Beneath the Surface: Exploring Mental Illness.

DSCN0356Mental illness, it’s invisible. There are no bandages, no casts, no crutches, no external wounds. How do you know someone is suffering from one? We, the afflicted, talk about feeling bad, talk about our depression and anxiety woes. You, our friends, look at us with bewildered eyes. You think to yourself “This person is all put together, she has makeup on, is dressed well, there are no signs of illness. I don’t understand.”

It’s not easy to explain mental illness to people who don’t have it. You can’t show them anything that is broken, or any flulike symptoms, or anything visible at all.

The key is listening, trying to understand where your mentally ill friend is coming from, what your mentally ill friend feels like, what they are trying to explain to you. And many will not even explain anything, because of the stigma, because they don’t want to appear “crazy” or abnormal.

Yes it’s confusing. I’ve had bipolar disorder since 1985, and sometimes it’s still confusing for me, so don’t anyone beat themselves over this. Basically the only empirical thing you have to gauge mental illness by is behavior. For example, in mania, people talk a lot, have very high energy, don’t sleep much, may have delusions of grandeur, may have a lot of anxiety. In depression, they have no energy, may sleep a lot, or not, are in a downcast mood, hopeless, and may also have a lot of anxiety. Paradoxically, in hypomania (the stage before going into full blown mania), we can actually get a lot accomplished, we are energetic, focused, not over the edge yet. This might be considered the “industrious” phase of bipolar disorder.

So the way your friend is behaving, a departure from their normal self, is a clue to their mental illness. What they are saying and how they’re saying it is as well. Are they being grandiose, talking non stop, switching from subject to subject (flight of ideas,) these are all clues.

In schizophrenia, people can have auditory hallucinations, where they hear voices, that’s definitely a clue, if they tell you, if they are aware that this is happening and admit to it… Yet most of the time, looking at a mentally ill person, you’d never know anything was wrong at all. It’s all below the surface, in their brain. Just like in a sea, where the water looks still and calm but a savage riptide is flowingĀ under the surface.

Signs and signals, feelings and observations, those are clues to understanding mental illness. Just being an observant and understanding friend who listens and tries to comprehend what is being said and shown to them, that my friends is what is needed to understand the illusive nature of mental illness.

Dr. Patrick McKeon presents Bipolar Disorder

A wonderful video describing the mental, emotional, and physical symptoms of bipolar d/o.

He talks about slowing down in depression and speeding up in mania, or elation as he calls it.

Very informative, highly recommend watching it.

Thank you Christina Tacaclu for this video. Christina is the newest member of my Bipolar1Blog group on Facebook šŸ™‚

Not Just Others.

not just others

Not just others, it is we who have and suffer from mental illnesses. Yes it is more difficult to know what a person with schizophrenia experiences with their illness. The following link to a video shows what a schizophrenic person hears in a psychotic, which means out of touch with reality, phase. And it is literally terrifying. The voices, the words, the tone of voice, how could anyone function like that? They can’t. I have a friend who suffers from schizophrenia and while I did know that neurons in their auditory cortex fire and make these voices, until today I did not know their experience was so horrifying and their mind had turned on them in such a cruel way! Ā (https://www.youtube.com/watch?v=qb8wQjwVu2g)

People with BPD 1 (bipolar disorder 1) also can be psychotic, that doesn’t mean they are psychos, again it means someone out of touch with reality. Oh so fortunately, people with BPD 1 do not hear voices. Thank goodness, the only voices I’ve heard are real voices, thank goodness a thousand times for that. People with Schizo-Affective disorder do hear voices, this is a combination of BPD 1 and schizophrenia. Some psychiatrists think this is just plain schizophrenia. So while we people with BPD 1 can get suicidally depressed, insanely manic, we still have the lesser of the two evil diseases.

