Category Archives: Research, Reviews & Resources

Comorbid Bipolar and Anxiety Disorders

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The largest treatment study of bipolar disorder conducted to date found that more than half the study participants with bipolar disorder also had a comorbid anxiety disorder.*

I have been experiencing what I thought were hypomanic symptoms – decreased need for sleep, restlessness, increased productivity/creativity, project-oriented tasks, irritability, OCD behaviors, agitation, and distractibility.

However, since my over all mood was not elated or euphoric but rather anxious, my psychiatrist said I was experiencing anxiety and not mania. I do tend to cope with anxiety by “keeping busy” to distract myself and to work off all of that “nervous energy.” And I get a bit obsessive with cleaning and organizing my environment in an attempt to control my surroundings in some way when I am feeling “out of control” on the inside.

It is frustrating to get confused on what my symptoms mean, however. I guess that is what the doctors are there for – to assess and diagnose. I would like to think I knew myself and my illness a little bit better by now though, but I guess we are always learning, aren’t we? Do your symptoms ever confuse you?

*Reference

Impulsive Decision Making in Bipolar Disorder

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block-party-pacific-beach-bike-jumping_w725_h544I try to make healthy decisions regarding my lifestyle. Things like eat well, take my meds, get proper sleep, limit caffeine, don’t drink or smoke. Some things are harder than others.

Today, I threw away my only pack of cigarettes with a new resolve to quit once again. I had plans to download a quit-smoking app to keep track of my days quit and to get active on the online smoking cessation forums which were a great support to me in the past. A half hour later I was retrieving the pack out of the trash and lighting one up.

Yesterday, I decided to start counting calories. My goal is to lose ten pounds. I lost more than this last year and have kept it off, so I know I can do it again, but by last night I was baking, and then eating way too many, chocolate chip cookies. My calories were blown for the day.

Impulsivity is running rampant in my life lately, and quite uncomfortably I might add. Initiating too many impromptu social visits is leaving me stressed and fatigued, but I can’t seem to curbed the impulse to do so. Shopping sprees are rampant under the guise of procuring Christmas presents.

Following these impulsive acts comes guilt and shame, plummeting self-esteem, and the beginnings of self-hatred. Up then down. Up then down. The wonderful life of bipolar disorder.

It helps to remind myself, however, that this cycle is not my fault. It is not a character flaw, a punishment, a sin, or a weakness. It is a biological, chemical, brain disease of which impulsivity is but a symptom.

I found a recent study where researchers looked at euthymic patients with bipolar disorder who were not taking antipsychotic medication and 20 case-matched controls performing a roulette task during functional magnetic resonance imaging. The controls showed higher brain activity during safe reward prospects while the bipolar patients showed higher brain activity during risky reward prospects!

The bottom line is impulsivity is part of bipolar disorder. Accepting this is what we have to do. It does no good to beat ourselves up over something we can’t control. Does this mean I am going to give up trying to quit smoking and losing weight? Absolutely not!

We must never give up trying to get better. We have to keep fighting our symptoms whether it be through medication management, lifestyle changes or both, all the while remembering that they are just that – symptoms, not who we are as a person, but just symptoms of a horrible disease that we didn’t ask for and don’t deserve. A disease that we do have and will continue to deal with the best that we can.

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Meditation: A Cure for Depression and Anxiety?

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Neuroscientists now have evidence proving what meditators have been saying for years: Meditation can improve people’s physical and emotional health.

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Imaging studies show that meditation increases certain areas of the brain responsible for memory and emotion. “Also the parts of the brain that respond the most to stress gets smaller with meditation. This means that anxiety and depression naturally fade with a meditation practice,” according to researchers.

I’ve been doing mindfulness and guided meditations using an app called “Insight Timer” on and off now for about a year, and I definitely notice a difference in my anxiety levels on the days that I meditate versus the days I don’t.  Although on many of the days I meditate, my anxiety level is already low because I tend to have trouble focusing long enough to meditate when my anxiety is high. Go figure!

I do believe the effects of meditation last me a few days and are somewhat cumulative in that sense. So, even when I meditate on a low anxiety day, it could be helping me avoid a super high anxiety day the next day or the day after that.

Meditation hasn’t had an effect on my bipolar depression levels, but maybe it would if I practiced it more consistently since one of my depression triggers is anxiety.  It’s probably worth a try, but to be honest, I have my doubts.

