Monthly Archives: April 2016

Back in the (Rx) Saddle Again

Living with treatment resistant bipolar disorder can be really frustrating, not just for me but also for those around me. With symptoms that have responded atypically (either worsening or not resolving and accompanied by outrageous side effects) to the traditional route of pharmaceuticals normally used to treat bipolar disorder I have to shift all of my focus onto using skills to help keep me calm and rational.

Even doing everything I have encountered; things like meditation, dialectical behavioral therapy skills, living openly about my illness and asking for help when I can, paying close attention to my diet, sleep, and exercise, -that bipolar spark in my brain remains elusive and unchecked. Under the right conditions, my big mood shifts can happen in whatever direction they choose and I find myself along for the ride.

Lately I’ve been seeing that frustration growing in my healthcare team. In the last two months I’ve been taking a significant shift into depression, enough that both my therapist and new psychiatrist (of about 6 months) have become edgy. My therapist let slip that, “well you would think something should be helping by now!” and my psychiatrist sat, horror-stricken, when I replied to her question about what we should do about my depression with, “well the past few years nothing has worked so we typically watch and wait, requiring hospitalization as necessary until the episode ends.”

Unacceptable!

Maybe so, but it is my life. As much as I dislike being subject to frequent mood swings and psychosis I have reached the point of feeling some form of acceptance over my situation. I can’t throw a fit (though sometimes I do) every time a new treatment option doesn’t go my way, but the slightly pissy attitudes of my healthcare team the past few weeks has initiated something of a domino effect kicking people into gear.

On one hand, it feels nice to know that my psychiatrist feels inspired to do everything she can to try to help me. On the other, after a constant barrage of negative outcomes from medication after medication the past few years I am pretty familiar with how it can feel to be a guinea pig. I’m not saying I am opposed to new options, quite the opposite. I want to keep trying, I want to move toward a life that is stable and more functional, I just need to find a balance where I can do that and not have to be pulled along in the wake of each drug that’s had a negative effect without being able to take a break. When psychiatrists take me on it can be easy for them to look at me as a sort of challenge and they feel eager to throw everything at me they can think of right away without giving me time to recover. It has tended to make me both more physically and mentally sick while this is occurring, so it is important that I can balance pursuing new treatment options and living some of the life I am working to improve.

After how hard it was cycling through medications the last go around (2010-2015) I have been floating around using my cognitive skills and sitting tight taking Lithium that isn’t helping. I have actually been doing better without the barrage of new drugs constantly eroding my mental and physical health, so I have just kind of been waiting for the right doctor, or something new to come on the market, or for things to get rough enough to push me back into feeling willing to roll the dice again.

I wouldn’t normally consider my current state of depression severe enough to make me desperate enough to move back into that place of uncertainty, but last week my boyfriend was gone for 8 days and I was really concerned about being home alone that whole time and having the added stress of taking care of our sick dog on my own.

My new psychiatrist is focusing on making tiny changes in medications (hoping that my big reactions to regular doses might be mitigated by tiny doses) and trying things that have a low chance for making my overall health worse.

We started with a huge increase in my fish oil consumption, up to 2400 mg daily of highly concentrated oil (with a bunch of other specific properties I can’t quite recall). I couldn’t tell if it was helping while my boyfriend was out of town, but I didn’t feel worse, so for depression that was causing me to steadily deteriorate that may have been enough to give me a more level playing field last week.

If the fish oil was helping keep me from sliding further into depression, the plan went to hell a little bit when my boyfriend came home from his trip with a broken shoulder. The immediate jump in stress level left me plummeting and I was frantic this week trying to take care of him, and the sick dog, AND me.

I found myself in a situation where I can’t really afford to be screaming at my neighbors or paranoid out of my mind at the grocery store so I called my psychiatrist and agreed to try an antidepressant again.

I tried Zoloft a few years ago in a similar situation and was manic within a couple days. My boyfriend found me feeling high out of my mind in our apartment jumping around uncontrollably and he thankfully had the frame of mind to point out to me that I was acting a little strange.

