Archive for June, 2008

Off to the hospital

Yesterday I saw my therapist and, after I told her of my depression and its extent, she suggested I go to the hospital for stabilization. Probably only a week or a bit more. I have been going to Timberlawn Hospital Trauma Unit for almost 4 years now. This will be the 4th time. In my opinion, the Trauma Unit is excellent and targets my needs very well. They treat symptoms, rather than disorders, which I think is a good idea since disorders are just attempts to categorize the wide variety of emotional symptoms. It’s easy to get hung up on exactly what someone’s diagnosis is, and also to make judgments about treatment based purely on the Dx and not on the person’s symptoms as a whole.

In fact, I like Timberlawn so much I wrote a review of the Trauma Unit and posted it to Associated Content:
Review:Timberlawn Trauma Program

I can’t say I’m glad to go though. I’m actually reluctant and dreading it. There is always the fear of people I don’t know, and the fear associated with being locked up and losing control over some aspects of my life. The fact that I’ve chosen to give up the control for my own good doesn’t make it any less frightening.

I’m fortunate to be getting a lot of support and encouragement. I really need it!


June 21, 2008 at 10:29 am Leave a comment

where next?

I have known I was bipolar for 11 years and I’ve had a lot of good therapy, beginning even before that when I thought it was just depression. I’ve been hospitalized numerous times as well. I know my disease intimately and I’m familiar with many, many strategies for alleviating symptoms.

But I feel there’s no point in all that anymore. I don’t want to try because it is just hopeless anyway, and I don’t have the energy. Trying to keep a positive outlook just makes me look like a fool, I think. It’s not going to change. It’s not going to get better, ever.

I feel I have an obligation to my family to keep trying, but it’s so painful. I just want to run away. I think to myself, I will just walk out my door to the highway and hitchhike to someplace far away. If I end up getting murdered, so much the better. I won’t really care.

June 20, 2008 at 3:27 pm Leave a comment

Dialectical Behavior Therapy (DBT) and Bipolar Disorder

If you are familiar with DBT, you probably know that it was developed for the treatment of borderline personality disorder(BPD). Borderline is considered one of the worst, if not THE worst, personality disorders to have. This is because borderline clients are notoriously difficult, they often do not view themselves as sick, and even if they do they have a very hard time changing because by definition the disorder is entrenched in their personality.

So what does this have to do with bipolar? I’m getting there. I myself have never been diagnosed as borderline (although I do have a diagnosis of ‘Personality Disorder, Not Otherwise Specified’), probably due to the stigma attached to it. I do have enough self-honesty and insight to look at the DSM criteria for BPD and see myself in almost every blinkin’ one. You could say I have a strong suspicion that I have BPD, along with being bipolar. In fact, I began to suspect I was borderline long before I ever guessed my mood swings could indicate bipolar disorder.

One principle I strongly believe is that we must take responsibility for our own healing — for getting our needs met. Psychiatrists and therapists can help but they are *just* helpers. They are the subcontractors in the reconstruction of our lives and our psyches. We are the contractors. This is a very powerful concept! It means that I get to decide what is the best way to approach resolution of my issues.

With that in mind, I poked through bookstores and researched on the Internet and I came across something called Dialectical Behavior Therapy (DBT). It is a framework for treating BPD that focuses on dialectics (opposites, or extremes), and combines them to help the borderline client achieve moderation (since lack of moderation is a hallmark of BPD). It teaches how to modify emotional states and techniques for interpersonal effectiveness. In short, it addresses many of the same issues that are characteristic of bipolar disorder!

In my growth process I have learned that the best way to judge a particular therapeutic technique is “does it work?” I believe that the techniques outlined in DBT can work for individuals with bipolar disorder. If you are interested in trying them out for yourself, here’s the book to look for:
Skills Training Manual for Borderline Personality Disorder by Marsha Linehan.
Just say Lunar Moth sent ya! 🙂

June 19, 2008 at 10:18 am Leave a comment

The Great Medication Dilemma

A common issue for bipolar individuals is medication — to take or not to take? Lithium, anti-convulsants such as Depakote, and atypical anti-psychotics like Abilify can each prove very effective in preventing and managing the cycles of mania and depression. Most of us don’t miss the depressed times, but let’s be honest, those “up” moods can be really fun and productive! Plus, research suggests a relationship between creative genius and the shifting moods and insights experienced during bipolar episodes. Given these facts, plus the side effects medications can have, it’s not surprising that many of us stop taking our meds periodically.

I can say from personal experience that, although understandable, the decision to stop taking prescribed meds is one I always regret. There are two main reasons: one, stopping the meds usually precipitates an episode, and two, stopping cold turkey results in withdrawal symptoms, sometimes severe.

