Monthly Archives: June 2013

Recommendations for Use of Antidepressants with Bipolar Disorder

Antidepressants and bipolar disorder, should they mix? My own experience with antidepressants has helped fuel the controversial antidepressant fire in my own life, but I was curious to see what the “professionals” had to say about it.

The International Society for Bipolar Disorders (ISBD) Task Force has just released a new set of recommendations for the use of antidepressants with bipolar patients in the American Journal of Psychiatry. The final recommendations are the result of 173 studies, and urge caution. Dr. Eduard Vieta states,

First, they shouldn’t be used in mania or in mixed episodes, they should only be used in bipolar depression in patients with a history of a good response in the past to antidepressants and no history of rapid cycling or switches into mania right away.

(Mixed episodes as well as rapid cycling and switches make me a poor candidate.)

In addition, antidepressant monotherapy (meaning taking an antidepressant alone with bipolar disorder) is not advised, neither is taking an antidepressant if you have predominantly mixed states.

Of course, I could say “tell me something I don’t already know”, but at least these people are putting it on the record and hopefully others will benefit from being spared antidepressants when they are prone to having a bad reaction.

For the entire article, go here.

 

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Camping Recap

While I was camping things were (mood-wise) mostly uneventful, but there was one day where I found myself diving into a mixed episode.

The type of camping I do is historic (pre 1840) camping, which means there are a lot of ways one can get hurt if not careful (guns, knives, cannons, even just stepping on one of the iron tent stakes can do a load of damage). Though I’ve been doing this for my entire life, I find myself rather nervous about the prospect of having a bipolar episode in a place with so many unknown variables.

After all, it is one thing to have a mixed episode at home (and just not to go out) but it is another when your shelter is a tent the size of a bathroom with a fire right outside (and its 40 degrees).

I had all of my pills in that newfangled pill box except my Risperdone (emergency medication for psychosis that makes me sleep) which was in a separate bottle.

I first noticed something was awry when the thoughts in my head became circular. Usually I’m not too worried when these are song lyrics or something similar but this time these were fragments of thoughts. They were getting faster and faster as I walked through the woods toward my tent, and I began to have anxiety about them (and, well, about having any sort of episode in general).

What was I going to do?

Head back to the tent at a faster pace. Take notes in my mood charting book. Possibly take a Riserdone.

Things were getting darker. Not physically, but in a frightening way. All of the little animal burrows around me were filled with snakes and badgers waiting for me to walk by so they could attack me. The forest floor was covered in pine needles and hundreds of spiders were going to come crawling out at any moment.

I remember thinking, “ok, so how long is this going to last?” As I stumbled the last hundred feet to the tent.

I went in and sat on my bed. I wrote in my little note book. Racing thoughts. Fear. Badgers and snakes…

I waited. It didn’t seem to be getting worse. The tent seemed relatively safe, except for the pile of buffalo jawbones staring back at me on one side. I didn’t want to take the anti-psychotic if I didn’t have to because it was still early in the evening (probably around 6) and I didn’t want to force myself to sleep yet.

After a little while I poked my head out of the tent. Lindy (my camping roommate) was sitting by the fire.

I was still worried about things. I know how my mixed episodes can turn into incoherent anxious ranting, so I was waiting for a sign to tell me what to do next.

That’s when Lindy said something (and I wish I could remember it) that made me burst into laughter. The sort of laughter where you’ve got tears in your eyes, whatever she said was really funny to me at the time, and the mixed symptoms sort of melted away into a gentle euphoria.

That was the only mood swing I had while camping (thank goodness) and I’m really glad it didn’t escalate any further than it did.

The last couple times I’ve come home from camping I’ve had mixed episodes, but this time I had two solid days of pretty significant depression instead. The kind of depression where you are so tired you can barely move and stay awake. Tired enough to take my medication wrong, tired.

Thankfully I felt a little more alert yesterday, and a lot more alert today (waking up at 6 am). Overall, a pretty successful trip!

Neuroimaging and Diagnosing Bipolar Disorder

In a recent study published in the journal Psychological Medicine, Sophia Frangou, MD, Professor of Psychiatry and Chief of the Psychosis Research Program at the Ichan School of Medicine at Mount Sinai teamed up with Andy Simmons, MD, of the Kings College London and Janaina Mourao-Miranda, MD, of University College London, to explore whether brain imaging could help correctly identify patients with bipolar disorder.

It was found that MRI may be an effective way to diagnose mental illnesses. The researchers used MRI to scan the brains of healthy individuals and those with bipolar disorder, and using advanced computational models they were able to distinguish the healthy brain from the brain with bipolar disorder with a 73% accuracy.

Currently, diagnosis of mental illnesses comes from a report of the patient’s symptoms and delays in receiving an accurate diagnoses can average a patient ten years.

Despite the promising results of the study, Dr. Frangou said, “diagnostic imaging for psychiatry is still under investigation and not ready for widespread use. Nonetheless, our results together with those from other labs are a harbinger of a major shift in the way we approach diagnosis in psychiatry.”

For the full article, click here.

The B.C. Blog Answering Machine

Hello, I am not available… so if you could leave a message after the beep, I’ll get back to you as soon as I can!

Seriously though, I just wanted to let you know that this is an automated message, and I am out of the state camping for the next week. Posts will resume when I return to Seattle, but in the meantime… why not go back and read some of  your old favorites? Here are a few of mine!

