Let there be LIGHT

Even though we live in Arizona, both my mom and I notice that we tend to slow down a little bit as the amount of daylight lessens. As I headed into my winter blues last year, my Dad bought me a light box to use as an adjunct to medicines. At the time, I didn't think it was working at all, but this year, that light box has become a miniature mecca I turn to at least once a day.

The theory, explained decently by a retailer in Alaska, maintains that less daylight means irritability, depression, lessened libido and massive carb cravings. Ha! And I thought that was just a natural part of Thanksgiving!

Anyway, using my light box, I've managed to stick to my nine hour sleep schedule without too many problems. I still have a very low threshold for stress; stupid things like cleaning my cats' litterbox will loom like mammoth projects when in actuality, they take about two minutes and dramatically improve my quality of life.

In the past couple of days, I've become very frustrated with the state my life. Last week, provigil put me into a bit of a medicinal haze and I couldn't escape from its stupifying clutches. This week, I'm itchy to be back on top of my game.

Looking at my mood chart for the past month helps me understand my confusion about how to articulate my state of being. One day I'm up, the next day I'm down. I'll spend five days up and the next week down. I've never been a rapid cycler. Usually I fall into deep depressions that lift into shorter hypomanic periods. Pinging between the two is confusing.

The mystery remains.

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Sleep Hygeine

In the interest of actually improving my condition instead of just analyzing it, I figured that I should look at some of the stuff therapists, doctors and old grandmothers tell us that we should do to make our lives better.

For me, one of the first ways that I know my life is out of balance is the amount of sleep my body craves. When I'm up, my body wants about 5-7 hours and when I'm down, my body begs for 10+ hours. I can track my sleep habits and the corresponding mood shifts easily when I look at the macro-trends of my mood chart.

Since I'm in a 10+ phase at the moment, I've been pondering what the professionals say about how much sleep I should be getting. Apparently, 8 hours a night is the general consensus and some contend that the number of hours is less important than having a regular pattern. Some folk even posit that electrical lights are to blame for activating bipolar disorder.

Anyway, I've been trying to reset my Circadian rhythym so I sleep from 10:30-7:30. I figure 9 hours should be plenty of sleep for a gal like me. But I've been having problems keeping my eyes open when I read. I find myself sinking into bed for afternoon naps. I get irritable and generally cranky by 8 pm because I want to get to sleep.

There are hypothetical answers to these problems. I could sleep more. I could chug caffeine in the hope that it would stimulate wakefulness and not crankiness.

Harumph. I think that I have a lot of good ideas when it comes to helping myself deal with bipolar disorder. But having the ideas is certainly not the same thing as implementing them. I guess I'll keep trying to maintain my sleep routine as best as I can.

Of course, travel and the holidays are never conducive to a solid schedule but I'll try nontheless. I suppose it only makes sense to start with the most elementary aspects of our lives first. I mean, I guess I need to exert some kind of control over how long I'm asleep before I can have an influence over what I do with my waking hours.

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Pop Rocks and Coke

When I was a little kid, I was always told that if I swallowed pop rocks and drank a can of coke, that my stomach would explode and I'd die an excruciating death. Similarly, I was told that if I made nasty faces, my face would get stuck that way and I would have to go through life looking stupid. My mom told me that the oil marks on the pavement near the grocery store were the remains of children who didn't hold their mother's hands.

We all believe in a lot of bizarre things when you think about it. Some people believe that there are faeries in the woods who sing and act of little mischievous deeds to bother passerbys. Others believe that there is life on other planets, that the Simpson-esque Kodos and Kang are hanging out above the atmosphere on their flying saucers watching us, as if we're that interesting.

But how do we know when our beliefs transcend a belief to become a reality. For example, how do I know that any of you exist beyond my imagination? How do I know that I have blood pumping through my veins? How do I know that my parents are my parents?

There are a lot of things that we think we know that we kind of take on faith.

When your foundations shake because of the quirks of mental illness, you have a lot of time to think about this. One of the things I think about everyday is why I take my medication. The ladies on my listserv tell that I'm in a phase that I will grow out of eventually, that everyone goes through their rebellious not-wanting-to-take-meds thing.

I don't claim to be different. But I can't help but wonder if taking these medications and expecting them to work is a bit like watching fireflies and pretending that they're faeries dancing in the twilight.

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Lab Mice

In a recent study, researchers found that lab mice who were given antidepressants in their youth grew up to be more depressed and anxious than their unmedicated counterparts.

This information doesn't actually mean anything to the average depressed or bipolar person. In fact, most of us will never even be aware that this study was done. But it does have some wicked implications, particularly for those of us who were given drugs in our younger years, and those of us who are still contemplating getting pregnant.

Man. I need to get over this love/hate relationship that I have with my meds. I know I need them, but sometimes I wish that I could just stop taking them and be done with it. I have this tiny dream stowed away that maybe after I have my kids, my biochemical environment will become overtly hostile to any resurgence of bipolar disorder. Could happen, right?

My perspective, which has been a bit dull, flat and apathetic as of late, is starting to recuperate in an attempt to throw off the medicinal shackles holding it down. It's this epic battle that I can feel in my head. It's like the invading medication is trying to disturb the restless residents of my synapses and no one is particularly happy about it. No wonder I always have headaches.

Hmmm. When I think about the medications we take right now, I make mental notes to pray for people who research these medications, their efficacy and their consequences. Hopefully progress will march on indefagitably.

Some eggheads somewhere have estimated that there are 10s of millions of depressed people in the world today. They've found that despite a low standard of living, people in Nigeria are the happiest people in the world. Makes you wonder, doesn't it? Is all of our progress really worth it if we aren't happier or healthier? Are we prioritizing the wrong stuff?

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Seductive Somnolence

I'm sitting next to my light box trying to figure out why I've been so exhausted lately. Last night, I slept for 11 hours. This morning, I woke up and felt like I had only slept for 5. My eyelids felt heavy, my thoughts sluggish.

