Bipolar 2 From Inside and Out

Posts tagged ‘bipolar disorder’

The Appropriate Committee

 

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When I was a teenager, my life was spent resenting the Appropriate Committee. I always ran afoul of them.

It seemed there was some nebulous group, invisibly judging us and deciding whether what we did, or wore, or how we acted was appropriate or not.

Part of the Appropriate Committee was, of course, the adult world. Teenagers were supposed to be polite and respectful and not talk or play music too loudly. To do otherwise would be inappropriate.

The social milieu was also part of the Appropriate Committee. How we monitored one another to make sure our pants weren’t too short, or that we didn’t wear ankle socks, or that we didn’t stay in the Girl Scouts past Brownies. The punishment was derision.

Of course being bipolar didn’t help. Both adult and junior versions of the Appropriate Committee took note of my mood swings – my loud, inappropriate laughter; my extreme, inappropriate crying; my extended, inappropriate isolation.

I tried to defy the Appropriate Committee. I laughed at them, thought they were stupid, and vowed not to let them run my life. They did anyway, of course. They were all-powerful and I had not yet gained the wherewithal not to care. It was like a pervasive, invasive form of bullying: Everything I did or said was wrong. The rules changed capriciously. I was punished with disapproval, mocking, and the wrong kind of laughter.

And they broke me. At times I tried desperately to fit in, to live up to expectations, to suppress my differences. At other times, when the effort became simply too much, I let my natural weirdness float to the surface and looked for the few other like-minded individuals that could tolerate that. Depression set in and, rarely, hypomania. I still dressed “wrong.” I still laughed at the wrong things, and too loudly. I still isolated and wept.

I thought that when I grew to adulthood, I would no longer be subject to the censure of the Appropriate Committee, Of course, that was completely delusional. I learned that the Appropriate Committee for Adults was a powerful force. It is particularly insidious in the business world, where it judges not just your appearance, but even seemingly minor matters such as where and how you eat lunch (with the “cool kids,” of course) and how you spend your breaks (cigarettes OK, crossword puzzles not). There’s still the problem of being laughed at in meetings and needing to go into the restroom to cry.

I finally realized that the Appropriate Committee exists in part to perpetuate stigma. So many of the behaviors of people with mental illness defy societal norms. It’s the Committee that insists we fit in, no matter what we’re feeling. It’s the reason that neurodivergent people are so reluctant to admit their differences in public and try their best to “play through the pain,” something that isn’t good for them, or for athletes either, really.

I’ve had enough of the Appropriate Committee over the years. Now that I’m properly diagnosed and medicated and relatively stable, I could undoubtedly fit in better than at any time previously in my life. But I dress how I like, even if it’s pajamas. I play my music as loud as I want and laugh or cry along with it if I feel like it. I embrace my weirdness, my differences, and seek out like-minded weird friends who are also living in defiance of the Committee.

Maybe the Appropriate Committee is needed for some places and times and people, like theater audiences or church services. Maybe. But for the mentally ill the Committee is hurtful, and stigmatizing, and unrealistic. We can strive to overcome our differences and sometimes we need to. But sometimes it’s better just to embrace weirdness, differentness, and our membership in the group of the neurodivergent.

And when I despair, I remind myself of songwriter Steve Goodman’s lyric: “I may not be normal, but nobody is.” And I let it blast.

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Bipolar Sex: Drought and Abundance

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Here’s something bipolar people talk about amongst themselves but not so much with the world outside: sex.

The two poles of bipolar, depression and mania, govern a person’s appetite for sex. A lot of other factors determine whether the sex will be any good, or good for the participants.

Of course the above is true for neurotypical people as well. Moods and emotions – things in the brain – have as much or more to do with sex than stuff in the body. Thinking about sex and wanting sex, for example, start in the brain and without them, nothing else is likely to happen anywhere else.

The depression side of bipolar sex is easy enough to map out. After all, some of the hallmarks of depression are numbness, inability to enjoy things that once gave pleasure, and a tendency to isolate. It’s hard to get your motor revving with all that going on.

