Monthly Archives: May 2014

A Bittersweet Return to Psychiatry

As you may remember, the healthcare reform required that I find a new psychiatrist… only to have that one present itself as unreliable. After a few desperate phone calls and a miracle (the fact that my old psychiatrst is now taking my new insurance) I made an appointment with him a few weeks ago.

The appointment was yesterday, and though I’ve only been without a psychiatrist for three months it has felt like forever. While I waltzed into his office feeling quite chipper and very glad to see him, the appointment was rather bittersweet.

At this point it seems like my mood swings have developed something of a pattern, something that hasn’t happened in the three years I’ve been mood charting and tracking my symptoms. I could be jumping to conclusions here, after all the pattern might have been spurred by the pain and/or medication from when my ovarian cysts have been rupturing (now two for two, two months, two cysts). While I would be thrilled to be able to expect some level of predictability with what I’m dealing with, I’m not holding my breath for at least another month so I can see what happens next.

So far, the pattern looks a little something like this:

16 days hypomanic level euphoria dominant mixed episode
6 days with multiple depressive mood swings per day
5 days of stable mood
6 days with multiple depressive mood swings per day
17 days hypomanic-manic level dysphoria dominant mixed episode
6 days severe depression

I realize this is like… barely a pattern, but it is more like a pattern than anything I’ve experienced before.

Anyway, bittersweet. Great to see my old psychiatrist, but somewhat alarming to realize he has given me every medication (save the newest one, Saphris) that is available or reasonable for me to try. Three months ago I knew this, so why did it feel like such a shock to hear again yesterday?

It seems like I’ve exhausted nearly every possibility when it comes to psychiatric medications without any luck. I say nearly because, again, I can try Saphris (though I want to make sure I can get it for free before consenting to that, it currently has no generic and is terribly expensive) and I’ve agreed to try Seroquel. Again.

The thing is, I was first given Seroquel (quetiapine) while hospitalized, and they gave me a massive dosage first thing in the morning. Within an hour I couldn’t stand or walk because I was so dizzy, and because of that I told them I wouldn’t take it again. 

I think things might be different if I can take a little bit at a time at bedtime and get my body used to the effects (as long as they aren’t as horrible as they were taking a massive dose). You see, I have a very sensitive body chemistry and I tend to feel side effects somewhat exponentially, in conjunction with most medications having little positive effect for me (treatment resistant symptoms!). I’m more than willing to try this again, because frankly I have few (two?) options left in this realm of medicine.

By 2 pm yesterday I was feeling completely despondent and suicidal. I mean, nobody likes to hear that they feel like shit but there are no medications left to treat me. Talk about hopelessness!

That is, until I started thinking about the other options out there. I know there are still many other types of treatments I can try, it just gets my goat how often people (patients, doctors, pharmaceutical companies) promise guaranteed relief from pharmaceuticals when that hasn’t been my experience at all.

At this point, though I’ve tried acupuncture, there are other alternative treatments out there I can try. The trouble is that the ones my insurance covers are the ones I can afford at this point. I went into a terrible amount of credit card debt when I was trying acupuncture as a treatment method and unfortunately it didn’t do much to help me at the time.

My mind circled back to the idea of ECT. I don’t think my psychiatrist has brought it up lately because I really freaked out on him the first time he did. My reaction was the same as the first time I was suggested lithium, namely;

“Seriously? My symptoms can’t be THAT bad, right?”

Here, three years later, I can’t hold down a job. I’ve given up doing most of the things I love to do. I’ve tried every medication available to me (well, nearly) with no improvement. I yell at people in public uncontrollably while manic, I deconstruct my relationships while depressed, and I can’t tell the difference between reality and delusions while in mixed episodes. Are my symptoms bad enough to warrant ECT? Yes, I dare say I think so.

So… there. That’s an option. And just feeling like I have an option (albeit a bit of a scary one) makes me feel slightly better. After my last hospitalization I’ve always said that if it came to being hospitalized vs. trying ECT, I would rather try ECT.

I’ll try the Seroquel thing first and see how that goes, and I’ve got Saphris to try as well. Having said that, I’m planning on putting the option of ECT back on the table next month when I see my psychiatrist and see what he says.

