Why I Never Get Used to Being Stable as a Person with Rapid Cycling Bipolar Disorder

Not barely one month ago I wrote here about my mental illness, and praised the universe for my glorious period of stability.  Months of relative non-dramatic and chaos and anxiety-free days left me to do as I pleased with family and friends; with hobbies and productive work.  I even made money doing something I absolutely love to do!  ME!  Someone on disability, making a dime doing a creative job for people that I would be doing anyway on my own.  It was a dream come true this summer, I tell you, a dream come true!  And then IT happened.

One day, all of a sudden, I dreaded the next paid gig that I was so eager to do just weeks prior.  The thought of having to do it; of being obligated to do it now weighed so heavily on me I started feeling panicky.  I was overwhelmed at the thought of all it entailed and so, so unmotivated to go through with it.  All I wanted to do was crawl into a hole and hide for the next … well, indefinitely.  I couldn’t focus on the amount of steps the whole job called for and I especially couldn’t cope with the social interactions it forced me to have.

Then two weeks later, the kids went back to school and things only got worse from there.  My depression plummeted to another level as I spent every day at home alone in bed with no purpose other than to get up when they came home seven hours later.  I came across this awesome mental health pain scale put out there by Rori, the Graceful Patient, and thought, “By God, I am already at a solid 6 going on a 7 here, and I was a fricking 1 five weeks ago!”

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As an aside, before my stable period this summer, I was in a mild depression for several months through the end of spring.  This is me.  This is the life of rapid cycling bipolar disorder.  It is not pretty or fun or predictable.  Although, many times the depression does coincide with transitional events like the kids starting school in the fall and ending the school year in the spring, so there is some predictability in that sense.  But, for the most part it is riding a mood wave that ebbs and flows over the course of weeks or months, sometimes even days when it gets really ugly.

So, here I am, turning to the thing I always turn to when I start to feel crazy: writing.  I get into that darkness and I write myself out (i.e, “write into the light” = this blog’s name.)  I also went and saw my doctor, of course, and told her what was going on.  So, I’m starting yet another new med this week.

I have been on so many medications I couldn’t even name them all.  No joke!  I seriously wouldn’t remember all of them that I’ve tried over the last 17 years.  I do know we make changes or adjustments at least a couple of times a year due to my rapid cycling.  She told me one time she has some patients with bipolar that go years without a med adjustment but not me and my rapid cycles.  I’m what they call “hypersensitive”…to people, to meds, to situations, to changes, to seasons, to temperature, to noise, to lights, crowds, to smells.  I also fall under the description of an “empath” as well, which explains a lot of my ills after being around certain people and large crowds.  It also explains my excellent intuition.

All of this just makes me realize this whole mood disorder, sensory system, personality thing is very complicated and intertwined.  Who’s to say what one thing is and what’s another or where one thing begins and another ends?  People are complex.  Don’t judge or compartmentalize, if you can help it.  We are all so much more than our labels.  Kind of makes me want to retitle my post.  But, for Google’s sake I won’t.  Google search likes labels. 🙂

Do you or anyone you know experience rapid cycling moods?  How do you cope with it?  What helps you manage?

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/

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

Mental Illness is a Surmountable Obstacle

~ Guest post by Jackie Cortez

According to the World Health Organization, 1 in 4 people suffer from mental illness. And while treatment is available, it’s often underutilized.

For many people, mental illness can be something that troubles them periodically in life but never something that incapacitates them. For others, mental illness can be completely debilitating. What’s important is recognizing mental illness and treating it with the best approach for people so they may live healthy, productive lives.

Inner turmoil

While there are social stigmas attached to mental illness, it is the self-stigma that can be the most dangerous to a person’s overall well-being. A person with a mental illness may feel ostracized from his peers and turn to outward or inward destructive behaviors to cope. These may materialize as bursts of aggression, depression, or isolation or as reckless actions including sexual promiscuity and alcohol abuse and drug abuse. A mental illness makes it difficult to see past the negative aspects of today to the bright and beautiful possibilities of tomorrow. It is estimated that more than 90% of suicides are committed by persons with a diagnosable mental disorder. Approximately half of these individuals will struggle with drug or alcohol abuse before their death.

Physical self-care

If you’re struggling with a mental illness, you should take extra care to take care of yourself. Stress takes a toll on the body and can cause headaches, insomnia, muscle tension, upset stomach, and fatigue. These symptoms’ impact can be lessened through protecting your physical health. It is easier to maintain good mental health habits when your body – your foundation – is strong.