Still, the depressed person may want to have sex, or at least want to want to. That’s the way it’s been with me. When I’m in a thoroughly depressed state, sex doesn’t even cross my mind. When I’m not quite as depressed, I think I might like to have sex but don’t have the energy for it. And when I’m relatively stable, there’s the meds.

It’s well known that medications for bipolar disorder can kill the sex drive and in men the ability to get or maintain an erection. Some drugs supposedly have less effect on sexuality, but I’ve never found the magic combination. Or the supposed sex-friendly drug has had side effects I can’t tolerate.

So if bipolar depression is largely a big zero for bipolar sex, how about mania?

Overactive sex drive combined with a lack of impulse control can lead to sexual excess. The tendency to minimize risk-taking behaviors means that some of that sex can be detrimental to one’s health, relationships, and self-esteem. Riding that wave is exhilarating, but then, inevitably, comes the crash and the need to pick up the pieces.

Full disclosure here: Since I have bipolar 2 and my hypomania tends to turn sideways and come out as anxiety, I don’t experience that manic sex high. On the whole, I think I am grateful for this. Sex has never been such an important part of my life that I would risk everything for it.

Once, though, I did experience what you might call a hypomanic sex drive. It smoldered for a long time, requited but unconsummated, until the right set of circumstances presented themselves. It was a restlessness, an obsessive thought, a longing for connection, rather than an ungovernable rush of need. It gave me, perhaps, a glimpse of what it might be like to be manic and sexually stimulated. But I’ll never really know.

I do know that I am glad I had the experience, whatever it was. I’m glad it was safe sex.  I’m glad it didn’t destroy relationships. But just to feel that desire again, even if only for a brief time, even with the anxiety it provoked – and there was lots – it was a kind of affirmation that my body and brain are still connected in some vital way.

Most of the time I limp along with only thoughts of sex too fleeting to act upon. And maybe this is not the best way to live, but I have made my peace with it. And once in a great while, every now and then, I still am reminded that I can have a sexual existence.

Even though I have bipolar.

Of course, as always, your mileage may vary.

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mental health

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The Disability Tapdance

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Once I applied for disability for my bipolar disorder and I was turned down Then I took the process as far as I could with a lawyer and he eventually advised me to give it up too. Here’s my story.

I had gotten to the end of my proverbial rope and we had gotten to the end of our money. For over a year I had been sidelined by unremitting depression. There was nothing I could do and nothing my psychiatrist prescribed or my therapist said had helped. We had been living on my husband’s salary and what was in my 401K from when I had last been able to work.

At last my husband pointed out that we couldn’t hold out much longer. He encouraged me to apply for disability. I knew that there would be lots of hoops to jump through and that there was no guarantee of succeeding. But Dan was willing to go with me to the Federal Building and help me get through it. I certainly wasn’t capable of managing it on my own.

Between the two of us, we had looked up what sorts of documents I would need and had acquired them. I was glad we were able to do this because going back again and again for missing documents would have been a horror. I had my appointment with the intake person and went back home to wait.

There were more forms to come. My psychiatrist had to fill out a long one, of course, or write a letter, I don’t remember which. I had to pay him for his time and trouble in doing that but at that point it was just another step that needed taking.

The big step was the psychological interview where I had to perform my little song and dance and convince someone that I was truly disabled. Fortunately, the appointment was not downtown in the Federal Building but in a relatively nearby office building that I knew how to find. Then the hoop-jumping and tap dancing really began.

They tested my memory. They told convoluted stories and asked me questions about them such as the order in which things happened and why the characters did what they did. They were confusing.

They tested my spatial perception. They had me put together those cubes with triangles on them to match patterns they showed me. I still don’t know what that had to do with bipolar disorder.

Then came factual knowledge. I was good at that one. I admit I guessed when they asked me how big around the equator was. I knew the easy stuff like who wrote Tom Sawyer and such.

By the time they got to the word association test, I was very tired. First they gave a pair of words and asked what they had in common, easy ones like truck and train. Later they gave difficult pairs of words that seemed to have nothing in common, like acceptance and denial, but I was supposed to come up with a commonality anyway.

Finally, an interview. I remember the woman asking me if I knew what the saying, “What goes around, comes around” meant. I replied, “As you sow, so shall you reap” and she looked at me funny.

