Bipolar 2 From Inside and Out

Posts tagged ‘depression’

A Bad Decision? Or Something Else?

I’ve been beating myself up for years. Feeling blame and shame. Not just for years, really—literally for decades. That’s a long time to carry the weight of those feelings.

I was in college, when many people make bad decisions as a function of venturing into a less restricted, more adult life. I certainly made my share of bad decisions.

I wrote papers the night before they were due and didn’t make a second draft. I skipped reading Moby Dick, even though it was on the syllabus for the course. I took Russian instead of Japanese simply because it was offered later in the morning, and I wanted to sleep in.

I switched from being a linguistics major because I thought there were no jobs in it, despite not researching the field or asking my advisor. I floundered, considering hotel management and landscape architecture for no particular reason.

Then there was the worst decision I ever made, the one that has haunted me all these years. I met a man—we’ll call him Steve—and went home with him that same night. A few months later, I moved in with him. This led to a year of gaslighting, depression, and more bad decisions about prescription drugs.

So, how can I explain my bad decisions? Some were simply the kind of decisions that a person out on their own for the first time makes. These don’t affect me the way the relationship with Steve did. Steve told my parents about our relationship instead of letting me do it in my own time, in my own way. That soured my interactions with them for quite a while.

Why did I behave the way I did? An avowed feminist, I let this man take over my life. I put up with emotional abuse for almost a year. I denied that I was mad at him for all I’d been through. I put all the burden of blame and shame on myself. And there it sat for decades. I had flashbacks and bad dreams. I had difficulty with further relationships.

Then, recently, a new idea came to me. At the time when all this happened, I knew I was depressed. I had never heard of bipolar disorder, much less been diagnosed with it. Now that I do know and have been diagnosed (and seen therapists and been properly medicated), my disorder has still leaned largely toward the depressive side. I do remember having hypomanic jags in which I spent too much, and a larger one when I got wrapped up in writing and tried to market a novel to 100 agents and publishers.

But the one aspect of bipolar disorder I never considered was hypersexuality. The idea that could be the reason I dove into the relationship with Steve so quickly and so deeply was a revelation to me. I hadn’t had any lightning-quick sexual encounters until then. I hadn’t thrown myself into them so wholly and so destructively.

Of course, I can’t blame hypersexuality for the whole situation. I did what I did, and I chose to do it at the time. That’s on me.

But the decades of shame and blame? Now that I know what hypersexuality is and what it feels like, I don’t have to carry that burden with confusion, devastated by what happened, and wondering why it all happened. I can see that I have carried those feelings with me for too long. I can perhaps lay down that burden, understand why it might have happened, and move on.

I have made plenty of bad decisions, but I don’t have to cling to one of them and beat myself up for it. Perhaps, with this new insight, I can at last move on, chalking it up to a bad decision under the influence of hypomania rather than a lifelong journey of guilt.

Perhaps, now that I understand how hypersexuality may have played a part, I can forgive myself.

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I’m Not Fragile

TW: Suicidal Ideation

When my husband and I were looking for a new house, we checked out various options. I found a house I liked, but it was too far from the businesses and services we used. Besides, it had a water tower in the backyard (which I was hoping Dan wouldn’t notice).

Then Dan found a beyond-fixer-upper that was crumbling into pieces. He looked at it as a challenge. I told him that if I had to live in it for more than a month, I would be compelled to commit suicide. To this day, I’m not sure whether I was serious.

At last, we found just the right house. Three bedrooms, two of which would be turned into studies. Over an acre of ground with many trees. It was a little more than we could afford, but we decided that this was our dream home.

It also had a small creek running through the property—more like a run-off, really. Dan’s mom tried to talk us out of buying the house. She had been through a flood many years earlier and feared that the tiny creek could possibly get out of control and destroy our house as hers had been.

“Besides,” she said, “Think of Janet. She’s fragile.”

By “fragile,” it was clear she meant my mental health was sometimes shaky, or beyond shaky.

I had made no secret of my bipolar disorder. At first, Mom Reily didn’t “believe” in mental illness, but eventually she admitted that there was something wrong with my brain. But it pissed me off that she used my mental condition to try to influence our choice of houses. However fragile I might be, there was no way that a tiny creek could break me.

I was not that fragile.

Nor was I fragile when our dream home was taken out by a tornado. I survived it, though I was on the upper story when the roof came off. I dealt with the insurance company, the motels, the rental property, our finances, and many of the other details.

