loudly, shopping, driving extremely fast. And, in the middle of all this, I a job in New Orleans, I drove my car down there. Nejat, who was my boyfriend at the time, was doing his postdoctoral fellowship in New Orleans, and I went there to work and join him. Once I got there, the antidepressants pushed me into a full blown manic phase. I became out of touch with reality. I thought everyone was trying to prove that I was schizophrenic. I thought the shower was bugged and people were listening to everything I did. Again total paranoia. I thought there was an under world gang of people who were following me to harm me and Nejat. I thought everything that anyone said was just dialogue for my benefit. I once called Nejat’s boss, telling him to leave Nejat alone. I told hime I knew about his designs on Nejat. I also, bizarrely, told him about the sweet olive bushes and how good they smelled… Needless to say, the man had no designs on Nejat and was married with kids! Nejat didn’t know what was going on with me, and I was pretty far gone by then to help myself. Finally, one day at 3 in the morning, I called my psychiatrist. His answering service said it was too late to speak to him. I unloaded a barrage of insults and pretty bad language on the woman who had picked up the phone, because I was sure she was in cahoots with the people who were trying to prove that I was schizophrenic, when in fact I had bipolar d/o. She must have realized that I was very sick and had my psychiatrist, Dr. Roniger, call me back immediately. I told him how people were hounding me and trying to prove I was sicker than I was. He asked to speak to Nejat and told him to take me to the emergency room IMMEDIATELY, as I was in a full blown manic phase. I packed my things and I even packed all of Nejat’s things, including his toothbrush, (the poor guy had no toothbrush the next morning) because I had to protect him from all these nefarious people who were trying to hurt us. On the way, I saw a man fixing his car, with his hood up, and I was sure he was trying to give me messages! Once I got to the hospital, they signed me in, and of course told Nejat to leave. I looked for him until they gave me huge doses of major tranquilizers, and put me in a group ward. I kept trying to get up and find Nejat. They had to put restraints on my arms and legs and tie me to the bed, I remember all this. Then I must have passed out from the meds. In the middle of the night, I awoke to find myself in a strange place with strange looking women. One woman, Myris, had tried to slash her wrists and they were all bandaged up, it was quite frightening. I had no idea what I was doing there. The next morning Nejat came to visit me and he said he cried when he saw me in restraints and looking as white as a ghost. I was in the hospital for one month. 30 days. For a while, I started thinking I was Alice in Wonderland. Dr. Roniger and Nejat were both the white rabbit. There was a young guy there, he always wore red tee shirts, he was the Queen of hearts. There was a male nurse, Albert, with red hair and a wide smile, he was the cheshire cat! Once, I went into another patient’s room, and it was such a mess that I cleaned it all up!!! Not something I was really supposed to do… Slowly all that started to pass as the meds worked. However, the major tranquilizers gave me, among many other side effects, a mask like face, and akathisia, which is a distressing sense of restlessness. So that when Nejat came to visit me, which he did everyday (!) I looked like a rigid mask and could not show him how happy I was to see him. Because of the akathisia, I must have walked about 500 miles around the floor where I was hospitalized. I used to have a dress that apparently looked like a nurse’s uniform, because Mr. White, another patient, always said to me when I was marching “Nurse, you do your rounds really fast!” There was Rachel, a very troubled teen, who actually tried to attack me once. There was Mr. Bartley, whose wife had abandoned him because, I think, he suffered from dementia. George, the Queen of Hearts, wrote beautiful poetry and went to high school everyday and had been in foster care and was sad that he didn’t know who his parents were. There was a young boy, Joseph who was a troublemaker. There was a young man Guidry, who though Nejat was my father and always called him “Sir” and apologized to him endlessly, saying he hadn’t touched me!!! Damn straight he hadn’t touched me, I would have clocked him if he’d tried! So I got better and finally 30 days after I’d been admitted, and after daily begging to be released, I was released. And I just took up my life where I’d left off. I went back to work, started cooking and having friends over for dinner. No side effects, no remaining symptoms. This was in March 1986. The next time I was hospitalized was in December 2009, and this was because my psychiatrist took me off lithium and put me on a drug that is totally ineffectual against bipolar 1 (the more severe form which I have) called Lamictal. I was on it for about 6 years and finally it pushed me into a full blown manic phase. And I flew myself down to New York City and admitted myself into the Psychiatric ward of Columbia Presbyterian. But not before being held against my will in CPEP (Comprehensive Psychiatric Emergency Program). A hellishly depersonalizing, awful, prison like place. But that story, another time.

GRACE

image

Grace.

Last night in my dream, I saw you

You were there, in my sanctuary, my idyll, where the sun shone bright and there was the sound of sweet birdsong.

You were there in my shelter, where the storm clouds had passed, and the day, bright and sweet, newly dawned.

Flowers with adorable faces of children here grow, throwing playful glances your way, you are free to rest and play, to let you know.

Here my father sun’s golden rays warm me, they caress my face as a mother’s hand caresses her child newly born.

Here Mother Earth supports me with her gentle, quiet, sustaining strength, so I can rest my bones so careworn.

Here, in this place, where a peaceful, gurgling river flows, I came last night to see if I could find you full of hope.

I had been looking for you for so long, yet till last night, you had eluded my grasp sure and strong.

Finally, I saw you in this place to which I go, where only days of pure goodness and joy surround me.

Where night blooming jasmine, and a wondrous, precious rose so rare, their perfumed garlands weave around me.

Here I am enveloped in safety and warmth and no one can hurt or harm me.

Even when dark night comes to this place, it comes gently, with promises of sweet rest and repose.

it is a silent night, full of restful sleep and such fantastic dreams, you can inhabit them all night long.

The full moon shines it’s calm, serene, white light here at night, lights your dreams as with a fairy orb.

Here, I am protected by the very trees that watch over me like strong, stalwart, silent sentinels.

And the stars glitter like jewels, winking playfully and teasing, laughing with their playful, little faces.

Last night, when I curled up in bed and came to this my magical place, you were there!

I saw you and said ” Hello. How are you? Where have you been? It’s been so long.”

And you said “Hello. I’m fine. I’ve always been right here. I was waiting for you to cast away your fear and look for me with your beautiful, big eyes, so fearless and bright. I have been here, waiting for you the whole time.”

And I knew you were telling me the truth.

And I knew we’d meet again… soon.

I am sorry.

One of the worst things about bipolar d/o is that when you’ve been in one of those phases and then come out of them, you feel as though your mind has betrayed you. Your illness took you on this path without your consent. You were simply dragged along without any recourse, at least for a while. The manic phase you were in caused you to act extreme and in an illogical and very emotional manner. You may have said and done things which you would never have done in your normal state. This costs you friends and relationships you valued very much. How do apologize in a meaningful way so that they will forgive you? How do you make friends and relations understand that that wasn’t you, it was your “evil twin”? Some people understand, some don’t. And some understand, but perhaps choose to stay away from you because they don’t want to have anything to do with a “crazy” person. I understand this. But it is extremely sad that because of an illness, you lose friends who are important to you and whom you would never hurt in a million years.

Just feeling sad that this happens because of mental illness. It’s already difficult enough to live with bipolar d/o, to lose precious friends and relations is almost too much to bear.dec31_2013