A seemingly endless time later my claim was denied and I got a lawyer to pursue it. By that time so much time had passed that I was coming out of the depression and was able to work a few hours a week. How much did I get paid per hour? he asked. “Thirty dollars,” I said, explaining that I could only work a very limited number of hours. It didn’t matter. As soon as I said thirty dollars the judge’s head would explode, evidently. Lawyer Joe recommended I drop the claim and I did. At least I was getting some work and some income even without disability.

It seemed that for me to get disability I would have had to be together enough not to need it, but sufficiently disabled that I would. Catch-22, as Joseph Heller said.

 

 

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Inspiration and Mental Illness

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I was manicky this week and it affected my blog writing. I had a post all ready to go this morning, but last night I thought about it and realized it was crap. It meandered, without focus. The ideas were confused. It sucked. So I got up this morning to write something different instead.

Many of you may recognize this aspect of mania or hypomania. You do something that you think is fantastic  while in the grip of mania and when you come down, you can’t see what you ever saw in it. Or you begin an ambitious project that you work on and work on but never can complete.

I was toying with the idea of “inspiration porn” – the sort of post or story or TV show that holds someone up as an ideal, usually because they’ve lost a bunch of weight and gotten themselves into shape, or have an illness or disability and managed to do – whatever – again. Think “The Biggest Loser.” Or amputees who’ve learned to eat with their feet. It’s put out there for entertainment and to make everyone feel good that whoever it is conquered whatever it was. It takes a regular person out of the context of their lives and reduces them to their condition. And the subtext is that if this brave person can become able to do or be whatever again, so can everyone else with the same problem.

It happened to a friend of mine who was at a gym on a treadmill. A woman came up to her and said how inspiring it was to see her working so hard to lose all that weight. “Excuse me?” was my friend’s reaction. She was doing it for herself, not for anyone else, and especially not to inspire some random stranger.

The thing is, there really isn’t any mental health inspiration porn. For one thing, it would make lousy TV. Oh, they’d get advertisers – all those purveyors of psychotropics that clog the airwaves. But who would watch a depressed person finally getting out of bed and taking a shower, unless she had a coach yelling at her?

Inspiration for those of us with mental health problems takes other forms. Celebrities who speak about their struggles with mental illness are one. They are inspiring because they break the taboo about talking about mental illness in public and because they have done so to help other people.

Then there are the superstars of mental health inspiration. Carrie Fisher, Glenn Close, and Jenny Lawson, to name a few. These are people who focus light on the difficulties and struggles of mental illness. Their communications don’t stop with the announcement that they have a condition and encouraging people to get treatment, though those are also good things. But the real inspirations are those who open their lives, take others with them through the journey of symptoms, treatments, relapses, small triumphs, and bigger successes. They speak and keep speaking and keep speaking their message. They don’t make the process sound easy, because it isn’t. And they speak with authenticity and authority because we know they’ve been there.

They do inspire us because they are honest and open, and they clearly care about helping others in the same proverbial boat.

We lost a true inspiration when we lost Mama Carrie. No one will ever really take her place. But you can tell that she was an inspiration by the many people whose life she touched and how they remember her. If someday they make a movie of her life, I hope it features not only her personal struggles, but all that she did for others. Her speaking and continuing to speak despite – or because – of her ongoing struggles.

We can carry on her work by doing the same, by shedding the stigma, by talking to others, even family and friends. Recently a friend “came out” to me that she takes an antidepressant and an anti-anxiety med (the same ones I take). I was proud of her, but I didn’t make a big deal of it. But I was impressed and pleased that she was able and willing to share even that much. She was saying that she was part of our tribe.

As Jenny Lawson reminds us, in this we are alone together. And that’s inspiring. 

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Back to Work – Full Time

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As is true with many of us who can manage to work only part-time while dealing with bipolar disorder, I was always one paycheck away from financial disaster.

Then the checks stopped coming.

When my main source of work dried up, that financial disaster loomed closer. I knew that it was time to try to go back to regular work. Full-time. Outside in the world, if need be, rather than in my home office, in my jammies.

