Bipolar 2 From Inside and Out

Posts tagged ‘psychotropic drugs’

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.

The Biggest Gaslighter

The subject of gaslighting is big these days. Everyone from your ex to the president is called a gaslighter. But what is gaslighting, really, and who is the biggest gaslighter of them all?

I’ve written quite a bit about gaslighting and here are the basics: Gaslighting is a form of emotional abuse. The gaslighter denies the other person’s perception of reality. The gaslighter tries (and often succeeds) in making the other person feel that she or he is crazy. Gaslighting is very difficult to escape from. Healing from the effects of gaslighting can take a long time, even years.

By those standards, I maintain that bipolar disorder, or maybe mental illness in general, is the biggest gaslighter of all. Think about it.

Bipolar disorder is basically your own mind inflicting emotional abuse on itself. It denies your reality and substitutes its own. It makes you think you are “crazy.” It is very difficult to escape from. And healing from it can take years.

First, let’s consider bipolar disorder as emotional self-abuse. Bipolar disorder uses your own brain to make you miserable. It takes control of your emotions and often your behaviors, and uses them in a destructive manner. Emotional abuse inflicts a conditional called “learned helplessness” on a person. The abuser turns positive and loving just often enough to keep the victim hooked – to keep the victim believing that the abuse is really his or her own fault. Bipolar disorder can relent just enough to let you think you are over it or gives you enough euphoria to make you think that your life is just dandy. These are lies, of course.

That’s the other thing that bipolar disorder does – tells you lies. Bipolar depression tells you that you are worthless, hopeless, and pathetic; that nothing you do is right; and that nothing you can do can change that. It’s a big suckhole for all your emotions, but especially good feelings. And those are lies. You are not worthless. You do many things well. You can escape depression’s clutches. Depression – your brain – tries to substitute an alternate reality for your own.

Bipolar mania lies too. It tells you that you are delighted and delightful, able to accomplish anything and indulge in any behavior without consequence. It lifts you up to a realm of unreality. Again, this is your brain telling you lies, ones that can adversely affect your health, your relationships, your finances, and more. And these lies you want to believe, because they are so seductive and at first feel so good.

These lies are denials of reality. No person is as worthless as depression makes them feel. No one is as invincible as mania says you are. Taking these lies seriously can cause profound damage.

And make no mistake, bipolar disorder makes you think you’re crazy, or at least ask yourself if you are. The out-of-control emotions, the out-of-control behavior, the mood swings, the despair, the euphoria feel crazy. You know your emotions aren’t under your own control and you don’t know what to do about it.

But just as there is healing from gaslighting, there is healing from bipolar disorder. The first thing to do in either case is to remove yourself from the situation. For gaslighting, that can mean breaking up with a partner or even moving away. Breaking up with bipolar disorder is even harder. It likely means starting medication and therapy.

With gaslighting, there can be a tendency to go back, to think that it really wasn’t all that bad. And there were undoubtedly things that drew you to the gaslighter in the first place, plus the intermittent reinforcement of loving apologies that make you deny your own perceptions of reality. And with bipolar disorder, the work of healing is so difficult that you may want to stop doing it – skip your therapist appointments, stop taking your meds, retreat to your emotional cycles, which at least are familiar.

But both gaslighting and bipolar disorder don’t have to steal your entire life. You can get away from the gaslighter. You can find healing from bipolar disorder. At the very least, you can improve your life and not have to ask yourself all the time: Is this real? Am I crazy? Getting treatment for bipolar disorder can break the hold it has on your life, disrupt the cycles that have you feeling perpetually out of balance.

But there’s the big difference between bipolar and gaslighting. You have to run away from gaslighting; you can’t change it. You can’t run away from bipolar disorder.  You have to face it and do the work to find remission and healing.

Self-Medicating: Bipolar and Booze

Self-medicating – using alcohol or drugs to dull the emotional pain of a mood disorder – is pretty common among people with bipolar and other mental disorders, particularly the undiagnosed.

It’s a dangerous thing to do. People with major depression are said to be twice as likely to develop a drinking problem if they self-medicate with alcohol a lot. Then there’s the possible interaction between alcohol or drugs with a person’s prescribed meds.

To be perfectly honest, there were times in my life when I self-medicated with wine, beer, or liquor. During one particularly dark time, when I had been prescribed benzos for a physical ailment, that was thrown into the mix. And, again with the honesty, I still sometimes have wine or beer with dinner, though I know I shouldn’t. I could say that I know how much I can drink without it affecting my reaction to my meds, but the fact is that I just shouldn’t.

Recently, however, a study was published in the journal Nature Communications which said that “getting drunk causes the same molecular changes in the brain as taking rapid antidepressants.” Here are the basics.

