Bipolar 2 From Inside and Out

Posts tagged ‘mental illness’

Mental Illness or Autism?

The other day I inadvertently created a firestorm on facebook. Someone posted: Question: What makes schizophrenia a mental illness and autism not a mental illness? Answer: Politics, advocacy, and marketing.

I didn’t understand the thrust of the post, so I asked a question: “Are you saying that autism should be classed as a mental illness or that schizophrenia shouldn’t be?”

Then the floodgates open. There were over 100 responses to the post, of which mine was just one. They ranged from “autism is not a mental illness” to “autism is a form of mental illness” to “autism is a developmental disorder” to “schizophrenia and autism are both neurodivergent conditions.” Few, if any, seemed to address the original question of politics, advocacy, and marketing. (I have no knowledge whether any of the responders were medical or other professionals; persons with one or the other diagnosis; or family members of those with the, let’s call them conditions for now.)

Some people responded that the term “mental illness” should not be used, because it was inaccurate, or stigmatizing, or both. They found the phrase “mental illness” offensive. “Mental disease” was suggested as a better alternative, though for the life of me I can’t see much difference between them. To me, “illness” and “disease” mean basically the same thing. One can go down the rabbit hole here. Is MS a condition or an illness or a disease or a disorder? Is a broken leg a condition? It’s certainly not an illness – unless it gets infected – or a disease. Someone said that mental illness implied a permanent condition, rather than a challenge that can be treated. My bipolar disorder can certainly be treated, and is. But it is also a permanent condition.

Some of the phraseology that was most often used to define autism were neurodivergent, neurological condition, developmental disorder, neurological condition that often presents with mental illness like anxiety. But neurodivergent was also used to described schizophrenia, which was sometimes linked to brain anatomy and genetics. Some classed them both as “disorders of the brain.”

Others pointed out societal or functional differences or other definitions – schizophrenia can be used in court for a “diminished capacity defense”; autism is listed in the DSM-V (Diagnostic and Statistical Manual, considered by many the gold standard for definitions and symptoms of mental illnesses); the age of onset for autism is three, or three to 18, while schizophrenia is usually diagnosed at 18 and over, but not always; autism used to be called childhood schizophrenia; schizophrenia is caused by over-pruning of the neurons, which disrupt the normal growth of the brain; ASD could be a result of disruptions in normal brain growth. Someone pointed out that with both autism and schizophrenia, there are different levels of severity.

Various books and articles were cited. Challenging questions were asked: Do those who insist that autism is not a mental illness think having a mental illness is shameful, whereas having autism is not shameful or perhaps is not an illness at all. Others considered treatments: Medications can help with mental illnesses but are not generally prescribed for autism. People with one or the other condition do not qualify for treatment.

And some responses were entirely cryptic: B careful what you wish 4.

But back to the original post. I think the poster was trying to say that the autism community did a better job of spreading the word about the condition and thereby defining it, in this case as not-a-mental-illness.

And it’s true that – whatever you think of them as an organization – Autism Speaks has gotten the word out about autism. They excel at awareness (of themselves as well as autism). They organize huge charity walks. They have numerous TV commercials. Their puzzle piece symbol – again, whatever you think of it – is for many the easily identifiable graphic that says, “autism.”

Mental illness, whatever you prefer to call it, does not have that same kind of presence in the public eye. For one thing, there are so many different conditions that it’s hard to choose one to spotlight. Depression seems to be the condition-du-jour. The conversations around it are that anyone can have it and there is help available, which is all well and good. But the vast majority of these messages come from people who are selling or associated with medications or call-a-therapist lines – money-making operations. Nor do the ads always get depression right, many making it seem like no worse than a mild hangover.

SMI (serious mental illnesses such as bipolar disorder and schizophrenia) are only now entering the public discourse, and again, mainly for advertisements of drug treatments. The ones for schizophrenia seldom discuss any symptoms of the disorder – they just show a happy person playing a guitar or some such desired outcome. They don’t convey much about the condition of schizophrenia, its symptoms, how it affects families, or much of anything else.

As for other psychiatric conditions, there is much silence. PTSD is discussed, but only of the “wounded warrior” variety, not the kind that can result from other traumas. Anorexia/bulimia, OCD, social and generalized anxiety, narcissism, and the whole spectrum of personality disorders get little to no screen time.