Four years ago I came to the (misguided) conclusion that, while I clearly had recurrent bouts of depression, I was not actually bipolar. So without talking to my doctor, I discontinued my anti-convulsant and anti-psychotic. I still took the anti-depressant, though, which made the situation even worse since anti-depressants can trigger mania.

For a long time — more than six months — I thought I was okay and that I truly was not bipolar. My behavior gradually became more erratic, however, and over time it was evident, to those around me at least, that I was escalating through hypomania into mania. I had the classic symptoms of expansive and grandiose mood (plus a LOT of irritability), excessive involvement in pleasurable activities, risk-taking, lack of sleep, and so forth. When I took off one day to cross five states for a romantic tryst, my mother did venture to ask, “Are you manic?”

My response was “Well, if I were, I probably wouldn’t realize it anyway!” But shortly thereafter I did realize something was terribly wrong, because I moved into a mixed state of mania and depression combined. Along with the above symptoms I had intense jealousy and fear, bouts of crying, feelings of hopelessness and self-loathing, and other signs of depression. I was very frightened, so I finally asked my pdoc (psychiatrist) for a mood stabilizer. He put me on Topamax — I had been taking Depakote before then — and unfortunately I had significant side effects including neuralgia and hyperasthesia (even the slightest touch or other stimulus to my skin and mucous membranes was extremely painful).

Finally I was on Depakote again, but by then I was well into the depressed phase. Because I was unmedicated in the earlier part of the episode, the depression was long and severe. I self-injured and thought frequently of suicide. I went so far as to make a plan, and was saved from carrying it out just in the nick of time.

I have to admit that there have been occasions since then when I missed up to several days of a medication, especially if I ran out because I forgot to refill it. However, as much as I hate taking the drugs, I know that I don’t want the experience I had before. I might not survive it the next time. And I’m not quite done with this Earth yet!

June 17, 2008 at 1:34 am Leave a comment

Mood cycles

One thing I have realized lately is that I have more than one level of mood cycling. So far I have identified three levels:
— the level of episodes, which occurs over the course of weeks or months
— the monthly level, in which my mood changes along with my monthly hormone cycle
— the daily level, in which my mood changes over the course of a day (generally better in the morning and worse in the evening)

The episode level is more difficult to predict, but the overall trend is for episodes to begin in the spring. My pattern is mania — mixed state — depression. Mania can be triggered by lack of sleep or working long hours on a project. The change to Daylight Savings Time seems to make a difference as well.

I have severe premenstrual syndrome which begins shortly after the midpoint of my cycle. The worst is the few days before my period actually starts; sometimes I can barely stand to be around other people without biting their heads off, and I hate myself so much I almost want to die. You can imagine that when I am in the depressed part of an episode, and I hit the depressed part of my PMS, I feel really wretched!

I think my circadian mood changes relate to fatigue. When I wake up in the morning I generally have more energy and my mood is more positive. As I get tired over the course of the day, my mood takes a dive too. Many people have the opposite pattern, so I guess I’m a bit odd that way. 🙂 Still, it makes sense to me, since mania (up mood) is associated with high energy and depression (down mood) is associated with low energy.

June 14, 2008 at 9:46 pm Leave a comment

New Website Focus and My Bipolar Story

I have decided that will now focus on a topic I know much more intimately than photo slideshows: bipolar disorder! I hope that the information, suggestions, and empathy I can share will be helpful for others who either have bipolar themselves or know someone who does.

It has been 11 years since I was diagnosed bipolar and began treatment with Depakote, an anti-convulsant mood stabilizer. The way I found out was a bit unusual, so here’s my story!

I knew that I had a problem with depression. That became really evident when I was in junior high school and my parents divorced. I quickly gained 30 pounds, and my grades dropped from all A’s to C’s & D’s. Plus, I had started self-injury. That was my first experience with psychiatry and anti-depressants.

Fast forward MANY years (I’m not saying how many). I realized there was no stability in my life — I kept changing what I thought I wanted, and my energy level varied from highly productive to sleeping all day. I didn’t understand the lack of consistency in my moods, behavior, beliefs, attitudes, and so forth. But at first I didn’t even think I could be bipolar. I just felt I didn’t “know” myself well enough. I was in graduate school at the time, and free counseling was available, so I presented myself at the counseling center with the statement “I need you to tell me who I am.”

Fortunately the psychiatrist was a laid-back guy; he didn’t immediately slap me in the loony bin. Instead he scheduled regular counseling sessions and, at my request, psychological and personality testing. One of the tests screened for various disorders, including bipolar. When he gave me the results I was astonished to receive a referral to an outside psychiatrist for assessment and treatment.

June 13, 2008 at 11:38 pm Leave a comment

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