Naturally, the idea of taking an antidepressant isn’t one I’m too keen on (I’ve had several mixed or manic reactions over the years to them) but I find my psychiatrist’s theory about trying the tiniest little bit to be intriguing, mostly because I’ve had the same thought myself and anytime I’ve brought it up to a doctor before (or my sensitivities to medications) they always just prescribed a regular dose anyway.

Yesterday I tried 1/8 the dosage of Zoloft as I did the first time around. 12.5 mg, half of a 25 mg pill that is so small I keep losing them. I was able to sleep (which is a good sign) so I expect to keep this up and see if anything happens.

In the meantime I’ll be here doing the best I can.

Swapping Big Moves for Little Moves

Let’s face it, living with bipolar disorder has had a huge influence on the way I make decisions. It hasn’t been all bad, I admit the impulsivity I tend to feel has left a trail of both exciting fun memories in my wake as well as some cringe-worthy ones, but I’ve spent a lot of time considering impulsivity and the ways it has both helped and harmed me.

Instead, today I want to specifically discuss making big moves.

For a long time I believed that I only made impulsive big, life altering decisions when I found myself experiencing hypomania and mania. This was evident when I dropped out of college, for example, at age 19. The idea of living aimlessly in the Colorado sprawl seemed like a wonderful idea, and it was great… for a while.

Likewise mixed episodes have lent themselves to impulsive big moves as well. Spur of the moment breakups would be an example, running away from home. Usually these kinds of big decisions have been fueled by the need to escape something (rather than make a positive change in my life) and the results have tended to be regrettable when I returned to rationality.

Recently I’ve been thinking a lot more about how that overwhelming impulsive urge influences depression, because for most of my life I would say I didn’t think it did. I mean, is sitting down and watching a full season of Ru Paul’s Drag Race because I’m too tired and depressed to do anything else a big impulsive move? Yeah… I didn’t think so.

Lately I’ve been seeing it a bit different. Maybe it is the nature of the depression I face, maybe it is a little mixed and coming with a small paper cup full of mania to act as a dipping sauce. Whatever the reason I’ve been able to hone in on this feeling, this urge to make a big move, and somewhere inside of me there is this spark that says,

If you make a big, sudden change in your life this depression with disappear.

To be fair, I’ve been doing this all along. In my younger years I found myself in some kind of Job-Hopping Phenomenon loop that I tried my best to grasp but couldn’t understand.

I would start a new job, be doing fine, and then start sinking into deep depression. The answer always seemed to involve quitting and starting a new job, where my hypomania would take over and I would feel great for a while until… you guessed it… wash, rinse, repeat.

For the most part I always chalked this job-switching thing to be coming from a place of reason though, not emotion. I told myself, “well, maybe this isn’t the right job for me,” and I’d launch myself out into the world feeling a sense of purpose every time I tried to find a new one. It kind of acted as a really inefficient, W2 swamping sort of band aid.

I didn’t connect the dots between these actions and that general bipolar big move urge until this month. I’ve been declining into depression for almost two months now, swiftly and severely enough for my psychiatrist to be on red alert (more on that next time). Honestly I think what I am experiencing may be a depression-heavy mixed episode because I’ve found myself in several swirling pools of psychosis where I seem to find myself in another place.

While I’m there everything is turned on its head, the only consistent element is that I feel overwhelmingly compelled to make a big move!

Sometimes the urge is to run away and start a new life, or get a job, or demolish my relationships with people… but every time the haze wears off I’ve been thankful to find I haven’t done any of those things.

With my manic and mixed episodes I feel like I have had the opportunity to practice not making those big moves I find myself gravitating toward. I’ve tried to remind myself of how horribly wrong they tend to go sometimes, and how what I am experiencing at the time is typically in the minority of how I feel otherwise.

The last few years my treatment resistant symptoms have left me experiencing severe depression without much alleviation, so much so that the only thing I could do was binge watch Ru Paul’s Drag Race. I feel like that might be what is causing me to hesitate when I fall into those whirlpools that try to bully me into mixing things up, because now I know that even when I do nothing at all I can make it out the other side.

