Saturday, July 08, 2006

How I Know When The Bell Tolls

Lately, it's been creeping up on me. That something's-not-right feeling. And then it starts. The anxiety attacks, the sleep difficulties, the sadness, the mild grandiosity, the up and down and up and down of a mixed state and rapid cycling.

Time for a med re-evaluation. I have a feeling that perhaps lithium is not doing the job. I'm at the right level and it seems to me that it is not taking care of the manic dysphoria that I am seeing once again.

When I was last diagnosed two years ago, as bipolar I, my psychiatrist felt that my dysphoric mania had pushed me from II to I. I believe he was right. And since I began with hypomania back in 1995, clearly the disorder is worse. Still manageable but unquestionably more serious.

I did a search on Google so that I could read what was out there about dysphoric mania. And I came upon something at that really made me think. I'd like to share it with you.

The standard propaganda about bipolar is that it is the result of a chemical imbalance in the brain, a physical condition not unlike diabetes. For the purposes of gaining acceptance in society, most people with bipolar seem to go along with this blatant half-truth.

True, a chemical storm is raging in the brain, but the analogy to the one taking place in the diabetic's pancreas is totally misleading. Unlike diabetes and other physical diseases, bipolar defines who we are, from the way we perceive colors and listen to music to how we taste our food. We don't HAVE bipolar. We ARE bipolar, for both better and worse.

In one way, it's akin to being God's chosen people. As God's chosen - the (un)lucky one or two percent of the population - we are prime candidates for God's wrath, but even as God strikes the final blow - as the old Jewish saying goes - he provides the eventual healing. In a way that only God can understand, God has bestowed on us a great blessing. Living with this blessing is both a challenge and a terrible burden, but in the end we hope to emerge from this ordeal as better people, more compassionate toward our fellow beings and just a little bit closer to God.

For some reason, I found this incredibly uplifting. I'm not religious--spiritual, certainly, but I don't Jesus-shout. Nonetheless, I am guilty of comparing bipolar to diabetes with those who do not have the disorder. I so want people to understand it and I am so tired of the stigma.

I am bipolar. I will never again compare it to diabetes. And despite the struggle, I would never accept a cure that would make me any less than myself.

So I'll be calling the doctor on Monday to make an appointment as soon as I can. Because this thing just don't quit.

Friday, June 30, 2006

The Kiss of Death

So, who do you tell about your disorder? And when?

I don't have a good answer for that because even though I tend to be quite up front about it, there are times when less is more and I don't disclose.

At least, not right away. And perhaps in dribs and drabs. Or maybe never.

When you've finally found out that you're bipolar, it's often such a relief to know that your behavior is to some degree quantifiable that you really want to tell everyone. "Hey, remember the time I spent $5,000 on diamond hairclips? Well, now I know why!"

I generally have a pretty good sense of who I can trust to understand. But I certainly don't wear my disorder on my sleeve for everyone to see.

For example, my boss, who is a wonderful person and someone who I consider a friend, knows, even though I've known her for a short time. She's a diabetic and understands that manic depression, like diabetes, is an imbalance. In the short time she's known me, she knows that I am a damned good editor and writer, that she can depend on me to get the job done, and that I never whine when the going gets tough.

My last boss, who was a clueless dork, never got it, even when I was grimly hanging onto my job during a particularly bad siege of side effects. He simply did not understand that medication could cause me to lose my sharpness and could not accept that I missed details due to a reaction to an increase in dosage. He just thought I didn't give a shit. When I finally explained to him that I took this medicine because I had a chemical imbalance and that I was manic depressive, all the good work I had done was worth nothing to him. He only cared that he wasn't getting what he wanted, not that I was struggling.

But bosses notwithstanding, there are other people with whom you may want to be careful. If you're single and dating, do you tell the boyfriend or girlfriend? That really depends on where you are in the relationship. If you've been dating only a very short time, say a couple of months, I'd say hold off until you know if it's solid enough.

Sooner or later, you have to say something, though. And it's taking a huge chance because you just don't know how people will react, really. My feeling has always been, if he doesn't like it, he wasn't worth it anyway.

However, understand this--people who do not have any mental health problems often do not know how to handle us when we're careening over the edge, be it with mania or depression. Erratic behavior, constant crises, anger issues and all the other baggage that comes with manic depression can be extraordinarily wearing on the other person. I know that in the 32 years I was married, I often drove my late husband, the epitome of patience, right to the brink before I was diagnosed and medicated. But we worked through it together and he developed an amazing understanding of the disorder for someone who never had a screwy day in his life. But he was the exception rather than the rule.

So weigh your odds carefully. Be honest when you can but don't spill the beans before you know the terrain.

Saturday, June 10, 2006

The Children's Hour

How do you handle a family member who's potentially bipolar?