I wasn’t fragile then.

Of course, there were times when my mental condition was fragile. There was the time when I was overwhelmed by three full years of a depressive episode, unable to do anything, from self-care to reading. And there was the times when suicide crossed my mind. Sometimes, it was idly wondering the plane I was on might crash (passive suicidal ideation) or if a fall from the balcony I was on would kill me.

Then there was the time I had active suicidal ideation. I had made a plan and everything. But I dithered so long over how, when, and where that the feeling passed, and I didn’t follow through. I didn’t tell anyone for decades, but then I told Dan.

So, have I been fragile? Yes.

But those were all times when there was something wrong inside my head. Flooding and tornados didn’t break me. The times I was fragile were all things that happened because of SMI, not purely physical circumstances.

Now—I’m not broken. I’m not even fragile. Years of therapy, years of meds, years of not experiencing floods and tornados, and years of supportive love from Dan have made me not fragile, but strong at the broken places.

I don’t fear the future. I’m not fragile anymore.

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Growth Mindset and Mental Illness

Let’s start with a little levity, a quote from Groucho Marx: “Change is inevitable—except from a vending machine.” Putting the vending machine aside, Groucho was right. Change is inevitable. Even if you think that your condition will never change, your circumstances certainly will. Friends may come and go. You may run out of your medications or your therapist may go on vacation. With bipolar disorder in particular, change is not only inevitable, it’s part of the definition of the condition.

When it comes to change, psychologists speak of two types of mindset: fixed and growth. Both have impacts on mental illness and how you adjust to it. Both mindsets have to do with how you approach the world and, particularly, setbacks in life.

A person with a fixed mindset believes that their circumstances cannot change. To some extent, that’s true. Bipolar disorder may get better or worse, but it’s always there. There are treatments, but no cure. A person with a fixed mindset believes that they’ll never get better, their symptoms will never lessen, and that it’s fruitless to try. They believe that their traits and their limitations are carved in stone.

Someone with a growth mindset believes that change can happen. Their circumstances can improve. They may not be able to eradicate the disorder, but they can improve their functioning. There are things they can do to affect their lives and their condition. A growth mindset also correlates with resilience, the ability to bounce back from setbacks. It’s also been cited as a tool to deal with anxiety, depression, and “stress due to life events.”

It’s easy to see that for those with mental difficulties, a growth mindset is preferable. But is your mindset predetermined, or can it change? The good news is that someone with a fixed mindset can develop a growth mindset—if they try. But since the person with the fixed mindset tends to believe that positive change isn’t possible, it’s difficult to move from one mindset to the other.

But it’s not impossible. There are exercises for all ages that can foster the development of a growth mindset. For example, children can be introduced to stories of famous people who experienced many failures before they accomplished their successes. This can reinforce the belief that failure isn’t permanent; one can learn from it. They can also learn the power of the word “yet.” Instead of saying simply, “I can’t ice skate,” they can change that to “I don’t know how to ice skate yet.” It leaves open the possibility that they can still learn to skate, especially if they get instruction and practice. Teens or adults can set out to learn a minor or silly skill like juggling or sudoku puzzles. Learning purely for the sake of learning can prove to them that improvement is possible and enjoyable. Interventions that explain the neuroplasticity of the brain can also foster belief that traits are not immutable.

Fixed and growth mindsets have been studied as factors in mental health. For example, young people who had a fixed mindset were 58% more likely to experience severe symptoms of depression and anxiety than those with a growth mindset. Because they view improvement as possible, those with a growth mindset understand that anxiety is a temporary condition. Even someone with bipolar disorder can experience changes in symptoms, including positive changes. The changes may not be permanent, but they exist and can recur.

The takeaways are that a growth mindset promotes growth, change, and improvement in psychological symptoms such as depression and anxiety as well as other difficult life circumstances. That it is possible for a person with a fixed mindset to develop a growth mindset. And that a growth mindset will help a person deal with the difficulties and setbacks that mental illness so often involves.

In other words, you can get change from that vending machine after all!

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My Two Diagnoses

For all my childhood, I assumed I had depression, though I didn’t know that it was a psychiatric diagnosis. I was always a moody child, given to bursting into tears at the slightest provocation.

