Posts tagged ‘bipolar disorder’

My SSDI Story part 3

The next few months weren’t too bad mentally, but I had started taking the atypical anti-psychotic Zyprexa in the spring. Today it is notorious for causing extreme weight gain and encouraging the development of diabetes. In the end I gained 70 pounds on the drug — very damaging to my self-esteem! I don’t remember much more about that year (the reason will be evident shortly), but in the fall the depression began again. In November or possibly December I
went inpatient for the first of many times throughout the next five months. I just couldn’t stay out — I was not safe. My pdoc (psychiatrist) tried different medications; nothing helped. Eventually we tried ECT — shock treatments. Even those did not lift my mood, although they did erase portions of my
memory.

After the ECT, the pdoc sent me home, mentioning the possible need of a stay in the state hospital since I was not responding to treatment. Needless to say I was terrified! The next time, I went to a different hospital but it was a very bad situation. My friend indicated that perhaps I should move back home and live with my mom, and since my mom was willing, this was what I did. After that I returned to the hospital only once then had two years without being inpatient.

In the meantime, I applied for Social Security Disability, since it was obvious that working was out of the question.

April 26, 2009 at 5:52 am Leave a comment

Bipolar Disorder and Women’s Health

A recent review of published literature revealed that bipolar disorder and its treatment are associated with reproductive and metabolic abnormalities in women. In particular, treatment with valproate (Depakote) was correlated with hormone changes and increased risk of polycystic ovary syndrome (pcos).

The hypothalamus and the pituitary gland in the brain interact with the gonads (reproductive organs) in a feedback loop to control the production of estrogen, progesterone, testosterone, and related hormones. The hypothalamus is a brain structure associated with emotion, which probably explains its significance in this process.

Treatment with Depakote is also related to increased risk of insulin resistance and diabetes, liver dysfunction, and pancreatitis. The use of the drug (like all medications) must be determined by balancing the positive effects with the potential negative effects.

I may be frying my liver and subjecting myself to fluctuating hormone levels, but right now, I know that I need my Depakote!

April 25, 2009 at 6:13 am 1 comment

My SSDI Story part 2

It was the additional weekend job that finally broke me. I could barely manage to go to work, and when I did go I was nervous and agitated. I fell down a staircase at the preschool and injured my knee, requiring arthroscopic surgery. At the same time my depression became acute and I was suicidal. I spent much of my time with a friend of mine because I was afraid to be alone.

One night I took an overdose of tranquilizers — just enough to make me sick. The next day my therapist found out, and she instructed my friend to take me to the emergency room.

I was in a severe psychotic depression by this time, which led to my first inpatient stay in a mental hospital (and my only involuntary admission). After a week in the hospital, I returned to my friend’s home and she helped me move out of my apartment. I was nervous about getting another job, but about six weeks later I started a temp job that ended up lasting about 16 months. The first half of that period I worked for the temp agency, then the company hired me directly.

I was the assistant to an administrative assistant, and she was a kind and friendly person. If she had not been patient as well, I would not have lasted a month. But it was summer before I had another manic episode and I was able to conceal it most of the time. It appeared occasionally in the form of unexpected insolence. I could tell she didn’t know what to make of it, but she didn’t question me.

Of course, as day follows night, depression follows mania, and once again I was suicidal. My boss had been depressed herself in the past and when I told her how I felt, she told me to go home and call the doctor. That was the last day I worked.

I went back to the mental hospital, then remained out on short-term disability, possibly a little longer than absolutely necessary. Meanwhile there were massive layoffs at the company and my boss herself was laid off. I returned from disability for only one day, so that they could give me my pink slip.

April 25, 2009 at 5:49 am Leave a comment

My SSDI Story part 1

I was first diagnosed with bipolar disorder in 1997, after a personality test resulted in referral to a psychiatrist. But it was not until 2 years later that the episodes began to seriously affect my ability to work, and I decided to seek out SSDI, or Social Security Disability Insurance.

Somehow, I had always been able to “scrape by” with excuses before then. Mania inspired me to overcommit (I believed I could do anything when I was manic), but the inevitably ensuing depression proved me unequal to my promises. People get tired of hearing excuses after awhile, and I was tired of making them. I felt guilty and ashamed for continually letting others down when they were counting on me.

In early 1999, I was “strongly encouraged to resign” from my position as
research assistant in the study of child language disorders. At the time I was supposed to be working 20 hours a week in my assistantship, 20 hours a week as a speech-language pathologist in my local school district, plus a regular load of doctoral courses. Looking back, I’m surprised I didn’t break down then!

In some ways, losing the assistantship was a relief. But the consequences weren’t — I had to move from my school-owned apartment, I couldn’t pay my bills with just one job so I took extra speech pathology work, and there was no time left for courses so I dropped out (besides, I absolutely could not face that professor again).

