My Experience Only. YMMV.

Archive for the ‘Mental Health’ Category

To Sleep or Not to Sleep – That Is the Question

According to WebMD (which I find a pretty reliable source), “An inability to sleep is one of the key signs of clinical depression. Another sign of clinical depression is sleeping too much or oversleeping.” http://www.webmd.com/depression/guide/depression-sleep-disorder#1

So, apparently, with either unipolar or bipolar depression, either way you’re screwed when it comes to sleeping.

Most of what I could find online about depression and sleep talked about depression and insomnia. WebMD says:

An inability to sleep, or insomnia, can be one of the signs of depression…. Lack of sleep alone cannot cause depression, but it does play a role. Lack of sleep caused by another medical illness or by personal problems can make depression worse. An inability to sleep that lasts over a long period of time is also an important clue that someone may be depressed. http://www.webmd.com/depression/sleep-depression#1

But, they add, “a small percentage of depressed people, approximately 15%, oversleep or sleep too much.”

I seem to be in the 15% that sleep too much. I usually wake up around 7:00 or 8:00, take my morning meds, and go back to sleep until 9:30 or 10:00. Sometimes I have a little nap in the afternoon. (For me, a “little nap” is about two hours.) I take my nighttime meds at 11:00 and am asleep by 12:00.

That’s a lot of sleeping.

Of course, those are just averages, just when I’m depressed, and just when I have no deadline-dependent work to do. Many days lately, I have been getting out of bed when I first wake up and skipping the afternoon nap. But then I go to bed even earlier, though I usually read for a couple of hours.

On the other hand, I’m subject to mixed states, when depression and anxiety coexist. When that happens, I want desperately to sleep, but can’t turn off my idiot bipolar brain. I’ll lie awake thinking about my writing, or my finances, or any damn thing. I’ll wake up at 5:00 and do the same. Those are often the days when I try to work in a nap.

Back to WebMD. They note:

Doctors may sometimes treat depression and insomnia by prescribing an SSRI along with a sedating antidepressant or with a hypnotic medication. However, hypnotic drugs usually should be taken for a short period of time. http://www.webmd.com/depression/sleep-depression#

Part of my nighttime meds are an anti-anxiety drug and a sleeping aid, plus an SSRI and an atypical. So, am I overmedicated?

It’s possible. But I trust my psychiatrist, and I’ve been on this regimen for a number of years now. My bipolar symptoms are now fairly well controlled, I’m able to work, and with the help of my husband, I manage to get through most days with level moods, only mild depression, and only occasional hypomania. I’ve been on other drugs and other combinations of drugs that did not work as well, or gave me horrible and vivid nightmares or other side effects.

I don’t want to hear opinions on the drugs I take from people who are not M.D.s and have never met me, or as Jenny Lawson said recently, “something that every person who deals with mental illness dreads…well-meaning advice from others.” Believe me, whatever it is, I’ve tried it. That’s not why I’m writing this.

What I do have to say: Whether you sleep too much or not enough, bipolar disorder may be the cause. There are treatments, some involving meds, and others not. Meditation, for example, helps many people sleep. (My mother used to sing herself to sleep with hymns when she had insomnia.) It’s a thing to discuss with your psychiatrist and/or your psychotherapist. He or she may be able to help. You don’t have to go through sleep disruptions without treatment. Even with all the problems that sleep causes me, I’ve got a system that works well enough for me.

And … now my insurance company thinks it knows better than my psychiatrist and only allows me a sleeping aid every other day. Apparently my choices are pay for it myself or take Benadryl. Again, I’m not asking for advice. Just restful, restorative sleep.

Don’t Tell Me Not to Feel the Way I Feel

“Don’t be sad/angry/upset.”

“Calm down.”

“Smile. It’ll make you feel better.”

“Stop getting all revved up.”

Never in the history of ever has any communication of this sort had the desired effect on a person – especially one with bipolar disorder.