My first really major depressive meltdown came when I was humiliated by another child at a birthday party. I ran home, curled up in a beanbag chair, and sobbed for days. The only thing that snapped me out of it was the fact that my mother was being hurt by it too. She was crying too and had no idea what to do about my emotional implosion. At that point, I went down the street and yelled at the girl who had instigated the incident. (I suppose this could have been bipolar rage. I was pretty incoherent.)

I still remember this event as clearly as when it happened.

Another time, some friends were making fun of the way I laughed. Without saying a word, I got in my car and drove home, removing myself from what was distressing me. They followed me home and apologized. Then, I practiced laughing until I came up with something more acceptable. I think I accomplished it, though who really knows?

In my college years, I spiraled further. I was prescribed benzos for a TMJ problem, and I was in such a bad emotional place that I supplemented them with wine. There was some risky sexual behavior, too. It was the first time I recognized that I had a hypomanic episode. After I got out of the situation, I stopped relying on the benzos. (Actually, I had first experienced benzos in my junior high school years, when they were prescribed for an uncontrollable tic.)

Eventually, I went into therapy where I was diagnosed, as I expected, with depression. I continued that way for years, being prescribed various medications but still having symptoms.

Finally, I went to a new psychiatrist who, after some time, said he thought I had bipolar disorder. Eventually, we found a drug regimen that worked to alleviate my symptoms to an acceptable point.

I was still having symptoms, though, before the right cocktail was achieved. I was unable to work, get out of bed, or do much of anything, unhappy all the time. I applied for disability—and didn’t get it. When I got my file from Dr. R., I saw that my diagnosis was actually both bipolar and anxiety.

That threw me for a while. But looking backward and forward, I realize that he was right. I had anxiety episodes when I was a kid, usually regarding finding and keeping friends. I was terrified when my high school counselor suggested therapy. (I declined.) I panicked when it looked like I would have to go to community college instead of a four-year school, which I had always assumed was in my future. When I did get to that college, I had a mixture of the depression and anxiety, and took a year off to work and reset my brain.

Now, years later, my bipolar disorder is largely under control. But the anxiety haunts me to this day. I am anxious about family finances (which I am in charge of). Many nights my brain won’t shut up and I can’t sleep. (Sometimes it won’t shut up about the unfortunate episodes in my past.) I had massive anxiety recently regarding a trip to Florida.

So, I think Dr. R. was right when he diagnosed me with bipolar and anxiety. One has been tamed, but the other lingers. I am now working with Dr. G. to help me alleviate the anxiety without letting the bipolar kick up again. It’s a delicate balance.

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Is a Keto Diet Good for Bipolar?

I’m sure you’ve read the ads and articles that say apple cider vinegar is good for anything that ails you. There are also supposed “superfoods” that activate your immune system and ward off diseases. Then there are diets—Mediterranean, paleo, Atkins, gluten-free, intermittent fasting, vegetarian, vegan, low-carb, sugar-free, South Beach, carnivore, and more. Each of them is supposed to be good for your body or some part of it. And that may be true. I can’t say that one or another is good for everyone.

But what about people with bipolar disorder? A quick Google tells me that Omega 3, folic acid, probiotics, magnesium, walnuts, whole grains, CoQ10, tryptophan, Vitamin D, Vitamin B12, Vitamin C, and Acetylcysteine (which loosens thick mucus) are recommended nutrients for us.

But the diet (or eating plan) I’ve heard the most about in relation to mental disorders is the keto diet.

First, let’s look at what the keto diet actually is. It involves consuming a very low amount of carbohydrates and replacing them with fat to help your body burn fat for energy. That means you should avoid sugary foods, grains and starches, most fruit, beans and legumes, root vegetables and tubers, low-fat or diet products, unhealthy fats, alcohol, and sugar-free diet foods.

What’s left? Good fats like avocados and EVOO, as well as meat, fatty fish, eggs, butter and cream, cheese, nuts, seeds, low-carb veggies, and herbs and spices. This diet is supposed to be good for people with neurological disorders like epilepsy, heart disease, cancer, Alzheimer’s, Parkinson’s, and traumatic brain injuries.

Lately, however, the keto diet has been investigated as being good for mood disorders including depression and bipolar disorder.

Healthline reports that, based on the idea that a keto diet is good for those with epilepsy and that anti-seizure medications are often used to treat bipolar disorder, “during a depressed or manic episode, energy production slows in the brain. Eating a ketogenic diet can increase energy in the brain.” Also, the keto diet lowers the amount of sodium in the cells, which is partially the way lithium and other mood stabilizers work. They note, however, that very little research has been done on this theory.