Looking for work was a job in itself (https://wp.me/p4e9wS-zY). It turns out I’m overqualified for many things and underqualified for others, sometimes both at once.

And the specter of bipolar reared its fearsome head. Even if I found full-time work, could I do it? Especially out there where it’s all people-y? It’s been years since I’ve worked in such an environment and my last few years at it did not go well, as I was beginning to slide into a major, long-lasting bipolar depressive episode.

Looking for work at home was not much better. Even telephone jobs (customer service or order handling, please, not sales) required some experience and my Girl Scout cookie days were back when we still thought it was safe to go door-to-door. When I responded to work-from-home jobs, many of them turned out to be Uber or Lyft, which is hardly the same as work-at-home, if you ask me.

I found a couple of small gigs to tide me over. Then I found one that was really promising.

Proofreader.

They warned me during the phone interview that I was vastly overqualified. I told them that this kind of job was exactly what I needed at this point in my life and please to keep me in mind if any of the other candidates washed out.

The job was with a transcription service, proofing scripts of meetings and reports that other people had typed up from audio files. But there wasn’t much of it, and it didn’t pay very well.

Then they asked me if I would move up to typing. And whether I would do it full-time.

Those were separate questions. I’m not a fast or good typist. I never took typing in high school (though I discovered that I needed it once I got into college). All these years I’ve been faking it, looking at the keyboard and using at most six or seven fingers to type with. But I said I’d try and I did. I’ve been sweating over these typing jobs and they take me lots longer than they do for other, ten-fingered, trained typists, but I’ve been hitting my deadlines.

Full-time was another issue. I said I’d try, with the understanding that I’d go back to part-time if I couldn’t handle it. It’s certainly been a challenge, forcing myself to spend six or more hours at the keyboard five days a week (and then using my days off to write blogs and work on my novel). It’s exhausting. But at least I’m still in my jammies and ready to go to bed afterward.

And I’ve learned a few things. One is “Never volunteer.” Often the company has extra work with even tighter deadlines that pay more per minute and are up for grabs. I made the mistake of grabbing a couple. It nearly did me in, combined with my regular work. (I did get an Amazon gift card for working on the Fourth of July.) Full-time work is hard enough. Full-time plus is a meat-grinder, or I should say a me-grinder.

So now for the big question – did I disclose my bipolar disorder?

I did not. As long as could do the work, it didn’t seem relevant. Work-at-home is not the sort of gig where they make accommodations or modifications for those with disabilities. And if I can keep up my stability and relative mental health, and get time off for doctor’s appointments, my mental status shouldn’t be relevant.

But I’m thinking I may have to cut back to four days a week. Five days is running me ragged. And then in December, when I retire, I can give it up altogether or work only a couple of days a week.

I will have a fixed income, which has both good and bad points, but at least it will lift from me the crushing anxiety of “Will we make the mortgage this month?” (I never was able to get disability.)

So, for now at least, and for the next few months, I will be working full- or almost full-time, if only my bipolar disorder will let me.

Wish me luck.

(Full disclosure: That photo is not an actual representation of my writing space. Mine is littered with legal pads, stuffed animals, Kleenex, and water bottles.)

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Forgiving and Forgetting

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Forgive and forget. That’s the saying.

To err is human; to forgive, divine. That’s another saying.

But what about when you can’t forget and can’t forgive? When you’re human, not divine?

Forgiveness is a tough subject for me, because there are things I can’t forget, despite the fact that either my bipolar disorder or my meds have made my memory spotty at best. But there are things I remember too well. And some of those I can’t forgive.

I can’t forgive the person who called my mother a murderer because she had her sick, ancient little dog euthanized. And then kept rubbing her face in it by saying she did not support my mother’s actions. This person caused my mother unnecessary pain when what she needed were understanding and comfort. By those criteria, I am a murderer too. A person that toxic is someone I don’t need in my life.

And maybe that’s wrong of me, but it was my decision.

Another person I can’t forget or forgive is my gaslighter, Rex, about whom I’ve written before (see https://wp.me/p4e9Hv-pm, https://wp.me/p4e9Hv-dR, https://wp.me/p4e9Hv-4t). In one of those posts I said, of forgiving and forgetting:

I can’t do either. The memories have faded over time and seldom give me flashbacks anymore. (The dreams still come.) As for forgiving? He’s never asked for it and never would. I’m sure he doesn’t think he did anything that needed forgiving….

