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Archive for the ‘Mental Health’ Category

Why I Stopped Therapy

I got my first hint that I might be ready to stop therapy when I realized how little I was going. Over the years I have scaled down from weekly sessions to biweekly.

Then I noticed that, effectively, I’d been going only once a month. I’d been forgetting appointments, showing up on the wrong day, oversleeping, or having too much freelance work to do.

Of course, those could have been signs that I was in denial, that I was resisting therapy, that we’d hit a bad patch of difficult issues and I just didn’t want to deal with them.

But I don’t think that’s what’s happened. Here’s why.

I’m stabilized on my medications and they’re effective. When my psychiatrist moved away, he left me with refills and a list of other psychiatrists. My PCP agreed to prescribe my psychotropics if I lined up another psychiatrist for emergencies. I did that, though I couldn’t get an appointment for months.

And that doesn’t alarm me. I don’t have the oh-my-god-what-if-my-brain-breaks-again panics. I don’t have the feeling that my brain is about to break again. I’ve thought about it, and I’m comfortable with letting my involvement with the psychiatric profession fade into the background of my life.

As long as I keep getting my meds.

I have more good days and I’m beginning to trust them. Oh, I still question whether I’m genuinely feeling good, happy, and productive or whether I’m merely riding the slight high of hypomania. But really? It doesn’t seem to matter very much. A little while ago I reflected on a string of particularly good days – when I accomplished things, enjoyed my hobbies, and generally felt content. And I simply allowed myself to bask in those feelings.

That’s not to say I don’t still have bad days. After a few days of hypomania, I hit the wall, look around for spoons and don’t find any, and require mega-naps to restore me. (I’m intensely grateful that I work at home and can do that. Most offices don’t appreciate finding an employee snoring underneath her desk. And my cat-filled bed is much more comfy-cozy.)

I still get low days too, but they are noticeably dysthymic rather than full-out, sobbing-for-no-reason, Pit-of-Despair-type lows that last seemingly forever. I know – really know, deep within me – that they will last a day or two at the most. And just that knowledge makes me feel a little bit better.

My creativity, concentration, and output are improving. I can work longer, read longer, write longer, take on new projects, think past today or even next week. I can trust my muse and my energy, if not immediately when I call on them, at least within a reasonable time.

I have trouble remembering how bad it used to be. I’ve made connections with several on-line support groups for bipolar and mental health. I find I’m astonished at the crises, the outpourings of misery, the questioning of every feeling and circumstance, the desperate drama of even the most mundane interactions. They are overwhelming. But I realized that it’s been a long time since they’ve overwhelmed me. I recognize that I could some day be in that place again – that’s the nature of this disease. But I have a good support system that I trust to help me not fall too far without a net.

I don’t have much to talk about when I go to therapy. There are issues I need to work on – getting older, getting out of the house more, reclaiming my sexuality. But most of those I feel competent to work out on my own.  My sessions are mostly an update on what’s going on in my life at the moment, plus a recap of my recurring problems. But those problems are ones I’ve faced before and know how to cope with. I already have the tools I need and use them without needing a reminder.

So I’ve talked it over with my psychotherapist and I’m quitting therapy. I know that if and when the bipolar starts giving me major trouble again, I can always call for an appointment or a telephone therapy session.

I’m not going to stop writing these posts. I still have a lot to say about where I’ve been, how I’ve got to where I am now, how things will go in the future, and all the many ways that mental illness affects society and vice versa.

You’re not getting rid of me that easily. I’m sticking around.

Tracking Your Moods: Low-Tech, High-Tech, and In Between

Many therapists and people with bipolar disorder recommend journaling as a practice that allows you to track your moods and figure out what your triggers are. And many individuals do well with journaling.

I didn’t, however. I tried starting a journal of what I was doing and what I accomplished daily. It rapidly turned boring and whiny. My entries looked like this:

Accomplishments:

  1. Paid cell phone.
  2. Forced myself to finish work assignment.
  3. Finally got off that stupid level of that horrible Candy Crush.

Writing is what I do, but journaling, especially when depressed, was an unrelenting series of pitiful nothing. Instead, I started this blog (on 1/7/14). In my blog, I could write about anything. Still, it wasn’t much good as a way to track my daily moods.

Technology is starting to address that problem. Recently some inventions have come on the market that promise to help you track your moods not just daily, but hourly (or even more often). Most of these devices resemble what would happen if a Fitbit and a mood ring had a child.

