The Days Are Getting Brighter

It has been very rainy this winter. It has also been snowy and freezing at times. There have been a lot of dark days. And night comes so early. I think it is the great reduction in daylight that brings on my depression more than anything else about the winter.

I have always enjoyed the outdoors, but the older I get, the less time I want to spend outside when it's cold. I have bought some warm coats to compensate, but I often stay inside a lot in the winter.

Spending time outside in the winter becomes like a fight for me and I usually give in to staying inside too much sometime in January or February. Luckily, the days get longer as the winter progresses and I usually start feeling better by the end of March.

I had an appointment with my psychiatric nurse practitioner earlier this month and she determined by the questions I answered that I was experiencing depression. She said she thought I should try adding Wellbutrin to my daily medication regimen of Seroquel, Lamictal, and Deplin. I had told her that I was putting all of my energy into work and felt little motivation for socializing, cleaning, or working out. I have also been dealing with some knee pain that has been unpleasant and annoying, but thankfully, seems to be lessening.

I have been taking the Wellbutrin every morning with Deplin for about two weeks now. I take Lamictal and Seroquel at night. I do feel better. I am sleeping less, and I have more energy to get things done. I have spent more time taking care of myself after work and I have been socializing a bit more. I feel more activated but I also feel a little bit more impatient although it hasn't caused me any problems, it is just something I have noticed about feeling differently and will self-monitor.

The Wellbutrin seems to be helping but if I feel hypomania coming on, which I am good at recognizing after being treated for bipolar disorder for the past 29 years, I will stop the Wellbutrin and call my psychiatric nurse practitioner as she advised me to do. If all goes well, I will stay on my current medication and have another appointment next month. She had talked about me switching to Vraylar from Seroquel. She said that it might have fewer side effects and she said that some of her patients have done well with Vraylar.

I have been feeling better with my current medication. However, switching medications to reduce side effects seems like a good idea. I have done that several times over the years and I have been happier living with fewer side effects than I have in the past. My current worst side effect is weight gain. Changes with my medication that could help me to lose weight and maintain a healthy weight would be welcome changes.

It is Saturday and I have social plans today and tomorrow. That is an indication that I am already feeling better because I have mostly felt like resting and getting ready for the work week for the past few weekends and not doing much else besides sleeping, eating, reading, laundry, and grocery shopping. That is kind of natural for me in the winter, but I'm hoping that having added the Wellbutrin will make it easier to be more active for the rest of the winter. I am not sure if I will be taking Wellbutrin year-round or just taking it as needed in the winter. I will find out more at my next appointment.

Recovering From Conversations With My Mother

One of the hardest things I do regularly is talk to my mother. She is very critical. I don't make enough money, my hair doesn't look right, my lipstick is the wrong color, I need to lose weight, I need to be more social, I need to go to the gym more--the list goes on and on. There are always a quite a few things I am not doing right that I need to improve. If it is not one thing, it is another. Things are constantly being added to this list of complaints. Some of them are minor, but the negative energy and disapproval wears on me nonetheless.

These conversations full of unsolicited advice are very demotivating. They make we want to quit everything and give up. My hopeless and suicidal thoughts ramp up the more I talk to my mother. I have told her that I try very hard to stay positive and that these conversations bring me down. I tell her that I need support, not criticism. Yet these unpleasant topics come up again and again. The negative emotions that come up affect me for hours and days.

My parents are getting old. I feel like I should spend some time with them, but it is very hard. Lately, I have been limiting the time I spend with them. I do not enjoy the time I spend with my parents. I see it as a duty. Most of the time it is depressing, lonely, and painful.

I have taken to giving myself pep talks after I talk to my mother. I tell myself that I don't really want to give up everything and die. That is just a reaction I have when I am repeatedly criticized and insulted. I think of all that I have to live for. I think of how far I have come. I tell myself that I have a very good job. I do not make a lot of money, but I have good benefits and I have been getting raises.

It makes sense to keep my job even though it is not good enough for my mother. My job is flexible and I need a lot of time off to go to various health-related appointments. That is a benefit that is hard for people to understand if they do not have to live with a chronic illness. My primary illness is Bipolar I, but side effects and other health conditions have come up over the years, and other medications and treatments have been added. Taking care of my health has become a juggling act that not every employer would support.

When dealing with my parents, there is no joy, but I think of the importance of compassion. My upbringing was far from happy and stable, but without my parents, I would not be alive. You do not get to choose your family, and this is the family I got. Maybe the purpose was to make me stronger.

My Current Cocktail

Since the start of this blog I've wanted to write about the medications I take and try because it has been difficult for me to find detailed information of this sort online. The difficulty in writing about medications is that they can often change, and what works for one person probably won't work in exactly the same way for someone else, and a dose that one person might be able to tolerate might be intolerable for someone else. Still, I've wanted to share information about the medications I've taken and am currently taking. Something peculiar that I've noticed is that whenever people discuss these medications they use the brand name, but most people I know take the generics. That is how I have written this blog. I have only taken brand name medications when generics weren't yet available.

As it turns out, Latuda didn't work well for me. I took it for five months and tried to be optimistic about it, hoping that it would have miraculous effects. The biggest problem with taking it was that it made me tired shortly after taking it, so I ended up taking it at night, before going to bed (although I tried to take it with breakfast, lunch and dinner), and I took it with a 350 calorie snack as directed by my psychiatrist. I can't be sure whether the weight gain was a side effect of the medication, or happened as a result of the nighttime snack, but I ended up gaining 10 pounds in the five months that I took it. That was unacceptable to me because I had just spent two years losing 54 pounds. Also, it didn't help me with sleep at all. In fact, it made me quite restless at night. I would fall asleep and then wake up after about an hour and a half. I tried to stay still and fall back asleep, but I ended up staying awake and just tossing and turning in bed. So, I decided to discontinue it. I have now tried Latuda, Geodon, and Saphris, and they have all made me restless. They are similar medications, so this makes sense. My psychiatrist said that Haldol would probably have the same effect because it is similar to those medications. I never noticed that with Haldol because I've never taken it outside of a hospital, I took it a long time ago when I was doing extremely poorly, and I only took it for a short time, but I thought I would mention it here because someone who is sensitive to Haldol might also be sensitive to Geodon, Saphris, and Latuda.

