Long Game: Depression

There are times when my rapid cycling gives way to a long, drawn out affair. Though I sometimes experience other moods “popping in” during these episodes I can usually distinguish an episode up for the long-game because my symptoms begin like a snowball rolling down a hill. By the time it reaches the bottom it can easily knock me off my skis.

While I have experienced four solid weeks of depression now I wasn’t ready to call the “big episode” until I felt certain the depression wasn’t going anywhere.

This week it became clear the depression is here to stay for a while. That is, unless the dosage of bupropion (Wellbutrin) I doubled on monday begins to work some magic.

The signpost I passed during my current descent was clear enough, and I felt pretty proud of myself for noticing. My thought process seems to have become overwhelmed by depression now, and I found myself wondering why my boyfriend cared about me so much when I really didn’t deserve it.

Errr…

There is this realm of guilt and self-loathing that I only really experience during depression (though sometimes it can occur during my mixed episodes), and it is something that tends to take a firm hold on me when the depression lingers long enough to convince me these thoughts and feelings must be true.

At this point, I think I’ve played this game long enough to be able to see where this is going. When I have episodes like this they often last for months at a time and in the past have been known to result in hospitalization… that is, unless something can pop me out of it.

Right now it seems clear that my next course of action is to batten down the hatches, and frankly since I am already in the process of pursuing ECT (electroconvulsive therapy) there is a chance I could get lucky and I can line it up by the time (or even before) I truly hit rock bottom.

For me it feels like the real bummer is that pretty much everything I own is still in boxes after moving, I’ve been extremely unmotivated (thanks depression!) and given this current situation, I’m not really sure when that might change.

Really, let’s be honest though. I have access to a tea kettle, some dvd’s, and a barrage of pillows, and I consider those all to be highly prized items when experiencing a depressive descent. I want to be prepared but, fingers crossed… maybe I wont reach that point.

Toadking – Free New Tracking & Charting App for Android Users

While psychiatric medications have not helped me manage my treatment resistant bipolar symptoms, there is one thing that has truly contributed to my understanding and daily management of both my emotional symptoms and those related to anxiety. I can easily say the most helpful tool I’ve come across is mood tracking.

Not only do I track the status of my moods, I also track things like anxiety level, sleep quality, and level of physical pain. Anything that might contribute to exacerbating my bipolar symptoms is something I want to keep tabs on, and this has helped me understand exactly what kinds of things trigger my episodes, gives me an easy way to relay information to my psychiatrist, and has given me a much wider understanding of the disorders I am dealing with.

These days, it can be hard to find time to jot down notes; it seems the easiest solution is to do so on the go. While there are a few mood charting apps out there, I am someone who really hates paying for something that might not work for me in the long-run.

That said, if you are someone who is already tracking different elements in your life or would like to start and have an android device, you’re in luck! There is a new, open-source app developed by a tracking-app user for android called toadking.

Toadking Charting App

Toadking Tracking & Charting App

The toadking app allows users to choose one or several elements to track (which could be anything from level of depression to sleep quality to stress level, there is no cap on the number of things you can track so the sky is the limit here!) and then designate a 1-10 value for those elements once each day. Don’t worry, if things change throughout the day you can always go back and change your value!

Once you have compiled some data, you can use the share tool to create printable graphs for each element, an excel file with your compiled data, or email that data to your doctors or therapist, creating an easy way for them to check up on your status.

Some of you readers might remember that I am a bit of a graph nut, and I was pleased to learn that the finished graphs can be bar graphs, line graphs, or a table. While viewing the graphs in “history” mode on the device, the graphs can be seen showing one month at a time, however when exporting graphs you can select from the current month, previous month, last three months, last six months, and even one year’s worth of graph data!

If you really want some perspective on how your mood or anxiety or sleep habits have changed over time, there is nothing quite like seeing a full year’s worth of data!