There are a plethora of videos that show people who are manic and depressed. And yes they show how we are acting on the outside, talking 100 miles per minute, jumping from topic to topic, having delusions of grandeur, all in mania; crying, being hopeless, anxious, expressing suicidal ideation, all in depression. They do not show how we are feeling on the inside. Depression is especially painful, it is like someone literally broke your heart into pieces and it hurts. And pure mania is exhilarating and joyful. If your thoughts weren’t so scattered, you might actually come up with some brilliant ideas. Mixed phases aren’t so much fun because anxiety predominates in these. I unfortunately have mostly mixed phases, but that may have been because I was on SSRI’s (selective serotonin reuptake inhibitors) and now that I’m off them, hopefully I won’t have mixed phases, my hope and prayer.

Anyway, the point of this post is to of course reiterate that it’s not others who have mental illness and also to give my readers an idea of what it feels like to have these extremely awful diseases. Maybe now people will respect and understand people with mental illness as strong people who are fighting battles daily with their illness and hopefully winning. That is the intent of this post.

What’s a Girl to Do?

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Well, first they come and tell you we don’t know if you have bipolar d/o or unipolar depression, so here take this antidepressant and you’ll be fine. Then you go into a full blown manic phase, with delusions, hallucinations, total insomnia. Then they say “Oops, you have bipolar disorder, you have to take lithium.” So you go on lithium with added antidepressants only when you’re feeling depressed. So mood stabilizers such as Lithium Carbonate all the time and increased dose for manis, antidepressants, in your case selective serotonin reuptake inhibitor (SSRI), for you it’s Zoloft. Then when you get used to this regime, Lithium Carbonate maintenance dose. Lithium Carbonate increased dose for manic episode. Zoloft + Lithium Carbonate for depression, they change the rules. Now no more SSRI antidepressants, ever! SSRI’s increase the likelihood of cycling, meaning going though depressed and manic phases. So done, gone, nada. Now what do you do when you into a depressed phase? Well there are selective norepinephrine reuptake inhibitors (can’t take them, make be burst with anxiety), there are other mood stabilizers such as Abilify or Depakote (can’t take them, bad side effects), there are Amphetamine derivatives such as Adderall (can’t take them, baaaad side effects.) What does that leave? Maybe, seriously, I have to think about MAOI’s. The monoamine oxidase inhibitors. These don’t inhibit the reuptake of neurotransmitter, they actually inhibit the enzyme (monoamine oxidase) that breaks down neurotransmitters, so there are more neurotransmitter molecules available for neurons. This is good! Unfortunately however, you cannot eat anything aged when you are on MAOI’s, which means no wine, cheese, and other yummy foods. I would try these though if a depressive phase was so bad that I couldn’t function. My friend swears by one called Parnate. This class of antidepressants had been shown to alleviate depression in people who may be otherwise drug resistant. Hmmm, maybe, if I go into a severe depression, I’ll ask my psychiatrist to prescribe Parnate or one of the other MAOI’s. I guess that’s what a girl’s supposed to do. Or a boy for that matter.

INSIGHT

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Insight may be the single most important factor in determining how well a person with a mental illness does. Major mental illnesses, of course, come with delusions, thought disturbances, illusions, and the seeming inability to accept the very fact or total or partial denial thatĀ “I” have a mental illness. This can lead to bad things. Then “I” will not go to see a psychiatrist, “I” will not take my medication, because “I” do not think there is anything wrong with me. In the meantime the disease is getting more severe and more difficult to treat. Also as time passes, bipolar disorder and schizophrenia will cause neuronal cell death in brains and this will be worse in unmedicated brains.

