My Experience Only. YMMV.

Posts tagged ‘bipolar type 2’

Drug Therapy: The Short Form

From what I’ve read in Facebook support groups – and noticed from my own experience – the effects of antidepressants don’t always last as long as we might want.

My first psychotropic medication was, as nearly as I can remember, imipramine (Tofranil). At the time I was only diagnosed with unipolar depression, so it seemed like a good choice. Imipramine is what is called a “tricyclic” antidepressant because of its chemical structure. Many people complained of the side effects.

Tricyclics were about all the medical community had to offer until 1987, when Prozac hit the market, followed by its cousins Zoloft and Paxil. All of these were classified as SSRI drugs, ones that selectively acted on the neurochemical serotonin in the brain, rather than a wide variety of brain chemicals as the tricyclics had.

Since then we have listened to Prozac, talked back to Prozac, and been referred to as a Prozac Nation. Prozac has been hailed as a miracle drug, damned as a gateway to violence or suicide, and prescribed in phenomenal amounts.

And Prozac has helped me. After about six weeks on it, when the drug started to kick in, I was on a sailing trip. One of the crew said I was the passenger most at peace with myself that he knew. It was a revelation to me and a new way of thinking of myself.

Prozac changed my life – possibly saved it. And then, not so much. I moved on to other medications.

“Major Study Finds Antidepressants Work, But May Have Limitations,” by Brigit Katz, published on The Smithsonian.com, validates my perception.

Her article states, “A meta-analysis [or study of studies] of existing trials suggests that the drugs are mostly effective on a short-term basis for patients suffering from acute depression.” Katz’s article also cites articles in the New York Times and The Lancet that report similar findings.

The Lancet study “analyzed 522 double-blind studies that included 116,477 patients and 21 commonly prescribed antidepressants. The results of the study showed that all 21 of the antidepressants were more effective than placebos in reducing depressive symptoms during the first eight weeks of treatment.”

“The new analysis suggests, however, that the efficacy of the drugs may be limited,” Katz reports. “For one thing, the benefits applied in the short term, and only to patients who are suffering from acute major depression.” [emphasis added]

The Smithsonian.com article and the studies conclude that “while the new study suggests that antidepressants are more effective than a placebo, at least in some cases, media reports claiming [as an article in Newsweek did] that the research shows ‘antidepressants do work, and many more people should take them’ are not entirely accurate.”

(This hearkens back to a pet peeve of mine: that headline writers (who are almost never the authors of the articles) do a poor job of summarizing articles in favor of more definitive or appealing descriptions of the text. https://wp.me/p4e9Hv-Br)

At any rate, the meta-analysis bears out my experience. Although I was bipolar 2, my disorder first manifested as major depression. I got relief from Prozac, results that later diminished. Since my proper diagnosis I have found more relief from a combination of an SSRI, an anticonvulsant medication often used for bipolar disorder, and an atypical antipsychotic also useful for bipolar as well as schizophrenia. Even though I do not have seizures or schizophrenia, these medications work for me and have not worn off for several years now.

So, what’s the takeaway from all this? I think it is that, if your medication for bipolar or depression seems to be “wearing off,” your perception may indeed be valid. But that’s no reason to give up on psychotropics altogether. People and their disorders differ in ways we just don’t know. You can ask your doctor to try a different medication or combination of medications that may work better for you.

The benefits of medication for psychiatric disorders do not simply go away just because the effect of one does.

Read more: https://www.smithsonianmag.com/smart-news/major-study-finds-antidepressants-work-may-have-limitations-180968452/#vjLKOqe2JdKEWOe3.99

My Love-Hate Relationship With Hypomania

Most of my time on the bipolar 2 spectrum has been spent on the depressive side. Lately, however, I’ve been trying to acknowledge my hypomanic side as well.

