Monthly Archives: October 2012

Jumping Back In With Both Feet

I have been working on a couple more thoughtful posts, but things have been so disrupted by the medications my psychiatrist gave me to try last week that writing has not been particularly realistic.

I guess the number one combatant there is against intense anxiety is a class of medications called benzodiazepines which contains things like Valium, Xanax, Ativan, and Klonapin.

To tell the truth, though very effective for many people, “benzos” scare me a bit. They have an addictive quality that means they are not only one of the most commonly abused prescription medications, but also that it can be easy to develop a physical dependance that results in withdrawals without them.

Again, some people are really helped by this class of drugs and if you are prescribed them and take them in the way your doctor intends, there may not be a problem.

That is where things start to get tricky, because for many people with a co-morbid diagnosis of anxiety with something like bipolar disorder, benzos might be prescribed in a long-term sort of fashion, as opposed to being a short-term solution.

And I’ve known for a long time that this is not something I’ve wanted to consider as a long-term solution.

As much as I’ve known that, I’ve willingly given them a try on three separate occasions.

The first one I’ve tried was Valium, and I tried it twice and stopped taking it because it didn’t seem to be effective. It was effective, however, when injected intravenously at my somewhat cataclysmic emergency room visit a year ago (when I had the mother of all panic attacks and hyperventilated, putting me into a state where I couldn’t seem to move my arms or legs). Obviously, it is unrealistic to expect to be running around shooting up Valium, so that was kind of the end of that.

Next, while hospitalized the last time, I was given Klonapin… and within a 30 minute window (though I believe it took even less time than that) I had a panic attack for no apparent reason whatsoever. The conclusion was that the anti-anxiety medication Klonapin had actually had the opposite effect as intended.

Alright, so before going on vacation at the beginning of this month, my doctor gave me Lorazipam (generic for Ativan). He told me to take it as-needed, and when things escalated at work I gained the nerve to take one, expecting some kind of feeling of release or relaxation. Instead, nothing seemed to happen. I tried it two or three more times on separate occasions (maybe I was doing something wrong? Did I need to channel inner peace or something at the same time?) but it was the same each time, nothing appeared to happen.

At my appointment last week with my psychiatrist I brought this up to him and he suggested I begin taking it once in the morning and once in the evening to help with my symptoms of anxiety.

So, that’s what I tried.

The first two times I took it I just became very, very dizzy. The room spun, I was nauseated, and that’s it.

By the third dose (the end of the second day) it felt as if a wave of awfulness (agitation, depressive mood, and extreme hopelessness) crashed over me within an hour or two of taking it.

But, wanting to give things a real shot and just to be sure, I continued and took it in the morning the third day as well.

And by day three, things (which were pretty bad depression-wise but seemed to be slowly improving) got suddenly much worse. Again, thunder-clouds rolled over me within an hour or two of taking it, and I was flung into an agitated mixed state with a level of hostility which made me genuinely consider the possibility of hospitalization again.

Since I knew this had been brought on by the medication, I opted to just curl up in a ball and try to wait things out. By the evening the hostility had vanished, but I was quickly flung into a much deeper depression than I have experienced for at least the last year.

Needless to say, I don’t expect to try any more benzodiazepines… just one more thing my body does not react well to. At least now I know.

And, for those of you just joining us, I am not entirely surprised by the reaction I had. I have reacted poorly to nearly every medication I have tried so far, with the exception of lithium and very low doses of Zyprexa (which made me seemingly gain 40 lbs in a day) or Risperidone (which seriously zombifies me). The reaction I have had isn’t typical with what people experience with medications like Lorazipam, so this isn’t meant to be a cautionary tale. I do, however, believe people need to take caution when trying new medications and know their bodies so if something out of the ordinary does occur, you have the power to do something about it before things potentially get worse.

So, the search continues.

Or, well, starts up again and then continues after the break I had been taking from pumping my body full of one random drug after the next while I was working. I guess, realistically, since I am not working this is probably a good time to pick things up again.

In a nutshell, that is where I have been… my mood seems to be a bit better today (after 13 hours of sleep) and I am on day three of trying Geodon. So far nothing out of the ordinary has happened, so I’m a bit hopeful.

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How Accommodating?

I had heard that most schools and businesses are willing to make accommodations for students and employees with disabilities, but for a long time I didn’t understand exactly what that meant.