So, my current cocktail is 200 mg. Lamictal, 1200 mg. Trileptal, and 200 mg. Seroquel. The combination of Lamictal and Trileptal has been a good alternative to lithium for me, preventing both mania and depression. I no longer experience extreme thirst and frequent urination, my hair has grown back and thickened, I no longer have a tremor, I've lost a great deal of weight, my thinking seems much clearer, and I don't have to worry about becoming dehydrated when working out. I don't miss taking lithium at all. 200 mg. of Seroquel helps me to sleep very well and my psychiatrist said that it also may be helping me with anxiety. I'm a little slow to get going in the morning, but I definitely have more energy than I have had at higher doses. Besides being a little tired from Seroquel in the morning, I'm not having any noticeable side effects, although I am possibly having metabolic side effects. (It is impossible to know whether my borderline metabolic syndrome is due to my medications or my weight gain, although I feel sure that I wouldn't have gained so much weight without the help of bipolar medications). I take the Lamictal at night, the Trileptal twice a day (one 600 mg. tablet in the morning, and one 600 mg. tablet at night), and the Seroquel at night. I've tried both lower and higher doses of Seroquel and 200 mg. is the least I can take and still sleep well. Over the past two months of taking this cocktail, I've been very productive, my symptoms are under control, I'm getting along well with my friends, boyfriend, family, and coworkers, and I'm exercising a lot, eating well, and steadily losing weight. I've lost the weight I gained while taking Latuda and am now down 55 pounds from my highest weight. I really hope that this cocktail continues to work and I won't have to change it anytime soon if at all. I've been working part time for the past five years and I still have hope that with more stable time under my belt, I will be able to get back to full time work. Of course, I will need to have a job with a flexible schedule that will allow me time off for doctors' appointments since I am being treated for quite a few health conditions now.

In my last few blood tests, my potassium level has been low. I tried eating more potassium for a few months, but that didn't raise my blood level, so my doctor prescribed a potassium supplement, and will be monitoring my potassium level. I've learned that having a healthy level of potassium should give me more energy, be good for my blood pressure, and may even help me have an easier time losing weight. Also, potassium level can affect mood, so having the correct level might also help my mental health. Having just the right blood level of potassium is important because both low and high potassium can cause serious health problems, so, besides trying to get enough potassium in your diet, any kind of supplementation should be monitored by a doctor.

Trying to stay healthy while taking psychiatric medications has been a challenge. The extreme weight gain I experienced raised my blood pressure and gave me sleep apnea. Treating my blood pressure and sleep apnea has made me feel better, this new combination of medications has made me feel better, eating right and exercising has made me feel better, and being able to steadily lose weight has made me feel better and has given me hope that I will be able to get off of my blood pressure medications and CPAP when I lose more weight. So, for a lot of reasons, I am feeling much better than I have in years, and I am very optimistic that my physical and mental health will continue to improve.

Stress

Tonight, while attending my biweekly support group, one of two support groups I attend, everyone spoke of stress more than usual. We all experience relationship stress, work stress, and the stress of having bipolar disorder itself. It's stressful to think about whether or not to disclose the illness to friends, families, and coworkers, and the mania and sleeplessness that occur at times with the illness, along with the with the seemingly endless depressions, are stressful states to be in.

At many times in my life, stress has sent me over the edge into mania and depression, and has caused me to be hospitalized more times than I can remember. As people with bipolar disorder, it is essential that we try to get a handle on our stress levels. For me, medication, diet, exercise, meditation, lifestyle changes, and therapy, have helped me to manage my stress. When stress seems to be getting out of control, I know I need to do something about it. If I can't handle the stress on my own, it's definitely time to call both my psychiatrist and my therapist. Spending time in a serious state of stress often leads to unpleasant outcomes for me: mania and depression. Hospitalization always seems like a huge setback, plus it's time consuming, often at the worst times, and expensive.

The biggest lifestyle change I've made is going on disability. At the time I went on disability, I was mired in a serious depression that I spiraled into after becoming so inert that I couldn't continue to teach. I had chosen to become a special education teacher because I thought that, as a person who had experienced many years of stability, I was ready to handle the stress, and my diagnosis of bipolar disorder would give me the insight and compassion to help students who were struggling with learning and behavior disorders. I did a good job for almost five years. In fact, I earned several awards and a lot of positive feedback from students, parents, and my principal. But the stress eventually got to me and I became almost immobile and was no longer able to gather the energy to teach. In fact, waking up was hard, as was attending to daily tasks such cooking and cleaning, and even getting dressed. I got to the point where I was barely able to care for myself, and I applied for, and was granted disability.

The period before I went on disability was the lowest part of my life. After I received disability, a lot of the stress I had felt was removed. Ironically, I saw disability as a time to focus on my health. I gradually regained my mental and physical strength. For anyone who has experienced long periods of depression, it's obvious that it's physically unhealthy. Too much time spent in bed or sitting causes muscular weakness, and many people who are depressed don't eat enough, or eat the wrong foods, and the poor nutrition causes a deterioration in health.

After a year on disability, I was able to begin working at a part time job, and now I've been working part time for slightly over three years. I'm feeling much better about myself, and people are beginning to wonder why I'm still on disability. The answer is stress. It has been a breaking point for me in the past and I need enough experience with my stable self to prevent stress from harming me again. I feel that I need a longer period of stability behind me before I go off of disability. My therapist and psychiatrist have shared their opinions that I am not ready to go off of disability yet, if at all.

Although I've been on disability for several years, and have reduced my stress, I've still become manic and have had to be hospitalized twice in the past three years. And I've experienced one serious depression where I was unable to work as many hours as usual for a couple of months. I'm hoping that my medication changes and lifestyle changes will continue to work, and I'll improve in my ability to handle stress to the point where I'll be able to handle the stress of working full time. I want nothing more than to deal with my bipolar disorder in a healthy way and to live the most productive life that I possibly can.

Picking up the Pieces

For me, the hardest part of recovering from a depression or a mania is the time after the episode, when I know I'm doing better, and able to move forward, but also realize how far behind I am in things like cleaning, going through my mail, and paying bills - the routine things that are important but go out the window when I'm not in my right mind.

