Goodbye Summer, Hello Relief!

As a child, summer was always a time to celebrate. After all, there was no school, no homework, and (if I was lucky) no real responsibility in sight. Unfortunately as an adult, my feelings about summer have changed dramatically.

The funny thing is, I know that in winter I’m complaining about Seattle winter. Dark days, the constant drizzle, and experiencing days, weeks, and even months sometimes without seeing that big yellow orb in the sky.

But now, as an adult, I am finding summer to be equally as challenging. While I admit it feels quite odd to feel so depressed when the sun is shining, the issue I have is with temperature.

Living in a cold corner of the country, we get excited when things warm up at the beginning of summer to about 65 degrees. By 70-75 degrees, people are sporting bikinis. The typical home in the Pacific Northwest however has not been built for true heat, so when things start getting into the 80’s and even the not-so-lucky 90’s there is a distinct lack of air conditioning that makes these temperatures more livable in other parts of America.

With that in mind, that is part of the reason I have been somewhat absent in the blogosphere through the middle part of this week. In addition to the knuckle-dragging depression I’ve been having, my medications (which seem to constantly warn me not to get “too hot”) make it even more difficult for me to cool down. Once I get warm, I can’t seem to cool off again very easily.

In the end, there is only so much time I can spend in a cold shower, or hanging out in an air conditioned grocery store before people start getting concerned. Even with windows opened strategically and every fan we own pointed right at me I was still averaging a body temperature of 100-101 degrees, and while the internet seemed happy to suggest I “sip a cool drink” I really wasn’t kidding anyone… the heat this week left me miserable.

Usually I can tolerate a pretty significant amount of misery before becoming agitated, but after three nights of waking up every thirty minutes due to the heat I was overjoyed to see some big, grey, poofy clouds this morning. I’m hoping a little cool air can help with my irritability and give me a chance to take a nap because frankly… I’m exhausted and I am well approaching the snapping point. I can’t really imagine how this lack of sleep has not triggered mania this week, maybe that is a sign of the tight grip depression has on me at this point? I don’t know.

I know in four or five months I’ll be eating my own words and I will be desperate for a little sunshine, but at this point, at the close of summer, I feel happy to hand over the keys of summer in exchange for the cold, grey, relatively stable weather of the rainy season.

Well, Well, …Wellbutrin?

Today I have been on Bupropion (Wellbutrin) for two weeks. I took 150 mg for the first week and then I was bumped up to 300 mg a week ago. I was a little nervous about going up to 300 mg as my notes (from my first hospitalization around 10 years ago) recorded my maximum dose of Wellbutrin at the time as being 150 mg.

As usual, my psychiatrist had been very specific about keeping tabs on any mania that might be triggered by this medication but (as I suspected) nothing even remotely akin to mania has taken place so far. In fact, the only changes I have detected are:

  • increased volume in the (already present) ringing in my ears
  • dry mouth surpassing anything Lithium every threw at me -to the point where I have been experimenting with different dry-mouth remedies and medications
  • greatly increased tremor action (increasing what was already present due to Lithium)

While I don’t particularly enjoy clanging glasses of water against my teeth while trying to drink or being almost entirely unable to apply eyeliner on myself because I’m shaking so much, honestly I’d rather experience that over, say, a headache lasting two full weeks (ahem, you  know who you are seroquel).

I understand that I have not been taking this antidepressant long enough to realistically expect any improvement in my (still sinking) depression, but the few inconvenient side effects I’ve had have been extremely preferable to pretty much medications 1-14.

Having said that, my psychiatrist was insistent that I increase my seroquel/quetiapine dosage to 50 mg before starting the wellbutrin. I realize this is considered a tiny amount to most people, but even so I’ve been having a very hard time on it. Beyond the two week headache I had when I increased the dosage (which seems to have abated now) I’ve also been having a host of gastrointestinal problems involving a lot of pain, more than a little discomfort, and enough bloating to make me look like a pregnant woman by the time I go to bed.

If I need to keep taking quetiapine, a trip to my gastroenterologist is imminent. None of my previous stomach medications are working anymore, and while this is something that is probably number one on my list of concerns there is an extremely close tie for number one, namely;

hair loss.

Yeah. Nobody likes to have chunks of hair falling out, and right now I am losing at least 3-4 times the amount I would normally lose in a day. My hair is very thick (so I am sure it is not noticeable yet) but I don’t particularly want to use the fact that I have a lot of hair as an excuse to lose more. I know this is not a side effect listed for Seroquel, but  when I did a quick search online it seems I am not the only one experiencing this (by far). Also, I wouldn’t peg this on the wellbutrin because it started before I began taking it.

Thankfully, today I get to address these issues (and more) with my psychiatrist. I am not exactly looking forward to going out in public but I have definitely been experiencing some things that need to be addressed. Hopefully I can find some relief from the physical discomfort, even if I’m still waiting on relief for the emotional.

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.