Not with kid gloves, that's for sure. Although I've been accused by daughter #1 of seeing bipolars under every bush, the fact remains that this is a hereditary illness, whether it's been proven scientifically or not.

That said, it runs rampant in my family. Virtually everyone has had something, whether it's been full-blown manic depression or clinical depression. So there have been sessions throughout the years where one family member has been talked to about their particular (or peculiar, if you like) brand of mental illness.

I recently had yet another family sit-down, this time with my youngest daughter, who is exhibiting some signs of bipolar and has, like her mother, been a pro at hiding them until she did something quite destructive. To me, with whom she is very close.

Approaching someone about their behavior is possibly one of the most difficult things any family can do, even if they've been there themselves. If the person is doing something destructive, it has to be stopped. And I found myself in the same position my late husband must have been in when I was at my manic worst.

My brother and I confronted my mother about her alchoholism many years ago. We didn't tiptoe around it, either. We simply told her that we loved her but that her drinking was destroying her relationship with us and we wanted it to stop. She did, and hasn't had a drink since then.

Telling someone that you love them but you hate their behavior is the way to go, always. You can never judge the person but you certainly can judge the behavior. And if you find yourself dealing with a family member, that's the way to go. You may not get through to the person the first time around. It may take more than one confrontation to get them into therapy or whatever it is they need to do. But if you don't try, you are then part of the problem.

Sometimes you will be successful. More often than not, you will be unsuccessful. Because in the final analysis, the person who is ill must recognize it themselves. But if you don't bring it to their attention, they may never know. It's that insidious.

So if you've been avoiding talking to a loved one, stop putting it off and do it. They may or may not listen. But at least you've given it a shot.

Saturday, April 22, 2006

To Anti-Depressant or Not...That Might Be the Question

Jeez, I haven't posted anything to this blog since February 26th. Little wonder, too, since it was about that time that I was waiting to hear about my new job, which I did get and am fully into now. It's good. I'm well.

Thanks, Matt, for writing about your questions on other kinds of bipolar. It seems to me that it's the kind of disorder that doesn't necessarily fall into one or two buckets. And yes, there are more than just I and II--there are other types as well, making it damned difficult to figure out what you might be.

I also went the same route as you. Depression and anxiety with a large ladleful of insomnia were my prominent symptoms. Or at least the symptoms I told the doctor about. I didn't realize that overspending, crabbiness and other things were "symptoms." Until much later.

The problem for those of us who do suffer more from depression than mania is that the psychiatrists can't always tell what kind of bipolar we are, if in fact we are. I find that Paxil has helped me considerably, even though it may tip my scales a little towards mania. I've found that I function better a bit on the manic side but I have to watch myself closely. Certainly, both depression and mania can be destructive.

It sounds to me as if you are very aware of how you function. That's a good thing. As for information regarding other types of manic depression, there are a few. There are the two major forms, I and II, along with rapid cycling, which happens to women more than men and is defined as having four or more episodes of mania or depression within a year. I am a rapid cycler. NIHM is a pretty good resource for info. Here's what they say about another flavor:

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

As far as all the types of manic depression that have been identified, probably the ultimate resource is the DSM-IV, which is used by psychiatrists to diagnose mental illness. Lacking that, there are many good books out on the market and I would encourage you to check into some of them. I did a list of my favorites in a previous post; however, I'm looking into two books right now: The Bipolar Disorder Survival Guide: What You and Your Family Need to Know and Bipolar Disorder for Dummies (I swear to God!). I'll let everyone know if they're worthwhile after I read them.

I read a lot, in any case. And I made it a point to read as much as I could get my hands on about manic depression. The internet is a great resource but having some books on the subject will give you much more information.

So welcome to the club, Matt. It's a good club, really. Because as the Church Lady said, we're "speshul." And I'll start writing more frequently, now that I seem to be adjusted to my new job. Plus, I don't need to put pictures up on this one, which means I can just type. Heh.

Sunday, February 26, 2006

Taking My Time

It's been a while since I posted an entry to this blog and to be honest, if it weren't for my friend Carol encouraging me to continue, I was seriously thinking about giving it up.

Why? Because there's something in me that says it's not all that healthy to write constantly about your illness. This could be interpreted two ways: First, as avoidance or second, as a sign of health. After all, if you're really mentally healthy, why would you want to keep dredging up the subject?

It would seem that a number of people have benefited by my discussion. And maybe I've benefited, too. So I'll keep writing, when the spirit moves me. It may not be on a regular basis but if nothing else, people use the links.

One of the last comments asked a few pertinent questions that I'll try to answer:

Mar tell us what it feels like when you take your meds. Does it makes you feel sedated? antsy? Why is it so common to stop taking them when a person does so much better on them. How long after you stop taking them do you begin to once again slip back into manic or depression. If you had a teenager would you sit on top of them until they took their medication for the day? Will you listen to someone telling you that you're not on your meds, or do you resent someone trying to direct your?

