Category Archives: bipolar

How to Be on Antipsychotics.

This young lady, who calls herself “the misadventures of me” wrote the funniest post on Antipsychotics.  It’s my favorite.  Enjoy her good writing.

Recently I was told I may have bipolar disorder and was promptly put on, you guessed it, antipsychotics. Now something about the name makes antipsychotics sound really scary, or rather, the person …

Source: How to Be on Antipsychotics.

A Not So Tough Pill to Swallow

Treatment for Bipolar Disorder is based on a menu of medications.  They Are a diverse group from Lithium, antieliptics, antianxiety to antipsychotics.  Depending on where you lie in the spectrum of your disorder, the med menu will change.  You may be challenged with having to take a polypharmacy and manage the side effects of many pills or be on monotherapy and contend with much fewer side effects.   I am one of the lucky ones because monotherapy has been successful for me.

My treatment was determined by the bipolar symptoms I told my psychiatrist.  This is very difficult because, in my first visit, I could not remember all the key things to tell my doctor.  I did display some pressurized speech so that was a clue that I was in acute mania…again.  But this was my first visit so it was not definitive.  Maybe I was a chatty person.  The doctor did not know.  Determining your mental illness is similar to a treasure hunt. The psychiatrist discusses  your behaviors, looking for bipolar indicators, and determining where you exist in the spectrum.  Do I exist in the spectrum? Or does the spectrum exist as a sliver in me?  We only had one hour to figure this out because one thing was for certain-I was in an episode of some sort.  I sat in the doctor’s office laughing, hyperactive, and certainly mentally ill.  There, I said it…mentally ill.  My initial diagnosis was Bipolar Disorder II but later on it changed to Bipolar Disorder I.

Did I behave a certain way because I was tired, stressed, anxious or because I was in a bipolar episode?  Some behaviors are evident such as manic and depressed behavior, but they have to be witnessed by a medical team in an inpatient setting to be certain; otherwise, they are considered subjective.  In the beginning, my mental health picture had not formed.  So you start with the moving target, and if you do not get it right, you start a “chance” of a med.  The next time, you now have to explain to your doctor why you behaved a certain way but on a psychiatric med.  Layers start to form from the side effects.

Once you are prescribed your med, the waiting game of seeing which side effect will occur begins. Do you need another med to counter a side effect? You have to wait and see if the new med stops mania or if it pushes you into mania.  Bipolar Disorder is push and pull of your mind. You can stabilize, but now you have to be on the look out for break through episodes of mania indicating the med did not work. All this while you are living your daily life, interacting with loved ones, and trying to keep your career from imploding. Exploding. Side winding.  The name of the game is to hang on while snowboarding an avalanche.  Hang on. With your eyes open.  Hang on.

Treatment is not a sure bet in the beginning which caused me great unease.  Some people in our community are treatment resistant which means the menu of meds does not treat the disorder.  Mentally, I was not prepared for the reality of psychiatric meds because of the uncertainty but more importantly, I had this idea that meds were my last resort.  What if they did not work?  I still had a long life ahead of me.  Initially,  I thought I would need them in my twilight years.  Just in case,  you know?  Because now, I am strong, young, and could handle this through pure willpower, but I was oh so wrong.  I since learned that this thinking is backwards.  In order to not be the crazy later on, I have to be on a med plan now.

The uncertainty of it all was disconcerting. I wanted to hold on to something that was a sure thing because I could no longer hang on to my foundation since it was crumbling.  Cracks a mile long were forming.  Mentally,  I was hanging on a cliff and could feel my fingers slipping.  Just hang on.  I wanted certainty.   For instance, I know I can take an aspirin for a headache, and the headache goes away. There is a definite cause effect that can be experienced.  When I realized that my med was not a sure bet, I became scared and opted out the first time.  I was not ready to contend with the “possibilities” of “might” getting well or more worrisome that my med would not work. I stopped Lithium cold, and two months later succumbed to another manic episode.  This one was fast and furious.  I remember each one sort of. There was the one in Salinas, which was a drug and alcohol fueled binge; the second one was a flashback of Iraq and my first psychotic episode; and the third one I call Utah, which was my second psychotic episode. I am a rapid cycler and like clock work, I experienced my third episode in nine months.

