Bipolar 2 From Inside and Out

Posts tagged ‘medication’

Sleeping or Not

Sleep is one of the most problematic aspects of bipolar and many other brain illnesses. With bipolar disorder, you tend to sleep too much when you’re depressed and not enough when you’re manic. For adults, the recommended amount of deep, restorative sleep is 7–9 hours. That allows someone to have the proper proportion of REM sleep, which is when you dream and when your brain consolidates memories and experiences.

To this, many of us say, “Hah!”

Right now, I’m torn between the two extremes. I’ve been having mixed episodes, so there are days when I want to stay in bed all day. On other days, I can’t get that restful, uninterrupted sleep. I wake up at around 2:00 a.m. and can’t get back to sleep until at least 6:00. I take a nap in the afternoon, and then can’t get to sleep until around 2:00. Or I’m so exhausted that I go to bed by 8:00 and again wake up at 2:00. Once in a great while I go to bed around 9:00 and wake up in time to see my husband off to work at 5:30. Those are the good days.

It’s true that I’ve had a lot of stress lately. Financial, legal, health, and emotional problems have been piling up for both me and my husband. I read at night after taking my bedtime meds, and I feel sleepy in about half an hour. But when I put down my book and try to sleep, I get racing thoughts about every impending disaster—and there are plenty to choose from. The anti-anxiety med I take does nothing, even if I take a second one (which my doctor allows).

If and when I finally do get to sleep, it’s not restful and restorative. I know that I do enter REM sleep, because I dream. One night recently, every single impending disaster combined into a vision of ultimate dread. It wasn’t just that everything that could go wrong did. They all were over the top, all my fears taken to the extreme with vivid color and sound. Worst of all, I couldn’t talk to my husband about my disturbing dream as I usually do. He was dealing with the same fears and facing the same disasters. It seemed unfair to dump my terrors on him. Although he was involved in the dream, I didn’t want him to think I was blaming him.

Along with the terror dream, I’ve had the normal variety of unpleasant dreams that express frustration or inadequacy—missing a plane, losing a competition—the kind that I can generally shrug off. Now, however, they seem to linger in the back of my brain all day.

There is one thing that helps, but I know I shouldn’t do it. That’s taking a sleeping pill. I don’t currently have a prescription for it, though I did in the past. I stopped taking it when I learned that I slept okay without it. But I still had half a dozen pills and didn’t get rid of them. I thought I might use them if I needed to sleep on a long flight. Instead, I remembered I had them during the current series of crises. And they work. But I have to dole them out carefully. I don’t see my psychiatrist until next month, and he doesn’t prescribe over the phone. I tried to make an appointment to see him earlier, but I don’t have transportation on the days he sees clients.

My best bet at this point is to hope that some of the crises resolve before my appointment and I don’t need the sleeping pill anymore. There’s a chance that some of them will, but then again, they may not resolve in our favor. It looks like more hamster brain for me.

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How I Treat My Bipolar Disorder

There are many treatments for bipolar disorder, from SSRIs to EMDR and more. I must admit that I haven’t tried all of them, but I have encountered a few over the years. Some worked well, others not so much. But I’m doing well now, so I thought I’d share what works for me—my roadmap to stability.

Note that I said, “How I Treat My Bipolar Disorder.” That’s because my treatment is up to me. My psychiatrist or therapist can recommend a certain treatment, but whether I take that drug, undergo that procedure, or engage in therapy is ultimately my choice. I look at my providers as people who recommend treatments and help me implement them. But they don’t make the decisions. I do. Most of the time, I take their suggestions—they know more than I do about medications, for example. But I feel free to make suggestions, too, if the medication isn’t working like it’s supposed to or is having side effects I can’t deal with.

Meds

My med journey started (approximately 30 years ago) with the then-ubiquitous SSRI, Prozac. It worked well for me, relieving my depressive tendencies (I hadn’t been diagnosed with bipolar yet). Until it didn’t. That’s when my doctors started throwing drugs against the wall, hoping they would stick. Over the years, I’ve been on at least three different SSRIs, two NDRIs, two SNRIs, and a sedative-hypnotic. Probably other ones, too, that I don’t remember. (One of the side effects for one of them was memory loss.)

