Treatment-Resistant Bipolar Disorder

Treatment-resistant bipolar, also known as med-resistant, is something that most of us know too much about. Sadly, it’s extremely common. Being diagnosed as treatment-resistant generally depends on the number of medications a person has tried during the phase that individual is in. Many individuals have been through all sorts of different medications without much success. And then of course, if a person finally finds a medication that helps even a little, it comes with side effects that are too much to handle. I have been considered treatment-resistant by my doctors many times throughout my diagnosis. I have taken so many medications that I’ve lost track of them all. I’ve even lost track of the horrible side effects. I know that for me, Abilify sends me into a huge manic episode, Depakote causes me to lose my hair, and I gained 80 pounds on Risperdal. Those are just a couple examples of medications that I couldn’t handle.

Treatment-resistant doesn’t mean that there’s no answer; there are several individuals that are treatment-resistant that have gone into ‘remission’ for multiple years. I am one of those individuals. Somehow, I was able to live a regular life, work a full-time job, and have a full-time social life. I don’t know what happened or what changed, but after a little more than 2 years, something changed. I was still taking my medication and seeing my doctors, but it was as if I was a ticking time bomb. Then I exploded into such a massive manic phase that I had to leave my job and go live with family. I haven’t been stable since that time, but I do know it’s possible. Sometimes I wonder if I can ever get back to the place in life that I was at before. Honestly, I don’t know if it will or will not happen, but I haven’t given up.

There is always hope, even for those that are treatment-resistant. New treatments and medications are always coming out that could help. Sometimes, a certain combination of medications or treatments is the key to remission. It’s not easy to be patient, or willing to try new treatments, but you never know when one of these new methods will be the key to our health. I am always willing to research and usually try new treatments and medications. I am doing ECTs, electroconvulsive therapy, every month (I’m doing the maintenance treatments at this point), and I am doing a rechallenge of the Clozapine medication. The ECTs helped me get out of a major depressive episode. The Clozapine is supposed to help take away my suicidal ideations; it’s too soon to tell how effective it will be. My conclusion regarding treatment-resistant bipolar is that you never know when some new treatment or medication is going to help; don’t give up before the miracle happens.

How Much Longer…?

Do you ever wonder if you can make it? Even if it’s just for one more day, can you handle life that much longer? It seems that no matter what you do, everything is working against you. If you’re anything like me, it’s a daily burden that you have to deal with. I’m constantly asking myself, ‘Am I okay? What if…?’ Sometimes, when I’m able to think positively, instead of asking myself, I tell myself, ‘ I’m okay. Everything is good.’ I say these things even when I know they’re not true; I guess I say them hoping to convince myself that they are true.

I constantly worry about pretty much any situation you could think of. I’ve had some people tell me, ‘Don’t worry, just relax’, and honestly, that makes me want to punch them in the face. Do they really think I would choose to live like this? Would I honestly decide to have anxiety attacks every day and almost never feel safe or secure? Nobody chooses this life; it’s not enjoyable or manageable. Living without control over your own moods is torture. These types of symptoms, the constant anxiety, not feeling safe, and questioning if life is worth it, tear apart a person’s life piece by piece. My support system is the reason I keep going, but it’s not easy. I just want to give up most days, but for some reason, I don’t, I never give up.

I compliment those individuals who are able to live with these symptoms and the other bipolar and/or PTSD symptoms and continue living their lives entirely. Individuals that can go to work, take care of their families, maintain a home, and manage their symptoms are impressive; I admire these people. That used to be me. I had a full-time job, a full-time social life, and I maintained my own home. I miss being able to do that. I’ve been on disability since 2009, and I wonder every day if I’ll ever have that type of life back. Even my therapist is unsure if that will happen; he said so himself. He says that I’m working on learning to deal with these issues better.

I hope I’m not the only one that feels this way; I feel lost enough already, I don’t want to be lost and alone. Although at the same time, I really don’t want anyone, even someone I don’t like, to experience these situations and emotions. All I can do is to stay positive, even if it’s fake, I just think positively. I pretend that things will be okay; if you think something enough, eventually it could come true.

Bipolar Extremes: Finding Balance

I tend to be quite the extremist when it comes to my mood swings. I either have so much energy that I can’t stop cleaning or I can barely get off the couch to get anything done. I will admit that I somewhat enjoy the first few days of my manic episodes. I love the fact that I can get so much done; my house looks beautiful, dinner is always ready for my husband, I find it easier to run errands, I call my family and friends to catch up, I need less sleep, and some things are less anxiety provoking than usual. I love all of that; if only it would stay that way, but it never does. I run out of things to do, I start pacing and shaking, I make random and inappropriate phone calls, and I spend money more freely than I usually would; these are just a few examples of my bipolar mania. Often, when I’m manic, I still feel pathetic, worthless, and insignificant, as well as deal with suicidal ideations. I think that some of these episodes are considered mixed episodes because of how badly I feel about myself; mania generally has feelings of elation.

As my manic episodes come to an end, I tend to crash hard. All of the sudden, I’m sleeping way more than I need, I have a hard time getting out of bed or getting up to do just about anything, and my feelings of worthlessness and uselessness grow even deeper along with my suicidal ideations. I never get a break from feeling horrible about myself, no matter what type of episode I’m in. While I like the productivity aspect of the mania, there is not one part of the depression that I enjoy. I wish there was a way that I could feel okay and still be productive, but I haven’t found one yet.

