Bipolar 2 From Inside and Out

My Unrecognized Mania

October 3, 2021

I thought I had managed to avoid mania for most of my bipolar life. Brief bouts of hypomania, maybe, but never the real thing. Then I thought back on the last year and a half.

For years I had been trying to write a mystery novel, but a year and a half or almost two years ago, I really kicked it into high gear. I wrote. I rewrote. I tweaked. I outlined. I thought of names for my characters and backstories for them. I mapped out on what day of the week each event happened. I even looked up the weather and sunset time for a certain, pivotal day. I showed the first four chapters to volunteer readers.

Then I decided it was done enough and ready for the world. I started in December, sending out three queries a day to publishers and agents. I was undeterred by the rejections. I knew that many famous authors had been rejected dozens of times before they were published. I sent out 180 queries. It was like my brain was popcorn, exploding with ideas and determination and optimism.

I got the expected rejections, of course. Many, many of them. Most were of the “This is not the right book for me/us. Agents’ opinions differ. You should keep trying” variety, which only egged me on. Surely there was an agent out there for me somewhere.

At last, I got two responses that showed the agents had clearly read the sample chapters. They commented on the substance of my work and told me what needed “improvement.” My eyes were opened. They were exactly right. My book contained serious flaws and was by no means ready to be published.

So, that was about six months or more “wasted” on hypomania. In addition to the obsessive (though futile) attempt to make contact with 180 agents, I had other symptoms of mania or hypomania. I had delusions of grandeur. I thought my book would be published and make a splash. I imagined it might win an award for “Best First Novel” from a noted mystery organization. I even imagined the phone call to tell me that I had won.

No one noticed that I was hypomanic. My husband thought that I was somewhat obsessed, but he felt his duty lay in offering me encouragement, rather than bursting my pretty balloon.

My symptoms backed off.

Then, just a few months ago, Dan and I discovered that we were due to come into a sum of money. We immediately started planning what to do with it, and part of that plan included overseas travel. My hypomania kicked back in. For several months now (though we haven’t gotten the money yet), I fell into a frenzy of planning. And I spent money.

I bought small things, but lots of them. Books of maps and guidebooks. Little pill cases for daytime and nighttime meds. Rain gear. And more – despite the fact that the trip is still at least seven months away.

And I prepped. Oh, how I prepped. I used those guidebooks to plan routes and sights to see, trying to balance the route between things that might please my husband and things I had seen before and wanted to revisit. I googled to find out how distant each b-n-b was from the various attractions, and how far the attractions were from each other. I planned where we would go on each day and how much time it would take to drive, so I would know when we had to check out of our accommodations.

And I researched the country and foreign travel. Were masks required? What would the weather be like? Where could we change money? How much cash would we need to carry? Would ATMs work with our credit cards? Were they even accepted at most venues? Would our banks charge a foreign transaction fee? Could our cell phones both work abroad and call back to the States? What days and months were some destinations open? Would they acknowledge my handicapped parking pass?

None of this was actually harmful, except maybe the money and time I spent. In fact, much of the obsessing was enjoyable. It’s been my habit in the past to research the places I was traveling, buying guidebooks and other useful things. But this was more than that. I felt internal pressure to make this trip as perfect as it could possibly me. I was planning the Bataan Fun March.

Recently, I snapped out of it and talked it over with my therapist. She affirmed that I was indeed having hypomania, though not a very destructive kind, except maybe the spending. Since then I have barely touched the guidebooks and schedules. I haven’t googled anything.

I must admit, though, that the feeling of accomplishment in both cases was quite enjoyable. I see why people romanticize hypomania or mania and even long for it to happen. It does increase energy and allow one to plan, even if mistakenly. I knew from seeing another manic person in my former workplace that mania seldom accomplished anything of lasting value. I suppose the lesson I must take from these experiences is that I should learn to recognize the signs of mania and try to drag myself back down to earth before I do something I’ll truly regret. That will involve my prescribing physician, my therapist, and my husband (once he realizes that I am getting manicky), all in an effort to get me back to a place of self-control.