The examples you always seem to hear are things like, “putting a ramp in for someone with a wheelchair” or “giving a student private space to take a test so they are able to concentrate better on the test,” but when I first learned that bipolar disorder can be considered a disability that could warrant accommodations, I couldn’t quite put together what that meant. Obviously a wheelchair ramp is a little more straightforward, are there things that a school or business could do to help someone with bipolar disorder function more successfully?

Now, I also want to mention that the spectrum of people who have a bipolar diagnosis is a wide one, and many of them function perfectly well (and some above and beyond) without the need of any sort of accommodations. At the same time, there are others (like myself) who work better under a certain set of conditions than others, and that could be due to any number of things.

For myself, I would say the lack of helpful medications has been a big one, and being without pharmaceutical help regulating everything means I am susceptible to many more triggers than I would, potentially, if I had something to lessen or space out the episodes. As time has passed, I’ve began learning what some of those triggers are, and that is where accommodations might be helpful in avoiding them.

I also wanted to mention that the phrase:

“Reasonable accommodation, which does not cause undue hardship”

is usually attached by employers to the word accommodations as (what I would consider to be) one of those little asterisks on a word that can act as a legal loophole.

I’ve spoken many times about losing jobs due to discrimination against mental illness, and the undue hardship portion of that phrasing is what most companies who terminate an employee in a discriminatory way (for having a disability) hide behind as their justification for their actions.

The thing is, the phrasing undue hardship is subjective, and will vary from company to company.

For example, if the accommodation you are requesting costs the company a lot of money, they will probably be less likely to consider it if it is a small company. Generally speaking, smaller companies have a tighter budget and less wiggle room (at least, from what I’ve experienced), and would have an easier time claiming they can’t afford what you need, that your request would cause financial hardship for them.

I’m not saying that this small company is doing a terrible disservice, or that they are being discriminatory, because the company will probably always consider the needs of the company first. That’s just business. There are situations where I do believe a request would cause undue hardship for a company, but there are other situations where I’ve seen companies claim undue hardship before even seeing the request for an accommodation, or when screening potential employees before employing them. That is discrimination.

These places are not all the same, and just because a company is small means it wont consider your request. In fact, sometimes making a request for a small company can be much easier, especially if that is a company of just one or two people.

“Can I have tuesday afternoons off for doctor’s appointments?”

“Sure.”

Done.

I would say that if you feel discouraged about asking for an accommodation (because of the potential for discrimination) there are a few things you can do to help  yourself out.

1. Consider what your needs are and what kinds of changes might help your situation.

For this bit I had to do a little research because I honestly didn’t know what kind of things people ask for as accommodations -and I certainly didn’t know what separated “reasonable” from “unreasonable” requests. But, looking back on my post a while back called  Work; the Main Roadblocks, I’ve been considering what exactly the issues are that I’ve been having in the work environment.

Stress is a big one, and that is caused by a number of things. My commute time, long hours, being in the middle of a group of people without any time alone, hearing people whispering, etc.

When I did a search, here are some of the accommodation requests I saw that might help out in some of those areas, as well as a few extras:

Flexible Scheduling – flexibility in start or end times at work, part-time shifts, or taking more frequent breaks.

Modifying Work Space – relocating to a quieter area, or working from home.

Changes in Supervision – being provided written (instead of verbal) instruction, having a weekly meeting with supervisor to touch base.

Technology – using headphones to block noise, using a tape recorder for taking notes, or using a lamp that isn’t fluorescent.

Changes in Training – allowing extra time to learn tasks, or providing individualized training courses.

 

I’m sure there are many more out there, and sometimes a creative solution is necessary. In the meantime, though, if you are interested in requesting one or more accommodation(s), what next?

2. Consider the impact of your request and if you expect it can realistically be met.

Would what you are requesting be expensive? Time consuming? Or is it a minor sort of request?

If you are asking to relocate your desk to a quiet area, is there somewhere in the building where that could happen, or would many other people need to move to accommodate that request?

If you are asking to work from home one day of the week, does the work you do allow being away from the office -or are you dependent upon information and interaction with the people there?

Consider what you know about your employer already and if your request can fit in with how the business already works. If you are a new employee, I would suggest speaking with someone about how the request process works, and for requests like desk location it may be beneficial to request this during your new-hire process. It might be easier to create a space for you right off the bat than create a space that needs to be relocated right away.

