Tag Archives: logic

Hypomania and Loss of Appetite

A few weeks ago I wrote about loss of appetite and depressionbut realistically loss of appetite is something I experience much more often during periods of hypomania.

Noticing a change in mood when hypomania comes on isn’t always the first thing on my radar, and that is why I try to keep close tabs on symptoms like insomnia and loss of appetite. These are symptoms that tend to show up in my episodes early on and are good indicators that things have changed.

The loss of appetite I associate with depression is both one of not feeling like eating, but also of feeling dissatisfied with food in general.

The loss of appetite I associate with hypomania (on the other hand) is one of not feeling like eating, but out of a sense of contentment or forgetfulness. Most of the time eating during times of hypomanic loss of appetite, my stomach will welcome whatever it is I eat, whenever it is I decide to eat it.

This can be a dangerous situation because it becomes entirely too easy to live off of a box of Hostess cupcakes, or the remnants of a pizza that has been in the fridge a few days. Eating doesn’t feel necessary, but when I do it I generally feel satisfied after eating anything. That satisfaction appears present whether I eat or not, and it can become easy to jump on the back of that satisfaction and ride it all the way through the episode.

I think the biggest problem I have with hypomania and loss of appetite is trying to determine whether it is better to force myself to eat regular meals at mealtimes, or if I should only eat when I’m hungry. Often hypomanic “logic” dictates I should only eat when I am hungry… but honestly I have had more luck eating small meals at normal mealtimes because otherwise my blood sugar has a tendency to crash (at which point I become a very abrupt, mean person).

This happened to me yesterday, and I went from eating eggs and toast at 8 am to suddenly realizing at 6 pm that I felt very irritable and needed food immediately (due to super low blood sugar).

It can be easy with the increase in energy, associated projects, and increased social time to find myself wondering, “well when do I have time to eat, anyway?” I find this easiest to combat during hypomania if I combine eating with social situations. Grab lunch with a friend! Make breakfast for my boyfriend (and myself)! Pop in with a friend for happy hour sushi!

Combining food and social situations while hypomanic can greatly improve on how healthy the food is you’re eating during an episode (sushi = way better than a box of Hostess cupcakes is for you) in a way that makes remembering to eat rather seamless.

I would also note that spending money during hypomanic periods can be particularly easy, and spending money on food is (for me) doubly so. If you’re short on cash, it can be more cost effective to throw a small dinner party, or have a few friends over to your house/apartment for a home-made meal. It can be fun to cook together, or just ask everyone to bring something to contribute!

It can be easy to feel like it isn’t a big deal not to eat (especially when it doesn’t feel bad to go without food). Realistically, our bodies need nourishment… so at least being mindful of this fact when the loss of appetite hits can be good news for a more well-balanced mind and body.

Making Decision Without Emotion

One of last year’s goals for therapy was to learn how to make decisions without having to rely on my emotions. Having bipolar disorder, my emotional state seems to be changing from each minute to the next, and attempting to rely on it is an extremely unreliable way to make decisions.

It is true that sometimes I believe people should follow their heart, but what happens when matters of the heart are present out of delusion or triggered by something else entirely? What is someone who wants to make smart decisions in their life supposed to do?

Well, I’ve been meditating on these questions for the last year or so and I thought I would share what I’ve come away with.

Usually there are two situations where I find myself in need of some personal guidance, and for each the plan is different.

Firstly, I find myself struggling sometimes with decision making when I am quickly being overtaken with a tidal wave of emotion. Right after being triggered, lets say, while my being is filling up rapidly with either an outrageous emotional response or the beginning of an episode, it is in these moments that I panic.

The immediate question is usually what do I do next?

In these situations I’ve found that I can usually hold on to the scrap of level-headedness I have left if I concentrate hard to make some last minute decisions about what to do before I am fully engulfed by the wave of emotion.

That might mean planning a retreat someplace safe, like leaving work, or going home, or making a run for the bathroom.

Or it might mean clearing my schedule of the plans I was expecting to participate in that day.

Being able to make quick plans about how to take care of myself in the event of an episode has really saved my butt the last few months. This sort of last minute decision making has really helped me prevent being irrational or out of control in front of co-workers, friends, and even my therapist. The trick is being able to detect that things are going sour before you’re already engulfed. With a little practice, I can assure you it isn’t such a tall order.

