Tag Archives: Depression

Thyroid Hormone for Depression

I mentioned recently that my psychiatrist has decided to change directions in how we try to treat the mood swings I have emanating from treatment resistant bipolar disorder (type 1).

In the past six years I have actively tried several benzodiazepines (like clonazepam, or lorazepam) , antipsychotics (risperidone, ziprasidone, olanzipine to name a few), mood stabilizers (lamotrigine, oxcarbazepine, gabapentin & more), and antidepressants (sertraline, fluoxetine, bupropion, etc.) but have always experienced either:

  • worsening symptoms
  • side effects severe enough to warrant stopping the medications
  • or tolerable side effects with no response from my symptoms.

The only psychiatric medication I’ve been able to keep taking regularly is Lithium, and while there is some debate on whether it is helping I’ve been taking it for long enough that I am having no side effects so the consensus is usually just to keep taking it.

Starting any of these new medications has typically made my mood swings worse (more frequent and more severe) so it has been a bumpy ride. After my new(est) psychiatrist got a good look at this happening she decided it is probably useless at this point to keep trying in these same classes of drugs I’ve had problems with. Needless to say, this was both a relief (hooray for no more psychiatric drug barrages!) and a little disheartening (alright then, now what?) but after all I’ve been through I’m more than willing to break away from this cycle and try something new.

Like anyone who finds themselves chained to the great lithium beast I have to go get my blood checked every few months to monitor the level of lithium in my blood. During these times I often also undergo other tests to check things like kidney and thyroid functioning.

Apparently my thyroid level doesn’t appear to be outside the range of “normal”, but my doctors have found that for me a tiny change can make a huge difference (as seen with my reactions to most drugs). My psychiatrist also told me that sometimes thyroid medications can be used to treat resistant depression, so our next route is to give liothyronine (cytomel) a shot and see what happens.

I always get a little nervous when I’m given a new drug to try and my doctor asked if I thought it would be better to start it when I am feeling more stable or unstable. That has always been a tricky question for me because if there are significant side effects a drug can easily take me from stability to a place of being unstable, and having less stability I tend to want to take advantage of those times as much as possible. At the same time if side effects occur when I am already very unstable I am less likely to cope in a healthy way so I told her don’t think there is a right answer here.

Ultimately, I’ve had the flu for the last week so as soon as I feel better physically I’ll start the liothyronine regardless of what my mood decides to do. This one comes with all kinds of obnoxious directions (take on an empty stomach at least 30 minutes prior to eating, no antacids for at least four hours after taking it, can’t be taken at the same time as vitamin or mineral supplements -sheesh!) so I need to do some work shifting all of my medications into a system that will allow me to follow those rules.

As scary as it can feel not knowing what will happen, I always feel some element of hope that this time might be different. If I didn’t feel that I’m sure I would have given up ages ago. It might be that I’m just stubborn or absurdly optimistic at times too, but it is easy to gamble when I feel like I don’t have much to lose and there is potential for increadible gain.

Advertisements

Coping with Coping

Of all the things I’ve read and researched and talked about in terms of coping with mental illness I don’t think I’ve ever quite been prepared for the notion of coping with what comes next. Having poured my full attention (alright, we’ll say about 75%) into how to cope with living with treatment resistant bipolar disorder I’ve found which strategies have been helpful for me (DBT, ongoing therapy, group therapy, limited drugs and herbal remedies) and which haven’t (CBT, psychiatric medications -though my doctor is now trying a new approach which I’ll discuss later on, and the old fashioned I’m-going-to-stuff-all-my-feelings-down-and-ignore-them trick, to name a few).

In the time I have spent with the majority of my focus on mental health related topics (about 5-6 years) I often found myself growing in helpful ways, but then sort of falling behind every time I had a major episode. I would say that in that time I very rarely felt like I was able to get ahead of the curve when it came to my mood swings or anxiety and even when I was able to rebuild my own sense of self and self-worth from the ashes of a major depressive or psychotic funk my treatment resistant symptoms had a habit of pulling the rug out from under me all over again, requiring me to start at square one.

While I don’t like the idea of calling myself self-absorbed or self-involved, living this way (without continuously going full ass-over-tea-kettle) has meant spending a LOT of time crawling my way out of the dark corners of my mind with nothing but a spoon and a flashlight, or untangling myself from the intrusive thoughts that pop up, or needing to ask people to help me by doing things that seem strange to them, to say the least, in order to keep from constantly triggering me. I’m fully aware that this sort of living probably doesn’t look good to those on the outside looking in, and having to spend so much time focusing on my own issues has meant having a hard time with personal relationships (wait, when is your birthday again?) and generally seeming like a distant asshole.

