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 flowing¬†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 ūüôā

Not Just Others.

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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! ¬†(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 that¬†“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. This¬†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,¬†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 major¬†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 ūüė¶ 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 mental¬†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 are¬†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 start¬†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 ūüė¶

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.

Something I just learned!

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First of all I’d like to say that I have been feeling fine, no major mood upheaval to report since late June/early July. That is a blessing and I am enjoying my normal mood and being able to handle what life throws my way in an able and normal way. I have been in a play for which I have had to memorize lines and perform in front of an audience, and that has gone extremely well. We have been getting standing ovations from the audience and our director is very pleased. So that is the good news.¬†

I had an appointment with my doctor today. Something he told me pretty much blew me away. He said I had to stop taking Zoloft, a medication I have been on since its approval by the FDA in 1991. He had said this to me in the past, saying it makes people with bipolar disorder cycle. This time he was pretty adamant that I should come off it. I asked him to explain further and he said that taking Zoloft is fine when things are going well, but when there is upheaval in your life, then it makes you cycle. It can either throw you in a manic phase or into a depression. He said that the mini manicky cycle I had gone through in June and July and the slight depression in the middle of August were directly caused by taking Zoloft. I am flabbergasted! I have always been told that you take Lithium for mania and anti-depressants for depression. Now my doctor is telling me that SSRI’s (selective SEROTONIN reuptake inhibitors) make people who have BPD cycle more and that we cannot take SSRI’s and should only be on lithium! I asked him what I do when a depression comes sauntering into my life, and he said I can take other anti-depressants or mood stabilizers. He mentioned Abilify, which I can’t take because it gives me severe Parkinson’s like symptoms and¬†makes me feel about a 100 years old. He mentioned Welbutryn, but I can’t take that because it makes me feel like I am literally going to explode from anxiety… so, hmmmmm, depression… I don’t know what I’m going to do. Cry a lot and feel bad a lot? Apparently what happens with SSRI’s is the number of Serotonin receptors is down regulated. Also, the number of synapses is reduced. This is what causes people with BPD to cycle. These changes in neurons are reversible but it takes about a year for neurons to go back to pre SSRI configuration. So for a year… he did tell me about a medicine called Brintellix, which is an SSRI but doesn’t do either of the things I mentioned above therefore does not make people cycle. However he said that would not be his first choice. But I think it would be mine out of the three he offered as alternatives to Zoloft. Well let’s see how this goes. Every time I get a new psychiatrists, things change, and not necessarily for the better. My mental health is of course affected by changes in these psychoactive drugs.

I do agree with him that I have mini cycles, exactly like I had in June/July (manicky) and mid August (just a tad bit depressed.) And both of those happened because of situations in my life. So I think what he is saying is correct. The only issue is how will I control the symptoms of a depressive episode if I can’t go to my trusted Zoloft. Scary. Well here we go into the wild blue yonder. Life without Zoloft. Thank you Zoloft, you have served me well (maybe not quite so well), but now we must part. Lets hope it will all go smoothly and my neurons will up-regulate Serotonin receptors and synapses at record speed :)) Actually I am sitting here smiling at my silliness, but truly hoping this all goes well.

All silliness aside, this should make my mood much more stable, no more “mini” phases, that have quite maxi effects on my life. Without the Zoloft, the cycling through manic, normal, depressed will decrease and the time in normal phase will increase. What a joy that seems, to not have emotional fits from anxiety, mania, and depression. I’m all for it and starting today to make sure that my mood stays normal :))

 

Impulsivity is a symptom of mania or hypomania!

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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.”

 

 

FYI: Phases in Bipolar disorder.

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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 ūüôā

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