Knowing Your Symptoms – Staying Ahead of the Episodes

Knowing Your Symptoms – Staying Ahead of the Episodes

I decide to look up from my screen this morning and I see the beautiful image of a sunrise. Without even realizing it, I stayed awake all night long. This was not done on purpose. In fact, I took all of my nighttime prescriptions and supplements like I always do. I’m not sleeping as well as I normally do, but at least I’m usually sleeping. Last night, however, I hope was an anomaly. I finally fell asleep around 8:15am and woke up at 10:00am. Something was off and I’d like to know what it was so I can avoid it in the future. Was last night a symptom or just a bad night? Everyone has bad nights on occasion.

My mind wanders constantly, I don’t need/want as much sleep as I’m used to, my energy is greatly increased, I’m dealing with auditory hallucinations, and I feel a bit more restless than normal. These all appear to be manic symptoms. However, I also have increased anxiety/panic, I’m indecisive, I feel worthless and pathetic, and I’ve had ongoing suicidal ideations. These seem to be depressive symptoms. I have learned over the years, through both manic and depressive episodes, to pay attention to my symptoms. It’s important to be able to tell your psychiatrist what symptoms you are experiencing, when they began, and how severe they are. I have currently been dealing with most of these symptoms for months, but the restlessness, wandering mind, and increased energy are new within the past couple weeks.

Knowing and keeping track of your symptoms can help you stay ahead of the episodes; at least that’s my experience. Sometimes I’m not aware of my own symptoms, so my husband or the rest of my family tell me what they see. Since my sleep has been so terrible lately, especially last night, I am concerned that it will enhance my other symptoms. All I can do to stay proactive is to be aware and then report the changes to my doctor. I can’t control the symptoms, but it’s important to bring them to the attention of my doctor. However, almost every time a new symptom happens, I tend to wait weeks or months before saying something, thinking that I can handle it on my own. I don’t like going through medication changes and new treatments. I already know that I’m coming up on a medication change next week. I have to decide between Clozaril and IV Ketamine by Tuesday, so my mind says, ‘What’s the point in saying anything if I’m already facing a med change?’ This is not a logical thought, but it is what goes through my mind. It’s possible these symptoms are brought on by the stress of choosing a new form of treatment and/or the loss of an old friend. I know the right thing to do, but I tend to procrastinate. My doctor already knows everything except how bad the sleep has really become. I can commit now that I will update him by Tuesday at the latest when I give him my answer regarding the new treatment.

The Importance of Those Who Understand

The Importance of Those Who Understand

You know the moment when your bipolar episode takes over, but you don’t exactly notice it until a few seconds after it happened? Well, that happened to me yet again. I’m pretty sure I’m overthinking it, but simply put, I just say things I shouldn’t say. My mouth keeps going because my head won’t stop. I have dozens of thoughts all at once, and for me, I can see the connections. However, I know that what I’m saying doesn’t exactly make sense to others. This may be becoming one of those times, and if so, I apologize.

I openly discuss my bipolar disorder here, and with some of my family, generally with those that I feel or have shown to be understanding. Mental health is not an easy thing to understand, and I don’t want to put too much stress on anyone by telling them what’s happening, but I may have just done that. It will probably all be okay, but my mind has played out at least 30 different scenarios where I get in trouble. I wish I could stop this senseless thought wondering, but it’s part of who I am, and I just need to learn to deal with it a little better.

This is another reason why I find support groups so helpful. The friends that I’ve made at the support groups I’ve previously joined are there to help me through all sorts of events, even the ones that are only in my mind. I have become close with these individuals and I’m so grateful for that, especially with one individual. It’s a give and take relationship, but we empathize with and encourage each other. In my opinion, having someone who can empathize with me can make all the difference. Empathy is about being able to understand what someone is feeling because you have experienced it on your own, while sympathy is simply recognizing someone’s emotions and providing support. It makes me feel so much more comfortable knowing that I am not alone. That every thought and action, no matter how extreme, is also felt by others who love me.

This is not to negate the love and support from my family. Honestly, I prefer that they don’t completely understand my emotional state, I don’t wish that upon them at all. I’m grateful for the individuals that do not struggle with mental health issues. But for the individuals that can relate, it’s important to stick together. My husband keeps trying to get me to go to a new support group, and I put it off because I’m afraid. Yet now that I think about it, only good things can come from it as it has before.

 

Alone but Wearing a Mask

Alone but Wearing a Mask

How is it possible that I can be surrounded by people I’m comfortable with (which is not an easy task), yet I still feel alone? In fact, I tend to feel even more alone, lonely, and depressed than I do when I’m actually all by myself. Don’t get me wrong, it’s not like I feel good about myself when I’m all alone, but for some reason I tend to feel even worse about who I am when I’m surrounded by others. This is especially how I feel in the past couple weeks.