However, UCLA Health is planning such a study. They note that, while most previous studies have focused on adults, the new study will include youth and young adults who have bipolar disorder. Participants will go on a ketogenic diet for 16 weeks while continuing their usual medications. Dieticians, psychologists, and psychiatrists are involved and there will be daily blood tests measuring metabolic indicators. In the future, the researchers say, they will compare the keto diet with another meal plan such as the Mediterranean diet.

Stanford has conducted a pilot study on the ketogenic diet. They say that, in addition to improving metabolic conditions, the diet improved patients’ psychiatric conditions and metabolic health while they continued with their medications. The results, published in Psychiatry Research, said that dietary interventions such as the keto diet may assist in treating mental illness.

A French study that was reported in Psychology Today focused on people with major depressive disorder, bipolar disorder, or schizophrenia. Symptoms improved in all the participants who followed the diet for more than two weeks. Almost two-thirds were able to reduce their medication.

There seem to be drawbacks to a keto diet, however. Healthline also notes that the diet can lead to shortages of vitamins B, C, and D, as well as calcium, magnesium, and iron. There can also be digestive difficulties such as nausea, vomiting, and constipation. They recommend supervision by a physician. Other people report mood swings related to the keto diet.

The advice from WebMD is that there is “insufficient evidence” to recommend the diet as beneficial for mood disorders. They don’t recommend it as a treatment option. As with any diet plan, consulting your doctor first is a good idea.

As for me, I have my doubts about currently (or formerly) trendy diets and superfoods, though the Mediterranean diet sounds good and balanced to me. Am I likely to try the keto diet? Well, I would miss bread, fruit, potatoes, and sugar-free products. Stocking up on meat, fish, avocados, cheese, herbs, and spices I could manage rather easily. But until more results are in from the various studies, I probably won’t change the way I eat very much.

As always, Your Mileage May Vary.

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What Was I Feeling?

It wasn’t supposed to be journaling. I thought I was writing a blog post to be called “On Happiness.” It was about the fact that, even though my bipolar disorder is well controlled, something was sucking the joy out of what should have been joyful times—our dream trip to Ireland, for example, or the fact that I just got a work assignment after a long drought. Not even a mid-winter trip to Florida lifted my spirits.

It didn’t feel like depression, though. That’s a creature I know well, and this wasn’t it. Oh, the lack of joy was the same, but there were no unexplained fits of crying or immobility. In fact, I was experiencing a flurry of activity getting ready for the Florida trip. Putting money away from every paycheck. Making sure we had enough meds for the week. Arranging boarding for the cat. Downloading directions to Google Maps. Checking the flight reservations at least twice a week. Planning what goes in the carry-ons. Juicing up my e-readers and my laptop so I could work on my new assignment and my blogs while we were away.

No, this wasn’t depression.

What it was, was anxiety. Where was this coming from?

Suddenly, I remembered. I had gotten a copy of my file when Dr. Ramirez had to prepare it for my disability application (which failed, of course). On it I read, bipolar disorder, type II, which was expected. But it also said anxiety disorder. And I forgot about that.

All these years, I’ve been concentrating on the bipolar diagnosis—keeping my moods level through a combination of meds and therapy, readjusting levels and times as needed.

But I had been ignoring my anxiety. I was taking one small dose of an anti-anxiety med, with permission to take an extra one as needed. Mostly, I just took the one at night to help me sleep. Unless I was under severe, immediate stress, I ignored the ability to take a second one. That only happened in Ireland, when we were driving on the unfamiliar side of unfamiliar roads with the first roundabouts I had ever encountered. After that, it was back to one a day at bedtime.

But then, as I was trying to write my blog post about how bad I was feeling, it occurred to me (duh) that what I was feeling was not depression, but massive anxiety. All my planning for the trip, all my worrying about our budgets and my work, were clear signs of it, even if I had somehow missed them.

By now, everything for the trip is planned, a few days early even, and my blogs are prepared to post while I’m away. I could relax. But you know I won’t, and I know it, too.

What I will do, though, is to start taking that extra anti-anxiety pill as part of my morning regimen. Unloading some of the remaining tasks like packing on my husband. And trying to distract myself by losing myself in a book.

