On The Road to Treatment: Figuring Out As Quickly As Possible If One Is Bipolar

Bipolar disorder affects at least 1 in 70 people. Bipolar disorder can start as early as adolescence, or as late as the fifties.

One difficulty can be diagnosis of bipolar disorder in adolescence. What adolescent doesn’t have raging hormones? Looking back, of course I cried when the person I liked starting dating someone else, or broke up with me for no reason. On the other hand, the backstabbing friend that starts spreading rumors. I think as a girl, these can tend to be normal or common reactions.  Alternatively, what about about the moodiness, as a boy, and dealing with the raging hormones, resulting in anger.

The National Institute of Mental Health conducted studies on mental illness, and concluded that 48% of all adults in the United States will at some point in their life will have a diagnosis if a mental illness. Although this is only one study, it really surprised me how high this statistics is! Like me, many individuals will be diagnosed with multiple psychiatric disorders, which usually referred to as “co-morbidity or co-occurrence.”

It is not uncommon for those who eventually are diagnosed with a mental illness, to initially try to grin and bear it, and try to “deal” with it on their own. Sadly this rarely works. However, upon receiving treatment, the sense of relief is tremendous.

While it took my psychiatrist a few years to “officially” diagnosis me with bipolar disorder, statistically the onset age was accurate. Multiple research studies out there suggest the median age of onset is between 20 and 25 years. At the time of my first hospitalization, I was 23 years.

I have always wondered why it takes so long for the initial diagnosis of bipolar disorder. I think in my case it’s because my bipolar is mixed and rapid cycling, so if the doctor sees me depressed he or she would probably diagnosis me with major depression. Sometimes when I am so depressed, it is hard to see the ups at that point in time. In my opinion, diagnosing bipolar is becoming easier to spot and the gap between initial symptoms and diagnosis of bipolar is becoming smaller.

While receiving initial treatment is great, the next step is not so simple. It is at this point I find and continue to find the most difficult. Discussing the type of medication. When somebody is diagnosed with Bipolar or any other mood disorder, other issues concurrently might be diagnosed. There includes alcohol and substance abuse, ADHD, and an increased risk of suicide. These are the most common, but it is not unusual that there are also other co-morbid diseases.

Unfortunately, for me I have a SEVERE case of Bipolar I. My full diagnosis is Bipolar I, mixed state, ultra rapid cycling, with psychotic features. Yes, I know that is a mouthful. When psychiatrists look at mood disorders there are a number of “specific clusters” the doctor assess. This is just a brief description, but for me this was used to help aid in the diagnoses of my bipolar. I was not diagnosed with bipolar right away, which is not that uncommon. I presented initially with depression, than mania, and after 4 years of observation during hospitalization, my psychiatrist finally gave me the mood disorder diagnoses.

In a future blog, I will discuss in detail the more common symptoms that can lead to a diagnosis of bipolar disorder.

Staying Healthy and Avoiding Triggers

It is possible, other than medications, to aid in mood stability. In conjunction with taking your medication(s), psychotherapy, self-management techniques, which I will address later, and avoiding outside triggers, stabilizing your mood is possible. Fortunately coping in society is 100% possible. I personally have discovered and am still discovering healthy ways and self-management techniques to assist with my stability. Additionally, monitoring my sleep is SO important. I need to make sure every night I go to bed on time, and take my initial does of medication at 6:00pm; otherwise, I will sleep until 1:00pm. Clozaril makes me sleep 12-14 hours a night. It SUCKS!!! 

One factor for contributing to relapse is stress. This can be a huge trigger and destabilize. Reducing stress as much as possible really helps. Way in which I do this includes exercising, relaxing, and eating healthy. Some folks find meditation and yoga helps, but I have not tried this before. As I have experienced, there are ups and downs in my life, and I cannot say that it is also easy and that the road had no potholes. However, I do not feel doomed, and shackled for the rest of my life! 

As I have experienced now and in the past that there are “red” flags. For example, my psychiatrist put me on a stimulant for my ADHD. For those that do not know, if a person is Bipolar, prescribed a stimulant, such as Adderall, can cause manic and rapid cycling episodes to occur. Particularly if a person is not stabilized with a mood disorder. I am not a medical doctor, so everything I am saying is based on my experience and personal opinion. 

