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.

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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?

Things are Getting a Little Personal

I noticed over the past year my posts have become somewhat generic and distant, like making small talk with someone at the water cooler. I haven’t offered much of anything in the way of myself or my personal struggles with mental illness. It’s not for lack of having symptoms, trust me! It’s just been easier to report the facts and keep anything extra under wraps.

My fear is mostly that my anonymity will be compromised, so I hesitate to write about anything in too much detail. I suppose my paranoia could be considered a symptom of my anxiety disorder, so there’s that.

I have recently become more open with family and friends about the limitations my anxiety disorder places on me as far as the things I can’t do, the places I can’t go, and the physical pain it causes me, especially if I push myself beyond my limits. I think this has surprised them some these last few months. I’m not sure they understand, but they seem supportive.

I feel blessed that I haven’t had a major depressive episode in quite a while. I do a little dance between hypomania and a brief down fall every spring turn summer, but other than that my mood disorder is fairly stable. It’s just this darn anxiety mixed with intermittent panic attacks.

I’ll continue to write what I know, sharing knowledge about mental health and mental illness, incorporating my voice a little more than I have been lately.

In the meantime, I’d like to know what you would like me to write about. I’ve written meditations, essays, writing prompts, poetry, and reported on research articles. What would you like to see more of?

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

When Panic Attacks Here is What You Can Do

Symptoms of a panic attack include:

  • Racing heart
  • Shallow, rapid breaths
  • Tunnel vision
  • Sweaty palms
  • Feeling faint
  • Nausea, vomiting
  • Fear of going crazy
  • Crying
  • Shaking, tremors
  • Irritability
  • Increased sensitivity to sound, lights, touch
  • Inability to focus or concentrate

There is usually a precipitating factor or something that has caused or is causing the panic attack to occur. Or fear about future events or a future incident can incite an attack. 

One way of dealing with it is to distract yourself from thinking about said event by reading a book, watching a show or playing a game. Draw, paint, listen to music or go for a relaxing walk. Find something to distract youself from your anxiety producing thoughts. 

Another way to cope is to take a short nap. Sometimes your brain just needs a break and it is okay to give it one. Just make sure not to overdo this one as it can become chronic and unhealthy. 

Talk to a trusted friend or professional to get the thoughts and feelings out of your head. Releasing them decreases the power they have over you. Also, problem solving ways to reduce anxiety is way more successful when you work on it with someone else. Keeping it to yourself only intensifies it. Trying to figure it out on your own only makes the anxiety worse. 

When possible don’t.do.anything.  Panic attacks are the body’s response to overstimulation. Resting in a quiet calming room may help tremendously. Experiment with what works best for you and take the time and breaks you need to let your system return to normal. 

Panic attacks are scary. Uncomfortable at best. Not your fault. Be kind to yourself when they come. Get through them the best you can and move on. Talk to a healthcare professional if they become chronic or significantly interrupt your life or cause you serious adverse effects.  There is medication and other treatment options that can help. You are not alone. 

Grief: A Meditation

For a time, sometimes a long time, grief can leave you in a fog.  Memories are all you have and the pain is gut wrenching as the sobs pull the breath from your lungs until they collapse in the dead weight of your chest.  

You don’t want to, but you get up everyday and you put one foot in front of the other and you move forward, resting often, sighing heavily, straining to act.

But, you are doing this a miniscule step at a time. Every inhale and exhale is a healing force. 

Where there’s breath there is hope. Where there is hope, I will create gratitude, for where there is gratitude, I will find peace.