My mania started in March, and was followed by a depression that started in June and ended in July - thanks to a medication change my psychiatrist made. So, I've been feeling better since July. August was a month of recovery. I started going out with friends again, started my exercise routine back up, started cooking more often, and made great strides in organizing and cleaning my apartment - my cleaning routine is always the last routine to recover after a serious mood episode. So now it's September and I'm pretty much back on track. I finally feel that I have recovered seven months after my symptoms of mania first began. That's a very large chunk of time!

It's hard for friends and family to understand the recovery that needs to take place after a mood episode. It seems like once I start acting normal again, everyone assumes that I'm back on track, but that's far from the reality because I always have a lot of catching up to do.

The process of surviving mood episodes and then picking up the pieces is exhausting. It's why I take my medication, try to stick to my routines, keep regular appointments with my psychiatrist and therapist, attend support group meetings, and aim for stability. It's disappointing when I have to pick up the pieces again, but at least I have enough experience with it to know what to expect and also see it as a good incentive to stick to my treatment plan.

The Right Dose

"All substances are poisons: there is none which is not a poison. The right dose differentiates a poison and a remedy." Paracelsus (1493-1541)

I was depressed for the month between my last appointment with my psychiatrist and my most recent one. I didn't reach the lowest depths of depression, but it was interfering with my daily activities. I was the happiest when I was at work, but I wasn't socializing as much as usual, and I was having trouble unpacking after closing a storage space I had rented when my boyfriend (now my ex-boyfriend) moved in with me.

When I was describing my depression to my psychiatrist, I didn't use the word depression, I told her that I thought I had a more realistic view of life after switching out Seroquel for Saphris in my bipolar cocktail. I am now taking Saphris, lithium, Lamictal, and temazepam as needed. There were problems I hadn't noticed, when I was taking Seroquel, that were worrying me, but I thought I would be able to keep moving forward.

About a week later, I called my psychiatrist and asked for another appointment. I told her that I don't like to use the word depression because it is the last state I like to be in, but I was worried that Saphris was causing me to be depressed, and I wanted to quit taking it. I had quit taking it many months before, because I felt like it had caused depression.

My psychiatrist said that she thinks Saphris is probably the best antipsychotic for me because it is less likely to cause weight gain than other atypical antipsychotics. She said, "I was probably blocking too much dopamine," and changed my dose from 5 mg., morning and night, to 5mg. at night only. I was skeptical that this change would help, but it did.

I felt good the next day and have felt good ever since. I really wanted to quit taking Saphris, but during the discussion with my psychiatrist, about the dose, I was reminded of the quote above, something I was exposed to in a college biology class, and it gave me the will to try a new dose. I'm really glad I did. Maybe Saphris will turn out to be the wonder drug for me that it has been for some others. I'm going to keep giving it a try.

Another Winter

"Spring, summer, and fall fill us with hope; winter alone reminds us of the human condition."
- Mignon McLaughlin

Winter is not my favorite season, and while I've always tried to embrace it, it has consistently given me mixed feelings. When I was a little girl living in Connecticut, I would stay out for the good part of many days making snow angels, sledding, throwing snowballs, and ice skating. I had fun, but I always cursed the resulting iciness and numbness in my toes at the end of each day.

Then there was the time I crashed through some snow-covered ice and landed in a swamp. I was able to climb out, but my snow pants and coat were soaked with muddy water, which really weighed me down. Luckily I was close enough to safely drag myself home on that freezing day.

Sometimes walking through a snowy landscape inspires an appreciation for the silence and the stillness of winter, and sometimes it makes me worry that if I fell and injured myself, I would slowly freeze to death as no one would hear my cries for help.
 
As a child, the beginning of the winter thaw would give me hope as I saw ice melting and water starting to run off the frozen school playground, but I knew I would have to be patient because the gradual warming to more hospitable temperatures would take at least a month, and probably longer, and I would still be stuck outside for every recess until that happened.

Most of my serious depressions have occurred during the fall and winter. This year I seem to be fending off that unpleasant, and often debilitating, condition. I've been keeping up with all of my routines and moving forward, but I still have some of that strange quietness and stillness inside that winter always brings me. Some people love it, but it just makes me feel off balance. I've been reading more, trying to enjoy spending more time indoors, and appreciating the relative warmth of some days, but I really can't wait to jump into a pool on a hot July day.

Openness

Two weeks ago, an editor from PatientsLikeMe contacted me to interview me about writing this blog. I've been a member of the website since August of 2010 when I searched the web for mood charts and came across it.

I'd been keeping mood charts on paper for several years, but I was looking for a more convenient way to manage the information. When I found the website, I saw that it not only had mood charts, it also had charts about stress, sleep, exercise, medications, etc.

In addition, it had a forum where I could interact with other patients with bipolar disorder. I was curious about it, created a profile, and got started. It has been very helpful. I'm definitely more in tune with my moods and how they are affected by my environment and the choices I make about my health. Being a member of PatientsLikeMe is definitely one of the things that influenced my decision to write this blog. I realized that when you're open with others, it's easier to share helpful information. After I started writing this blog, I posted it in the forums of PatientsLikeMe as well as on Facebook pages dealing with mental health and bipolar disorder.

I'm fairly open about having bipolar disorder in my everyday life. I don't tell everyone, but I tell people I'm close to at what seems to be the appropriate time. Most people have digested the information easily, but some have backed away. I used to be upset if people retreated, but then I came to realize that I actually have closer friends than before I was given my psychiatric label. Unpalatable diagnoses can be a good way of weeding out unsupportive people. So now, if people can't handle the information, I let them go and don't worry about it. I don't have to be friends with everyone--that would be impossible anyway!

I'm kind of on the fence about how to handle the information in professional environments. I really like my current job, and most of my coworkers, as well as my boss, know that I have bipolar disorder. It became obvious when I was manic for a few weeks and was then hospitalized. I acted bizarrely and even called my boss at 6 o'clock one morning to see if I could go to work early because I was bored and needed something to do. After the hospitalization, I became extremely depressed and was quite unproductive for a couple of months, but everyone was patient with me, and eventually I recovered and got back up to speed.