Feeling like this makes it extremely difficult to pretend everything is okay when in a group of people. I have become pretty good at faking okay. I have some automatic responses and a fake smile that goes along with those answers. It’s as if I’m wearing a mask, but I’ve recently found out that there are aspects of bipolar that I can’t cover up.
Masks 3-19-16
The extreme episodes can be read on my face, even if I can deter some of the manic or depressive behavioral changes. I have had people who work at stores that I regularly visit who have pointed out that they can tell something is wrong. Usually it’s my anxiety, panic, and restlessness that tell people I’m faking it. I’ve been told that my face shows how I’m really feeling, despite what I say or how I act.

I’m aware that any emotion I feel while either manic or depressed, is not always real. If I seem to be happy, it’s probably just because I’m manic and can’t sit still or control my emotions. And when I’m depressed, just because I fake a smile doesn’t mean I’m really happy or feel good. The truth is that lately, I pretty much feel alone, no matter what. This has nothing to do with my friends or family. I know that I am loved and supported, especially by my husband and my mother. But I can’t help how I feel or my mood swings. If only I could show people how much they mean to me, no matter how I feel, but that is not something that I see as a possibility, at least not for today.

The Importance of Support Groups

The Importance of Support Groups

There are many different types of treatment for any mental health disorder including but not limited to various types of medication, talk therapy, family education, rehabilitation, and support groups. I have especially found support groups to be helpful in dealing with and managing my bipolar disorder and PTSD. There are various types of support groups; some are for generalized mental health, while others specified for certain disorders.

I was very reluctant to go to a support group my first time because I was afraid. One of my PTSD symptoms causes me to be terrified of anything, especially anyone, that I don’t know. It’s a challenge for me to simply run errands; the thought of sitting next to another person and talking about my life seemed to be impossible. When I was in Connecticut, I researched support groups at my local hospital and found a weekly group called ‘Depression and Bipolar Support Group’. In the beginning, my mother came with me, she has always been extremely supportive of me in every way. It took many weeks to get comfortable with the others at the group, but soon, these individuals became close friends that I still talk to years later.

Going to a support group where the other people there have the same illnesses as you do is a comforting feature. I moved back to Arizona in 2009 causing me to leave my Connecticut support group and the friends I have there. Again, I was scared to start going to a new support group. Meeting new people and the intimacy of discussing what’s going on in your life and how you’re feeling is nerve-racking for me. My husband came with me in the beginning for this new group, ‘Taking Control’, which is also for bipolar and depression. Over time, the others in this group became my close friends who I still hang out with.

Each support group that I have been a part of has become a huge part of my life. The groups gave me a place to go and talk about my mental health issues where other people actually understand and relate to me. Sadly, my last support group was discontinued, but luckily I still talk to and see some other group members. I have found a new support group for bipolar depression called ‘Bipolar Bears’ (I love the name), but again, I’m extremely frightened to go. This is a new group for me, at a hospital that I’ve never been to, in a part of town that I don’t know. I’ve talked to a close friend from my last support group, and we have talked about going together; we will support each other, while we go to a support group. Now, I just have to get myself to actually do it.

Mental health support groups have helped me get through many difficult times and I suggest them to anyone and everyone who struggles with mental health. Being able to have people relate to the things we go through is a very comforting feeling. Meeting more people that help support you through your life is a blessing. Maybe this post will help me actually get to this new support group. I suppose I’ll find out soon enough.

ECT – Electroconvulsive Therapy

ECT – Electroconvulsive Therapy

Electroconvulsive therapy, ECT, is one way to treat severe depression and mania. The treatments are done under general anesthesia, allowing the doctor to induce a seizure by passing small electrical currents to the brain. ECT is known to be controversial because of how it was administered many years ago and the serious side effects it used to cause, but it is now much less dangerous.

I started ECT in February 2015 because no other treatments were working and I was desperate for something to help. In the beginning, I was doing the treatments 3 times a week for 4 weeks, then once a week for 4 weeks, then every other week for 8 weeks, and finally once a month. It has been a successful treatment for me. It has not solved all my problems or completely removed my depression, but it did get me out of a major depression when every other treatment failed. At this point, I want to stop the treatments, but I remind myself how beneficial they have been for me.

ECT is physically demanding the day of the treatments. I’m groggy (I assume from the anesthesia), I have confusion, my jaw hurts badly from the seizure clenching, and my body is overall exhausted. All of these symptoms go away within at least 24 hours. The only lasting effect I have is memory loss. Supposedly, the memory loss for most patients is temporary and only goes back a couple weeks or months at the most. Memories generally comes back shortly after treatment ends. However, my memory loss goes back years. I had even forgotten that my grandmother passed away, so I had to deal with her death all over again. Since I’m still doing monthly treatments, my memory does not improve. The cost is also a difficult aspect to handle, but all of the side effects and aspects are still easier to deal with than many months of a major depression with no relief.

Today was my 33rd treatment. It’s a lot on my body and mind. I don’t know how much longer I can handle these treatments. I know that my psychiatrist and my mother want me to continue with the therapy because they have been mostly successful. They are concerned about what will happen if and when I stop because of the success. This I understand, but I wish they would put themselves in my shoes. I feel that if ECT got rid of my depression and made me stable, then I would be happy to continue. However, I still take 7 different psych medications every day and an additional 2 medications as needed. In addition to all of that, we are going to be adding another psych medication within the next couple weeks. I also have to take 3 other medications for some medical conditions. I hope I get to stop ECT at some point, but I fear that if I do, I will regress to a horrible depression or mania.