There is growing discussion about things society – and especially first responders – should know or do about people with psychiatric conditions, but those are largely at the talking stage and a few pilot projects. When the subject hits TV, it is usually triggered (sorry) by an individual incident and is more likely to involve unorganized protests rather than coordinated efforts to address the larger problem. And at times, it seems that no one is listening.

Especially to the people with “forgotten” mental conditions – those that don’t have drug treatments or celebrity proponents or coordinated responses. It’s not that I think autism doesn’t deserve the attention it gets – though clearly there are more discussions to be had around the subject. I just sometimes despair of getting attention for mental illnesses.

But to go back again to the original post, mental illness and autism are two different things that cannot be easily compared. But it is true that autism, at the moment, has an organization with a loud voice behind it. Mental health, not so much.

Jenny’s Back!

Jenny Lawson (aka The Bloggess) is back with a new book to accompany her wildly successful Let’s Pretend This Never Happened and Furiously Happy, plus the coloring book that I can never remember the name of.

Her new book, Broken (in the best possible way), which debuted at #3 in the New York Times, takes Jenny’s weird and out-of-the-ordinary sense of humor and adds more laughs, as well as more serious material.

I haven’t counted how often she talks about vaginas and “lady gardens,” but I bet someone will. And f-bombs abound. (Hardly surprising, since the most requested way for her to sign books is “Knock, knock, motherfucker!”)

Note: If you’re at all a sensitive soul or offended by certain types of language, steer clear of the chapter on “Business Ideas to Pitch on Shark Tank.” It’s raunchy even by Bloggess standards, which means it’s beyond simply raunchy. Of course, if you were a sensitive soul who objected to certain types of language, you probably wouldn’t have picked up this book in the first place.

Jenny’s previous book, Furiously Happy, dealt a lot with struggles against depression and anxiety – Jenny’s own and other people’s. The new book goes into those subjects in more depth, including a personal narrative of using TMS (transcranial magnetic stimulation) to deal with her treatment-resistant depression. There’s even a picture of her using the device.

She also reveals her own “really serious and raw stuff” – experiences with avoidant personality disorder, imposter syndrome, ADD, OCD, tuberculosis, rheumatoid arthritis, anemia, depression, anxiety, and suicidal ideation. So be ready for a bumpy ride.

There are also sweet, sad, funny chapters about her family, and especially how they are dealing with her grandmother’s dementia and Alzheimer’s Disease. And there are chapters that are not sweet, funny, or sad, where she rails against insurance companies and their unhelpful (to say the least) ways. These chapters and passages, I am certain, nearly every reader will identify and agree with.

And, lest you think this is a complete departure from Jenny’s funny stories, rest assured that there is plenty of what Jenny herself calls her “baffling wordsmithery,” including times she lost shoes while wearing them, dog penises and condoms, attic vampires, arguments with her husband Victor, embarrassing moments shared with other people (those who inadvertently say IUD when they really mean IED, for example), roller skating monkeys, dubious beauty treatments, the perils of being an editor, the perils of cooking and cleaning, taxidermy (of course), and high school proms.

As for the title, a broken lawn ornament (not Beyoncé the chicken, thank goodness) leads Victor to explain the Japanese concept of kintsugi. According to this practice, philosophy, or art form, broken ceramic items such as vases or teacups are repaired with a fixative mixed with gold powder, which creates something new, stronger, more artistic – and beautiful at the broken places, a theme which runs throughout the book.

What sets Jenny’s books apart from other humor books and from other books on serious illness, especially serious mental illness, is her ability to connect – both readers to herself and readers to each other. Her humorous chapters are over-the-top funny and many evoke a sense of “Yes! Me too! That could/did happen to me!” Jenny even includes instances when people have shared their own stories of faux-pas with her and by extension, with all her readers.

Her serious chapters are educational, descriptive, and occasionally searing. She tackles tough topics with fortitude and forthrightness, educating as well as illuminating. Far from being a textbook on serious mental illness and chronic illnesses, though, her stories bare the truth and present the subjects powerfully. They give hope and understanding as well as connection.

Connection. That’s Jenny Lawson’s superpower.

Laughing Out Loud

There’s nothing funny about bipolar disorder. In fact, one of the ways that I know I’m having a spell of bipolar depression is that my sense of humor flies out the window. Nothing brings a smile or a laugh – not my husband’s awful jokes. Not my friend Tom’s silly songs. Not a funny movie like Arsenic and Old Lace.