I've had some jobs where I went for years without having a mood episode and didn't tell anyone about my condition. I always felt like I was hiding something or holding back, and consequently, developing close relationships with my coworkers seemed unnatural. As a result of being secretive, I rescheduled many appointments with my therapist and psychiatrist and ended up going to many fewer appointments per year, which I'm sure was not good for my mental health.

So now I'm writing this blog. I started out as Anonymous, and I recently began to use my first name, Andrea. The article PatientsLikeMe posted on their blog only reveals my first name. I've started posting some blog posts to my Facebook page, so I assume that some of my (not so close) friends, who I haven't told of my diagnosis, may have noticed...I'll see what happens. So far, I've found that I'm happier the more open I become. Being open has enabled me to connect with a lot of amazing people. The only thing that worries me is some kind of future discrimination that might lead to me being unemployed at some point...because, after all, everyone needs money to survive. But, for now, I have a job that I like and I feel that I'm being treated fairly, and even supported...maybe there's nothing to worry about.

In the Holiday Spirit

This time last year, I was struggling with a deep depression that started in November and lasted until March. I felt awful, which is really hard at one of the most festive times of the year. I went to the bare minimum of social functions that I felt I could get away with. I only made it to my work party, my boyfriend's work party, and small gatherings with family and my closest friends.

When people are depressed, they are encouraged not to isolate themselves, but it is really hard not to. Most people are confused by drastic mood changes. They don't understand why someone who is normally animated and talkative would sit silently in a corner watching everyone else have fun. When I am depressed, I only feel comfortable with those who know me well and understand that, at-times, I can't fully participate in social events, even if I want to. Big parties, which are usually fun, and great opportunities to meet interesting people, become strangely intimidating if I am depressed. At those times, it is extremely awkward to try to have a conversation with someone new, because I can barely focus on what they are saying and I can't think of anything to say myself. So, I avoid those types of encounters by turning down invitations to events that would be difficult to handle.

Fortunately, this year, I'm feeling happy and healthy, and I've been stepping up my social life ever since Thanksgiving. I'm looking forward to the abundance of merriment to be had throughout the holiday season. Last night, I met seven friends at an Indian restaurant and had a pleasant dinner in a charming part of town where a holiday festival was being held. After dinner, we walked through a shopping center which was hosting a  beer tasting as a fundraiser for a private school for children with autism. We didn't participate, but it was good to see such a big crowd having fun and supporting a worthy cause. Next, we walked to one of my friend's houses for an impromptu get-together. There was a lot of talking and laughing, and a lot of silliness and fun. I'm so thankful that I'm able to enjoy the simple pleasures in life this year, and I hope to keep it up. I feel like I've finally figured out how to maintain my mental and physical health, and I hope to savor the good times for many years to come.

Writing

I have always loved to write. Writing helps me to clarify my thinking and allows me to express myself  much more eloquently than in speech. I enjoy having time to process the things I experience, and I also like telling stories and providing helpful information.

When I was seven years old, my mother gave me a scrapbook. I pasted in pictures of friends and family, postcards and letters from penpals, going away notes from friends I knew I would never see again, and awards I had won. I enjoyed keeping track of the events in my life. It gave me a sense of history, and it was comforting.

At the age of fourteen, I began keeping a journal. Soon after I started journaling, I was introduced to stream of consciousness writing in my high school English class. I adopted that style because my mind was always racing, so it was easy to write. For the next five years, all of my personal writing was stream of consciousness. I used my journal mostly to empty my mind of confusing and negative emotions. Ironically, whenever I read my journal, I would dwell on the very memories that I wanted to forget.

During my first serious depression, I gathered all of my journals and threw them in the dumpster behind my apartment. I felt free. My depression lingered, but I'm glad that most of those painful memories have been trashed. Since then, I have ditched stream of consciousness writing. I prefer to write after I have had a chance to think. I'm considering keeping a journal again, instead of the scattered notes I currently keep, but it won't be about serious problems. It will be observations of things I encounter in daily life, and it will be funny. Now I would rather laugh at problems than worry about them.

Spinning

At the beginning of the month, I started thinking about spending more time in the gym now that the weather is getting cooler, and the days are getting shorter. I am prone to depression in the fall and winter, and exercise is a major antidepressant for me.

Last fall and winter, I became extremely depressed soon after a bout of mania that required hospitalization. I knew that exercise would help to relieve my depression, but it was almost impossible for me to drag myself to the gym, or even go for a walk. I ended up becoming very weak, and it took a lot of effort to get back in shape over the spring and summer. I knew that this year I had to be proactive and make sure I had a good exercise routine going at the gym before the cold and dark weather set in. As I get older, I am realizing that depression can be physically debilitating, and that it is harder to spring back after each episode, so I need to work harder to prevent it.

I have always enjoyed exercise classes. I like having an instructor charged with giving me the best workout possible, and I look forward to seeing familiar faces in the group. I belong to my local YMCA, and I appreciate the diversity present there.

So, a couple of weeks ago, I went to my first spinning class at the YMCA. I have been to spinning classes before, but this one is the best ever. My instructors are great, the music is uplifting, and the room is well ventilated and sunny, as there is a row of floor-to-ceiling windows in the back letting the daylight in. The people in my class appear to range in age from early twenties to mid sixties. It really motivates me to see such an assorted group of people working out together. I'm on a schedule now where I'm spinning on Tuesdays, Thursdays, and Sundays. I'm pushing myself as hard as I can, and I'm loving it. I'm pretty sure that if I keep this up, I'll have a great fall and winter.

Work History

I began working and paying taxes when I was fourteen year-old cashier at the Arby's that my father owned. I didn't tell my coworkers that I was the owner's daughter for quite a while, so I guess working there was a realistic introduction to the working world. I didn't work many hours, and although it was my first real job, I had already spent many years doing household chores, such as cleaning and pulling weeds, and I had just started babysitting.

In college, I worked whenever I had time. I started out working in my dorm cafeteria serving food, cleaning, and sometimes just checking the diners' ID's. Later I worked at a Lil' Caesar's Pizza and then a Subway--it was hard to get jobs in better restaurants without experience. Eventually though, I got a job waiting tables at a Tibetan restaurant owned by a nephew of the Dalai Lama. I will never forget working there and also meeting the Dalai Lama when he ate there one evening. Then there was my stint doing research on the sensory perception and mating system of a parasitic wasp. Also in college, I did construction work and odd jobs such as pulling weeds in large gardens and cleaning rental houses (very much like my childhood chores). One of my favorite jobs was working as a party photographer. I mainly took pictures at fraternity parties and other Greek events. It was interesting to observe a lifestyle in which I had no interest in participating, and I was proud to win a few awards for taking best-selling pictures.