Most of them claim to monitor your moods by tracking your heart rate and/or your breathing. (One notes that it tracks your steps too, so you don’t need an extra device to do that. Another promises to monitor galvanic skin response, pulse, and skin temperature, which sounds more like a lie detector than mood tracking.) Then you take that data and compare them with what you were doing at the time and voilà – a mood journal.

Of course, these devices make certain assumptions – for example, that when your heart rate is elevated, you are anxious or tense. Needless to say, there are plenty of other things that can raise your heart rate and breathing. Sex, for one. Or running. Neither one of which is necessarily a source of anxiety for everyone. There is, as far as I can see, no way for the device to tell when you are depressed. They appear to assume that everything except anxiety is normal.

Then there’s the fact that you still have to journal. The devices work on the theory that you can look for patterns in your breathing and respiration, then figure out what you were doing when that happened. Upgraded devices and apps are planned that will add calendar and location functions to make this easier. But if you’re in your house the whole time the moods are happening, it won’t tell you much.

(One brand of these devices is available only from an employer, health plan, or EAP, which, if you ask me, is pretty creepy. If there’s anyone I don’t want to have information about my moods, it’s my employer.)

My friend Mike came up with an in-between solution that uses both higher-tech and lower-tech approaches to monitoring his moods. Over a period of several months, Mike had been on four different drug regimens for depression. Not all of them worked, and he was unsure which did the most good.

His idea was to go to his social media and chat apps and take a look at when he was the most active, engaged, and responsive. Then he looked at what medication he was on at the time. He noticed, for example, that in the first few weeks of April, he was posting more about accomplishments and responding to others’ posts and chat messages. A quick check of his pharmacy records and he had a pretty good idea of which medications were working best. No journaling involved – the evidence of his increased energy was right there in front of him, already recorded. And no $150 expense for an emotional tracking device.

Maybe journaling is right for you. Maybe a wearable mood tracker is the thing that will help. But don’t overlook the tools you already have. Think about them in new ways and you may already have a handle on understanding your moods and meds.

Sources

https://www.l2inc.com/daily-insights/spire-wants-to-be-the-fitbit-for-your-emotions

https://www.entrepreneur.com/article/239743

http://nerdist.com/sentios-feel-wristband-fitbit-for-your-emotions/

Depression, Mania, and Mystery

Writing a book takes a certain amount of mental stability. Also, you have to be a little crazy.

Despite the fact that in the popular imagination, creativity is linked with insanity, having a mental disorder is not all that conducive to productive work, particularly to the sort of sustained, focused writing that a book requires.

Still, bipolar, OCD, schizophrenic, and other writers have managed to write books – and some very good and highly acclaimed ones.

I have taken on that venture myself. I am writing a book.

Now, settle down. I am not (yet) asking you to buy this book. It is still only a book in process. Nothing has been published. Maybe nothing ever will be. Nevertheless, I persist.

Actually, I have two books in the works. One is out of my hands now. It is languishing at a publishing company, where it has languished for a year, waiting for them to determine if their interest in it will lead to actual publication. That book is a memoir of sorts, based on these blog posts. Unless I want to start pimping it to agents and other publishing companies, there is nothing more to do with it right now.

In the meantime, my attention has turned to the other book. It is a mystery, and has nothing to do with bipolar disorder. Except that the writing of it has everything to do with bipolar disorder.

First depression. Depression is great for writing certain types of scenes – deaths and reactions to them, for example, which are good for mysteries. Depression, however, periodically leads to the “this book is shitty” phenomenon, which I understand is not exclusive to depressive writers.

When depression leads me into that trap, I stop writing. Instead, I do “research.” If I am not too depressed to read, I delve into books about the craft of writing – plotting, description, etc. Or I study the works of writers that do things exceedingly well – dialogue, word choice, narrative voice. I highlight examples of good technique. Then, at some point the depression lifts and I try to put what I have learned into my manuscript. Of course this means lots of rewriting and revising, which slows my progress, but, I hope, makes the manuscript better.

Then there’s mania. Or at least hypomania, in my case. It carried me through the first eight chapters of the mystery before the depression hit. If it’s a truism that depression lies (it is and it does), mania is a liar as well. Recently I was tootling along at about 500 words per day, and it occurred to me that, at that pace, I could reasonably expect to have a rough draft by July 4, ready to send to my beta readers.