The reason I came up with this goal for therapy, however, was for another situation entirely. I wanted some kind of method to discern how to tell a good decision from a bad decision while in the throes of an episode. If I’m delusional, how do I keep myself from making a bad decision?

I think anyone with bipolar disorder has probably experienced this at one time or another.

You’re depressed, and your instincts tell you to kill yourself. This is not a good decision, but it can feel like one.

You’re in a mixed episode and your instincts tell you to break up with your significant other. This may or may not be a good idea, but is it a good idea to pursue this idea while under the influence of the tricky bipolar beast?

Bipolar disorder can play tricks on your mind and heart, so it can easily make you believe things that aren’t true. Acting on these beliefs can cause a huge crapstorm of confusion and pain for everyone involved, so what is there to do?

I wish I could say I learned an amazing secret here on this one because this has haunted me for a while now.

The best I’ve come up with is not to let myself make major life decisions while in an episode.

Admittedly, this isn’t the best be-all end-all rule in this situation though. I mean, what about those times you’re in an episode (or episodes) for years at a time? What about those life decisions that can’t wait? Are we just supposed let life pass us by without making any big decisions?

Realistically, I don’t have an answer. What I do know is that I’ve reached the point where I require myself to really stop and think (for days, or weeks if I have to) about something big before taking action if I am in an episode. I’m normally a pretty impulsive person, so this has been a big change. A helpful one though, to be sure.

No longer letting myself make big decisions while experiencing bipolar episodes has been both liberating (my anxiety is a lot better off not constantly worrying about making them) and grounding (I’m not making as many impulsive, questionable decisions). I realize this is an idealistic sort of model, but I really just mean it to be something to think about.

Think twice, are you becoming engulfed in emotion? Are there things you need to take care of before it hits?

And before acting on those big, life-changing decisions, should you really be making them now?

The Pharmacy, and then… The Pharmacy

As you probably know, my insurance has kicked in, and with insurance you are bound to stumble upon one thing or another that pisses you off -even after having read all of the information available to you.

Last Saturday (as in a week ago Saturday) I had taken the prescriptions I was hanging on to until my insurance kicked in to the pharmacy. When I was told that my Risperidone prescription needed to be ordered and wouldn’t be available until Monday, I felt fine -knowing that I had a doctor’s appointment Monday morning and could swing by afterward, before work.

So I swung by on Monday, and it still wasn’t ready. Cut to the work week (which was full of the most intense stress I’ve experienced so far at my new job, and a nasty cold/flu thing that popped up at the end of the week) where I was completely unable to pick up the prescription. It wasn’t until Friday (where I was home sick and miserable) that I finally concluded I need to go down there to pick up the dang thing.

Already feeling disgusting, the guy behind the counter told me it was going to cost $30.

And that is when all of the barriers keeping nasty, rude Sarah at bay came down.

According to my insurance, my medication co-pays are supposed to be either $10 or $20. I went to the website ahead of time and checked. I found the price of my exact prescription and it wasn’t thirty dollars. On top of that, I had now had to wait almost an entire week for this medication, only to be surprised with the notion that it would cost me three times what my insurance said it would.

I exploded. As the employees tried to calm me, I slammed the surge protector on the counter that I had been planning on buying. I yelled. I pointed my finger and growled. And in the end, I threw the surge protector into a display of over the counter drugs.

Completely enraged, I tried calling my insurance company. There was nothing on the other end except a recorded voice asking me to speak into the phone clearly (which is quite difficult while enraged). An employee waited, standing 10 feet from me while I tried to calmly say, “risperidone” into the microphone over and over again before storming out of the store.

As I stood in line at the bank I immediately knew I had over-reacted. My internal dialog calmly whispering,

“You know, if it is $30, you should probably just give them $30. If anything has been a testiment to you needing this medication lately, I dare say this is it.”

And then, the flood of overwhelming shame and guilt that comes after an overreaction hit me. Those people definitely had not deserved the brunt of what they got, and now you are that rude customer nobody likes.

The conclusion I came to was to go back and get the prescription, but I was quite horrified by the thought of having to re-approach the people I just screamed publicly at. Part of me felt like I should apologize, whether I got the prescription or not, as something of a reminder that no matter how sick I feel, or how crappy my mood, it isn’t ok to take it out on others or use bipolar disorder as an excuse to attack others.

