Bipolar 2 From Inside and Out

Posts tagged ‘psychotropic drugs’

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.

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

A Letter From the Future to Bipolar Me

by sosiukin via adobestock.com

Dear Me:

You’re 13 years old now, and there are a few things you should know.

You have bipolar disorder. No one knows this, not even you. But a lot of people notice that you act “weird” at times. You have decided to embrace your weirdness, which is fine, but what you really need is psychological help. And medication.

Don’t pass up any chance to get that help. Your high school will recommend to your parents that you get counseling. When your parents leave the choice up to you, take it. It will not go on your permanent record, and you will still get into a college. A very good college, in fact.

I know that at times you sit alone and cry. Other times you laugh at things no one else finds funny. This is not just “weirdness.” This is a mood disorder, called bipolar disorder, type 2. Your mood swings will make it difficult for you to make and keep friends. Keep trying. The friends you will find are worth it and will stand by you when you really need them. You will not be alone in dealing with this.

Your choice to go to college out of state will be a good one. There you will have a variety of experiences that will make you grow in unexpected ways. Your mood disorder will go to college with you, though. Leaving Ohio will not mean you will leave bipolar disorder behind. You will still feel the mood swings, and most of them will be depression.

It’s a good idea to take that year off between freshman and sophomore year. I know it will feel scary, but at that point you will be in no shape to carry on with academics. Instead, you will get a job which, while not great, will introduce you to more new people and new ways of life. At least one of those people will stick with you till you are old and gray.

Returning to school will be a good decision. Your parents will support you in that decision. They won’t object to your year off, because they know you will go back. It still won’t be easy, but you will have a core group of friends that accept you, even though you are different from them.

Your bipolar disorder will follow you back to college. It will make you miss some opportunities and choose others that will not be good for your mental health. You will be unhappy most of the time, but you will find that music helps you through it.

Try not to self-harm. I know you will feel numb and want to feel something else, but cutting yourself is a bad decision and will not help. You will carry those scars forever.

When you meet Rex, though, you will be encountering a problem too big for you to handle, and the relationship will leave you scarred as well. It would be best if you were to steer clear of him altogether. But then again, you will find some true friends in his circle, and it would be a shame to miss them. Try your best to hold yourself together, remember what I said about self-harm, and don’t give up on who you are. You are not your disorder, and you will get through this, despite everything.

I know you never gave a thought to marrying, but you will meet a man and in a few years you will marry him. This, I assure you, is a good decision. He will stick by you no matter what and help you find help.

Going into the building that says “South Community Mental Health” will be a good decision. Whatever you will be feeling at this point – most likely misery – it’s not mentally healthy. This will be the place where you will start to climb out of the hole you have found yourself in.

At last, a doctor will tell you that you have bipolar disorder – most often depression, but also anxiety. He will work with you to find a combination of medications that will help you. When that happens, you will become reacquainted with your brain and relearn how to function in the world at large. Your brain will function in a new way, one with fewer out-of-control feelings. You will experience life more fully and be glad of your new outlook.

It won’t be quick, and it won’t be easy, but you will have therapists, and friends, and work, and love, all of which will help see you through. You will have bipolar disorder all your life, but it will not be your life, though it seems that way now.

Reach out for help whenever and wherever you find it. Cherish your friends. Keep trying, even when you want to give up. Better times are on the way.

I promise.

Love, me (older and maybe wiser)

Bipolar Conversation

This morning a podcast called Bi-Polar Girl was uploaded, and I was the interviewee. (You can find it on Apple, Amazon, and other podcast sources.) Here’s a look at what was like.

