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Emerging Patterns in Cyclic Analysis

I wrote With This Pill in extreme aggravation.  I have a theory based on observational findings about the pattern.

I cycle around every two months.  Pendulum began June 19, 2011, with the post To See If I Still Feel, describing an incident involving depression and self-injurious behavior.  Three days later, on June 22, 2011, in Shifting Gears, I described the sparks of a hypomanic episode.  Eight days later, on June 30, 2011, I detailed panic attacks and highly reactive emotions in Overdrive Mode.

There was a period where I went through a fluctuating depressive episodes varying throughout the spectrum of twos through fours.  It was a result of Somatopsychic trauma from a six-week long, progressively debilitating bout of Walking Pneumonia.  During a two-week long prednisone treatment, I had erratic emotions, which sent me reeling into a serious depressive state.  It was quickly fixed in two weeks by a medication adjustment.

That medication adjustment threw me into the first dysphoric hypomania I can ever remember having.  I had another incident of self-injurious behavior reported in Confessions of the Pain of Payment, on September 22, 2011, three months after the first noted episode.

That was followed by the longest, most intense hypomanic episode I have ever marked.  I marked it at 16 days, but I have a feeling that it was closer to 30.  I had a brief reprieve when I was down for the count during an illness.  I eventually attributed the extreme hypomanic episode with a chemical change in Big Money, No Whammy, STOP!.

Prior to my first post, my last hypomanic episode happened three months prior in late March into early April for 14 days.  That was my first record breaking hypomanic episode.  I attributed that to anxiety, that led to insomnia, which paved the way.  As for what happened between then and late May when I recall my depressive episode first beginning, I’m not sure.  I will have to check my personal logs to shed some light on that.

I’ve always looked to external factors to explain the occurrences.  But, the pattern is emerging.  I cannot deny that.

Now, I’m waiting for the other shoe to drop.  I have always had a depressive episode closely follow a hypomanic episode.  What Bender? detailed an alcoholic relapse at the start of a long depressive episode.  The depressive episode lasted for about two months and left three weeks until the onset of my next hypomanic episode.

However, it has been three weeks since my hypomanic symptoms subsided, and I am now only feeling small pangs of depression here and there.  I am not entirely convinced they are depressive.  I am irritable and reactive, but I have not yet had the urge to isolate myself.  I am not entirely disinterested in enjoyable activities – actually quite the opposite.  I am only interested in the most enjoyable activities and have had quite the hedonistic urge to indulge myself.

That is unusual for me.  I am not a creature of hedonism.  The Irish and Scottish had a philosophy that with every great pleasure in life came a great pain.  It was kind of their own yin and yang in their society – a way to describe the balance of the universe.  I am mostly of Scottish heritage and was raised in such an environment.  There was no escaping the pain that accompanied indulgence.  Therefore, I am not inclined to do so.  In fact, I am quite disciplined to do the opposite by taking on the role of the martyr.

What to do, what to do?  Do my brain and my body know something that my conscious mind does not?  Is this impulse a way of circumventing a depressive episode?

Antidepressants – Which Witch

“Can you turn the light off?”.

I touched the brushed metal lamp, and the dim light flickered off. There was a quick glance at the alarm clock – 12:38PM in glowing red numbers. Only a computer monitor playing Netflix illuminated the room. I was like a moth to a porch light in the summertime. It’s not the light you have to worry about. It’s just the attraction.

My eyes were fixed on the screen. I was entranced by the show, but it was just one screen in my mind’s eye. On another screen were stacks of paper and nameless faces of children. The tube next to it featured me, practicing endless monologues of the words no one will ever hear. Notebooks, pages flipping, with black cursive scrawled across each page. Blurry flashes of days, nights, people, and places past.

Yet, I was not compelled to do anything but sit idly and watch everything fly by at a speed that could’ve put a breeze through my hair.

This brain is entangled in itself while trapped in this useless body.

Another glance – 1:31. While my body was finally exhausted, my mind was still churning out the video feeds.

Finally, I let the screen go black. 2:14. And T.D.’s Developmental Therapist was scheduled for 9AM, which meant that I would have to be up at 8AM. Another less than 6 hour night. No dreams. Just darkness.

Why did I suddenly stop dreaming?

In A Mixed Bag, we determined that it was ultra-rapid cycling, probably brought on by a med change or an antidepressant.

I stumbled upon an article from psycheducation.org about controversies with antidepressant treatment with bipolar disorder. Here’s the problem. The depression and fatigue were crippling before. I couldn’t hold a job or take care of my life. Now, I am hit with rapid cycling every three months for about two weeks as opposed to four month of depression and one week of hypomania.

Which witch is the good witch and which witch is the bad witch?

Where I End and “It” Begins

There is great mystery and confusion that surrounds us when we try to differentiation symptoms and personality. James, who writes the award winning blog James Claims, inspired me to finally write a piece on this subject with his shout out. Which is which? Episodes surely have a profound affect on our cognition and behavior. Then, what about medication? Does medication give or take when we are defining traits and types in studying our own personality?