3. Back yourself up with the right documentation. 

If you are planning on requesting an accommodation, you will undoubtedly be required to provide a doctor’s letter with your request. I would suggest getting this information before making the request, to provide a professional demeanor and show that you know what your needs are and how to go about getting them met.

At the same time, keep copies of all paperwork you provide your employer, as well as request that any negative response you receive in writing. This way, if you begin suspecting a discriminatory situation and feel so inclined, it would be possible to hire a lawyer in your defense. In that situation, the employer would have to prove that your request creates undue hardship. Keeping copies of the paperwork you have provided and the process you went through creates a trail of evidence on your behalf, should you happen to need it.

There are other situations where such documentation might come in handy if things go awry. Unemployment may ask for such documentation (and they have asked me at least once), and other government agencies and services might as for it as well, so it is good to keep anyway.

When having trouble at work, it can be easy to abandon the job and begin over again with the belief things will be different the second time around. I am a total culprit here, and the 15 jobs I have had in the last 5 years is pretty good proof of that.

I’ve been trying pretty hard to learn what I can do, and what I can ask for, to help my chances of success in the workplace lately, and the information really warranted being shared, I think. Most of this I didn’t know before a week or two ago, and why not pass it on if there is someone out there who could use it!

A Stand-in

I have been working on a couple posts, but today is kind of the culmination of the last three weeks -I am finally going to be seeing my psychiatrist. Naturally, I’m feeling pretty rough with the flood of anxiety that has been coming in the last few days leading up to today. This is little more than a confirmation that more stress = more anxiety.

But, instead of shrugging off my Monday morning post completely, I thought I’d post this as something of a bookmark until after things come to a head tonight.

In any case, happy Monday! I’m hoping good things will come of this one.

And as Everyone Knows; Waiting is the Hardest Part

Bipolar Disorder is a funny beast. The moods I find myself in always seem to be completely distinct from one another, and when in one, I’m blind to the others. This leaves it quite difficult to get a full overview at any given time.

A Visual Aid

The chart above is brought to you by moodscope.com, and rather than divulge most of the gory details about what has been going on lately I figured this simple red line could probably tell you all you need to know. It seems to have settled nicely around rock bottom.

So, it has returned. For real, this time. Depression. And as I took that rather steep plunge you can see on the graph around October 1st, I fell into a place I had forgotten. This has occurred enough times now that it goes beyond just an odd familiar feeling, it is like stepping into another version of the life I’m living. Time traveling to begin where the last depression left off, and everything else is a blur of intensely vague in-distinctiveness. The solution? Wait for the time travel to snap back again.

So it goes.

I am currently on a leave of absence from work, or at least I am in limbo -somewhere between a leave of absence and not until the proper paperwork is filled out.

This is new territory for me, the furthest I’ve made it before was asking for the leave of absence and having my HR representative say no. This time around there is a much greater possibility of stepping back into that other reality with a job, but my past experience tells me not to expect too much.

In  any case, I am still waiting things out until Monday when I am finally able to see my  psychiatrist. Though I have seen some slow improvement, the re-introduction of severe anxiety around the prospect of paperwork associated with work (and the leave of absence) has brought back some of the insomnia I had been having with a vengeance. In that way, my job is doing the opposite of what I need right now by not letting me step back from the stress entirely.

Until then at least, this, unless it decides to be cured by an intense bout of pumpkin carving.

When the Doctor is Away

Many people I know who experience symptoms of mental illness have partnered up with a therapist, psychiatrist, prescribing nurse, or general doctor to aid in their care. These kinds of relationships may take a lot of time and effort to grow, and from my own experience I can say that things like trust and understanding don’t come immediately, they generally take some time to form.

That said, it can be a harrowing experience when you have built this kind of relationship and lose access to it when your professional partner in care is sick, experiencing an emergency, or taking time off.

I know I’ve talked a little bit about this before, but my recent circumstances (basically experiencing intense symptoms and being unable to work while my psychiatrist is out of town) have been something of a reminder that it is never a bad time to create a plan in case of future emergency -and know what you need to do in case that emergency occurs when your professional support person is not available.

Now that the weather in Seattle has finally started to turn and it is obvious that fall is upon us, I thought this might be a good time to bring this up again as well. Winter can be a particularly difficult time for people who experience depression or mood swings, particularly in the Pacific Northwest.