During Utah, I called my doctor and well..I was in Utah and refused to voluntarily admit myself to an Emergency Room so my treatment could not start until I returned home.  I have a short story on Utah called, “The Poop Story and Other Tales of Love.”  The good thing about Utah was that I displayed very distinct bipolar behaviors such as psychosis that gave us the ammunition to pick a more precise med. Initially, I was on Lithium, and although this is known as the gold standard, it was not for me.  I felt…like…the sound you make when you place your tongue on the roof of your mouth and click it.  That sound.  For me, that sound was how Lithium felt on my mind.  After I made the click sound with my tongue my doctor asked, “You mean you feel blunted?” Her training and experience was good because that was the word for it. Blunted.  For me, blunted is the sound of your tongue clicking off the roof of your mouth.  After this episode, my diagnosis changed from Bipolar Disorder II to Bipolar Disorder I with Psychotic Features.

I was prescribed an antipsychotic that has worked well for me. Up until today,  I have been in denial and embarrassed that I have to take an antipsychotic.  It is the word is it not?  A med that clearly states that I can become psychotic.  This is a tough pill to swallow.  However, the antipsychotic is helping me by allowing me to be mentally free.  It keeps me somewhat in hypomania which is where I want to be.  I am more of my creative self then mania ever allowed me to be.  My med also helps me manage my daily stressors, which I am not so good at anymore.  Stressors mentally fatigue me in ways I never could imagine.  I am on a new path in my journey. It use to be that I was a “mental mountain.” Now, I need help.  Even though I am managing my disorder, my core being is changing.  It has to change I think.  Not so much outwardly that people might notice right away. Certainly, your thoughts change; therefore, be and then become happens.  You become a new normal.

The good thing about meds is, when you get the right kind and dose, the effect isolates the mood disorder. This enables you to see the paths to managing a stable daily life.  You can separate from the disorder.  It helps you discern trigger effects on your mood and behavior.  Enables you to develop stress release actions and form crisis plans.  Also, they reduce the cycles of bipolar episodes and protect my beautiful, sweet brain, which I love so much.  Meds can be effective.  It is what I call my good, hard work.  My goal is to swallow this pill and stay of healthy mind, peaceful, and loving of heart.  For this, it is not such a tough pill to swallow.

 

 

There is no “I” in “Loneliness”

A discussion I had a few weeks ago with my psychiatrist came to the forefront of my mind.  This was not an intrusive thought or episodic depression breaking through.  Not dysphoria. I can tell the difference now that I am on medication treatment.  It is something that I am  working through, which is about the emotion of feeling “lonely.”  I realized I have never experienced it.  Even if I ever did, it is not an emotion I can remember.  When did it secretly depart? This realization lingered in my mind.

After the first week on my new med, I experienced the emotion of “loneliness.”  I was in my apartment relaxing as usual.  My life is somewhat effortless.  I have it made.  On one particular evening as I worked on a short story, a new feeling pulled at me in a disconcerting manner.  I did not like it and was unfamiliar with it.  My apartment was cozy, and I had my things around me.  I had my freedom.  My friends and family were all fine and available; however, this feeling of something I knew not what trailed after me.  It was subtle.  It barely showed its face and whispered its name–loneliness.  It was hollow.

At my next therapy session, I discussed this with my psychiatrist.  Our session was moving along as usual in her white clinical office with the bright lights of a surgical room.  Perhaps the lights helped her search for the darkest corners within me.  She asked me how loneliness felt, and I replied that it was unpleasant.  It tugs at things.

My psychiatrist said that I would experience a lot of new emotions and moods on my med. My med would clear a path for them like a pathfinder. That it would take time to learn how to manage them.  Manage is the clinical word for feeling an emotion in a more balanced way.  Being the curator of my emotions, I was dismayed that I had not noticed that loneliness had been missing from my collection.  What I was uncertain of was whether it was stranger to never have felt loneliness or to never have realized it. Perhaps both are equally puzzling.