So the important thing then is to help the mentally ill patient realize that they have an illness. Make them aware of the symptoms, for example in mania the symptoms are:

  • Euphoria
  • Inflated self-esteem
  • Poor judgment
  • Rapid speech
  • Racing thoughts
  • Aggressive behavior
  • Agitation or irritation
  • Increased physical activity
  • Risky behavior
  • Spending sprees or unwise financial choices
  • Increased drive to perform or achieve goals
  • Increased sex drive
  • Decreased need for sleep
  • Easily distracted
  • Careless or dangerous use of drugs or alcohol
  • Frequent absences from work or school
  • Delusions or a break from reality (psychosis)
  • Poor performance at work or school

These (except for the break from reality or psychosis) may seem like normal human behaviors, but when many of them are present at the same time and with a high intensity, then it may be fair to assume that this is an illness and not just normal behavior. If untreated, people will bipolar 1 disorder will go into a psychosis, meaning they will have delusions and be out of touch with reality. ThisĀ is the most dangerous part of the disease. And psychosis happens at the extreme end of mania as well as at the extreme end of depression. Both very bad places to be. In mania you may think you are super man and you can fly and literally try to do so, causing yourself harm. In depression you may think other bizarre, unreal thoughts, such as you are a “dark lord” with powers, who knows, at this point in someone’s illness, they can think anything and may do some very strange things, that can result in self injury or injury to others.

So, as I said, insight, which is the ability to judge who you really are, and when in one of these episodes, realize that this is not you, it is your illness which has taken over your brain and is now making the decisions of how you act for you.

I think I was “lucky” in a way because I didn’t manifest bipolar 1 disorder till I was 25 years old. So, I had 25 years to be ME, so when the illness took over me and my life, at some point I knew it wasn’t me and called the doctor. Even when I had reached the psychosis stage, in between periods of being out of touch with reality, when I would come back to myself, I realized I needed to be in the hospital and even though it was done with a lot of drama and emotion, I did have my self hospitalized. And I strongly believe that because of my insight,Ā I have only been hospitalized twice in the last 29 years. Most of the time, I and my doctor, we have caught the disease early enough so that it was treatable by increasing the doses of the meds I was on, or temporarily adding another medicine. My champion of course is Lithium Carbonate extended release (ER.) Since last March, I have been on 900 mg of Lithium and have experienced no majorĀ mood disturbance. Most notable is the absence of the yearly foray into mania around the end of the year.

I have had minor mood fluctuations, mostly towards the depressive side, but thankfully nothing too extreme. Also, these may be happening because I am totally off Zoloft, a selective Serotonin reuptake inhibitor (SSRI,) and I have been on it since 1991, when it first came out. So, having been on it for so long, there are changes in the brain that happen, and these changes (changes such as Serotonin receptor down regulation and Serotonin synaptic vesicle up regulation, both of these result in less Serotonin reaching the Serotonergic neurons) make Serotonin less available to the neurons. And since Serotonin is needed for normal mood, not having enough of it would cause depressive episodes. These changes take about 6 months to a year to reverse themselves. This is what makes it so difficult to come off of SSRI’s. And this problem only happens specifically for SSRI’s šŸ˜¦ But I’ve done difficult things before and coming off Zoloft successfully is just going to get added to that list of difficult things.

But, back to insight, if we can somehow cultivate insight, or perhaps find someone whose judgement we trust and listen to them when they say “Uh oh it’s happening again,” meaning the disease is acting up again, then I seriously believe we’ll have a fair chance of beating mentalĀ illness.

So lets all keep a check on our moods and actions and feelings and take action when it seems like they are running rampant upon out lives. Insight can and will help us keep our illnesses from destroying our lives.

Sleep Cycle Alarm Clock.

helps.https://itunes.apple.com/us/app/sleep-cycle-alarm-clock/id320606217?mt=8sleep cycle 1 sleep cycle 2 Sleep Cycle 3slepp cycle 4

Sleep is one of the most important elements in managing a mood disorder. Sleep deprivation happens when you areĀ manic, you don’t need sleep then at all. You can go all day, all night, like a zombie, without any sleep. Your brain is working full throttle, you can’t turn it off.

In a depression, you sleep all the time. You don’t want to wake up. You have no drive, seemingly no reason to do anything. Your mind is not working at all, you and your brain are sluggish, you have no energy. Getting out of bed is actually a Herculean task.