What about you?  Do you meditate?  What benefits has it brought to your health?  Or in light of this recent research, would you consider trying meditation?  Why or why not?

Book Review of An Unquiet Mind

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I recently read An Unquiet Mind: A Memoir of Moods and Madness by Kay Redfield Jamison. It is an older book, published in 1995. In it, Jamison details her life events beginning in childhood through adulthood with Bipolar I disorder.

She focuses mainly on the mania part of her disorder and on the love relationships of her adult life, as well as on her experiences with lithium, the drug used to treat her bipolar disorder. Much detail is given to her academia life as a psychologist, and to her world travels as woman who never had children, making this memoir a bit inaccessible to me as a homemaker and stay-at-home mom.

Moreover, I have bipolar type II, have never been on lithium, nor have I experienced the extreme manic highs of Bipolar type I disorder, so I couldn’t identify with much of her story, making this book a bit of a disappointment to me and a waste of money for me.

However, if you have Bipolar I and long-term treatment with lithium, you will be able to identify with a lot of what Jamison writes.

When Better is Not Well in Bipolar Disorder and Depression

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bipolarLast week, the Depression and Bipolar Support Alliance (DBSA) hosted a forum entitled “Better is Not Well 2014”, in Chicago, IL.  I do not live in Chicago, so fortunately, they streamed the 90-minute event online where I was able to view it from home.

The purpose of the forum was to discuss the issue of raising treatment expectations; of taking patients from simply “surviving symptoms to creating thriving lives.”  The forum moderator and presenter, Allen Doederlein, opened the discussion by listing some of the negative consequences of living with residual mental illness symptoms.

When we’re not all the way well we are:


– at greater risk of relapse
– at greater functional impairment
– more likely to have co-occurring life-threatening conditions (heart disease, diabetes, etc.)
– at greater risk to die by suicide

So, with these negative risks, why do we settle for better instead of striving for wellness? Panelist, Dr. William S. Gilmer, M.D., Clinical Professor in the Department of Psychiatry at Northwestern University, who has specialized in the treatment of depression and bipolar disorder for more than 24 years, said the following.

We have lower expectations because we:


– feel like we’ve won just because we can get out of bed now
– don’t want to set ourselves up for disappointment
– don’t want to rock the boat or lose what we’ve gained by messing with the current treatment regimen
– see a little bit of mood dysregulation as the “new normal”

What does “better but not well” mean?

Dr. Gilmer suggests that lack of “wellness” means that “subsyndromal symptoms” are present. Subsyndromal symptoms are either one or two severe symptoms OR lots of mild ones. Either way, the symptoms do not meet the threshold of being considered an illness state but they are still there, causing discomfort and some impairment.

“Wellness is not just the absence of sickness.” ~ Panelist, Dr. Judith Cook, PhD, an internationally recognized authority on mental health services research

How do we go from better to well?

Panelists’, including two consumers with bipolar disorder, suggestions include:
– utilization of measurement-based outcomes in symptom evaluation to better track wellness levels
– better optimization of medication dosage and therapy frequencies
– not settling for better; striving for wellness
– discussing wellness with your psychiatrist; if he or she will not listen find a new one

What is your definition of wellness?  What would it look like or does it look like in your life?

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Smoking Cessation and Its Effects on Depression

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smoking and depression

I quit smoking seven weeks ago! Seven long weeks ago. It hasn’t been easy. Anyone who has ever kicked the nasty habit can tell you, it down right sucks at times! The physical withdrawals are, of course, at their worst the first week or two, and can play havoc with your moods, causing irritability and the like. But, what about the longer-term effects smoking cessation has on moods? Are there any?

Over at about.com’s Smoking Cessation Forum, members talk about the “Icky Threes” – the first being around day 3 of going through physical withdrawals. The second icky three is around week 3 where the psychological withdrawals begin and we have to “tackle the mental side of nicotine addiction.” Finally, comes the third icky three around 3 months of quitting where the newness of the quit wears off and we start to feel somewhat depressed.

My bipolar depression started a month after quitting, and became increasingly worse as the weeks went by. So, like a good mental health patient I visited my doctor and this is what he had to say:

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“Quitting smoking affects the levels of dopamine in the brain, a neurotransmitter that is responsible for feelings of pleasure and well-being. Quitting smoking also affects how your body metabolizes medication, which could therefore, cause shifts in your mood.”

Makes sense to me.