But of course, we know that’s not really how bipolar disorder works.

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Mental Health

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Another Kind of Depression – Dysthymia

September 26, 2021

Of all the types of depression that get discussed – major depressive disorder, exogenous depression, endogenous depression, bipolar depression – there’s one type that isn’t talked about very often: dysthymia. The word comes from Greek, where it is made up of dys (bad or ill) and thymia (mind or emotions). But in clinical terms, dysthymia has a more exact meaning than “ill humor” or “bad mood.” I had always assumed that it came along a scale of severity that ranged from major depression through dysthymia to stability to hypomania to mania. It could be that I was mistaken.

Johns Hopkins Medical has this to say: “Dysthymia is a milder, but long-lasting form of depression. It’s also called persistent depressive disorder. People with this condition may also have bouts of major depression at times.” So, it’s milder, but long-lasting, persistent, and may occur in people with major depression. Not very specific, is it?

Johns Hopkins also notes that to diagnose dysthymia, “an adult must have a depressed mood for at least 2 years (or one year in children and adolescents).” The Mayo Clinic also refers to it as “Pervasive Depressive Disorder.”

Dysthymia seems like a “squishy” diagnosis, as the signs and symptoms overlap so greatly with major depressive disorder.

Garden-variety depression or “Major Depressive Disorder,” again according to the Mayo Clinic, “affects how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living.” The risk factors and symptoms of the two disorders are virtually the same.

However, major depressive disorder, according to multiple sources, must last around two weeks, while dysthymia lasts for two years or more. Personally, I can’t see how this is called “milder.” Alternating between the two conditions is sometimes referred to as “double depression.”

I have thought of dysthymia as milder, and perhaps it is what I have now that my depression is pretty well controlled by medication and therapy. I no longer have extreme symptoms such as the self-harm and suicidal ideation.

Then again, one of my major depressive episodes lasted three years or more, with no visible letup. Was that relatively mild? It sure as hell didn’t feel like it.

Perhaps it doesn’t matter what you call it. The experience of the disorder seems to me more important than the label put on it. I haven’t looked the conditions up in the DSM (I don’t have a copy). But all my life I have been diagnosed with depression or major depression (before my diagnosis was changed to bipolar type 2 with anxiety, and it seems pointless now to call myself dysthymic. Maybe I’ll ask my psychotherapist when I see her next week if she can shed any light on this confusing nomenclature. Maybe she’ll have a handle on which of these I technically have.

However you want to name it or frame it, though, I have – and probably have had since I was a child – some version of the disorder, and have applied the treatments for it (meds and therapy for both), and now experience occasional episodes of the “milder” version, though they certainly don’t last two years.

In a way, I wish the various authorities would make up their minds and quit changing the labels. In another way, I don’t care what the labels are (unless they affect insurance companies and what treatments they allow). I experience this disorder in the way that I experience it. Most of the time I simply call it depression, and I don’t see how it helps to subdivide it. When I hit rock bottom, I call it a major depressive episode. When I’m relatively stable, I call it “in remission.” These may not be the technically correct terms, but they’re what make sense to me.

I don’t know whether other people with bipolar disorder make these fine distinctions, or simply think of their shifting moods as lows and highs, depression and hypomania or mania, or whatever.

But do we really need more labels? Isn’t lived experience good enough? Does the definition affect how our doctors treat us? Are there going to be more subdivisions in the future (a trend which seems particularly rampant right now, as with autism, Asperger’s, high-functioning, low-functioning, and more and more variations)? Does what we call it really help anyone get better?

Maybe I’m wrong here, but I don’t think so.

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Mind and Body, Again

September 19, 2021

We know that the body affects the mind affects the body in various ways, especially when it comes to mental illness. Many of us who live with anxiety, bipolar disorder, or another condition experience physical symptoms like tremors, nausea, hives, and diarrhea.

The last one is my particular curse, which no one wants to hear about, but there you have it. Or rather, there I have it.