This has been difficult to do. My psychiatrist told me that my hypomania generally comes out sideways, as anxiety, and I’ve certainly had my share of that. One of the earliest I remember, from my teens, was when I had panic attacks in the cereal aisle at the grocery. I attributed it to the bright, loud colors that bombarded my senses and, if my later reaction to Chuck E. Cheese’s is any indication, that may have been accurate. My doctor at the time, however, thought it was an ordinary panic attack that I just happened to have while in the cereal aisle, and the two became linked in my mind. Of course, this was before I was diagnosed bipolar, so who really knows?

I also used to have the panicky kind of hypomania when my husband was driving the car, particularly on the highway. I still maintain that panic while on the highway is not completely unwarranted (compared, say, with the cereal aisle). It is, after all, a dangerous place.

The first time I can remember having the swooping, soaring type of hypomania was when I worked at a publishing company. A young woman came through and asked me about how to get published. Pressured speech? I babbled, I burbled. I spouted advice. I sprayed out ideas. I rejoiced in my own success while encouraging her in hers. I had no idea if she really had the talent or the drive necessary, but by the time I finished twittering at her, she had caught my spark and resolved to go right home and put my advice into practice. I have no idea, to this day, whether she succeeded. But at least, in that case, my hypomania was inspirational.

I used to say, when I was diagnosed unipolar depressed, that I wished I were bipolar, because then I might get something done. (I will pause here while you all laugh.) But the truth is, hypomania pushes me to take on challenges that I can only sometimes accomplish. Once I agreed to interview an old Chinese lady and write something based on her experiences. After the interview, which was fascinating but overwhelming, I was unable to write. It was one of the few times I took on an assignment I couldn’t finish.

More recently I took on an assignment to write 13 children’s stories of 2500 to 3000 words each, with very specific deadlines. Although I’ve met all the dates so far, I wonder whether hypomania has fooled me again. All I can hope is that this is one of those times when it has pushed me into doing something difficult, but will help me maintain until I get through it.

So, it seems, most of my hypomania is related to work (except for the cereal thing and the driving thing). I occasionally get the urge to spend money, but since we don’t have much money, it’s not too hard to fight that one off. Plus, we don’t have a credit card. We learned that lesson years ago.

What to make of all this? I now know that hypomania is part of my psychological makeup. I now know that I have to watch out for unwarranted spending (enabled by my husband, who has that tendency too). I now know that hypomania can push me into work that may overwhelm me. I now know that it can still come out as anxiety and panic, which can have unwanted effects on my everyday life. For those reasons I hate it.

Hypomania can also push me past what I think I can do to what I learn I actually can do. It can let me feel the buzz, the blast of joy that depression so long denied me. And for that I love it.

Mostly, though, I have to be wary of hypomania. It could dump me in either direction, and I won’t know which it is until it’s already happening.

Surviving College While Bipolar

I had two goes at college, and they were very different from each other, based on the state of my bipolar disorder at the time.

The first time I went to college, for my undergraduate degree, I was undiagnosed and unmedicated – except for self-medication. I was away from home for the first time – that was my first goal when choosing a college, being after a “geographical cure.” I ended up in the Ivy League, a scholarship student and a fish out of water. And profoundly depressed.

I did manage to hit the ground hiking, as the university sponsored backpacking trips led by juniors and seniors for entering students. We used to joke that it was meant to lose a few along the way, but really it was for orientation. Campfire chats about college life and the like.

On that hike through the Adirondacks, I met Caren, Roberta, and Cyndi, who instantly became my best friends and were my support system throughout the five years I spent there.

Yes, five, though only four of them were really at the university. After my first year, I took a year off. My depression had gotten so bad that I was given to sitting on the floor in the hallway, staring at a poster for hours at a time instead of sleeping. During my year away, I worked a dreary but educational job as an evening shift cashier at a restaurant. When I returned, I had a new major and the same old depression.

Oh, I did have fits of hypomania. I joined a sorority during one, though I deactivated later in a depressive downturn. And I went through the ups and downs exacerbated by several failed romances, including one total trainwreck.