In fact, I feel like a sloth hanging lazily from the branch of my favorite tree, constantly eating and contributing to my expanding girth. I feel uninspired and overwhelmed by even the simplest tasks. My limbs feel heavy, like each cell weighs ten pounds.

And in my stupor, I'm annoyed. And upset. I've been in one of those moods for about a week. I want to shake some sense into myself. But I'm stuck and quite cranky about it.

Ugh. I'm angry and cranky and I feel like sitting down and having a tantrum any self-respecting two year old would be jealous of. (I can't believe I just ended a sentence with of! twice!)

I desperately need to get myself heading in a different direction. This one isn't working for me.

I wish I knew how to change this crappy mood. :(

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Unintended Consequences

So as I mentioned before, my pdoc started me on provigil, which some have called the new panacea handed out like speed to depressed people. Personally, I'm getting to the point where I don't give a crap about what these meds claim that they do because inevitably, they have some horrific consequence like the development of a flesh eating rash or the repeated development of an open sore on the tip of your nose.

I'm convinced that instead of making me more alert, it has merely heightened the urgency I feel about needing to sleep. Moreover, I have a horrible headache, I feel like I want to beat the crap out of everyone, and I feel lethargic. Sad. My memory has faded like an unspectacular sunset and thinking of the most basic words and ideas is torturous. Writing papers has been brutal, an exercise in self-control I don't have. My computer is lucky to be in one piece and I periodically email my papers and notes to Brendan so that if I lose it and destroy this hunk of junk, I'll still have the most essential data.

I don't know why I feel so sad. Maybe I'm resigning to this incessant and irritating frustration. ugh!

I'm going to stop taking the provigil. I've never responded so poorly to a medication before. I mean, I've had medications that clearly don't do anything for me, but I haven't had one push me so hard toward instability. I feel like I was walking on a precarious mountainside path before, but taking provigil has made me blind as a newborn kitten and massively more likely to stumble.

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At any rate, there are interesting posts in the bipolar blogosphere.

Michele has some thoughts on changing meds and manic insomnia.

Nick has a counterpoint for those who insist that drug costs in the US are rising. DB has more.

GrossAnatomy has some information on why we fart and a decent round-up of the supposed health care workers' draft.

James Baker questions why psychiatrists are expected to restrain mentally ill people if they are a danger to themselves or others, but other physicians feel that a quaratine is unethical.

Shazam! has returned from her trip to Honduras, so hopefully she'll be posting more often!

In a tiny study at Johns Hopkins, researchers found that certain anti-psychotics can raise a child's risk of developing diabetes.

Pediatricians feel unprepared to treat mental illness in children. Maybe that's because these kids should be seeing a specialist.

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Okay, that's enough excitement for y'all.

Keep breathing. We'll all make it.

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The Missing Post

Ugh! It seems that cyberspace has gobbled up my previous post and I don't want y'all to feel like I'm rejecting my blog because I love it, but I'm also terribly sleepy.

Here's something to sustain you, via The Scientist.

The selective serotonin reuptake inhibitors (SSRIs), a class that includes the popular antidepressants Zoloft, Prozac, and Paxil, are the workhorses in depression therapy. First approved in the late 1980s and early 1990s, their combined US sales reached $4.5 billion last year, according to Atlanta-based health information provider NDCHealth.

While SSRIs currently dominate the market, watch for a novel twist on depression treatment. DOV Pharmaceutical of Hackensack, NJ, has done early testing of a new class of medications, called triple reuptake inhibitors, which have been shown to be safe, effective, and well tolerated. "That is very interesting because it may offer enhanced tolerability over existing drugs," Hohenberg says. DOV recently granted Merck & Co. exclusive worldwide rights to develop and market its two compounds for depression therapy.

And progress marches relentlessly on.

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The Butterfly Flaps Its Wings

Somewhere along my educational journey, a fool with authority, AKA a teacher, thought it wise to attempt to explain religion and faith in terms of chaos theory. More grounded people tend to theorize about chaos theory in terms of the weather—like a butterfly flapping its wings in Brazil could cause a tsunami in South Africa. Or something like that.

I warn you that this train of thought actually has a destination!

Sometimes I feel like some molecular butterfly flapped its wee wing in my brain and set off this massive chain reaction that has led me to my current existence. That formerly-beautiful-but-now-butt-ass-ugly insect fucked with my brain and set in motion a chain of events that has forever altered the course of my life.

Now, think about this with me, every psychiatric patient knows that every medicine has some kind of side-effect, whether its the death of your libido, constipation, paranoia, irritability, eczema or the ever-ubiquitous weight gain. The pill becomes its own butterfly and it's starting to get windy.

Eventually, the side-effect becomes unbearable, so either a new drug is introduced to deal with the side effect or the old drug is removed. The consequence is more instability.

Do you see where I'm going with this? We keep taking pills until we're popping 10 a day. Makes me feel like a drug addict sometimes.

My pdoc appointment went soooo much better than the last one. Brendan is in town and I dragged him along as a few friends and commenters recommended. Brendan, being the charmer that he is, quickly endeared himself to my shrink by talking about college football. LOL!

I guess, in my mind, the appointment was relatively uneventful. He gave me some samples of Provigil for daytime sleepiness. I don't particularly feel any different, but I only started taking it this morning. :)

There was one wicked cool part of the appt though! My pdoc is interested in developing a sort of virtual office because he knows that people are always moving and traveling and so they constantly have to recreate the wheel in terms of their treatment. So anyway, he needs someone to be the guinea pig for this endeavor so he offered me the opportunity to try it when I move to Indiana. The bitchin part is, since the program is in its trial period, I'd get my appts for free!

How frickin COOL is that?

In the back of my mind, I'm sure the a digital revolution in medicine is too advanced for insurance companies and so eventually, I'll probably have to switch shrinks anyway. But I guess we'll cross the bridge when we come to it.

Of course, virtual doctoring opens up a whole new can of worms. Is the face-to-face interaction between the doctor and the patient more important than the temporal integrity of the patient's treatment? In other words, for someone like me who has lived in Los Angeles, Buffalo, Phoenix and soon to be South Bend within the past three years, is that face-to-face interaction worth losing any semblance of a long-term treatment plan?