That emotional abuse happened, and I can’t forget it. It was my first serious relationship and I left chunks of my soul and most of my barely existent self-esteem in that house on the hilltop. I had failed – at the relationship, at meeting my parents’ expectations, at so many things. I felt I was the one who needed forgiveness and spent much of the following years repeating incessantly, “I’m sorry.”

I once encountered a Christian who said that the essence of forgiveness was to “fore-give,” to give someone something before they ask for it, as in Jesus, fore-giving his life for His followers. Or giving a homeless person your coat before they ask for it.

I’ve since been told that that’s an inaccurate reading of the word “forgive.” But at the time it stuck with me and influenced my thinking. If that was forgiveness, I didn’t understand it and couldn’t accomplish it. Something to do with that “to forgive, divine” thing.

I couldn’t fore-give my mother’s pain. I surely wouldn’t have given it to her myself and I couldn’t fore-give that other person the right or the opportunity to do so.

I couldn’t fore-give Rex my pain. I gave him enough of my life – over a year – as well as some of my hopes and dreams and aspirations. And yes, at the time, my love.

I’ve thought about writing him a letter, the kind that therapists often suggest you write as an exercise in exploring your feelings, explaining what went on from my point of view. But I haven’t – not even the kind that you don’t mail.

It would be futile. I’ve written about the person and the pain here in these posts and it hasn’t done a thing toward making me forget or forgive. Far from forgetting, I sometimes need to remind myself of the pain – to affirm to myself that yes, it really was that awful and to warn myself never to get caught in a situation like that again.

I don’t go through my life holding grudges against everyone who has ever wronged me (or my mother). Everyday hurts – unless they come every day – are possible to let go of. I’ve mostly forgotten the kids who bullied me in school. And I’ve forgiven them. They were kids and didn’t know any better. I’ve forgiven friends who have cut me out of their lives because they couldn’t handle my bipolar symptoms. Sometimes I can’t handle the symptoms either. If I get fed up with my disorder, it’s easy to see how someone else could too.

I’m not going to give you any advice on forgiveness and whether you should forgive or not. The topic is too complex and I don’t know how or why you’ve been wronged.

All I’m going to say is to be a little easy on yourself if you find you can’t forgive what you can’t forget. Those sayings about forgiveness are guidelines, not laws, and your situation may not fit into those guidelines. Just know that I do understand.

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Realistic Self-Care

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I hate articles about self-care for mental illness such as the one I saw recently that said:

…[W]ays I practice self-care include swimming and Pilates, getting regular massages, spending time with friends and family, since staying connected is an essential part of emotional health at every age, watching TV, and seeing movies. I also love going for walks, especially near Santa Monica beach, and reading or listening to books.

If I could do all those things, I wouldn’t need self-care! When I’m depressed or anxious, I cannot make myself swim or exercise, or even get out of bed and shower at times, which lets out going to the movies and spending time with friends, too. I can maybe read a book or listen to a podcast if I’m not too twitchy and if my attention span and concentration will cooperate. And I can sit on the sofa and watch TV, but that feels like uselessness, not self-care.

Plus, guess what? A lot of those activities cost money.  Massages, movies, exercise classes (for which you need exercise clothes), and swimming (for which you need a swimsuit) would all require “shopping therapy,” which I loathe IRL and can’t afford online.

I personally would love a massage, but that’s not self-care for everyone. As Emily Roberts points out in “Self-Care for Mental Health: Find Ways That Work for You”:

The myth of a massage as an essential self-care activity – or anything that makes you more anxious – isn’t helpful for your mental health. I didn’t listen to my body the first time I booked a massage and guess what? It was so triggering to my body I couldn’t even finish it….I started to cry and couldn’t compose myself 10 minutes into the appointment. I was embarrassed and confused. I thought, “This stuff works for all the people in the magazines. What is wrong with me?”

I decided that booking an extra appointment with my therapist and having a date with my best friend was more helpful as self-care for my mental health than pushing myself to practice self-care in the way the media was telling me to.