The only help I got, aside from the support of my friends, was one brief therapy group at the campus mental health center and a brief stay at the university clinic, because of some suicidal ideation that my friends recognized.

Needless to say, I came out in no better mental shape than I went in, but I did manage to snag a B.A. degree. Now I feel that I missed a lot of opportunities along the way. It was just another occasion when I felt that my lack of mental health got in the way of what could have been a more productive time, as a well as a happier one. When I left college I was still almost as ill-prepared to function as when I went in.

By the next time I gave college a try, I was, if not mentally healthy, at least mentally healthier. And being back in the town I had been so eager to leave, I had a larger support system, now including a therapist, parents, close friends, and a husband. This time I had help.

I was still a mess, but less of one. With my depression lifting, I was able to teach introductory courses and manage my own course load. I remember my first semester teaching as a blaze of hypomania as I adored the subject and thought I was sweeping all the students along with my enthusiasm. Then one of the students gave me a bad review and I plunged again, never to recover that soaring sensation. I plodded through the next three semesters of teaching.

This time I came out with an M.A. and better job prospects. The day after I graduated I was working as a temporary editorial assistant, a job I kept for 17 years, moving up to editor along the way.

What did my experiences with college teach me (aside from modern poetry and how to swallow aspirin without water)?

  1. Making it through college is possible when you’re unmedicated and have minimal support, but I don’t recommend it.
  2.  Even with diagnosis, medication, and support, it’s still not easy. You know how hard it is to get out of bed and take a shower some days? Now think about going to a class on top of that, where your work will be critiqued. Taking a year off was one of the best things I ever did.
  3. Being bipolar isn’t your only identity, though it looms large in your life. I was also a student, a teacher, a friend, a daughter, a wife, a poet, a cashier, and so many other things. I may not have enjoyed them as I should, gotten as much from them as I could, but they were as much a part of me as bipolar was.

I can’t see myself at this point going back to college and getting a Ph.D. Which is not to say I’ve never considered it. But I like to think that, were I to try, this time I would have a better chance of getting through, sanity intact, with something more to show for it than a piece of paper to hang on the wall. This time, I tell myself, I wouldn’t let Bipolar Me take the experience away from Me.

The Fragility of Hypomania: A Reminder

Note: I was away for part of this week and dealing with a personal/financial disaster since I returned, so here is a post – as relevant to my current situation as it was two years ago.

I was in Ireland, on a bus full of journalists and two monsignors. The sun was shining, though the day was cool. We were on our way to some scenic inn where there would be a fragrant peat fire and servings of Irish coffee.

The guide was playing a mixtape through the bus’s sound system. The song playing was “All God’s Critters,” by Bill Staines, a folk song I knew quite well. Here’s the chorus:

All God’s critters got a place in the choir
Some sing low, some sing higher
Some sing out loud on the telephone wires
And some just clap their hands, or paws, or anything they got now

I was happy, with that golden glow of joy I had felt so seldom in my life. I was peaceful, with a sense of everything being put in place especially, just for me. I was contented, beyond glad to be where I was and doing what I was doing.

Then one of the other people on the bus asked the guide to turn off the tape. It was weird, she said, and didn’t make sense.

I don’t know whether she didn’t like folk music, or Bill Staines, or that song in particular. Perhaps she thought it was a children’s song. Perhaps she thought we should be listening to something authentic and Irish.

But the guide turned off the tape. And my golden glow was gone. I was still on a bus in Ireland, traveling through sunshine toward a scenic little inn somewhere.

But my feeling of well-being was gone. It was like the breeze had blown it out through the windows of the bus. Everything became plain.

I didn’t do anything about it at the time – ask to wait till the song was over or say it was one of my favorite songs – though now I like to think I would.

Was it hypomania that settled briefly on me like an aura? I hadn’t been introduced to the concept then, but I think that’s what it was. Peace, joy, well-being, a sense of being right where I fit. That could have been just regular happiness, I suppose. But it felt different, and special, and exhilarating.

