Bipolar 2 From Inside and Out

Posts tagged ‘Spoon Theory’

Does “Natural” Treatment Work for Depression?

Not for everyone. Not all of the time.

Angel Chang recently posted on LittleThings.com “The 10 best natural ways to treat depression.” (See http://www.aol.com/article/2015/11/06/the-10-best-natural-ways-to-treat-depression/21260290/?ncid=txtlnkusaolp00001357) While she does acknowledge that “clinical depression is triggered from within, and very often need[s] medical attention” and “it’s imperative to consult your physician if you notice an abrupt change in your mood, feelings, or sense of well-being,” her article is about “easy” ways to treat depression yourself.

Unfortunately, her tips are not very helpful for me and many others who suffer from clinical bipolar or unipolar depression. Here’s how I respond to them.

Meditate. This is both nearly impossible when you have racing thoughts and a way to sink even lower if you can’t clear your mind of negative thoughts, which is one of the hallmarks of depression. And if you’re manic, even sitting still in one place for any length of time can be a challenge. After you’re stabilized on medication – go for it.

Eat Foods With Vitamin B. It may be true that vitamin B has been linked to neurotransmitters that we need more of, but preparing them is not realistic when I’m in the Pit of Despair. I try to imagine myself preparing a meal of fish, Swiss cheese, spinach, and eggs, and I just can’t. Or shopping for them, for that matter. I might be able to scramble an egg in the microwave, but that’s about it. (I wrote about food and depression recently: http://wp.me/p4e9Hv-db.) I do take a multivitamin along with my bedtime psychotropics, so I guess I can follow this advice a bit.

Set goals. Chang recommends starting with “small, daily goals.” When in full-blown depression, mine are about as small as you can get. Get out of bed. Make it through the day without crying. Take my meds. Poof! Out of spoons! The expert Chang quotes gives an example of a goal to work up to as washing the dishes every other day. To me, that implies a series of goals: Gather up dishes. Find soap. Fill sink. Wash a dish. Put in drainer. Repeat. My tip: Wash the spoons first!

Sleep on a schedule. Going to bed at the same time every night may be do-able, but getting up at the same time isn’t possible for me, which is one of the reasons I can’t hold a regular job. An alarm clock awakening me before my body is ready leaves me groggy and unfit to work. And there’s no guarantee that I’ll actually sleep during those scheduled hours, even with Ambien. Chang advises not taking naps, but I seldom make it through the day without one, even if I have slept eight (or nine or ten) hours. In fact, I love naps and consider them therapeutic, for me at least. Naps are my friends.

Get out of your rut. Structure is the only thing that keeps some of us going. And if we could find joy in a painting class, a museum, or making a new friend, as Chang suggests, we probably wouldn’t be depressed in the first place. J. K. Rowling described the Dementors in the Harry Potter books: “Get too near a Dementor and every good feeling, every happy memory will be sucked out of you. … You will be left with nothing but the worst experiences of your life.” She has stated that they are metaphors for depression. With every good feeling sucked out of you, you can’t see anything but the rut. I am told that for some people, Cognitive Behavioral Therapy (CBT) lessens the tendency to keep traveling in the rut. But “easy” and “natural”? I don’t know.

Talk. Chang is advocating talking with trusted loved ones, which is good as far as it goes. What it ignores is that friends and loved ones are not universally understanding of depression or supportive in dealing with it. She never suggests talking with a therapist or doctor. I don’t know why that’s less “natural” than talking with someone who has no training. Except you have to pay them (or your insurance does), but painting or language classes or art supplies aren’t free either.

Exercise. This is a classic antidote for depression, and I understand that it works for many people some of the time. But I would put this under the same heading as setting goals. I know it would be good for me, but motivation is hard to come by and immobilization thwarts me. But I wish I could take this advice. I looked into water aerobics, but there’s not a feasible program in my area.

Responsibilities. “Because you might feel down,” the article states, “you may also want to withdraw from your daily activities in life and your responsibilities at home or at work.” Yepper. “Try staying involved as much as possible in the causes you care deeply about, and take on new daily responsibilities. These can be as simple as volunteering at your local food pantry, or going back to work part-time.” Big nope. See getting out of your rut, above. For the clinically depressed, working even part-time is unimaginable, with responsibilities of the crushing sort.