I didn’t even know that this was a problem related to my mental state for many years. All I knew was that whenever my mother or father was taken to the hospital, I would invariably and eventually find my guts in an uproar – usually when I got home, but sometimes in the waiting room. I thought that my bowels were my “attack organ,” as the saying went, and that I was merely reacting to the stress of the situation.

Of course that was true, but it never occurred to me that this was not just a physical problem, but a mental problem manifesting physically. At the time I was undiagnosed with bipolar disorder and knew little about the condition or how the mind and the body were connected.

The severity of the problem was impressed on me years later, when I was having severe anxiety, just after coming out of a severe and lengthy spell of depression. The more anxious I got, the more episodes I would have, sometimes up to six times a day. I lived with Immodium within easy reach at all times. During the worst of it I didn’t dare to leave the house. When I applied for disability, it was this affliction as much as my bipolar disorder that was the basis of the case.

Naturally, I told my primary care physician about the problem, and he sent me to a gastroenterologist. The specialist thought I might have Irritable Bowel Syndrome, but then again he wasn’t sure and didn’t seem to give it much more thought.

My psychiatrist, though, had a different idea. He suggested that the upset in my guts was caused by upsets in my mind – not that I was imagining it (there was ample evidence that I wasn’t), but that my nerves were overstimulated by anxiety and that caused my gastric symptoms. It was a feedback loop – anxiety caused diarrhea caused anxiety and so on and on.

I don’t know if it was the anti-anxiety med he gave me or if my anxiety just calmed down on its own, but the episodes became fewer and less frequent. I no longer stayed strictly at home, within easy reach of a bathroom, or feared going out. (I did make sure I knew where the bathroom was any place I did go.) I even stopped carrying a change of underwear in my purse. And my disability claim was denied. (I was also making so much money at my at-home freelance work that my lawyer said the judge’s head would explode.)

I still get anxiety-related diarrhea at times, but nothing like the biohazards I used to have. It’s no longer an everyday (or many-times-a-day) occurrence. I still do keep a supply of Immodium in my desk, my purse, and the bathroom, though, just in case.

I hesitated before writing this post, as it’s a difficult and unpleasant topic. But I know that a suffering mind can make the body suffer too, and I thought there might be people out there who have similar problems and needed some reassurance that they weren’t the only one. I don’t know what your “attack organ” may be or what your particular symptoms are, but do keep in mind that the interaction of the mind and the body can produce unwanted results. And that you are not alone in dealing with that.

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Why CBT Isn’t for Me

September 12, 2021

It’s been suggested more than once that CBT, or Cognitive Behavioral Therapy, might help me with some of my problems, including “depression, anxiety disorders, marital problems, and severe mental illness” (bipolar disorder, in my case), according to the American Psychological Association (APA). And I understand that it’s helped a lot of people, including some in my position, with some of the same problems I have. If it works for you, that’s great. I’m not saying that no one should ever use it or that it’s a rotten form of therapy.

I, however, dislike the premise of CBT and have never felt comfortable trying it. Here’s why.

One of the basic tenets of CBT is that the client’s thinking is faulty and the therapist helps the client to discover how and where. Then they work together to pinpoint the faulty thinking and replace it with healthy behaviors, or at least less destructive ones.

Again, according to the APA, “CBT treatment usually involves efforts to change thinking patterns” and examine “what is going on in the person’s current life, rather than what has led up to their difficulties.”

When I first got into therapy with the counselor who has helped me the most, what I needed was not someone to convince me that my thoughts were faulty. I had worked hard to reclaim my memories, validate them, and recognize that they really were damaging events. I would resist any attempt to undo that work by invalidating those memories, and my attempts to understand them, as “faulty.”

Despite all the times it has betrayed me, I think my brain is the most powerful weapon I have in moving forward, but that does not include denying the past or brushing it aside in favor of what the APA calls “learning to recognize one’s distortions in thinking that are creating problems, and then to reevaluate them in light of reality.” Evaluating the memories and the thinking associated with them is a large part of what has helped me most, but calling them “distortions” would not be helpful. I needed to reclaim those memories and understand the feelings, accept them for what they were and how they changed my life, and then go on to rebuilding a new life – not one free from those memories and feelings, but one that validates them as part of my lived experience.