It was a study done on mice, which means it’s a long way yet from applying to human beings. The set-up was this: Mice were given alcohol, then placed in a container of water. Being passive and willing to drown was taken as an indication that the hapless creature was depressed. Sure enough, the mice that were given alcohol proved to be more active and energetic in trying to swim, which was taken as a sign of not being depressed.

The study did not end happily for any of the mice, however. Their brains were examined to determine how the alcohol achieved its antidepressant effects.  The scientists say that changes in the boozy mouse brains showed that alcohol has effects on neurotransmitters that were similar to the way antidepressants affect the brain. That’s a long way from saying that alcohol is good for the depressed, though.

The premise of the experiment sounds a little shaky to me. I mean, assuming the swimming mice to be less depressed than the drowning mice strikes me as just a wee bit anthropomorphic. Plus, the mice seem to have been situationally depressed (by being left to drown), rather than chronically, as in clinical depression. However, the brain study seems more interesting to me. After all, it compared the effects of alcohol directly with the effects that antidepressants have on neurotransmitters and said that the former “mimicked” the latter.

What’s the takeaway from all this? Well, first of all, it’s hardly blanket permission for the depressed to go out and indulge indiscriminately. Further experiments are needed, presumably ones that will work their way up the animal kingdom until they come to depressed humans, though one hopes that they are not thrown into water to sink or swim.

If those further studies go the same way as the mouse study, I rather imagine the result will be something like the medical advice that you can take a glass of red wine to stave off heart disease – not a blanket approval, but the use of a potentially hazardous thing to ward off a potentially worse thing. Of course, that will not apply to alcoholics or others who must avoid the substance altogether for any of a variety of reasons.

I also note that the study focused on the effects of alcohol in relation to depression only. The manic phase of bipolar disorder was not part of the study and drinking while manic is well known to be a really bad, though often occurring, thing. Of course the same can be said of drinking and depression.

For now, the best advice is simply not to drink if you are depressed or bipolar. Don’t use me as an example. I’m not sharing this to encourage anyone to indulge in potentially destructive, even lethal, behavior. As always, Your Mileage May Vary, especially when compared with that of drunken, depressed, or dead mice. But drinking is still far from a good idea for the bipolar.  And don’t mix it with benzos either.  Trust me on this. It’s a slippery slope.

 

The One Pill I’m Embarrassed About Taking

I know that there are lots of people – and not just the bipolar ones – who don’t like taking medication and especially don’t like needing to take them. It’s a reminder of their illness, I guess, or a dependence on a chemical answer when we’ve been told for so long, “Just say no to drugs” and indoctrinated by DARE. The only thing they leave out is that some drugs are good for you – the prescribed ones that allow you to live and function.

I don’t mind my psychotropic medications. In fact, in many ways I love them. They are the things that keep me relatively stable, on a mostly even keel, and make sure that none of my mood swings lasts more than a couple of days. I loathe pill shaming and consider it just one more kind of stigma that attaches to mental illness (and other chronic illnesses).

But there is one medication I take every day that gives me pause. It is my sleeping pill. My psychiatrist prescribes them and I take one every night, along with my other nighttime pills. In about 20 minutes to an hour, I’m asleep, and I stay asleep usually until 8:00 a.m. or so. It means I get about eight or nine hours of uninterrupted sleep per night.

I do need that sleep. I’m not one of those people who can function on four or five hours of sleep, the way tech geniuses and high-powered execs claim they can. If I don’t get my eight hours – and sometimes even if I do – I take naps during the day. Not just naps: mega-naps. My brain and body sneer at 20-minute catnaps. If I’m going to sleep, they say, it must be an hour at a minimum. Two is even better.

It’s not like I want to go back to the days before the sleeping pills, either. I do still remember the long nights of fear and sorrow, the fits of crying, the panicky sensation of not being able to breathe. The endless mental replay of every stupid thing I’ve ever done. The anticipation of the disasters the next day would bring. The hopelessness and the helplessness and the loneliness. The feeling that I was the only being awake, maybe in the world. If a single little pill can save me from all that, I should be glad to take it.

Why, then, does it bother me?

Perhaps it’s because it doesn’t feel necessary in the way my psychotropics do. They are prescribed for my bipolar condition and somehow make the difference in how my neurotransmitters operate. The sleeping pill feels like a different category of drugs.

Or perhaps it is because sleeping pills are often a drug of abuse and even suicide. My psychiatrist trusts me with them, though, and has for years. Plus, my anti-anxiety med is also often abused and I feel no guilt about taking that.

Maybe it’s because a sleeping pill feels in some way like a luxury. I don’t think it does anything specific for my bipolar disorder – except that sleepless nights are certainly associated with depression and my middle-of-the-night anxiety as well.