I dunno. I suppose if my living situation had any hope of being stable in the next three years, I'd be more inclined to work with someone in person. The shrink I stuck with the longest was able to tell from my clothes and my facial reactions to his questions how I was feeling, although he didn't always know what to do about it.

I'm telling you, if I could combine him and my current doc in terms of their treatment styles, I think I might have the best doctor ever. Niedorf really understood the value of forging an interpersonal connection. He had a touch of old school psychotherapy in him. Sitting in his office felt like walking into the cubby hole of some ancient academic. He had shelves upon shelves of books—but old books like The Naked Ape. He was compassionate. I totally would have stuck with him if he hadn't made a medication error that almost killed me.

My new doc strikes me as very knowledgeable in terms of medications and diagnoses. I feel like he could probably quote the DSM verbatim and he's on the cutting edge of treatment. He probably knew about cymbalta before the FDA did. LOL. But his office is sterile. He has an enormous desk where Niedorf had his cozy rocking chair. He has his medical certifications on the wall; they're like a constant reminder that you are, indeed, in the presence of a doctor. For some reason, whenever I'm in his office, I always have the feeling that I'm a lowly subject who has been granted an audience with some aristocrat. He's not the type you would tell about a major life problem, event, change etc. Then again, I'm relatively certain he won't fuck up in how he deals with my meds.

But man, if I could squish them together and create a doctor with the hard-earned wisdom Niedorf has about people AND the academic acumen and medical expertise of Greenman...that would kick ass.

I guess I've never really given thought to what characteristics I truly value most in a shrink. I suppose when push comes to shove, I intellectually prefer the hard-core medicinal basis of Greenman's care. But emotionally, I'd take Niedorf's questions and stories any day.

Gosh. If any of you find a shrink who has both sides of the psychiatrist coin, you'd better thank your lucky stars. I hear about those patients who feel like they form a team with their shrink and their therapist in managing their mental health. I think they're an anomaly.

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Tongue-tied

I have never been a shy or private person. If anything, my friends groan and complain about me disclosing too much information. But get me around my pdoc, and I have no idea what I'm supposed to say.

It's not like appointments need to be scripted or something. It's just that the first question he'll ask is "how are you?" and my automatic response will be "I'm doing great. How are you?"

Of course, that's not the answer he's hoping to get.

Describing this illness when put on the spot can be daunting, particularly when some combination of meds and stress has turned your brain into a gelatinous goo. Besides, I'm not sure what symptoms are the most important to talk about, and what can wait until the next appointment.

My common sense tells me that I should complain to him about what bothers me the most. The problem with doing that is that what bothers me the most this morning may not bother me at all in a few days. Does that make sense? While I've been incapacitatingly irritable the past few days, before that it was my mental radio and before that it was being bummed out and before that it was headaches from Hades. So, do I complain about the most recent problem, even though it may not be the most serious because of the arbitrary convergence of the symptom and the appointment?

Then, I internally debate about which symptoms are more pressing—physical ones or emotional ones. I typically refer back to my severity scale, which is forever ingrained in my brain as a series of frowning, smiling and sobbing faces courtesy of a poster in my pediatrician's office.

But alas, I'm always concerned that I'll be having some symptom that doesn't really bother me, like my mental radio, and so I won't mention it but it will turn out to be some sort of huge red flag that I should have mentioned but didn't because it didn't fit into my severity scale rubric.

For all I know, I could be ignoring the nuclear bomb in the corn field because the corn is so much more prominent.

Ugh.

I'll let you know how my appointment goes.

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Irksome. Irritated. Irate.

There is nothing more irritating than being constantly irritated by everyday events. I was only inches away from shaving my head bald because my hair is driving me nuts. The way my fan distorts light annoys me. Everything annoys me. And then, the fact that I'm annoyed annoys me. AHHHHHHHHHHHHHHH!!!!

But I honestly cannot decide if this irritation is a symptom of bipolar-ness, or if it's a conglomeration of stress, stress and more stress. Really, I just need to win the lottery and then I wouldn't have to worry about money and I could eat out more, instead of microwaving another tomato slime package of "spaghetti." I haven't declined into the realm of Banquet dinners (which are $1 each here), but I've been tempted.

I've decided that graduate school is not good for my mental health, particularly when you write a decent 11 pager and your professor decides that it doesn't "fit within the perameters of this course" because its scope is too narrow. WHAT?!? If you aren't into academics, NO ONE in this entire history of the world has EVER critiqued a student for having a topic that isn't broad enough! I guess detail isn't her thing. So hurray, I can read 5 more books and write another 10+ page paper to satisfy her quirkiness. GRRRR.

I mean, it's not like Nov. 3, my arbitrary deadline for completing my thesis is rapidly approaching and I only have 35 pages written out of my 100 page goal.

And let me tell you, it's not like the thought of finding a moving company for my Jan. move, planning my wedding and how the f**k I'm going to pay for Christmas presents is stressing me out. Nah.

And stress NEVER exacerbates ANYONE'S mental problems. LOL!

Man, where is a hella productive hypomanic state when you need one? Damn mood stabilizers. I need to kick this crap into gear. If I'm going to have this crappy disease, I might as well be able to manipulate it better than this!

I can tell you one thing. Since I started taking meds and stuff, this crap has only continued to get worse AND the fun parts of this disorder have been swallowed whole by the stupid parts. What is UP with that?

Ugh. When I come off of these drugs to have kids in a few years, I am going to be so curious about how I'll feel after about 6 months drug free. That's not to say that drugs don't work—they do.

But at the same time, all of this crap in the news about antidepressants and Vioxx and the old phen-fen heart attack thingy has to make you wonder, at least a little, whether there isn't something to what all those hippies keep telling us about how corporate America is creating health problems only to sell us a cure.

I mean, I had this elaborate theory about how McDonalds and Jenny Craig were conspiring with the media to make women feel inferior when they read magazines with beautiful models in them, so the women go to Jenny Craig to feel better about themselves but then they watch some movie with models in it and run off to eat away their sorrows as inexpensively as possible at McDonalds. Man, that run-on sentence annoys the crap out of me, but I'm too lazy to fix it.