The methods used in CBT discomfort me as well. The idea of “homework assignments” and role-playing my future interactions does not appeal to me. I have gotten on much better with good ol’ talk therapy (and medications) than I believe I could with body relaxation and mind-calming techniques.

My problem largely involves confronting my memories and not denying them or downplaying them, but learning how to live despite having them in my past. It does me no good to deny a train-wreck as “faulty thinking” or to dismiss it as part of my past. Owning it as part of my past and realizing what it did to me is much more helpful. Validating my feelings and reclaiming my memories, then moving beyond them, is what I need. My therapist has helped me do that, without ever once suggesting that my thought patterns are faulty. We’ve worked on coping skills, sure – but never based on the premise that my past doesn’t affect my present or future.

CBT is also said (by NAMI, the National Alliance on Mental Illness) to be a short-term process (which I’m sure the insurance companies love) or one that can be carried out without a therapist guiding it. To me, this smacks of the “think away your troubles” idea. If I could have, I would have, without the help of long-term talk therapy.

My therapy has been a long and often painful process, but never one that attempts to make me think that my memories are invalid and that my progress will come by admitting that. Talk therapy is hard work, and I don’t believe there is any shortcut to mental health. Even now, after I have largely ceased therapy, I sometimes need a “booster shot” when my problems become overwhelming. Again, this comes from recognizing that my problems are real and that thinking them away rather than hard work is not the answer.

I am sure that people will tell me that I have misunderstood CBT, what it is all about, and how it is practiced. They may have many good experiences with it. But I don’t want to take a chance on a form of therapy that denies my reality and dismisses it as “unhelpful thoughts.” I need my reality heard and validated and examined. I need depth and breadth of therapy that recognizes my “train wrecks” and to what degree they have left me wounded. I need coping mechanisms that acknowledge my past as part of what going forward may mean.

I don’t trust CBT to do those things.

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Anxiety, Fear, Panic, and Phobias

September 5, 2021

I’ve heard it said that you know when you’re a problem drinker when your drinking causes you problems, whether of the emotional, legal, financial, or several other varieties.

Similarly, I think anxiety, fears, panic, and phobias are problems only when they cause you problems.

Let me unpack that a bit.

Phobias are considered to be a type of anxiety disorder or panic disorder. For example, social anxiety is sometimes defined as social phobia. Everyone has anxieties. Many people have at least one phobia. And most people can avoid these triggers with little or no effect on their daily lives. There are habits they can cultivate to avoid the things that make them anxious or phobic.

For instance, someone with acrophobia, a fear of high places, isn’t usually incapacitated by a stepladder, and can fairly easily avoid standing on cliff edges, rotating top-floor restaurants, and hotel rooms over the first or second floor. (When the anxiety/phobia extends to fear of flying, or aerophobia, the person can limit or eliminate air travel from their lives, usually without much difficulty.)

Crippling phobias, however, are generally classed as mental illnesses. My panic around bees (apiphobia) does not rise to that level; I would call it an anxiety reaction or a panic attack, not a phobia. It usually only manifests as bodily stiffening, tremors, and immobility, and pleas for anyone in the area to shoo away the offending insect. (I once took a beekeeping class to try to get over my phobia. Big mistake. Didn’t work.)

Agoraphobia (fear of unfamiliar environments or ones where you feel out of control), however, can be socially and psychologically crippling. The Mayo Clinic says that agoraphobia “can severely limit your ability to socialize, work, attend important events and even manage the details of daily life, such as running errands.” (Technology has made these constrictions less onerous, what with doorstep delivery and Skype.)