  • Prepping. Before we recorded the podcast, my anxiety kicked in, and I tried to overprepare. I bombarded the hosts with emails asking what I should be prepared to talk about or what questions they were going to ask me. Basically, they told me we were going to “wing it” and have me tell my story.
  • History. The thing we talked about most was when I started showing signs of bipolar and when I was diagnosed. I explained that I was showing signs of it as early as my high school years, how I decided to seek treatment after college, and how I was mistakenly diagnosed with major depression for years before receiving the proper diagnosis and medication.
  • Meds. We discussed medication in some detail – pill-shaming, how every person reacts to meds differently (so it’s useless to “recommend” a particular drug to friends or support group members). We talked about the side effects of various medications, including the fact that the most-feared one seems to be weight gain. One particular point of discussion was how many people are afraid that taking medications to treat their disorder will stunt their creativity or turn them into “zombies.” Snowflake (one of the hosts) and I agreed that our creativity and ability to work were actually improved while on medication, because it enabled us to focus and do more creative work.
  • Family. We also talked about the fact that I have no children and my reasons for that. (We also introduced some of our pets during the Zoom call, or they introduced themselves. Just try to keep an animal out of a Zoom call.) I shared that I felt it would be unfair to a child to have a nonfunctional mother, that I was afraid of going off antidepressants while pregnant, and postpartum depression afterward. Snowflake shared her story of medications, potential side effects, pregnancy, and postpartum depression.
  • My publications. I talked about my blog and my books, Bipolar Me and Bipolar Us. In particular, we discussed gaslighting, which features in my second book, and how people with bipolar are more susceptible to it. Both Snowflake and I shared how we had encountered gaslighters in our own lives.
  • Groups. Chacoman, the other host, questioned me about whether I was involved in any local or regional support groups, and I had to admit that I’m not. Now, during the pandemic, group meetings are problematic at best, but I don’t react well to groups at any time, due to my anxiety (which is how my hypomania manifests). In my case, outreach is limited to my blogs and books, and membership in online support groups.
  • Miscellaneous. We got off topic a number of times. I don’t want to make it sound like the interview was all serious or grim. We also talked about our pets, positive relationships, college memories, and even politics.
  • Plans. I talked about how my next book will be a mystery, with a bipolar main character, and received positive feedback on the idea.

All in all, it was a good experience, worth overcoming my anxiety for. I had only participated in a podcast once before, a not-altogether-successful interview about my first book with an interviewer who had obviously not read it and was more interested in whether any of my family members were also creative. (It was supposed to be a podcast about first-time authors.)

This was not the same sort of thing at all. I told my story, as the hosts had recommended, and we had a genuine, far-ranging conversation about not just my own experiences with bipolar disorder, but with how others cope with it as well. Actually, I learned a lot about myself, from how much my anxiety – and especially social anxiety – still affect me, to how much my teen years illustrated my journey into depression.

So, here’s a big thank you to Snowflake and Chacoman for the opportunity to share with them and their audience. I would absolutely do it again. It helped me step out of my comfort zone and, I hope, will help the listeners as well. It’s a form of outreach that I had never considered, but one that I found valuable – and just plain fun!

 

 

Mental Health Privilege

Vectorarte / Adobestock.com

These days we hear a lot about privilege – class privilege, white privilege, first-world privilege, male privilege, and, I’m sure, many more. The idea is that people who have privilege don’t have problems that other people deal with every day and. In fact, they don’t usually realize that they have this privilege and benefit from it.

I know that I am privileged in many ways. I am white and heterosexual. I have a house, a husband, and work I can do. I have an Ivy League education and grew up in the suburbs, the child of loving parents who never divorced.

But what I don’t have is mental health privilege. I have bipolar disorder.

When a person has mental health privilege, they don’t have to take multiple medications just to keep their brain functioning in something like a normal manner. You won’t get pill-shamed for the meds you take or have random people suggest your problems will all be solved with prayer, yoga, apple cider vinegar, or acupuncture.

(I do recognize that there are many people who take meds for a variety of disorders, including life-threatening ones. I don’t mean to discount their struggles. Physical health privilege and ableist privilege also exist.)

When you have mental health privilege, you don’t have to question whether or when you should inform a boss, a potential employer, or a friend or romantic partner that you have a mental disorder. You don’t have to fear that that one fact will make it more unlikely that you can achieve a stable work situation (or any work situation) or a stable relationship.

When you have mental health privilege, you don’t have to try to find a therapist who specializes in your problem and can actually help you. You don’t have to repeat your whole psychiatric history every time your therapist gets another job, causing you to start all over with a new therapist. You also don’t have to ask your primary care physician, who may or may not know much about psychotropic meds, to prescribe for you until you find a psychiatrist or when one isn’t even available to you.

When you have mental health privilege, you don’t worry that people will avoid you because you act “peculiar,” miss appointments and dates, or can’t handle crowds or even family gatherings. 

When you have mental health privilege, you don’t have to fear that you may have to stay for a while in a mental ward or have treatments like ECT.

When you have mental health privilege, you won’t get shot by a police officer just because you have a meltdown or a really bad day or a psychotic break.

Of course, the privileges I do have protect me some. Realistically, there is less chance that I will be killed by a police officer than would a person of color. In fact, my race and income make it easier for me to access mental health care.