I hate to think it, but maybe the pill-shamers have gotten to me. I take such a cocktail of assorted psychotropics that it’s perhaps natural I should ask myself every now and then if I’m overmedicated (my doctor doesn’t seem to think so) and whether I could do without any of the drugs. The sleeping pill is the only one that might be in that category.

But no. I don’t want to go back to the nights of distress, despair, and devastation. I don’t want to wake my husband up as I gasp for breath and need him to stroke my hair until I fall asleep. And I surely don’t want to go through those bad feelings all alone in the night while he works the third shift.

All in all, I think the sleeping pill is a good thing for me and that I shouldn’t try to give it up. I just wish I didn’t feel so ambivalent about it.

 

 

No Resolutions – Just Memories and Hopes

I don’t make New Year’s resolutions. But since January is named after Janus, the two-faced god that can look both ways, I do look to the past and the future just to see what I can see.

Last year was a very mixed bag. It brought the heights of joy and the depths of depression, along with a little hypomania and dysthymia thrown in just because my brain does that.

The big negative this year was my husband’s heart attack in August and all the medical and financial repercussions that entailed. He’s back at work now, though he’s having difficulty managing the mental and physical stresses of it, so much so that he hasn’t made it to cardiac rehab in over a week. Rehab is not just a good thing physically; Dan said it made him feel energized, productive, and cheerful. I know, I know, exercise could do the same for me.

Still, there have been good things. My book, named after this blog, has now been published. This is a huge event in my life that lifted me temporarily out of depression and into (possibly) hypomania. And I have retired, meaning only that I will start collecting Social Security next year. It will not alter my blogging, writing, or other pursuits, since what I make from them won’t be over the “allowed-to-make-in-addition” line.

As for next year, I expect to see more of the same (minus, I hope, the heart attack). There will still be problems paying the bills, including the massive hospital one, but at least I will have a steady, fixed income. It will help me with my anxiety over potential financial collapse and my unreasonable fear of losing the house.

I’m also planning to get away for another long weekend at a bed-and-breakfast on a working farm. The last time we did it, it proved enormously soothing and relaxing. Another such mini-vacation would be ideal. We certainly won’t be able to take a full vacation, so I won’t even hope for that.

The other good news is that my second book, Bipolar Us, will be published. It may not be attended with the same level of hypomania that the first one was, but at the very least there will be real joy. Also in the coming year, I plan to finish my mystery novel and place it with an agent.

As far as my bipolar disorder, in the coming year, I will still have it. I expect that my meds will change not at all, or minimally since I’ve been relatively stable for so long. But I know it won’t go away just because I’ve crossed “publishing a book” off my bucket list. That’s not the way it works.

If this sounds like my 2019 will be more of the same, well, that’s because that is truly what I expect. Of course, my expectations will have no influence on the outcome. The year will be what it will be, as rife with unexpected events as this one was. My main hopes are that my husband’s health and my writing both improve.

I’ll try to remember the lessons learned from this year – that we are both strong and good things can happen to us. And I’ll try to plan for some positive accomplishments in 2019 and hope they’re within our reach. I won’t call them resolutions, though. Resolutions are so easily broken and I don’t like to think that my plans and hopes are.

Big Box Mental Health

photo by rawpixel.com from Pexels

According to an article published on the blogsite She Knows, “a Boston-based company that manages mental health care for 40 million people, has opened a small clinic in a Walmart location in Carrollton, Texas, and has plans to expand the program in other retail locations throughout the country.”

And I don’t know whether to vomit or applaud.

Walmart’s ubiquity is one point in its favor. They’re everywhere. And for some people, whether they love or despise Walmart, it’s the only choice they have for groceries, household goods, or much of anything else. Those areas are also likely to be underserved by the mental health system, such as it is.

And sparse as the options offered by the Walmart walk-in clinics is – treatment for anxiety, depression, grief, relationship issues, and stress management – it’s more than a lot of people have access to now. The trial site is said to be staffed with one licensed clinical social worker, has a sliding fee scale for those with no insurance, and will soon be approved for Medicaid reimbursement (it is hoped). There will even be remote Skype therapy services if necessary.

All that is good, as far as it goes. But does it go far enough? Will people be able to get more than a pat on the head and a pep talk as they do their weekly or monthly shopping? How will the walk-in clinic handle referrals for people with serious mental illness or a need for psychotropic medication, something that clinical social workers can’t provide? How many people can get help from a single professional? How good is internet therapy? And what percentage of Walmart shoppers have access to the internet?