Anxieties as a symptom of mental illness are harder to define. While some anxieties have triggers, others simply don’t. “Free-floating” anxiety comes on unexpectedly, like the depressions and manias of bipolar disorder. This doesn’t mean that the anxiety isn’t real. It certainly is. It just means that the anxiety has no identifiable cause such as high places or bees. It is simply (or not so simply) a panic attack, which the Cleveland Clinic says is “sudden, unreasonable feelings of fear and anxiety that cause physical symptoms like a racing heart, fast breathing, and sweating. Some people become so fearful of these attacks that they develop panic disorder, a type of anxiety disorder.” They add, “Every year, up to 11% of Americans experience a panic attack. Approximately 2% to 3% of them go on to develop panic disorder.”

Sometimes I have anxiety that is attributable to triggers, such as financial difficulties, which are relatively easy for other people to understand. Who wouldn’t be anxious when the bank account is dry and a bill is due?

Other times, free-floating anxiety or panic simply descends on me, with nothing that triggers it. It’s an awful feeling, like waiting for the other shoe to drop when there has been no first shoe. Like a cloud hovering around me with the potential for lightning bolts at any time.

The thing is, I don’t know how to get rid of my anxieties, fears, or phobias. There are desensitization procedures that are supposed to work by getting one used to the trigger gradually. (I think that was my idea behind taking the beekeeping class. One of them, anyway.) There are antianxiety medications, including antidepressants and benzos, designed to take the edge off, if not remove the anxiety. (I take antianxiety medications. I’m still afraid of bees. Not that it affects my daily life much, but I’m never likely to visit that island off Croatia that’s covered with lavender.) For phobias, Cognitive Behavioral Therapy (CBT), as well as exposure therapy, has been recommended. This is usually a short-term procedure, according to the Mayo Clinic. But I have an aversion to CBT.

Still, despite my therapy and medications, I have to live with my anxiety and phobias. I’ve probably not reached the point where the anxiety causes me severe problems, like bankruptcy, though I have been known to overdraw my checking account on occasion and run my credit card up too high. These, of course, are signals that I may have a problem or am beginning to have one. It’s something to explore with my therapist, anyway. Maybe she can suggest ways I can deal with my anxieties before they turn into more significant problems.

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For Those Who Wanted to See It

September 3, 2021

Here is my new mental health tattoo, which I wrote about in https://bipolarme.blog/2021/07/18/my-next-mental-health-tattoo/

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Coming Down From a Manic Jag

August 29, 2021

I have been manicky lately, and it has expressed itself, as it does for so many people, with spending money we don’t have. Or at least spending money we’re supposed to be getting but don’t have yet on things which we can’t afford until we get it.

The thing is, we have a nice lump sum of money coming, but we don’t know when it will arrive. And instead of sensibly waiting for it to arrive, I have already begun spending it. A new-old truck for Dan; passport applications for us both; tattoos for us both; concert tickets; clothes and maps and guidebooks and airline tickets for a trip we plan to take next year; a short getaway vacation last week; gardening and home improvement supplies. Just to name a few.

All this leaves us very little for necessities like mortgage, electricity, internet (essential for my work), and even food. We can probably live on our credit card for a while, but I know that’s only a temporary solution, and a bad solution at that, even though the credit company increased my credit limit so we could pay for the airline tickets.

Of course, I am mostly responsible for all this spending. Some of the expenditures wouldn’t wait – the airline tickets, which we had to buy immediately to lock in the current price, and the passports, which I understand can take months to arrive and we shouldn’t wait till the last minute to apply for.

But for other purchases, Dan has been enabling me – “You know you want to go hear Emmylou Harris,” for example. “She’s one of your heroes.” “Might as well get the ticket for Rodney Crowell, too. How likely is it that he’ll be playing in this area again, at least anytime soon?”

Now the proverbial chickens are coming home to roost. Last week I had to deal with a guy at the door who was there to shut off our electricity unless I gave him a check for the past-due balance on the spot. The credit card company may come to regret the limit increase. I’m sure they gave it to me because I regularly paid them more than the amount due, and I can’t do that anymore.