When your mood is normal, you are sleeping the 6-8 hours a night and getting up in the morning with a smile and going to bed at a good hour.

If your sleep gets disturbed, it can throw your mood off. Conversely, when your mood is off, it can affect your sleep cycle. It’s the proverbial vicious cycle. As someone who suffers from mood disorders, you have to be extra vigilant about getting the right amount of sleep consistently.

Lately, I have been having a dickens of a time waking up every morning. I simply don’t want to get out of bed. I wish someone would invent an intravenous coffee machine that I could hook up to every night, which will deliver the right dose of coffee to me every morning so I can open my eyes. Haha. Barring that, I just read about Sleep Cycle alarm clock. It’s an App for iPhones. Just got it to help wake me up, lets see if it works.

You put it on your bed, close enough so it can detect your movement. And it wakes you up in the correct phase of your sleep, the lightest phase of your sleep cycle. According to the description and it makes sense, this is the natural way to wake up, rested, refreshed and relaxed. And Wow! since you move differently in bed in different sleep states, it can monitor your movement in bed to determine which phase you’re in. I hope big brother isn’t watching this, haha.

I’ll keep you posted. Starting tonight. Good night, y’all

Maybe, maybe not…

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Don’t really have anything to say. Tired. Very low energy. Low mood. Beginning of a depressed phase? Don’t know. It’ll become apparent soon enough. If It’s hard to wake up in the morning, if it’s hard to get anything done, if I don’t even want to get anything done, if I have lost interest in activities that were pleasurable, such as taking pictures, or singing, then yes it looks like the beginning of a depressed phase. These things have been happening to me in the past few days, but only the past few days so it’s still too early to tell. It may just be a blah period and not the beginning of a real depression. At least Zumba is still FUN! If that stops being fun, then I am in serious trouble…

Also if I do go into a depression, there is one big problem this time: No Zoloft. My psychiatrist will not let me take Zoloft or any SSRIs (Selective Serotonin Reuptake Inhibitors), because he says that they make people with bipolar disorder cycle more, and apparently research supports his claim. But this is pretty scary for me, because until now, whenever I felt a depression coming on, I would startĀ taking Zoloft and it abated. This time I don’t have that option, that safety net. If I truly do go into a depression, I don’t know what I am going to do. And just this fact is causing me a lot of anxiety and stress.

The drugs he has recommended I go on all have given me very bad side effects in the past. For example Abilify literally gave me Parkinson’s like symptoms, with very stiff muscles, a shuffling gait and muscle tremors. When I took Welbutryn in the past, I thought i was going to burst because of an insane level of anxiety. Latuda gave me blinding headaches and Saphris also gave me a lot of anxiety and severe headaches. Provigil, which is a stimulant is also one that he has suggested, but I will not take it as it can push people with bipolar d/o into full blown mania. I don’t understand how he even suggested that, given the fact that this is a side effect! So there we have it. The one medication I can take without side effects is now forbidden to me and all the ones I am allowed to take are ones I cannot take because of awful side effects. The fear, anxiety and stress of what’s going to happen if I do go into a depression are quite enough to send me into a depression šŸ˜¦

Going to NYC for Thanksgiving. A lot of close and extended family will be there. Hoping I will be fine. I was so looking forward to this trip to NYC with my husband, my son, my stepdad, my brother, my sister, my cousin, her children and many, many others. And now I don’t know. Oh well, all I can do is hope for the best.

Also wondering if it is time to find another psychiatrist. But what if what this one says is true… then it would be unwise to find someone new… going around in circles and have no idea what to do. Even deleted a whole post I’d written because I thought it was garbage… simply going around in circles. Not so bad that it is definitely a depression, but definitely some symptoms, and maybe on my way to a depression.

Oh yes, bipolar strikes again, as usual with its impeccable timing, and all it does is make my life a living hell. Tired, so tired of this. Of fighting depression, of fighting mania, wtf bipolar d/o, leave me the hell alone.