And it was so fleeting. Once it was gone, it wouldn’t come back. I enjoyed other parts of the trip, but never recaptured that singular moment, that uplifting rush. Once it was gone, it was gone.

Even a regular good mood is hard for me to hang onto. If someone around me is grumpy or cranky, I find it hard not to get sucked into the downward spiral. If they’re angry, forget it. There’s no holding on to any good feeling then. My natural instinct is to cringe, and to apologize.

Or at least it was. As I have slowly gotten stronger and more stable, I do not cower the way I used to. I remove myself from the sucking drain of a person or situation if I can.

Going into the kitchen to make tea is a strategy I have often used. It’s also a grounding method I can use when things are spinning out of control. When everything around me is chaos, the simple, familiar, soothing action of heating a pan of soup can bring me closer to stability. Whether I really want tea or soup is not the question. Making it for someone else may even be more calming.

Right now I am pretty far from hypomania. My husband and I are without transportation and without funds to acquire some. We came close to being stranded in another state, but thanks to the good graces of AAA made it home safely. But before that, we were sitting on wicker rockers on a porch, watching cats and chickens and goats, enjoying smooth jazz, and drinking iced tea. At least now I know what hypomania feels like when it hits, and maybe I can hang onto it for just a little bit longer the next time.

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.

 

Five Things Psychotherapy Has Done for Me

Why pay $250 an hour just to talk to someone?

That was my sister’s reaction when I said I was going to start seeing a therapist. This is my answer.

Mental health symbolWell, Lucy, while a psychiatrist doesn’t cost 5 cents anymore, therapy can be had for a lot less than $250. There are community mental health centers with sliding fee scales – which is what I was going to then. There is insurance, for now at least. I’ve even known psychotherapists who would accept less than their usual fee for long-time patients in temporarily dire straits.

And I’m not paying to talk to just “someone.” A therapist usually has at least an M.A., and sometimes a Ph.D. Psychiatrists have an M.D. or D.O. They have years of training, more years of experience, and colleagues they can consult if your problem is particularly challenging or out of their area of expertise. You can also find peer counselors, religious counselors, and proponents of every variety of therapy or treatment you can name, from neuro-linguistic programming to electroconvulsive therapy.

Now, as I reflect on my clueless sister, I’ve started thinking about all the things that therapy has done for me.

Diagnosis. When I first started going, back in the 80s, I could only afford one of those community mental health centers with the sliding fee scale. (At the time, I paid $5 per session.) There I was diagnosed with depression. The primary treatment they offered was “talk therapy,” but I had years and years of mental difficulties to talk about. Later, when I was seeing a psychiatrist, I was re-diagnosed with bipolar 2 and anxiety disorder. Suddenly, my past became a lot clearer, even if my present was still messed up.

Medication. There has been a lot of it over the years. I started, as so many did, with Prozac, which had a noticeable effect on my depression. It was like the difference between watching a black-and-white TV that got only one channel that showed only tampon commercials, compared to a wide-screen color TV that got hundreds of cable channels. The meds I’m on right now keep me functional, at least enough to make a living and be creative.

Perspective. When I first started going to my current therapist, the word I used most often to describe myself was “pathetic.” I no longer call myself that. Dr. B. helped me view parts of my past in a different light and helped me develop techniques and strategies to deal with the problems I was facing at the time. Now she keeps me on track, reminding me that I have the tools to cope with many of my recurring problems. And she reminds me how far I’ve come since my “pathetic” days.

Couples counseling. When we married, I was still smack in the middle of clinical depression. (My husband had problems too, but I don’t want to talk about them here, except to say that a codependent and a depressive living together can never decide where to go for lunch. And that was the least of our difficulties.) Several times since then, we have had to turn to counselors to work on problems related to sex, money, and just plain living and communicating together.