That life, though, that sort of living and coping with the constant need to pay attention to every little detail inside myself in order to keep from being overwhelmed by it, that is honestly where I have built a (we’ll say -though not exactly) comfortable existence for many years. This is the world I know, the world that is 75% me dealing with my own mental health issues and having 25% of my time and energy and interest left over for things like relationships with other people, doing housework, leaving my apartment, having a job, and being creative. Showering. Playing with my dog. Discerning which banana has reached peak ripeness. Important things. If you consider it, 25% of my time isn’t a lot to try and do all of those things and I’ve had to cut out a lot of them, especially since that 25% has encompassed when I’m feeling at my best. In a full blown episode I might have only 5% of my brain available for all of those things, so obviously taking advantage of every resource available to me to try and increase that number has been my main priority.

Alright, so if that is a general approximation of how things have been the past 5 years, what does it look like when the numbers begin to change?

Even without a medication to help stabilize me my doctors and I are beginning to realize that I am more stable when not subject to a constant barrage of new medications to try. My system is simply too sensitive to keep playing medication wheel of fortune on repeat, but given the proper amount of down time to sweat out all those side effects I can function better without them (go figure). It isn’t the difference between being totally stable and in crisis, more like 25%-30% stable or in crisis. I’m not suddenly a rocket scientist or anything, but every little bit helps.

After that important discovery, DBT (dialectical behavioral therapy) coming into my life has made a huge impact. Again, not cured or totally stabilized by any means but I’m learning to cope more effectively. Instead of having to crawl through the dark recesses of my mind with a flashlight and a spoon it’s like I’m learning where all of the light switches are. When I’m getting tangled in obsessive or anxious thoughts I’m learning that the less I struggle, the less hold they seem to keep on me (like that plant in Harry Potter, oh, you know the one). With all of the things I am learning, I am definitely making changes in my life that are allowing me to go beyond having that limited 25% external focus.

But here’s the kicker. I’ve found that working on coping with my mental health issues isn’t enough. No, there is actually a subplot here where I am rapidly discovering that having time to focus more on the world around me, and particularly the people in that world, has meant having to learn a whole new set of skills to cope with the clarity that my newfound perception is affording me!

Being in a position to improve my own mental health has made it difficult for me to watch the people in my life who may not be coping with their own situations very well… and I may not have noticed how frequently many of them were struggling until I was able to look away from my own problems enough to see it. In a sense, I’m having to find ways of coping with the realizations and discoveries brought on by my initial coping and it feels like the most bizarre twist life has thrown me in a while (and I’ve had psychotic episodes so that’s really saying something).

Somehow… being more self aware has led to me needing to spend less time being self aware, and all that extra focus I’ve been able to put on the people around me because of it has made me see things I really didn’t notice before. The most maddening part of all of it is discovering that most people aren’t even aware these issues exist, or are quick to deny them, or cope in ways I know are wildly self deprecating and dangerous.

In that way, the coping that has been afforded me through DBT really started out as all hearts and stars (and horseshoes, clovers and blue moons… pots of gold and rainbows, and the red balloons!) but I’ve concluded that with the knowledge I’ve gained I inadvertently stumbled upon a double edged sword. I never asked to be able to use this strange, newfound mental health x-ray vision on others… I only wanted to use it on myself! Damn.

I’m doing the only thing I can do (or at least, what I can do and keep the relationships) and try to practice being nonjudgmental and accepting and all of that exceptionally difficult stuff, but there seems to be a natural shuffle where many aspects of my life (including my different relationships) are currently up for reevaluation because I’m seeing everything in a whole new light. I want a healthy life that will help reinforce the positive strategies I have been learning because without the aid of medication, they’re one of the only tools I’ve really got. At the same time we’re all human and I can respect the fact that no matter where I go or who I meet, the vulnerable flaws of humanity are not escapable.

As always, I’m working to find the balance between these things, even if the ride has been wholly unexpected.

 

 

PokéMania

I remember waking up early on a Saturday morning before my parents were awake to play Duck Hunt on the NES as a child. I wouldn’t call that my introduction gaming induced mania, but it certainly had me hooked on gaming.

By the time I was a teenager and my mood had begun to destabilize (even though I didn’t know it was bipolar disorder at the time) I found that the power I felt beating my teenage boyfriend at Mario Kart 64 on vs. mode 82 times in a row was obviously feeding something, and I didn’t quite know what it was or how to stop it -but then again I didn’t want to. It felt incredible.

By the time Everquest was in full throttle in the early 2000’s I was able to limp our computer and dial-up to a place where I could play it, and I discovered some very important things.

  1. I didn’t want to stop. Not to pee, not to eat, not to shower. Heaven forbid any of my family members needed to make a phone call, that was outrageous.
  2. The main reason I didn’t want to stop was because of how miserably depressed I felt in my daily life, and when I played Everquest I found myself feeling like a million dollars.
  3. Constantly choosing the sleepless mania of gaming and feeling good also seemed to have negative consequences in all other aspects of my life, but for a while I was feeling far too great to care.

After that blew up in my face I went years without playing another substantial game, I swore off of anything more rigorous than Wii bowling or Zelda. I hadn’t really displayed the ability to make good choices when engrossed in a fantasy world (particularly a social one) so I figured it would be best to let it lie.

But then, as an adult, I started dating a gamer. I started out trying to be careful, but before long I was being swept up by the Xbox 360 and then the Xbox One, feeling overwhelmingly tempted to stay up until 3 am because, well, everyone else was.

