Posts tagged ‘insight’

Hurricane Ike Effects

By the time it reached us it was actually a tropical storm, but nonetheless Ike left his mark on Marshall. My power was out for almost 24 hours. Some areas of town flooded and many trees were blown over, some onto houses.

Soon after my electricity was restored, I realized just how stressed out I had been the last few days. The exhaustion set in quickly, and my body began to ache all over. I felt mentally numb. The relief I felt just as the lights came on gave way to malaise and restlessness.

I have a theory about this. I mentioned in a previous post that stress hormones, adrenaline and cortisol, create a chain reaction that shuts down the reproductive, immune, and digestive systems (plus areas of the frontal cortex). My period is two days late — it was supposed to start on Friday. I have been having bouts of IBS for three days as well. That’s two systems clearly affected.

Now that the perceived crisis is over, the stress hormones ceased production and my reproductive system is functional again. It is probably gearing up for my period, and I always get terribly exhausted right before it. Plus, the absence of the adrenaline in particular has left my body without fuel. My muscles ache because they were tense under stress, readying me for the “fight, flight or freeze” instinct if needed.

I knew that I was nervous and anxious, but I didn’t realize just how anxious I was! I did not expect to feel like this when everything went back to “normal” — I expected to feel normal. LOL


September 14, 2008 at 7:11 pm Leave a comment

Being active — but not too much

I’ve discovered something new about my bipolar and what can trigger episodes. In the past I was able to function at a higher level — I could withstand the last-minute frenzy of deadlines, intense classes and studying, caring for small children all day by myself, jet lag and other hazards of travel, and similar stressors. In a word, I could be more active. I did have episodes back then, but they were much less severe and didn’t seriously impair my daily life. And it took a more intense, sustained period of stress to trigger them.

I did not know I had bipolar disorder until I was 33. Like many others, I have stopped and started my medications along the way. I also did not take seriously the suggestions from my psychiatrist on how to adapt my lifestyle. As a result, my condition has worsened.

In the last 6 years, since the serious episode of ’01-’02, my activity level declined (partly due to medication) to such a degree that sometimes I slept several hours a day. I didn’t have a job or any social contacts where I live, I only had my family and some friends I visited in Dallas. I tried working several times but was not able to maintain it. Each time, I became very stressed and compulsive in my work, developed physical complaints such as pain over my entire body, then rapidly deteriorated emotionally, sometimes requiring hospitalization.

Even my home-based job as a freelance writer led me down that path. Earlier this year I began writing web content, and for awhile everything seemed peachy-keen. What I didn’t realize was that I was already entering a manic phase, which leads inevitably to mixed mania/depression and then deep depression. Once triggered, the cycle usually plays itself out, although some effects can be mitigated with medication and lifestyle. I am just now, in August, finishing the cycle which began in the latter part of January.

Now I know I must walk a very fine line. Too little activity, with its concomitant isolation, is bad for me and will cause depression. Too much activity, with its concomitant stress, is bad for me and will induce mania.

This is when I am very, very glad that God cares about me and will help me along this path. I firmly believe that the spiritual nature of human beings must not be neglected in emotional disorders (or any disorders). I encourage anyone with bipolar disorder to turn to the God of their understanding for assistance. Also, examine your life closely, not to condemn yourself, but to see cause and effect. In this way you will determine your own triggers and, hopefully, ways to avoid them.

August 23, 2008 at 6:08 am 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

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