Monthly Archives: November 2012

How Best to Assist?

I have several things to talk about, but they will need to be put slightly on hold today and tomorrow while I attend an ASIST – Youth Suicide Prevention Program workshop.

Many of you may not be aware, but I do receive a hefty chunk of emails from people in crisis, or from people who have a loved-on in crisis. If that is part of the territory of having this blog (or from having an association with a local peer support network), I figured having a little extra knowledge on suicide prevention is never a bad thing!

 

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Making Up for Lost Time

I think anyone who has experienced a euphoric low level (or “hypo”) manic state would have a difficult time labeling bipolar disorder as;

entirely dangerous,

entirely awful,

and entirely worth eradicating.

Though there are many people who may not recognize this state (or may not experience it at all), the energetic, positive attitude that comes with it is proof, many say, that bipolar disorder has positive benefits. 

I’ll admit, any time I go a long period of time without being in a hypomanic state I find myself wondering if it is really as great as everyone keeps reminding me.

On days when I experience severe depression or mixed episodes I feel more than willing to do whatever is suggested to me in an attempt to eradicate bipolar symptoms entirely. Even though I’ve seen hypomania as a benefit in the past, it also hasn’t seemed like a worthwhile trade-off. A couple weeks of euphoria for a couple weeks for sheer and utter despair?

Because, don’t forget, hypomania has its down-side too. Potential inflation into full-on mania, or the potential to switch into a mixed state at any moment, even the seeming inevitability of the crash to come are all reasons I could easily say,

it ain’t worth it. 

But then I have a euphoric mood shift, and (as with depression), it doesn’t take long before it has me in its grip. A really fun, pretty, warm, energetic, hilarious, comfortable grip.

I admit, I was very nervous when the Geodon I recently started sent me flying skyward, but after things began to taper off and settle into a place of euphoric hypomania I found myself knocking down the fort of blankets and pillows I had built up around myself because of the depression I was in last month and suddenly I was productive. Finishing projects with little to no effort, beginning new projects with little to no effort, and as the end of my leave of absence has been fast approaching, all of the anxiety I had previously had about it seems to have evaporated.

For me, the total alleviation of my anxiety has been one of the most surprising, and welcome changes. Severe anxiety is one of the major factors in my problems working (I was going to say lately, but actually for the last few years). Being without the burden it had put on me, even if just for a week or two, feels incredibly rejuvinating.

I find myself wandering back to a place of consideration, of wonder, and of easy acceptance. Was I wrong about hypomania? I never meant to rule it out, but I also never expected to find it again any time soon. It has been months since any real stretch of it, maybe the cynicism of the depression and anxiety had beaten all memory of euphoria from me.

Hypomania is the lynch-pin of bipolar disorder. It is what makes it so mysterious, both to those who are observers and those who have experienced it. Our minds want to wrap our mind around this thing, the symptoms as being a horrible and rotten thing that needs to be expelled from the population.

But it is hard to think that way when you feel so good. Free confidence boosters, relaxed muscles, enjoying physical exertion, is it a coincidence that I suddenly feel more similar to the general population than I have in two years? It feels like liquid hope, and it tastes like sour apple ring pops.

(Remember the return to denial I was talking about? I think I’ve met one of its catalysts!)

My particular favorite, out of all of this, is when the floodgates of the mind seem to open after having been shut for so long. Hundreds of ideas come pouring out, and I’ve been running around collecting them to last though the winter (when I am particularly bored, lonely, and out of good ideas).

Need a project? I have a whole list of interesting things to try. Are they interesting because I’ve been disinterested for so long, or are they interesting because they’re truly interesting?

Finally, this break has allowed me to move on to the next thing. I hardly know how to move on anymore without a swift change in mood. For the first time in ages I feel ready for whatever comes my way, and if that’s a fluke, I’ll still take it. 

The Tables Have Turned

I’ve had several inquiries about how things have been progressing with the Geodon, so I thought I would write a quick update.

To my surprise, the reaction I’ve had to Geodon involved being flung from depression up into hypomania territory. Good when compared to depression, bad in a case like today where I have been awake for 20 hours with no apparent sign of impending sleep. 

I have had a few other mild side effects, the most notable being a weird, jittery shaking that makes my teeth chatter sometimes. It leaves me feeling oddly like Cosmo Kramer.