Have you ever taken the Myers-Briggs Type Indicator personality test? If not, take a moment to review the MBTI. It doesn’t matter if you’re having an episode. The results are very reliable on a test-retest reliability scale, regardless. Don’t worry, I’ll wait.

(Pause.)

Anyhow, this subject of personality and the MBTI spawned from a conversation with Brandon who writes The Daily Bipolar. I had mentioned the MBTI and how we can get a more stable idea of ourselves.

I started taking the MBTI in 2007. I have taken it every six months since then. Each time, I scored ENFJ (Extroverted, iNtuition, Feeling, Judging). That is, until the most recent retest. Suddenly, I scored Introverted, iNtuition, Feeling, Judging – INFJ. How could a person go from a well established extrovert to an introvert?

Before I was diagnosed, I was all over the place. When I was hypomanic, I was the life of all of the parties. I could throw down with the best of them. I was always prone to doing things that were strange, dangerous, and / or illegal. And having friends that would be in awe and amazement at my latest stunts only added fuel to thay fire.

But in those days, I didn’t isolate myself when in a depressive state. I really leaned on my friends. I had no other support system. If I lost my friends, I lost everything. In those days, friends would take 3AM crying phone calls. A boyfriend would dedicate his Friday night to talking me through a depressive compulsion, like self-harm, and not think of me differently. Before we were together, C.S. used to insist that I come to his apartment to stay for awhile.

I was already married with a baby when I was diagnosed. I have been in treatment for Bipolar Disorder II for two years. By treatment, I mean several different psychiatrists have shuffled pills at me, and I faithfully swallowed them. I went through a lot of life changes in that time, too. I settled into my domestic life and started a career path.

What’s different now?

Firstly, I am a mother and a wife. Week long benders and non-stop parties are out of the question. In fact, most of my social life crumbled. I have a strong dedication to my family. I will do anything to ensure their health, well-being, and happiness.

I had dedicated myself to school and am beginning my career. I have great enthusiasm for teaching and music. Many of the dreams and ideals that had been trampled in my past have begun to emerge once more. Arts, music, literature, philosophy, politics, and the pureness of real love were all resurrected.

My vast social network dissolved. And do you know what? I don’t really care. After all of it, I’d rather be alone. I much prefer using my time to enjoy family and intellectual pursuits. These activities would be art and literature mainly. That is opposed to wasting time investing in people who will never be a good friend.

Much of this wouldn’t have been possible for me without the medication. I have more control. Having the ability to regulate my emotions has enabled me to have a more solid marriage. It allows me to be the best possible mother I can be. Even on a bad day, I can still pull myself together and responsibly honor my obligations. My judgment is better and I’m more logical than ever.

I regained and retained all of the great things about myself with only a small fee. My short-term memory is shot. It wasn’t great to begin with, but Lamictal completely did it in. Unless I repeatedly write something down, like a name or a phone number, I will immediately forget it. And by getting the bipolar disorder under control, I unearthed a terrible underlying anxiety.

In my adult life, my attention has been focused inward. When I was officially diagnosed, I knew that I couldn’t escape it any longer. It is time to work on myself.

And my E changed to an I.

Pillbox

After working through numerous scheduling conflicts, I finally had my visit with the psychiatrist today. And I finally had a chance to express to him everything that has been going on.

His first reaction was not what I had expected. Instead of generalized anxiety disorder or a medication reaction, my doctor seems to think I’ve had underlying panic disorder. He wanted to change my antidepressant to Effexor. I very kindly reminded him that my depression had caused significant weight gain in a short time. He changed his sights to Prozac. I stopped him there.

I didn’t think it was the antidepressant that was the problem. We just changed the dosage on my Wellbutrin and there was no change. None. Not better and not worse. But we haven’t moved anything around with my mood stabilizer or my anti-anxiety meds in six months or more. I told him that irritability was always the calling card of destabilization. And I’ve been a firecracker lately.

So I have some new things to add to my pillbox. Xanax, 1 mg 3 times daily, and temazepam 30 mg once daily. C.S. added a couple of nutraceutical add-ons to help.

My daily regimen looks as such:

Morning:
300mg Wellbutrin
1 capsule Cogni-flex
1 capsule Ubiquinol
1 capsule Adrenomend
1mg Xanax
100mg Lamictal

Afternoon:
1mg Xanax

Bedtime:
1mg Xanax
30mg Temazepam
150mg Lamictal
1 tablet Orthosept
1 capsule Quell
1 capsule L-glutithione
1 capsule Seditol

As needed:
2 puffs Ventolin
1 capsule Maxalt

Note: The nutraceuticals are not all aimed at mood support. I take some for heart support, weight management, and immune support. Some psychiatric medications lower white blood cell count and leave a person susceptible to infection.