So if you, like me, prefer no-frills tools and abhor obnoxious adds popping up constantly on your “free” apps and you have an android device, I would definitely recommend giving this tracking app a try. After all, it is totally free… so what do you have to lose?

Here is a link to the toadking website where you can find more information, as well as access to the source code (I know I have some programmers out there reading so a little shout out to you!) and a support area if anyone has any questions regarding usage.

I also want to provide a link to the page at Google Play where the app can be downloaded, so you can get straight to the fun part if you’re interested in checking it out!

Finally, I want to make a quick note about the creator of this app, because this app is something he could have sold to someone (who would ultimately charge you and I to use it) and decided instead to share it for free with those that could really get good use out of it. In my book, that is really saying something, so I really want to encourage people to try this out and potentially pass it on to anyone you think might find it useful.

Find that you love this app? You can drop the creator a line or kick in a donation to his cause here

Viewing the Past Through Someone Else’s Eyes

While I’ve met many people who have had symptoms of mood or anxiety disorders appear in their 30’s or 40’s or 50’s and can only imagine how jarring the result must have been, I find myself at the other end of the spectrum.

Many of my childhood memories involve big emotional explosions (good and bad) and frankly, the anxiety I feel today spans back to as far back as I can remember.

Though my emotional journey has been somewhat complicated, it seemed to me (as an adult) that my experiences with anxiety haven’t been. The anxiety is something that has always been there, but for a long time I didn’t see it. The feelings I had were typical for me (for lack of a better word), I really didn’t know anything different.

I think the difficulty in this route (vs the sudden, immediate cresting of symptoms later in life) is that the realizations I have had about the depth of my anxiety have happened slowly over time. There was no one moment where everything became clear, it has been more like a trail of discoveries.

Discovering, for example, that I have been having panic attacks since I was in 5th grade and I didn’t know it (because it was something that just became part of my life).

Or discovering that my unruly digestive tract and IBS is related to the anxiety I have always experienced.

This time, a few weeks ago, I was cleaning up some papers before moving and found a note written to me by my boyfriend my sophomore year in high school. The note was one of distress, and he said I was acting completely different at school than I did when we were hanging out otherwise. Apparently in the setting of school, I could hardly speak to him, let alone do things like typical teenager hand-holding in public.

Though I don’t remember any of this taking place, I admit I was a little shocked when I read about it. What I do remember was that this boy’s interest in me finally detached the creepy tentacles of the teacher who had been sexually harassing me for the last two years, and for that I felt an incredible weight lifted off my shoulders.

Apparently even without that weight, my social anxiety was practically paralyzing. I admit, I don’t remember feeling terribly anxious about school, but based on that letter (and others) everything I did and felt was within the realm of what I already knew: a world based on anxiety.

It isn’t very often I find things like this that can lend such a different perspective on the past, but when I do I am thankful they can give a little insight about things that took place (and the status of my mental health at the time).

“Bipolar”; Synonymous with Passion?

When I think of passion the thought of artistry or craftsmanship often enters my mind. After all, artists (of all kinds) are often considered the most passionate people around, and I initially coupled this idea of “passion” with something like a tenacious drive to succeed or create.

Earlier this week I was contemplating this notion, and I concluded that I didn’t really have a solid idea of what passion really is. I was having trouble putting my thoughts into words, and when this happens I generally find myself making a run for the dictionary.

While I did see some definitions that involved enthusiasm or romanticism as a main theme, I was surprised to find the following definition at the top of the list in regard to passion:

A powerful emotion, such as love, joy, hatred, or anger.” 

The idea that passion could be linked to any strong emotion was a new concept to me. As I began to consider it, it became clear; what is my life experience, but the amalgam of powerful emotions?

I am someone who can be, admittedly, a person who can be hard to compromise with. I know that a lot of that comes from the fact that I have strong feelings attached to everything I do, and because of bipolar disorder (or whatever it is that inherently contributes to the depth of my emotions) that passion can quickly overshadow the shrugs and indifference of the people around me.