I’ve been on it a week and a half now, and for a brief period I thought the hypomania was venturing dangerously close to mania. It backed off for a couple days, but now has been increasing in severity again.

I’ve been trying to work with my doctor on the sleep issue, but when I changed the dosage times (two a day) around I wound up in a fast-acting unconsciousness between 2 pm and 6 pm. Given the choice, I’d almost just rather not sleep.

Obviously that isn’t a solution, but I will be meeting with my doctor on Thursday, at which point this medication situation will be looked at head-on, as well as figuring out a final game plan for the end of my leave of absence from work in a week.

As a side note, there are days where it feels like I really struggle and I can look at the word “disabled” and feel comfortable with that term. Other days I look at that word and don’t feel like I can relate. Regardless, it was comforting tonight hearing the newly re-elected president saying, in front of the entire nation, that “disabled or abled, [we] can make it in this country.”

FDA Considering Latuda for the Treatment of Bipolar Disorder

A recent article in the Boston Business Journal notes that the FDA is considering Sunovion Pharmaceuticals Inc.’s requests to approve recent drug Latuda for use in treating bipolar disorder.

Currently, Latuda is only approved for the treatment of schizophrenia, but one application is requesting it be approved to be used in conjunction with other medications to treat bipolar disorder, and another application requests it be approved to treat bipolar disorder alone.

If you aren’t familiar with Latuda (Lurasidone), it is an atypical psychotic approved by the FDA for the treatment of schizophrenia in 2010.

Looking at the list of side effects, they look comparable to those of Geodon (which I just started recently). Side effects range from things like uncontrollable muscle movements, insomnia, nausea, drowsiness, and agitation.

I know this drug has not actually been approved by the FDA for bipolar disorder yet, but I do know one or two people that have been taking it for bipolar symptoms. For those of us who have symptoms bordering on schizophrenia (or schizoaffective disorder) or for those who haven’t been able to tolerate other atypical antipsychotics (like abilify, zyprexa, or geodon) it is always great to hear that there may soon be another option out there!

The Denial Relapse

Denial, they say, is not just a river in Egypt. It is also said to be one of the most difficult things to overcome in accepting a notion we don’t want to hear, anything from the death of a loved one to a mistake we may have made, or even an illness we’ve been diagnosed with that might have a particularly harsh connotation. Bad news, it seems, is easier to ignore than accept… and for those that have been diagnosed with bipolar disorder, denial is often the first roadblock that springs up.

What interests me most is a time further down the line. After acceptance has happened (which can take anywhere from days to months to years for those with bipolar disorder) there often seems to be a relapse into that same denial at a later time. What I’ve been thinking about the last, well, couple weeks to be honest (I’ve been trying to write about this for a while), is this question:

What makes the notion of bipolar disorder so difficult to accept?

What is it that makes it so easy for someone with bipolar disorder to slip back into denial about having the illness? It is one thing? Is it many? I don’t think anyone really knows the answer, but I’ve brainstormed a few ideas of where it might come from.

Invisibility – Unfortunately, there is no easy, straightforward way to diagnose bipolar disorder. Something that is seen by one doctor might not be seen by the next, and diagnosis requires a certain amount of perception; on the part of the patient (perception of their symptoms), the doctor (perception of the patient’s symptoms), or on a third party (a parent or friend’s perceptions of the patient’s symptoms).

Since these symptoms may be entirely internal, or happen when others aren’t around, or the doctor may have only seen the patient in a depressed state (without having seen anything else) -well, the whole thing can be messy. I know many people (including myself) who were initially diagnosed with depression or another illness before bipolar disorder, and the information required to make a bipolar diagnosis may take years to show itself. Even if a doctor picks up on it at that time, it could take years before a patient begins to recognize it in themselves.

And, after so long a time, finally receiving a bipolar diagnosis might leave the patient questioning themselves and the doctor that diagnosed it. Is the doctor’s perception correct? Why did it take so long to come to this conclusion? And what if my own perceptions of myself are incorrect? Maybe it isn’t bipolar disorder at all.

Perception of an invisible thing (which isn’t even a thing but a series of feelings and actions) is a tricky business. After all, is a completely un-knowing person more likely to be convinced of the existence of wind over the existence of something that can only be perceived from time to time over a long period by one or two people?