Group therapy. Actually, though I’ve attended group therapy a few times, what I’ve learned from it is that it’s not for me. I do appreciate the fact that it’s there if I should need or want it, and that my therapist can recommend a group if she or he is going to be away for a while. Perhaps I just haven’t found the right group yet, although the support communities I’ve found online may serve part of the same purpose.

In short, therapy has given me my life, my sanity, my coping skills, my emotional strength, and my creativity back. And I can definitely say that professional therapy has been worth more than 5 cents, or whatever insights my sister could have offered.

 

Getting in Touch With My Hypomanic Side

I know all about how it feels to have depression. For dozens of years, that was my diagnosis and my daily companion – unipolar depression.

In the last dozen years or so, however, I have had to come to grips with the idea that I am actually bipolar – bipolar type 2, specifically. And that I sometimes have hypomania.

It was quite a revelation.

I didn’t believe I had ever felt manic in my life. I couldn’t recall feeling anything but miserable, despondent, and worthless. Although objectively, I was doing well in school and in college, had a few friends, and was never suicidal, in fact I was a depressive mess. Later, as I learned more about mania, I was able to identify some manic – or at least hypomanic episodes that had occurred during that time, but that I had never noticed when they were happening.

When I was hypomanic, I thought I was just feeling what everyone else described as “normal” – happy, able to enjoy activities, functioning pretty well. They didn’t last long, but I didn’t realize how very tenuous and brittle those good feelings were – how they could be shattered by the slightest bump, plunging me back into the old familiar depression. It was even more depressing to think that I couldn’t even do feeling good right.

I struggled along under these circumstances for years, until at last one-half of my problem was diagnosed – the depression half, of course. It certainly was the most noticeable half, the most troubling, and the most disruptive of the problems that plagued me.

My doctor prescribed Prozac and I remember it working pretty well at first – at least when it kicked in after about six weeks of taking it. I can remember feelings of calm, contentment, and enjoyment. It changed my life, and probably saved it. Prozac didn’t alleviate all my problems, but it did let me glimpse a world in which they were not the only things that existed. It’s not too extreme to say that I rejoiced.

But, unknown to me (and my doctor), I was not purely unipolar at that time – or ever. What was happening to the lurking hypomania during while the depression was being treated? Did it disappear? Did the Prozac take care of it too?

No. With the depression more or less at bay, hypomania found new outlets to express itself – as anxiety, for example. I had a spell of being alarmed in the cereal aisles of grocery stores. There was a time (not yet completely gone) when I thought other drivers were swerving into my lane, even when I was a passenger. (That one alarmed my husband too, when I would fling out my arms and gasp or cower, shaking in my seat, at the thought that a crash was imminent.)

My psychiatrist later explained to me that these were manifestations of hypomania that came out sideways, as anxiety instead of euphoria, ambition, desire, exaltation, and assorted addictive or destructive behavior. Trust me to have the less-fun alternative. (Although somewhat less life-wrecking.)

Since that revelation, I have tried to harness my hypomania and use my power for good. I channel my hypomanic binges into writing, for example. I can’t say that it’s always good writing, but at least I get words on the screen that I can fix up later. I usually have several projects – paying and non-paying (like this blog) going at the same time, so I can switch among them as needed. That may be hypomania too.

Sometimes I can even use my hypomanic fits to enjoy myself – have a pleasant lunch out, read a book, do a puzzle, have a conversation with my husband or another friend. Of course, these activities do not always fit in well with my hypomania. At times, instead of simply enjoying these activities and sensations, I am too twitchy and nervous to relax and enjoy them.

I must admit that two of my strategies for controlling my hypomanic spells are naps and anti-anxiety pills, not necessarily in that order. But at least I am getting better at identifying when the anxiety, which I used to think of as free-floating, is actually a form of hypomania. Then a combination of hot tea, silence, cat-petting, reading, and Ativan can bring me back to some kind of stasis.

If not, I just have to accept that I’m having a hypomanic episode and try to stay away from things I can buy using my PayPal account.

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