Some questions I constantly ask to myself: Is my mood stable right now, have I noticed any severe manic or depression symptoms? What trigger my moods, and have I been staying away from these triggers? Can I make sure I can diminish my chances for destabilization? For me personally I self manage by tracking my moods daily, by using a mood chart. This also proves beneficial when I meet with my psychiatrist so that she can see how stable or unstable I have been. Which in turn also helps with adjusts, if needed, with my medication. Another point I would like to make, is if you have a mood disorder, and do not track your mood, think make….do you clearly remember your mood yesterday, the day before, last week. Assessing my behavior and moods has become second nature to me. Sometimes I do get paranoid a little around folks who know I have bipolar disorder. I tend to ask myself when around them, how is my behavior and how am I being perceived. What if I am manic and don’t notice, what if I am depressed and not sociable? These questions are constantly in my head! 

For me, as well, there are questions I am constantly asking myself, to ensure that I am remaining stable. I also ask my friends and family to have these questions in the back of their mind when interacting with me. Some of this includes: Am I talking a lot? Jumping from topic to topic? Not sleeping as much? Sleeping too much? Keep to myself for more? This is only a summary of the questions that arise. Someone times it is harder for me to look in rather than look out at yourself. Thus, making it important those close to you are also monitoring your mood and actions as well. 

Another suggestion that I have found usual, and others too, is building a support network. This includes friends, family, and others diagnosed with a mental illness. For me personally for the first couple of years I found it difficult to rely on my friends and family for support. Not because they were not there for me but because they did not “get it.”  However, I too was just learning about it. 

**Additionally another suggestion is to contact your local Depressive Manic Depressive Association (DMDA) to identify local support groups. www.dbsalliance.org

If there is not one in your area, there is a link on this website that provides suggestions and help for starting your own support group. While at first the membership may be low, eventually folks will come out of the woodwork and reach out! Research has shown that individuals diagnosed with a mental illness who have some sort of support network stay healthy and do better. So if it's finding a support group, checking out resources online, as well as online blog or mental illness "talk" forums, there's help out there.

**Bipolar Support Group: http://bipolar.supportgroups.com/
 

How do you avoid triggers, still healthy, or utilize outside resources?

Bipolar Betty

**These resources I have utilized....I don't have any connection to these websites, I've just suggested them because they have helped me.

Check In 2

Have not forgotten about my readers!!! Been a little depressed and unmotivated, as many of you can relate to!!! Trying to post this week a new topic(s)......Hoping for a little wave of mania to help with motivate me!!!!

Expression of Creativity, Such As Poetry, In Those With Mood Disorders

Hello Followers,


I created this next blog to provide an outlet for those with mood disorders, or other psychiatric illnesses to post their poetry or reveal how you express your creativity. It is a known and studied fact that bipolar individuals tend to be the most creative. I eventually would like to publish a book on poetry and expression's of creativity among folks like us!!!!

The History of Your Treatment

For this blog, I decided to do something a little differently. Because I am a research analyst by trade, I really enjoyed looking up this information and learned SO MUCH from this blog post!

For anybody whom has not toured Williamsburg, Virginia’s Asylum for the mentally ill, it is very enlightening and I highly recommend the visit.

In 1773, known as the Eastern State Hospital, the first public building in colonial Williamsburg Virginia, devoted to treatment of mentally ill, opened. On October 12, 1773, the first patient was admitted. The "Public Hospital for Persons of Insane and Disordered Minds" was the first building in North America devoted solely to the treatment of the mentally ill. The Hospital was situated on 500 acres and consisted of two patient care buildings, and had a staff of over 900 to care for the 300 patients.

By then the popular theory of the colonists, entailed mental illnesses being diseases of the brain and nervous system, in which the mentally ill “chose” to be irrational. Another theory was these “lunatics” were possessed by the devil, and removal of these types of individuals from society into an asylum was essential and off the street society would be safer.