Unwind and relax. If your depression comes with anxiety like mine, this idea is a non-starter. Unless you count drinking as relaxation, though it isn’t the best idea if you’re on meds.

Stay off caffeine. Okay, I can pretty much do this one, except for one cup of coffee or a caffeinated soda to get me started in the morning.

“Did you learn something new about how to naturally treat symptoms of depression?” the article ends. Not really. Well, except for the B vitamins. We’ve all heard these kinds of advice before. They’re good tips for situational or reactive depression, but largely not feasible for the chronically, clinically, biochemically depressed. In a way they add up to the much-hated “Just stop it. You must want to be depressed or else you’d be doing all these great things.”

But try them if you can, perhaps in addition to medical treatments. Maybe some of the ones that won’t work for me will for you. In the meantime, get help. See your therapist and/or psychiatrist. Keep taking those meds. Those may not be “easy, natural” ways to treat depression, but if they work, isn’t that the larger point?

P.S. Do NOT Google “CBT.” Spell out “Cognitive Behavioral Therapy.” Trust me on this one.

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Mental Health

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Social But Spoonless

In the past week I have been out of the house more and seen more people than I have in years. It’s almost like having a social life.

In the past week I have also slept more than I usually do in my sloth-like, torpid existence.

I think the two are not unrelated.

If you follow Spoon Theory (http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/) you know that each spoon represents an amount of coping that you can do.

Every day you get a certain number of spoons – not the same number every day.  You use them to perform everyday tasks that most people think nothing of – things like getting out of bed (some days you don’t even have that spoon), taking a shower (1/2 spoon for Janet’s patented “super-fast smelly-bits sink wash-up”), getting dressed, finding something to eat, fixing that something (keep a box of Cheerios by the bed in case you run out of spoons at this point), and all that is without even leaving the house. Some days that’s all the spoons you have and when you’ve used up your spoons, that’s it.

Other days you can manage to do all that and leave the house, go to work, run errands, and assorted other normal activities. But for those of us who have mental disorders, such days are few and far between.

You hear depressed people talk of not being able to get out of bed, and for the most part that’s caused by lack of spoons. I am usually notoriously low on spoons. My husband now understands Spoon Theory and we use it as common shorthand for “I’m too tired” or “That’s all I can handle right now.”

Dan, however, is an over-scheduler and I often have to rein him in by pointing out that his proposed slate of activities will not be possible because I, for one, will run out of spoons, and he may too.

The dry run for my recent spurt of socializing began last week. After I went for my final session with Dr R., I managed a trip to the bank, a trip to the place where I could pay my power bill, and since it was right next door, a stop at Kmart to buy underwear. It was a good thing that was a hypomanic day, but it floored me for the rest of that day and the next. And it started a cycle of bipolar up-and-down oscillations that were clearly related to spoon usage.

My spate of social endeavors started with a double-header. On Saturday I had lunch with a friend at a favorite restaurant I almost never get to go to. We talked about politics, social issues, and book proposals. Then I went home and had a little nap.

That evening Dan and I went to Monkey Bones for Zombie Dogz. I know that takes a little explaining. Monkey Bones is the tattoo studio where I got my semicolon tattoo (http://wp.me/p4e9Hv-9G). Zombie Dogz is a local food truck. (Also, it’s fun to say “We went to Monkey Bones for Zombie Dogz.”)

Notice that in a single day I had to get up, out of bed, and get dressed twice. That’s a lot of spoons. Sunday I was not able to get out of bed at all.

Monday did not involve socializing, but it was another hellacious spoon-eater. Dan and I spent the day scrounging for documents and information that the IRS wanted. It was taxing. (See what I did there?)

Tuesday was an extra-special social event, though it did not involve getting dressed and going out, or even interacting with other people. It was Jenny Lawson’s online book launch party. Better known as the Bloggess, Jenny has severe social anxiety. At this stage in my life, I certainly would not be able to dress up, mingle, and make polite conversation with both friends and complete strangers. The online party was a genius idea.