The Norm – There is no guarantee that there will be enough evidence for those apart from the patient to perceive bipolar disorder, and unfortunately there is not a guarantee that the patient will even perceive an issue.

I would say that most people are so used to how they function and how they were raised that they don’t think twice about how they think or function. If you are living with bipolar disorder and have been for a long time, your actions may not seem odd, your thoughts or thought process might not seem odd, they may be familiar and comfortable. When that is the norm, it can be difficult to see why there is any problem. If there is no problem, why change anything?

Blinders – I don’t know if this happens for everyone with bipolar disorder, but I’ve spoken with several people who have experienced this (as I have). The emotions I experience are so intense and convincing that I feel perpetually stuck living from one moment to the next. Each moment is so intense that it becomes its own entity, completely cut-off from the other moments I have had/will have. It is as if each episode comes with a set of blinders, and when depressed there is nothing but depression. When euphoric there is nothing but joy. It becomes very hard to see the “bigger picture”.

This element in particular is the main reason I would guess so many people stop taking their medications suddenly, or suddenly deciding that since they feel amazing, they must not have bipolar disorder.

Mood charting is one of the few things I have found that helps with this, and will let me see a long period of time with no immediate mood affiliation. If anything, it has helped me accept the fact that I have intense mood swings because what I see on the page both shakes off all blinders from mood to mood and the invisibility of bipolar disorder by making something tangible and visual.

Ambitions – This isn’t relevant to everyone, and many people with bipolar disorder are able to hold steady jobs or reach the goals they wish to achieve. Unfortunately, being ambitious is one of the main reasons I have experienced a denial relapse (and have several times) because I don’t know when to pull back.

My expectations for myself are the same as before bipolar disorder was an issue, and though that isn’t realistic for me (as things have not only worsened but I have no supportive medications) I have a hard time knowing what I can and can’t do. Nothing makes me believe I can shake off bipolar disorder like a good challenging opportunity, especially if there is a chance I will make good money off of it.

I am in a situation where I need to set some limitations for myself, but that isn’t the norm for me. Failing to make a change here will probably ultimately lead to continued relapses in denial.

Existence Stigma – Denial relapse can be particularly easy when someone who is ignorant, but important to you, tells you that mental illness doesn’t exist, or that it is something that people “make up”, or that being stronger, talking less, and thinking happy thoughts will eradicate all of your symptoms.

It could be anyone, a relative, significant other, maybe even someone on TV, but being told that your illness doesn’t exist enough times could potentially leave you believing it.

I am someone who is all for looking at different types of treatments or philosophies around mental illness, but encouraging people not to get some kind of help and denying the issues entirely is something I can’t stand.

This is something I have come across, and I can sadly say that at one time in my life I totally dodged treatment because my boyfriend at the time told me that there wasn’t anything wrong with me and “love” would make everything better. When young and manic, that made perfect sense to me, and I found myself back in the denial relapse.

Flaw Stigma – There is also the belief that having something like bipolar disorder means that you have a large character flaw, and you can probably see how that might make one second-guess a diagnosis. If being told that having bipolar disorder made you un-likable, you may not want to admit to anyone, not even yourself, that having bipolar disorder was a possibility.

Treatment Stigma – Sometimes fear of treatment deals the ultimate blow, and there are so many misconceptions about what treatment means for mental illness that the notion can be confusing and overwhelming. Some might believe that treatment involves being locked up, or being given medications without consent, or being shocked without consent.

Usually the view of treatments for mental illness are that they are hell. While many people have absolutely no problem at all, it is true that other people struggle. Unfortunately the alternative tends to be a worsening condition, requiring more treatment once that denial relapse wears off.

So what makes the notion of bipolar disorder so difficult to accept?

I think the answer is a little different for everyone. In the last ten years, I’ve been guilty of falling victim to at least half of the things on this list, if not more, and that’s what troubles me I guess. Somehow, after ten years I still find myself slipping into a place of denial… and to claim that I haven’t would be an almost bigger lie. I thought by considering the reasons, I might find a clue in avoiding another relapse.

Did I miss anything? Have you ever found yourself believing that there is nothing wrong, that you suddenly woke up and don’t recognize the illness you’ve been told you have? What has brought about a denial relapse in your life, if you’ve had one?