I managed that way for several months, until the end of summer — and my school salary — approached. I had not been offered another school district contract; apparently my performance in that job was as dismal as in the assistantship. I had to find a new job, so I began teaching 4-year-old preschool. Twenty children, one teacher, at $10 an hour. Much better than minimum wage, of course, but very stressful and still not enough to pay the bills.
— to be continued —

April 21, 2009 at 2:12 pm Leave a comment

Bipolar Spectrum Research

It is almost inevitable that when people attempt to categorize anything they make the initial categories too narrow. Psychiatrists have know for some time that the diagnostic categories for bipolar in DSM-IV TR continue to be inadequate, in spite of revisions. Inevitably, people fall through the cracks, usually into the dreaded NOS (not otherwise specified) category. I say “dreaded” because a nonspecific diagnosis often results in lower quality treatment, especially if the physician is inexperienced with bipolar patient.

A recent review of the literature looked at the 4 recognized types of bipolar (I, II, III, and IV) and compared their symptom criteria with what is actually seen in clinics and hospitals. The author (Hagop S. Akiskal, MD) found evidence for five additional categories, as follows:

Bipolar _ , or schizobipolar, falls under a separate DSM category, Schizoaffective disorders. These are diagnosed in patients who exhibit both psychotic symptoms and mood swings, satisfying most of the criteria for each type of disorder.

Bipolar I is a well-known type that represents what many people think of as “bipolar”. The patient’s mood episodes cover the entire range from depression to mania (which often has psychotic features). Akiskal suggests that an additional category, bipolar I_, includes those who have frequent depressive episodes interspersed with a few manic or near-manic but not psychotic periods.

Bipolar II was first identified in 1976 by researchers at the National Institutes of Mental Health. In a nutshell (no pun intended!), these individuals experience recurrent deep depressions along with hypomania, often at the end of the depression. Mood shifts can occur quickly, and the delineation between the two moods is more clear. These are “typical” bipolar II’s.

Bipolar II_ individuals, according to Akiskal, experience greater mood dysregulation and frequent occurence of depression and an irritable rather than euphoric hypomania. Even between episodes they are considered “moody” by those around them. In fact, the moody person who develops major depression is more likely to shift to bipolar I or II in the future than is the person who is not normally moody. This is an important clinical consideration (although I have not seen practical application of it). Panic disorder and/or social phobia are also classified by Akiskal as indicators of potential bipolar II_.

Bipolar III is diagnosed when anti-depressants prescribed for a major depression produce a shift into hypomania. It most often occurs in patients with a first-degree bipolar relative, which reinforces the genetic link for bipolar spectrum disorders. The hypomania does not generally last long, and recurrs infrequently.

In Bipolar III_, the bipolar episodes are inextricably linked with substance abuse, such that it is impossible to determine which came first, the chicken or the egg. (My experience here:) These individuals are now termed “Dual Diagnosis” in hospital settings, based on the belief that it is depression that caused the substance abuse in the first place. However, it could just as easily be bipolar disorder — one reason why it is often better to treat according to symptoms instead of diagnoses.

Bipolar IV, as described by Akiskal, is a category I have never encountered myself. Apparently, sometimes people (mostly men) who have led successful and seemingly happy lives develop depression in the latter part of middle age. This quickly leads to an agitated depression or “mixed state” in which the person fulfills criteria for both depression and hypomania. The author suggests that this disorder may be the cause of unexpected suicides — “but he was so successful, I don’t know what went wrong.” An agitated depression is highly dangerous for anyone no matter what their diagnosis is, because if they are suicidal that have enough energy to complete the act, unlike typical depression with complete lack of energy (personal experience again).

Of course, these categories can still be further refined, but I think this work is helpful in recognizing the various stops along the bipolar spectrum. In the end, though, I think the symptoms are what’s most important. It’s nice to have an “umbrella” designation to give the physician a place to start. On the other hand, the inadequacy of the categories in the DSM can fool them into a simplistic view of bipolar (“are you I or II?”) and likewise, a simplistic method of treatment.

Reference:
Akiskal HS. The Emergence of the bipolar spectrum: validation along clinical-epidemiologic lines and familial-genetic lines. Psychopharmoacol Bull. 2008; 40(4):99-115.

October 12, 2008 at 5:30 am Leave a comment

Bipolar and Anxiety Disorders

A study conducted in Ontario, Canada indicated that the co-occurence (technical term “comorbidity,” which sounds worse than it really is) of multiple anxiety disorders with bipolar disorder may be more common than expected. Of the 138 individuals diagnosed with bipolar disorder, over half had at least one anxiety disorder, and almost a third had two or more.

Using the DSM-IV (Diagnostic & Statistical Manual of Mental Disorders), researchers assessed participants for generalized anxiety disorder, panic disorder, post-traumatic stress disorder, social phobia, and obsessive-compulsive disorder (see bottom of post for more info). The participants were re-evaluated over the course of three years to determine their clinical progress.