This was mania talking. Lying, rather. In fact, there was no way I could maintain the pace, meager though it was, of 500 words per day and not a chance in hell that I could meet the self-imposed deadline.

What came next? More depression, of course. More research, this time into how various authors use dialogue tags. And a confusing attempt to improve the pacing by scrambling the order of the chapters.

Until writing mania sets in again, I plug away at scenes I know need to be written, even if I don’t know where they go, and keep my eyes and ears open for both the depressive lies and the manic ones. I have over 45,000 words written and refuse to abandon them now.

So I don’t know all that much about whether bipolar disorder is a help or a hindrance to creativity (I would suspect it is both), but I do know that it is possible to work around it.

Eventually, if I’m lucky and persistent, I’ll ask you to buy my books. Someday.

What I Learned About Ketamine and Depression

Trigger Warning – Meds

Note that I’m not a doctor or a pharmacist or any kind of medical personnel. Do not consider this post to be advice on what you should do. If the subject interests you, ask a licensed physician for more information.

What did I know about ketamine before I started doing some research?

Not much.

I knew that as a street and “club” drug it was known as “Special K.”

Then I heard that it was being used for treatment-resistant depression. Here’s what I found.

First, you can’t just go down to Brown Street and buy a few pills. That’s illegal. And what you get may include other substances that you didn’t intend to take.

So, you need a prescription for it. Once you get that prescription, usually after a consult with a psychiatrist, you need to find a treatment center that will administer the drug. Clinic operators may be anesthesiologists, as ketamine is primarily used as an anesthetic.

The treatment is delivered via IV or injections. No simple pills to take. It’s a course of treatments, each lasting 45 minutes to an hour, with a rest of an hour afterward. The treatment may be delivered for as many as six doses over the course of 12 days. (There may also be a nasal spray option, but the IV version seems more typical.)

You have to have someone who can drive you. The possible side effects include confusion and blurry vision. You can’t drive for 24 hours after the treatment, which basically means you can’t drive for two weeks, since the treatments are roughly every other day.

They don’t know how it works. I don’t find this surprising, since every time I’ve asked my psychiatrist how a medication works, I’ve been told, “They don’t really know, blah blah blah, neurotransmitters, blah blah blah, serotonin, blah blah blah.”

It’s expensive. The initial treatment may cost $500–$1,000, and a full course of treatments may cost as much as $3,800, which insurance won’t cover. These are estimated costs, based on treatment in various regions of the country. (The wholesale cost is approximately $.32 per dose, by the way.)

The results don’t last. They give relief for as little as a few hours to as much as nine months, after which a $600 booster shot is required.

You may still need regular antidepressants and psychotherapy. Ketamine may get you “over the hump” until your regular antidepressant kicks in, but is not a stand-alone treatment.

There are side effects. Confusion, hallucinations, and high blood pressure are among them, along with something called “lucid daydreaming.”

More research is needed. Duh.

The FDA has also approved trials of MDMA (Ecstasy) for treating PTSD. It is also being researched for effects on OCD, depression, and other conditions.

So, assuming that I could afford it, would I try ketamine? There’s not one easy answer to that.

Back in the days when my depression was drug-resistant, when I had spent years trying different combinations of psychotropics, when I was considering electroshock, I might well have seen ketamine as something to consider before I took that step. It should be noted that, at the time, my psychiatrist did not recommend or even mention it, so it might not have been appropriate for me whether I wanted to try it or not. And anyway, a combination of meds and therapy finally kicked in and made the subject moot.

Nowadays, I would not try ketamine (or MDMA, for that matter). My bipolar depression has moved from drug-resistant to drug-alleviated, at least for the most part. And that “most part” is enough for me. I have no need to be driven 45 minutes to the nearest clinic or to try to find a psychiatrist and anesthesiologist willing to go off-label. I am satisfied as I am.

As always, Your Mileage May Vary.

Sources

http://www.webmd.com/depression/news/20140923/ketamine-depression#1

http://www.ketaminetherapy.com/Depression.html

http://uchealth.com/intranasal-ketamine-infusion/

https://psychcentral.com/blog/archives/2012/12/01/should-you-try-ketamine-for-depression/

https://en.wikipedia.org/wiki/Ketamine

http://www.webmd.com/depression/news/20161130/fda-ecstasy-ptsd-treatment#1

Why I Didn’t Get Depressed When I Got a F**k Off Letter

Brenda was a friend to my husband and me for many long years. We partied with her, and talked with her, and grieved with her and supported her when her marriage ended.