The walk-in clinics are touted as reducing stigma around mental health issues. After all, the thought is, getting your mental health services at Walmart will become as natural as getting a haircut or an eye exam there. Well, maybe. On the other hand, how many people are willing to have their friends and neighbors see them publically, sitting in the waiting room or ducking surreptitiously through the door? It seems to me it might perpetuate stigma, rather than lessening it.

Besides, Walmart is hardly a bastion of high-quality goods and services. Will the mental health services be second-rate as well? It could be that even second-rate care is better than no care at all. But it’s surely not enough to deal with issues that require long-term therapy with actual treatment plans; scheduled repeat visits; building a relationship with a particular therapist; access to medications; and all the other aspects of more effective treatment, especially considering complicated disorders like bipolar, OCD, or anorexia.

I fully admit that I hate Walmart – the way they have driven out local Mom and Pop stores, for example, and the way they treat their employees. But I have many choices of where to shop near where I live, and access to both therapists and psychiatrists, and insurance that covers my appointments and medications. If I weren’t looking through the lens of privilege, I might see things a lot differently.

So for now, I guess my attitude is to wait and see. One test location does not a Walmart Psych Empire make. Perhaps it will succeed; perhaps not. Perhaps it will become the Great Clips of the psychotherapy world.

But while I’m waiting, I’m hot holding my breath.

 

Low-Jacked Pills and High-Tech Mental Health

I’m a known geek and ordinarily a fan of technology – though not technology for its own sake. It has to do something useful and needed.

Imagine my surprise to learn that tech companies are now doing what so many of our public institutions aren’t, and devising possible solutions to assorted mental health problems. Stat reported (in their Business section) that now:

with an influx of funding, companies are revamping pills with digital sensors, designing virtual reality worlds to treat addiction and other conditions, and building chatbots for interactive therapy.

But are these techno-wonders likely to be any help? Let’s take the innovations in reverse order, shall we?

Chatbots. We already have remote counselors, which may be a godsend for people with no access to mental health clinics (although they charge a fee, which may be prohibitive for some). I’ve never investigated this service, so maybe some of you who have can tell me how they work and how well.

Remote counselors rely on already existing technology, however, and are therefore not of interest to tech innovators (or potential funders). Chatbots are something else. They are, essentially, computers that respond to human input with output that is supposed to simulate human responses.

To my knowledge, no computer has ever passed the “Turing Test,” which means that a person has no idea whether they’re chatting with a real person or a computer. A psych computer is likely to respond with generic responses such as, “Why do you feel angry with your sister?” “What do you mean when you say anxiety?” “Explain how depression affects you,” and “Tell me more about your mother.” The supposed AI is in no way trained in psychology or any therapeutic techniques.

One company that received funding for “telepsychiatry” (called Regroup Therapy and Woebot Labs) brands their idea as “Your charming robot friend who is ready to listen, 24/7.” Admittedly, many persons with mental health issues need someone who’ll listen, but that’s far from all they need.

Virtual reality for addiction (and other conditions). Startup Limbix wants to sell its programs to therapists and clinics. According to Stat,

Among the company’s VR programs is an exposure therapy for patients with phobias or trauma associated with driving. While patients strap on the headset, clinicians can work with them to introduce different conditions (a clear or rainy day) or different road situations (a bridge or a tunnel or blind left turns).

This sounds promising, though the cost of VR headsets and the programming for various conditions again might be prohibitive for your average community or campus or rural mental health clinic. I’m not clear on how it would work for addiction, unless combined with aversion therapy, which is generally brutal.

Pills with digital sensors. Aren’t psychotropic medications already too expensive, especially for people who have no insurance? Now we need technological pills that must make a profit for both drug and tech companies?

And what a pill they’re talking about. Basically, it’s a pill that rats you out if you don’t take it, or rather alerts your doctor when you do take it. Presumably, your doctor has enough staff to monitor whether clients take the pills and record it if they don’t. Then what? A robocall telling you to take your meds? A visit from a social worker?

Admittedly, such low-jacked pills might have a place in situations where schizophrenics are court-ordered to take their medication, but again there is the problem of what to do about non-compliance.

Another company plans to sell “a cardiac drug meant to be popped like a mint to people anxious about public speaking and first dates.” Would people need prescriptions for those, or will they be dispensed like Tic-Tacs? Even anti-anxiety drugs aren’t meant to be “popped like a mint.” And a cardiac drug? I can’t see any possible downside there.

If only the ingenuity and investment that goes into these products were instead available to fund and repair the shaky mental health system instead. What we need are more psychiatrists and therapists, more hospital beds for psych patients, less expensive drugs, better insurance, more education for the public about mental illness, and an end to stigma.

But those would require systemic reform and political backing, not just some new-fangled gadget. And good luck getting investors for those.

Reference

https://www.statnews.com/2018/07/20/tech-developers-tackle-mental-health/

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