I have been in a spell of depression for a little while now. As I mentioned last week, part of it may be reactive depression. But here’s the thing. Reactive depression feels the same as bipolar depression. You have the same sense of misery, loneliness, helplessness, hopelessness, anomie. But you know what caused it and that it will end pretty soon, relatively, unless you tip over into a true depressive episode, which can last a lot longer than that.

But yesterday I laughed. And that was a good thing. It didn’t pull me completely out of my depression, but it let me know that escape was possible, and maybe even starting.

It happened like this:

My husband and I were sitting on the couch, watching TV. I was not enjoying it. Then a commercial came on about “man-boosting” pills that increase testosterone. It promised everything: strength, leanness, stamina, and outstanding performance in the bedroom.

Dan turned to me and said, “Hey, honey. Maybe I should try some of that. Improve my performance in bed-woo-woo-woo!

I turned and looked him straight in the eyes. I said, in a solemn, deadpan voice, without a trace of a snicker: Woo. Woo. I never got to the third Woo because we both dissolved in giggles. And it felt good – not only that I could laugh, but that I could make him laugh. Just thinking about it made us laugh all over again.

Today I am back to feeling overwhelmed, if a little less miserable, but still functioning on some kind of level. I don’t think my depression is over with. But for just a moment, I saw a ray of hope. Yes, it was over something stupid. Yes, I delivered the line with a flat affect. No, I didn’t know it was going to be that funny. I even thought Dan might be offended that I was making fun of him. But the important thing is that we both laughed. 

What I’m saying is that laughter, by itself, is not a cure for depression, however much the memes and the positive thinkers tell you that it is. But if laughter happens to you, it at least reminds you that the depression will end sometime – maybe quicker than you think. The giggles are building blocks that will help you climb up out of your hole, or at least see that there is a way out.

That’s a lot of philosophizing about two words (or syllables, really), and I’m not sure the magic would happen again if either one of us said Woo. But I am taking the memory of that moment with me, for whatever strength it can give me and whatever amusement will stay with me when this depression ends.

How Depression Sneaks Up

I had a blog post all written and ready to go. It was about my fluctuating moods and my writing, and how they affected each other. Some of what I wrote is still true. The depression I suffered during my early years and the exceedingly depressive poetry I wrote during that time allowed me to learn something about how poetry works and something more about how depression works.

I wrote about how hypomania affects my writing, and that is still true. Hypomania pushes me to do my writing, even when I don’t feel like it. In fact, at times it pushes me into doing more writing than I can probably handle. Case in point: This week I wrote three samples for a work-for-hire outfit when I should have been writing or at least outlining my WIP (Work In Progress), a sequel to the mystery I have already written and have been sending around to agents.

And last night, that’s where I hit the wall. I figured out that I have sent out about 180 or so query letters and gotten only the most minimal results – rejections that said I had an interesting premise that was not right for them. Most, though, have received plain rejections or the dreaded “no response means no.” I am now second-guessing myself and everything about the manuscript.

Last night, the depression caved in on me. I spent the night in bed, not sleeping except for nightmares, and not wanting to get up in the morning.

Because my identity is invested in being a writer, though, I did get up (late), sent a few more queries, and got to work on rewriting my blog posts, which I had determined were wretched. In the blog post that I abandoned, I had pontificated about how keeping a schedule kept me going with all the writing projects and various other work I do. 

I had also crowed about my relative stability and how that was helping me keep that schedule, which was supposed to be keeping depression at bay. I found out that I lied. The fact that I have maintained functionality for some time did absolutely nothing to prevent the depression that hit me.

Admittedly, this is probably a reactive depression, with my lack of success being the trigger. The thing is, it’s awfully difficult to tell apart from endogenous depression. In fact, I have known the first to melt into the second. At first you have a clear cause that would depress anyone, then you find it clinging to you long after what would seem to be reasonable. (This is subjective, of course. What is the “right” length of time to be depressed over 180 rejections?)

What’s left? Self-care, of course. Trying to sleep if I can, and squeezing in a nap if possible. Eat something, even if it’s only some guacamole and chips or a bowl of soup. Take my meds religiously. Try to cling to that schedule even when I don’t want to.

But the truth is, I’m running out of agents to submit to. I’m running out of energy to try. And I’m running out of the frame of mind to keep me functional. I’ll be okay, I know, but it may be a long, hard climb. 