I realize this is relatively minor compared to some spending jags that people in the manic phase of bipolar have gone on – gambling debts, for example, and even ones that end in homelessness. But the spending adds up, and we are strained past our limit until that windfall finally arrives.

Naturally, because that’s the way things go, now that I have come to and realized the reckless spending, it has triggered my anxiety. Financial troubles have always been one of my triggers, but it’s appalling to realize that I have dug this hole myself.

And naturally, because that’s the way things go, that anxiety triggers my depression – maybe not a full-blown depressive episode, but enough to affect my life and actions. I isolate. I grow surly with my husband. I have trouble sleeping or sleep too much.

In truth, I am angry with myself and with this damned disorder. When I get manicky, I generally am able to limit my spending to amounts of $25 or less, if sometimes for several such items (or meals). But this time I have overwhelmed myself, and my husband as well. I know we’re not supposed to use bipolar disorder as an excuse for bad behavior, but I can’t help thinking that hypomania is involved at some level. The idea of live music and foreign travel were just so irresistible. I couldn’t make myself wait until a better time.

We’ll get through this, I know. Someday the expected check will come and I can start straightening out some of the mess I’ve created. But until then, anxiety and depression will be my companions. I hope the mania stays fully tamped down until then. At least, I’ll take my meds and hope so. And not skip my therapist appointment in a week and a half. We haven’t had much to discuss lately, but now I’m sure we do.

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Naming Names

August 22, 2021

A lot of us I know write about our bipolar disorder or other mental conditions, whether it’s in a letter, journal, blog, or elsewhere. One of the problems that comes up is how to refer to other people who have affected your story or been involved in your life.

When I blog, for example, I try to disguise – at least thinly – the person (other than me) I’m writing about. For family members, I usually leave it at “my sister,” “my mother,” “my aunt,” “my cousin,” etc. Admittedly that’s not much of a disguise, as I’m estranged from my sister (which is a story I’m not likely to tell) and my parents have both passed away. But I have only one sibling and two parents, which makes their identities easy enough to guess, if you know my family at all.

My husband I refer to as Dan, having gotten his permission and never using his last name, which is different from mine. And my doctors I simply call Dr. G and Dr. B, or “my psychiatrist” and “my therapist.”

For friends or others who have affected my life, I invent pseudonyms, usually beginning with the same letter of the alphabet – Brandon for Bob, Joan for Julie, and the like, or a descriptive phrase – my friend the artist, my friend the writer, the rotten-ex-boyfriend-who-almost-ruined-my-life (I assure you he would be unable to recognize himself from that, even if he read my blog, which I’m sure he doesn’t). Some of these people are vital to my past, my present, and my stories, but I don’t feel I have the right to divulge their names.

If I write about these people in my other blog, the non-bipolar one (butidigress.blog), I might – and sometimes do – call my friends by their first names: Peggy the artist, Michael the writer, or sometimes leave them anonymous. In those blogs, I mention them with no pejoratives attached, or I use pseudonyms if I do.

When you’re writing in a letter or a journal which someone else might read (journals are not as sacrosanct as you might think or wish), it’s hard to avoid naming names. Once I was writing in my journal and a nearby person happened to glance over my shoulder and see what I was writing. Or you might let your therapist read a few pages of your journal to explain a situation that you were reacting to in the past. That’s safe, though. Your therapist is your therapist and not allowed to discuss your case with anyone you know.

Letters, however, are dangerous. First, there’s the kind that your therapist has you write to a person who hurt you, for example, as an exercise on how to express your feelings. Never send these letters. Even if you want to tell the person exactly how you really feel or felt, your raw, uncensored emotions and view of events are more likely to do harm than good. Especially if you’ve been in an abusive relationship or have been gaslighted, never reach out. It gives the person another way to be involved with your life, which is what you don’t want.

Then there’s the possibility that whoever you wrote about accidentally reads the letter or journal. This can ruin whatever chance you might have had to repair the relationship (if that’s what you really want to do). Tear letters up, delete them, put them in a file called Never Send if you feel you must keep them to remind yourself of how you felt back then. But don’t send them or show them to anyone other than your therapist. (And keep in mind that your letters can be found accidentally, or after your death.)