What I really want is to find some middle ground somewhere. I must have experienced it at some point during my life, but right now, I can’t remember any moment like that. Maybe it’s just because of my memory loss from ECT. I know that I have come out of a few major episodes before, but no matter how balanced I seem, there is always something going on in my head telling me how pathetic I am. I just have to trust that I have had balanced times in my life. This is where positive thinking comes into play. It’s not easy to be positive, but there are several techniques that I use to help me through these difficult times. None of these techniques are easy to do, but they are vital to our health.

Use these techniques to get past the bipolar extremes and find peace and balance in our lives:

Remember there is always hope; believe in that hope. If you can’t, having someone else believe for you can help. When I can’t, my husband and mother believe for me.
Reach out to your loved ones and caregivers.
Find a support group that you’re comfortable with.
Be 100% honest with your psychiatrist, otherwise they can’t help you.
Take your medication as directed, otherwise it won’t work properly.
Write down the different methods that help you feel better and worse so you know what to do and not to do in the future.

Productivity with Bipolar Disorder

Being productive can be an extremely difficult task for those with bipolar disorder depending on their mood. Personally, I have no problem maintaining productivity when I’m manic. In fact, I can’t sit still during manic episodes; I’m always finding something to do. However, staying productive during a depressive episode is one of the most difficult challenges I face; it can even be difficult at times when I’m feeling well. I use the following techniques to help me stay productive and organized:

I make a to-do list every day. During depressive episodes, I write down some of the smallest tasks such as make the bed, feed the dog, brush my teeth, etc. Writing these things down helps me to see how much I actually get done every day. Once I complete a task, I cross it off my list; this shows me all of the things I’ve done each day.
When I’m really struggling with depression, I write down some tasks on my to-do list that I’ve already completed and cross them off. Then I can look at my list and feel more productive.
To-do lists not only help me stay productive, but they also help me remain organized. My mind tends to get easily distracted, so organizational skills are extremely important for me.
Taking medications regularly is vital. Our doctors prescribe these to us for a good reason; the meds can only really help us if we take them regularly, as prescribed.
Keeping a regular routine is also extremely important. This includes waking up and going to bed at the same time, showering at the same time, eating at the same times every day, setting aside a specific time each day to call friends or family, and working out at the same time every day are some examples of learning to keep a routine schedule.
A good night’s sleep is extremely important. It helps us to stay healthy. It’s important to sleep in bed instead of on the couch, and it’s also important in my experience to sleep at least 7 hours. If only I could follow my own advise for this one. Sleeping is something that’s easier said than done, but we can generally be more productive when we’re not tired all day long.
Exercise helps us feel good, and when we feel good, we are more productive. Walking the dog is a great form of exercise. Sometimes, all I can do is walk around the house, but it’s better than nothing. Sometimes I can do workout videos, but it’s not necessary to push yourself to do that much, as long as you do something.
Eating healthy is important. This is another one of my struggles. I tend to eat things that are easy to grab; or when I cook it’s generally unhealthy but tasty.

These suggestions are what I use to stay productive and feeling healthy. The to-do lists and taking medications are the things that work the best for me. I know I need to improve with the other healthy habits. They don’t always work, but it’s better when I try. Please remember that these suggestions are just from another person diagnosed with bipolar disorder, none of this information is from a doctor or medical professional.

Clozapine (Clozaril) Labs & Registration

Friday was the beginning of the Clozaril rechallenge (generic is Clozapine) process. I had my blood work done; there was some difficulty getting the lab to send the results to my doctor and my pharmacy. It was partially my fault, I did give them the wrong fax number for the pharmacy, but it took 4 phone calls to try to fix the mistake. Even when they finally said the problem was resolved, it turns out that it wasn’t; the pharmacy never received the results. Luckily, I ended up talking to one of the nicest and most caring pharmacists since my father and aunt. He was happy to call the lab himself and request my results so that I could get my prescription. Once he got my lab results, he realized that I had to be registered again in the Clozapine Database because I hadn’t taken the medication since this past summer; all patients need to be registered by both their pharmacist and their doctor. My pharmacist told me he would call me once the registration is complete so I can get my prescription filled. There aren’t many pharmacists that are as polite and happy to help as he was.

Sometime tomorrow I should receive a phone call from the pharmacy letting me know I can bring in my prescription. I admit that I am nervous. I’m not nervous that I will end up with some of the horrible side effects of Clozapine such as neutropenia, which is an abnormally low level of white blood cells, making the patient susceptible to infections. This is why there are so many protocols with Clozapine. I feel like I should be nervous about it, but I’m not. What I am nervous about is the fact that I don’t know if this will work or not. I’m trying to remain positive; I keep saying that this time it will work, I won’t get a fever, I won’t have to go to the hospital, and there won’t be any problems. I’ve been so nervous about this rechallenge, my anxiety level has been much higher than normal; I’m anxious even sitting at home in my comfort zone.

Is this weird that I’m more concerned the medication won’t work than I am concerned that the med will cause serious side effects? I think it’s just because I don’t know how much longer I can live like this. I have had suicidal ideations for more than 5 months. My hallucinations keep getting worse making the paranoia intolerable. And in my mind, the worst part of it all is that I won’t do anything about it. I can’t take my own life, no matter how much I think about it. I know that technically that’s a good thing, but if you lived in my mind for even a day, you would understand. Every day I put a smile on my face and do my best to pretend everything is okay, but inside I’m a disaster. I want to live and be happy to be alive. I need this medication to be the answer. I’ve taken pretty much every other medication and I still do ECTs. I currently take 7 other psychiatric medications, 2 additional meds to treat side effects, and 3 other medications for physical conditions. I just need to catch a break, I’m hoping that will happen with this Clozapine rechallenge. We’re all about to find out.

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.

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.

My Side of the Pole

Bipolar – Mental Health

Tag: Depression