And, of course, remembering all this for when we return and I have another appointment with my psychiatrist. Who knows? Maybe the twice-a-day pill regimen will have made a difference by then. And if it hasn’t, we can discuss it and see what else might help. (I know, I know. Breathing. Meditation. Mindfulness. Exercise. All of which are difficult for me to practice regularly. I haven’t been able to turn them into consistent habits.)

My husband helps me with my moods. I check with him when I start feeling manicky. He gives me loving attention when I start sliding into depression. He has proven that he can recognize extreme anxiety in certain unusual situations and recommend that I take that second anti-anxiety pill. What I plan to do, at least until my next med check, is not wait for that extreme anxiety to hit and work the second pill into my routine to see if it helps. And ask Dan for help in remembering to do that.

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Overeating and Bipolar Disorder

When you think about co-occurring disorders associated with bipolar disorder, you generally think of drug or alcohol abuse. But there’s another one you should consider: eating disorders.

For example, binge eating is a problem that many people with bipolar experience. Both conditions typically begin at a fairly young age. Both are experienced in cyclical patterns. And both are associated with changes in energy levels and eating patterns.

There’s scientific evidence that the two conditions are related. For example, research has shown that 30% of people with bipolar disorder also have problems with binge eating, Binge Eating Disorder (BED), or bulimia, and more than 9% of people with BED also have bipolar disorder.

The two disorders are intertwined, affecting each other. Someone experiencing a manic episode may be likely to overeat or binge, probably because of impaired impulse control. Depression, on the other hand, may lead to decreased appetite and low energy that makes it difficult to prepare food.

That’s not always true, though. The revved-up feeling of mania can lead someone to skip meals. Depression can lead a person to eat more “comfort foods,” which are often laden with carbs and sugar, as a coping mechanism, however maladaptive. These foods may increase serotonin and so make the person feel better temporarily. Either way, the over/undereating can cause stress while shopping or preparing food, or result in dissatisfaction with body image.

Medication for bipolar disorder can also have an effect on eating behaviors. We all know that certain drugs cause weight gain as a side effect. Antipsychotics, for instance, may contribute to increased eating because of changes in the brain’s reward system and a decreased ability to tell when you are full. And weight gain may lead to cycles of bingeing and purging.

Research has also shown that people with co-occurring bipolar and an eating disorder also may have PTSD, indicating a possible link between the conditions. It’s thought that people who have experienced trauma may use eating as a control mechanism.

At any rate, the combination of the two disorders is complex, and it’s likely that a person with both conditions may need help from a team or a holistic approach to treatment, both psychological and medical. It’s been suggested that topiramate (Topamax) or lamotrigine (Lamictal) can be considered, as these mood stabilizers don’t appear to result in weight gain.

Personally, I had a combination of the comfort food eating/skipping meals cycle. When I was in college, my weight fluctuated from roughly normal to too thin. Since then, thinness has not been a problem, possibly because of the medication I take. I certainly have a desire for comfort foods like mashed potatoes, pasta, and large amounts of cheese. One of my crazier comfort foods has been ridged potato chips with cream cheese, topped with M&Ms. My husband knows that when I want those particular ingredients, I’m sliding into depression. Lately, I’ve been swinging between comfort foods and skipping meals. On the other hand, I’ve lost 18 pounds since the spring. (My doctor asked me how I did it and I replied, “Eating less” rather than “skipping meals.” He thought I meant portion control, which I do try to do.) My bipolar disorder, while mostly stable, is still a cause of (less extreme) mood swings. My eating habits are likely just that—habits that I need to break. And I need to increase my activity, which should be easier once I get my knees replaced.

At any rate, I’ll try to keep an eye on my consumption and ask my husband to help me when it comes to eating better. Now that the holidays are almost over, it’s time to get back on track. Losing another 18 pounds sure wouldn’t do me any harm.

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Why Can’t You Just Get Over It?

That’s a question we all get—and we all hate. It implies that we can just get over it, but haven’t, for whatever reason.

The questioner may believe that we just aren’t trying. That we can pull ourselves up by our metaphorical bootstraps or choose to be cheerful. That we aren’t doing all we can to “regain our sanity.” That we haven’t tried the right diet, the right exercise, the right supplements, or the right therapy. Everyone has an answer.