After I graduated with a Bachelor of Arts in Journalism, my father persuaded me to work for a company he partly owned. He was afraid of me working as a writer--what I was trained to do--because he thought the starting salary would be too low, and that the health insurance probably wouldn't be good enough to cover my medical expenses for bipolar disorder. So, I ended up working in a barbecue sauce factory where I worked in production, and also helped out in the office with accounting and other paperwork. While the job was somewhat interesting, I wanted to see what it would be like to work for other companies.

I decided to work for a temporary service as a way of exploring different work environments. It was interesting to work in various offices, but I soon realized that I was just doing a lot of work that no one else wanted to do. I spent a few months working in the foreclosure department of a major bank. That was quite an experience. I was responsible for calling people to tell them that if they didn't make a mortgage payment, they would lose their house. I heard a lot of sad stories--many of them probably true. People sent me letters explaining the causes of their financial problems and they often included  pictures of their families and their homes. They were desperate.

Around that time I started thinking that I would be happier in a permanent job. I still had little idea of what I wanted to do, but I decided to try working outside of an office. Because I had a lot of athletic experience, I applied to work at Lady Foot Locker in a local mall. I was hired to be the assistant manager and the salary and benefits were decent. I was in the management training program and did quite well managing people and tending to the store and the paperwork. In addition, I excelled at selling athletic shoes and apparel. I was only there for a year and I won a mountain bike, a tennis racquet, and a trip for two to Chicago based on my superior sales performance.

I had never tried to sell anything before and, at Lady Footlocker, I discovered I had a talent for it. So I decided to look for a job selling higher priced goods or services knowing that would boost my income. One day, I was sitting on my couch, trying to envision what to do, and it came to me. I started to think of telecommunications and how complicated it must be behind the scenes, and how much money telecommunications companies made. Shortly after that, I looked at the classifieds--this was 1997--and discovered that Sprint was hiring. I applied right away and got the job. I consider Sprint to be my first professional job. I stayed there for three years--my longest time with any job until that point. I did really well as a business solutions specialist and I even won a Sprint President's Club award for being one of the top salespeople in the company. The reward was a nice plaque and a week-long conference at the Ritz-Carlton near Laguna Beach, California. While I was at Sprint, I had to go on short term disability twice for serious mood episodes, but it didn't matter. My performance was good and I was respected and rewarded anyway. Sometimes I could kick myself for leaving.

Next up was a short stint at National City Bank. My plan was to start out as a teller and then train to become a branch manager. After a few months though, I learned that a local telecommunications company was hiring, so I applied to work there as an account manager. I got the job, based on my experience at Sprint, and I liked it, but six months later, the company needed to cut back, so I was laid off with 200 of the company's 600 employees. I was given a severence package and instructions on how to apply for unemployment benefits, and that's what I did.

While I was unemployed, I decided to apply to AmeriCorps VISTA to become a literacy coordinator in my local school district. I did that for two years and then decided to become a teacher. I used my educational awards from AmeriCorps to pay for graduate school and my school district paid for half of my tuition because I worked as a provisionally certified elementary school special education teacher while I was also going to school full time. I took out loans to cover the rest of the tuition. Sometimes I don't know how I survived that period of time. It was quite stressful and I was really busy. While I was in school, I wasn't taking the best care of myself, and the medication I was taking was overly sedating. I drank tons of Diet Coke to stay awake--probably the equivalent of 2 liters a day. I also didn't have much of a social life, but I looked forward to spending time with other teachers at school, and my classmates in my night classes. I also coached my elementary school's chess team, and I really enjoyed spending time with my students and chess players, and their families.

I graduated with a Master of Arts in Teaching on time and with a 3.8 GPA--much better than I had done as an undergraduate. I guess I can thank Diet Coke and my sedentary lifestyle. I was more focused as a graduate student, so it was easier to be responsible and complete all of my work on time, but as an undergraduate, I was in great shape and I had a great social life. I think most people would have judged me to be more successful than my more educated, experienced, older and heavier self. The point is that with bipolar disorder, it is challenging to keep everything in balance. Although I still need to lose weight, I now enjoy better physical and mental health than I have in many years, but I am only working part time. 

After almost four years of working as an award-winning teacher (I had won awards for raising test scores, coaching chess, and even perfect attendance) I suffered a debilitating depression and had to take medical leave. During my medical leave, I went through shock therapy, which I also consider to be debilitating. At my parents' suggestion, because I seemed to be worse off than they had ever seen me, I applied for Social Security Disability, and I qualified easily, but I have been told that the lawyer who represented me is one of the best in my state.

While I was undergoing shock therapy, I volunteered at the same barbecue sauce company that I had worked for in my twenties. I was in charge of obtaining and organizing four pieces of paperwork for every ingredient we used--and we had several hundred. I had my own office--thank God! I was tired and sleepy for the entire 6 months that I received shock treatments and I caught myself sleeping face down on my desk several times each day. I wondered if anyone ever opened my office door and saw me like that, but if they did, nobody ever said anything about it. It was so strange to have a shock treatment and then come back to work and see work that I had obviously completed, but had no memory of working on. I am thankful that I could work there, even though it was without pay, because I know it was better for me than staying at home by myself.

A few months after my shock therapy was over, I started working for another company my father partly owns. It's a food manufacturer and franchisor for a small chain of Cajun restaurants. I started out volunteering by working as a management assistant, but after a year and a half, I was hired to be the director of administration. I'm responsible for filing the paperwork required to do business in various states, writing the company newsletter, collecting data from franchisees, and other various administrative tasks. I'm working part time and am really happy with this company. My job is interesting and my coworkers are fun to work with. Because I had to be hospitalized for mania last fall, and went through a severe depression after that, the people I work with know that I have bipolar disorder, and they don't have any problem with it, and because I am working part time, it is easy for me to work on living a more and more balanced life.