I have known a couple, one of whom wrote to the other to present an ultimatum, and it didn’t work. The oblivious partner simply ignored it, which you’ll understand also caused great pain. It was a significant factor in breaking up their marriage. They were both, by profession, supposed to be good with words, but in this case, neither writing the letter nor reading it succeeded.

I suppose it’s time to resurrect that old adage, “Sticks and stones may break my bones, but words will never hurt me.” When used to “encourage” children who have been bullied, it is a lie. But keep in mind that your words can definitely hurt someone else – or yourself – too. Try not to do that.

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When Depression Doesn’t Go Away

August 15, 2021

Back in the day, I suffered from treatment-resistant depression. (This was likely due to the fact that what I had was actually bipolar 2, but never mind that for now.) My psychiatrist prescribed me medication after medication, but none of them worked, or at least not for long. We got into a seemingly endless spiral of trying one drug, adding another, weaning me off one drug and ramping up another, then another and another.

Some of them just plain didn’t work. Others had intolerable side effects, from vivid horrible nightmares to making me feel like I was about to jump out of my skin.

All this went on for certainly months – maybe years. (Memory problems were one of the many intolerable side effects.)

Eventually, my doctor reached the correct diagnosis, and then there were months of trying medications that were targeted for bipolar disorder instead of plain depression with anxiety. Again, nothing worked, or didn’t work adequately.

Nowadays, there are non-pharmaceutical methods of coping with treatment-resistant depression, including ECT (better known as electroshock), TMS (transcranial magnetic stimulation), and ketamine treatment.

I never had any of these treatments, since my psychiatrist and I finally worked out a drug combo that brought me back to balance, with only minor tweaks in dosage over the years. Nonetheless, I’ve become interested in the alternate means of dealing with treatment-resistant depression, and here’s what I now know. (If you want a patient’s own experience with ECT, TMS, and ketamine treatment, look up Kitty Dukakis or read some of the Bloggess’s posts.)

ECT, or electroconvulsive therapy, is what used to be known as shock treatment. For a long time it went the way of prefrontal lobotomy, stigmatized as a cruel and harmful procedure. The portrayal of ECT in Ken Kesey’s novel One Flew Over the Cuckoo’s Nest and then the movie of the same name were major influences in terrifying the general public, leading to a nearly complete disavowal of its use.

It’s making a comeback, though. The theory behind it is that electric stimulation of the brain will shock the brain back into normal functioning. The American Psychiatric Association notes that it is now performed under anesthesia, with medical personnel attending the procedure. They report improvement in 80% of patients.

(ECT is the alternative treatment that I was ready to try when none of the drugs prescribed for me proved effective. Then my doctor wanted to try one last drug, and that was the one that did the trick.)

TMS, or transcranial magnetic simulation, is described by the Mayo Clinic as “a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.” It’s also called rTMS, or Repetitive Transcranial Magnetic Stimulation, because more than one treatment is generally needed. The theory is that the magnetic pulses stimulate areas of the brain involved with mood control and depression. It doesn’t cause seizures or require anesthesia. The exact mechanism of how it works isn’t really understood, but that’s true of many other treatments for depression, including medications.

Harvard’s Health Blog reports that rTMS helps about 50% to 60% of people who did not respond to drug treatment “experience a clinically meaningful response.” They do note that treatments, “while encouraging, are not permanent,” which is true of many other forms of treatment.

Ketamine is the newest of the treatments for treatment-resistant depression. Ketamine was once known as a “party drug” called “Special K,” described by the DEA as “a short-acting anesthetic with hallucinogenic effects.” As a treatment for depression, however, it is thought to “enable brain connections to regrow,” according to scientists at Yale. The American Association of Nurse Anesthetists notes that ketamine “is not a first-line therapy for psychiatric disorders,” but then, neither are ECT and TMS.