Let me tell you one more thing before I stick my nose in a book. The #1 worst task to work on when you are annoyed by existence is formatting footnotes and a bibliography. Trust me, you can't imagine how fucking pissed I was when I had to redo commas in my bibliography because I had accidentally used periods. WHO CARES???

AHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH!!!!

Man. I need a vacation.

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The Pogo Stick

My moods have been all over the place today. I woke up feeling downright happy—joyful even! Personally, I have everything to be happy about. I have three fantastic kittens and an adorable puppy. I have the best fiance' in the whole world. Yup, life was shiny and happy.

And then it wasn't. I sat down to try to write a couple of pages of my thesis before Brendan came into town, but my thoughts were uninspired. It felt like I was trying to view a stunning painting with 20-400 vision.

Naturally, not being able to think can be quite distressing. So I got bummed. Really really bummed.

So I spent a day couch surfing and watching college football. Seeing my alma mater's football team kick ASU's ass was fabulous. Made me very happy.

Until I tried to muster the energy to clean more of my house. But alas, it remained messy and I became bummed again.

So I took Robbie out to the dog park and he was able to play with some of his doggie friends. I love it when animals are able to be carefree and goofy. Happyhappyhappy.

And now I'm irritated. My skin itches. My face itches. My back hurts. And I want to break things. And scream. And beat pillows. And rip phonebooks to shred.

ARGH!

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The Black Box

The FDA just released the contents of the new black box labels for antidepressants. I included the whole thing, just for shits and giggles.

"McMan’s Depression and Bipolar Weekly

Breaking News Oct 15, 2004

FDA Implements Black Box Warnings on Antidepressants for Kids

The FDA has directed the manufacturers of all antidepressants to add a "black box" warning to their product labeling that describes the increased risk of suicidality in children and adolescents given these drugs. A "black box" warning is the most serious warning placed in the labeling of a prescription medication, but does not ban physicians from prescribing the drug to children and adolescents.

The warning reads:

Suicidality in Children and Adolescents

Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents with major depressive disorder (MDD) and other psychiatric disorders. Anyone considering the use of [Drug Name] or any other antidepressant in a child or adolescent must balance this risk with the clinical need. Patients who are started on therapy should be observed closely for clinical worsening, suicidality, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber. [Drug Name] is not approved for use in pediatric patients except for patients with [Any approved pediatric claims here]. (See Warnings and Precautions: Pediatric Use)

Pooled analyses of short-term (4 to 16 weeks) placebo-controlled trials of nine antidepressant drugs (SSRIs and others) in children and adolescents with MDD, obsessive compulsive disorder (OCD), or other psychiatric disorders (a total of 24 trials involving over 4400 patients) have revealed a greater risk of adverse events representing suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants. The average risk of such events on drug was 4%, twice the placebo risk of 2%. No suicides occurred in these trials.

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The FDA has mandated additional product labeling changes that include:

• All pediatric patients should be observed closely for clinical worsening, suicidality, and unusual behavior, especially during the initial months of treatment or during dose changes. At least weekly face-to-face contact is advised between physicians and patients or family members or caregivers during the first four weeks of treatment, biweekly visits for the next four weeks, then at 12 weeks, and as clinically indicated beyond that.

• Anxiety, agitation, panic attacks, insomnia, irritability, hostility (aggressiveness), impulsivity, akathisia (psychomotor restlessness), hypomania, and mania have not been causally linked to antidepressant use, “there is concern that such symptoms may represent precursors to emerging suicidality.”
• Consideration should be given to changing the treatment regimen or discontinuing the medication in patients whose depression worsens or who are experiencing emergent suicidality or symptoms that might be precursors to worsening depression or suicidality.
• Families and caregivers of pediatric patients on antidepressants need to monitor patients for unusual changes in behavior, agitation and other symptoms, as well as the emergence of suicidality, and report these symptoms immediately to health care providers.
• Rule out bipolar disorder to the extent possible. “Prior to initiating treatment with an antidepressant, patients should be adequately screened to determine if they are at risk for bipolar disorder.”

The FDA has also advised that a user-friendly patient medication guide will be included with every prescription or refill."

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The Falling Star

At a WW meeting yesterday, our leader asked us if we had ever exorcised a bad habit, like smoking or drinking. My mom piped up and mentioned that for her, a big part of learning not to smoke was viewing herself as a non smoker. Making that change in her mental outlook helped her to affect a larger change in her life. The pebble that starts the avalanche.

I've been pondering how I see myself lately. Most people have a reasonable idea of who they are and where they're going, but the past several years have really disoriented me. I'm not sure that I've had a clear idea of who I am since my mental health saga began in earnest in 2001.

I have a lot of trouble reconciling the image I hold of myself as an independent person with the memory of sobbing on the phone with my Daddy about how I couldn't possible survive school my junior year of college. Most kids freak out as freshmen, if they are going to freak out at all. Not me. I was fine as the 17 year-old adventurer. In fact, I was fine as an 18 year-old sophomore. I worked as an editor at the school newspaper and the executive director of a student assembly with a budget of more that $30,000.

And then, it was over. It was as if my rocketship just ran out of fuel. I backed out of my student leadership commitments. I was just too exhausted to do anything other than school work. Brendan dragged me out to a few shows and activities, but other than that, I only went to class, the library and my apartment.

I barely managed to graduate. In fact, the primary reason I was able to nab my degree (frickin .03 of a pt off of graduating summa instead of magna cum laude) was that my advisor cut me a lot of slack because Brendan had talked to him and told him that I was in the hospital and he knew that by hospital, Brendan meant a psychiatric facility.

I only took two courses that semester. Five semesters before that, I had taken five courses and written for two different sections of the newspaper. By my senior year, the rocketship was dead.

I picked up life again at ASU after a summer of laziness living with my parents. At ASU, my existence has retained the same lackluster glaze the last two years of undergrad had.

And here I am today.