When you offer this sort of “advice,” what you are basically doing is telling the person not to feel the way they feel. Not only is this useless, it’s insulting.

It’s useless because ordering someone to feel a certain way simply won’t work. Saying, “Be cheerful” will not make it so. Emotions aren’t like flipping a switch on command. Even for neurotypical people, emotions are complex interactions of chemicals in the brain. While some people claim – or may perhaps be able to – shift their emotional state at will (from angry to merely annoyed or to neutral), it isn’t easy or natural. There’s a reason that you feel the way you do.

For the person with bipolar disorder, it’s even more difficult – if not impossible – to shift moods at a whim, especially someone else’s. Bipolar is a mood disorder. It affects moods and emotions in a nonstandard, often unpredictable way. Telling someone to alter their own brain chemistry merely by thinking about it is ludicrous.

Even if the bipolar person’s moods or feelings seem exaggerated or uncalled-for to you, that person is having an experience no different than when you feel elated or despairing or fearful. The emotions may even be more profound, less susceptible to alteration by force of will.

But telling bipolar people not to feel the way they feel is not just pointless, it is insulting. You are denying their perception of reality, invalidating their experience, dismissing their concerns, minimizing their problems, discounting their feelings. In effect, you are saying, “I don’t feel the same way, so your feelings are wrong. Change them to match mine.”

Imagine that you have written something – a report, a poem, whatever – and feel good about it. You’ve made your point and done it well. You’ve captured reality as you see it and communicated it in a way you think is clear and effective. Then someone comes along and reads it and says, “This is crap.” They have denied what you feel and believe. And even if they’re right, even if it is crap, they have profoundly insulted you. And, of course, they may be wrong.

Diagnosed bipolar people already know that their emotions do not run the same as other people’s. There’s no need to remind them of that. And bipolar people are generally doing what they can to alleviate their symptoms, be it through therapy, medication, mindfulness, meditation, or whatever works best for them. When you discount their feelings you are discounting them as persons. That can be anywhere from annoying to soul-damaging.

Adam Savage, of Mythbusters fame, sometimes wears a t-shirt that says, “I Reject Your Reality and Substitute My Own.” He is (I hope) talking about substituting a provable, scientific reality for a mythical, uninformed one.

But to go around substituting your own emotional reality for other people’s – and trying to make them agree with you – does a disservice to the people you think you are trying to help.

So, what would be better than saying, “Don’t feel ________”?

How about, “I know you feel _________ and I can see why.”

Or “I can tell you’re feeling _______. How can I help you?”

In other words, start by acknowledging that the other person’s feelings are real. Then ask what the person needs. This lets the person know that you understand his or her feelings and that you would like to help in the way that the person thinks best.

If you know other things that have worked in the past, you could suggest them (after validating the feelings, of course). Would you like me to run a hot bath? Do you need a hug? Do you just need time alone? Do you want to talk about it? Maybe later?

It occurs to me that this is not really news to a bipolar person. The ones who need to read it are the ones who are doing the invalidating, not the ones who feel invalidated.

So, if you know someone like that – a friend or loved one, feel free to copy this post and give or send it to them, if you think it will help. I know it helped me when I figured out what was going on and what my husband and I could do about it.

The Tools for Tackling Bipolar Disorder

When you’re facing bipolar disorder – which is, when you have it, nearly every day – there are some things you can do to lessen its hold on you. But in order to do so, you’ve got to have the right tools. Try to collect as many as possible for best effect.

Shall we take a look at what they are?

The Usual Suspects

  • medication – to tame your symptoms, level your moods, get your brain back in gear, and/or regulate your energy
  • psychiatrist – to prescribe your medications (a primary care physician may also do this)
  • psychotherapist – to discuss with you the issues you haven’t resolved, the problems you still have, and the things the medication can’t do

Self-Care 

The two most important tools you need for self-care are sleep and food. Without either, the body can’t function properly, and if the body doesn’t function, the brain is less likely to function properly either.