One person’s mani-pedi can be another’s nightmare. I much prefer small ideas for self-care rather than big expeditions or splurges. For me, comfort food is one form of self-care. It has to be something I can make easily, though, like frozen mashed potatoes, mac-n-cheese, or French bread pizzas. (The microwave is my friend.)

Of course, these comforts require a little planning when I’m not overwhelmed to the point that I need self-care to restore me. I must think ahead, during those times when I’m able to go to the store, to bring home the foods that are easy to make yet soothing.

Another self-care technique I came across is definitely more my speed. Caiti Gearsbeck, in “Make Your Own Mental Health Self Care Kit” offers a simple, DIY alternative. She recommends filling a shoebox or other box with soothing things that appeal to all five senses, plus a few activities. Here are a few of her examples:

Sight: photos, cards, and letters

Smell: essential oils or candles

Taste: chocolate or tea

Sound: meditation CD or an mp3 player with a playlist

Touch: soft cloth or stuffed animal, stress ball or fidget cube

Activities: coloring books and pencils, a journal, a favorite movie

She adds: Whatever works for you!

For me, that box would contain photos, Irish Spring soap, oolong tea, an mp3 player, a stuffed animal (I have lots to choose from), and a CD of The Mikado. I’d need a cat in the box, too. But given the nature of cats, there would probably be one in there anyway, whether I wanted it or not. All of that is stuff I have around the house, unless I’m out of Irish Spring or oolong. Add a quiet room like the bedroom or my study and I’m all set. At least until I can afford a massage.

References

https://blogs.psychcentral.com/millennial/2017/10/make-your-own-mental-health-self-care-kit/

https://www.jwi.org/articles/mental-health-and-self-care

https://www.healthyplace.com/blogs/buildingselfesteem/2018/5/self-care-for-mental-health-find-ways-that-work-for-you

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The Compliant Patient

My mother was not a compliant patient. She would have side effects from medication and just stop taking them: The meds gave her sores in her mouth or nauseated her.  And that’s valid. We’ve all had medications that we couldn’t tolerate because of the side effects. But Mom stopped taking them without telling her doctor. Once she went to the emergency room, where they had a list of the meds she was supposedly still on and I had to tell intake, “No, she stopped taking that one. And that one too, I think.” (She was not mentally ill, but that’s where I’m going with this.)

There is only one psychotropic medication I know of (though there may be others by now that I haven’t heard about), where the potential side effects are so horrible – potentially lethal – that patients are advised to stop taking them immediately and get medical help right away.  The side effect is called Stevens-Johnson Syndrome and it is a potentially fatal rash.  I wrote about it a few years ago, (https://wp.me/p4e9Hv-1g)

Other than that one instance, psychotropic medications should never be discontinued unless you have consulted your physician. You never know what withdrawal symptoms lie in wait for you, but they’re bound to be unpleasant, even if they don’t cause you to relapse, which could easily happen. Withdrawal from any drug is not fun; it’s to be avoided.

Nonetheless, I read posts in support groups all the time which say that people have decided by themselves to stop taking a medication, or even all their medications on their own. I have friends who have taken their treatment into their own hands this way.

There are several reasons they sometimes give for giving up medications. One is that the meds aren’t working. What they really mean is that the meds aren’t working yet. Many psychotropics don’t show positive effects until they have built up in your bloodstream, which can easily take four to six weeks. Expecting results in a day or two is unreasonable.

Others stop taking their meds because they “feel better” and think they no longer need the pills. This is just ridiculous. The meds are the reason that you feel better. Your psychiatric condition does not just go away, like the flu, when you feel better. Your disorder may soon come roaring back (or creeping back). And the thing is, when you restart a medication, it sometimes no longer works as effectively. Then you have to start all over with a new prescription and have another four to six weeks of symptoms while you wait to find out if it works or doesn’t.

Still other people simply don’t like taking medications.  This I don’t understand.  People take meds for flu and infections and such conditions and never seem to resent them. Maybe it’s the idea that you could well be – will likely be – on psychotropics for the rest of your life. But lots of people have meds they need for life – insulin, cholesterol meds, anti-inflammatories, asthma meds, thyroid meds, and others. People don’t quit taking those just because they don’t like to take pills or injections.

