Rapid Cycling Bipolar Disorder: What it is and What You Can Do about it

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She said, “You’re fine and then you’re sad.  Then you’re up and then you’re depressed.  Then you’re fine and then you come back and your anxiety is out of control.  Then you’re fine again and then you’re sad.  You are a rapid cycler.”  When my doctor summed me up in that way I couldn’t help but feel deflated, almost hopeless, and at the very least, more ill than when I walked into her office.

Then I realized I’ve been dealing with this illness my whole life and the ups and downs have been such a part of my daily living that I hardly think twice about them.  To someone like her, observing from the outside with a critical eye, I must seem extremely unstable, but to me, everything feels completely normal, and believe it or not, my life does not have major disruptions due to my mood swings.

This is not to say we aren’t always trying to achieve stability because we are.  Tweaks to medication and coping skills are constantly being made.  It is a dance of fine tuning that takes the skill of a seasoned and caring specialist and the patience of a willing and compliant patient.  She said there are some people she sees with bipolar disorder who go three or four years without needing a medication adjustment.  She adjusts my medication several times a year.

According to WebMD, rapid cycling is described as having four or more episodes of mania, hypomania or depression in one year.  For many people, this is devastating and wreaks havoc on their life.  For me, it’s just another day in the life of me.

You get to the point of acceptance after living with an illness for so long and you learn that it is not going to kill you and it doesn’t have to control you either.  It doesn’t scare me anymore.  I know what I need to do to deal with my symptoms and I know that I won’t have my symptoms forever.  It is the very nature of cycling: the symptoms are constantly changing.  I think the vigilant tweaking of my medications keeps my symptoms from getting too far off-balance, so I am fortunate in that respect, but the cycling is still there.

Do you rapid cycle?  What does that look like for you and how do you cope?

As an aside, I just received news that Write into the Light was selected by Feedspot’s panelists as one of the Top 100 Bipolar Blogs on the web.  What a nice surprise!  I always thought you had to pay to be on those lists, but I was wrong. 🙂  Check out the list at https://blog.feedspot.com/bipolar_disorder_blogs/

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New Issue of Turtle Way Journal

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A new issue of Turtle Way, Write into the Light’s online mental health journal, was just published.  Check it out here!

Call for Literary and Art Submissions

Turtle Way™ is Write into the Light’s online creative arts magazine showcasing the work of individuals suffering and recovering from mental illness. Its mission is to offer experience, strength and hope to those who are living with mental illnesses.

Each issue of Turtle Way™ may include poetry, photography, artwork, and prose (including quotes, meditations, opinion pieces and essays) from individuals with mental illness and/or those who love them.

It has been quite some time since an issue has been published, but I would like to put another one together soon. So, please check out the submission guidelines here if you are interested in being a part of this project.

Bipolar Disorder and Chronic Pain

The Bipolar-Pain Connection

According to recent research, about 14% of people with bipolar disorder experience migraines and another 24% experience some other form of chronic pain. That’s almost a third of people with bipolar disorder who are in some sort of serious pain!

In particular, migraines affect 1 in 7 persons with bipolar disorder, which is 3 times more likely than the general population. I’ve been living with chronic migraine for ten years now. Some days I feel like it’s a death sentence. Some days I wish that sentence was carried out. My doctors are still trying to figure out a way to decrease the frequency of my 8 to 12 migraines per month. Apparently, “bipolar disorder and migraines are multifactorial in etiology—there appear to be vascular, cellular, molecular, neurochemical (serotonergic and noradrenergic), and genetic (KIAA0564) components in common between bipolar disorder and migraine conditions.”

Pain and Mental Illness’s Affect on One Another

In general, people with mental illness who experience chronic pain tend to have worsening symptoms of their illness. Often doctors do not take seriously the complaints of physical pain from those individuals who have mental illness. A lot of times people with mental illness have increased sensitivity to pain because they are experiencing depression. Also, because they are experiencing symptoms of mental illness, many times people with mental conditions do not seek the medical care they need to address their physical pain. This leads to greater functional impairments, poorer quality of life, increased disability, and increased risk of suicide compared to those without pain.