The Journal of Psychosocial Nursing and Mental Health Services, in its July 3, 2017 editorial, makes clear that mental health privilege affects not only people who have mental disorders, but also the people who care for them.  The piece, written by Mona Shattell, PhD, RN, FAAN and Paula J. Brown, MBA, points out, “More than 70% of all health care providers in the United States are White (U.S. Census Bureau, 2017), and many, if not most, have unconscious (or conscious) biases (Institute of Medicine, 2003).” Their level of privilege may interfere with their treatment of their clients. The authors of the editorial encourage those with privilege to use it to help others.

Racial privilege is particularly problematic when considering mental health providers and their clients. NAMI Illinois “reported studies found that ‘black professionals make up only 2.6% of mental health clinicians in the United States, which is low considering that approximately 20% of black Americans seek mental health specialty treatment within a 12-month period.'” “While access to culturally diverse providers is low, the cost of mental health treatment remains high,” they add, “which serves as an additional impediment to bridging the gap between the onset of symptoms and accessing professional care.”

Education about mental health privilege may or may not help. Many people pooh-pooh the idea of any kind of privilege and bridle at the idea that they themselves have privilege by virtue of their health, sex, economic status, or other attributes. Some people’s eyes can be opened. (My husband didn’t recognize male privilege until I pointed out that no one suggested he change his name when we married or that we were “shacked up” because he didn’t.)

It’s understandable in a way.  People have a hard time envisioning that they themselves might ever be mentally ill or poor or homeless or denied work or discriminated against in any number of ways.

But with mental health privilege, it’s even more difficult to get people to understand. Until a close friend or family member faces mental or emotional difficulties – suffers from PTSD, experiences major depression, develops schizophrenia – people will not usually have the opportunity to realize the mental health privilege they have. And they may not even then.

As with any kind of privilege or stigma, if there is to be any improvement, people need to be educated. It’s not easy to open their eyes. But doing so can make a difference in the lives of people who do not share that privilege.

My Hypothetical Baby

By pololia / adobestock.com

Having bipolar disorder was one of the reasons I decided not to have children. Really, it was having major depression, which was what I was diagnosed with at the time.

I wasn’t so much concerned with passing my condition on to any potential offspring, since, at the time when I was contemplating motherhood, the genetic links were not yet that firmly established. Now that I know more about it, I think that might have been another deterrent. My parents had no idea what to do with me when bipolar symptoms started happening, and there’s no guarantee that I would have done any better. I’d like to think I would, but there’s no telling, really.

No, what I feared was having to go off my medication while pregnant (and breastfeeding, should it come to that). I was terrified of being unmedicated and I knew that psychotropic drugs were not good for pregnant women or their developing babies. Once I had discovered the benefits of Prozac and other mood-regulating meds, I knew I never wanted to be without them again. I never wanted to again fall into the pit that I had clawed my way out of. (In truth, that pit was waiting for me anyway, when I experienced a major depressive episode many years later.) 

Postpartum depression scared me too. I had heard the horror stories of women killing their children and/or themselves while suffering from the illness. I knew how out of control I could get with just plain ol’ garden-variety depression and anxiety. Adding postpartum hormones to the mix could be a really bad thing.

But the main reason that I decided my bipolar disorder made it unwise to have a child was that it would be unfair to the child. How to explain to a toddler that mama couldn’t get out of bed today or that she burst into tears for no apparent reason? How to explain weeks or months like that? How to deal with a child jazzed up on mama’s sudden hypomanic jag, who would then be let down when she crashed? How to soothe a child’s anxieties when mine were making me jump out of my skin? How to take care of a child’s essential needs, when I suck at taking care of my own?

Is that selfish? I know there are people who would say it is. That when the time came, I would suck it up and do the best I could. And I might. But would that “best I could” be good enough? I’ve heard it phrased that I was too involved with giving birth to myself – a relatively stable, reasonably happy, mostly functioning self – to give birth to someone else. And I think there’s some truth in that. It’s been a struggle, filled with despair, misery, hard work, setbacks, immobilization, dangerous thoughts, and living too much in my own head. To do the work of bringing myself to some baseline of functioning while trying to nurture and bring up another person daunts me.