Mental Illness and Homelessness

By Halfpoint / Adobestock

There are a lot of assumptions made about mental illness. One is that all of the homeless population are – or at least predominantly are – mentally ill. That’s far from the truth.

Homeless people get that way for a variety of reasons. Some lose their jobs or are evicted from their housing. Some have no friends who can put them up when that happens to them, so they have time to pull themselves together and find a new job or living situation. Some live on the streets because of alcohol or drug addiction.

And yes, some people are homeless because they are mentally ill. Disorders such as depression and bipolar disorder, schizophrenia, anxiety disorders, and substance abuse disorders are frequently seen in the homeless population. According to the Harvard Medical School, “about a quarter to a third of the homeless have a serious mental illness — usually schizophrenia, bipolar disorder, or severe depression — and the proportion is growing.” 

Psychiatric Times states, “There is clearly a link between psychiatric disorders and homelessness; disentangling the nature of this relationship is complicated….Mental illness had preceded homelessness in about two-thirds of the cases. Homelessness in turn has been associated with poorer mental health outcomes and may trigger or exacerbate certain types of disorders.” 

PTSD is also a factor among homeless veterans and others with traumatic pasts. Many military veterans suffer from it as a result of their experiences in combat situations. A traumatic event such as witnessing or being victim of an attack, sexual assault, and so forth experienced during homelessness can itself cause PTSD. And homelessness itself can be the traumatic event that leads to PTSD.

The system is rigged against homeless people. With no address, phone, no reliable transportation, no place to bathe, it is hard to get and keep a job. Many times homeless people are taken advantage of when they can get day labor such as mopping a store, cleaning toilets, or sweeping a parking lot. The job “broker” for casual labor can easily demand a kickback from the homeless person in exchange for finding the person a job.

Some homeless people have been kicked out of their houses because of their alcoholism, drug addiction, or disturbances caused by mental illness – or because of “tough love” philosophies.

And let’s not forget people who have been released from jail or a mental health facility. It can be almost impossible to find a job and an affordable rental. Thanks to a broken system of both prisons and psychiatric facilities, the recently released have no place to go but the streets. When Reagan closed down and defunded “asylums,” he took away the most common way for the mentally ill to get help. Where did these people end up? Either in prison or a homeless camp.

In fact, being in jail is a luxury for some homeless people. They may commit petty crimes in order to be arrested and put where they know they will receive “three hots and a cot” for at least a couple of months. But there is little to no psychiatric care for homeless people in jails or prisons. Despite this, the prison system is clogged with mentally ill people who have no way to get better and nowhere to go when they are released.

With a few exceptions, people do not choose to be homeless. Many people look down at the homeless, sure that they know what would be best for them or clinging to the outdated notion that a homeless person can “pull themselves up by their bootstraps” and conquer both mental illness and homelessness. People who experience schizophrenia or psychosis are particularly hard to place, even in shelters.

What about those shelters? To begin with, they are overcrowded. Not everyone who needs one is able to get a place. Many are horrible, crowded places, where theft, assault, and rape occur. Many make the residents leave at 7:00 a.m., whether they have a place to go or not. Many others make residents adhere to codes of conduct little better than jail, or insist that a resident profess the preferred religion of those who run the shelter. And don’t forget bedbugs, lice, and infections linked to too many people being in an enclosed space. COVID restrictions make it even harder to find a place in a shelter. There are more shelters for women – and especially women with children – than can accommodate the women who make up 29% of the homeless

And what about the violence associated with both the homeless and the mentally ill?

Lynn Nanos, in her book Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry, makes an excellent case that schizophrenic and psychotic patients, especially those with anosognosia, are the most likely of all psychiatric patients to commit violence and be victims of violence. 

But murderous violence is not the only kind. An NCBI study reported that “mental illnesses only moderately increased the relative risk of any violence, that is, assaultive behaviors ranging from slapping or shoving someone to using a weapon in a fight.” In addition, they said, “the absolute risk was very low; the vast majority of people with diagnosable serious psychiatric disorders, unless they also had a substance use disorder, did not engage in violent behavior.”

In terms of the myths about the mentally ill homeless, much of that is related to the stigma surrounding the seriously mentally ill. When we look at the facts we find that, while mental illness may be one cause of homelessness, it’s wrong to say that all the homeless are mentally ill – just as wrong as it is to say that all of the seriously mentally ill are homeless.