When I take the right combination of medication, I feel OK. When I went back on medication more than a year ago, it was a bitch. I had terrible tremors, I would fall asleep at any time, which made driving very dicey, and I couldn't focus on my work at all. It took a bit of doing and adjusting but now I'm fine. The anxiety is gone, the depression and mania are kept at bay, and I can still write, knit, spin, whatever.

People generally stop taking medication because they feel good. Duh. It's the medication that makes it so. I stopped my medication only once, in June of 2001. And it was not because I really wanted to or felt that I was "cured." It was a financial decision. My psychiatrist no longer took insurance at all, so I had to leave her. I couldn't afford the $180 a session. My primary care physician refused to continue my medication. So I went off meds. And stayed off for more than three years. During that time, my husband became ill and died, leaving me with no money and a big mortgage. I had to sell the house we built together and move. And still, I managed to stay balanced. I have no idea how.

However, in November of 2004, I again became extremely dysphoric, as is my tendency at this time in my life. Bad crying jags, extreme irritiblity accompanied by anxiety. It's sometimes hard to differentiate between dysphoria, a type of mania, and depression. However, with a true depression, it's very difficult to do anything. With dysphoria, you can still function, get up, go to work and so on. So back I went on meds. I was fortunate to find out that UMDNJ had a center not too far from my work that would take insurance. I didn't need anyone to tell me I needed to go back on meds. I know that better than anyone else.

Slipping back into depression or mania or both happen quickly or, in my case, slowly. It's a crapshoot. Everyone's different. The thing is, you are playing Russian Roulette if you go off your medication. Sure, you might not feel anything right away. But depression and mania are insidious and they can sneak up on ya before you know it.

As far as kids taking their meds, that's one I've never had to deal with. I think that rather than making medication a point of contention, I would work with my child so that they understood exactly how important medication is. And that's not easy either, especially with teenagers. The bottom line: You can't force anyone to take anything, be they adults or teenagers. It has to come from within. And if you force the issue, it becomes worse. Bipolar children are a special case, one that warrants specialized handling.

I do listen if someone says I need to be back on meds. Actually, I know it before it's apparent to my family. In fact, generally they don't have a clue because I tend to keep my behavior steady in public. It's in private that I don't do too well.

I think it's a good thing to feel someone out before suggesting that they need medication. Rather than say, "You need some drugs, your behavior is ridiculous," I think a better approach would be "Don't you think you'd feel better if you saw the doctor and see what s/he can do for you?" People with mental illness respond badly to demands, especially manic depressives.

However, everyone responds to love and caring. No matter how off the wall they are.

Tuesday, February 07, 2006

Have you ever stayed up 48 hours straight? No, but I did 60 once.

I've been thinking a lot about Birdie's comment the past week. She asked: can you tell me how you personally proceeded to receive help? You know, that initial step?

I didn't think I was at all sick until 1994, when I was 44. All the years of depressive and manic phases were nicely hidden from all but my husband. My first severe depression was about three months after my father's death, when I was 17 and a senior in high school. My mother was dealing with her own grief and was drifting into alcoholism, so she really didn't notice that I was skipping classes to stay in bed. My grades went downhill but at that point, I was already accepted into college.

My first manic episode began in October of my freshman year of college. I met a guy at a frat party at another college and we proceeded to have a wild affair, with me living in his room most of the time. That ended and I went back to my boyfriend, whom I married a few months later because I got pregnant.

Nice, huh? A real happy story so far. Terrible pre- and postpartum depression, when I tried to cut my wrists, landed me in therapy with a friend of my mother, a woman who had no bona fides other than she had counseled a lot of people in lifestyle management. She was no doctor and therefore, although I benefited greatly from her advice and help, did not see the deeper problem of manic-depression.

For the next 20 years, I managed to be a decent mother and wife, work hard and advance my career from a psychiatric technician (another great story I'll have to tell sometime) to the point where I became an editor without the benefit of a degree. But all along, there were continuous bouts of mania and depression. I don't know how I controlled their severity but I was always good at talking sane and thinking crazy.

One day, my husband Jimmy came home from a visit to the doctor and handed me a pamphlet on manic-depression. "I dunno, honey. This sounds an awful lot like you."

I read it and I realized he was right. Still, it took another two years and a terrible depression, one that I couldn't control, to make me desperate enough to call the local hospital and ask for names of psychiatrists. That's what made me call. I just couldn't stand living such a shadow life, with the ups and downs.