I sat at home in my pajamas with some red wine while the Bloggess read chapters from her new book, Furiously Happy. (You should get it, by the way. It’s about mental illness, but funny.) As low-key a social situation as that was, it still used up spoons because it was something I had never done before. Making sure I had the right URL, converting Central Time to Eastern, not being able to ask questions because I don’t Tweet, worrying that Dan was getting bored – not a lot a lot of spoons, but still some.

The effects were getting cumulative. Again I was unable to get out of bed the next day. In fact, Dan and I both slept away most of the daylight hours. For him it’s understandable because he works third shift, but I have no such excuse. Except that if you borrow from the next day’s spoons, or try to keep going without them, you will pay.

Thursday, I was determined, with or without spoons, I was going to meet a friend for coffee. I’ve seen her only once, briefly, in several years. In a way, it was a test of my ability to maintain anything approaching a real social life.

I put forth the extra effort because a mutual friend cut her ties with me because I canceled so often on social engagements. I suppose I really have nothing to prove to anyone but myself but it seems important that I do so. It’s not like coffee with a friend is an ordeal or anything. It’s just that I know I’ll be using a spoon for more than stirring my coffee.

And I hope I have enough spoons left over to work on my other blog.

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Mental Health

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Abilify: The Next Chapter

I’ve been taking Abilify as an add-on to my other psychotropics for about six months now, and I have some pieces of good news to share.

Good news #1: The generic (aripiprazole) is now available! There was a slight delay between the time the FDA gave approval for the generic (April) and the time it went on sale. But now it has arrived in drugstores. (I understand that the same company makes both the brand name and the generic, which strikes me as goofy, but then what do I know about drug marketing?)

Good news #2: Between my insurance and my pharmacy, I now have to pay only $15/month for the generic. The brand-name Abilify was $800 without insurance and $125 with. My insurance is not cheap, though it is still less than the cost of brand-name Abilify. When you add in all my other prescriptions and doctor visits and tests and such – plus all my husband’s drugs and other medical expenses, the insurance suddenly doesn’t seem so pricey. (I got this insurance through the Affordable Care Act, and I hope the Supreme Court doesn’t screw it up for me.)

Good news #3: Despite my tiny dosage (2 mg.) I have noticed significant effects. After six months on the drug, I have more energy, better focus and concentration, and fewer down/useless days (unless I overdo and run out of spoons). (See http://www.butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory/ if you don’t know what I mean by that.)

I’ve been doing major housecleaning/sorting, going out – actually outside the house – to run errands other than my shrink appointments, and I even went to a party – a reunion of people I used to work with. I wore my new skirt, navigated the social milieu successfully, and stayed an hour and a half. (The next day was one of my no-spoons days, though.)

This is only the third time in my life that I’ve noticed a significant effect from taking a new prescription. The first was Prozac (fluoxetine), which felt like looking at a color television after years of black-and-white. With static. Showing only commercials. The second was Lamictal (lamotrigine), which felt like a switch flipping and turning on my ability to think rationally. And now there’s Abilify.

Whatever side effects I may have, I’m willing to live with. (Unless I get the tardive dyskinesia. That would be a deal-breaker.) This feels like real living and I’m happy about it. I don’t think this is hypomania, either. I think I’m supposed to feel this way. I’m going to run with it.

Of course this isn’t the end of bipolar disorder for me, or the end of this blog. I still have plenty to say about my experiences with bipolar depression, mental health in general, and particularly mental health in the media and society.

Sorry if I sound sappy, but it’s good to be alive and functioning!

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Mental Health

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Dear Folks: Sorry I Haven’t Written Lately

This has been the longest trough I’ve had in a while, and I’ve been spending all my spoons on work, because the cats do insist on eating.

Tomorrow begins a new adventure: My psychiatrist has prescribed Abilify. The $800/month price tag seemed a tad bit high to me. We have insurance, but the benefits don’t really kick in until we meet the absurdly high deductible. A few months of Abilify would probably do it. (We couldn’t afford the gold plan. I think ours is aluminum, or maybe tin.)

The manufacturer does offer a free month’s trial and a discount card, so at least I can see if it works for me. If it does, I’ll figure out how to pay for more. (BTW, if your meds are way expensive, check out needymeds.org. They have a database of manufacturers, discounts, requirements, and contacts. My psychotherapist turned me to that.)