Prolonged and often permanent confinement in an asylum was not uncommon.  In the beginning, patients were subjected to immoral procedures and often subjected to horrific treatments. Some patients were continuously restrained in straitjackets and were treated like criminals rather than individuals with a “sickness.” Additional treatments consisted of the use of strong drugs, plunge baths, and cold "shock" water treatment until the patient passed out, which caused bleeding, and blistering salves.  Colonists felt that if these “insane” individuals bled, the draining of the “bad” blood would lead to a cure.

In Europe around the turn of the 19^th century, Europeans created a new treatment approach for individuals diagnosed as mentally ill. This approach was known as “Moral Management,” which embraced the belief that environment played an essential role in treating mental illness. For example, creating a more relaxing atmosphere for confined patients would help to “calm” them. By placing pictures, decorations, and providing comfortable beds, it was more likely recovery could occur and patients would feel more at ease because these surroundings would mimic the comfort of their home. This was not really an effective tool!

Between 1773 and 1790, about 20 percent of the inmates were discharged as cured. However, there still was severe overcrowding of these asylums, and how and what to do with these patients was an important issue. The overcrowding led to a decline in the patient care and use of the harshest treatment methods were once again utilized to keep patients sedated and quiet. Around this time, the lobotomy was introduced. Surgeons would open up the patient’s brain and separate neural passages. The desired outcome was for patients to forget their depression or tendencies. The result was horrible. Many patients became comatose, had no memory, or died.

Thankfully, through the years an increased understanding of emotional and mental illnesses has lead to further ethical and civilized procedures.

 

It was not until 1808, the German physician Johann Christian Reil formulated the term “psychiatry.” This term literally means the “medical treatment of the mind.” Translated from ancient Greek, psych=soul or mind; iatros=healer.

By 1840, in the United States, there still were only eight mental health asylums for the “insane.” Around this time a woman by the name of Dorothea Dix started crusading for the establishment and enlargement of many more mental health facilities and removing from jail patients that had a mental illness and where not just thought of as “crazy”.

In the 1930s, a treatment method, known as Electroconvulsive Therapy (ECT), was developed for treatment of schizophrenia. This included the use of electrodes place on the head, and use of an electrical current that would create a seizure. Today this procedure is more refined, while back in the 1930s patients were not put to sleep for the treatments.

In 1949, Lithium was discovered to treat and reduce symptoms for folks diagnosed with bipolar disorder. In the mid-1950s the development of additional psychiatric medications for treating mental illness was developed. For example, in 1952 Thorazine, one of the first psychotropic drugs, known as an antipsychotic, was produced. This medication assisted those with severe psychosis, such as delusions and hallucinations. Unfortunately, the initial medications came with unfavorable side effects, which were often unpleasant, and included patients looking like over sedated “walking zombies.”

Unfortunately, because this field was slowly emerging, there was a severe lack of medical professionals and funding to further understanding of the treatment of those with mental illnesses.

By 1946 politicians, such as President Truman got on the bandwagon to aid in funding mental health research, and created the National Mental Health Act. For the first time in the U.S., this was the most significant funding to date. Truman created a course that continues to present day. He put mental health on the radar and now funding, research programs continue to grow, and advancement in psychotropic medication is constantly evolving.

Over the years, fortunately, the development of psychotropic medications has advanced, and research on medical treatments continues to transpire. Inpatient treatment as well has changed over the past several decades. In the beginning, patients were kept sometimes in the asylums for a lifetime. Over the past 30 years, psychiatric patients were often hospitalized for six months or more. At present, the average length of stay in a psychiatric facility is one to two weeks, and psychiatric hospitalization is used as a last resort if outpatient therapy is not working.

Unfortunately, for me I have been hospitalized at least 18 times, and usually spend a month at a time in the hospital. Due to strict guidelines set now by health insurance companies, the length of stay for individuals needing longer hospitalization is less likely to be approved because the insurance companies always find “the need” for continued inpatient treatment as unnecessary. Even times when I have been severely suicidal, with back up documentation from my psychiatrist, my insurance has booted me.

As mentioned above many folks receive psychiatric care on an outpatient basis. This usually includes the use of a psychiatrist, for prescribing the medications, and a psychotherapist “for talk” therapy. I have chosen not to go into the history of psychotherapy in this blog. Please look for further blogs on the history of the involvement of this type of treatment as well as the various types of treatment options.