So, here are some suggestions that could help you avoid unnecessary risk and potentially make a difficult situation much easier.

1. Talk to your professional support people about what to do in the event of an emergency in their absence. Your therapist or doctor may have special instructions on who to contact if you are having an emergency and they are gone, so speaking with them before and emergency occurs is a great way to start setting up an emergency plan for yourself. At the same time, you may want to request that your support person give you notice if they will be going out of town so you can be well prepared in the event of an emergency.

2. Consider the needs you might have in an episodic emergency and discuss with your doctor if having an emergency medication (such as an antipsychotic you can take as needed) is a possibility in your situation. If an emergency medication is not a possibility, at the very least I would suggest making sure you have enough refills to last the duration of your doctor’s absence.

3. As discussed in In Case of Emergency, I would highly suggest taking the time to create a card or sheet of paper you can carry in your wallet/purse with the following information on it:

  • Your primary care doctor’s name and contact information
  • Your therapist’s name and contact information
  • Any diagnoses you may have
  • Your current medications and dosage information
  • Your medication allergies, if any
  • Any previous hospitalizations
  • And if I am in a situation where I might be given a new medication to try, I like to include previous medications I’ve taken, dosages, and what effects they had (namely the reason I am no longer taking them).

This information can be extremely helpful to have in an emergency when the professionals attempting to help are unfamiliar with your particular situation. It might even be wise to add notes on things like, “do not give antidepressants” in the medication allergies section if you have a history of switching to mania when given an antidepressant. Just last week I had to wrestle with my general physician because the seemingly obvious thing to do (in his opinion) was to give me an antidepressant for my current situation of depression. My psychiatrist absolutely knows better, but my physician isn’t familiar with my history -which is why it is important to be able to relay this information to someone new.

4. Create a plan with someone close to you that defines exactly what an emergency situation is, and when emergency procedures need to take place (such as the emergency room or potential psychiatric hospitalization). It might be helpful to consider the following questions to help define what an emergency looks like to you:

  • Are you someone who is more likely to seek emergency care because of a depressive episode, a manic episode, or a mixed episode?
  • Have you sought emergency treatment before? What symptoms made it an emergency? (Ex., suicidality, homicidality, psychosis, self harm, etc.)
  • Have you experienced a range of severity levels in these emergency symptoms?

For example, I have a 0-3 rating scale for suicidality. If it is at 0, it is not occurring. At level 1, new suicidal thoughts begin occurring in a fleeting way. At level 2, I begin flirting with the suicidal thoughts, and that is where suicidal ideation begins (imaging different acts of suicide). Level 3 denotes a place where I feel convinced suicide is the correct course of action.

So even though “suicidality” might be my emergency symptom, I often feel stages one or two without feeling concerned enough for hospitalization. If I reach a stage 3, I have a contract with myself and my doctors to seek hospitalization immediately.

For issues of psychosis I generally consider severity and length of psychotic period. If you are someone who typically has long psychotic episodes, I would suggest considering any psychotic symptom a cause for emergency.

The idea here is to consider what is the worst you can foresee, based on what you have experienced. I would take those symptoms and make a checklist, and perhaps fill out that checklist twice a day, once your mood begins going into a more intense area.

Talk with someone about what you would consider an emergency, and share the scores you get from the emergency checklist with that person. This way, if you reach a point where you can no longer discern what is an emergency and what isn’t, your friend/family member can make that judgement call for you. And the checklist is a great tool if you do go to the emergency room, they can look and see exactly what the emergency is about.

5. Maybe you don’t have access to a friend or relative that you feel comfortable sharing this kind of information with, and that is ok. I would still recommend coming to conclusions about what you would consider an emergency, and if you ever find yourself at a loss for someone to talk to, contact the Crisis Line. 

I am pretty sure the number varies from region to region, but I am under the impression that most states have one, so it may be worth your while to google it and jot the number down on a card in your wallet/purse. The people on the other end of the line are used to receiving calls from people who are in crisis, so in lieu of a physical person who is present and able to help give direction in an emergency, I would highly suggest this route. These folks are level-headed, and if they are under the impression that your or someone else is in danger (which really trumps whatever your definition of emergency is in the case of most medical professionals), they will suggest going to the emergency room.