I also know that this passion is something that draws many people to me, particularly those that also experience big or powerful emotions themselves. Frankly, it can be difficult for me to understand the motivation of people who don’t seem to care about much, and when I am surrounded by passionate people I feel the most at home.

While I don’t want it to sound like passion is limited to those who have bipolar disorder, I think we simply experience those big emotions much more frequently than the “average” person (average here used in more the mathematical sense than a dictation of social standing). Frankly, the disorder itself it based on the fact that we do. 

Of all the words I could possibly use to describe my emotional states (many having negative connotations) I think it is important to level the linguistic playing field from time to time and remind people that the attitudes we use to describe our lives have a big impact on overall social acceptance. At the same time, I find it extremely important to remind myself that the thing I keep trying to silence has truly contributed to an interesting life.

I hope that if you take nothing else away from this post, you will take away a short and sweet reminder this Friday:

Through all the ups and downs, there is one constant: your life is one of passion! 

WA Supreme Court Rules Psychiatric Boarding Unlawful

Across the nation there have been problems with a shortage of beds in psychiatric wards to accommodate patients in crisis, and in Washington state I have come face to face with this issue firsthand. It is bad enough when psychiatrist’s schedules are booked out six weeks in advance or more (making it practically impossible for someone in a crisis situation to see someone immediately), but when these situations erupt into one requiring an involuntary hospitalization, a lack of available beds has meant keeping some of the most desperate psychiatric patients in ER or regular hospital beds in the meantime.

I guess I can see where this kind of action is coming from, having a lack of beds in psychiatric hospitals has meant having an overflow… and where can these people go? Without a proper budget in the state, it seems the next best thing would be to keep these patients in the hospital until they can receive care, right?

Wrong.

I first heard about this issue when other hospital patients (and some employees) began expressing concern about having involuntary patients who aren’t in the proper secure setting they need, and without the staff having the proper training to deal with potentially dangerous situations.

Oddly enough, that wasn’t the issue that brought this problem up to the state Supreme Court. The lawsuit was actually filed by one of the patients who had been involuntarily committed but temporarily held at a local hospital without treatment. 

Normally (at least in Washington state) the policy is that anyone who is admitted into a psychiatric inpatient setting (voluntary or involuntary) must begin receiving treatment by a licensed professional within 24 hours of intake.

I know how frustrating it can be to be admitted and have to wait 23 3/4 hours before seeing a psychiatrist (on top of waiting nearly 24 hours to be admitted) while in a crisis situation, but apparently there have been several cases where people have been held involuntarily (even strapped into a bed) for days without any kind of treatment due to lack of qualified staff.

Frankly, that sounds like a nightmare to me, and that is why I am pleased to say that the Washington State Supreme Court ruled that holding patients while withholding treatment is not only inhumane but also unlawful.

The ruling quoted the Involuntary Treatment Act;

“Each person involuntarily detained or committed pursuant to (the Act) shall have the right to adequate care and individualized treatment.”

While this feels like a big step in supporting and protecting the rights of the mentally ill in Washington State, the next big issue will be trying to find a solution to the issue of bed shortages.

You can find more about this trial at the Seattle Times blog The Today File here.

Re-evaluating the Past; Wellbutrin Revisited

Ten years ago, my seventeen year old initial manic/psychotic trip largely fueled by fluvoxamine (an SSRI antidepressant) that landed me in the hospital pushed me through something of a revolving door and I left the hospital on another newer, shinier antidepressant; Wellbutrin.

When I started taking Wellbutrin, it didn’t have a generic counterpart (bupropion, the generic formula, wasn’t approved until 2008 and my hospitalization had been in 2003) and as a teenager I didn’t know the first thing about psychiatric anything. I’m sure I couldn’t tell you that wellbutrin/bupropion is different from most antidepressants, or why, or why I needed to take it with an anticonvulsant.