Ideally, the food should be nutritious and eaten regularly, but let’s face it, that doesn’t always happen. But you’ve got to give your body something to run on. If there are carrot sticks there, eat them; if there is mac-n-cheese, eat that. If there’s Raisin Bran, well, it’s easy to eat and requires no preparation. Try for at least one substantial meal per day – two is better, if you can manage it.

(Of course, this advice doesn’t count if you have an eating disorder. In that case, see your doctor or psychotherapist or support group.)

Support

Find support where you can – a friend who’s willing to listen, a support group online or in real life. Try for a combination of these and don’t rely on any one of them for too much. Maybe you have a friend you can phone once a week; a support group that meets every two weeks; and an online group or two of people who really understand, with links to helpful articles and blogs. Before you know it, you’ve got a support system, especially if you count your therapist (which I do) or have a supportive family (which I don’t).

Spoon Theory

If you don’t know what this is, see https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/. Basically, Spoon Theory is a way to measure how much energy you have on any given day – and an understandable metaphor for explaining your symptoms to others, and a shorthand for other people who are also up on the theory. It can also help alleviate the guilt of not being able to do all the things you are “supposed” to do in a day. It’s not an excuse, but an explanation.

Distraction

Let’s face it, it’s all too easy to dwell on your symptoms and how miserable you are. And if you’re at the bottom of the depressive well and your meds haven’t kicked in yet, there may be nothing you can do about it.

But maybe there is. Do you know a person who tells good jokes – or really bad ones? Do you have music you used to play but have forgotten about? Do you know of a TV show that features people whose lives are an even worse train wreck than yours? Do you have a go-to movie that never gets old no matter how many times you see it? (Mine is The Mikado. )

Creativity

If that distraction involves creativity, so much the better. Coloring books and pages for adults have been the trend for a while now. (Some of them are really for adults.) Jenny Lawson draws and also puts together tiny little Ferris wheels. I know someone who can make little sculptures out of drink stirrers or paper clips. The point is, you don’t have to paint masterpieces. Just keeping your brain and your hands occupied is a good idea.

Comfort

Soft warm, fluffy things and smooth, silky things are soothing. They just are. Cats and dogs come instantly to mind (they also provide distraction). But I also have a collection of teddy bears and other plushies that I sometimes cuddle with. These are “comfort objects,” which is an actual psychological Thing. (I wrote about them once: http://wp.me/p4e9wS-k9.) I even took a plush bunny with me when I went to have a sleep study.

Stubbornness

This may be the most important tool of all. Be stubborn. Take those meds, even if you hate them. Eat that egg, even if you don’t feel like it. Go to that appointment, even if will take all your spoons for the day. Call that friend, even if you don’t think a joke will help. Post on your support group, even if you feel you are alone.

We can’t let bipolar disorder beat us. Not when we’ve got so much to beat it back with.

When Bipolar Disorder Wrecks Your Sex Life (NSFW)

I had a hot sex dream last night. That’s fortunate, as it’s the only hot sex likely for me these days. I have bipolar disorder 2 and tend toward the depressed.

I have only once experienced the hypomanic rush that leads one to the desire for uninhibited, crazy, insistent, steamy motel sex. So I can’t really tell you much about that, except to make sure it’s safe sex, even if it is spontaneous, wild, and compelling. Coping with the aftermath is also something I can’t help with.

So. Bipolar depression and sex. (I am writing from the point of view of a cis-gender heterosexual female, so YMMV.)