When Dr. R. prescribed Abilify, he told me that it could make me restless. “How will I know whether it’s the drug or my usual twitchiness?” I asked. “You’ll know,” he said. After reading the literature, I can see what he means.

So here I am with three work assignments (not particularly tight deadlines, though) and am about to start a drug that could feel either heaven-sent or hellish. Or just “meh,” I suppose, which would leave me exactly where I am now.

Wish me luck.

And tell me if you’ve had any experiences with Abilify. I know anecdotal evidence doesn’t mean squat to scientists, but I’m interested in hearing from people who have tried it, or seen how it worked (or didn’t) for a friend or relative.

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Mental Health, Uncategorized

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The Seven Wonders of the Bipolar World

I wonder if I can get out of bed today.

I wonder if a different drug would help.

I wonder what would happen if I told my friends and coworkers.

I wonder how long this mood swing will last.

I wonder if I have enough spoons for all I need to do today.

I wonder if people can tell that I have a mental disorder.

I wonder if this is the best I will ever get, for the rest of my life.

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Mental Health

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From Panicky to Manicky

I’ve been having one of my rare, slightly manicky  upswings for the last few days.

Why? And about what?

Well, I survived the business meeting/lunch on Wednesday. I prepared for it with a lot less anxiety than the last time (hair, outfit, jewelry, car, arrival time – all came together with astonishing speed). I even made it through lunch without my hand tremors causing me to dibble all over myself. Yay me!

And although the subject matter could have felt like an attack directed at me, it didn’t. I didn’t get defensive (well, maybe a little) and I help uncover some problems that indirectly supported my point of view.

Maybe I am getting better at this stuff, or remembering how I used to do it.

Also, I was not completely spoon-depleted that evening or the next day, as I had told my husband to expect.

I’ve donated small amounts of money ($25 and under) to a few charities and causes. I don’t know if this is cause or effect of the upswing, but who cares? I was motivated, and I did it. A small enough accomplishment for many people, but summoning the will to care and to act constitute progress.

I have supported a friend in his first solo freelance venture, predicted its astoundingly rapid success, and reveled in it with him. It’s a good feeling to share, even if my own freelance efforts have been less spectacular (though significant to me).

I won’t deny that this upswing makes me wary that a crash may be on the way. You know how feeling happy always seems like tempting fate? With bipolar disorder, I know that there will always be another downswing waiting around the corner for me.

But at least, for now, I can enjoy the good. And that’s a major improvement.

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Mental Health

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My Brain, My Books

It used to be that I could never be found without a book within arm’s reach. I had a purse book, a nightstand book, a bathroom book, and a car book at the very least. (I kept them straight by having a different genre in each location.)

Now that I have a Nook e-reader, I have hundreds of books with me everywhere I go. But I’m doing a lot less reading.

I think it’s a function of my lack of concentration, but whether that’s the disorder or the meds, I couldn’t say.

I do know that when I was in the depths of my most recent breakdown, I barely read at all. I watched moronic reality shows like Trading Spouses, on the theory that these people’s lives were bigger train-wrecks than mine. And I watched cooking shows, because they were calming. (This was before cooking game shows really got going.)

During an earlier meltdown, I tried to watch sitcoms, but the relentlessly upbeat theme songs made me weep.

Now I have to hoard my concentration like I hoard my spoons. I am fortunate enough to be able to work freelance from home. But it’s the kind of work that sometimes has deadlines. On days when I can force myself to work, I can concentrate for about 2-1/2 to three hours at a spell. Some days I have to do two sessions like that with a nap in between, if a deadline is approaching too rapidly.

But when it comes to non-work activities, I can usually only concentrate for an hour at the most. Sometimes I try really hard so that I can watch a movie, but mostly I stick to half-hour or hour-long shows.

But reading takes concentration too, especially if the book has a plot (which I recommend) or is information-rich nonfiction. I do a lot of my reading in bed at night. (Yes, I know you’re not supposed to do that because it keeps you from falling asleep. But it’s a life-long habit.)

My mind flitters, the hamsters and sometimes the badgers stir, and I find myself several pages along with no idea what happened. At that point my need for distraction and my attention span collide and I have to find something moderately absorbing but short-term to do. It’s a good thing I have some games on my reader so I can play a hand of rummy or work a sudoku puzzle.