Ugh.

So I started the long (and by long I mean one city block), hard walk of shame back into the store and up to the counter. The employees eyed me suspiciously from behind their computers and, with the total opposite demeanor as the first time around I said,

“Hi, I’m sorry I was a total bitch just now, that was really quite rude and I apologize.

(I quickly considered and then rejected the idea of  making a, “I sure do obviously need that medication, don’t I?” joke).

“The thing is,” I continued, “I think if my boyfriend was here he’d say I was overreacting… so that is probably the case. May I please still fill that prescription now?”

The girl had un-filled the prescription but she re-filled it for me in about five minutes. She was actually quite understanding, which of course made me feel a bit more like an ass than I already did.

In the end, I made 5 trips to the pharmacy for that prescription, and though I know I am certainly not the most threatening customer that frequents the downtown Seattle area (by far) it was still a little sobering to become that person, even if only for about 15 minutes.

I realize this story does not make me look like a saint, but I know (and I know that many others would agree) that it is ok because I’m not one. There are times I still crack under the weight of illness and stress and become something of a monster, but I feel a little better knowing I can recognize it after 15 minutes, as opposed to spending days dragging my knuckles on the ground.

A Balancing Act

As I’m attempting to navigate the waters of this week (I am now on day six of Corey’s absence) I am doing a much better job of finding the right balance of time engaged with others and time alone.

I wrestled for about an hour last night with the fact I was planning on going to a weaving guild meeting first thing this morning, the idea of which was making me feel incredibly stressed and I felt my mood begin to sink (though ever so slowly). The decision I made was that going would only be more stressful, which would cause more harm than good at this point.

I still woke up feeling a bit more morose than yesterday, but “a bit morose” is worlds better than day six of the last few times Corey has been out of town.

That balancing act is so hard for me to achieve, all of the things I want to do vs. the things that will help or hinder my mood, or even what I can realistically achieve. The process is about as far from my default action setting as possible, which is namely,

If I want to do something, I do it.

And if I don’t want to do something, I usually just still do it.

I find it extremely confusing to consider that the things that I like, like going to the weaving guild meeting, sometimes produce a considerable amount of stress and anxiety. This stress and anxiety makes me feel bad, which is the completely opposite of what I’d expect when it is an activity I like. Shouldn’t liking it make doing it make me happy?

No, apparently not.

This is where I give therapy a thumbs up, because without it I never would have reached this (seemingly backwards) conclusion.

So here I am, 9 am and still in pajamas, ready to take on the long list of things I have to do today (though feeling guilty about missing the meeting), I might be able to tilt things back in the other direction just a smidge. I can feel excitement starting to trickle back in where the anxiety was, but that is something I’ll tell you a bit more about tomorrow.

10 of the Most Common Reasons People Stop Taking Medication

The most common emails I get are from concerned parents, upset that their recently diagnosed teen/young adult has stopped taking the medications that were clearly helping improve their situation (from an outsider’s perspective). When something has proved to seem helpful to someone in the past,

Why would [anyone] stop taking their medication?!?

I realize that for a lot of people, this is an extremely baffling situation -and it isn’t limited to the young, the newly diagnosed, or the “unruly” patient. As someone who has gone through the process of trying different medications, it can be difficult for me to understand why this notion seems so foreign to people.

So, I wanted to take some time today to address some of the main reasons people stop taking their medications. People might think this sort of behavior is completely spontaneous or unjustified, but you’d be surprised at how much logic actually goes into the process of “quitting” whatever medication, for a lot of people.

1. Side Effects side effects are easily the number one reason people stop taking their medications. The side effects for psychiatric medications cover a huge spectrum of different areas (both psychological and physical), some of which can be quite unpleasant. If side effects are unpleasant enough for someone to consider stopping their medication, I would highly suggest speaking with the prescribing doctor as soon as possible. Stopping a medication abruptly due to side effects can potentially make matters worse if a high enough dosage is being taken to cause withdrawal effects, and trust me. You don’t want that to happen.

2. Fear of Dependance – a lot of people go through one (or several) period(s) where the idea of taking a medication for the rest of their lives sparks fear around the idea of dependance. What if I reach a point where I can’t afford them anymore? What if something catastrophic happens an I no longer have access to the medications I need? What if I want to travel? The idea of having something that is not only helpful, but now seemingly essential to your well-being can be terrifying, because what if it is suddenly taken away?