It will likely come as no surprise to you to learn that bipolar disorder has an effect on your sex life. And, aside from mania, that effect is to lessen or completely kill it. And there are varying levels: low libido, lack of desire, difficulty ejaculating, etc. The question is what to do about it. Here are some examples of advice:

[S]ex is a part of life and it’s a part you don’t want, or need, to hang up just because you have a mental illness…There are therapeutic techniques that can deal with hypersexuality or low sex drive, and, of course, there are always medical options as well.

http://www.healthyplace.com/blogs/breakingbipolar/2013/01/normal-sex-bipolar/

And this:

Getting bipolar disorder under control is the first step to improving your sex life. It’s easier to address these issues when your moods are stable. Many people with bipolar disorder have healthy relationships and satisfying sex lives. The key is working with your doctor to find the right treatment and talking with your partner about any sexual issues.

http://www.healthline.com/health/bipolar-disorder/sexual-health#outlook5

And that’s all well and wonderful, but how much does it actually help?

Not that I’m an expert, but here’s what I can say about the subject.

Realize that most of sex happens in the brain. The body goes along for the ride. If you’re bipolar, you’re already having trouble with your brain. It makes sense that you’d have trouble with sex too. Don’t beat yourself up. It can be a nuisance or a sorrow or a loss, but it doesn’t have to be a tragedy.

Decide how much sex you actually need in your life. Some people have naturally low sex drives and are quite satisfied with long gaps between sexual encounters or occasional masturbation. If this is the case for you, dandy. The real problem comes when you and your partner(s) have a mismatch in your sex drive. That’s where the talking comes in.

Ask for what you need and encourage your partner to do the same. And accept and/or give what you can. If you need a hug or a cuddle, ask for it. If your partner asks for one, give it. Don’t push for more right then. Even if you have no desire for “the act” yourself, you may be able to give your partner some of what she/he needs. Or vice versa. Of course, if you’re at the very depths, you may not even be able to ask for a hug. But if one is offered, don’t turn it down. Keeping that bond going may improve your connection when the depression has eased.

You can try different medications or see an endocrinologist, but don’t expect quick results. Or any, necessarily. The one drug that peps up your libido may also be the one that gives you side effects you can’t handle. And after years of trying different combinations of pills, you may decide, like I did, that having a reasonably functioning brain is more important to you than having regular sex. In other words, you may face a trade-off.

Listen to your body as well as your brain. I already know that my brain is not performing up to specs. Occasionally, when I’m reading a book or watching a movie or remembering a dream or thinking about an old friend, I feel something that reminds me of what it is to feel desire. If that happens, enjoy and encourage it. It’s a signal that you may not be totally numb from the neck down.

I could tell you that everything will be okay and you’ll soon be back to romping between the sheets with wild abandon. I haven’t seen statistics on it, but it seems unlikely. If you want to get your sex life started again, you’re going to have to work at it, just like you work at taming your bipolar disorder.

 

Why Do I Write About Mental Illness?

I have bipolar disorder. But that by itself isn’t the answer. Here’s why I write about mental illness and mental health.

It’s what I do. I’m a writer. It’s what I would be, bipolar disorder or not. I’ve been writing since I was a kid, and writing and editing professionally for decades. But that isn’t the whole answer either.

It’s what I have to do. I have plenty of topics to write about besides mental illness. Over the years I have written poetry; a few children’s stories; and articles about martial arts, religion, cats, education and teachers, technology, architecture, and other subjects. In addition to this blog, I have another – janetcobur.wordpress.com – in which I write about whatever crosses my mind or my path – books, news, humor, and the things that made me name my blog Et Cetera, etc.

But this blog is the one that I have to write. It started as journaling but quickly – in a matter of weeks – became more.

It’s what I am. Mentally ill, that is. A life-long acquaintance with – or rather, experience of – a mental illness makes the subject one that goes to the bone. I can’t call up a memory from my childhood that doesn’t involve desperation, sobbing, and disaffection, or fragile, giggling glee at things no one else noticed or cared about. My college years were marred by distress, anxiety, and apathy. My adulthood has been marked by breakdowns, immobility, and psychotropics. I can’t get away from the subject, even if I try.

I have the skills for it. I have read a lot about mental illness and bipolar disorder, in self-help books, more scholarly works, memoirs, and even fiction (http://wp.me/p4e9Hv-nE). I have an academic background and an intelligent layperson’s knowledge of science and psychology. I can share that perspective with others.