He went on to say that eventually this tends to all work itself out in most people, but for those of us with mental illnesses, we may need our medication adjusted to make the transition from smoker to non-smoker a bit more tolerable. I agree.

On the other hand, according to a review of the literature done by Ragg, et al, there is almost no published research asserting that people with depression have an increase in symptoms or return of symptoms when they quit smoking. Moreover, they state that quitting smoking may even improve their mood in the long run. (Maybe they all just had their meds adjusted??? Huh? Did the researchers ever think of that?)

Quitting smoking – improving my mood? I will have to see it to believe it. Grrrr…. Stay tuned.

And in the meantime, any former smokers out there, feel free to lay some words of wisdom on me. I will treasure them!

Why Being a Hermit Doesn’t Work

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We all have problems. Let’s face it: humans are problems. We create problems, we live problems, we solve problems, we prolong problems, we complain about problems, we hate problems, some of us love problems, we…well, you get the idea.

Whether your problems come from within such as in the case of an illness, or from something outside of you, such as your demanding boss, research shows that we are more likely to better cope with our problems with some kind of support from peers who have been in the same situation as we face.

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By coping better I mean we may live happier lives, have less stress, increased psychological well-being, and decreased negative symptoms.

Now, while you might not join a support group to deal with an a-hole of a boss, you may want to consider one if you deal with chronic mental or physical illnesses, bereavement issues, weight loss or addiction issues, or if you are a caregiver for someone who is ill or dependent.

In one study (1), 82% of the 129 members of the Manic Depressive and Depressive Association were hospitalized before joining the support group. After joining, only 33% reported any hospitalizations.

In a substance abuse study (2), 180 participants with high self-help (Alcoholics Anonymous, Narcotics Anonymous) attendance rates used alcohol and/or cocaine less than half as much as did those with low self-help attendance. In a second study (3), in the 18 months following treatment, the more days the patient attended Alcoholics Anonymous self-help meetings, the longer their abstinence lasted.

In a bereavement group study (4), 197 widows and widowers over age 50 who participated in self-help groups experienced less depression and grief than the 98 nonparticipants if their initial levels of interpersonal and coping skills were low. (If their interpersonal and coping skills were high they still benefited after eight weeks of participation.)

I have been attending support group meetings for alcoholism for the past 10 years and believe I would not have remained sober for this long without doing so. Currently, I am participating in an online smoking cessation support group that is proving to be an invaluable part of my quit program. And let’s not forget this wonderful blogging community, which I consider to be a large part of my mental health “support group.” Thank YOU for that!

The greatest thing in the world to hear while you’re in the depths of your struggles, whether it is with an addiction, a mental illness, the loss of a loved one, or just a crappy day is, “I understand how you feel. I’ve been where you’re at. You are not alone.” And that, my friend, is why hermithood is not for me.

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Resources:

(1) Kurtz, L. F. (1988). Mutual Aid for Affective Disorders: The Manic Depressive and Depressive Association. American Journal of Orthopsychiatry 58(1): 152-155.

(2) McKay, J. R., A. I. Alterman, et al. (1994). Treatment Goals, Continuity of Care, and Outcome in a Day Hospital Substance Abuse Rehabilitation Program. American Journal of Psychiatry 151(2): 254-259.

(3) Pisani, V. D., J. Fawcett, et al. (1993). The Relative Contributions of Medication Adherence and AA Meeting Attendance to Abstinent Outcome for Chronic Alcoholics. Journal of Studies on Alcohol 54: 115-119.

(4) Caserta, M. S. and Lund, D. A. (1993). Intrapersonal Resources and the Effectiveness of Self-Help Groups for Bereaved Older Adults. Gerontologist 33(5): 619-629.

Psychiatric Medication and Heat Illness

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There are many medications that affect the way your body cools itself during extremely high temperatures that could put you at risk for developing heat-related illnesses. Beta-blockers and amphetamines are examples. Many of these medications are ones taken by psychiatric patients, yet rarely do we hear warnings on the news to check on this population along with the elderly and children during extreme heat like I think we should.

I am on propranolol (beta-blocker), Adderall (amphetamine), Cymbalta (antidepressant), Risperdal (antipsychotic), Ativan (antianxiety), and Topamax (anticonvulsant), all of which increase my sensitivity to heat.

So, when we were boating last weekend in the 95F degree weather and stopped for lunch to which the group “leader” thought it would be a great idea to sit outside and eat, I said, “Are you crazy?!”