I wish I could say that the release of Pokémon Go this week didn’t rattle me, but the original debut of Pokémon landed right in the age-range sweet spot for my sister and I the first time around. We played the games, we watched the show, and our binder full of cards probably weighed a metric ton.

I knew it might be a slippery slope for me, but I had an easy out. With a windows phone I couldn’t download the Pokémon Go app, and my brand loyalty to Microsoft started out feeling like a blessing until I was sucked down into a vortex of depression. After two days of not being able to play the game everyone else around me seemed to be playing I felt miserable, and the safety of going without this game somehow transformed into a wretched despair over missing something potentially profound.

That night I couldn’t sleep, I could hardly eat breakfast, and as soon as the clock struck nine I was out the door headed to the mall. Before I had time to think, before I had time to react, really, I’d signed up for a brand new phone and spent the next eight hours setting it up so I could play Pokémon Go.

In hindsight it is hard to say if manically buying a new phone to play a Pokémon game is more or less embarrassing than last week’s manic interlude (after all, catching socially acceptable pretend creatures is probably less alienating to people on the street than collecting the dead corpses of real ones) but after the jolting, humming, rush of ecstasy subsided a day or two later I’ve been able to be a little more objective.

After spending the last five years getting to know my brand of bipolar disorder intimately and getting a grip on some of the things that trigger it for me I think I’m able to do a better job of regulating something I know can amp me up if I’m not careful. I intend to follow all of the rules I’ve set for myself playing any videogames in order to avoid issues with triggering hypomania and mania, things like:

  • No games after 10 pm (11 at the latest on weekends). Part of the reason games can trigger mania for me is that I lose track of time, and without having a set time in place for me to detach myself from the games and work on winding down before bedtime I wont be able to sleep. I’ve found that anything after 11 (and I try to be safe and stick to 10 pm) only makes me more alert and is huge for triggering insomnia for me. Guess what? Insomnia breeds mania!
  • Play at set times. I like to have a routine, to have structure in my day to make me feel less useless (since I’m just at home alone most days). My boyfriend and I play Xbox in the evening after dinner before we watch tv and I try to limit my Xbox time to that window (even if I am not always successful). Likewise I’m trying to limit Pokémon time to specific times of day (lunch time, walking home from an appointment (not to it or I’m likely to lose track of time), waiting for the bus, etc).
  • Limit my interaction with others. Ok, this might sound odd, but if I am starting to feel amped up and then I begin talking to other players who are equally amped up, I can easily become hypomanic or manic. Being aware of my mood state before interacting with people online or in person has been really important to help me understand how much I should interact and when to just be silent.
  • Food Food Food Food. I need to eat, and I need to eat more than candy and chocolate. I have to keep eating on my regular schedule, and not settle for eating a few handfulls of stale fruit loops becuase I am not willing to walk away from a game. If I don’t eat my mood gets all out of whack, and it doesn’t always mean a date with hypomania but that is one of the (less sucky) outcomes that could occur. Limiting caffeine is also huge, it has also triggered hypomania for me in the past as well as insomnia if I have any too late in the day.

As the case has been with everything lately, I’m working hard to try and find a sense of balance in as many areas of my life as possible. I want to be able to enjoy the things I want to enjoy (like catching them Pokémons) while remaining as stable as I can. It can be a tough nut to crack, but I’m hopeful that a little extra effort I can do it.

Self Identity & Mental Health – Pride Edition

Pride weekend is a pretty big deal in Seattle and while I tend to avoid events like parades (too much standing still with too many people for me to feel comfortable) I found myself on Capitol Hill twice during the celebration. I enjoyed having the opportunity to see all kinds of different people milling around smiling and laughing, and the attitudes of the multitude allowed me the briefest window where my self-consciousness could melt away.

Pride was, in a roundabout way, what led to a conversation where I was asked how important I think it is for us as human beings to be able to categorize ourselves in different ways. Even though I’ve only just started becoming familiar with the particulars of gender when it comes to self identity I couldn’t help but point out that this is a topic of conversation that comes up in regard to mental illness pretty frequently too.

In those instances the question is usually about diagnosing mental illness and if trying to fit our symptoms -which can vary widely even within an illness- into one category or another is more helpful or harmful in the long run. Even though opinions vary greatly on this topic I’ve found that the majority tend to see reaching a diagnosis as something helpful and can appreciate it as a tool to better understand their symptoms and how to live with them. For me being diagnosed with bipolar disorder felt more like a relief than anything else, even despite finding my symptoms don’t line up with the majority of those with the disorder.

In terms of self-identity I’ve always been curious as to how other people live their lives and what we have in common, but for as long as I can remember I have struggled with the idea of who I am. Trying to find commonalities has felt exhausting at times because I’ve had a hard time locking down what my values are, what I want my life to be, and who I am.

Issues of gender and sexuality have definitely played into that. Discovering that I might not be attracted to the same people my friends were was both alienating and isolating. Not being able to really understand why I feel uncomfortable when people address me differently than I imagine myself has been frustrating because being unable to explain this strange off-putting feeling to myself has meant being unable to explain it to anyone else too.