Mixed Episodes – Feelings of Depression are Too Much To Handle

Mixed Episodes  – Feelings of Depression are Too Much To Handle

I feel worthless and pathetic pretty much every day. If I’m lucky, I’ll get a 20 or 30 minute reprieve during the day where I still feel horrible, but I don’t necessarily wish I was dead. I have not been lucky today. I am continuing to experience a lack of sleep and an excess amount of energy. My productivity is ongoing, I continued to deep clean various parts of our house and organize everything I could find. However, even though I remained physically energetic, my emotional side diminished into an even deeper depression.

From the moment I woke up today, I felt as if I could do nothing right. My mental state has been overall unworthy. My feelings are menial, shameful, worthless, insignificant, pathetic, stupid, and undesirable just to name a few things. Just as an example to the depths of my emotions, I watched a movie that is absolutely hilarious, but I wasn’t able to laugh at even one thing. I just stare at the TV, watching the movie and trying my best to sit still, and I listen to others laugh hysterically.

Normally I am capable of faking how I feel. I just put on a ‘happy mask’ and I don’t let people see how I’m really doing. I have been waiting all day for even the smallest part of my emotional state to change, but there have been no improvements. Honestly, I don’t really expect anything to change, I don’t deserve to feel better.

Tomorrow morning is my next ECT treatment. I’m not looking forward to it, but I will be extremely grateful if it can help even out my mixed episode. Feeling this depressed but not being able to sit still is extraordinarily excessive. It’s too much on my brain and my body. I wish I could allow myself to give up, but that’s not something I allow myself to do.

IV Ketamine vs Clozaril

IV Ketamine vs Clozaril

I know I need another form of treatment, and my psychiatrist is respectful enough to give me a choice. However, as stated in my last post, making any decision is extremely difficult. This decision feels as if it’s nearly impossible.

At first thought, IV Ketamine terrifies me. I used to get high off of Ketamine, I’m now 11 years sober, but the possibility of dissociation is what scares me the most, it brings back traumatic memories which trigger my PTSD. I’ve already tried Clozaril once and ended up with a fever around 2 weeks. I had no other symptoms and my weekly blood work came back completely normal. Even though Clozaril is a very risky medication, it doesn’t scare me like the IV Ketamine does.

The information I found out about Clozaril after research and talking to my psychiatrist:

  • Giving Lithium with Clozaril can help prevent the low white blood cell count with a 94.5% success rate. I am already on Lithium, so this is beneficial to me.
  • The risks of this drug are increased for me because I’m Ashkenazi, which is Eastern European Jewish heritage.
  • Only 1-2% of patients that take Clozaril develop agranulocytosis, a blood disease that increases the susceptibility to infection. Only 1-5% of patients may have seizures, but that can be avoided by titrating the dose up slowly.
  • Clozaril is 60% effective for patients.
  • I would have to do weekly blood tests for 6 months, then do blood tests every 2 weeks for 6 months. I could then go to blood tests every 4 weeks if there were no problems. Blood tests are required to get medication.
  • From what I understand, my worst case scenario is: I start to get a fever or other symptoms, I call my psychiatrist, he would send me to the hospital where I would get blood work done and they would make sure my fever goes down. Then I stop the medication again and have to try something else. This is what happened last time.

The information I found out about IV Ketamine after research and talking to my psychiatrist:

  • The IV Ketamine trial consists of the first 2 treatments, which are done within 1 week. I would generally start to see some type of result within 24 hours. If I don’t see results after the first 2 treatments it would be considered ineffective for me.
  • This treatment is very effective, and patients don’t have to wait 6 weeks for medication to start working.
  • I would be monitored at all times by a doctor. If I had a panic attack during the infusion, he/she would be able to treat me.
  • I can take something for my anxiety before the treatment to help me stay calm.
  • Some patients experience dissociation during the infusion. Dissociation can cause a lack of control mentally and/or physically. This is the part that is a trigger for me. Just writing about it now is causing a massive anxiety attack.
  • Maintenance treatments are done anywhere from every 3 weeks to every 3 months. Every patient is different.

Now that I have all of this research, I should be able to make a decision, but my indecisiveness is always there. I’m leaning more towards the Clozaril rechallenge. I understand the risks and as long as I immediately tell my psychiatrist about any symptom I have, I should be okay. I know I could get a fever again and it won’t work, but then my options will be narrowed down for me. I also have several reasons not to do the IV Ketamine. First of all, it terrifies me. I’m having an anxiety attack right now just thinking about it, what will happen when it’s time for the actual treatment? It is very expensive and not covered by insurance. The first 2 treatments are $600 each, and every maintenance treatment is $400. The IV Ketamine is also new to me, and new things scare me. I’ve done the Clozaril before so I know what to be on the lookout for.

The only reason I’m considering either is because the psychiatric benefits outweigh the medical risks. Writing this post has helped me realize how scared I am of the IV Ketamine. I don’t think I could handle the treatment. I think my best option is to rechallenge the Clozaril.