Ok, so those are a few ideas on how to handle emergencies in the absence of our professional support team, and I would suggest taking a look at In Case of Emergency as well where I talk a bit about mapping out emergency rooms and hospitals in your area to be prepared in the event of a psychiatric emergency.

For all of this, and for all emergencies, it is much more helpful to begin working on a plan of action when feeling fairly stable, as opposed to waiting for an emergency to happen first. By having a plan worked out, knowing that your psychiatrist or therapist or whomever is out of the office will be a lot less stressful, and less risky in the event an episode does occur.

Controlling the Wave vs. Riding It

For several years I fully believed that if I controlled everything around me I could also control my bipolar symptoms, and that by eliminating all possible triggers I could also eliminate the possibility of intense episodes.

By controlling things like diet, sleep, exercise, and more I found that things were significantly improved, but at the same time, attempting to control everything around me was exhausting. Trying to control everything at the same time felt like a torturous juggling act that would never end, and that is one of the biggest reasons I began trying the traditional pharmaceutical route again a couple years ago. Any help I could get to manage my symptoms became a welcome notion, trying to do everything myself left me wiped out and unable to keep fighting.

It seems like just as there is a spectrum of symptoms for people who are diagnosed with bipolar disorder, there is a spectrum of views on how to manage it.

Living in the realm of intended total control put me at one end of that spectrum, but I have also witnessed the other end up close and personal as well. When I was younger I spent a brief period of time with a religious congregation that believed that my symptoms and subsequent episodes had little, if nothing, to do with what was going on around me, and that by relinquishing all control to God I would be freed of bipolar disorder.

I’m sure most of you know I am not here to condemn any view, belief, or way people with mental illness seek solace -in fact, I definitely encourage people to learn as much as they can about different views on the notion of mental illness and then make their own decision based on what feels right for them.

Saying that, I have to admit that relinquishing all control did not seem to make things easier for me. At the same time, attempting to control absolutely everything had the same outcome; it was not making things easier for me.

For a while I wasn’t quite sure what that meant, if wrestling a beast left me so tired I couldn’t get back up to fight its second wind, and trying to ride it by simply just holding on meant being bucked off over and over again before it was finally subdued, what strategy can I use?

By now I’ve really fallen into a place where controlling those elements around me is helpful, but needs to be met halfway with the idea that if I can’t subdue the tidal wave when it is beginning, it is sometimes more realistic to just batten down the hatches and ride it with what strength I have left. Once the wave becomes a certain size it is important for me to step back and say, “alright, I don’t think I can control this thing anymore, it is time to ask for help wherever I can and ride it out until it finally breaks.”

I can’t say that this has been a magical fix-it solution, in fact I’m really just giving this theory a go the past few months for the first time. I don’t think that just because neither of the extremes of these notions worked well for me it means there isn’t something in them that is helpful and important to learn. It just means that each person is an individual, that our beliefs and the ways we take on the world are all different, and sometimes they change as we do.

One Year Anniversary

So this is the first job I’ve had in a while that is full time, but I’ve quickly fallen back into my old ways. Harassed by insensitive co-worker until I reach a deep state of depression and a high level of anxiety before snapping, and then crying, overwhelmed, to a stone-faced HR representative who is eagerly taking notes.

It feels a little bit like re-living the past, though I am hoping I can change some element of how this goes down before I quit in a final fit of desperation. Or, at least, that is always what seems to have happened before.

This is my one year anniversary of starting this blog, and I’ve been thinking about what to say about that for about a week now. I’ve considered all of the things I’ve learned about myself, and things I have improved, and people who I’ve been able to reach out to. All of that almost seems a little ironic when paired up with this current work scenario, facing something that has seemed almost unpreventable for the last several years -yet again, and finding myself in the same situation.

I’m sure it is my depressed state that is telling me that I obviously haven’t learned enough, or that what I learned wasn’t particularly useful or I wouldn’t be doing this again. But… I don’t think that is true. These guys have a way with telling lies…

In any case, I am going to be comforting myself today with the notion that I have learned a lot, and I’m sure that I wouldn’t be going through the same situation again if there was something there I didn’t learn from it the first time. Or the second, or whatever. This could be a stepping stone to a revelation, after all, who knows.

So, thanks blog. And thanks readers. I’m hoping for something of a tradeoff today, where you give me a little bit of hope, and not the other way around.