Self identity in that sense has had a huge impact on how I act, how I interact with other people, but also on my mental health. Feeling estranged from people I can relate to has often meant feeling depressed and isolated. Being unable to pinpoint and communicate where a lot of those thoughts and feelings are coming from and, even more, feeling the need to constantly explain myself has fueled a lot of the anger I have toward myself and other people.

While issues with gender and my sexuality have fueled issues like depression and low self-esteem I have found that living with mental illness itself, in my case treatment resistant bipolar disorder and anxiety, has played a huge role in keeping me from being able to pinpoint who I am and what I want out of life. Mood swings make a habit of constantly changing my motives and desires, so getting a grasp on what is underneath has often felt like digging a hole in the sand at the beach that is constantly being refilled by each wave that rolls in.

After six months of DBT (dialectical behavioral therapy) I’ve got a new-found appreciation for the fact that having a real understanding of ourselves and what we want in life is how we are able to find ways to make ourselves happy and move toward our goals. What can we expect if we don’t know how to make ourselves happy? Where do we go if we’re not moving toward the lives we want?

Without categorizing our needs in other ways, like the diagnosis of mental illness, how can we expect to move toward improving our symptoms? Without understanding our needs and being able to communicate those needs in a way other people and healthcare providers can understand, how can we address them?

I can understand how categorizing the elements in our lives can seem limiting to some people, but throughout history mass communication has been based on shared common knowledge. That might come from our language, or our understanding of science and theories at the time, or things we’ve learned from our friends and family (among others). Being able to communicate what we need in a way that other people can understand is a huge part of being able to be successful in both feeling acceptance from other people and moving toward what we want, and while sometimes that communication comes at the price of having to simplify things to help people understand, the understanding and acceptance is the ultimate goal.

Granted, there are big differences between something like identifying gender identity or sexual preference, and identifying a mental illness. I think it is important to remind people that our sexual preference and gender identity are inherent to who we are and to express those things comes from a lot of personal reflection and understanding of ourselves.

Conversely, most people in the mental health camp consider mental illness to be just that, an illness. I would be remiss if I didn’t say there aren’t people that disagree, but to most the symptoms of anxiety, depression, bipolar disorder, and schizophrenia, among others, are things that are keeping us from being happy and living the lives we want to.

If you consider it though, identifying mental illness is one way we are all able to be true to ourselves and to act in a way that will bring us a better understanding of ourselves and how to move toward living the lives we want. We seek treatment to try to get back to the sense of self we understand and feel that we have lost.

What is the expression and self discovery that comes with coming out, or expressing a change in gender identity but an act in the same direction? Taking steps to understand and communicate our identity is another way in which people can reaffirm their sense of self and actively move toward finding happiness and living the lives they want to live.

In both situations we fight to protect our sense of self and our identities, and though it might initially feel like an act of self-preservation both the LGBTQ and mental health communities know the value of protecting our inner-self and see that being true to ourselves, whatever that means for us, will make us happier in the long run.

I know that I’ve felt the effects of ignoring my most inner sense of self, and that whether that came from hiding who I truly felt I was or denying myself help from the constant attack on it that came with my mental illness I like to think that each day I know myself a little better. I understand myself a little better. I can keep moving in the direction of supporting who I am and what I want because I know that I am the only person who can do that for myself –and I deserve it.

How DBT is Changing the Game

I have been celebrating all week because as of last Thursday I have officially completed all of the sections in the DBT workbook and group. Apart from high-fiving myself (alright, so that’s just a clap really) for seeing this through I’ve been reflecting on how DBT (Dialectical Behavioral Therapy) has been a game changer in a life largely structured around living with treatment resistant bipolar disorder.

Before I can offer up a delightful before and after like some kind of mental and behavioral makeover I have to say that I feel lucky just for getting into a DBT program here in Seattle. I am on Medicaid and the waitlist for people receiving public mental health services here in Seattle means it takes typically months and in some cases years to get into a group. In the time it took me to get in I tried all sorts of treatments and even went to two consultations for ECT (electro-convulsive therapy). Obviously it seemed like DBT was a popular option, but after having a hard time with other types of therapy (like CBT, cognitive behavioral therapy, as an example) I couldn’t be more pleased with discovering why DBT has gained so much popularity and why I had to wait in the first place.

Me

Just so you know where I’m coming from on this I think it might be helpful to tell you a little bit about what I experience.

I have treatment resistant bipolar disorder which means there haven’t been any medications that have been able to help stabilize my ongoing mood swings or prevent new ones from happening. My mood swings range from several intense swings in a day (which can range all the way from euphoria to suicidal depression and back again in a matter of minutes) to long intense episodes that can last months at a time. I experience mania, depression, agitated and sometimes hostile mixed episodes, suicidality, homicidality, and psychosis.

Needless to say… that has been a bit of a handful both for me and for other people to deal with. I can be unpredictable around other people which means they don’t typically know if I will be excited or devastated or aggressive from one moment to the next and I’ve had too many issues with homicidality, suicidality, and psychosis at work to keep a job for the last several years to boot.