Once I was under care, it took my psychiatrist two years to make a firm diagnosis of bipolar I because I neglected to discuss my spending sprees and my out-of-control rage with her. I was better than I had been, simply because the depression was under control. However, a dysphoric manic episode convinced her that there was much more to the story.

It's critical that you tell the psychiatrist everything. I didn't, and it was the reason I was not diagnosed faster. I was afraid of appearing less than perfect. I was embarrassed that a person of my intelligence would do stupid things such as spend money I didn't have and run my mouth when I should have controlled it.

Psychiatrists have heard just about everything. You won't be judged for your behavior. Your behavior is the one symptom you have that will help the doctor make a diagnosis. And even then, it's not that easy. But taking the first step and calling is the biggest one. Once you've done that, you've started to participate in your wellness.

Tuesday, January 31, 2006

I Think, Therefore I Read Way Too Much

A little late on the Tuesday entry but today was one of those days where time slipped by and here it is, almost 7 p.m.

Books on manic depression. Yep, I have three that I like and own. One is a reference book, the other two are a memoir and a treatise on manic depression and creativity.

The reference book that I have used, New Hope for People with Bipolar Disorder by Jan Fawcett, Bernard Golden and Nancy Rosenfield, is the perfect primer for the newly diagnosed as well as parents and spouses/significant others who live with bipolar children and adults. It's easy to read, has a lot of good information and addresses many, many concerns.

What makes this book worthwhile is that it was co-written by a psychiatrist (Fawcett), a psychotherapist (Golden) and a manic depressive (Rosenfield). Truly a balanced viewpoint of the disorder. While I would not wholly depend on any book for medication info, since pharmaceuticals, dosages and side effects can change, New Hope talks drugs in layman's terms. New Hope is practical (how about a real, down-to-earth disorder management plan), friendly and understanding. And above all, it does give you new hope. Really.

The other two books, An Unquiet Mind and Touched with Fire: Manic-Depressive Illness and the Artistic Temperment, are both by Kay Redfield Jamison, a psychologist who is also manic depressive. An Unquiet Mind is the story of Jamison's manic-depressive life and how she took control of it. Very inspirational and well written. Her other book, Touched with Fire, deals with how the illness affects creativity and discusses famous poets, writers, painters and other creative souls who were bipolar or depressed. Completely fascinating, especially when you consider that treatment for bipolars has come a long, long way. Certainly An Unquiet Mind should be required reading for anyone who has been diagnosed bipolar. And perhaps their family members, too.

Jamison, who teaches at Johns Hopkins, is a highly regarded figure in the bipolar world. She and Frederick J. Goodwin, M.D., have written a comprehensive book on the subject, Manic-Depressive Illness, which is commonly acknowledged as the definitive tome. However, this is not written for the masses. It is a serious reference for psychiatrists and tough going for most people. But it's comprehensive, to the nth degree.

I know that when I was first diagnosed, I wanted to know absolutely everything I could about this disorder. I still do. Because I keep learning, even ten years after the fact. These are not the only books on the subject but they are the ones that gave me hope and encouragement. And I re-read An Unquiet Mind once a year, just because it's such a good book.

If anyone else has some good books, let me know. I'm always on the lookout.

You know that whacked-out Tony what's-his-name with the Gazelle exercise contraption on TV? I swear to God, whenever I get bogged down, I hear his crazed voice in my head screaming, "YOU CAN DOOOW IT!"

You can. I can. It's all about being big boys and girls and not fobbing our disorder off on parents ("My mother hates me so that's why I spend too much"), spouses ("He makes me so crazy"), kids ("They make me so crazy") or anyone else. Ya wanna be well? Take responsibility for yourself. Read some books. Get some knowledge. Talk honestly to your doctor. Don't decide that you're hopeless or that it's your "fault" that you're sick. Keep at it. And sound off in the Comments, if you want.

I've heard it all before and believe me, I've probably been there and done that. If there's some topic or question in particular that you'd like me to write about, let me know. I'm not a doctor but I've been around the Horn with this thing, so if I don't know the answer, I might be able to point you in the right direction at the very least. This is your sounding board, too. So use it.

Tuesday, January 24, 2006

You Talkin' To Me? Huh? You Talkin' To Me?

If you had asked me a few years ago, had I ever had a psychotic break, I probably would have answered no.

Now I feel otherwise. For many years, as I began to come down from manic euphorias, the first sign of impending depression was a weird paranoia. People were talking about me behind my back. They were watching every little thing I did at work and criticizing me in secret. I would drive with apprehension, watching out for every cop on the road because they might stop me for some unknown breakage of the law on my part. I was sure my neighbors were watching me from behind closed curtains.

Of course, all of this was totally ridiculous and completely untrue. Nonetheless, when it happens, it's real. Too real. And quite psychotic, in its own way.