I know I’m not the only one out there who has had trouble finding treatment options that work for them. I know it is simply the sickly, syrupy voice of depression when I feel singled out of a group that has already been singled out. The truth is not that I’m an “outcast’s outcast”… but so much of our lives involves comparing ourselves to the people around us that the things that make us unique often feel like pitfalls. I have to (and I will) find a way to make life work for me… and given my tenacity I can’t imagine anyone better suited for the job.

Update! A New Page is Now Available!

Hey folks! I just wanted to let you know that there have been a few changes to the website, chiefly a new page called About This Blog which I hope will act as something of a manifesto outlining the ideas that back up the bi[polar] curious blog!

When I started this blog a couple years ago I didn’t know exactly where I was going with it (or what I was getting myself into). Now that I’ve been doing it for a while I’ve been able to nail down the values I intend to keep powering the things you get to read!

I also wanted to add this page to inform people of where the posts on my blog are coming from and why I don’t endorse certain products or websites, often brought to my attention by third parties. That doesn’t mean I’m not willing to consider your writing, images, fundraiser, or product for the blog, just that I hope people will be able to get a more straightforward idea of what my criteria is for these kinds of posts.

So, do you have questions about this blog? Are you curious as to where this information is coming from? Check out the new About This Blog page, now available from the tabs at the top of the home page.

Thanks! And as usual, if you have any questions you can reach me at host@thebipolarcuriousblog.com

Tattoos and Closure

In many parts of America I think tattoos are written off as the hallmark of degenerates. I think what our culture is slowly realizing (on the tails of American youth) that tattoos are no longer symbols limited to criminals, gang members, and salty dogs, but are swiftly being acknowledged as a disciplined art form that has been spreading (especially through the Pacific Northwest) like wildfire.

Today many different people have and are getting tattoos, and the reasons people get them are practically as widespread as the artwork itself. Some people consider their tattoos to be living works of art with no connection to any specific motive beyond a sense of their own enjoyment of a color, a shape, or an artist. Others collect tattoos to represent things that are important in their lives, like their children. It isn’t uncommon for people to get tattoos as a milestone representing a celebration like graduating, moving to a new place, or starting a business.

While I don’t want to detract from these (and other) reasons people have for getting tattoo work done, I want to specifically address another big reason people seek out the experience of getting a tattoo; closure.

While many people get tattoos as a symbol for a milestone event in their lives, it is very common for these events to have something to do with loss. A memorial piece for the loss of a loved one (like a parent or pet), a cover-up piece to detract from scars associated with physical loss (like a difficult surgery or self-harm), or a piece to symbolize the end of something difficult (like a relationship) are all ways people seek closure through the art of the tattooing.

I find that many, especially those seeking a tattoo to move toward closure, are infatuated with the ritualistic method of tattooing as well. I really believe that most people in the process of seeking closure experience some degree of anxiety about it, which is somewhat amplified when that person is about to be tattooed. As the artists works, there is physical pain that might (as some might suggest with self harm) be like a physical manifestation of the pain the grief of loss has been causing internally. When the piece is finished the pain subsides and is replaced with something beautiful, something permanent that can act as a visual reminder of our loss, replacing that constant need to obsess over it mentally.

***

After somewhat inadvertently escaping an abusive relationship in 2006 I didn’t realize how much I’d been effected by it until a couple years later. Though I’d moved on and lived in a different place and was in a new relationship, I was in a constant state of terror that my ex would reappear and set fire to everything I’d built.

This fear was not entirely far fetched. It had been common for him to track people down and show up without warning, and though I thought I had made it clear to him never to come near me again, I had the slow churning of the anxious bipolar mind working against me as well.

When I would have periods of psychosis, I was the most afraid. Afraid in general, but mostly afraid of him. My paranoia would take over my life and I would be afraid to open the curtains or unlock the door. After changing my phone number and moving again (for the 4th time since I’d seen him last) I still didn’t feel safe. I still didn’t feel free.