Ketamine can be administered via nasal spray, but for psychiatric purposes (including to treat bipolar disorder and PTSD) it is often given as a series of infusions. An article in The Lancet says that “Ketamine is thought to act by blocking … receptors in the brain.” Another article by doctors at the National Institutes of Health comments that ketamine “has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.” Repeated treatments are generally necessary.

I don’t know about other patients and doctors, but after years of drug therapy not working, I was ready to give almost anything a try. ECT was next on the list, and the only likely alternative, as TMS and ketamine were not available at that time. I’m just glad that now patients and their doctors have more options when depression resists drug treatment and “talk therapy.” And I hope that even more alternatives become available for people with depression who are desperate to find a treatment that works for them.

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Mental Health

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Good News, Anxiety (and a Little Hypomania)

August 8, 2021

My husband and I have been waiting for various pieces of good news for several weeks. If they come, and the money associated with them, we could accomplish a few things, both necessary and frivolous, that have been on our minds.

Naturally, the waiting that triggers my anxiety isn’t over yet. One of the good things that we’re hoping to indulge in is a trip abroad, in the early part of next year. Since I learned of this, I’ve been preparing for it like it was the Normandy Invasion.

I got a travel agent (my husband’s nephew) and spent a lot of time with him, going over what we wanted to see (scenic things, not big cities), what we wanted in the way of accommodations (guesthouses and bed-and-breakfasts), airline details, passport details, COVID details, birth certificate details, and more.

Though the trip is over six months away (which should be about right for getting passports), I’ve fallen into a morass of hypomania/anxiety. I’ve been checking what the weather will be like, how much local money we’ll need, any language difficulties, etc. I’ve started ordering things we’ll need, like rain slickers, a road map, power converters (I found ones with USB ports), extra underwear (I have a fear of running out), and so on. I’ve been poring over suggestions that our travel agent sent detailing interesting sights along the route he roughly mapped out for us, given that we’re going on a fly-drive plan. I suppose I’ll settle down at some point and just wait for everything to come together, but then again, maybe not.

Another anxiety-producing (or really, dread-producing) thing that may happen in the near future is getting my teeth fixed. I have a major phobia regarding dentists and have avoided them for far too long. I now have an appointment for a consultation. Even for that, I’ll probably need Ativan. If I make it through the anxiety and phobia, I perhaps will have done something that will bolster my sometimes-quite-low self-esteem. I’ve had problems with my teeth for years, but I am determined (well, sort of determined) that this will be the time that I will conquer them.

Our other new addition is a work truck for my husband, who needs to haul gardening equipment (including dirt and rocks) and timber and large tools around. This is also a piece of good news for me. Because of his work schedule and our one car, I have been unable to go out during the day. Not that I usually need to go out during the day, as I work from home, but it’s nice to have the choice.

Plus, I’ll be able to schedule appointments not just on Mondays, when my husband has off work, but during the rest of the week as well. With only one car, if I have a medical appointment, I’m limited in my choices of appointments and times. I have to drop my husband off at work at 6:00 a.m. to have the car for most of the day. Now I can have much more freedom and don’t have to feel trapped in the house. If I want or need to go somewhere, I can.

If we were sensible people (we aren’t), we would settle for using the infusion of money to fix my teeth and buy the work truck, then put the rest away for a nest egg. But, damn it, after all we’ve been through in the past few years, frankly, we need a break. I know that many people with bipolar disorder are not able to travel, even outside the town where they live. I know that I am lucky to be able to. I imagine I will still have some anxiety when we get there, such as when trying to adjust to driving on the wrong side of the road. But we’ve built rest and self-care into the plan.

Another time when we traveled, I gave myself permission to be depressed if I felt it coming on. It was a revelation. I didn’t have to force myself to participate in all the activities. I could sleep late if I needed to. I didn’t have to resort to “smiling depression” to seem “normal.”

I hope that on this vacation I can do the same. I hope I won’t get depressed very much, but if I want to skip part of the many activities that our travel agent has found, or sleep late in the b-n-b, I can choose to do that. And that’s part of how I practice self-care when traveling abroad.

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