My present psychiatrist has been very wary about prescribing me an antidepressant in any form, and after attempting to give me an SSRI (in conjunction with lithium) to ward off a bout of severe, suicidal depression three years ago my mood shot through the roof so fast I could barely contain myself. It was immediately apparent that route wouldn’t work, but in the back of my mind I kept the thought of wellbutrin on file for another, perhaps equally distressing, rainy day.

You see, they say the past is clearest in hind-sight, but even then… the last year and a half I spent in high school (the time I spent taking wellbutrin) is an odd blur of experiences and behaviors. After all, who is to say if my late-night escapades in black robes and black angel wings standing in the road waiting to scare the crap out of motorists was a product of (mild?) mania or simply the warped mind of a teenager confined to an island aching to amuse oneself?

While I did do some rather questionable things while taking this drug; I feel confident in saying I don’t remember any of the psychotic sorts of symptoms I’d had six months to a year earlier cropping up. I don’t recall plotting to kill anyone, and though there may have been some genuine flickering moments of mania (again, it is hard to say as these moments may have just been a product of my bizarre sense of humor) I feel safe in saying I felt free of the depression and oppressive obsessing thoughts that had completely engulfed me a year earlier.

Did I feel a lessening of my anxiety and depression because of the drug? At this point that is debatable. I remember remarking to someone that though I felt more free while taking it, I also felt much slower (which doesn’t seem like something I would say if I was manic).

My change in attitude at that time could have come from anything, my newfound recognition that, as a senior, I would be able to leave soon (enabling me to see the light at the end of the tunnel) or the fact that my upperclassmen had departed, leaving me without the majority of the people who had enabled my obsessing.

I admit, I’ve spent ten years thinking about all this, and every time a friend of mine with bipolar disorder has told me they are taking wellbutrin/buproprion I am thrust into a pace of contemplation. After all, the last 13 mediations I’ve tried haven’t helped… and there is a chance (though a blurry one) that this one drug may have helped me in the past.

A little over a week ago while my mood has been dragging at rock bottom, when my psychiatrist suggested trying an antidepressant again (for lack of any other options while he tries to sort out the ECT situation) I piped up and suggested bupropion. Frankly, it is the only antidepressant I’ve tried that didn’t give me a horrible time, and my history with it is thus:

it either helped me, or did pretty much nothing. 

While nearly all the drugs I’ve tried at this point have done nothing, it feels nice to roll the dice and expect one of two (reasonable) outcomes. I am not expecting to swell up into a balloon until I burst, or get some kind of killer rash, or start twitching uncontrollably. I was able to tolerate this drug ten years ago, all I can do is hope I can tolerate it now.

So I am starting this week with Wellbutrin, Revisited. 

Of everything I’ve tried, this is the one I am the most curious about, simply because my seventeen year old self didn’t have the knowledge to be able to put its effects into words. Now, ten years later with a much larger vocabulary, I am hoping I can finally make an educated conclusion.

Ten Days in a Mad House – An Historic Expose

Nellie Bly

Nellie Bly

There have been times I have consider the treatment and care I’ve received in psychiatric inpatient units to be practically medieval; sleeping under blankets so thin I could see through them, eating portions too small to warrant any condiments, and witnessing both incompetent doctors and vicious nurses. Granted, not all of these places have been created equally, and while some psychiatric hospitals or wards have been brought up to date, others remain wanting.

With those feelings in mind, I began a journey listening to the account of a 19 year old woman living in the 1880’s who purposefully had herself committed to the local asylum in a journalistic effort to report on the conditions therein.

I believe I was directed toward Ten Days in a Madhouse by Nellie Bly by an episode of one of my favorite podcasts, Stuff You Missed In History Class. I secured an audiobook version of Nellie Bly’s account through my local library (I’m not sure I would recommend it, the accents done by the recording artists have little bering on the actual places the people in the account are from) but you can also find the entire written version (initially published as several articles and then as a compilation in 1887) for free here.