Once the depression set in, the paranoia would get worse, to the point where I would be afraid to leave the house. In any case, generally my depression would be debilitating enough where I wasn't capable of getting dressed without a huge effort. Because I always seemed to have a little bit of energy left, I could usually manage a shower by noon. Of course, three hours later, I would have to go back to bed. Bed and warm bedcovers, by necessity womb-like, were the best and only comfort.

Psychosis plays its own role in manic-depression. In a way, the euphoria that goes with the mania is very psychotic. I can write a bestseller to pay for all my overspending. That was my favorite delusion. Yeah, sure. Perhaps I do have the writing ability to do that; however, during a manic episode, my thoughts and actions were certainly not cohesive enough, nor sane enough, to put together any kind of a book proposal, let alone write a chapter.

And then there's the old "there's nothing I can't get accomplished without sleep" syndrome. Working away at 2 a.m., having huge amounts of energy and yet getting little done because I was too off the wall to think rationally.

These days, although I still have sleep disruptions, they are nowhere like the ones I had during acute manic phases. I try to get at least seven hours of sleep. I try to eat properly, although I still have a bad habit of skipping breakfast. Unfortunately, much of what I do is sedentary. That's about to change, though. On the advice of a good friend, who is not manic-depressive herself but lives with a bipolar, I'm about to get my ass out to the gym and get some exercise into my routine. That will help raise my seratonin level. And perhaps get me back into some kind of physical shape. I've been doing some walking during the day but I need more structure.

As far as posting to this blog is concerned, there are two things that I've decided. One is that I will post on Tuesdays only. It's really not all that healthy to be so obsessed with one's disorder that it must be written about daily. The other is that I put most of my effort into the book that I'm writing and into my other blog, The Knitting Curmudgeon.

In my next entry, books about manic-depression. There's some good ones out there. And some bad ones too.

Tuesday, January 17, 2006

Don't Ask, Don't Tell?

It's very nice that some of the people who have commented think that I'm brave and courageous for writing a blog on a disorder that makes "normal" people's hair stand on end.

It's really got nothing to do with bravery, courage or any high moral values on my part. Believe me, I'm the world's biggest chickenshit.

What it has to do with is my acceptance of who I am. Consider a gay person coming out of the closet. Now that takes guts, in my opinion. And total acceptance of who you are and complete disregard for "public opinion". Which may or may not include one's family.

And then there is always the question of who do you tell. I don't wear a "Kiss Me, I'm Bipolar" badge on my shirt. Most people don't even suspect that I have any kind of mental disorder when they meet me or even get to know me. However, the workplace can be extraordinarily difficult for someone with a mental disorder. Let me give you an example.

In my last position, which was operations manager for a small consulting firm, I was literally chief cook and bottlewasher. During the course of a week, I might have been off at a client site doing database consulting work, managing the network back at the office, running statistical spreadsheets, interviewing someone for a temp office position, designing and implementing the company web site, organizing trade show crap, writing contracts for clients, and a host of other things. I juggled many responsibilities.

However, during a medication change, suddenly I was falling asleep in front of my computer at 2 in the afternoon. Despite my using a Franklin-Covey planner religiously, I could not remember simple things, such as renewing service contracts on the company laptops. Always a sharp proofreader of my own work, suddenly I was making mistakes that were being caught by other people. Not good. And my boss was concerned enough to ask me if there was anything wrong.

So, what do you say? "Gee, I guess I screwed up?" Or, "I didn't tell you when you hired me but I'm a manic-depressive and I take killer drugs that can turn me into a zombie."

Anyone who takes psychotropic medication will find at some point that their functioning may become somewhat less than it had been. My feeling regarding my employer was that while he had the right to some explanation of why my performance wasn't up to speed, he did not necessarily have the right to know everything. My solution was to explain to him that I had been recently put on medication that had certain side effects such as drowsiness and that I did not expect the side effects to be permanent. And of course, they weren't. In the context of my work performance, he completely understood. To a point. I knew that if my mental state did not improve, he wasn't about to live with it indefinitely.

Sure, there's always disability when the going gets tough. I've been on disability exactly once--during a severe depression, for three months until I was better. However, I prefer to keep working rather than rely on SSI, which is harder than shit to get anyway. Working at something is really the best medicine, whether you have a high-level job or not.

In this country, people with mental disorders have rights under the Americans with Disabilities Act. Making sure that your rights are respected at work may mean that you will have to disclose your disorder. Here's a very good article about handling your disorder at work. I've found it to be quite helpful.

And when you're really struggling at work or with anything at all, think about all the well-known, creative people, past and present, who've been manic-depressive or depressed. They did it. There's always hope.

Saturday, January 14, 2006

To Sleep, Perchance to Wake Up Every Hour

I dunno about you but my biggest problem lately seems to be a sudden screw-up in my sleep patterns.