3. Fear of Losing the Self – this is another extremely common fear, especially for people who are just starting to take medications or are teens/young adults. Will psychiatric drugs alter or diminish my creativity? My intelligence? My personality? Most adolescents are just beginning to to discover who they are and  in that time it can be terrifying to imagine discovering that person (let alone building a life for oneself) with these things dampened or altered. I began taking medications around age 16, and this was a really big fear for me. It is important to consider that the right medication(s) will not damage this “self”, but for many adolescents trying to wade through however many medications it takes to find the “right one”, this can seem like a waste of important, younger years.

4. Cost – it is also extremely common (unfortunately) for people to quit taking their medications because they simply can no longer afford them. There are things you can do to get the medications needed, for more information I would check out Best Kept Secrets For Getting Affordable Treatment for Mental Illness.

5. Not Feeling Included – I would say this is also fairly common for teens or young adults who are in the care of their parents. If someone is not included in the decision-making regarding their own care, I would definitely expect some backlash. Many parents give their child a pill and that is the extent of their involvement in the process, and I am constantly reminding parents that that pill alone will not solve everything. Try to take the time to talk openly with your child about what they are experiencing, try to include therapy or group therapy if you can. If your child is not included in their own medical care (and decisions regarding medications as well), can you ever expect them to continue care on their own after they’ve left the nest?

6. Mania Addiction – this is something I am planning on going more in-depth about a bit further down the road, but addiction to mania or hypomania is a very real problem for a lot of people. If you can imagine, let’s say your body suddenly produces a natural high that lasts for days (often for no apparent reason) for a week every month. Now, you’re given medication that keeps this high from happening. Sure, it may alleviate the bad symptoms you were having, but it also keeps you from feeling that natural high. Do you keep taking the medication? It is a lot easier said than done, and in a culture where addiction is already prevalent (cigarettes, for example) this is something that acts as a stumbling block for a lot of people.

7. A Sense of Shame – there are a lot of ignorant people out there (sorry to burst your bubble about that) that have no grasp whatsoever on the concept of mental illness. Some people face bullies that make them feel ashamed to be taking psychiatric medications, and these people can be peers, co-workers, bosses, family, even parents. Anyone who has sought help for anything in regard to mental health deserves to be praised for overcoming fear, but unfortunately feeling a sense of shame (ingrained by whomever) is quite common.

8. Misinformation/Misdiagnosis – now, more often than you think, people are given misinformation by their doctor or a misdiagnosis (or a series of them, if you’re particularly unlucky). Being told, for example, that an episode that someone experiences is singular is definitely more likely for someone to shrug off medications more quickly (yep, this happened to me). This can’t be skipped over as a real threat to people’s willingness to be treated, and a misstep by one doctor can lead to a mistrust of many down the road.

9. Fear Around Performance at Work – in regard to what I mentioned with mania addiction, there people who rely heavily on this “natural high” to produce a lot at work in small periods of time. There are industries that have come to expect this kind of output from their employees (and rely heavily on it), so there is certainly a genuine fear by a lot of people that taking medications will hinder their abilities to perform as intensely as they have in the past.

10. No Noticeable Improvement – finally, when people don’t actively see any benefit from a drug they are taking, the are much more likely to stop taking it. To come full circle, this is something that should be discussed with the prescribing doctor as they are probably more than willing to try something else instead.

If someone close to you has recently stopped taking their medication without a doctor’s authorization, try having a conversation with them about why. Chances are, there could be some very real physical discomfort they are feeling, or that they have been experiencing some very intense fear around the idea of committing to taking medications.

I just want to note that people have a choice in the matter, so whenever there is a choice, people will choose whatever route makes sense to them at the time. The best thing you can do is be open and willing to have a discussion about where those choices are coming from.

B-E A-G-G-R-E-S-S-I-V-E

Be aggressive, B-E aggressive!

Last night seemed to shed a little light on why I may have been so fascinated with playing contact sports when I was in school. I like the rush, I like to fight, and I like to be aggressive. Sports are an easy way to dump that aggression into something that isn’t illegal or harmful (at least, not harmful to those that didn’t ask for it).

Watching sports, though, I cannot do as well. I have trouble sitting still (particularly while feeling aggressive) so the sport becomes more of a curse than a blessing at that point.