I became closer to her than Dan had, although he had met her first. Then we grew apart. Then I heard that she had given up on me. I wrote, asking for one more chance.

Recently, she sent me a three-page letter. When a mutual friend asked what it said, I replied, “Basically, ‘fuck off.'”

I’ve written before about the friends I’ve lost due to my bipolar disorder (http://wp.me/p4e9Hv-2W) – the pain and loss I sometimes still feel, my unsuccessful attempts to apologize or rebuild the relationships, the continuing rejection, the knowledge that those important people are gone from my life forever.

But this time, the rejection didn’t seem to bother me as much.

Why? I wondered.

I know that people sometimes do drift apart, and there was an element of that in the death of the relationship.

I knew that I had refused many invitations and stood her up many times. But apparently, when I did show up, I brought along an extra person, “my misery.” It seems like a trap: don’t accept an invitation, or be unwelcome when I do because of my constant companion, which I was unable to just leave at home. In those days, and sometimes still, the Black Dog was always with me. But Brenda saw it as something she couldn’t compete with, something that was always more important to me than she was.

In a sense that was true, though I didn’t see it as a competition. It wasn’t like I valued my disorder more than I valued her. Feeling miserable was important to me, in the sense that it seemed ever-present, but it was important to me in a bad way – the thing that dragged me down, the thing I fought against, the thing that did make my life a misery. But it was a misery I could not put down, much as I wanted to, even for people I cared about. At the depth of my depression, it was simply a part of me. I am sometimes amazed that I came through it with any friends left. But I have.

To be fair, Brenda also blamed her own misery after her divorce as a contributing factor to our parting. Then there would be four of us present – two people and two miseries – and evidently it was too much.

Most perplexing to me, though, was Brenda’s contention that her growing religious fervor and burgeoning political conservatism contributed to her decision to cut ties. I freely admit to being a liberal and to disliking organized religion, but I have friends who feel otherwise and yet remain my friends. There’s lots we agree to disagree on or simply choose not to talk about. Even my mother and I had profound differences but never gave up on each other.

According to Brenda, her religious and political leanings required “personal responsibility” – including responsibility for one’s moods. As she put it, despite her reactive depression, her happiness was a choice. One that she made and I didn’t.

She compared mental illness with high blood pressure and diabetes – conditions that one must take personal responsibility for treating and trying to control. The fact is, I was trying to control my disorder, with therapy, with medication, and once almost with electroshock. I know she knew this, as once we went to the same therapist.

And that’s why I said, “eh” when I got the letter. By Brenda’s own criteria I was doing my best. And that’s all anyone can do. I couldn’t go back and change my misery, or try harder to find relief. And I couldn’t simply choose to be happy, which I don’t believe is possible for most people like me. If you can manage it, more power to you, and to Brenda.

I think what bothered me most about the letter is that Brenda has a degree in psychology and is teaching psychology in college now. I wonder what her students are learning from her.

 

 

Caregivers Need Care Too

While there are professional caregivers, family members often provide care and support for those with bipolar disorder and other mental illnesses.

My husband of 35 years is my caregiver. He does a spectacular job – making sure I have my meds, taking me to my appointments, running the errands that I have no spoons to do, keeping the house quiet when I need to sleep, making sure I eat at least one nutritious meal a day.

It’s a lot. And there are things I can give him in return. Things he needs.

Appreciation. When my father was dying of cancer, my mother was his primary caregiver. One day she came to me, wanting me to tell her that she was doing a good job. She knew that she was. She just needed to hear it from someone else, someone who could tell her that her excellent care had been noticed and appreciated.

Appreciation – validation – is the thing that caregivers need most, to replenish themselves, to allow them to keep doing the things that are so vital for their charges. And it’s the easiest to give. When you’re in the depths of depression, it may be difficult to remember to say “thank you,” but it means a lot to your caregiver.

Now I’m mostly out of my depression (usually), and I say “thank you” a dozen times a day. And he always responds, “You’re welcome, friend.”