My previous psychiatrist experimented with a variety of meds until we hit on a cocktail that worked: an SSRI, a broad-spectrum anti-seizure drug, an atypical antipsychotic, and a benzo. My current psychiatrist mostly tweaks the dosages up or down when I need it. I’ve quit the sedative-hypnotic altogether and only take the benzo as needed. Recently, when I told him that I thought I was having mixed states, he upped the dosage of the atypical antipsychotic. (I don’t like to give the names of the drugs I’m taking because what works for me doesn’t necessarily work for others.)

I see the psychiatrist four times a year for med checks, though I can call if I have any adverse reactions or increased symptoms.

(When I was looking for illustrations to go with this post, I was astounded at the number of images of mushrooms that I saw. I guess it’s trendy now, but I’ve never tried them. There were also pictures of marijuana plants. There’s a medical dispensary in my area, but I’ve never pursued getting a prescription. I have taken CBD gummies, but the only effect they had was to make me foggy and dizzy, which I didn’t like. They did nothing for my moods. They didn’t even relax me; I was too nervous about my balance and the potential of falling.)

Therapy

Individual talk therapy is my go-to form of therapy, though I recently felt I could stop. (I keep the number handy in case I ever need it again.) I guess you could say I weaned myself off therapy. When I started I was going once a week; later, once every other week. When it got to three or four weeks between appointments, I decided it was time to fly on my own. I don’t know what particular kind of therapy I had—CBT or DBT, for example. She never said and I never asked.

I went to group therapy when I was still undiagnosed, but it wasn’t helpful. Once, when my therapist was out of town, I went to a therapy group she recommended but had an adverse reaction to it. Another group just seemed to have a weird format and a book they used like a “bible,” and I didn’t get anything out of that, either. A few times, my husband and I went to couples therapy, and it seemed to help. Another time, we went to a few sessions with a different therapist and I felt shredded. She seemed to think that I was the “sick one” and my husband was the “normal one.”

Treatments

Most of the modern treatments I haven’t tried because medication and talk therapy work so well for me. I had a close brush with ECT, which frankly frightened me, when I went through multiple drugs for several years and nothing seemed to work. My psychiatrist gave me the information and gave me time to think it over and make my own decision. I was almost ready to try it when, miraculously, a different drug brought my mental function under control. But when it comes to TMS, ketamine, EMDR, et cet., I have no experience with them. I don’t believe in reflexology and won’t try herbal remedies because they might interact badly with my meds. Basically, because what I’m already doing works for me, I see no need to explore alternatives.

Self-Care

It’s hard for me to keep up with self-care. I do stick to a sleep schedule and get 8-9 hours a night, with occasional daytime naps. I don’t exercise. It’s hard enough just to walk with my arthritic knees and bad back.

My husband helps me enormously with self-care. He works at a store with a grocery section, and he makes sure I have a variety of food and beverages on hand—fruits and juices, fizzy water, bread, and cheeses, for example—and fixes meals with protein, starch, and vegetables. Left to myself, I would probably subsist mostly on peanut butter sandwiches and breakfast cereal. Back in the day, he used to drive me to my therapy appointments when I was too nervous or depressed to drive myself. Now he picks up my scripts at the pharmacy department in his store.

What’s the takeaway here? I’m not telling you that I have the answer for how you should treat your bipolar disorder. I know what’s worked for me, but you have to find a path that’s right for you. I merely offer my experiences for what they are—mine. You can create your own roadmap, too.

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Bipolar Questions and Answers

Have you heard of Quora? It’s like a crowd-sourced online question and answer center, where anyone can ask questions on practically any topic and request an answer from a specific person, or leave it up to whoever wants to answer.

I’ve used it myself for answers to questions about Ireland and about gardening. But since my Quora “credential” says that I have bipolar disorder and have written two books on the subject, I get questions about bipolar (and other mental health topics), usually several a day. Some I can’t answer. Some have already been answered. But I answer a couple every day. I consider it part of my goal of spreading information about mental health wherever and whenever I can.