It’s often said that most of the U.S. population is one paycheck, spouse, illness, job loss away from homelessness. Let’s add mental illness to that list of potential causes. As the sign in the accompanying picture says: Once I was like you. We need better programs to serve the homeless, the mentally ill, and the homeless mentally ill.

 

 

 

 

 

 

 

Are Lobotomies Gone for Good?

By alexlmx/adobestock

If I were a few decades older, I might have undergone a lobotomy. Treatment-resistant bipolar disorder (or manic depression, as it was called then) and schizophrenia are some of the disorders lobotomies were recommended for. It was thought that such mental illnesses were caused by faulty connections in the brain and that the cure was to sever those connections. Lobotomy pioneer Antonio Egas Moniz received a Nobel prize for inventing the operation.

The main problem was it didn’t always work as planned. There were other problems as well, such as the flattening of affect and severe brain damage (what a surprise). The most noted person to have a lobotomy (also called leucotomy) was Rosemary Kennedy, the developmentally delayed sister of John and Robert.

There were two kinds of lobotomies, though only the method differed. The prefrontal lobotomy involved drilling holes in the patient’s skull in order to get to the frontal lobes, where the trouble was thought to lie. The other, and to me more alarming, version was called the transorbital lobotomy. The “orbit” in transorbital refers to the eye socket. An instrument was introduced into the brain by going through the eye socket (without disturbing the eye) and used to sever the connections between the frontal lobe and the rest of the brain. Around 50,000 lobotomies were performed in the U.S., most between 1949 and 1952

Doctor Walter Freeman was the champion of the transorbital lobotomy, often called “icepick surgery” for the slender instrument that was inserted and then swooped about, in hopes of severing the faulty brain wiring. Dr. Freeman was so adept at this that he could perform many of these surgeries in a day, and indeed performed around 3,500 during his career, including 2,500 icepick lobotomies. He once performed 228 of the procedures in a two-week period and taught the technique to countless other doctors. Some of his patients underwent more than one lobotomy.

Eventually, the lobotomy came into disrepute for A) being the horrible invasion that it was, B) reducing many patients to an emotionless or brain-damaged state, and C) being depicted in Ken Kesey’s 1962 novel One Flew Over the Cuckoo’s Nest as a punitive, brutal, and unnecessary procedure. The lobotomy all but disappeared from the psychiatric and surgical landscape.

But wait! Lobotomies may be out of fashion, but psychosurgery (or “functional neurosurgery”) is still performed for treatment-resistant mental illnesses. In these operations, however, rather than randomly severing neural connections, the surgeon removes the areas of the brain thought to be the cause of the psychiatric problem. Modern versions of psychosurgery include “amygdalotomy, limbic leucotomy, and anterior capsulotomy,” none of which I know enough about to comment on. Suffice it to say that the days of drilling burr holes in patients’ skulls or taking an icepick to their brains are, as far as I can determine, gone. 

Psychosurgeries are now performed rarely, deep brain stimulation being the preferred form of treatment, especially for non-psychiatric conditions like Parkinson’s or treatment-resistant seizures. And they’re always performed under anesthesia. The patient’s consent is required.

Electroshock therapy is much less invasive and is still used today, although in a lower-key and safer manner than the original procedure – under sedation and with lower amounts of electricity. It still has side effects, such as the loss of short-term memory for the period surrounding the treatment.

Electroshock therapy was considered in my case because of my long-term, treatment-resistant case of bipolar 2, which involved years-long depressive episodes. At first I was terrified, but after doing some research and talking to knowledgeable people, I was just about ready to agree to it. At that point my psychiatrist suggested we try one more drug first – which worked, alleviating (though not curing) my condition like turning on a switch.

(Side note: When I began researching lobotomies, I found that the book My Lobotomy, by Howard Dully, was particularly interesting. The story didn’t follow the usual pattern. Instead, it seems, Dully’s hospitalization and operation (in 1960, when the boy was 12) were largely instigated by his stepmother, who wanted him out of the way, though schizophrenia was diagnosed by Dr. Freeman (see above) before the transorbital procedure.)

 

 

Time Flies When You’re Bipolar

Finding stability is difficult when you have bipolar disorder. The days seem to melt into one another, either life in dense fog or life on a tightrope. You can’t remember whether you’ve eaten that day or showered that week or when you need to pay that phone bill.