In terms of diagnosing mental illnesses, in 1952 the creation of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was developed. Since then this manual is used as the basis for establishing the diagnosis of all mental disorders. Every few years the manual is updated and new diagnosis are added or revised. The fifth addition is schedule to be published in 2013.

Fortunately, at present, individuals who have a severe and permanent disability can receive Social Security Disability Income (SSDI) and Medicare. While I am on both of these, I feel the federal government can do more. Last year I spent over $18,000 on out of pocket medical expenses, and only a portion I was able to write off on my taxes!!

Additionally private health insurance companies are slowly being required to provide additional coverage for individuals with mental illness, such as being required to set the same prices on psychiatric care as they do on general Medicare care. In my opinion, this process has been slow going, and even though legislation upon legislation is passed, we have such a long way to go! I am sure many of you can relate and have come across these issues and barriers as well!!!

There is so much more history I did not include, I included the points, and information I found interesting. There is so much additional information on current funding, various research, as well as the production and trials of new psychotropic medications. As mentioned above I chose not to discuss types of additional treatments, unrelated to medications, such as psychotherapy, etc. look for this topic in a future blog, as well as an in-depth discussion of the various categories and types of psychotropic medications.

Love,

Bipolar Betty

All About Me!

Unfortunately, 15 years ago I received a diagnosis of bipolar, which happened to be the type of bipolar which is the most difficult to treat. In 1998, three years after initial symptoms developed, the diagnosis of bipolar I, mixed state, ultra rapid cycling, with psychotic features was made.

Having mixed state bipolar is different from being diagnosed with “bipolar” or “major depression.” The reason is a mixed state involves being in a polar opposite symptomatic state. With bipolar and depression, a person is either happy or sad. Being in a mixed state, equates to being happy and depressed at the same time.

So what symptoms for me emerge during a mixed state? When destabilized life becomes a living hell and I would not wish the symptoms on a worst enemy. There obviously are different characteristics of mania and depression. Depression for me is straightforward, I want to sleep all the time, unmotivated, can get very suicidal, and want to be left alone. During a mixed state, I become depressed and manic at the same time! Literally, I can be crying, depressed, and bouncing off the wall manic. My bipolar is not a euphoric mania but a dysphoric mania; I become highly paranoid, agitated, and aggressive. In the past, I have experienced psychotic episodes, and when my mania is severe I have a heightening of senses, I see colors brightly, almost in 3-D, noises are very loud, and there is increased creativity.

Personally, mania emerges in different ways with different types of symptom combinations for each individual. For example while one of the characteristics of bipolar can be going on shopping sprees, this behavior has never happened with me. My bipolar needs to be monitored closely or severe destabilization can occur when symptoms are not monitored. For me, when I am hypomanic, I get hyperfocused on project-oriented tasks that I see as very important to others or myself. This blog is an example of this, it has become an important mission for me to research topics and to help and bond others with mental illnesses together. This blog has also been therapeutic because I am getting everything out in the open in a positive honest venue.

While on one side of the line I am manic, I usually stay closer to the hypomania side and closer to stable (cross your fingers and knock on wood).  When I am in the hypomania stage, it is usually not as severe and can be controlled with medication adjustments. Unless in full-blown mania, hospitalization can be avoided. In the past, I have been hospitalized in a psychiatric unit at least 18 times, two of which were in an eating disorder clinic called Renfrew. I once tried to estimate how much of my life was spent in a hospital, and it added up to approximately 3 years!

Because I have tried to commit suicide 4 times in the past, it is important to monitor my suicidal thoughts. To continue my path of stability it is also important that my psychiatrist, therapist, family, and friends keep a close eye on my symptoms because I do walk a fine line between mania, hypomania, and depression. Sometimes I need an outsider’s perspective since it is easier for folks to observe and notice symptoms that I do not notice.

During hypomania, I get very talkative, whether with my friends, family, or even random folks in public! Along with racing thoughts and jumping from topic to topic, pressured speech and an increase in activity and energy levels. That is why I have been able to write successfully with this blog….I cross my fingers everyday that I do not crash and become depressed and withdrawn and continue on this positive path that I have started.