Surely, I watched it play out on TV, read about it in books, and provided a shoulder for my friends to cry on after their most heartbreaking breakups where they expressed the depths of their loneliness. All those times, I thought I was relating to them, but really, I had not been at all.  I had been understanding their loneliness by knowing the definition but not because I was drawing from experience.  In order to relate to my world, I substituted the feeling of “longing” because I knew how that felt. However, longing means a yearning desire which is completely different from loneliness.  All my life, I had existed in a way where there was no “I” in”loneliness.”

As a person who exists in hypomania, the feeling of loneliness is nonexistent.  At least not in my spectrum. Some people would wonder, “What had gone wrong?” or maybe even “What had gone so right?”  Because loneliness is such a negative emotion, who would care to feel it? However, loneliness can cause people to form and hold on to attachments to others.  The consequences of not feeling it are much greater than I am able to understand at this time.  Again, I am working through it. I am fortunate to have a good friend to discuss this with because I trust him implicitly.  It is good to have a strong person’s view on these new emotions of mine.  His responses in words and facial expressions are my carpenter’s level.

It would seem that hypomania would be a wonderful place to exist in because it is a devil may care feeling.  The world is conquerable, but a more important statement that effects practical efforts of daily life, is that everything and I mean everything is possible. This sets me apart from most people.  Therefore, my feeling of loneliness is one of the three definitions that pertains to place and defined by Google as, “(of a place) unfrequented and remote.”

 

 

Restless

Oil running

Together

Along a smooth surface

All things

You mean restless is like agitation?

No

Liquid carrying

On

No place

Water flowing

In unity as one

On the move

Nowhere to go

You mean restless is like agitation?

No

Ebb and flow

On the go

Everywhere

You mean restless is like agitation?

No

Restless is fluid

Agitation is grating

 

 

 

The Brightest Red

I make my way through the streets of my city driving to my psychiatrist appointment. As usual, the weather is beautiful in my lovely Californian town.  It is considered a Mediterranean type of weather here which evokes temperate warmth, sun and cool breeze of the nearby ocean.  I turn right then left and always have to remember to go straight through the intersection and not turn left as I have done a few times on previous visits.  Visit.  A nice word to use when seeing not a friend but my doctor who is the leader of my mental health team.  My team consists of a psychiatrist and counselor.  They are my guides who navigate me through my wants, needs, feelings, and moods with the effects of my medication.  They are an imperative part of my life now, and I am getting use to this.  There is a comfort in this arrangement.

I bring my truck to a stop in front of the building.  The parking lot is emptier than normal since my appointment is after lunch.  It is quiet here today.  My hand grabs the key from the ignition, and I pause in my seat. A deep breathe pushes out from my between my lips, and I mentally settle in for today’s discussion of how my new med is working out for me.  The inside of my truck is tan as my handbag.  My hand slips into my purse reaching for my favorite red lipstick. It is the brightest red. I adjust the rearview mirror to get a good look of my face in order to adjust my makeup.

My face is an olive canvas of the finest material, and I enjoy wearing a lot of makeup as a sort of fine painting.  My eyeliner is particularly black with sometimes two coats of smudge coal running along the top and bottom of my eyes.  For dramatic affect, I wing the black out to the sides like an Egyptian goddess, but I am not Egyptian.  My eyeliner is smudged more than it should be, and with my finger tips, I clean it up ever so gently.  In the reflection of the mirror, I look into my eyes and see that I am aging and that is quiet alright.  The wrinkles of time have started to slightly show from a life of moods and emotions.  Finally,  I open my red lipstick and generously apply it to my full lips and fix up the outlines.  I take another pensive breath.

The waiting room is completely empty which makes the pale white walls and sparse decor even more austere.  I sit quietly with my hands in my lap and admire the fine lines starting to appear on them.  I can remember what they looked like as a young woman.  A young woman who had no idea what lie ahead.  How vast my possibilities were in those days.  I certainly did not ever think I would end up here in a psychiatrist office treating bipolar disorder.  However, I am thankful for the treatment.  As fearful as I was at the beginning of it and the great unknown it posed, I feel deep inside that it is what is best for me, my child, my family and friends.  It is a necessity of my life as much a necessity as my emotions and raw passions.  I hold them all dear and want to do the best to balance them all so I can live a colorful life.  As colorful as the brightest red.