And forget those lists of self-care things you should do. Contemplating even one (“go for a walk outside”) leaves me feeling defeated. It involves too many steps – getting out of bed, finding clothes, getting dressed, and then the actual walking. Most of the self-care lists contain things that are next to impossible for a truly depressed person to do (wash one dish), or too mundane to engage a manic person’s psyche (nap, complete one craft project).

For myself, I get lost in the week, since I usually measure time by weeks. What was I going to do on Thursday? Isn’t there a call I need to make this week? Do I need more groceries this week? I can also get lost in the month sometimes – Is it time to water my plant? Do a breast self-check? Pay a bill? Most of these I can handle with small nudges. Water the plant on the first day of the month. Pay a bill when I get an email or call about it.

When I worked in an office or a restaurant, there were ways to measure days. Casual Fridays were a dead give-away, for instance. But there were no weekly group meetings or, in the case of the restaurant, even specific chores or a consistent schedule for each week. I used to be able to pinpoint Thursdays because it was chicken-n-dumplings day at the Hasty Tasty.

But since COVID I no longer go out to work or to the Hasty Tasty or get dressed for work (I work in pajamas at my desk). I can sometimes tell time by my husband’s days off – Thursday and Sunday – but even that gets confusing, since I measure by when he goes into work (Wednesday, for example, and Saturday evenings) and he counts by when he gets off (Friday and Monday mornings). “Thursday into Friday” or “Sunday into Monday” is too much for my poor glitchy brain to handle.

I have better luck when I measure by my own work. I have off Thursdays and the weekend. Sometimes there is no work on a particular day, and sometimes I take on extra work on Thursdays or over the weekend, so it’s not completely reliable.

I do try to stick to a schedule when it comes to my writing, though. By Tuesday, I try to have an idea for my blogs. Wednesday I firm it up or do research, if needed. Thursday, I write a draft, since I don’t have my regular job to do. Fridays I tweak the draft. Saturdays I proofread and add tags. Sundays I publish. Mondays I check to see how well my blogs have done. Since my novel is finished, I have added doing three queries a day, first thing in the morning. And when I don’t have regular work, I try to either do research for my next novel, or write scenes that I know have to go in it somewhere, though not in order, since I don’t have an outline firmed up.

I suppose self-care encompasses going to bed. I usually get in bed by 9:00 or 10:00 and read to unwind (I know that this is not recommended, but it’s an essential part of my daily cool-down, whatever the day of the week it is). After I start to get sleepy, I take my nighttime pills and read a little more until they kick in. I usually just awake naturally, unless I have a work assignment that’s due early in the morning. Then I set an alarm.

These are the techniques I use to keep grounded in my days and weeks. When something unexpected happens, such as my husband’s days off being switched, I get back into the trap of not really knowing what day it is.

But as for self-care, I don’t schedule a massage or take up yoga or call a friend (I keep in touch on social media). It’s all I can do to get through a week at a time and be grateful for that.

 

All Mixed Up

Leigh-Prather/Adobestock.com

As I mentioned a few posts ago, my psychiatrist and I are working on a medication change that will, I hope, pull me out of bipolar depression. The medication that we changed was a mood-leveler, which sounds like a productive way to start.

We’re increasing the dose, which means it shouldn’t take the time it would for the old drug to “wash out” of my bloodstream (and/or brain) while we’re waiting for the new one to kick in. I’ve been that route before, and it’s miserable.

While I haven’t noticed my moods becoming exactly stable since the change, I have noticed certain effects. I am able to get through the minimum of what I need to do each day, though nothing more. And I have noticed that I am getting irritable. This does not happen so much when I’m depressed. When I’m depressed, I don’t care enough about anything to be irritable.

In fact, irritability is one of the ways that hypomania manifests for me, before I get to the euphoria/super-productive/reckless spending stage. I get snappy with my husband about all his annoying habits, like never giving me a straight answer to a simple question. (What are you watching? A movie. What did you get at the store? Food.) I think he thinks he’s being funny, but I find it frustrating. Not that I don’t have annoying habits too, especially when I’ve either depressed or irritable.

So, I guess in one way, the irritability is a good sign. It doesn’t mean I have level moods yet, but it seems to mean that I’m not totally stuck in the depression. (I explained to my husband what was happening with me, and he seems to understand more. Though it remains to be seen if he’ll answer simple questions informatively.)