In the grand scheme of things, I often picture bipolar disorder as a set of scales. I used to chuck whatever blocks I could find at them knowing that if one landed, they would flip my emotional state into the opposite direction and I could slide from depression into mania almost immediately. This crude method was effective short-term, but didn’t set up any kind of system for long-term stability.

The last few years I have been learning to scale down those moves when the urges hit. Instead of running away, maybe I’ll take a shower. Instead of getting a job, I assign myself to take out the garbage every Monday and see if I can consistently do it. Instead of destroying my relationships I turn on the Xbox and funnel my aggression into some kind of PvP deathmatch.

Instead of chucking those big blocks at the scales it is more like I am adding single grains of rice. While there is a kind of tension that comes from refusing the big move beast the satisfaction of an impulsive remix, I’m finally understanding that I can come closer to making those scales balanced by making little moves than I ever did with the big ones.

 

Mental State Dual Citizenship

Psychosis has often made it really hard for me to keep things straight, and even in my younger years I put a lot of effort into trying to separate depressive or manic periods and thinking from those where I am more stable. Before I was really able to pinpoint when I was experiencing mania or depression, one of the ways I did this was to consider these situations almost another version of reality.

Trust me, the idea of reality gets rather skewed while experiencing psychosis and though I’ve been on the hunt for ways to gauge whether the reality I’m experiencing makes sense with the reality of the people around me it can be frustrating (and impossible at times) to try to truly gauge the two.

So, as I mentioned, one of my first lines of defense has often been to think of my psychosis ridden bipolar disorder as something of a dual citizenship. That means I am a resident of two worlds; one world everyone else knows and sees on a regular basis, and another where (much like Alice’s wonderland) things can get a little weird.

It might sound a little funny, and while this other reality I live in from time to time doesn’t have talking playing cards or freaky cats (that would be something) I do often find myself dealing with life seeming to have a much different pace, the truths of the reality are often a far cry from what I’m used to, and even my motivations and dreams seem very different than in my regular day to day life.

Yesterday, for example, I spent about half the day living regularly. I washed some dishes, watched Ru Paul’s Drag Race, and talked to my Grandma on the phone.

The other half of my day was spent in depression land, a different sort of reality where (pace) no matter what I did, I couldn’t seem to catch up with what needed to get done. The (truths) I faced in this place seemed to be that my relationship was totally unstable and deteriorating before my very eyes, leading my (motivations) to demand I make sudden and dramatic efforts to curb the situation.

After several hours I found myself back in regular life, the reality of depression land having vanished and been replaced with (pace) feeling on top of things. (Truths) My boyfriend cares about me, he even brought me home some chocolates. (Motivations) For the love of pete, don’t make any sudden moves!

It seems like the last few depressive episodes I’ve had I find myself plopped down right in the middle of where I left off, which is rather maddening and definitely confusing as heck. A bit like waking up from a bad dream only to fall asleep and find myself right in the middle of it again!

Mania land is a little different for me, less like I feel overburdened by the information around me and more like everything starts to fade away like one of those Bugs Bunny cartoons where he keeps screwing with Daffy by drawing him into some kind of weird half plant half platypus and the setting becomes little more than a blank sheet of paper.

The (pace) often feels like I am so ahead of the game that spending six more hours writing isn’t a big deal. The (truths) usually suggest I’ve been worrying far too much lately, leading my (motivations) to urge me to brush off all forms of responsibility or concern. Hijinks ensue.

Mixed land, well, it’s a place I try to avoid at most costs but unfortunately I’m quite familiar with it. Everything about the (pace) there usually feels much too slow, like I am ready to run a marathon but I’m trapped in a vat of peanut butter; too much energy and no way to expel it. The (truths) that seep in tend to be based on suspicion, that people are hiding things from me or are up to no good (heh), leading my (motivation) to either have a meltdown at them or try to sleuth my way to the truth in some kind of jacked-up Film Noir version of reality.