I guess it's time that I sat down and reassessed the accuracy of my self-image. This illness has changed me. I'm not sure that I'll ever find the vitality I used to have. I think I have to reassess my life goals, scale back my dreams and learn to live my life in a diminished capacity.

It's time to accept the fact that I don't have the luxury of having "normal" ambitions because I am not normal. Instead of running an election campaign or teaching university students, maybe I'll breed dogs and work a cash register.

I think it's time for me to compromise before I become psychotic trying to capture some shape-shifting mirage of success.

Maybe I'm just bummed. Or maybe I'm on to something.
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At any rate, this study on sex and the brain is most definately on to something for you scientific nerd types.

This post over on the blog synergy provides an excellent glimpse of the challenges of having a bipolar partner.

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Switching

So far, coming down off of this high has been like lying on the spine of a feather swishing gently up and down as it makes its way to the ground. The workings of my brain are starting to slow down. The hamster is coming off of its crack and is finally moving at a more normal pace. My thoughts are slowing a bit too.

I'd be lying if I said all was well because all is most definately not well. I've been beset by a fatigue so thick and unrelenting that I can scarcely get up to turn my alarm off and crawl back in bed. When I first settle in to sleep, I feel like my body is impossibly heavy, as if all of my blood has turned to steel.

The way I see the world is changing as well. Do you remember those red things that had the little circles with pictures around the edges and when you held the red thing to the light and looked through it, you could see the picture? Well, if my normal life is looking through those little red viewfinders with no intervening picture, that is to say, that I see everything as it actually is, lately my view has been obscured.

Focusing on small tasks is difficult. My concentration is gone. I can barely drive and listen to music at the same time. I can't watch TV and blog. I'll start reading a book for school and be overwhelmed with the need to do something else, like empty my dishwasher.

I'm frustrated with my current state of being. I hate being distracted. I hate losing my train of thought in the middle of a sentence. Trying to compose an argument in my mind is like trying to make out a broken cellphone signal when you get every third word and an occasional sentence here and there.

Not being able to think the way I always used to is devestating. I feel like my mind is turning into an amorphous sludge from its former cauliflowerish grandeur.

I hope my thinking returns someday. It's the thing I miss the most.

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Mixed Messages

In the wake of the FDA's decision to include blackbox labels on antidepressants and Merck's "voluntary" recall of Vioxx, the media is tittering with news on the relationship between pharmaceutical companies and physicians. The rest of us merely read these stories and laugh.

Anyone who has ever been to a doctor's office, or worse, a convention can see the telltale signs of this consanguinity. The pens, the clipboards, the samples, and even the bags you take stuff home in bear the label of some multi-billion dollar corporation.

I guess the more significant question is, does it matter? Does the fact that my doctor gets tons of free stuff from pharmaceutical companies matter in the course of my treatment?

It's a scary question to ask yourself, when you really think about it. I mean, optometrists who successfully sold proclear compatible contact lenses got kickbacks from the manufacturer. When you know that and your optometrist recommends proclear lenses, do you think you're getting the best quality lens for your eye? Maybe. Maybe not.

I feel for pdocs. The few tools they do have that actually work are under attack.

I mean, when Prozac has that same little box that cigarettes do...

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Fire Burn, and Caldron Bubble

In the 1800s, travelers would write down their observations of foreign lands and upon returning home, the more worldy and wise folk would find a publisher for their thoughts and voila, Alexis DeTocqueville emerges as a philosopher. I wonder what someone who could slide around my glia would say upon their return.

I can imagine this sign at one of my synapses describing the bizarre tidal pattern. There's probably a herd of visitors there right now trying to check things out. Some nerdy Dad with a camera around his neck is dragging his bored little kid through an exhibit about the abnormal synaptic activity.

I've been pondering my brain a bit lately because I've been plagued with the return of my daytime tiredness. I expected it would return and, as my body is apt to do, I've fallen into a frustrating pattern. I'm half-awake and unfocused during the day and just as I lay down to bed, I remain exhausted but my mind launches itself into overdrive.

For example, last night I was thinking about what would happen if a terrorist cell detonated a nuclear bomb on the moon. This, naturally, gave way to a bizarre tale of how I found a nuclear bomb in my office at ASU (gotta love Tempe!) and when I tried to alert the nearest law enforcement official about it, he wouldn't believe me and when I insisted, he threatened to institutionalize me. So I went home, grabbed my pets and headed over to my parents. As I was speeding East, I saw the mushroom cloud in my rearview mirror. Surreal.

Anyway, as I was just about to get incredibly cranky about this whole thing, I stumbled on this study that suggests that "abnormal thalamocortical network function may underlie sleep anomalies and complaints of nonrestorative sleep in depressed patients."

Ha! Now all those 14-hour nights of sleep feel more justafiable.

At least my mood is still decent, although I think the bull is about to trample this matador.

That's the impression that I get.

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Brendan's Rant

One of the aspects of my relationship that I value the most is that Brendan and I can disagree with each other and scold each other without being afraid of jeopardizing our relationship. In fact, I don't know what Brendan would say, but I believe that disagreeing with each other and using our influence for the better is part of what makes our relationship strong and healthy.

Life is roses, but those fuckers can have some nasty thorns. And in a good relationship, your partner should tell you when you are headed for a thorny spot, even if you don't want to hear it.

When Brendan read my last post, he was not a happy camper.

So he let me know how he felt:

...I totally don't approve of this:

In talking with other bipolar people, I've found that a lot of us will tell each other about our benign hallucinations without feeling the need to tell our pdocs about it. Patients can be so strange, but I guess we all have our reasons.