Reading has been one of the great joys of my life, since I was four, and it bothers me that I no longer have the ability to immerse myself in it the way I used to.

But, like so many other things, it’s something I’m having to learn to live with.

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Mental Health

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Cookie Theory

Many of you are probably already familiar with Spoon Theory (and if you’re not, go here and read it: http://www.butyoudontlooksick.com/wpress/articles/written-by-christine/the-spoon-theory/).

In my previous post, I explained my Theory of Misery and Math. This week, inspired by something a friend posted, I will expound on Cookie Theory. Here’s the post:

argument

As I commented then, even an RSVP is optional. This is especially good advice if your FB friends post on controversial topics, as a number of mine do.

On to Cookie Theory. Just as I didn’t invent Spoon Theory, I can’t claim Cookie Theory as my own. My husband shared it with me, on the weekend over 30 years ago when we met.

I was having a difficult time (to say the least) with my boyfriend at the time, whom we’ll call Rex. Among the difficulties was that I was stranded, several hundred miles from home, with no money. I had to borrow money from every single person I knew there, including some, like my future husband, that I had just met, in order to get bus fare. And find someone who would take me to the bus station.

Dan, the aforementioned future husband, was the one who gave me a ride, and as I was waiting for the bus, he shared with me these words of wisdom:

Just because someone hands you shit cookies doesn’t mean you have to eat them.

The more I pondered this metaphor, the more I realized how insightful it was. Rex had generously supplied me with shit cookies over the year and a half I knew him. And I ate them. I was also supposed to pretend they were chocolate chip. And say yum, yum.

And I did.

The bus wasn’t the only thing that stopped for me that day. So did my willingness to eat the cookies.

The first step is training yourself to recognize the difference between shit cookies and chocolate chip. The second is saying no. (Like refusing an invitation to an argument. Just say no and walk away. Or catch a bus.)

I’m not claiming it’s easy. But when someone hands you a put-down, a micro-aggression, a lie, ask yourself, “Is this a chocolate chip cookie?” If not, don’t take it. Don’t eat it.

Then stay on that diet. It’s amazing how much weight it will take off you.

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Mental Health

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Taking Turns

For the past several days, I have been dealing with a husband in severe pain from osteoarthritis, plantar fasciitis, and back spasms.

I have driven him to Urgent Care, picked up prescriptions, provided him with a walking stick and a cane, set up a heating pad, researched his conditions on the computer, talked him through his exercises, and more. I wish I could do all this without getting cranky. I wish he would follow my advice more, especially when I tell him to see a doctor. But sometimes he’s such a guy.

What I have been doing for him is nothing – at all – compared to what he did for me and how he supported me when I had my last breakdown, which lasted several years. He did everything. Shopping, pet care, cooking, paying bills, earning a paycheck. Not to mention loving me through the despair, irrational thinking, sobbing uncontrollably, immobilization, and all the rest.

He really took that whole “in sickness and in health” thing to heart. Now it’s my turn to do likewise.

I am completely out of spoons. I will carry on anyway. He deserves it.

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Mental Health

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Mission Accomplished

I have survived the business meeting. With the help of my husband and a hell of a lot of spoons.

(If you haven’t heard of “Spoon Theory,” go here and read this. It is a metaphor that helps people understand what life is like for people with “invisible disorders,” including mental illness. http://www.butyoudontlooksick.com/wpress/articles/written-by-christine/the-spoon-theory/

My Competent Business Woman Disguise was augmented with hair color (requiring spoons), mix-and-match options from the thrift store (more spoons), trying to remember everything I might need and put it in my good purse (still more spoons), prepare a small supply of assorted drugs just in case (you guessed it), finding boots and wrestling them on (borrowed husband’s spoons), eating a hot breakfast (again, husband’s spoons), checking out restaurant menu online (reminder: don’t order soup because of hand tremors and literal spoons) and so many other details that I used to take for granted. And that was before I even got to the meeting.

I know I borrowed from today’s spoons as well. And quite likely tomorrow’s too. I may not get more spoons until the weekend. In the meantime, I guess my husband will need to spoon-feed me.

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