Parts of their answers may be part of our answer, sort of. Diet and exercise are important, to be sure. But one food, like apple cider vinegar or acai berries, is not a secret remedy. A healthy, balanced diet of meat, veg, fruit, and grains is ideal. But many of us are simply not able to cook like that. I’ve had days when all I could manage to eat was Cocoa Puffs straight from the box or peanut butter straight from the jar.

Exercise and fresh air are good, of course, but again many of us are simply not able to accomplish it. Some can’t leave the house except for absolutely necessary errands and appointments. Then we bustle back to the safety of home. Or, if we have someone to help, they can do the errands for us. My husband can sometimes get me out of the house for a meal, but usually not a healthful one. If a friend invites me over for dinner, it’s a very special occasion and I make sure to hoard my spoons for it. Those are times I’ll even take a shower and get dressed for. As for exercise, I just can’t. I have severely arthritic knees that need to be replaced, so I can’t even do yoga or tai chi. Plus the whole getting out of the house thing.

Another common comment is, “Get some therapy.” I have and am and most of us are. What people who say this don’t realize is that therapy doesn’t work quickly, even if you can find the type that’s right for you. Personally, I can’t handle group therapy. I’ve tried. I have problems with the idea of CBT and DBT, currently two of the most favored forms. Talk therapy is the one I choose, and that helps, but I’ve had to go to the same therapist sometimes for years. A quick fix is not what I need or can get.

Also, there’s “Have you taken your meds?” which really pisses me off. First, there’s the assumption that I’m even on meds (I am, but it’s rude to assume that), plus the idea that a layperson can tell me when I need them.

No, I can’t just “get over it,” and neither can most people with depression, anxiety, phobias, bipolar, PTSD, or schizophrenia. They’re just too complicated.

Think about it. There are three causes considered likely to be the cause of brain illnesses: genetics, psychological trauma, or brain chemistry. None of those is something that can be gotten over by choosing happiness. If the origin is genetic, pulling yourself up by your bootstraps is not even a possibility. It will likely take years of therapy and medication to achieve stability, if that’s possible. If the cause is trauma, you can’t just forget about it. Imagine all your worst nightmares hitting you suddenly, asleep or awake, as though you’re experiencing the triggering event just as you did when it happened. Think about how it would feel to have grown up with repeated abuse that you couldn’t escape because you were a child. And if your brain chemicals are out of whack, there are dozens of meds that might work and dozens more that won’t. Finding the right combination is a lot more complicated than just popping a pill.

When you get hit with the question of why you can’t just get over it, you might be able to take ideas from this discussion and try to educate the person who asked it. Or you can print out the whole post and give it to them. (I give you permission.) They probably won’t realize they’ve just insulted you. At the least, you can tell them that they have. Maybe that will stop that one person from coming at you with the same question over and over.

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Where to Go First

Most of the advice about depression that’s out there says that the first place to go for help is your primary care physician. That may seem counterintuitive. After all, doctors are notorious for being oblivious to psychiatric problems. Either they dismiss them, assuming that all their complaints (especially those of women) are “all in their head,” or they over-diagnose mental illnesses and pass out pills indiscriminately. At least, those are the stereotypes.

The reality can be far different. Family doctors can absolutely have a positive role to play in diagnosing and treating mental illness.

The last time I went to my primary care physician (for a nail fungus), the nurse practitioner, after taking my vitals, proceeded to ask me the questions collectively known as the Depression Screener. “Do you feel like a burden to your family/do you no longer enjoy things you used to All the time/Most days/Sometimes/Once in a while/All the time” and so on.

My blood pressure was high that day and I see a psychiatrist and take all kinds of psychotropics. I’m sure all that is in my file. “Can’t you just put down that I’m anxious and depressed and leave it at that?” I asked.

“Let’s go through it anyway,” she said. And so we did. No surprises. I was anxious and depressed.

The depression screener may not have been useful for me, but it is for lots of people. There are a lot of seniors, for example, who are living with depression without realizing it. Children, too. Teens. People of all ages. Finding them and getting them help when it’s in the early stages can help them avoid a life of misery and despair.

Not every person gets to find out through the screener. My mother, who was in a nursing home, made some remarks that suggested to me that she was depressed—extremely depressed, including suicidal ideation. I excused myself, found her doctor, and told him what she said, and that I believed she needed antidepressants. Rather than pushing back, he believed me and prescribed them.

Of course, it’s easy enough to beat the screener. The answers are fairly obvious. In fact, I know one person who gave all the answers that would keep him out of the psych ward. But fortunately, most people answer the questions truthfully and get the help they need.