“Crazy-girlfriend Sarah” made an appearance last night. From what I’ve gleaned from other sources (reading people’s accounts, bipolar or on the receiving end, hearing tales, living it, and much much more) it isn’t uncommon for this to happen.

In my own bipolar life, I tend to think of it as my brain playing a trick on me. Sometimes I will be thrust into a completely new reality where black is now white and suddenly, without question, the people who love me are attempting to hurt me. It is a switch that turns me into the incredible hulk of girlfriends, but outwardly I may not appear any different than I did a moment ago.

I can remember very vividly the first time I concluded this was happening, which wasn’t until long after the fact. In that situation, though, it has been argued by witnesses that I may have also been having auditory hallucinations, because I was in full belief that the guy on the receiving end of my wrath had just attempted to verbally attack me. I admit, it is a little funny to me now, poor guy didn’t know what hit him, but it was probably a year before I realized that the situation that catalyzed our breakup was largely fictitious on my end.

Another boyfriend experienced this beast more frequently, and I would attribute that to the fact that there were clearly moments when he genuinely did want to hurt me. I know this because not only did he follow through sometimes, I saw the words spill out of his mouth myself. At that point, isn’t that just asking for it? Want your girlfriend to become paranoid as all heck? Make her believe you might actually kill her at some point.

It is hard to say in those days though what was really going on and what was a product of those brain-tricks.

Anyway, these days are different. I know these tricks of the mind happen, so I have been doing a (somewhat) better job of curbing this problem.

My boyfriend now, well he’s a gem (and I’m not being facetious). He is sweet, trustworthy, and I can’t imagine him ever trying to hurt me on purpose. These facts have been a dot of light in an otherwise dark tunnel, when the tricks happen. Enough light for me to say, “Aha! This is a tunnel, not an apocalypse!” So I can forgo the ever-embarrassing interrogation that would normally follow.

“Do you really love me? Because my brain is telling me you don’t. And I usually trust my brain.”

My brain is a tricky creature, and I’ve come to learn not to trust it in most situations. It loves to see me slip up, or make a fool out of myself.

Basically, I’m stuck in a game of chess with my brain, which has been hard because I suck at chess. I’m learning though, and I’m getting faster at responding to its moves.

When I read horrified accounts of failed bipolar relationships, various versions of crazy-girlfriend are what I always see. Obviously I can’t speak for others, but in most situations where I’ve broken up a relationship for no apparent reason, or suddenly pushed people out of my life that I held dear a moment ago, well it isn’t exactly me. Or well, it is, but it’s my response to a fictitious situation, and I imagine there are many other people who would say the same.

Usually the aggression is a sign. A warning.

Close your mouth.

Don’t let anything out.

And run like hell to the end of the tunnel.

Verbal Chinese Finger Traps

I’ve come down a little bit, my manic symptoms seem to have spiked yesterday afternoon. I am still having some trouble, but the beast is transforming.

Now I’m being plagued with one of the manic symptoms I experience sometimes and really dread, when my ability to communicate verbally and understand verbal conversation are compromised.

I seem to be able to read fine, write fine, and listen to most radio or television music/words fine, it just has something to do with the intricacies of communication with people who are verbally communicating directly with me.

Maybe my body language is thrown off, I don’t really know, but at the pharmacy I couldn’t seem to articulate what I wanted to ask about. The young, female pharmacist behind the counter was obviously very frustrated with me, so I kept attempting to straighten out the conversation, to no avail. She tried to explain something to me, but I don’t even understand what that something was about. I got my prescription but none of my questions were answered, and even though I know I wasn’t communicating properly the whole thing left a bad taste in my mouth.

I also took the dog out, and she jumped up excitedly at a little girl (my dog is a Boston Terrier so she is quite small, not threatening in any way). I made Luna calm down, and then when I tried to explain to the little girl that Luna has bad manners, I said, “she’s very mild-mannered,” which is definitely NOT the same thing!

Best to just keep my mouth shut I guess until it passes. It really is like a Chinese finger trap, once the conversation starts I’m trapped it in, and no amount of wiggling or trying to back my way out of it seems to make a difference.

At least this time around I’m aware that it is happening. Last time I was under the impression that I was communicating quite well and everyone around me must just be going crazy, a thought that seemed totally rational while I was feeling manic at the time.