Alone time. Primary caregiving can be a full-time job. I know that one thing I need in the process of healing is alone time. Dan needs it too. He needs time off, even if that’s just time to retreat to his study and watch a movie or go outside and dig in the garden. I can always reach him if I really need him – for example, if I have a panic attack – via cell phone if nothing else. But, as the saying goes, you can’t pour from an empty vessel. That’s part of the reason that he’s able to give me so much of what I need.

Couples time. This doesn’t necessarily mean sex. It means time spent together, doing something other than dealing with mood swings and trauma. It’s a little gift we give each other. Sometimes I sit through a movie I don’t really care for, just to give him the gift of snuggling on the couch. He got me color-and-bake ceramic mugs that are great for creativity and distraction. One rainy afternoon we sat together and each colored one side of the mugs.

Life stuff. Dan does most of the chores and tasks of daily living, but I do what I’m able to. I earn money. I pay bills online and do most of the other computing, except what he does for leisure. I help with cooking to the extent I can – sous-chefing, finding recipes, breading or mixing or inventing dressings and sauces, making grocery lists. He can ask me for help too.

Sharing my spoons. When I do find myself with a few spare spoons – a little extra energy occasionally – I try not to be selfish with it. When I have spoons to spend, I like to shower and dress and go out for lunch. But the other day, I showered and dressed and went for a walk in the woods with Dan, something he’s been longing for. My spoons ran out pretty rapidly, but he appreciated that I made the effort and shared one of his delights. It was another gift that cost no money.

In other words, when you have a caregiver, don’t think it’s all one way. Your caregiver needs care too. Small or large, what you are able to give will be appreciated.

 

I Don’t Care If They Discover the Cause of Bipolar

Recently there have been several so-called “breakthroughs” in discovering the cause of bipolar disorder.

And I really don’t care.

Whatever they decide the cause is, I still have bipolar disorder. No matter if it’s toxoplasmosis, gut bacteria, or faulty synapses that are behind it, I still get to experience the lows and (sometimes) highs, the apathy and psychological pain, the weeping and despair, the irritability and touchiness, the anxiety and the gloom.

Knowing the cause will not alleviate my symptoms one bit.

I know that people believe that discovering the cause will bring us that much closer to a cure.

But will it really?

If the cause is genetic, how am I supposed to go back and change my genes? Or does anyone really believe that gene therapy will be available to the mentally ill when even hospital beds are denied them?

If the cause is viral, does that mean that a cure is right around the corner? We now know what virus causes AIDS – HIV was discovered in 1983 – but nearly 35 years later, a cure is still far away. Yes, there are treatments that improve health and extend life, but there are also treatments that alleviate some of the symptoms of bipolar disorder. Will any advances be orders of magnitude greater, or merely incremental? And how much money will be devoted to finding those treatments when Huntington’s disease, multiple sclerosis, and a host of other conditions are still without a cause, a cure, or sometimes even minimal treatments?

With most bipolar sufferers being treated (if at all) in community mental health centers, via EAPs, or through six-weeks-and-out insurance programs, what are the odds that any new breakthroughs and any new treatments that result will be available to the bipolar-on-the-street (or in the group home or even at home or at work)? Will someone really arrange MRIs or TMS or brain implants for the homeless?

With bipolar disorder once again considered a pre-existing condition and not given parity with physical ailments for insurance purposes, will any advances trickle down to us at all?

What do you want to bet that any breakthroughs regarding the causes of bipolar disorder will lead to more pharmaceutical research and yet another pill that costs more than the average person can pay or the average insurance will reimburse? And how long will that treatment take to get through the FDA pipeline to reach the people who need it?

Nor is knowing the cause of a disorder necessary to cure it. Isaac Semmelweis didn’t need to know the cause of childbed fever, a disease that killed thousands – perhaps millions – of new mothers. Germ theory wasn’t even developed until decades later by Lister and Pasteur. But Semmelweis knew that if only doctors washed their hands between conducting autopsies and putting their hands in pregnant women’s vaginas, the death rate would decrease.

So when I hear that there’s a new theory on the cause of bipolar disorder – and they seem to be coming with increasing frequency – I say, “Where’s the treatment? Where’s the cure? Who will be able to access it? Who will be able to afford it? When will it produce positive results for me and those like me?”

Get back to me when you’ve found something that will help. Until then, keep splicing your genes and culturing your bacteria and stimulating your synapses. I’m getting pretty good results with what you’ve already discovered. For now.

Don’t keep raising my hopes until you have something more than “mights” and “some days.”

 

 

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