Treatments that Address Pain and Mental Illness

Sometimes tricyclic antidepressants or other select antidepressants can be used to help minimize physical pain symptoms as well as address depression symptoms in some patients. Care needs to be taken in patients with bipolar disorder, however, due to the increased risk of triggering a manic episode in those who take antidepressants alone. Often times, a mood stabilizer will be used in conjunction with the antidepressant in these patients.

This is exactly the treatment I am currently receiving under the care of my physician. I am excited to see if it will decrease the frequency of my migraines while addressing my depression and anxiety symptoms at the same time.

Non-pharmaceutical treatments for physical pain and some mental illness symptoms can include things such as meditation, yoga, exercise, prayer, talk therapy, and diet modifications.

Work with your doctor to figure out what may be the best course of action for you. The most important thing is to not give up hope and to never give up trying to find a way out.

Mental Health and the Highly Sensitive Person

Do you ever find that noises are just too loud? Lights are too bright? Scents that don’t seem to bother others are noxious to you? You’re always either cold or hot? You find yourself exhausted after spending time with people? If so, you may be what psychologist, Elaine Aron, calls a “Highly Sensitive Person (HSP).”

About Highly Sensitive People (HSP)

HSP have super sensitive nervous systems that pick up on external stimuli more easily than most other people’s do. They also have a hard time filtering out or ignoring cues in their environment that are irrelevant to their situation.

For example, when having a conversation with someone at a party, a HSP may become distracted by the other conversations going on around them instead of being able to tune them out. Or they may not be able to concentrate on reading a book in a quiet room with a clock ticking softly nearby.

Cluttered countertops, the noise level of a cheering crowd at a sporting event, a crying baby, a windy day, a sunny day, a hot day, tight clothes, or a dirty bathroom can all send a HSP over the edge into an anxiety attack or severe agitation.

HSP also tend to over respond emotionally to situations. They can easily pick up on the emotions of others and can even feel drained or stressed out by negative emotional content portrayed on television or in movies.

Because of their decreased ability to regulate their emotional response to stimuli, HSP often have mental health disorders such as bipolar, depression, and anxiety.

What to do if you are a HSP?

  1. Recognize the warning signs. Take notice when you feel yourself becoming overwhelmed, anxious or agitated. Ask yourself, “Am I having a highly sensitive response to some neutral external or internal trigger right now?”
  2. Identify the trigger. Is it something outside of yourself like noise, light, temperature, or smells? Or is it something internal like fatigue, hunger or physical pain?
  3. Have a plan in place to counter act your triggers. Use headphones to block out irritating noises; sunglasses to mute lighting, cold compress to cool off, if hot. Bring a sweater or dress in layers, if cold. Spray perfume on the back of your index finger and inconspicuously bring to your nose to block out environmental odors. Drink green tea for fatigue; carry healthy snack for unexpected hunger pains and pain medicine for unexpected flare ups. Take time outs from social gatherings in your car, in the bathroom or back bedroom or leave early. Drive yourself so you can leave when you need to. Wear comfortable clothing, get a simple hair style, stay organized, and keep a routine.

All of these things can help a Highly Sensitive Person thrive. Are you a HSP? How so? What helps you cope?

Are You SAD? 3 Ways to Battle Seasonal Affective Disorder

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Do you feel depressed during the winter months?  Do you get the post-holiday blues that seem to hang on through February?  If so, you may suffer from SAD or Seasonal Affective Disorder.

What is SAD?

SAD is a mental illness that consists of clinical depression which manifests during the winter months when the daylight hours are shorter.  Researchers report that the decreased exposure to sunlight during the winter months could lead to an increase of melatonin and a decrease in serotonin, both of which are brain chemicals that need to be at appropriate levels to keep an individual’s mood healthy.

Couple that with colder temperatures, which often keeps people indoors more than usual and you have a recipe for fatigue, decreased activity, decreased motivation, sadness, increased appetite, sleep disturbances, and poor concentration.