While the inpatient system these days can still seem somewhat barbaric (especially if you aren’t there voluntarily), Nellie Bly’s account of the Blackwell’s Island Asylum in New York shows how far things really have come. I must warn you, there are some accounts of violence that can be shocking (though not incredibly graphic), and the lack of human decency is completely deplorable. On top of that, if you aren’t familiar with historic language at all (or the fact that anyone suspected of having mental health problems was simply considered “insane”) you might find the language jarring, but I think it is important to realize that the lack in any tasteful language around mental health in the 1880’s came from a real misunderstanding of the issues themselves at the time.

One thing that really stood out to me in this account (aside from the terrible treatment of some 1600 women living confined to an island asylum) was the actions of the citizens, the police, and the doctors. Nellie (who has never seen anyone “insane” before) must convince people she is unwell enough to warrant a trip to the asylum. She pieces together several symptoms concocting a performance including forced insomnia, paranoia/nervousness, and amnesia (with no violence or aggression, primarily just confusion) and within 48 hours citizens have had her brought to the police and a judge has sent her to the Bellevue Hospital staging area before taking the ferry to the asylum.

The “tests” the doctors perform to determine each patient’s level of mental health are laughable, and while one doctor perceives Nellie’s case to be the result of being given drugs, the next doctor concludes,

An Insanity Expert At Work

“Positively demented,” he said. “I consider it a hopeless case.”

In this account there seems to be no knowledge of any of the aspects one might consider “mental health” today. Unfortunately, being sent to the asylum was practically a hit or miss situation, and part of the problem was that even when perfectly rational people ended up there by mistake (being a foreigner and having no translator, or being requested to go to the poor house and accidentally being sent to the asylum) they often became irrational very quickly because of the very harsh, very poor conditions.

In one of my favorite passages, Nellie accounts;

“If the confinement was but for a few days one might question the necessity [of a translator]. But here was a woman taken without her own consent from the free world to an asylum and there given no chance to prove her sanity. Confined most probably for life behind asylum bars, without even being told in her language the why and wherefore. Compare this with a criminal, who is given every chance to prove his innocence. Who would not rather be a murderer and take the chance for life than be declared insane, without hope of escape?”

At this time in history, being declared “insane” (whether you were or not) was pretty much a death sentence unless you had family or friends willing to take care of you.

Even after trying to speak rationally to the doctors in the asylum, Nellie is not given a second chance to prove she is rational, and her claims of not belonging are considered further proof of her insanity.

As I mentioned, her account goes on to describe several vicious and brutal actions by nurses, the inedibility of the food, and how each cell needed to be opened with a key individually; proposing that if there were a fire, all 1600 women would likely burn to death (the nurses would not be willing to risk their lives to try to save any of them). Her description of bathing time is equally as distressing, and the women were likely to only be allowed to change their scant clothing once a month.

After Nellie’s friends come to bail her out (with a tongue in cheek promise to the staff to take care of her) the subsequent articles published by Nellie created a huge outcry from the public and produced an investigation of the Blackwell’s Island Asylum by the grand jury. Nellie’s ten days in a madhouse and her expose of her experiences ultimately resulted in a one million dollar increase in the budget “for the benefit of the insane”.

Though her written account of most patients who did exhibit symptoms of mental illness was one primarily of fear and pity, I must personally consider Nellie Bly to be a true hero of mine. Not only did she singlehandedly plunge herself into an extraordinarily terrifying situation in an attempt to benefit others, she also did go on to help raise the standards in asylums in our country.

If the history of mental health in America is a subject you are interested in exploring, I would call Ten Days in a Madhouse a great reference. The book itself isn’t very long, however if you aren’t used to reading historic writing it can be tedious at times. Some of the violent accounts once inside the asylum -though not extremely graphic, may be triggering, but overall I would say I learned a great deal from this piece of work.