By last year (six years after the relationship ended) I still felt as anxious and terrified as ever. I was afraid I would bump into him in the street (despite a rumor that he lived in another state). I was afraid that I would come home one day and he would be in my apartment. I was afraid that he would do something irrational… and that’s when I took a look in the mirror.

If anyone was being irrational, it was me. I was in a constant state of being engulfed by fear, fear of something that wasn’t very likely going to happen at that point, if it had at all. I had obsessed and worried so much that I felt swamped, completely unable to tell what signs to consider threats and what was harmless.

In a manic epiphany (I tend to have one every few years) I concluded that I should get a tattoo. The tattoo would be a moth, because my ex was terribly afraid of moths. This permanent symbol would act as a talisman, and perhaps not directly repelling him, if I associated myself with something he considered repellant, I hoped I would feel empowered. A reminder that I am safe now.

Frankly, I wasn’t sure if the idea would work. Surely, getting a tattoo would work (I already had two at the time) but I didn’t know if I could ease my mind this way, particularly a very anxious, obsessing, bipolar mind.

When the mania wore off I still felt inspired, and within a few weeks I met up with a local artist (a great one, I might add) who tattooed me.

(I also wanted to note that you wont find any images of my tattoos on this post because I don’t post images of my tattoos on the internet. I prefer they remain singular works of art, not copied by anyone else.)

I don’t think the change was immediate, but I am sitting here almost a year later and haven’t had any problems with anxiety or paranoia about my ex-boyfriend in months. Of course, that isn’t to say that I haven’t had any anxiety or paranoia about other things, but the fear I had before (particularly about him breaking into my apartment) seems to be quelled.

Going through with getting something as simple as a tattoo has greatly improved the amount of closure I have felt about a traumatic time in my life and lessened my fear about my past, and scaling back that fear has meant specifically (for me);

  • Less frequent apartment lock checking (especially when I was getting up in the middle of the night several times to check locks)
  • Being able to keep the window open when I am at home
  • Being able to be home alone without leaving every light on
  • Feeling comfortable leaving the apartment more frequently
  • Less concern that he will jump out at me on the street, I am able to walk much more relaxed
  • I no longer feel the need to keep moving around or changing my phone number

I realize the idea of using tattooing as a way to help combat anxiety or fear is something that people may be skeptical about, and that is why I wanted to share my experience about it. There are many people out there who, like me, see tattooing as a form of therapy.

After all, there have been moments in my regular therapy sessions where my therapist has asked me to close my eyes and imagine wearing an outfit that makes me feel confident, strong, and relaxed. She said that any time I can close my eyes and imagine I’m wearing it.

All I’ve done is taken this idea one step further. I thought of something I can wear that makes me feel confident, strong, and relaxed… and I’ve permanently adhered it to my body.

Now I never have to close my eyes and imagine, I can just look down and remember who I am.

Improving Mental Healthcare Access for Veterans

Happy Memorial Day folks!

I wanted to take some time to bring a little awareness regarding an issue that I consider extremely important right now, and that is the long wait times and limited access Veterans have for receiving mental healthcare.

As someone who lives with bipolar disorder in the pacific northwest, I have seen (and experienced) huge wait periods between when myself or my peers have needed to see a specialist and when we’ve actually been able to see one. Unfortunately, this is something I’ve rather come to expect these days.

What I don’t expect is similar wait times for veterans. While I’m not here to say that veterans are somehow better than the regular population (in fact, I generally consider myself anti-war) but these are people who have already given up an extraordinary amount for the sake of the rest of us.

As someone who has been in the position where long wait periods for psychiatrists left me with no other choice than to enter a psychiatric hospitalization I understand how hopeless this situation can feel, and I hope our government can take action on getting these folks the help that (I dare say) they’ve earned.

You can find an article with a little more detail about the situation here.

Study Suggests Link Between Migraine and Bipolar Disorder

As someone who experiences both migraines and bipolar disorder, I was not particularly surprised to hear that a new study is suggesting a link between the two.

The study conducted at the Penn State Milton S. Hershey Medical Center found that migraines were more likely among those with bipolar disorder than the general public. To top it off, these folks are also more at risk for worsened psychosocial functioning, more severe depression, and an earlier onset of bipolar symptoms.