The things I have felt needed the most immediate addressing have been things like:

  • feeling strong urges of violence toward myself or others
  • feeling unable to communicate with my boyfriend or others during intense episodes
  • losing relationships and jobs because of my emotional reactivity
  • constantly relinquishing my own self-respect in attempts to make others happy and avoid confrontation or the potential triggering of more episodes
  • isolating myself due to constant fear and paranoia that someone might hurt me or I might hurt someone else
  • negative thoughts I could not seem to stop or make quieter

In addition I have experienced very intense anxiety since I was old enough to remember. This has typically caused problems like:

  • worrying to the point of causing physical illness
  • believing horrible, sometimes life-ending events are about to unfold at any minute
  • fear and panic overwhelming enough to keep me from having a driver’s license (at age 30)
  • attempts to control other people’s actions to keep their unpredictability from making me more anxious (I wouldn’t recommend it…)
  • constant obsessive thoughts that I felt powerless to stop that also often keep me from sleeping
  • Ongoing panic attacks

Sometimes I can pass as a typical stable adult to others because I am intelligent (might as well toot my own horn there but people often point that out as a reason I can be high-functioning at times) and periods of hypomania tend to dissolve the anxiety I feel when they are occurring. Unfortunately as I have gotten older my episodes have gotten progressively worse and those periods of “normalcy” have been few and far between.

Before DBT

The ways in which I have coped with these issues have definitely evolved over the last 15 years. I’ve gone through my fair share of harmful coping strategies (self-harm, alcohol, binge eating) but I have also gone through a long line of coping methods that may not have been directly harmful but weren’t exactly effective either.

Ineffective coping strategies are usually those I’ve come up with and then discarded after a period of trial and error. Without much direction (both from my doctors and therapists previous to DBT – with exception to CBT) I kind of just came up with ideas I thought would work and tried them… I’d like to chalk this up to the scientific method but it may have been equally spurred by a constant feeling of desperation. Sometimes the methods would work for a while and then I would begin to get exhausted because they took all of my focus and effort to maintain. Things like:

  • seeking approval from other people when I was depressed
  • reaching out to every person I knew in times of crisis instead of just people I could trust (resulting in sometimes landing myself in dangerous situations)
  • constantly fighting the obsessive or negative thoughts by arguing with them
  • keeping myself in a state of constant distraction so it wouldn’t get quiet enough for me to hear negative or obsessive thoughts
  • never being alone because then I would be alone with the obsessive or negative thoughts
  • changing jobs frequently in an attempt to find one that “made me happy”.

Obviously I found a few things that worked, even if I didn’t know it at the time. Writing, art, playing music, playing video games… all seemed to make things feel easier, just not enough for me to base all of my activity on them. After all, how was playing the piano going to help me maintain friendships? How could I work retail and be drawing at the same time?

When it came to CBT I could get behind the idea of doing activities like journaling but the idea there was that there was a thought that was ultimately prompting my emotion and behavior. I found many of the activities soothing for a time, but even after I managed to figure out what negative thoughts were prompting my emotions or behaviors I couldn’t find anyone who could tell me how to change those negative thoughts (or stop from obsessing) in a way I could understand and it frustrated me.

I was disheartened when therapists would simply say, “you just stop obsessing.” or “you just accept the situation,” and when I asked how one does those things (as I couldn’t seem to make them happen voluntarily) nobody could answer with anything more than a statement a golf caddy could have given me. It seemed to go against the whole idea of working toward having better mental health, after all… if I could stop obsessing or just suddenly accept a situation I wouldn’t need to ask how to do it.

Beyond that I often felt like I had mood swings that seemed to happen totally independently of what I was thinking or doing. I could be at Disneyland on a roller coaster and suddenly find myself depressed, but none of my therapists or any of my hospital workers were willing to consider or explain why that might be happening. Most of them told me I didn’t know what I was talking about which I could watch transform my curiosity into livid rage.

Needless to say, I started DBT feeling skeptical after my time with CBT but what I found was a language I could understand.

Dialectical Behavioral Therapy

I think it is import to point out that in my situation (one where every previous treatment option has failed) I have been desperate for any kind of help with my mental health for some time which means I found myself in the DBT group both ready and eager to learn as much as possible and practice the techniques. I needed relief from my symptoms and without anything that could provide that previously I was ready to throw my whole self into the class and take it very seriously. Being willing to dive in to the class helped me push through the frustrating or difficult parts I faced in the beginning.

I encountered the material in a structured weekly class with homework each week and I think in my case that structure really helped hold me accountable to practice the skills and do the reading. The previous week’s homework was reviewed each week so I needed to finish it. Being in a group also allowed us to compare ideas on what different ideas meant and discuss which coping strategies worked best for each of us.