I didn’t really say that, but I did ask if everyone would rather eat indoors, to which the leader responded, “No way!” and everyone else followed suit by sheepishly smiling. So, I got up, recruited my husband to walk with me into the restaurant and we sat in the air-conditioning until our food was served. By this time, I was cooled off and probably saved myself from the beginnings of some heat exhaustion.

Even though my friends know I am on psych meds, they don’t get the seriousness of the side effects. It’s up to me to be assertive enough to take care of myself, and that’s what I did.

The next morning we went on a hike, and while the morning temperatures were cooler, the steep hills got my heart pumping and pores sweating. We took a 15-minute rest break on a bench by the lake.

After our rest break, I noticed my friends’ faces were no longer perspiring or flushed. I, on the other hand, felt like I was running a fever and was feeling light-headed and nauseous. I decided it would be best to call my husband to come pick me up rather than continue on the rest of the hike with them, so that is what I did.

It bums me out that I can’t keep up with my friends in the heat, but without my medications I wouldn’t be able to do anything with them regardless of the weather.

Here’s a brochure by the Ohio Dept. of MH which includes a list of some of the medications that can impair the heat response, as well as what to look for and do in the case of heat exhaustion and heat stroke.

RxList is a comprehensive drug index that provides in-depth information on probably every drug you are on. Search the medications you are currently taking to see if they make you sensitive to the sun or heat, or ask your doctor or pharmacist.

Heat illness is very serious. Make sure you know if your medication is putting you at risk. Let’s keep summer safe!

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Treating Multiple Mental Illnesses

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With my multitude of diagnoses and their over-lapping symptoms, I often wonder which illness has a hold on me. Am I on edge because I am hypomanic or anxious? Am I depressed because of a hormonal change/Bipolar issue or because my husband is working long hours/Borderline (BPD) issue? Am I exhausted because I’m depressed, because I’m not sleeping well due to anxiety, or because I’m overwhelmed with the kids being off school for the summer (BPD thing again)? You see my dilemma?

I know from experience what is usually causing my symptoms. Right now, I know I am dealing with anxiety because change is hard for me and with this being the first week the kids are home from school there has been a big change in my daily activities.

I also know from past experience that anxiety exhausts me physically, and that being physically exhausted makes me feel depressed. I say “feel” depressed because I know that it is just a feeling – I am not clinically depressed as in I need a medication change (yet.) First, I’d like to give myself time to adjust to the new schedule, and see if the fatigue and anxiety subside on their own.

I came across a study that looked at the interactions of Borderline Personality Disorder (BPD) with Major Depressive Disorder (MDD) and Bipolar Disorder over the course of 10 years. They found that BPD impacted major depression remission and relapse rates, and vice versa, but argued for the treatment of the BPD as a priority.

BPD and Bipolar Disorder remission and relapse rates, on the other hand, were largely independent of one another except for one area: bipolar type II lengthened BPD’s time to remission. (Wouldn’t you know that would be my case!) BPD did not affect bipolar mood swings. The study suggested that BPD and Bipolar be treated as independent disorders.

I do have rapid cycling bipolar and I also have borderline personality traits, so both on a physiological and psychological level I am battling quick fluctuations. Can anyone else relate to this? How do you cope with over-lapping symptoms from multiple diagnoses?

Bipolar Disorder and Migraine Link

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There’s a new study out that suggests a link between bipolar disorder and migraines. More specifically, “six percent of the study’s healthy control group had migraines, compared with 31 percent of the 412 bipolar patients.”

As someone who has bipolar and who also suffers from chronic debilitating migraines, I found this study very validating to my situation.

Researchers found that those with bipolar disorder who experience migraines are “at risk for worse psycho-social functioning, more severe depression, and earlier onset of bipolar symptoms.”

This gives me all the more reason to keep working with my doctors to decrease the frequency of my migraines. There have been many times I have just wanted to give up, thinking that this is as good as it gets, but then I tell myself that I have to keep trying, keep fighting, keep searching – new meds, new doctors, new triggers, new ideas, just keep talking to people and researching.

Over the past three years my migraines have went from 3-4 per week to 1-2 per month! What a huge difference!!! It took a lot of trial and error and perseverance and patience to get to this point, but it was worth the relief from the horrific pain these migraines can bring.

Do you have bipolar and suffer from migraines too?