I don't know, nor particularly care, what other bipolar people do, but YOU NEED TO TELL YOUR DOC about this stuff!!! You're probably right that it doesn't matter that much if it seems benign and doesn't affect your daily life right now.... but neither you nor I have the expertise to make that call!! What if your "benign hallucinations" are a warning sign that worse hallucinations are possible, and one of your medications might tip you into bad hallucinations if your dosage is changed at some point down the road? What if the "benign hallucations" indicate some heretofore unknown quirk in the diagnosis that is crucial to your future long-term course of treatment? The point is, you have GOT to tell you doctor about what is going on with you! That's what he's there for... that's what you pay him the big bucks for. You can't hide stuff from him! That's SO STUPID! It's like going to the doctor when you have a cold and not mentioning that you've been throwing up everything you eat ... how the hell is he supposed to know if you don't tell him? Not acceptable, not acceptable at all!! It's one thing if you feel some sort of undeniable urge to put on a "performance" for your doc by wearing weird clothes or something. Fine, whatever. But you at least need to tell him all the pertinent information and not keep things from him for ANY reason, including that you don't think they're important. That's not your call to make, because you're not qualified to make it, you don't have the training or the expertise. It's your doc's call (in consultation with you, of course), because that's his job, and he is qualified!!

Similarly, coming off your meds because you feel like it is also not okay!!! Don't trick yourself into shirking responsibility for your actions by saying, "Well, I was feeling kinda manic." I know you don't always have complete control over what's going on in your brain, but I know you, Becky, and I know that (except perhaps in your very, very worst moments) you do still have control over things that you know are very important. Like not actually crossing the yellow line, or not actually going and having sex with another man. Well guess what? You need to add your FUCKING MEDICATIONS to your mental list of things that are VERY IMPORTANT!!! You can't just fuck around with this stuff. I know the "trial and error" business sucks, but the fact is, you're making things worse when you make arbitrary changes, because now the doc can't even figure out the results of the "trial." If you have a change in your condition, how is he supposed to know whether it's because of getting on Lithium or because of arbitrarily getting off Lamictal? He can't know, because you introduced a variable that wasn't supposed to be there! If you're really in a place where you feel like a medicine is doing you absolutely no good, or even doing you harm, TALK TO YOUR DOC about it!! Honestly and candidly!!

And if I seem ticked off, well, I am!!! This is OUR future that's at stake here -- not just yours, ours! And our babies' future, too! (Awww...babies.) And I won't tolerate you playing these games with your health! You're smarter than that, Becky!!!

Okay, rant over. I think we're even now, on the scolding-each-other-for-being-dumb front. (Remember, you scolded me twice on Thursday. :)

I love you a lot. (Even when you do dumb things and/or things I don't approve of, I still love you!)

I miss you.

Love,
Brendan, a.k.a. your hunny bunny

Now that's a verbal smackdown if I ever heard one. So why am I not upset? Several reasons.

First, Brendan is not trying to be demeaning in any way. He's looking out for my best interests and I know that. Yes he's mad. But he's mad because he wants me to be in the best shape I can be in. Somehow, in the midst of this smackdown, I got the warm fuzzies because I know that Brendan cares so much about me and because I feel the same way about him, I'll probably redouble my efforts to hang in there while this whole medicinal Gordian knot is waiting to be untangled.

Second, I'm not upset because I do the same thing to Brendan when he deserves it. In my opinion, we have a duty to take care of each other and we can't do that if we don't confront each other about our mistakes.

And third, I'm not upset because I guess a part of me thinks he's right. Maybe I shouldn't admit that! :)

Either way, I'm just so in love with my Brendan. I have the real deal. I think that's part of how I know that I actually have an illness with this whole bipolar thing actually. If I can have the best man on the face of God's beautiful earth and still feel blue, something is definately amiss.

Awww. Warm fuzzies.

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Benign Hallucinations

I'm of the belief that there are two kinds of hallucinations in this world: the scary, dangerous type and the benign, relatively amusing type.

My only experience with the first variety happened when I was withdrawing from Effexor (which I will NEVER take again after withdrawing from it!). I was so out of it, sick and just generally in pain and miserable. I kept feeling like there were bugs—beatles, cockroaches or fleas—crawling all over my skin. Not only is that sensation horrifying, but the truly scary part was that I wasn't entirely sure that I wasn't actually covered with insects. I mean, now I know that I wasn't, obviously, but at the time, it felt SO real.

That's why some hallucinations are so crappy. My friend Eric, another bipolar kid, totally lost it once when he stopped taking his meds and ended up spending 3 months in a psych ward doped up beyond comprehension. Combining hallucinations with delusions is no good. Poor Eric. He ended up being interviewed by the FBI because he honestly believed that he was a secret informant with information for Hilary Clinton. Can you imagine being sedated off your gord while simultaenously being interveiwed by the FBI!?!

Anyway, the second kind of hallucination is different because it doesn't really cause a problem. In talking with other bipolar people, I've found that a lot of us will tell each other about our benign hallucinations without feeling the need to tell our pdocs about it. Patients can be so strange, but I guess we all have our reasons.

Right now, muffled beneath the sound of my dishwasher but still clearly audible, I keep hearing a commentator announcing a football game. I'd imagine that I'd be hearing this because I watched far too much college football today, but still, usually when the TV is off, you stop hearing the sound!

I don't mind it though. It's not like hearing football commentary that isn't actually there is going to hurt me in some profound way. (Ha! There was just a holding call. lol!)

I also occasionally hear people call my name. Sometimes that will scare me a little because I'll be alone in my house and I'll hear someone whisper my name and dude, I totally grab Robbie (my beloved pooch) before I double check the locks on my doors. Not that Robbie is at all effective as a guard dog. He'd be much more likely to hurt someone with his boney tail than with his teeth.

Anyway, I have been hearing things a bit more often these days. I think it's because I'm under a lot of stress trying to write my thesis and do a halfway decent job at it so I can graduate in December. People keep telling me that I can delay my graduation, but I have my heart set on graduating this year.

In my mind, as crazy as that mind may be, hallucinations only become a problem when they actually interfere with your everyday life. They have to cross that threshold. It's like knowing the difference between being moody and being bipolar. If you're moody, why put yourself through the system and pay all that money to fix a problem that wasn't all that bad to being with?

On a completely unrelated note, a couple people have asked me about what meds I take. At the moment, I take 20mg lexapro, 450 mg wellbutrin and 900 mg of eskalith. I take xanax for anxiety once in a great while. I also take a multivitamin, a vitamin B6 supplement, a vitamin E supplement, chromium carbonate (which is rumored to help stabilize blood sugar) and a handy pill w/ my essential fatty acids in it.