Mood Charting – the Color Band Mood Chart

The Diagnostic Discrepancy

Lithium Toxicity

Cresting the Loop

See you in a week!

Not An Island

Lately I’ve been thinking a lot about why I lived silently with bipolar disorder for as long as I did.

There was, of course, the terror that people would reject me…

Or that, even worse, they would want to bar me from doing the things that I loved.

As much as that fear was an integral part of my silence, there was something else that I think played a larger role.

I didn’t think bipolar disorder, or the inner workings of my brain anyway, was affecting my life in any significant way. Especially when I was in more stable periods.

I thought of myself as an island, and the only parts that would be effected would be the ones that knew about this hidden illness.

Of course, I was one hundred percent wrong. My mood swings were affecting everyone around me, and were effecting my own life in a very significant way.

I’ve been attending a peer recovery class the last few weeks and early on we made a list of the ways mental illness affects our lives.

It can affect

  • our relationships (with friends, family, co-workers, etc)
  • our ability to work (for better (hypomania) or worse)
  • our ability to complete schooling (at practically any level)
  • our housing situation
  • our financial situation (both via working and due to medical costs)
  • our physical health (depending on how well we can take care of ourselves)
  • our ability to take care of others (children, pets, etc)
  • our spiritual lives

And I’m sure there are more that I’m forgetting! Looking at this list really made me aware of how many aspects of my life are affected by bipolar disorder, not just work and relationships. I know that I’ve experienced every single one of the things on this list, and not in a minute way.

I think that only after being open and honest about what I experience could I get the help that I needed in all of these aspects of life. The result? Though these areas are all affected, I am able to lead a more stable life.

Dog Day Afternoon

Today has been a rough one.

I’ve been getting ready for a long camping trip, which has been less stressful than I imagined it would be, however it has been enough to elevate me to the point of being stressed enough for things to set me off.

The neighbor’s dog, for example, was barking today. All day. 

I’m not good, usually, with the introduction of noise that repeats itself for any length of time. My college roommate played the same song on repeat for two days straight so I moved out, and our xbox 360 gets a limited amount of play due the the high pitched whining noise it makes… so you get the picture. I am not someone who can handle noisy situations, or any noise that might cause my brain to warp and want to eat itself.

So the dog. It barked. All day. And by noon I was hysterical. I yelled at the dog, I opened and closed various windows, I stood outside and made eye contact with the dog (during which time he would stop barking until I moved). I even marched over to the apartment with the dog in an attempt to make peace, but his owners wouldn’t answer the door.

I get really panicky in these sorts of situations, and I called Corey in hopes that he would have some brilliant idea I hadn’t thought of to shut the dog up (or noise proof the apartment so I couldn’t hear it bark).

He suggested I leave the apartment. I had so much to do today trying to pack for the trip I didn’t want to leave, but after enough crying and gnashing of teeth, I fled and took Luna for a walk.

I found myself thinking, this is what work feels like. The feeling of being trapped in a situation where I am slowly being driven up the wall, and the only options I have are to do something that makes me incredibly anxious (like confront the noise) or run away.

I know it could probably be said that I am a controlling person (wanting a dog to stop barking and all) but controlling my environment often gives me the best chances of escaping dramatic mood fluctuations triggered by, well, things like barking dogs.

I realize there are other ways to deal with this, but at this point neither a lot of therapy nor a lot of drugs have been able to curb my overwhelming emotional responses so I can’t say I feel like I have many options, short of buying a house with no neighbors with dogs.

But it doesn’t end there, does it? This happens to me when I get things in the mail too, and in so many other innumerable situations (we’ll call it Bipolar Disorder) I can’t seem to catch a break.

I guess today is just a pessimistic sort of day, brought on by one very annoying dog. I’m already armed with the notion of talking to the building manager tomorrow if this somehow repeats itself, so it isn’t like I’m sitting here wallowing in my own misery.

Or maybe I am, but just a little bit.

The Dreaded Weekday Pillbox

Ok. This is exciting news. Are you ready?

I’ve finally done it.

Here is my old system (a.k.a. the bathroom counter):

The Counter

And here is my new, improved system:

Streamlined

(It is almost like I’ve moved into the 21st century!)

I bought one of those handy-dandy sunday through saturday pill containers today.

Why did it take me so long? Well for one, pill containers like the one shown above remind me very much of my grandmother (who is no longer with us) and elderly folks in general. Maybe this is a cop out, but I am not elderly… which for a very long time meant (in my mind) I couldn’t own a pill container.

Just last week I told my sister,

But I am too young to have a pill container! They don’t even make them in cute colors for young people, or maybe I’d consider it.

So what changed?

Well, I’ve had a couple incidents where I took the wrong medication, or the right medication twice, or I couldn’t remember if I took it or not. Though these instances have not happened lately, I am constantly having anxiety about recreating those situations and ultimately putting myself in the hospital by accidental overdose.

On top of that, I’ve been attending a group (more on that later) that was raving about the ease of taking medications from these medication containers, which left something of an impression on me.

Finally, I was at Target today and noticed that, though I probably can’t fit all of the pills I need to in this container, it looked young-ish (thanks to the lime green buttons) and did not scare me off with the traditional seventies color orange that most pill containers I’ve seen seem to be.

My conclusion on the bus ride home was that my need for a better system really outweighs the automatic reflex I have of shying away from these things, and if it will keep me from taking my medications wrong, clears up some counter space, and helps me travel without a second piece of luggage for my pill bottles, then I can breathe a little easier.