Findings also suggested that women are more likely to have both migraines and bipolar disorder compared to men, and those that have been subject to abuse (emotional or sexual) or emotional neglect were much more likely to have both problems.

The article closes with a statement suggesting;

“Some patients have more stable moods when their migraines are well-controlled.”

Personally, I have found this has certainly rang true in my own life. The less migraine pain I experience, the less severe my bipolar symptoms (generally) are.

You can find the full article here, check it out!

Mixed Themes and Risperidone Dreams

Day 17 of the mixed episode I’ve been residing in, longer than most mixed episodes I’ve tracked at this point. Mixed episodes are generally the biggest time for concern in the day-to-day of my bipolar life because each one brings something new to the table (a new concoction of depressive and manic symptoms) while adhering to an underlying theme of cynicism, anger, and hostility.

To top that off, mixed episodes are also the time I most often (though I do, at times, during mania as well) experience psychosis. Delusions, hallucinations, paranoia, and unbridled fear aren’t always present at these times, but they can pop in at a moment’s notice, rearing their ugly snake-covered heads and bringing down everything around me.

I often consider mixed episodes to be the trifecta of evil. My symptoms of rage and hostility put all of my relationships at risk, the unbearable agitation and confusing physical symptoms leave me desperate, and therefore put my own life at risk (via impulsive suicidally), and the ever-present chatter of what seems to be thousands of thoughts all being read aloud by different voices talking over each other in my mind (well, that and the psychosis) is a recipe for mental falling-down-the-rabbit-hole risk well outside the realm of what depression or mania seem to press on their own.

During my last hospitalization (April, 2011) where I was jumping between suicidal depression and psychotic mixed symptoms the house psychiatrist prescribed me Zyprexa. That was the first time I had ever taken an antipsychotic drug before, and though it seemed to help something at the time, I couldn’t convey to my psychiatrist upon leaving the facility exactly what that was. 

I’m not particularly surprised by this, after all… I was pretty familiar with symptoms of depression at the time, and though less familiar with symptoms of mania I could identify them. Mixed episodes were, however, something I did not understand yet. All I knew was that I felt horrible at times, the most horrible I’d ever felt, and I couldn’t quite nail down exactly where that terrible feeling was coming from.

I continued taking the Zyprexa for two months and rapidly gained 40 pounds. Long red stretch marks began to appear across my entire body, and it seemed that any benefit the drug was giving me was being quickly outweighed (heh) by incredible weight gain.

Together, my doctor and I began testing other antipsychotics on my system. We landed on Risperidone, and though I had the least side effects from taking it I still had to deal with intense drowsiness (often knocking me unconscious within 30 minutes of taking it and elongating my sleeping habits to 12, 14, sometimes 16 hours after having taken it) and severe brain fog that made it difficult to put thoughts and words together.

Because of how sleepy it made me, both my psychiatrist and I concluded I couldn’t take it all the time (as I still had a job at the time). Instead he decided to give me a prescription and allow me to take the drug as needed. 

As needed. Yes. The last couple years I have taken .5 mg of Risperidone as needed for symptoms like psychosis or… you know… violent hostility. Honestly, I’ve often opted to take Ambien instead because it put me to sleep immediately in a similar manner but didn’t leave me feeling like a total train-wreck the next day. Since most of my mixed episodes have been fairly short and sweet, it didn’t seem necessary to really bombard myself with drugs. I’ve been somewhat wary of taking more Risperidone because I was nervous about not being “on the ball” for plans the next day, and because I haven’t take it much, I often forget about it entirely.

It can be easy to fall into a place where I feel overwhelmingly awful and not be able to see the things around me that might normally help me feel better. I think this is part of the reason why I am on day 17 of my current mixed episode and only began taking the Risperidone on day 15.

And I found it. That thing, the elusive thing that I couldn’t discern when I was taking Zyprexa a few years ago. I knew that when I took it, something was different. Some symptom was gone, but my mind was just too foggy to be able to point it out.

Yesterday morning I woke up after a 14 hour Risperidone nap and there was the brain fog I was expecting. However, there was something else I wasn’t expecting.

