Reposting because of technical difficulties.
SSRI
What’s a Girl to Do?
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
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 😦 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.
Maybe, maybe not…
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 😦
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!
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 :))
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.
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 :-))
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