You might expect that having multiple anxiety disorders would result in worse outcomes, but the study showed that the type of disorder was more important. Generalized anxiety disorder and social phobia had the most negative impact (given the importance of social support in bipolar, the latter doesn’t surprise me). However, when participants with at least one anxiety disorder were compared to those without, any type of anxiety disorder resulted in a poorer outcome.  For example, anxious participants spent more of each year ill and their symptoms were more severe.

Those of us who are bipolar need to be proactive to ensure that we are assessed and treated for other disorders we may have. Although it is intensely annoying to have a string of diagnoses (and a bag of pills to go with it), failure to adequately treat one problem may hold back progress in another area.

Similarly, many physical disorders occur with or even cause psychological problems. If financially possible, get regular physicals and blood work to check for problems such as anemia, hypo/hyperthyroidism, diabetes, arthritis, inflammatory bowel disease, and others that will complicate a mood disorder.

Anxiety Disorders in a Nutshell

Panic disorder — Attacks of terror, accompanied by frightening physical symptoms (pounding heart, shortness of breath, faintness, dizziness, nausea) and an overwhelming sense of impending doom, occur with no apparent provocation.  The most crippling aspect of panic disorder is the fear of another attack, especially while driving, in public, or in another difficult situation.

Obsessive-compulsive disorder — If you watch the TV show Monk, you are familiar with this one. Persons with OCD have disturbing thoughts that will not go away unless they perform some sort of ritual. However, doing the rituals is like doing crack; over time more and more is required until the person spends most of the day doing rituals.

Post-traumatic stress disorder — First identified in war veterans, this disorder was soon recognized in the context of many other terrifying experiences that involved death or the threat of death. Natural disasters, terror attacks, rape, child abuse, car accidents and many other events can cause the symptoms. These include flashbacks (reliving the event), nightmares, watchfulness, inability to trust, and startling easily.

Social phobia — If you become overwhelmingly anxious and self-conscious in social situations, you may have social phobia. Persons with this disorder may be bothered by certain types of social situations or by any contact with people.  When they are in the frightening situation, they may experience rapid heartbeat, shortness of breath, nausea and dizziness similar to a panic attack. They feel that everyone around is looking at them and judging them negatively. When forced to attend a social event that they usually avoid, they may dread it for weeks and begin feeling panic long before reaching the actual situation.

Generalized anxiety disorder — GAD rarely occurs alone; instead it is usually comorbid with another anxiety disorder, a mood disorder, or substance abuse. It is diagnosed when an individual spends most of the day worrying about everyday concerns. They can’t relax, startle easily, and have difficulty concentrating. Sleep disturbances and physical problems are also common symptoms.

September 16, 2008 at 6:26 pm Leave a comment

Music Therapy II

In a previous post (July 21), I wrote about my interest in self-prescribed music therapy, specifically entrainment CD’s. Entrainment is just a fancy way to say that the CD presents a sequence of music designed to train the emotions. The ones I have been making bring me gradually from depression to happiness. I think my latest one, #3, is the best so far.

1. Crush — Dave Matthews Band

A romantic song that is associated with a depressed time of my life.

2. Losing My Religion — R.E.M.

This song isn’t about religion, as you might think, but about frustration and depression. According to lead singer Michael Stipe, “losing my religion” is Southern slang for “fed up” or “at the end of my rope.”

3. Ordinary World — Duran Duran

Popular during a drastic change in my life, in which I was desparately seeking that “ordinary world.”

4. My Immortal — Evanescence

Almost any song by emo band Evanescence would do, but this is one of the most depressing songs I’ve ever heard. It is, therefore, the peak of the “depressed” portion of the CD.

5. One Headlight — Wallflowers

Although “One Headlight” talks about a suicide, it is one step up from #4. Believe me.

6. I Let the Music Speak — ABBA

Rich in a variety of emotions, the words and music in this somewhat dark song are a nice transition.

7. Eyes Without a Face — Billy Idol  &  8. Baker Street — Gerry Rafferty

Both are melancholy, but the sadness is not depression because there is still hope.

9. Turn! Turn! Turn! — the Byrds

Self-explanatory I think! If you are not familiar with the song, here are some of the words (adapted from the Bible book of Ecclesiastes):

To everything (turn, turn, turn)
There is a season (turn, turn, turn)
And a time for every purpose, under heaven

A time to be born, a time to die
A time to plant, a time to reap
A time to kill, a time to heal
A time to laugh, a time to weep

10. I Made It Through the Rain — Barry Manilow

We’re now in positive territory, but this is not just a happy-go-lucky fun song. It’s a tribute to victory over grief, depression, pain, and struggles of all types.

11. Waterloo — ABBA, 12. When Smokey Sings — ABC, 13. Walk of Life — Dire Straits, 14. You Get What You Give — New Radicals.

These are the fun songs! Listening to them always makes me smile, but they work much better when preceded by the rest of the CD. The first few songs acknowledge my feelings and maybe even help me express them (sometimes I cry). Gradually I’m led into hope and empowerment, and the final four are the icing on the cake!

I highly recommend this technique to anyone who has a mood disorder.

September 15, 2008 at 4:19 pm 3 comments

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