Here are some of the types of questions I’ve been asked and how I answered them. Maybe they’ll help some of my readers as well.

What is the best medication to take for bipolar?

This one is the question most commonly asked, and it is easy to answer. I don’t know which medication is right for you. Only you and your psychiatrist can figure that out, basically through trial and error. It may take a while to settle on a med or combination of meds will work for you with the maximum effects and the fewest side effects.

I am thinking of quitting my meds, as I don’t feel I need them anymore or am having bad side effects.

DO NOT DO THIS. There are dangers in going cold turkey, not the least of which is withdrawal symptoms. Work with your psychiatrist. She/he can help you decide whether it’s a good idea to quit a medication. If going off a med is a reasonable idea, your psychiatrist will help you do it safely, most likely tapering off on the med you are on and possibly ramping up on a med that works better or has more tolerable side effects.

Besides, meds for bipolar are supposed to make you feel better – but it’s not a one-time thing. You have to keep taking them to keep feeling “better.” And if you go off a med and then decide to go back on it, it may not work as well.

Would bipolar disorder be eradicated if everyone came from a loving, stable home?

Sadly, no. While bipolar disorder may have a genetic component and may run in families, it can affect any person in any family. I had the most stable, loving family you can imagine, and here I am with bipolar 2.

What causes bipolar disorder?

The jury’s still out on that. Some people will tell you the cause is genetic. Others will say it is caused by deficiencies or overproduction of chemicals and receptors in the brain. Still others will say that trauma, especially childhood trauma, can cause bipolar disorder. Personally, I don’t know for sure, but I suspect it could be any one of them, or any combination of the three.

How do I help a family member with bipolar disorder?

First, you may be able to help them manage their disorder. In the early stages, you can perhaps help them find a psychiatrist, drive them to appointments, pick up their medication, and so forth. Be supportive. Tell the person that you love them and hope they feel better soon. (They may not respond to you at the time, but later they will remember who stood by them and helped them.)

You can also help by helping the person practice self-care. Provide an environment that contains the things that comfort and help ground them – comfort food, soothing objects such as blankets or pillows, favorite scents, or even stuffed animals. Encourage them to bathe or shower and facilitate that: Have clean towels available and clean clothes or pajamas ready to wear. Make sure there is soap and shampoo handy.

For persons in the manic phase of the illness, you can accompany them when they go out, try to help keep them centered on projects at home, try to help them when it comes to overspending or other reckless behavior. Again, remind them that you love them and will be there for them now and when they feel better.

How do I deal with a narcissistic, bipolar boss?

You can’t know that your boss really has a personality disorder or a mood disorder unless you have read their medical files, which is illegal. They may have narcissistic traits or change their mind frequently (which is not the same as having bipolar disorder). You basically have two choices: Put up with it or quit. You will not be able to change your boss’s behavior.

I’m afraid my parents will find out I have bipolar disorder.

If you are underage, you can probably not hide it from them. It’s not a good idea to delay treatment until you are of legal age, though. You can ask your family practice physician to recommend a good psychotherapist or psychiatrist. You can ask your school counselor to help you find help. There are telephone and text hotlines. The best bet may be to talk to your family about it, in a quiet, low-stress environment and explain what bipolar disorder is and why you believe you have it. Their responses may surprise you.

Will I be bipolar for the rest of my life?

Unfortunately, the answer is yes. Bipolar disorder is not a disease like cancer that can in some cases be cured. It’s more like diabetes or asthma, in that you will have to live with it, cope with it, and have treatment for it, most likely for the rest of your life.

But it’s not a thing to be feared. If you have the proper support, such as therapy and sometimes medications, you can live a fulfilling, “normal” life, and accomplish many if not all your goals. I have bipolar disorder and have completed grad school; have a loving, stable marriage; own my own home; and do paid work. You are not tied to a future of despair or fears or bad effects.

Keep trying.

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