It helps me and others understand. Examining aspects of bipolar disorder necessitates that I learn more about it – and therefore about myself. Planning, writing, and editing posts help me clarify my thinking about this illness I live with every day. Sometimes I am just too close to it until I step back and look at it from a different or even new perspective. That’s one of the benefits for me.

The feedback I get – comments from readers and other bloggers – leads me to believe that what I write has value for them too.

It needs to be talked about. The general public – society at large – doesn’t understand mental illness. There are widespread jokes, misunderstandings, and inaccurate media portrayals. Above all, there is discrimination – in jobs, housing, medical treatment, the legal system, and more. There is more trash talked about mental illness and psychotropics every time there is a mass shooting incident or a domestic terrorist bombing.

One of the solutions to these problems is education. Most of the writing I’ve done in my life has been on (or near) the subject of education. I consider myself an advocate for education. And now I am an advocate for education about mental illness. That education should start in public and private school health or social sciences classes. It should continue in adulthood for those who never learned it in school.

Celebrities like Glenn Close and Richard Dreyfuss have big names and big audiences and a vital message to spread about mental illness. I don’t have the big name or the big audience, but I do what I can.

Because the people, including me, who live with bipolar disorder and other mental illnesses every day, need messages of hope and sympathy and experience and activism and explanation and thought and outrage and kindness.

And that’s why I write about mental illness.

 

 

 

 

Why You Don’t Need to Know What Meds I’m On

I have actually written quite a bit about the meds I’m on.

I’ve done a whole saga on Abilify – about its price and how impossible it is to get without decent insurance.

I’ve written about how various meds have caused me embarrassing memory lapses.

I’ve written about all the different categories of drugs I have taken, and how long it was before my psychiatrist and I found a “cocktail” that actually works for me.

I’ve written about how it feels when you’re running out of your pills.

I’ve written about how close to electroshock I came when none of the meds seemed to be working.

I’ve written about the side effects I have and haven’t had, and the stupid way psychotropics are advertised to consumers, and natural treatment vs. psychotropics, and animals that take psychiatric meds, and crimes that are blamed on psychiatric meds, and needing a new psychiatrist to prescribe them, and whether psychotropics affect creativity, and being embarrassed when someone at the pharmacy recognized me when I was picking up my meds.

But what I’m not going to tell you is exactly which meds I’m on and what the dosages are. You don’t need to know that.

Here’s why.

I see a lot of comments and questions in online support groups telling what meds a person is on, and asking if anyone else is on the same medication, and what their dose is, and what side effects they have, and whether they should stop taking them or take a different one or a different dosage.

You’d think I have something useful to say. After taking psychotropics in every category you can think of (except lithium), usually multiple drugs at the same time in various combinations, I know a lot about how drugs affect me.

Me.

Yes, we are all the same in having bipolar disorder. But we are not all the same in how we have it.

I have mild to deep depressions, occasional hypomania, which sometimes comes out as anxiety, rapid (or maybe ultrarapid) cycling, and a couple of complete breakdowns. I have never been hospitalized.

But that’s just me.

You may have more dysthymia, more manic episodes, four or fewer cycles a year, no anxiety, or any other combination.

My medications are ones that relieve my depression, calm my anxiety, level my moods, and allow me to sleep. That may not be what you need. And even if you do have the same symptoms, at the same severity, my drug regimen still may not be right for you.

Bipolar disorder, you see, is all about brain biochemistry. And no one knows exactly how their own – or anyone else’s – brain chemistry works. What are my levels of serotonin? dopamine? norepinephrine? I have no clue. My psychiatrist has no clue either. And neither of us has any clue about your brain chemistry.