I do understand that there are women with bipolar disorder and even postpartum depression who have children and that those children can be happy, healthy, and as well-adjusted as any modern child ever is. I don’t know how they do it, though. I was fortunate that I had a choice of whether or not to have children. I know that not all women do, and that many are delighted with their choice – whichever way they decide. I know that there are those who desperately want children and are unable to have them. I was fortunate that my husband didn’t push the issue, despite the fact that he would have welcomed a child.

I also had irrational thoughts about that potential child. I imagined that if the child were a boy (which run in my husband’s family), Dan (whose inner child is, shall we say, close to the surface) and the little boy would be natural allies and I the odd one out. He would be the fun dad and I the not-fun mama. And while that’s somewhat irrational, it also might be partly true. It took a long time for me to learn how to relax and have fun and share it with another person.

The one time I was open to having a child was when my father was dying a slow death. I thought that if he was going to see his grandchild, I’d better produce one promptly. Fortunately, it didn’t happen. I later realized that that was a really poor reason to bring a new life into the world.

What I’m saying is that the decision is not – was not – an easy one. Having a mental disorder makes it even more difficult.

 

Caution: Wide Mood Swings

imageBroker – stock.adobe.com

Mood swings are universal. Everybody has them at one time or another.

Bipolar disorder is not just mood swings. Not everyone has moods that can last for months or years at a time or moods that are so extreme that they interfere with one’s daily life. The depths of despair and the rocketing highs are not what most people experience – and they should be glad they don’t. Bipolar disorder is a serious mental illness (SMI). It can be more or less severe, and it can be well or poorly controlled with medication and therapy, but the reality is that bipolar is a mood disorder, an illness, and a curse. 

Of course, the mood swings of bipolar disorder don’t always last for months or years. Sometimes you go spinning out of control every few weeks. This is called “rapid cycling.”

But even rapid cycling doesn’t describe the lightning-quick mood changes that can happen within a day or two. That’s called “ultra-rapid cycling,” and it’s like being whip-sawed by your brain. Those valleys and peaks come so closely together that you don’t even have time to catch your breath between them.

I think that the official criteria miss the mark on this. Many of them define rapid cycling as experiencing four mood swings within a year. Ultra-rapid cycling seems not to have a specific definition, but I and a lot of other people with bipolar disorder experience moods that swing not over the course of months, but over the course of weeks, or even days.

Ultra-rapid cycling blurs the lines into mixed episodes. Those are occasions when high and low moods occur at the same time. For many bipolar sufferers, this means simultaneous exaltation and despair, which is a terrible combination and a bitch to experience. For me, a person with bipolar type 2 whose hypomania expresses most of the time as anxiety, a mixed episode is a frightening blur of defeat and nervousness, a simultaneous feeling that the worst has already come and that it is about to descend to even lower levels. It’s like ricocheting off the insides of your own skull.

What to do at a time like this is a puzzle. Do I try the things that soothe me when anxiety strikes? Do I try self-care for depressed moods? Do the two strategies cancel each other out, leaving me swinging helplessly? Do I try to suppress both moods, knowing that the consequent numbness will make it all the more difficult for me to feel “normal” moods again? Once those walls are built, they are hard to tear down.

Ultra-rapid cycling and mixed episodes may be handy jargon to describe mood swings that don’t fit the common mode of bipolar disorder.  But they’re hell to live through. And since mood levelers, antidepressants, and anti-anxiety meds generally take a while to build up in the bloodstream enough to have an effect, there is little in the way of pharmaceutical help. An anti-anxiety pill may relieve the jitters and racing thoughts, but may also leave you more susceptible to the inevitable lows.

I don’t know if there’s much research going on regarding rapid cycling and mixed episodes. It seems like they’ve barely been named, much less defined or studied. And it’s true that there is a lot about plain old garden-variety bipolar disorder that remains to be understood and treated.

But for those of us who don’t fit the mold of months-long or years-long mood states, rapid cycling can be an uncomfortable way of life. When I was undiagnosed and unmedicated, I experienced those long, interminable lows. They did last months, years, until the depths of hell were all that I could see. The jags of ambition seldom visited me, but the creeping, lingering anxiety could easily take over. Now that I’m no longer subject to those excruciating extremes, I still am subject to the quick-change, rapid-fire series of moods. My mood levelers do work, in the sense that they reduce the peaks and valleys, but they never seem to put me on a totally even keel.

Perhaps that’s too much to expect. I’ll have to admit that I prefer a life of rapid- or ultra-rapid-cycling bipolar to the monotonous despair of long depressive cycles. At least now I have a firm conviction that the moods will end, or at least shift, to something more tolerable, and that that will happen sooner rather than later.