I am grateful to be in the position I am in right now. My family has helped me a lot. It doesn't hurt that my father is a business professor and serial entrepreneur, but I have also worked very hard over the years on my education, work, and on overcoming the obstacles presented by bipolar disorder. Over the summer, I began working with vocational rehabilitation on finding full time work and getting off of Social Security, but both my psychiatrist and therapist believe that I am more stable than I have been in quite some time, and that it would not be a good idea to make any changes in my employment. I am hoping that my company will continue to grow, and that I will be able to work more hours as that happens. But for now, I am okay. Social Security plus my part time pay allows me to pay my bills, and that is all I need right now. Someday though, I hope to earn more money, and maintain the stability I have established, but I know I have to be careful, because stress has thrown me for a loop many times in the past.

Light Therapy

I started using light therapy when I was having shock therapy in 2008 and 2009. The psychiatrist who administered my shock treatments prescribed the Day-Light Classic, and I bought it at a local medical supply store for $200. He instructed me to use it for 30 minutes in the morning, as soon as I wake up, so I did, and still do. I think it helps. I know that if I use it for too long, or too late in the day, it can cause me to begin to feel manic, so I don't do those things. I believe that, for me at least, it works better to prevent depression than to relieve depression. I use it from fall through spring. I just started using it on Sunday, and predict that I will be using it through March, although it will really depend on how I feel. Sometimes I have felt better by the end of February.

By nature, I'm a spring and summer person. I'm already missing my outdoor summer swims in the bright sunlight. So many people love the fall. There are many wonderful and beautiful things about the season, but watching the days getting shorter and darker has always bothered me. However, I have noticed that I feel better in the fall, the more time I spend outside in the daytime, and at night, so, I try to do that, and it helps. But there have been times, over the years, that I haven't spent as much time outside as I needed to, and I almost always became depressed during those times.

Saturday was a typical early fall day where I live. It was dark and dreary, and I spent the day inside and started to feel somewhat melancholy. That night, however, I had plans to go to a street festival in the art district of my city. I got there around sunset and it was beautiful. My boyfriend and I ate dinner from a booth serving food from one our favorite local restaurants, outside at a picnic table, in a dining area that was part of the festival. While we were eating, we watched the sun go down. I enjoyed taking in the beautiful pinks, blues, and purples, of the sky.

After dinner, we walked around, looked at booths from local vendors, and watched a band play as it got darker. I gazed up at the dark blue night sky behind puffy white clouds and felt happy. At that moment, I thought of the importance of spending time outdoors in the fall, even though there is a temptation to hibernate. I have had good falls and winters, and those have been when I have tried to appreciate the seasons for what they offer, and have allowed myself to get caught up in the merrymaking and festivities that abound during the darker months. And the light therapy can't hurt, so I'm going to continue to use it.

Routines

Last week, I wasn't feeling quite right. I wasn't depressed, but I wasn't as spirited or productive as usual. I'm okay now, and I'm grateful that the way I felt was just temporary. I always have a sense of foreboding when I think that I might be getting depressed. Because I have survived quite a few long and terrible depressions, including one last fall and winter, avoiding depression is very important to me.

When I noticed I was slipping, I resolved to make sure I was following all of my routines--something most people who are being treated for bipolar disorder are aware that they should do when they feel that they are heading toward either depression or mania.

I have so many routines! These are the important ones: wake up routine, morning routine, medication routine, work routine, after-work routine, sleep routine (this is not a joke), workout routine, diet/meal preparation routine, cleaning routine, sorting through mail routine, bill paying routine, and, last but not least, the checking and updating my calendar routine.  

Today was a good day. I successfully completed all of my routines, and I feel stable. I was sure of this after dinner. After work, I went grocery shopping and prepared a really good meal using two recipes from Weight Watchers. My boyfriend and I enjoyed pan-fried chicken breasts, a spinach-feta saute, and some potato salad. Kind of a strange choice of side dishes, but my boyfriend is a really picky eater, and I know he likes potato salad. I am thrilled whenever we eat the same food, because if I cook something that doesn't sound good to him, he will eat a Hot Pocket instead of something healthy.

Earlier this month, when we visited our friends out west, they asked my boyfriend if he wanted them to have any particular foods ready for him. He asked for Hot Pockets and Mountain Dew, and he ate that meal whenever whatever they were cooking didn't appeal to him. I'm glad he doesn't only do that when I cook! Anyway, tonight was really nice. I enjoyed cooking, spending time with my boyfriend, sharing a good meal, and realizing that I am definitely not depressed.

Sleep

Shortly after I was diagnosed with bipolar disorder, my psychiatrist told me that he thought it would be a good idea for me to sleep between 10 p.m. and 6 a.m. every day, even on the weekends. I was a 19 year old college student and I knew that would kill my social life. He tried to convince me that nothing good happens during the hours he thought I should sleep, but I knew that was not the truth. Even dinner parties often lasted until at least 11 p.m. My psychiatrist's unrealistic sleep suggestion is part of the reason I was, for the most part, a non-compliant patient until I was 24.

Even though I chose not to sleep between those restricting hours, our talk about sleep did make me think of the importance of sleep, but I didn't change my sleep habits much. It wasn't unusual for me to go for weeks just sleeping 3 or 4 hours a night. I would often go to sleep around 2 a.m. and wake up at 6 a.m.

As a college student, I was hospitalized for one serious psychotic break. There were a few days when I thought I was going to another planet. I was making preparations and going through elaborate rituals in order to hasten the time that I would go to The Great Unknown, as I was calling it. I also did a few things I don't remember, like walking around the neighborhood naked, knocking on neighbors' doors, also while undressed, and trying to jump off of my friend's deck.

Although they lived in another city, my parents sensed that something strange was going on, so they took out a mental inquest warrant and the police came for me and took me to the hospital, where I was locked in a room by myself for three weeks, and given major doses of multiple medications. When I finally came to my senses, and was released from solitary confinement, I couldn't believe the extent to which I had lost control. I got back to normal, but I was haunted by the memory of having completely, but temporarily, lost my mind.