Here's the drill:
  1. Go to bed at 11:30
  2. Lie in bed for 45 minutes with at least ten topics jumping around my brain such as:
    • If I decide to redesign this Aran sweater, which motifs should I use? And how should I place them?
    • Where did I put that reference book?
    • Do I really want to go back to school?
    • Why hasn't my brother-in-law called me lately?
    • Should I call him?
    • Did I forget to buy toothpaste?
    • Maybe I could move to New Hampshire
    • Maybe I should go back to work at a real job instead of writing a book
    • Should I include a chapter about weaving and spinning in the book?
    • Do I want to get married again? If I did, who would I marry anyways?
  3. Get up and get a drink of water
  4. Go back to bed
  5. Count backwards from 10
  6. Switch positions
  7. Look at the clock
  8. Doze off
  9. Wake up an hour later
  10. Look at the clock
  11. Repeat from Step 1.
Now I don't mind taking my regular meds but I sure as shit don't like sleeping medications. First of all, they make me groggy, which is an entirely different state than just being tired. Second, if I don't have to take something, then I won't. However, I'm always worried that poor sleep can morph into a full-blown manic episode where I just don't sleep at all. Of course, being manic means being hugely productive. But then, there are other not-so-great things about being manic. Like the ensuing paranoia, the gross irritibilty and the inevitable crasho grande.

So I've been trying melatonin, which is a homeopathic sleep aid and really can't do much harm. I buy my vitamins at GNC, so I'm pretty sure the quality is OK. I'm all for homeopathic remedies as long as they aren't harmful and they work in conjunction with my meds. One that I've found doesn't work for me is St. John's Wort. (It should never be taken with antidepressants, incidentally.) I know a lot of people swear by it but when I hit a depression, I do the best with regular pharmaceuticals. Paxil CR works well for me.

Actually, in its way, lithium is all natural, since it's an element and a salt. I guess there's some comfort in that, although the side effects can be a bitch.

The melatonin seems to have helped quite a bit. It certainly makes me sleepy and shuts off the brain chatter for a bit. However, the chatter and the poor sleep cycles probably have little to do with each other. I suspect that the chatter needs be dealt by a medication increase. That will come in a few weeks, when I see my new pdoc.

I'm glad that people are reading this blog and that it's been of some use. As with any blog, generally the writer gets the biggest rewards from writing it, not the reader who reads it.

However, if you knit and you're crazy, then I'm your woman. For sure.

Thursday, January 12, 2006

It Didn't Come From OUR Side of the Family

I was thinking about my aunt Helga a few weeks ago. She's been dead now for 10 years, hit by a cab in NYC one sleety December Saturday in 1995. I miss her sometimes. For all of her craziness, she was a good aunt and was always willing to take me to the Metropolitan Museum of Art to see the mummies for the thousandth time.

When I had gotten out of the hospital that previous summer, I went back to work in NYC as a managing editor for a collector's magazine. Helga had recently retired from Swissair and we would occasionally meet for lunch. The story behind my father's family is a lengthy one--they came to this country in 1940 from Hamburg, Germany via London. My grandfather was a Jew, my grandmother a Gentile. Their children, my father Herbert and Helga, were, in a sense, both victims of this mixed marriage because my grandmother, a neurotic, anxious woman, and my grandfather never got over their guilt.

Now all of them were dead except for Helga. There were no other relatives on my father's side as far as was known. Helga lived her entire life with my grandparents, never marrying, having relationships with married men and working for a Swiss company where she would never be appreciated because she was a woman. Helga suffered from depression. My father, who died at 43, may well have been bipolar. He was an excessive spender, often had rather grandious ideas and also may have had depression. My grandmother had at least two major depressions, one after my father's birth and another after an abortion when my aunt was small.

But were they mentally ill? Of course not. As far as they were concerned, psychiatry was akin to witchcraft. So I debated with myself before that lunch with Helga. Should I tell her? Should I not? I wasn't quite sure how she'd react. But I thought that perhaps by telling her, I could get more information from her about the family psychiatric history. What little I knew, I had heard from my mother.

So we sat down to lunch and I said to her, "I've been diagnosed as manic-depressive and I've just been released from the hospital."

She immediately said, "It didn't come from OUR side of the family."

Yeah, right. I almost said, "Well, where else do you suppose it comes from?" So much for being upfront and honest. I dropped the subject. Even though I knew her doctor had prescribed an antidepressant for her, which she refused to take, I decided that there was little point in trying to have an open discussion on the family's mental health history.

That was the last time I saw her, although I spoke to her on the phone thereafter. Two months after that lunch, she was gone.

If it had not been for my mother overhearing conversations about my grandmother's breakdowns, I would never have known. I might have figured it out, since it was obvious to me, even as a child, that my grandmother was an anxious, unhappy, depressed woman.