The sections discussed were:

  • Mindfulness
    • basically how to live in the moment instead of being distracted by internal thoughts as well as how to enjoy each moment fully
  • Emotion Regulation
    • how emotions work, what goes in to working to keep them balanced, and how to change an emotion
  • Interpersonal Effectiveness
    • maintaining relationships and how to have positive social interactions
  • Distress Tolerance
    • tools for crisis situations

The thing I found most effective about the material is that it suggests that the best strategy for living a balanced life is to operate using both emotion and reason. Each section goes on to describe strategies that work to help you create that balance by bringing in whatever is missing (usually for me it is the reason element) into the situation.

While there were some aspects of the workbook I had already figured out on my own through the trial and error I mentioned earlier this style of workbook offers many different kinds of strategies and basically you keep what you like and leave what’s left. I really respected that idea because I was able to tailor my own set of skills based on my needs and everyone else in the group was able to do the same. In that regard I can see where DBT’s popularity comes from because it is accessible to a wide audience.

After DBT

The important thing to understand about DBT is that I still have mood swings. I still feel suicidal urges, I still feel most of the things I felt before. The group wasn’t a magic cure for those feelings and urges, but it helped me understand how to negate or change them in healthy and manageable ways. More than that, I’ve been equipped with an arsenal of coping skills that work for me, and that is HUGE.

The mood swings may not be gone but being able to bring reason and logic to the table when they happen tends to mean less reactivity on my part. Less reactivity means it is easier to maintain relationships. Being friendlier to people means I feel less paranoid about potential reactions to my reactions. It all starts to trickle down through all these channels because everything is connected.

The only hard part here is that it only works as long as I use these skills. That might seem like a no-brainer, but mood swings can sweep me up sometimes and I find myself swirling around with no idea of how long I’ve been there. Anxiety can leave me worrying so much that I forget to let myself rest or use the skills that might provide some relief. Yes, it takes a lot of effort, but I’m doing my best to be as diligent as I can because even though this may require more energy than if I’d found a medication that worked straight away DBT has led me to the first glimpse of relative functioning in years.

Even though I only started this class six months ago I can see changes. Three or four situations happened just over this last weekend where I found myself thinking, “wow, this really would have ruined the whole weekend before, but I seem to be able to accept and to move past these situations much more quickly now.”

I had a neighbor who kept parking in our building’s guest parking spot in an attempt to dodge paying for a spot. It went on for months, and even though I had to remind myself every time I saw it that it would be better to accept the situation (and not leave rude or threatening letters on his windshield) and to be effective than to make enemies with my neighbors I did it. They moved away and I did a celebratory dance because I was able to keep myself from being a total A-hole.

I’ve also found it very useful to distance myself from my own thoughts and remind myself that just because I’ve thought it doesn’t make it true, it doesn’t mean I will act on them, or that they will happen. I’ve got several ways of weeding out bad ideas now before I find myself doing them, which means creating a sense of self-trust and self-respect where I didn’t have one before.

While DBT has made things easier (less effort for better results) the more stress I am experiencing the less reliable the system is for me. If I am too distracted or upset to complete the skills things simply operate… well, as normal. In some respect that means I’m working to weed out stress before it’ll swamp me now, trying to be proactive about avoiding avoiding things. There are some situations though, like Corey’s broken arm, that came with an intense whirlwind of stress I couldn’t dodge and as a result I quickly slipped right back into a state of crisis. I’m still working on climbing my way out of it but each day gets a little easier.

Finally, apart from being immediately useful to me, I really respect the DBT program because it provided content that wasn’t given to me in a condescending way but made sure to fully explain why each part was important. DBT fits my personal values, and makes room for those with values that are different from my own.

The obvious take away here is that there is some serious potential for more DBT groups in the Seattle area, and I wouldn’t be surprised if that was a trend across the country.

As for me, when seeking treatment for mental illness has often meant taking one step forward and two steps back I am really glad to have had a chance to work through this program because in many ways it is changing my life for the better. Having the opportunity to change my negative behaviors while learning how to take the reigns back from mental illness has given me the footing to be able to respond with, shove off, I’m queen of the mountain now!”

 

Antidepressant Turnover

You may have read (here: Back in the (Rx) Saddle Again) that I have been experiencing a significant enough decline into depression to warrant attempting an antidepressant again. Being home with my boyfriend who has a broken shoulder on a daily basis has been quite exhausting, and despite my typically treatment-resistant symptoms (and negative reactions to new medications in the past) I have a new psychiatrist who seems hell-bent on un-wedging me from my latest foray in desperation.

Her latest idea was to start me on 12.5 mg of Zoloft (sertraline). Previously I tried 100 mg of Zoloft and started to vibrate out of my own skin with manic energy so we were hopeful that a tiny dosage might be enough to nudge me out of the black abys without launching me sky-high like some kind of slingshot of euphoric destiny.

As much as I find myself feeling like an emotionally unstable lab rat I admit, I’ve always been interested in science and how the body works. I’ve spent the last six years documenting my symptoms several times a day to try to help me understand where they are coming from and what helps me negate them. This has led to a complicated system of notes I sometimes see my boyfriend trying to read but tends only to result in a lot of head-scratching on his part. That said, even though my doctor has recommendations for my health and what might help, I have worked hard to pay close attention to the process for every medication we’ve tried, even those that were meant to help curb side effects and several that haven’t been related to psychiatry at all.