Silence.

My mind, so loud and chattery and unruly the night before, seemed to keep sleeping even after I opened my eyes. Yes, I felt a little stunted and perhaps a little dull, but this was a dullness I was thankful for. That brain fog that I had wrestled with so much a few years ago was now the thing that seemed to be making taking this drug worthwhile!

I feel like treating bipolar disorder is a constant game of “which is worse?” While some side effects from medications or other treatments might seem unbearable in times of stability (or during less severe episodes), there may be times where certain symptoms or types of episodes feel far worse than those effects. The biggest trouble is that ever-changing-symptoms make it incredibly difficult to discern when “worse” might become “worth it”.

When Therapy Doesn’t Work

I’m a firm believer that therapy has helped me a lot. It has helped me understand things about myself I didn’t know before. It has helped me move on and get closure from trauma. It has also been a space for me to be able to express all of my frustrations (without bringing down everyone else in my life). I have learned the so-called “tools” in therapy to help me cope with anxiety and bipolar episodes as well. In fact, I often suggest to people dealing with any issue they find to be overwhelming (not just mental illness) that they see a counselor or therapist to talk about it. Something about talking about our problems out loud helps us understand them better, so overall I think it is a win-win situation.

While all that sounds great (and it is all true), finding a therapist who is a good fit can be challenging. On more than one occasion I’ve found myself in a position where the benefits I was receiving from therapy was being outweighed by negative parts of the experience.

In the past I’ve had issues with the attitudes of therapists, whether that was from being aggressive (which was a turn-off for me), or being too passive (not seeming to care about my issues). I’ve had issues with therapists who had conflicting viewpoints from me (though rarely). I’ve had issues with therapists who didn’t know enough about the issues I was dealing with to provide a well-educated viewpoint.

The one issue I have had with therapists that I consider a hands-down deal-breaker is disorganization.

As someone who lives with Bipolar Disorder, OCD, and Anxiety, there is a certain level of reliability that I require from my health care providers. That includes my primary doctor, my prescribing psychiatrist, and my counselor or therapist. There are times where my condition requires emergency treatment, and I need to be able to rely on my team to get the help I need.

I always feel that I am in a constant state of reminding people that they should expect quality treatment from their doctors, therapists being no exception to the rule. You wouldn’t believe how many people I know who continue to see and pay therapists who do not act respectful to them, who don’t call them back in a timely manner, or who make them feel worse after a session than when they came in. Essentially, this is a situation where you are paying someone to provide support to you… if they aren’t doing that, what is the point?

The difficulty comes in finding the right match, and that many therapists have continued to have paying patients despite providing poor care. If people seeking out therapists aren’t demanding great service, how can we expect to find that great service without creating that demand?

At the same time, I understand that therapists are human. They’re human! Some of them have even gotten into their current field because of their experiences with depression or mental illness in their own lives, which I think is awesome. This is one of the reasons why I think there is a certain level of negotiation you can turn to when it comes to interacting with a therapist.

I’ve been having trouble with my most recent therapist since I began seeing her. I knew part of it was because I liked the one before her so much and we’d worked so well together, so when I reached the point where I was having trouble connecting with her (the new one), we talked about it. Since then I found she was much more attentive and empathetic to what I was saying, which really helped me feel more at ease.

Over the last year and a half, we’ve had ups and downs. For a while she was rarely on time, but began showing an active interest in fixing that, so I let it go.

What I can’t let go, however, was last week’s Lithium emergency. She told me on Tuesday she would contact my (potential) future psychiatrist about a prescription, and then never called me back. She also seemed wildly cavalier about the notion that I would suddenly be unmedicated… which is a big red flag for me. If one of the people on my healthcare team doesn’t care when I am experiencing an emergency, I know I need to shift that position to someone who will. Even giving her the benefit of the doubt (she could have been busy?) I would rather work with someone who has the time to help me.

Six months ago I was worried sick about the prospect of changing therapists, but now I think it is necessary. I am only hoping the clinic will allow me to switch to another person there, instead of having to reach out to other clinics in the area.