It is important to exercise daily. This may be done individually or in a group setting as exercise provides the body with natural stress relief hormones. Maintaining a balanced diet devoid of processed foods, including sugars, additionally goes a long way toward whole-person health. Sleep is essential and most adults require between seven and nine hours each night; a brief 30 minute nap in the early afternoon can also offer a person with a mental health disorder a bit of a boost. Most importantly, drugs and alcohol should be avoided completely as, despite common belief, these substances actually exacerbate stress and depression.

A mental illness will not go away overnight. However, many people find they are less affected when they practice these good mental health habits:

Avoid guilt

Negative emotions happen and it is important not to dwell on them or pass judgment. Understand that it is how you react to these emotions that matters. Recognize them but don’t get caught up in the moment.

Pay attention to the positive

Even in your deepest, darkest hour, positive things are going to happen in your day. It could be as small as a glimpse of the mountains or fresh ocean breeze. When they happen, pause and enjoy. It may help to keep a journal and write down one good thing that happens each day. You can go back and read about your happy days when you’re feeling sad or stressed to remind yourself that not everything in life is bad.

Find strength in numbers

There are virtually countless support groups in every city in every state for people struggling with mental illness. You can perform a quick online search for groups in your area. Know that you cannot solve things on your own and there are people out there who, like you, are dealing with invisible and taboo issues. Spending time with others will not only help you get things off your chest but will keep you connected to the world around you.

If you or someone you love is dealing with a mental health issue, such as depression or drug abuse, get help. Always remember there is no shame in asking for assistance from others, be they medical professionals, family, or friends. Tomorrow is a new day and a new opportunity to look at the world with a fresh set of eyes.

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~ Jackie Cortez works with The Prevention Coalition to identify and highlight resources on every aspect of substance abuse, ranging from prevention to addiction treatment. Her mission is to use her writings to help prevent drug and alcohol abuse.

Neuroimaging Shows Increased Activity in Bipolar Mania

In a recent study looking at the difference in neural activity between persons with bipolar I disorder who were experiencing mania, those with bipolar I disorder who were experiencing euthymia or a normal, non-depressed mood, and persons who did not have any psychiatric disorders and were considered “healthy controls,” researchers found some significant differences in two brain networks.

The first was in the Dorsal Attention Network (DAN), which is a group of regions in the brain that plays a large role in our internally motivated goals using our visual attention and short-term memory processes. In other studies, increased activity is evident in the DAN after the presentation of cues indicating where, when, or to what participants should direct their attention.

In this study, those individuals who were manic had significantly higher levels of activity in their DAN compared to the euthymic group and the healthy control group, possibly explaining the often apparent hyperattention, arousal and emotional response of those experiencing mania to external stimuli.

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This figure shows the increase of connectivity in mania (A) versus euthymia (B)

The second brain area assessed was the Default Mode Network (DMN), which is a group of brain regions that shows a lower level of activity when we are working on a particular mental task like paying attention, but higher levels of activity when we are doing more generic thinking tasks such as daydreaming, recalling memories, guessing about the future, monitoring the environment, speculating on the intentions of others – just thinking without any task-oriented goal in mind. Recent research has begun to find connections between the DMN and mental illnesses like anxiety and depression. Also, meditation is thought to be related to the DMN, which may be why its influence in well-being is significant.

Of particular note in this study, was the fact that those with bipolar disorder in a euthymic state showed hypo-connectivity in the dorsal nodes of their DMN compared to the mania group and healthy control group. The mania and healthy control groups showed the same connectivity.

Does this mean that the euthymic group was more relaxed, less worried about the past and future, less concerned about their surroundings and the behaviors of others than the other groups? Even the “healthy” group? I don’t know. The researchers didn’t comment on what this particular finding suggested other than the fact that this dorsal node is the exact location that corresponds to the target for transcranial magnetic stimulation (TMS) for the treatment of depression, even though they made sure to reiterate the fact that the euthymic group was not depressed.

The researchers pointed out the fact that their study’s results contribute to a body of growing evidence that points to bipolar mania as a behavioral pathology due not to circuit disruption but rather increased coherence (connectivity).

As far as the hypo-connectivity of the dorsal nodes of the DMN in the euthymic group goes, the researchers were not sure if this was due to a compensatory mechanism of the disorder trying to right itself or if it was in fact still part of the diseased state.

Of note:
– Diagnosis was determined using the Structured Clinical Interview for the DSM-IV (SCID)
– Limitations of the study included a small sample size of 23 manic, 24 euthymic, and 23 healthy controls.
– There were no significant differences in participant age, sex, and medications

Resources:

Differential brain network activity across mood states in bipolar disorder
Dorsal Attention Network
Dorsal and Ventral Attention Systems
Know Your Brain: Default mode network