Given the choice between the lingering depths and the more rapid changes, I’ll take the one that doesn’t leave me in misery for years at a time.

 

The Worst Side Effect of Psychotropic Drugs

I’ll admit that I’ve had a lot of side effects from the various psych meds I’ve taken over the years, and some of them were bad enough to make me ask for something different. There’s been insomnia, sleeping too much, twitchiness, vivid nightmares, and others. But as far as I can see, there are only two side effects that would make me completely quit taking a prescribed medication, even before I could ask my doctor about it.

The first is Stevens-Johnson Syndrome. It’s what they mean when they say on TV commercials, “a fatal rash may occur” (I didn’t even know rashes could be fatal). Indeed, your skin starts to come off. I think it’s always a bad sign when your insides suddenly become your outsides, like in that Simpsons episode where everyone turned inside out. Among the medications that can cause SJS are anticonvulsants, antipsychotics, and other psychotropic drugs, at least two of which I take daily. When he prescribed them, my psychiatrist told me to stop taking the meds instantly if I got a rash around my mouth and nose, and go to the emergency room. It’s that serious.

Apparently, the anti-smoking drug Chantix and maybe some others can also cause SJS, which I guessed from the “fatal rash” warnings on the commercials and later confirmed. I idly wonder if the rate of Stevens-Johnson has increased now that more of these drugs are being used.

The other side effect that I truly fear is tardive dyskinesia. Tardive dyskinesia means involuntary, repeated muscle movements, which can affect the face (tics, twitches, grimaces) and other parts of the body (legs, arms, torso, and fingers). Think John Nash in A Beautiful Mind. These movements appear after taking medications such as antipsychotics. Worst of all, the movements may become permanent and a number of people are disabled because of them. There are now medications that treat tardive dyskinesia, but I still wouldn’t want to have it.

Yet, what is the most feared, the most despised side effect of psychotropic medications?

Weight gain.

I see countless comments in online support groups asking about weight gain on particular medications and posts that say such-and-such a drug caused weight gain. A number of people post that they will not take these medications, or will stop taking them, because they can cause weight gain.

Admittedly, weight gain is not often a good thing. It can certainly lead to other health problems. But my point is that many people are more concerned about their appearance than their mental health. 

I’ve struggled with my weight too over the years, and I have written about it (https://wp.me/p4e9Hv-7o). But I’ve struggled more with my mental health, which could kill me just as surely as obesity.

There is vast stigma in our society surrounding fat people. That’s undeniable. Fat people are stereotyped as lazy, sloppy, unattractive, unhealthy, and more. Despite recent body-positivity messages and a few clothing commercials that now feature more plus-size women (I haven’t seen plus-size men), this stigma continues virtually unabated.

Of course, there is stigma around mental illness, too. Those with mental disorders are stereotyped as out of control, violent, dangerous, suicidal, and a burden on society. I can see that people are reluctant to add the two stigmas together.

But honestly, is weight gain so very bad compared with the chance to alleviate the misery and suffering that accompany serious mental illness (SMI)? Personally, I prefer to weigh more and not live my life in despair and hopelessness.

Some of the medications I’m on can cause weight gain. Some of them can cause Stevens-Johnson Syndrome or tardive dyskinesia. Fortunately, weight gain is the only side effect I’ve had, and I can live with that. Stevens-Johnson is potentially deadly and tardive dyskinesia is potentially permanent. There are things I can do about my weight if it really concerns me, or I can chalk it up to a side effect of being content, stable, and productive.

Frankly, of the possible side effects, I fear weight gain the least.

Do It for Yourself

The commercials advise you to do it for them. The family. The children. The laughing, smiling friends who have great social lives and adventurous spirits. You want to join them, don’t you? You have only to take these drugs to alleviate your depression, keep your bipolar disorder at bay, tamp down your manic highs.

Do it for the ones you love, and the ones who love you.

Well, that’s all well and wonderful, but what about you? Maybe you have a family that doesn’t understand mental illness. Maybe you don’t have a loving bunch of children and a husband or wife ready to embrace you if only you’d get cured and be able to do the laundry. Maybe you’re alone with your disorder and your own self.

Do you still have a reason to seek treatment and get relief from your disorder and your symptoms?

Of course you do! Whether or not you have that picture-book family waiting for you to shape up and smile, you are worthy of a better life, one free from the seemingly non-ending drag or jags of mental illness.