When I started seeing all the requests for drug information on the support group boards, I was tempted to answer. I even did once or twice. But I found I had only a few things to say that could be helpful. And those apply to anyone and everyone. So here’s the advice I can give:

  1. Stay on your meds. Even if you think they’re not working, they may just be not working yet.
  2. Stay on your meds; I mean it. Stopping your meds without advice from your doctor can be dangerous.
  3. Stay on your dosages. Do not change your own dosage. That’s your doctor’s job. She or he will likely want to ease down the dosage and ease upward on another drug if you’re changing medications. Ask your doctor if you think you need to change dosages.
  4. If you can’t find or get to a psychiatrist, your Primary Care Physician may be able to prescribe your meds. But keep looking for a psychiatrist. They have more training in the specifics of psychotropics.
  5. You can track your side effects, but then report them to your doctor. She or he should have advised you about any really dangerous ones to watch out for.
  6. If you have questions about your medication and can’t see your doctor, ask your pharmacist. She or he may be able to answer some questions about side effects and drug interactions. But not dosages.

Self-Care for Overwhelming Days

It’s been said that time is nature’s way of keeping one damn thing after another from being every damn thing all at once … However, every now and then the damn things gang up on you.

– me, “The Overwhelming Problem,” http://wp.me/p4e9Hv-hy

It’s also been said, by Canadian astronaut and all-around awesome guy Chris Hadfield, that he managed to stay alive in space by always asking himself, “What’s the next thing that might kill me?” If, for example, the most immediate danger were running out of oxygen, the next thing to do would be to check your tank and hoses.

I find that attitude soothing in a way, and helpful in getting through one of those every-damn-thing days. It’s not traditional positive thinking, but it does help you set your priorities.

Today and yesterday and the day before have been examples of every-damn-thing days. I’ve gotten through by asking myself, “What’s the next thing I absolutely have to do?”

It starts when I wake up and can involve the simplest of decisions: Do I take my meds first or do I pee first? Pee first. Pee first is almost always the correct answer and is one of the Mystic Rules of Self-Care.

Do I get dressed or do I eat something? I don’t absolutely have to get dressed yet, because I’m not going out anywhere yet, so eat something. Eat something is almost always the correct answer and is another of the Mystic Rules of Self-Care.

This can get me through the entire day. What is the next thing I absolutely have to do? Get dressed. What is the next thing? Go to the bank and get money. What is the next thing? Pay the power bill. Those are absolutes if I want to have a functioning computer. And I do. Very much.

Next comes a real decision: K-Mart is right next door to where I pay the power bill. Do I stop in and get the loaf of bread I need and maybe some underwear, or do I eat first? I eat first. (See above Mystic Rules.) By the time I finish my banh mi (if I’m out and dressed and in motion, I may as well make the most of it), it’s pouring rain. Do I absolutely have to go back to K-Mart, walk through a wet parking lot, and get that loaf of bread? I do not. I go home. One errand (two if you count the bank, and I do) is a major accomplishment for me.

After I get home, there is no “next thing I absolutely have to do,” so I switch to “What is the next thing I could do?” Say there are three choices: take a nap, watch TV, do some work. Obviously, the work is out. I am spoonless by now. I decide to watch TV until closer to bedtime, then go to bed.

If there is work that absolutely has to be turned in the next day, I get up early and do it when I have a fresh supply of spoons. (After peeing first and taking my meds.)

There is also an element of creative procrastination to this. (See http://wp.me/p4e9wS-ct.) It’s like sorting your tasks into three piles: absolutely, would be nice, and meh. Not that I’m recommending writing them down. That’s not flexible enough. Throughout the day, an event can wander down the progression. “Buy loaf of bread” started out as Category 2, but the rain pushed it into Category 3. I ate the other half of my banh mi for dinner and bought bread the next day. And if I hadn’t had the banh mi, I still had a jar of peanut butter as a back-up plan. Eating it straight out of the jar is pretty depressive, but you do what you have to do when your spoons run out and you still need self-care. (Have I just discovered another Mystic Rule?)

Of course, I’m describing a moderately-functioning day. There are other days when the categories shut down after peeing and meds.

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