I've been taking the lexapro and wellbutrin for over a year and the eskalith for about, uh, 3 weeks maybe. In a moment of manic retardation, I figured it would be a good idea to stop taking my lamictal, so I'm off that. Honestly, I still don't think it was doing much for me. Others have said that it has been like a miracle drug for them.

Hmmm. I suppose getting a wee bit of sleep every now and then will probably cut down on the voices too. :)

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It's Not Me, It's My Brain!

Check out this news story from the university of Michigan. The highlights:

"ANN ARBOR, MI - People with bipolar disorder have an average of thirty percent more of an important class of signal-sending brain cells, according to new evidence being published by University of Michigan researchers.

The finding, in the American Journal of Psychiatry, solidifies the idea that the disorder has unavoidable biological and genetic roots, and may explain why it runs in families.

The discovery is the first neurochemical difference to be found between asymptomatic bipolar and non-bipolar people. It could help the understanding and treatment of a disease that affects as much as 1.5 percent of the population. Bipolar disorder has in the past been known as manic depression.

"To put it simply, these patients' brains are wired differently, in a way that we might expect to predispose them to bouts of mania and depression," says Jon-Kar Zubieta, M.D., Ph.D., assistant professor of psychiatry and radiology at the U-M Health System. "Now, we must expand and apply this knowledge to give them a treatment strategy based on solid science, not on the current method of trial and error. We should also work to find an exact genetic origin, and to relate those genetic origins to what is happening in the brain."

You know, Zubieta is on to something here. This whole trial and error method of treatment doesn't breed the best doctor-patient relationships. I mean, it's one thing to manipulate your hair style and something entirely different to fuck with your brain chemistry.

I wonder if, years from now, somebody will look back in horror at how mental illness was "treated." Will the future looks on us as barbaric? In some ways, I certainly hope so. I hope medicine will advance to a state where people can legitimately manage being bipolar instead of suffering through years of medication changes misdiagnoses.

One of the women on my listserv said that it took her 11 years to find a tolerable cocktail that actually controlled all of her symptoms without causing some hideous side effects. That's more than a decade. That's unacceptable.

Of course, I'm on my way to joining her in the long quest for some good medications. It'll be 3 years this month that I've been searching.

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Hamsters on Crack

When I was a kid, I had this fat, but adorable hamster that simply adored running in his squeeky wheel all night long. Eventually, I had to disable the wheel at night so I could sleep, but the little bastard would run and throw himself into the sides of the cage until I relented and repaired his wheel for him. I don't know how I managed to get the diabolical hamster. Rotten luck, I suppose.

Anyway, I was actually thinking about hypomania which made me think about sex which made me think about prostitutes which made me think about walking in heels which made me think about my hamster's wheel. Somewhere in that convoluted train of thought, I started thinking that hypomania is a lot like sex. Sometimes, it's absolutely mind blowing and earth shattering and amazing (hat tip: Brendan), usually it's marvelous and fun and occasionally, it's just not exactly what you were hoping for.

The strange part of my current hypomania is the sense I have that if my mood is like a whore, I have a slave-driving pimp. Alternatively, if my mood is my hamster, that little fuzzy ball of doom is going to implode if he doesn't run in his wheel all night long.

I'm not only energetic and productive (finally!), but I'm frantic and frazzled and driven by some force my psyche isn't exactly comfortable with. I'm entirely ambivalent about my current state. On one hand (does it have to be a hand? why can't we say on one foot?), I love being ambitious. It brings me back to the days when I was drowning in work, sleeping 3 hours a night and loving every second of it. I feel alive in a way that I haven't in months. I feel like I'm more myself like this than at any other time. When I die, I want people to remember me when I'm this way.

On the other hand, this particular jaunt into the realm of superBeckydom has had drawbacks heretofore foreign to me. My first prolonged sojourn into the manic spectrum of this charming disorder was beautiful. Not only did I feel impervious to the petty machinations of those around me, I also felt intensely coherent and capable. And apparently I was, seeing as how I have this bitchin "Undergraduate Student Leader of the Year" award hanging on my wall. On a big ass urban campus like USC, that award made me feel even better than I already did.

This time is different. It's not that I don't feel great, because I do. It's just that there's a fly in my jello. I'm so easily distracted; I feel like I know what it's like to be one of those C students in grade school. My thoughts seem like those of a drunk on speed—they race enthusiastically around my head and forget where they were going about halfway through their journey. I feel exhausted but I absolutely cannot sleep more than 8 hours a night. (Doesn't seem like a big deal, but from the girl who was averaging 12+, it's quite a change.)

I get anxious in an irritated sort of way. Instead of feeling the impeding doom of a panic attack, I feel this gnawing, grating, persistent anger that warps into an unnerving intuition that all is not right with the world.

I feel more self-destructive than I did before. I've been tempted to throw wild tantrums, an urge I've thankfully resisted as adult rages accomplish very little. I've been contemplating picking up some average bloke at a local bar for a carnal treat. Thankfully, I see Brendan often enough to restrain that urge, but the powerful temptation swells and berates me incessantly. I suppose that aspect of things isn't so different from previous episodes...as I suspect quite a few of my former neighbors with ambiguous sexual identities could attest to.

Honestly, I try extremely hard to manage this illness well. I have a rough daily schedule. I take my vitamins and my meds (most of the time). I work out. I see my doc.

I know that certain behaviors and impulses I have (ie, the "let's buy a new sound system for my car" impulse or the "let's pick up the first willing male" impulse) aren't the most productive or helpful. I know I shouldn't act on them.

But we don't always do what we should.

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If I won the lottery

Have you ever played the "if I won the lottery..." game? The AZ lottery has chugged up above $100 million. Given, you win that kind of money and you barely keep any of it because of taxes and what not. But could you imagine it? Winning, let's say, $30 million after taxes? Wow. How fantastic would that be?