I think the real reason people don’t like to take their psychiatric meds is that they’re psychiatric meds. There is still massive stigma around the subject of mental illness. Taking medication for a mental illness means admitting you have one, which some people are reluctant to do.

Or they may be giving in to “pill-shaming.” There are plenty of people, perhaps in your own family – and certainly across the Internet – who will tell you that all you need is self-love or affirmations or sunshine or exercise or vitamins or meditation or willpower to banish your mental illness. Funny how they never tell people that sunshine will cure their broken leg or that exercise will cure their breast cancer.

I hesitate to say that I love my psychotropics, but in a way I do. They have brought me out of states of mind that were harmful to me. They have made it possible for me to function and create and communicate. They probably have saved my life.

Occasionally I let my psychiatrist know that I may need a change in dosage or that one of meds is no longer working. I’ve even reviewed with him whether there are any meds I could quit taking (there aren’t at the moment). But I keep taking them faithfully, every day, morning and night.

I need the psychotropics. So I am a compliant patient.

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Bad Thoughts and Tattoos

Sometimes I have bad thoughts. We all do. I find that mine fall into three groups.

The first kind of bad thoughts are when I want to snap or snipe or snark at my husband, despite the fact that he is indispensable to me. He takes care of me, understands me, helps me, hugs me, feeds me in ways I can’t begin to describe.

When those bad thoughts arise, I have a brief internal chat with myself. (It looks like I’m thinking what to say because that’s exactly what I’m doing.) Then I choose not to say the nasty thing or I think of a less-nasty way of saying it. (I’ve written about the phenomenon before in “Managing My Anger” https://wp.me/p4e9Hv-kw.)

The skills involved are impulse control, the use of “I statements,” and the ability to rephrase. I try to say something that will get my point across without hurting or making things worse. These are techniques I have learned over the years, which makes me think they are things that can be developed with a little practice.

Learning to restrain myself has prevented many a fight. Some people find this style of communication inauthentic or wishy-washy – that I am tiptoeing around my husband instead of saying what I really think. All I can say to that is that it works for me and for our marriage.

The next kind of bad thought is the kind that comes with depression: I’m useless. I’m pathetic. I can’t do anything right. I’m worthless. Jenny Lawson (aka The Bloggess) talks about these thoughts in her book Furiously Happy, and she has one thing to say about them: Depression lies. These are the thoughts of a biochemically influenced brain that makes you miserable and sometimes wants to kill you, or at least kill your possibility of happiness.

Fortunately, my husband has read Jenny Lawson too. When I express these bad self-thoughts – and it’s best if you have a safe person to tell them to – he reminds me. He doesn’t try to deny the thoughts (You know you’re not worthless. You do lots of things right). He tells me, “That’s depression lying to you.” I used to get stuck in these cycles a lot before I was properly medicated and before I had his help and that of my therapist.

Then there are the really bad thoughts, those of self-harm or worse. Most of the time I don’t have these anymore, but when I do, there is one thing I can do. (Actually, there are more things I can do, but this is one that works for me.) I look at my tattoos.

The one on the right wrist is a symbol for bipolar disorder made up of punctuation : ) :  in the form of a smiley face/frowny face. This reminds me that my brain isn’t working right and is sometimes out to get me.

The other is on my left wrist, near my scars from self-harm. It is a semicolon. You may have heard about the Semicolon Project or seen the semicolon symbol on t-shirts or jewelry.

The semicolon is my favorite punctuation mark. It comes at the place in a sentence where a writer could choose to put a period and stop; instead, she continues the sentence. The semicolon says, “My story isn’t over,” something you’ll also see on t-shirts and such. (I’m thinking of making that sentence my third tattoo.)

Recently I had a bout of those really bad thoughts. But I looked at my tattoos and told myself, “My story isn’t over yet. I still have things I need to do.” One of them is to tell my story, in this blog and in a book I’m trying to write.

My tattoos helped me get over the bad thoughts. They have paid for themselves many times over. I never regret getting them. They may have saved my life.

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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

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