As for my mother's side, she and my aunt are both recovering alcoholics. Mom says that her father often suffered from Lincolnesque "black moods," where he would lock himself in the bedroom and not talk to anyone for weeks. So there's a bit of something on the other side of the family too.

The result of this family history is that it was passed on to my generation. I am bipolar, my brother is clinically depressed and on medication and my sister insists that she has ADD. Which she probably does, although I don't see her doing anything about it. My 12-year-old nephew has a cognitive disability, although he does very well these days. My oldest daughter has had depressive episodes in the past. Her treatment has been sporadic but she seems to be doing fine at the moment. My granddaughter, we watch as she grows into her teens. Her father is probably bipolar but was never diagnosed or treated. However, he is an alcoholic and has been to rehab many times without much success.

My grandparents were born more than 100 years ago. When they were alive, mental illness was never discussed and treatment never sought. These days, our family talks about it openly and frequently. We support each other.

When my brother became severely depressed a year ago, he came to me and we talked about it. He went back on meds. When I start having symptoms, I call him or my mother. If somebody's behavior is off and they are unaware of it, they get told. I'm sure the old folks would be shocked if they were still alive.

I'm very fortunate to have the family I have. We stick together because we've been through a lot together. Family relationships can make or break you. Acceptance of each other is the critical ingredient. Without that, there's nothing.

Tuesday, January 10, 2006

I'm Not Sick, It's Just Hormones

Being manic-depressive, really understanding all it entails and then managing the disorder means having an epiphany of sorts.

Like being a born-again Christian, only not nearly as obnoxious.

A good, swift kick in the ass helps the process along. In my case, it was hospitalization. I'd finally reached the point in July 1995 where the antidepressant I was taking was not making a dent in my condition and Dr. D, my pdoc, decided that perhaps I wasn't just clinically depressed, I might be bipolar.

It didn't help that up until that point, I hadn't mentioned the continuous out-of-control spending sprees that had gone on for years and that had driven my poor husband Jimmy absolutely crazy. Dr. D immediately decided to put me on a lithium kicker and hospitalize me for observation because I had made this damning statement:

I want to stay in bed until I rot.

This, my friends, is considered a suicide threat. I didn't quite see it that way; after all, "rotting" has no time limitations and is a pretty ineffectual tool. If you're going to kill yourself, you usually pick a more efficient way of doing the deed.

So off I go to the local psychiatric/rehab facility, The Charter House, which is located in Summit, NJ, and was formerly known as Fair Oaks. Its main claim to fame was having treated Papa John and Mackenzie Phillips for their drug addictions. I believe it has again changed names to something else.

I was a mess when admitted. Crying constantly, unresponsive to other people. I was barely able to sign the admitting papers. Somebody, a counsellor, took me up some stairs and into a large dayroom, where I sat at a table with my head down, crying, for several hours. And then, suddenly, I felt fine.

And I knew why. It wasn't manic-depression, I had gotten my period. Why, it was simply a bad case of PMS. Of course. That explained everything.

It didn't quite explain why I had been severely depressed for weeks, but hey--a minor detail. I was now a well person sitting on a ward with a bunch of crazy people. This was going to come to a screeching halt. I was not about to waste my time here. But having worked as a psychiatric technician myself (yes, this is true--the crazy leading the crazy), I knew that the only way I was going to get my ass out of this hole was to present a reasonable case to the attending physician, whom I was due to see momentarily.

Presentation is everything. The attending doc seemed like a reasonable guy. So I figured, if I treat this like a job interview, I'll present my facts intelligently and coherently and he'll have to agree with me. Anyone who can do that, doesn't belong in a nuthouse.

He took my medical history and when I told him that I didn't drink, he looked at me askance. Many manic-depressives drink to self-medicate--in fact, more do than not. So right off the bat, he was skeptical that I was telling him the truth. And then, as I presented my PMS situation to him, he simply listened and said nothing. That was not a good sign.

"So I think if I just go home and take a hot bath and some aspirin, I'll be fine." That's how I finished up. And his response? "You can discuss your plans with the ward doctor tomorrow morning, when he comes in."

Shit. Foiled. I'm in a rather shabby dayroom, with people watching "Baywatch" on the TV, for crissakes. And then I discovered my NJ Transit monthly train ticket in my pocket. The train station was a block away. Escape was in order.

But the doors were locked. I tried every single one. I waited to see if I could slip out when someone came in. Nothing doing. We were taken out for a cigarette break. Into an enclosed courtyard. No exit there.

Back upstairs I went and sat in a chair. Nobody spoke to me and I was damned pissed off. I went up to the head nurse and loudly demanded that I be released. Sure, fine, she said. But if you leave against medical advice, you, not the insurance company, will be responsible for the entire hospital bill.