Sometimes describing my mental and emotional states as places helps people understand how jarring it is to be sitting around one minute, minding my own business, and then suddenly be thrust into another odder, often less productive version of my life. I can be sitting pretty one second and in depression land, or mania land, or mixed land without warning; sometimes it takes me some time to even recognize something has changed. After all, the people around me go on with their lives and their own reality as if nothing has changed, and if I’m having a good day they may not notice that anything has changed on my end, even though I’m somewhere else.

Ultimately, time has shown me that I am probably not actually trapped in some outrageous form of reality manipulation by warping me to suspiciously similar copies of my life and that this dual citizenship is actually coming from within me, not externally. Still… I can’t say for certain that there isn’t some kind of brain gnome in my noggin who happens to keep forgetting to turn the basement light off or something, leading me to hear a high pitched whine where there wasn’t one before.

In all seriousness though, mental health is a tricky thing to understand, even for those of us who experience mental illness every day. Having said that, thank nuggets it is therapy day today.

 

Providing an Outlet

Even since childhood I have often equated pain (emotional or otherwise) to be like electricity. Failing to provide an outlet for that force once it has entered my system generally results in short circuiting; an explosion of force down an unintended pathway as it tries to escape.

This morning I leaned in to kiss my partner goodbye as he left for work and stubbed my toe. You know the feeling you get when you know something gruesome has occurred to part of your body (in this case: a toenail) without looking -you can just feel it? Well, as pain started shooting through my foot I knew I wasn’t ready to look down and look at the damage quite yet. Even so, my first impression was to scream out in pain… but with my boyfriend standing less than 12 inches from my face (and it being 7 am in a crowded apartment building) I decided to hold it in.

Big mistake.

That energy that should have been released out my mouth shot down my throat to the next available thing; my arm. I immediately punched the wall (twice, apparently the first time wasn’t quite enough to allow all of that energy to escape) and winced as he left, attempting to walk off the pain in my foot.

While my big toenail is split (right in time for sandal weather, drats!) it wasn’t until my hand started to swell up from punching the wall that I realized that maybe I should have just screamed. Denying myself a natural outlet for letting that energy out certainly backfired, and my attempt to help my boyfriend and neighbors by keeping my seemingly inevitable screaming at bay ultimately hurt me in the end.

In my experience, the turmoil experienced in mental health isn’t much different. Providing myself with an outlet while depressed usually means verbalizing or writing through what is bothering me, while my manic outlets tend to be more physical; cleaning/exercising/and creative based projects. It took me many years to realize that, like punching the wall because of my big toe, failing to give myself an outlet for that energy trapped inside has often led me to explosive behavior, and outlets that have been seriously more damaging than what might have occurred if I had just followed my natural instinct.

I’ve done several training workshops about how to mitigate suicidality in crisis situations for other people, and I was shocked when each technique boiled down one core idea; confront the person about feeling suicidal, and then talk about why they feel that way with them.

Certainly I was expecting black hawk helicopters and swat teams and maybe a little magic to be involved, but ultimately providing an outlet for the person to express those feelings verbally in a nonjudgmental atmosphere proved that allowing some of that energy to escape was usually enough to disarm the threat of imminent suicide and get the person to some kind of treatment.

I would say that usually in my most dire moments I find myself at a loss for how to get that energy out. The fog associated with depression or mania might make it seem impossible, or unnecessary, and I might feel trapped in the moment, unsure of where to focus that energy without hurting myself or other people.

And obviously… I’m not perfect at it. After 15 years of considering this idea I still find myself punching walls occasionally or throwing my phone or rushing to my therapist feeling like a ticking time bomb because I’ve become certain that any words or actions on my part will destroy whoever I’m around (not true, as it turns out, but it still feels that way sometimes).

One thing I’ve done to help myself along though is to make a list for each of my intense mood states of good, useful, positive, harmless outlets that can help me get whatever energy I’m feeling out in a safe and satisfying way. Any time I think of something new, I add it, and that way when I am in the throes of a depressive fog, or so revved up on manic sunshine, or so irritable and agitated I don’t want to leave my room I have a little something to jog my memory.

Otherwise I might wind up punching the wall all the time and I’d never get my deposit back.