As the minutes tick by on the clock on the wall, I reach into my purse and pull out my mirror and check my lipstick one last time.  This is a habit of mine.  I use to love watching old movies where the ladies would always pull out their finest compact and apply their lipstick ever so properly or seductively.  The waiting room is very quiet and lights gleam off the pale white floors.  All the seats are tan like the inside of my truck and have a blonde wood framing them.  In my mirror, my lips appear the brightest red like the petals of a red rose arranged gently against my soft olive skin.  I try to recall all the effects of my new med so I can relay them to my doctor.  Some memories are heavy with hurt and discomfort.  Other memories are champion good stories of how I believe my treatment is going well.  A long sigh draws out from my rose petal lips

The door into the doctor’s office opens and my name is called.  My psychiatrist appears and greets me with a smile.  I return her greeting and follow her down the hall.  “I love your lipstick,” she says, and I respond politely, “Thank you.  It’s the brightest red.”

 

 

Bipolar Question #2

Q: Is it okay to call you crazy?

A: Initially, I thought sure who cares, but actually I care so no. It’s not okay to call me crazy because it a negative connotation of me.  I have a child, family and friends.  My career and educational achievements are quite impressive.  I have bipolar disorder and treatment is good, hard work and successful.

More importantly, it’s a slippery slope. If you call me crazy, and I can handle it because I have better sex than you (see question #1), then you might/will call someone else crazy like a child or teenager with bipolar disorder whose identity is still being shaped.  We cannot have them believe their identity is a crazy one.  They didn’t ask for the disorder. None of us did.     We have to have compassion and be friends.

{Bipolar Question is based on my personal experience.  A little fun too people.  In Bipolar Question, I do not speak for the Bipolar Disorder or Mental Health communities}

The Hurt

When I start a new medication to treat bipolar disorder, there is a learning curve of the primary side effects.  This holds true for any medication; however, bipolar medications directly cross the blood-brain barrier and target the brain.

In the beginning with a new med, I am learning to be cautious in order to learn how and when it affects me the most.  In the case with my new med, I opted to stay indoors for the first two weeks and take advantage of my new way of experiencing my moods. It was a carefully forced situation where I turned down parties and hanging out with friends.  I had become somewhat reclusive but was content in my cocoon for now.  Safety and certainty permeated my surroundings.

In my apartment, I am surrounded by my art supplies, books on philosophy, political theory, art, and the rise and fall of nations and civilizations. On my new med, I can read for leisure again. I am changing.  Art and reading these books were all things I had loved but had lost during my years of rapid cycling.  At any given time, my friends reached out to me through text and phone calls with their constant invitations of going out to parties.  Sometimes, they would visit.

One evening, I decided to join a friend for her birthday.  What could go wrong? Well…I am a fun-loving type of woman and see the bright in everything.  I am not the type to stay home and fawn over tall tales and love stories.  I live them.  I write them. That is what can go wrong.

The evening started with a beautiful full moon covered by wispy clouds.  The weather was warm for this time of year, and the wind felt good on my face as I drove with the window down. The road opened up, and we played the music loudly, talked and laughed the whole way to our first place.  We went to a bar and instantly hit it off with the patrons. When they learned of my friend’s birthday, drinks were sent our way.

There was no reason, at this point of the early evening, to think about my med.  I felt great. Laughter filled the bar.  The evening ended in a wonderful restaurant with good food and much celebration.  My friend offered to continue the party, but I realized it was past my med time.  I had not brought it with me because I did not want to be sedated while out on the town.  We ended the evening at 10:30 pm, and I returned home at 11:00 pm with my med at the forefront of my mind.  See how this is playing out? So carefree at first.

My med time is at 8:00 pm, and sedation lasts for two hours until bedtime at 10:00 pm, but here, it was 11:00 pm.   Even though I am sedated for the first two hours after taking my med, I cannot sleep at all because I am mentally alert but sedated at the same time.  It is a restless mind.  Next morning was going to start early at 6:30 am so I had to sleep.  I thought about not sleeping in order to ensure I would be awake on time like many times during my more hypomanic periods in the past.  But, this was not the past, I was here, now, in my new treatment, which had to be taken seriously.  I just did not think going to dinner and drinking was going to end up so late and screw me up.