So back I went to my chair. And sulked. And cried. And called Jimmy from the pay phone and told him I had to come home, I couldn't stand it. He calmed me down and told me he wasn't coming to get me, that I needed to stay at least for the night. He had forsaken me. I slammed the phone down and went back to my chair.

And then, something happened. It hit me from nowhere. What if they're all right and I'm wrong? What if I really am manic-depressive? Doesn't being manic-depressive explain all the bad behavior, all the ups and downs, all the unhappiness for all those years? And if it's so, maybe I should just shut up and listen for once. Maybe I haven't done a great job in managing my life and maybe I can stay here and try to learn something.

I tentatively went over to a group of patients sitting at a table and introduced myself. Sure, they were a little whacked out, but being manic-depressives, they were intelligent people with stories to tell. Stories that I could relate to. Stories that mirrored my life. Talking to them and slowly coming to accept the fact that I had a serious chemical imbalance but that it could be treated.

I spent four days at that place. And got far more from talking to people who had been in my shoes, who understood exactly what manic-depression was and who were in most cases bright, intelligent, successful people.

I've not been hospitalized since. Probably more from luck than from learning to manage my disorder. But I became a believer and that is critical to managing any illness. There are days when I don't even think about the disorder and days when I do. But most of all, I accept that it's not PMS.

In the ensuing years, I spent a good deal of time juggling my medication and spending time in one-to-one therapy. The therapy helped as much as the drugs insofar as it taught me how to manage the disorder. Get enough sleep. Eat properly. Learn the warning signs. Don't wait to get help. Let your family help you.

With the latter, I've always been fortunate because my family has been enormously supportive. My brother, who has clinical depression, in particular has been the one family member with whom I could share my trials and tribulations. He knows. He's been there too, although he doesn't get the manic highs. It's all in the family, you know.

So maybe the next time I post, I'll talk about getting the cure if there ever is one. And in the meanwhile, if you have something you'd like to discuss, put it in the comments.

And for those of you who read my other blog, The Knitting Curmudgeon, be advised that my manic spending sprees encompassed buying yarn. Of course.

Sunday, January 08, 2006

Abilify? What the Fuck?

I've been doing some research on this "new" drug, Abilify. Probably not for me, since it's supposedly for those manic-depressives who are in an acute manic phase.

Which I'm not. I tend towards dysphoria rather than the full-blown, Vivian Leigh-run-naked-in-the-street mania.

I'm a lover of drug names and it's a job I'd love to have, thinking up new, catchy names for chemical compounds. I mean, Abilify? Shit, that's fucking great! I'd love to meet the genius who thought that one up.

Sounds like something Bush would use: "Allegations that we have abilified the oil companies are false."

Tegretol. I make the connection to "integrity." You can depend on Tegretol because it's trustworthy.

Lamictal. Laminated.

Depakote. Protective coating. Sounds like Home Depot's house-brand paint.

The drug companies spend a ton of money making their pharmaceutical brand names reflect the drugs' implied function.

Umm, umm, good.

I would prefer names that reflect the actual effects, like Woozit, Tremolin, Vaguen, Zombil.

Don't get the idea that I'm anti-meds. I'm absolutely not. Medication has saved my ass many times. But despite the fact that I live in New Jersey, home to many of the major pharmaceutical companies who employ many residents here, I have no love for the pharmagreed.

Next time: If you could be cured, would you?

Friday, January 06, 2006

The Zone

I'm in the zone. That's the only possible reason for starting a second blog.

But no. It's more than that. It's a nasty dysphoria that's knocked some sense into my head. And made me realize that this disorder the shrinks love to call "bipolar" isn't going away. When I find it impossible to verbalize, I can always write. Hence my blogging.

I prefer the term "manic-depressive" to "bipolar." In an onomotopoeia sort of way, it sounds like it is. Bipolar just doesn't cut it, doesn't give the sense of grand movement like manic-depressive. However, since my latest doctor has diagnosed me as bipolar I, I suppose it has some use.

I was first diagnosed bipolar II at 45 (I'm nearly 56 now), after years of borderline functionality, huge depressions, and manic behavior that I tried to cover up. In fact, I'm almost convinced I was a bipolar child--there were temper tantrums, anxiety attacks, impulsive behavior, and moodiness as far back as I can remember. Who knows? It certainly took the better part of my adulthood to be diagnosed.

Every manic-depressive's story has its interesting edges. Mine certainly does. This blog will help document my life as a manic-depressive and provide a forum for me to express my views on a very unique ailment.

I'm still in the process of formatting this blog, which will take a while. Ultimately, I hope this will become a resource for other manic-depressives as well as their family and friends. Yeah, you can Google for info but it's nice to have a repository.