I am also aware of the potentially dangerous interactions between several of these medications. Don’t worry. Dr. Husband (with some sarcasm) has vowed to look after me. Mainly, we’re concerned with too much sedation. Orthocept increrases Xanax and Xanax and Temazepam are both benzo’s. Temazepam isn’t forever – it’s temporarily treating the insomnia until we can get things under control$

If you see something I might have missed, let me know.

Holding My Medicine Hostage

If only there were chains...

Today was the big day. I was rescheduled to see my psychiatrist’s nurse. I had to beg my mother to babysit T.D. and bribe my father to drive me the 15 miles up there in rush hour traffic, but I made it.

Here’s the big deal about going to see my pdoc. He’s located 15 miles away, I don’t have access to a car because C.S. takes it to work, and I have no one to watch T.D.

To be honest, I don’t have a great relationship with my parents or siblings. We don’t feud anymore, but decades of doing so has left our relationships strained. The state of our relationship only matters a little. They aren’t very giving people, and each “favor” ends up being a debt that can be called for repayment at any time. I’ve known more understanding loan sharks.

My friends work. And I’m also very particular about who watches my son. I prefer mothers, experienced nannies and babysitters, or female teachers. Those seem like high standards for babysitting a kid for an hour, but I consider it to be reasonable for a child with PDD-NOS and a significant speech delay. Would you leave your baby with someone with limited experience with babies? Though T.D. Is not quite a baby chronologically or physically, the same principals apply.

I actually made it there early, despite the traffic. But, it was certainly a “hurry up and wait” situation. Not only did I end up waiting the 15 minutes that I was early, I waited an additional 15 minutes past my appointment time. That is 45 minutes that my father had to wait around in the parking lot for me.

And all for what? Exactly what I predicted – a pitiful, unproductive, and largely inconvenient appointment with a nurse practitioner who probably shouldn’t be dealing with the likes of me.

I outlined the problems and ineffectiveness of my medication very clearly for her:

      I’ve been so depressed that I gained 10 lbs in three months. She answered,

“That kind of weight gain is practically impossible on Lamictal and especially Wellbutrin.”

      Yeah, I know. Both of them are notorious for weight loss. I have a genetic predisposition for extreme weight gain. That’s why I chose them.

My anxiety is unmanageable. I have regular anxiety attacks over every little thing. I’ve developed migraines over this again.

I don’t sleep anymore, apparently. I’ve been taking supplements for insomnia and now they don’t work. I started taking over-the-counter medication for it, but you can only take that in moderation without risking frying your liver. So, now I’m stuck with increasing sleeplessness.

It’s been about 6 hours a night off and on for two months now, and has been every night for the last week. And some nights, it’s 5 or less. Last night, I slept 4 and a half hours. I used to become hypomanic when this occurred. Now, my brain and my body are so tired that I am in a perpetual fog where I am completely dysfunctional.

    My moods are all over the place and I am highly reactive. This began slowly about two weeks ago. It started as only certain things that could trigger an unpredictable response. I would laugh hysterically, cry uncontrollably, or fly into a fit of rage at the drop of a hat, for seemingly little reason. Now, it’s progressed into constant states of arousal. I’m either delirious with hilarity, extremely irritated, or crippled with depression.

The nurses solution? Increase the dose of Wellbutrin and let the doctor determine the rest two weeks from now. My suspicion? She’s not allowed to adjust any medication other than antidepressants.

So now I take my medicine like a good girl and hope that I can manage my life within my two week period of the waiting game.

I decided that I hate nurse practitioners masquerading as psychiatrists more than I hate doctors.

Ugh.

Called Off?!?!

I was prepared for my psychiatrist appointment this morning, for a change. With the help of my bipolar bloggers, namely Ruby and Manic Monday, especially when referring to the post The Case of the M&M Interactions.

I had determined that my medicine is not right for my current symptoms. I’m cycling faster and faster. And the irritability has returned. I’m not grumpy – I’m flat out pissed. And I’m always a ticking time bomb as a result. I can’t sleep at night and it’s hard to be motivated in the day. This med check, as annoying as they usually are, was absolutely necessary.

My doctor is located about 15 miles away, so it’s quite a trek to get there, and usually very inconvenient in my busy schedule. I arrived early only to discover that my doctor had just called off 10 minutes ago. It was absolutely enraged. I had dragged myself out of bed extra early, called my mother out to sit while T.D. slept, inconvenienced my husband to take me up there before he went to work only to be sent away. WTF?!?! I know things come up. But there was absolutely no consideration for his patients.

To make matters worse, I had to sit and wait an unacceptable amount of time to be rescheduled. Where is the level of professionalism in that office? I watched the minutes pass and knew that if I didn’t get out of there soon, C.S. would be late for work. And even worse than all of that, I had to push to be scheduled before my medicine ran out. That left me to be scheduled with Nurse Betty. I know what she’s going to say. The same thing she says every time I have a complain about my medicine, “We’ll keep you on these medications and see what happens. I’ll have you scheduled in a month with the doctor.” UGH! Why bother?! Wait, oh yeah. They are holding my medicine hostage.

I really hate doctors. Seriously.