It’s just that our society says that one person’s not enough. We must live for others. We must thrive to spread pleasure to and with them. Only in a family, only when we fit in, only when we are properly medicated or counseled, are we whole.

I’m here to call B.S. on that. Many of us live our lives alone, without family who understand us and friends who support us. If you have those resources, great! No one is saying that you would be better off without them. But many of the mentally ill have to make do with no such support system, no back-up for when our brains go wonky, no squad to cheerlead when, at last, things go right.

And I say that’s okay. You are enough. You deserve to have mental health and stability whether or not you are part of a couple or have children. Your family may be estranged from you. You are still worthy of healing and stability. You deserve it because you, by yourself, are a human being who needs that.

Society calls us to sacrifice for our spouses, parents, and children. We are to think of ourselves last, give our all to the ones we love. They deserve our support, attention, and caring. Mothers especially are exhorted to give all for their offspring. But is our mental health truly something that we should sacrifice in the name of others?

Should we not go to counseling because our schedules are full with family activities? Should we not pay for our medication because there are other household bills? Should we not take those medications because they might affect our moods and thoughts?

We are all worth it. We all deserve mental health – the poor, the lonely, the abandoned, the difficult, the single, the friendless. We have value whether or not we are connected to the vision of society we see on our televisions and especially on commercials for psychotropic medications.

I say, do it for yourself. Seek treatment if you need it. You are enough, just the way you are. Don’t let social programming convince you that you are lesser, unworthy, just because you don’t fit into the roles that are deemed suitable for everyone.

If you need help with your mental health, seek solutions. Don’t worry that others have needs. Your need is just as valid. If you need help, go out and find it.

You are enough. Do it for yourself.

In Remission

My bipolar disorder is in remission. I know I’m not cured. There is currently no cure for bipolar. But I’ve reached a point where I’m stable enough that I don’t expect a crash or a buzz to descend on me at just any old time.

I still get moods, of course. They’re just not severe or long-lasting enough to be symptomatic. Yesterday, for example, I spent several hours wrestling with phone trees and people who wouldn’t switch me to a supervisor when all I was trying to do was straighten out a couple of bills that contained errors. Afterwards, I felt frustrated, cranky, and a bit sad. But those were normal emotions, based on what I had just gone through. After a nap I felt better, and dinner blew out the remaining cobwebs. Napping is definitely better than staying in bed the entire next day.

Of course, I didn’t achieve remission alone. It took years of doctor visits, therapy, and medications to reach this state. I am particularly grateful for mood levelers. For me, they actually do what they’re intended to do. They keep my moods within an acceptable range, or at least one that’s acceptable to me.

Too many people fear mood levelers, I think. Level moods sound boring – as though there are no variations, just a blank, straight line. That simply isn’t so. Mood levelers have pushed the spikes that used to go wild in either direction to a less extreme range. If you think of mood as an EEG, mood levelers prevent the lines from going off the charts, settling them to fluctuate within a middle range that most non-bipolar people have naturally.

I think the term “mood leveler” scares some people. They seem to think that such a drug would make them perfectly level, robotic, unchanging. They fear that any spark of personality or creativity would be lost.

That’s not the case. Instead, with level moods – and especially for depression-prone bipolars – a person has much more ability to explore his or her creative side.  I know that’s true for me. Now that my moods are stable and level, I’m able to get more writing done, but also to tell whether the work is good or needs serious revising before I post it.

My doctor recently increased the dosage of one of my medications, a mood leveler, because I was having trouble with hypomania that wouldn’t let me sleep. And it worked. I am now getting seven to eight hours of sleep each night and have enough energy to at least face the day, if not always to conquer it.

Don’t think mine has been a case of spontaneous remission. I’m not sure I believe that’s possible with bipolar disorder. It’s taken a lot of years and a lot of work to get to where I am today. For example, it took literally years for assorted doctors and me to find a combination of chemicals, a cocktail of psychotropics, that would work for me. And during all that time, it was as if I was not medicated at all. Only the right combo of drugs and dosages would unlock my brain and level my moods.

So, here I am, in remission – and I love it. My moods aren’t blunted, they’re leveled. I am not as fearful now that my extreme moods may return and wreak havoc on my life. Oh, I still have some symptoms and side effects that remind me I’m not cured. But now I know that remission is possible, with work, with luck, and with the right mood levelers.

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