I think what I’m experiencing is a phenomenon know as mixed states. If to be depressed is to care about nothing and mania is to care about everything, a mixed state is some hellish combination of the two. Imagine being immobilized and jumpy all at the same time. That’s what it’s like, paradox that it is.

I haven’t had mixed states too often in my life, though I have had emotions that swerve drastically from happy to depressed in an instant (which is an extreme version, I think, of what’s known as ultra-rapid cycling). This is something different, though.

Now, I use up all my spoons early in the day and nap, or I stay up but go to bed at around 8:00. Ordinarily, if I went to bed that early, I’d read for a couple of hours, but these days half an hour or 45 minutes is it, tops.

Still, I think (or hope) that this mixed state of affairs is a step along the way to level moods that are higher than the numbness and not-caring of depression. It’s not comfortable to go through, but then neither is depression or mania, even hypomania.

It’s been about six weeks since the change in my medication. Within another four to six weeks, it will likely become apparent whether the change, once set in motion, will have an outcome I can live with. Until then, I need to spend my spoons as wisely as I can and try to remember not to snap at my husband, even when he’s being annoying.

Distance Psychotherapy: Is It for You?

By Alice / adobestock.com

I will make a confession: I have never used distance therapy, except for when I couldn’t drive to my therapist’s office, my husband wasn’t available to drive me there, or when I had the last-minute I-just-can’t-go-today feelings or I’m having-a-crisis feelings. This was in the days before teleconferencing, texting, and other long-distance forms of therapy, so occasionally my therapist would agree to do a telephone session, which I appreciated greatly. In general, they didn’t last as long as the standard psychotherapy 50-minute hour, but at times they were lifesavers.

Now, when everything seems to be online, and especially during pandemic lockdown, quarantine, or simply fears of going outside, tele-psychotherapy seems to be becoming a thing. Many services are now available via the internet, smartphones, and whatever way you pursue your online life.

I’ve been looking at these services, not because I need one now, but because I want to know what’s available in case I ever should. The APA (American Psychological Association) provides a lot of helpful information on the subject. Their site has provided a list of pluses and minuses regarding telehealth for psychology. They note: “With the current research and with the current technology, mobile apps and text messaging are best used as complementary to in-person psychotherapy…Research does show that some technological tools can help when used in conjunction with in-office therapy,” though “There are cases in which Web-conferencing or therapy via telephone does seem to be a viable option on its own for some people.”

Inc.com provides a helpful list of the pros and cons of online therapy. Some positive aspects are that:

  • People in rural areas or those with transportation difficulties may have easier access.
  • Most online therapy services cost less than face-to-face treatment.
  • Scheduling is more convenient for many people.
  • Individuals with anxiety, especially social anxiety, are more likely to reach out to an online therapist.

among the negatives are:

  • Without being able to interact face-to-face, therapists miss out on body language and other cues that can help them arrive at an appropriate diagnosis.
  • Technological issues can become a barrier. Dropped calls, frozen videos, and trouble accessing chats aren’t conducive to treatment.
  • Some people who advertise themselves as online therapists might not be licensed mental health treatment providers.

Despite the concerns, research consistently shows that online treatment can be very effective for many mental health issues. Here are the results of a few studies:

  • 2014 study published in the Journal of Affective Disorders found that online treatment was just as effective as face-to-face treatment for depression.
  • 2018 study published in the Journal of Psychological Disorders found that online cognitive behavioral therapy is, “effective, acceptable and practical health care.” The study found the online cognitive behavioral therapy was equally as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder.
  • 2014 study published in Behaviour Research and Therapy found that online cognitive behavioral therapy was effective in treating anxiety disorders. Treatment was cost-effective and the positive improvements were sustained at the one-year follow-up.
  • A recent review of studies published in the journal World Psychiatry compared people who received CBT treatment online with those who received it in person.  The two settings were shown to be equally effective.

One possible pitfall, warns APA, is that “online therapy or web therapy services are often not covered or reimbursable by most insurance providers. If you plan to be reimbursed, check with your insurance company first. Otherwise, prepare to pay for the full cost yourself.” The services I explored charge about $35 to $80 per week for unlimited messaging and one live session per week. MDLive provides a psychiatrist at $284 for the first visit and $108 afterward. (They have lower rates for seeing a therapist rather than a psychiatrist, and do accept insurance.)