But back to primary care physicians. They’re also helpful in cases of depression, anxiety, and other mental disorders. They know about the most common antidepressants and other psychotropics and can prescribe them to get you through until you can see a psychiatrist. They can give you a referral to a psychiatrist. And, difficult as it is for a first-timer to get a prompt appointment, they can keep monitoring your condition, prescribing as needed, until there’s finally someone who’s taking new patients. My own family doctor was willing to keep prescribing all my medications when one psychiatrist retired and I had to find a new one and wait for an appointment.

My primary care physician is part of my treatment team.

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It’s Not That Simple

I’ve bitched before about the ads on TV for psychotropic drugs, and I’m about to do it again. The first ones that caught my eye were the ones that compared depression to holding up a smiley face mask in front of their face, while the person’s actual face exhibited sadness.

But it’s not that simple. Smiling depression is a thing, of course, but treating it is not as simple as taking away the mask and replacing it with a real smile. Psychotropics don’t work that way. Of course, since the ads are for psychotropics that are supposed to work quickly (though not as quickly as the ads imply), we can’t expect them to mention the years of struggle and therapy that go into improving the condition.

The next kind of commercials are a tiny bit better. They mention actual symptoms of depression: sadness, loss of focus, lack of interest in fun things, or an inability to do chores.

But it’s not that simple. Personally, I don’t think it’s a tragedy if the barista has to wait two seconds while I remember whether I want oat milk or if the family has to put away the laundry. These are obvious but probably not major symptoms of depression or symptoms of major depression. What about not getting out of bed for three days or not showering for a week or more? Crying all day about nothing or everything? Thoughts of self-harm or suicide? They just don’t make for good 60-second television. The long, lingering effects of depression are glossed over or ignored.

There are also ads for treatments for bipolar disorder, both types I and II. Most of them concentrate on the mania or hypomania side of the problem. Most of the ads use metaphors—climbing a tower of cards or going from darkness to light. Overspending is the issue most illustrated in regard to bipolar if you don’t count all the depression ads. I recall one that showed a woman who had bought a lot of expensive cameras and came to realize that she had overdone it.

But it’s not that simple. Bipolar disorder is a complex disorder that metaphors just can’t capture. Like depression, the ads concentrate on only one symptom, and don’t do a good job of creating those metaphors. (I’m just glad they don’t use a metaphor of someone on a swing.) I realize that it’s not likely that ads on TV will address hypersexuality, but what about the pressured speech, euphoria, irritability, bad decisions, and reckless behavior that go with mania?

Schizophrenia is probably the worst. The ads show not the disorder, but the lack of it—women saying, “I’m glad I don’t hear voices anymore” and “I’m glad I don’t still think everyone is looking at me” or men playing guitar to illustrate how “normal” the drugs make them.

But it’s not as simple as that. I admit that it’s not possible to portray some of the more frightening aspects of schizophrenia, which would probably only add to the stigma surrounding schizophrenia. But making it seem like one pill will cure it isn’t reasonable or accurate.

Then there’s tardive dyskinesia, also called TD. The ads do a competent job of giving examples of uncontrolled movements and how they interfere with a person’s life. The drug being advertised may indeed help with those.

But it’s not that simple. If you read the fine print at the bottom of the screen or listen to the rapid-paced list of possible side effects, you’ll notice that one of them is uncontrolled movements. WTAF? It gets rid of uncontrolled movements but may cause uncontrolled movements? Why take it and take the chance?

The ads I may hate the most are the ones that emphasize family. We see a woman folding the family’s laundry, grandparents romping with the kids at a park, and other idyllic scenes.

But it’s not that simple. Treating a mental illness is not something you do for the benefit of other people. It’s something you do for yourself, even if you don’t have a nuclear family or grandchildren or a large circle of friends. Granted, the people around you may be happy that you’ve found a therapy that works (and the ads almost never show a combination of drug therapy and talk therapy). That’s a side effect—a good one, but still not the intended effect of the psychotropic drug.

I attribute this primarily to the lack of inventiveness and understanding shown by people at the advertising agencies, as well as the tiptoeing around the whole subject of SMI. But what happens is that the viewers get an unrealistic view of both the disorders themselves and what the drugs can do to relieve them. It’s not simple, and the ads simply don’t reflect that.

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Mental Health

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