Some people dream about cars and houses when they think about winning the lottery. I think about health care. I sit around and think about how with that kind of cash, I could see any doctor anywhere in the US. I could take any medication I wanted for however long I needed to. I could see a therapist...everyday if I wanted to and uh, they had the time. I could get my blood tested everyday, take all sorts of body and brain scans. I could get a daily massage. Oh! And I could hire a delicious personal trainer to motivate me to get to the gym. I could order food from one of those healthy delivery places that costs a fortune, but gives you a balanced diet anyway.

Even better, I could get into an intensive outpatient program when I feel really messed up instead of waiting for the feeling to pass. I could build some sort of mental health Mecca for people like me so we could have a place to meet and support each other and develop peer-to-peer groups and such. It could have a big ass fish tank, cuz fish are supposed to be soothing.

random aside

When I was researching a paper about gender identity disorder and Robert Stoller once upon a time, I spent way too much time in the archives of UCLA paging through Stoller's old notes. He's a cool guy. If I ever find my ambition again, I'd love to write a biography while Richard Greene is still with us (or the Brits anyway). So yeah, Stoller. Somewhere in his writing he mentions explaining gender identity to a young boy using guppies.

That was one of the more disturbing papers I wrote. At one point, the gender identity disorders clinic advised parents to hit their kids whenever the youngins performed some gender deviant behavior. I had this horrible vision of some 6 year old boy wearing a towel like a dress giving a concert for his stuffed animals when his Dad catches him and whips his belt off and wails on the kid.

random aside over

Where was I? Oh yeah, the lottery. I guess there's a reason that I'll never win the lottery. I mean, it would kick ass, but Lord knows that with all the money in the world, I'd still get depressed about something stupid.

At least I'm not alone.

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Addictions

While procrastinating this morning, I stumbled on an article about NYC teens abusing prescription medications. While I have to confess that reading this article merely confirmed the numerous reasons why I would never want to live in the city, a part of me felt for these kids a lot.

Personally, I thought being a teen was fun, despite all the ups, downs and uncertainties that come with the territory. But, given teens' propensity toward melodrama, I do pity parents. How do you know if your kid actually requires professional intervention or if adolescence is just rearing its ugly head?

I think there are two primary indicators of severity—persistence and degree. Being a teenager is like watching The Real World on MTV. Dramas happen and they seem like the the most important event in the history of mankind, until next week, when something new comes up.

Illness is different. It's that extra ten pounds around the middle that just won't go away. It's that inexplicable shadow hovering over success. It's seeing the full glass as half empty.

But you know, this article makes me mad in some ways because these kids are fucking around with serious medications and illicit drugs and such, and then they seem surprised when their brains get all whacked out. I guess this can become a chicken and egg question; were their brains messed up by the drugs or did they turn to drugs because their brains were messed up? Either way, I'm never as sympathetic as I could be toward any mentally ill person who is using some hardcore drug. I mean, if you're doing coke and complaining to me about being paranoid or anxious, I'm not going to cry a thousand tears for you.

I suppose my caveat to this is that I actually do feel bad for people who are untreated who abuse drugs and alcohol. I guess the distinction I draw is that some people, like the priviledged teens in this article, have access to quality mental healthcare. They can afford it.

For so many ill people, a constant supply of beer is a helluva lot cheaper than regular appointments with a shrink and adequate amounts of psychiatric medications. And I feel bad for them because they genuinely can't afford it.

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The Mind is Absent

My mind is quiet today. I feel like I'm watching a really fabulous movie without sound. Everything's a bit disconnected.

I'm exhausted as well. I could sleep for 16 hours and wake up hoping the day will be short so I can sleep again. Maybe that mono is rearing its ugly head again. Or maybe the crash is coming.

I feel like I'm in that part of a horror movie when the protagonist is walking down a long, poorly lit corridor and the audience sees a dark figure move silently in the shadows. The evil sadistic murderer is just about to stab our heroine with a jagged hunting knife when she turns around, sees him and *poof*, *sputter*.

Sorry folks. This tape ends there. We don't know what happens to her, or who the demon is or what she's doing in that hallway.

My life in a nutshell right now. My brain starts on an interesting train of thought that can only end in some mundane, yet worthy discovery but every freakin conductor decides to stop the engine before we get there.

I feel like I'm on a choppy sea in a small boat. I'm getting bounced around without any coherent idea of where I'm going and why. And ha! Maybe I'm taking on water that looks an awful lot like my thesis and I have a bucket that looks an awful lot like pages of text and I can only keep this dingy afloat by getting rid of some of that freakin water.

I don't know if you've ever read Ernest Hemmingway's "The Old Man and the Sea." It's short and horrible. But I swear I feel like that old man right now, trying to make it against the odds. Hopefully, my journey won't end with broken dreams and an enormous carcass.

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Outside In

My visit with Brendan in South Bend has been wonderful! From playing presidential debate drinking games to tailgating to listening to live bands play in semi-smokey bars, we've had TONS of fun. I've met so many friendly people whose names I'll never remember.

I'm surprised I've been doing as well as I have. Usually, I get anxious going out, particularly with a bunch of people who I don't know very well. I suppose that's not such a bad instinct, but it gets annoying when I have Brendan right next to me and I'm still all keyed up.

I've been feeling more shy and self-conscious than usual. Sometimes, I feel like I could walk around completely naked and not care at all whatsoever. Today, I feel like everyone is staring at me, or worse, they aren't seeing me at all. Everything has been clear-cut extremes the past few days. Either I'm the white girl at the black panther's meeting or I'm the wallflower trying my hardest not to be noticed. It's rough.

I've been having trouble with getting dizzy and feeling utterly exhausted. I feel like I'm walking around with 80 extra pounds all the time, just dragging me down. I'm still in good spirits, but I guess I'm also pretty scared of heading into another depression.

I feel like I'm walking on a razorblade. As long as I keep my balance, I'll be fine, but the instant I take a false step, it's going to be nasty.

I'm scared for myself. I wish there was something I could do to ensure that I'll be okay.

I guess I'll be saying my prayers.

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