Near the end of my college years, I found a psychiatrist who specializes in treating athletes and musicians. She is one of the rare psychiatrists who prescribes medication as well as providing talk therapy. I told her that I was afraid for my future. I wanted to know how I could ever trust myself not to break down like that again. We thoroughly discussed the details of my breakdown and she asked me if I could see a connection between my lack of sleep and my psychosis. I couldn't really. I told her that I thought that lack of sleep would just make someone tired and irritable, but not psychotic. She then explained that I had been seriously sleep deprived. She told me that, in their training, Navy SEALS are kept awake for 36 hours and made to complete strenuous missions. She said that many of them experience hallucinations and delusions, and that is expected, and considered to be part of the training. That information provided a moment of clarity for me. Instantly, I realized that I could have more control over my bipolar disorder, and I was no longer afraid of having a psychotic break at any moment. That story gave me a lot of hope.

After I graduated from college, and began working, I realized that I needed more structure in my life than I had provided for myself as a student. I worked as a student, but only in restaurants and other casual settings. Professional environments are much different. In the real world, I realized that I would have to work regular hours and be consistently dependable and polite. It was at this point that I decided to start taking my medication as prescribed. And since I knew that sleep was so important, my medication included sleeping pills. I took Restoril for many years. An older pharmacist once smiled and winked at me and said, "Restoril is great, and it's cheap. I've been taking it for 30 years." One day though, my psychiatrist said, "There's a new sleeping pill I want you to try. It's called Ambien. It works really well." I asked him why I couldn't continue to take Restoril and he said that he was concerned that it could be habit forming. So I started taking Ambien. It put me to sleep, but it didn't give me the pleasant feeling that Restoril had. I took it every night, just as I had done with Restoril.

For the past year, I have been seeing a psychiatrist with a different perspective on sleep. She doesn't prescribe any sleeping pills. She believes that if you're not sleeping well, your other medication needs to be adjusted, or you need to change your lifestyle. I was worried after she told me that she wouldn't be prescribing sleeping pills. As it turned out, I was hospitalized for mania last fall, and was then depressed for about three months, but, since then, I have been sleeping well. I have cut down on my caffeine, am getting regular exercise, and keep regular sleeping hours. On weeknights, I  am always in bed by midnight and, on weekends, I am always in by 2 a.m. This sleep routine is working out well for me. It has taken 20 years, but I have finally learned how to sleep!

Awards and Accomplishments

Who doesn't like earning a gold star? From a young age, I have been goal-oriented and, throughout my life, I have won many awards. I have always enjoyed receiving the awards, and the positive feelings associated with success have lingered in my memories, but once I won the awards, I usually kept them out of sight. When I was in college, one of my friends suggested that I make a "brag wall", a wall in my house dedicated to my awards. I always considered it, but my awards lay collecting dust for years nonetheless.

When in the throes of a deep depression, I would sometimes reflect on my accomplishments and how they had been rendered meaningless by my lack of productivity. Luckily, as soon as my depressions subsided, so would my negative feelings, but my awards still lay collecting dust.

When I started my current job, my boss asked me decorate my office. I had just been on medical leave from my job as a teacher and had gone through six months of shock therapy, after which I decided to resign from teaching. I was still recovering from my depression and my self-esteem was pretty low, but I thought of the "brag wall" idea and of all of my awards stacked up on top of my filing cabinet at home. It seemed like the time to finally create a "brag wall".

The next day, I took all of my most meaningful awards to work, dusted them off, and hung them up. My "brag wall" definitely attracts attention. Most first-time visitors to my office look at the wall and ask questions about the awards they find interesting. It is fun to talk about my accomplishments. I used to be shy about discussing my awards, but now, with all I have been through, thinking about how consistently productive I have been, for most of my life, motivates me to keep moving forward at times when I am feeling less than optimistic.

In the Aftermath of My Diagnosis

I was diagnosed with bipolar disorder I in July of 1989, after a suicide attempt. During a short hospitalization, I began taking the mood stabilizer, Lithium, and moved back into my college dorm, for my sophomore year, in August. Because of my suicide attempt, I wasn't allowed to have a roommate, so I moved into a single dorm in the same complex I had lived in my freshman year. Everyone in my new building had their own room.
 
Since I was on the soccer team, I moved into my dorm earlier than everyone else, because soccer practices started two weeks before classes began. No other soccer players lived in my dorm. That meant that I was living in the dorm by myself and going to soccer practice. Soccer practice was a disaster. I had been playing soccer since the age of 5, but it was like I had completely forgotten how to play soccer in the space of two months. I could barely run, dribble, pass, and shoot. I had always done all of those things effortlessly, and  they had suddenly become impossible. I felt really clumsy and disoriented on the field.

My life seemed to make no sense and, in my isolation, it was easy to slip into depression. I thought of my suicide attempt and the resulting shame. I wondered if I could just do something natural that could cause my death. I came up with headstands. I thought maybe if I did them for long enough, I might have a stroke. So, after soccer practice, I started doing headstands for longer and longer periods of time.

After about a week of soccer practice and headstands, I was feeling really desperate. I bought some razor blades and considered slitting my wrists. I thought I would do it in a hotel. I drove around and checked in and out of two or three hotels. Then I started thinking about killing myself somewhere in the wilderness where, hopefully, a wild animal would then eat me, so no one would have to find me.

It finally became clear to me that driving around, while dwelling on all of those thoughts, was dangerous, that I didn't really want to kill myself, and that I needed help. I called my mother and tried to explain everything as well as I could. She drove over an hour to pick me up and she said, "I want you to talk to someone about this." She ended up taking me to a hospital in my hometown and, in a short time, after speaking to a psychiatrist, I ended up in a psychiatric unit for a second time. I was angry and felt that my mother had tricked me into going to the hospital, but now, looking back on things, I don't know what else she should have done.

This second hospitalization lasted for about 6 weeks. Each day seemed almost the same as the last. Meals, groups, passes to go outside, killing time playing cards and hanging out in the smoking room, even though I didn't smoke, because the smokers laughed and told stories while the people in the non-smoking areas mostly stared into space and watched television. My experiences with hospitalization have shown me that the point is to get you stabilized on your medication and the therapeutic activities like art therapy and assertiveness training are secondary, and do more to help pass the time than actually improve your life.