I guess it helps that I am interested, but much of my documentation has come out of necessity. Living with a mental illness has been super hard to get a grasp on and for many years I didn’t know exactly what was coming from bipolar disorder or anxiety and what was me. My rigorous note taking was what allowed me to show something like physical evidence that my doctors could contemplate to diagnose me in the first place, and beyond that it has been necessary because having treatment resistant symptoms (and often unusual side effects) has made it hard to know if something is helping or potentially hurting me overall. I have enough experience with physicians at this point to know that they are much more likely to believe what I tell them when I can present it in a formal and organized way. Rationality doesn’t hurt either, but sometimes that is hard to come by.

On a personal level, these notes have been totally invaluable when it comes to situations like trying Zoloft again a couple weeks ago, not just because they are something I can show my doctor but because living with a mind that can have trouble judging reality from fiction can make it difficult to believe in myself and the conclusions I am drawing at any given time. Having something tangible I can go back to so I know that I’m making important decisions (like whether to start or stop a medication) based on my experience and understanding of my situation and not a psychotic delusion has made me more confident about understanding my own health than I feel about any other aspect of my life.

As helpful as that can be, it can undermine me as well. Being confident about how I have assessed the results about any medication I’ve tried tends to leave me on the defensive with some doctors and I can come off as hostile or difficult to work with. When faced with the wrong doctor, one who tries to push their own agenda rather than listen to my point of view, I know I can become volatile. That’s why having the right doctor has been equally as important to me as the note taking.

So everything I’ve said about note taking was to get to this: the last two times I tried a new medication each one was a repeat of something I tried many years earlier. 5-15 years earlier. It is the oddest thing because I would almost swear that I’ve become even more sensitive to medications and develop more side effects than I did a few years ago. I don’t know if that is possible, but that’s the way the data seems to lean.

Ultimately this time around 12.5 mg of Zoloft had more adverse effects for me than the original 100 mg did. Yes, last time I was manic, but this time I waded through several days of intense dizziness, nausea, and GI upset only to be blindsided by 8 straight days of severe headaches in a row.

By the time I reached the seventh and eighth day my irritability was rising exponentially, to the point of being more reactive and depressed from the pain than I was before I started the Zoloft in the first place. I didn’t want to gamble the pain continuing(or even worsening) over the weekend since both my boyfriend and dog are relying solely on me for their care and I was already irritable to the point of arguing with every commercial that was coming on tv.

I called my psychiatrist’s office and the nurse suggested the headaches were a product of allergies (due to the intense tree pollen bloom this year) but if I really felt sure I should stop the medication over the weekend and call on Monday to report any changes.

I went with my own gut and stopped the Zoloft and within 24 hours I felt totally fine physically. The 8 day headache was gone, as were the other issues -all except the irritability that took more time to reduce itself. I admit, I did a little jig -both because the headache was gone and because I was happy I had made the right decision.

All too often it seems that doctors are more than willing to force me into a position of feeling much worse before I can begin to feel better, and while I understand the concept of waiting out side effects long enough for them to dissipate, in my particular situation of treatment-resistance it has never once paid off. Either the side effects become debilitating to the point of requiring a trip to the ER or hospitalization or I manage to get through the side effects after several weeks or months of struggle (like with lithium) and find I receive no beneficial effect from the medication.

Thursday I will be meeting with my psychiatrist to go over the notes I took from the trial and I’ll see what advice she has for me next, if any. Writing about the situation in this forum allows me the space to really think about the situation and try to understand it without feeling overwhelmed or sad or angry. I guess I am just ready and willing to accept that this is how things are for me, and even though I would say that is some serious progress I still hope to find whatever it is that will allow me to move toward wellness -or at least the best approximation I can afford.

 

 

 

 

Inspiring Inspiration

Writer’s block. Drawing a blank. Creative stagnation. If you’re a creative person, you’ve probably felt it at one time or another. Working on a project or in a job that requires constant new ideas and drive to complete them often  sounds great until I realize just how much inspiration is required to keep up.

People have typically always considered me to be a very creative person and I feel lucky to have grown up with one parent gifted in fine arts and another who is a skilled musician. Both were constantly supporting my desire to be creative, even when I made a change from attending a typical university to go to art school.

I don’t remember feeling very hard pressed for inspiration as a kid or through school. Ideas seemed to come easily while making videos or sketching or writing (really bad) poetry, and it wasn’t until I found myself in a job as an adult that I really began to struggle with trying to balance having a job and being creative.

The funny thing is that I was working in design in the fashion industry and most people would probably consider the work of a fashion designer to be creative, right? I had trouble trying to align inspiration with the rigorous, fast-paced schedule of the companies I was working for and ultimately didn’t feel much creative fulfillment.

The more I worked, the more my creativity seemed to be totally tapped out. I wasn’t doing projects at home, not even drawing anymore, and the more depressed I felt the more frustrated I became. The constant pool of inspiration I had been able to draw from previously seemed completely gone and I couldn’t help but wonder why or where it had gone.

