Planning Ahead Helps Reduce Stress

I have a difficult time doing anything that is not in my normal schedule. Even if it’s as simple as going to a new store to go shopping, meeting someone at a restaurant I’ve never been to before, or going to a get together at a family member’s or friend’s house. I do my best to prepare myself for any situation that I will be getting myself into. Basically, all I try to do is to find out as much information as I can about the upcoming event and come up with a plan for what I can do if I have an anxiety/panic attack, if I start crying, or if I become uncomfortable in any way. Planning helps me feel safer and reduces stress when I walk into these unknown situations, but it doesn’t always solve every problem.

For example, today I went to two different family member’s houses. The first house was somewhere I had never been before. I started planning by trying to figure out who was going to be there, my husband helped me with this. Then, my mother helped me by reminding me that I can handle this. Also, if I became too uncomfortable or scared, I could always walk outside and call someone to talk me through it. Additionally, I planned on taking a Valium on my way over there to help keep me feeling relaxed and prevent an anxiety/panic attack. Furthermore, I planned on sitting by someone I’m very comfortable with and having my husband sit on the other side of me, that way no one could catch me off guard.

Nothing every goes perfectly as planned, but things almost always go better when you have a plan rather than going in unprepared. When I arrived at the first house today, I was surprised to see that there were 5 people there I didn’t know, and I had no clue these people would be there. I freaked out at first, my heart started to race, but at least I had taken a Valium, otherwise my reaction would have been much worse and more noticeable. Then I thought about my plan and I sat myself down next to a family member that I find enjoyable and is also understanding of my bipolar disorder. This kept me calm. I used these techniques help me through the day, and to my surprise, it was easier than I thought it would be. I’m sure that the people I didn’t know thought I was different because I avoided them at all costs, but oh well; all I really cared about was making it through the day without freaking out.

The second house I went to was fine; I’m already comfortable with the people there, and everything went well. I’m proud of myself for making it through the day, especially since things didn’t go as I thought they would. Planning ahead doesn’t solve every situation, but it does make it a whole lot easier. It also helps a great deal to be with someone that knows your situation and is there to support you; for me, that’s almost always my husband. He knows how to make me feel safe and comfortable. I’m extremely grateful for his love and support, as well as the love and support from my mother and other family members.

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

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

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.

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

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.

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.

My Side of the Pole

Bipolar – Mental Health

Category: Bipolar