3 Ways to Battle SAD

    1. Light Therapy

For many people, light therapy is an effective way to combat SAD.  Sitting in front of a specially designed light box for a brief period of time each day can affect the brain chemicals that affect your mood.  It is best to follow your doctor’s recommendations regarding light therapy, and special precautions need to be taken for those individuals with bipolar disorder since light therapy can induce mania.

     2.  Social Activity

Maintaining an active social calendar can help ward off SAD during the winter months.  It is easy to want to stay inside the home where it is safe and warm, but that leads to isolation which increases depression symptoms.  Make a plan to put regularly scheduled activities on your calendar and stick to them no matter how you feel.

Attend church once a week or more.  Plan a weekly lunch or dinner or coffee date with friends or family members.  Join a writers’ group or other hobbyists’ group that meets weekly or bi-weekly.  Go to weekly support groups.  Take a continuing education class at the local college.  Join a gym.  Take an exercise class or cooking class or photography workshop at the local community center; anything to put yourself in contact with other people with whom you can socialize and form bonds.

    3.  Professional Treatment

Some people need medication to help manage their SAD symptoms or need adjustments made to their current medications.  If you feel symptoms of SAD, which are listed below, for more than a week or two, contact your doctor for help.

Symptoms of SAD

  • Oversleeping
  • Appetite changes, especially a craving for foods high in carbohydrates
  • Weight gain
  • Tiredness or low energy
  • Feeling depressed most of the day, nearly every day
  • Losing interest in activities you once enjoyed
  • Feeling agitated
  • Having difficulty concentrating
  • Feeling hopeless, worthless or guilty
  • Having frequent thoughts of death or suicide

Don’t let SAD symptoms go on and on, thinking they will go away on their own.  SAD is a serious disorder that needs professional treatment.  Call your doctor for help.  And if you are currently having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.

Bipolar Anxiety or Bipolar and Anxiety

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Bipolar disorder is a mental illness marked by extreme mood episodes ranging from mania to depression.  Anxiety can be a symptom of bipolar disorder as stated by Dr. Emil Kraepelin, back in 1921.  The International Society for Bipolar Disorders (ISBD) also claimed that anxiety is a symptom of bipolar disorder in a Task Force report on “mixed states” in bipolar disorder.  They described this anxiety as:

  • General hyperarousal
  • Inner tension
  • Irritability/impatience
  • Agitation
  • “Frantically anxious”

Individuals in mixed states may feel increased energy and have racing thoughts while also experiencing hopelessness and despair.  They may have insomnia and increased risky behavior but also feel empty and blank inside and have unexplained crying spells.

While anxiety can be a symptom of bipolar disorder, it can also be a separate condition in addition to bipolar disorder.  Having more than one condition or disorder is referred to as “co-morbid” and basically means that the two conditions stand alone and are not a symptom of one or the other.

It is important to know the difference because if the anxiety is coming from the bipolar disorder then it should get better when the bipolar disorder gets better.  If not, then when the bipolar disorder is stabilized, the anxiety may still persist.

There are several types of anxiety disorders.  They include:

  • Generalized Anxiety Disorder (GAD)
  • Social Phobia
  • Panic Disorder (with or without Agoraphobia)
  • Post-Traumatic Stress Disorder (PTSD)
  • Obsessive-Compulsive Disorder (OCD)
  • Specific Phobias

Regardless of whether the anxiety is a symptom of the bipolar disorder or in addition to the bipolar disorder, mood stabilizers are recommended as first line treatment choice due to the potentially mania-inducing risk of antidepressants in patients with bipolar disorder.  Psychotherapy or cognitive behavioral therapy is sometimes then recommended even before antidepressants as well.

References:
http://psycheducation.org/diagnosis/mixed-states/anxiety-and-bipolar-disorder/
http://www.dbsalliance.org/site/PageServer?pagename=education_brochures_bipolar_disorder_rapid_cycling