Business Insider, in its article on the subject, dealt specifically with a service infelicitously known as Woebot. Unlike the other services, Woebot is a “chatbot” that substitutes artificial intelligence and natural language processing for a real, live therapist. It uses cognitive behavioral therapy. Their website claims that Woebot “is the delivery mechanism for a suite of clinically-validated therapy programs that address many of today’s mental health challenges, from generalized anxiety and depression to specific conditions like postpartum depression, adult and adolescent depression, and substance abuse.” Like a non-directive therapist, it asks probing questions and responds to questions and answers from the user. For now, it is free to users, though they seem to be exploring a paying model.

Other telehealth counseling services include:

Amwell

Betterhelp

Brightside (depression and anxiety, not bipolar or mania)

Online-Therapy.com

ReGain (couples therapy)

Talkspace

teencounseling (will consult with parents)

If you decide to try online therapy, it’s best to compare services and determine what services they offer, at what price, and what the credentials of their therapists are. If you have already tried it, I would be glad to know the results. Feel free to comment.

 

 

The Journey to Proper Meds

By areeya_ann / adobestock.com

This week when I went to my four-times-a-year med check, I told my psychiatrist that I thought I needed a change in medication. The previous time I saw him I had expressed concerns over assorted Life Stuff that was making me extremely anxious. Given what was going on in my life at the time, the anxiety was understandable.

Since then my anxiety has lessened somewhat, now coming out mostly as irritability and difficulty sleeping. And my depression now makes me feel like I have a low-grade fever – logy, listless, exhausted (which is not helped by the sleep problems) – plus the usual depressive numbness, lack of holiday cheer, and all the rest.

My psychiatrist listened to my symptoms, then discussed my meds with me. There were only two, both mood levelers, that he would recommend increasing. I chose the one that had had the most dramatic effect on me when I started taking it. So he increased the dosage from 200 mg. to 300 mg. We’ll see how that works out. I’m to call him before my next med check if I need to.

I’m used to changes in medications. It took a long, trying – even painful – time for my previous psychiatrist and me to work out the cocktail of drugs that would alleviate my seemingly treatment-resistant bipolar disorder. We tried various antidepressants, anti-anxiety agents, anti-seizure meds, antipsychotics, mood levelers, and I-don’t-remember-what-else. At last, when we were about to give up and try ECT, one of the drugs worked. It took some more tinkering before we got the dosages right, but for years now, I’ve been on basically the same “cocktail” of drugs.

Psychiatric Times, in an article on switching antidepressant medications (most of the literature seems to focus on antidepressants), reports that approximately half of all patients fail to achieve an adequate response from their first antidepressant medication trial. High treatment failure rates make it critical for prescribers to know how to safely and effectively switch antidepressants to ensure patient-treatment targets are met.” Other publications put the figure at nine percent, one-third or two-thirds. Whichever is correct, it’s a substantial number.

One method of switching medication is simply called “the switch.” The patient goes off one drug and onto the other. But there are problems with that, including drug interactions between the old medication and the new one.

The technique most recommended is the one that my previous psychiatrist used with me, which is known as “cross-tapering” – tapering down on the first drug and then ramping up on the second. A “wash-out period” when no drug is given allows time for the first med to clear the body before the second is given. This is promoted as the safest method.

I can testify that it is also the slowest and most miserable. Going off one drug, being basically unmedicated while you wait for the second drug to ramp up, and then possibly going through the whole process again when the second drug doesn’t work either (or has side effects you can’t tolerate) is brutal. I went through the process more than once, and it was hell. Basically, it took me back to full-strength depression during the wash-out period and minimal to no effect as the new drug being tried ramped up.

However, eventually, we found a drug that made a huge difference and that, in conjunction with my other medications, allowed me to function almost normally. Close enough for jazz, as they say. The recent adjustment in dosage does not appear to be having much of an effect yet, but I didn’t expect it to. Pretty soon, relatively, I’ll know. And if it doesn’t help – or if it induces side effects – I still have my psychiatrist’s phone number.

References

https://www.psychiatrictimes.com/view/strategies-and-solutions-switching-antidepressant-medications 

https://www.uptodate.com/contents/switching-antidepressant-medications-in-adults

https://www.healthline.com/health/mdd/switching-antidepressants

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