At 1:00 am, I finally fell asleep.  It felt like as soon as I fell asleep my alarm went off at 6:30 in the morning.  I opened my eyes and thought, “ouch” and “no, no, no this cannot be happening.”  I just laid there and stared at the ceiling.   Boy, was I out of it. I tried to fall asleep for a few more minutes but was restless–this is a side effect.  I need at least 12 hours to feel the med wear off from my brain.  Here I was, at barely over seven hours.

Slowly, I got out of bed and started my morning routine.  My shoulder hit the armoire, I tripped over the rug, walked into the wall, made it out of my bedroom, and then held onto the bathroom counter to get a fucking grip.  A moan escaped my lips.  I pouted and whimpered. This hurt. What does hurt mean? It is not a sharp pain kind of hurt or a headache type of hurt.

It is a hurt I have experienced before and know well but not from a med.  The closest thing I can compare it to is how I mentally felt during my times in the Army when I had to stay up physically exerting myself for 48 hours or more with only four hours of sleep–we are talking complete physical and mental exhaustion.  Where my mind was forced to stay alert and perform but was numb from exhaustion.  Numb, agitation,  buzz, narrow, focus and intense are all good words to describe that sensation.  My med on the other hand lacked focus and intensity and my thoughts sounded like sounds in a sound proof room.  It felt bizarre and mentally agonizing. The hurt.

Yet, the experience in the Army was a mind and body unison of hurt, and I could see why I hurt. I could make connections from what I was putting myself through to the hurt. That connection gave me focus.  The med on the other hand was invisible and my body did not hurt. It was isolated to just my mind.  My body and mind seemed disconnected.  For 16 years, the Army taught me how to push through pain. I knew how to will myself through the hurt.

My will is not a mood.  I think it comes from my Amygdala and is more an emotional reaction.  My honed response. A force.  However, my will is not a match against the affective mood changes such as hypomania, mania, and mixed state or this med or I would will myself through this entire disorder.  I can use my will to push through a moment.  It is a reserve stored for moments such as this.  It gets used up by one moment against this disorder and then takes awhile to become strong enough for another time.

I managed to arrive at work, which was actually at a different location than my office. Let us not even go into the details of the drive to work except know that everything was white from the sun.

All week, I was in a training class to learn new things.  I just met the instructor and barely new my other colleagues.  The class was eight hours long of lecture in a room with an echo.  The room was large with windows that looked out to the sky blue and manicured garden, but I sat in my chair and blankly stared ahead.  I could not understand the instructor because I was too busy trying to focus.  My brain has never felt so restless in my life, but you could not tell.  My body was still, and I was not jittery or anything like that.  My mind was obdurant and would not think, I could not receive transmission. Everything, including his words stopped at my eyes.  It was complete torture.

After the longest ten minutes of my life and thinking I could go stark raving mad if I sat for one more minute, I quietly stood up and and walked out. Now, this is my profession, and I have to be in the class.  What was I to do?  I realized I needed a few more hours to let the med wear off so I went back to my SUV, jumped in the back seat, stretched out and fell asleep in the parking lot. This is why I bought my SUV in the first place–to have a place to sleep in between classes during graduate school six years ago. After one hour, my alarm went off, and I went back to class.  It did not matter, my mind was still reacting to the med, but now, I also felt mentally worn out.

Again, I just could not sit in that class.  After five minutes, I left.  I did not care how I appeared because I was dealing with the hurt.  I returned to my SUV and rolled down the window for air.  This time I threw caution to the wind and stretched out in the back more. I laid on my back with my boots out the side door window in the parking lot. There, I fell into a deep slumber for more than an hour.

My alarm went off, and this time I opened my eyes feeling alert.  The hurt was gone.  I walked back to class with my long hair knotted up in the back, my make up smeared, and lipstick gone.  As I walked across the parking lot, I looked back at my SUV and imagined someone seeing my boots hanging out of the window and how ridiculous that probably looked.  With the sun in my face and a pep in my step, I continued to the building and thought, “yippee ki-yay mother fucker” to the hurt.