Even though I received my bipolar diagnosis over 12 years ago, I still ask myself sometimes why me? This disease is highly genetic yet all other members of my family are completely healthy. My husband is bipolar as well, and we have gone back and forth about starting a family. Statistically if one parent has bipolar disorder the odds of a child, being diagnosed with it is 10%. When two parents have bipolar the odds jump to 55-65%!

One of the many questions I have struggled with for years “who am I apart from my bipolar?”Originally, for years I felt treated like Bipolar Betty by friends, family, and not Betty with bipolar. It was frustrating because I did not want to be defined as my mental illness.

Another initial question I asked my psychiatrist was “will I have to take medications the rest of my life?” The answer was ‘yes”. While he did state in the future he might be able to wean me off some of the medications, the fact I have treatment resistant bipolar makes it highly unlikely, and if anything, more medications continue to be added to the medications that I am already taking.

I know I have come a long way with acceptance but sometimes when I am taking my eight psychotropic medications in the morning and evening it gets to me. How can it not? Right?

So let me tell you about my medication regimen. This ironically makes me depressed!

Due to treatment resistance, I have consulted with three of the best psychiatrists in the country who specialize in bipolar disorder, specifically pharmacology. Different doctors have different theories and approaches. It has been so frustrating and many tears shed because I have felt so helpless. I feel sometimes I am knocked down time after time. Luckily, I am a fighter, but after 15 years, it gets harder and harder to bounce back, which doesn’t help with depression.

Currently for my bipolar and other psychiatric issues I take eight medications. These medications include Clozaril, Pristiq, Wellbutrin, Lamictal, Liothyronine, Zaleplon, Clonazapam, and Adderall. These medications facilitate in keeping various symptoms of my bipolar, ADHD, and OCD in check.

The Clozaril and Lamictal are mood stabilizers, which help keep my moods from going up and down, and rapid cycling.

The Pristiq and Wellbutrin are both anti-depressants and assist with preventing depression. It is important to note that unless an individual with bipolar disorder is stable, use of an anti-depressant is risky. Especially the class of anti-depressants known as Selective Serotonin Reuptake Inhibitors (SSRIs).

The Zaleplon is a sleep medication that aids helping me stay asleep, as well as the Clonazapam, which is an anti-anxiety medication, but it helps me sleep as well.

For my ADHD I use Adderall, which can be risky to use for a person with bipolar. This medication if not watched closely, could cause rapid cycling and severe mania. My psychiatrist is constantly monitoring my moods because multiple times in the past after only a week of use I ended up in the hospital destabilized. This medication really helps me focus, and wake up especially since some of the medications cause drowsiness throughout the day.

Lastly, I take Liothyronine which is a thyroid medication I do not have a thyroid problem, so I need to make sure my thyroid stays just below hyperthyroid, but the goal of the thyroid medication is to  aid the other medications to work more effectively, with the thinking those with hypothyroid tend to be more depressed.

Of all the medications, the Clozaril is the harshest. If I do not take this medication around 6pm, I will sleep in late. Over the past two years, my dose has been decreased from 400mg to 150mg and I still sleep 12-14 hours a day. It also requires monthly blood work to make sure that my white blood cell count is normal. This is due to the fact Clozaril can cause deadly reactions.

I once made a list of all psychotropic medications I have been tried on. Of about 50+ medications, I had been tried on all but approximately eight! Some medications I have tried were rough. When I was given Zoloft, I was ready to attack, I was so angry and aggressive it was horrible. Abilify made me feel like I was about to have a seizure. Since Lithium is a salt it made me feel like a marshmallow, I gained 60 pounds, and it was horrible.

I would be lying if I do not get depressed when I am putting my medications into my weekly pill container and when I swallow these medications daily. In addition to my eight psychotropic’s I take seven others for other health issues including asthma, allergies, acid reflux, seizure disorder, and chronic pain, which includes morphine and a muscle relaxer. Because of my chronic pain, my depression is intensified.

So there you have it a brief synopsis of my psychiatric issues! While this blog is about my diagnosis of bipolar disorder, please check back for specific blogs on my other issues, such as my eating disorder, ADHD, and OCD.

Thanks for Reading,

Love Bipolar Betty