Increased creativity is often said to be connected to those with mental illness, though we still don’t quite know how or why. It doesn’t surprise me because living with bipolar disorder has allowed me to experience extreme mental states like mania and psychosis where it has felt as though I have ideas faster than I can recognize them. Many of these ideas seem to take root like small seeds that quickly grow on their own until they’ve created a jungle of fiction around me.

I know I am not the only one to have seen this jungle and said, “ah ha! That’s where the pool of inspiration must be!” In severe moments of frustration at not being able to produce things creatively at the rate at which I have wanted to I have found myself grabbing a machete and traipsing into that jungle like Ponce de Leon looking for the fountain of youth.

It can feel easy to believe that this is the one and only source of true inspiration when I am not used to having to work for it. After all, who would want to work for something they can get for free, right?

As I have gotten older I’ve come to believe that my mental illness isn’t the one and only source of inspiration. I’ve been able to create things while stable, even while depressed, so my idea that mania is a prerequisite for creativity has become somewhat antiquated.

What got me thinking about this topic was writing. I started this blog five years ago and, surprise surprise, I was in a pretty elevated state heading somewhere near mania at the time. I could sit down and write post after post, but as time wore on I found myself having to work for that inspiration that came so easily at first.

I had a goal to keep writing, and the biggest change I made was to shift my mindset from being someone who let creative ideas flow into me to someone who actively pursued things that interested me. Lo and behold, the more I scientific articles I read, the more people I talked to, the more blogs I read, the more I had to say.

I always wondered why people would say, “if you want to be a writer, read a lot of books.” The more I read and the more I write, the more true I find that statement to be. When it comes to my mind I’ve been ignorant about the fact that to get something out, to produce something, I need to take something in first.

Now that I recognize it, the concept makes perfect sense to me. When I was younger I drew inspiration from being in school. Constantly learning new things about history or art, talking to people and hearing new points of view; if you think about it school itself is a breeding ground for inspiration, I just didn’t know it at the time.

Beyond that, what is my mental illness but a constantly changing experience informing my senses in new ways all the time? In a sense, bipolar disorder has informed me emotionally the way reading has informed me in a literary way; it has been a platform for me to absorb something new without realizing it.

It seems totally reasonable that becoming more stable might make one feel less creative  when we consider how easy it can be to lean on the unprompted ideas sparked by mental illness for inspiration instead of taking up other hobbies or interests that might produce similar results.

Needless to say, I think it is really important to teach ourselves where to look for inspiration and how to capture it without having to rely on something that can otherwise be detrimental to our lives. I truly believe that creativity does not require an element of self-destruction. Sometimes it might take a little more effort to initiate that creativity with activities and engaging our senses, but imagine the things we can learn and pass on along the way!

Inspiration can come from anything, anywhere, any time. For me, finding it is about putting myself in a position to experience something new, whether that is experiencing something emotionally, visually, physically, or mentally, etc. Paying attention (being mindful) to what I am experiencing is key to getting something useful out of it, but I don’t go in with any expectations. Sometimes it takes me a few days to let something stew for inspiration to pop up, sometimes it happens right away. It is all about the mind making new connections.

Here are a few ideas for ways to help inspire inspiration:

  • Watch something new
    • Youtube
    • Movies
    • Television shows
    • Plays or musicals
    • Comedy
  • Listen to something new
    • Music
    • Audiobooks
    • Street noise
    • Sounds in nature/wildlife
  • Read something new
    • Books
    • Magazines
    • Blogs
    • Web Articles
  • Learn something new
    • take a class or workshop
    • Youtube how-to videos
    • watch how someone does their job
    • volunteer
  • Experience something new
    • Attend a sporting event
    • Meet new people
    • Join a club or group
    • Try out a gym
  • Be somewhere new
    • In nature
    • In the city
    • Travel
    • Take a new route home
  • Create something new
    • try a new hobby like pottery or knitting or photography
    • try a new medium like watercolor, charcoal, ink
    • allow yourself the freedom to make “mistakes”
    • try writing or drawing prompts
    • try a new genre for writing like mystery, romance, or non-fiction

One of the benefits of experiencing mental illness in my lifetime is that even in periods where I am stable, I am able to draw on that experience. Sometimes, like with this blog for example, I might not be having an episode and there is no intense emotion to fuel a subject for my writing. I’ve come to actually enjoy those periods because it allows me to write about my mental health in a different way, I can shift my perspective to think about topics like creativity when I might normally be too engaged with feeling depressed or manic to consider them.

Ultimately I’ve reached the point where I am happy to be learning how to inspire inspiration for myself without having to rely on my own unpredictable behavior. The most helpful elements for me have involved making an effort to step outside my comfort zone (and be open minded about it) and chasing what interests me. While it is true that “chasing what interests me” might be making my boyfriend a little crazy right now (because what interests me is South Korean pop music videos) there is little substitute for the feeling of feeling a new idea take root and watching it grow.