 

 

Psychosis

Psychosis is a special word isn’t it?  It certainly conjures up scary images of insanity. Like bipolar disorder, psychosis exists on a spectrum.  I am either a little psychotic or a lot of psychotic.  Either way, it is a definitive state that is disconnected from time and space; meaning, I have been disconnected from reality.  I have experienced psychosis in two episodes–one last summer and another just last month.  My clinical diagnosis is Bipolar Disorder Not Otherwise Specified (NOS) with Psychotic Features. (Read my first post titled, “Rattlesnake, Dreamer, Child and King”)

Being told I had psychotic features, sent me quickly into denial.  I mean, basically telling me I had Bipolar Disorder for rest of my life was hard enough to handle, but to tell me I had psychotic features was another twist. Of my mind.  The word itself “Psychotic” sounds well… like the center of all things insane.  Bipolar Disorder is a mood disorder and psychosis is another realm of the mind.  “Psychotic” each syllable sounds surgical and succinct.  Like a drill.  I have spent many nights researching the word Psychosis.   Psychotic means having psychosis.  Medline plus defines it as

“Psychosis occurs when a person loses contact with reality. The person may:

  • Have false beliefs about what is taking place, or who one is (delusions).
  • See or hear things that are not there (hallucinations).”1

What I learned is that psychosis occurs from a chemical imbalance in the brain and not from an internal disposition.  Studies have shown cause and effect with an imbalance of dopamine and serotonin.  That’s why anti-psychotics are used for it. They balance the dopamine and serotonin.  Medication treatment is the only way to not experience psychosis.  No herbal remedies, sleep, yoga or meditation can prevent psychosis from occurring.  However, my psychosis is triggered from mania–I have to be in mania for psychosis to occur.  I have not experienced it in the reverse order.  All the stars have to be completely fucked up and misaligned.

So what does psychosis feel like?  I can assure you that when I experienced it,  I knew to be terrified by the disconnect from time and space.  Terror becomes the basis for my irrational behavior.  It swallows me up whole.  Psychosis is an intruder.  It is an invader that enters and quickly removes the ropes that keep me firmly tied to time and space–reality.   I cannot tell when it starts happening because the ropes are released all at once.  All this while I’m in the throes of mania.

At the time, I am not able to say, “okay, I need to chill cause I’ve disconnected from time and space” and then go lie down or stay quiet.  However, as I lose grasp, I will scream at you “What is real?” or “Is this real?” or ask if what you are doing “Is it real?” The first psychotic episode this past summer, I thought I was back in Iraq and thought it was 2008; but really, I was laying on my carpet in the middle of my living room and crying.  These behaviors are my cry for help and indicators that the ropes have unraveled.  I am in great distress as it happens.

I have not experienced auditory or visual hallucinations or maybe I did and that is why I believed I was in Iraq.  I am not quiet sure because I cannot remember.  My manic response to the delusions in psychosis is paranoia.  The two start working together to assault my understanding of my “self.”  My being.  My identity.  The worst part is that they play off each other like dominoes slamming down next to each other.  I think I know I have lost a grip with reality and that explains why I am terrified.  I must feel like there is nothing to hold on to but not for certain because I cannot remember.  I cannot stop it and probably feel like I’ve fallen into worse than an abyss–an unknown.

Each episode ended because my good friend was there to somehow help me out of it. In a psychotic mania, I can be dark, abusive, delusional and irrational.  I have not been physically violent and have not felt an inclination for it.

The second time, he was a godsend at at our expense, but his presence and words also perpetuated it too.  Anyone’s presence and help would perpetuate it.  It gets tricky to help me.  During this episode, he gently took my hand, and my psychosis ended in the snap of a finger.  Like the ropes instantly tied me back to reality again.   I have come out of each episode not understanding what I’ve just said or done. Out of sorts. Confused.  Tired.  Later on, I had flashbacks of what happened during the psychosis, and that is how I start to remember these episodes and a little of how I felt–through flashbacks.

The first time I think I was in psychosis for less than an hour, but the second time I was in psychosis for one hour.  After each episode, as I sifted through the insanity of what I said or felt, there can be no doubt that I felt terrified.  Mania with psychotic feature is an assault of the mind on the “self.” On my beautiful, hypomanic, joyful self.

 

1  https://www.nlm.nih.gov/medlineplus/ency/article/001553.htm