When I got out of the hospital, I decided to live with some friends in my hometown, as it was too late in the semester to return to school. I shared an apartment with two of my best friends, a couple of guys I had gone to high school with, and one of their girlfriends. There were four of us living in a two-room apartment and rent was only $85 a month each. The entrance to the second floor apartment was off of an alley, and the stairs outside led to the kitchen. If you were cooking on the gas stove and someone came in from outside, the stove would often blow out. I got a job as a cashier at a grocery store and joined the YMCA. I was making enough money to get by, and I was still taking my Lithium. For those few months, I remember spending all of my time working, working out, and goofing off with my roommates.

I returned to my university the second semester of my sophomore year, and it wasn't hard to get back into the swing of things, as I had feared it would be, although I quit playing soccer, because I couldn't move as well while taking Lithium. I just gave it up and focused on my journalism and biology classes. I thought that someday I would become a science writer.

Diagnosis: Bipolar I

I had been to a therapist my senior year in high school, because I had been depressed. I only remember going once, though I could have had a few visits. I didn't really understand therapy at the time, and I don't really think it helped, but my depression eventually subsided. I had a good summer after graduating from high school, working, spending time with friends, and spending a lot of time at the pool.

By the time I was ready to start college, I was relaxed, ready, and very excited. I lived in a beautiful Gothic limestone dorm, and was surrounded by creative and intelligent people. I enjoyed meeting people, and eagerly attended my classes. I also played soccer with the women's soccer team and spent a lot of time practicing and traveling to games.

During the winter, I slowed down and felt disconnected and disoriented at times, but I didn't really have a full-blown depression. I kept going, and by February it had subsided. My mood gradually escalated and I began sleeping only about 3 or 4 hours a night and I felt really restless. I had experienced this kind of shift while living at home, and had also stayed up late at night, but I would stay up late reading alone in my room. In college, I was free to leave my room whenever I wanted, so I started going out at night and staying out until the early morning with friends from my dorm, going to parties and hanging out in 24 hour diners, but I was still waking up at 6:00 in the morning, going to classes, and going to soccer practice.

I felt like I was exhausting myself, but I also felt like I couldn't slow down. I went to the student health center and asked to speak with someone about my overabundance of energy, and I ended up speaking to a therapist who advised me to meditate and eat yogurt, because, as she explained, yogurt was a calming food. I tried those things, and they didn't work, but I didn't go back to the health center, because I felt that I really hadn't been taken seriously. So, I just kept going. 

That summer, I decided to live in my college town and work and take classes. Around July, I became extremely depressed. In fact, I started to feel like a ghost and I wasn't sure if I were dead or alive. I quit talking to people, so they quit talking to me. I remember sitting in a class one day and feeling invisible. No one looked at me or spoke to me, and when I walked back to my apartment, I also felt as if I weren't really alive. I spoke to my roommates, but not much. Everyone seemed preoccupied and busy, and our unairconditioned apartment was unbearably hot.

I started keeping a serrated knife on the table next to my bed, and at night, I would try to cut my wrists, but I could never bring myself to press down hard enough to draw blood. I did this for several weeks until I decided to buy some sleeping pills and chase them down with vodka, as a less painful way of ending my life. I went to different stores buying sleeping pills until I had what seemed like enough to kill myself. I really had no idea. This was before the era of the world wide web, and it was harder to find this kind of information.

One night, I took the pills and the vodka and fell asleep. Instead of dying, I woke up and started hallucinating. I had an out of body experience. I rose out of my body and looked down at myself and saw a disgusting cockroach lying in bed, dying from poison. I knew that I must get up. I stumbled into my roommate's bedroom and woke her up in the very early morning. I told her what I had done. She told me to eat bread to soak up the poison and then she called the ambulance.

When the paramedics came, they took my pulse and it was around 40. They asked me if I worked out a lot and I said I did. I guess then they worried less about my low pulse. They asked me why I had done this, and I said, "Because I want to die." They took me to the hospital where nurses worked a tube down my throat and into my stomach which they filled with  activated carbon to absorb the poison. Then they told me I had to stay in the psychiatric unit of the hospital because I had attempted suicide.

I stayed in bed for a couple of days, recovering from my suicide attempt and the activated carbon antidote. A psychiatrist came to talk to me and determined that I was depressed and then he prescribed Prozac. Within a few days, I became hypomanic. I was out of my bed and all over the unit. I was talking to the other patients, pacing the halls, playing ping pong, and doing whatever I could do in the hospital, which wasn't much. But the switch in my mood and activity level was extreme enough that my psychiatrist took me off of Prozac, which should not be prescribed to people with a history of mania, and started me on lithium, and after talking to him and telling him more about my life, I was diagnosed with Bipolar I, which I didn't really understand at the time, but I now have no doubt is the correct diagnosis. If you are unfamiliar with Bipolar I, here is an article from Web MD that explains its symptoms and treatments:  Bipolar I Disorder .

Shame

When I have read of others' experiences with bipolar disorder, I have often thought that they have not revealed much about their worst moments, and I have thought that if I decided to write about my experiences, I would be more forthright, so that others would know that they are not alone in feeling shame from their own strange and out-of-character behavior. However, now that I am writing about my experiences, I realize that I have the need to protect my privacy, but I will say that there are many things I have thought, said, and done, during both mania and depression, that have brought me shame, and I will share some of them.

Thankfully, I have never been arrested, but I have acted impulsively and aggressively, and I know that I have scared people with my unpredictable behavior when I have been manic. I have made scenes, thrown tantrums, thrown things, and have had hallucinations and delusions. Once, when I was depressed, I attempted suicide. Some people have compassion for someone who feels that desperate, but others believe taking one's own life, or attempting to do so, is one of the worst things a person can do.

Once, when I was manic, I was locked in a hospital room by myself for about three weeks, and I have been put in restraints more times than I care to remember--mostly for attempting to run through open doors. When I think about these times, the person I remember, doesn't even seem like me. Everyone always tells me how kind and dependable I am. When I have told people that I have bipolar disorder, they have often reacted with disbelief. They say that I am one of the most normal people they know, but the people who see me daily know that there are times when I have behaved like a different person.

There are shameful moments I will always want to keep to myself. Although everyone experiences shame, I think that if you have a disorder that affects your behavior, you are probably much more familiar with this feeling than the average person. A positive result of shame, is that it has motivated me to stick with my treatments. I have realized that I would rather battle side effects than constantly deal with the repercussions of  mania and depression. Shame can be painful, but at least it fades over time.