Reclaiming My Health

When I was diagnosed with manic depression (now called Bipolar I), at the age of 19, as a student at Indiana University in Bloomington in 1989, I was told that I would have to take lithium for the rest of my life. I started taking it the summer before my sophomore year, and my athletic performance was immediately negatively affected. I quit the soccer team because my coordination had become so poor. I could no longer quickly visually track the ball on the field and I couldn't handle the ball or pass or kick as well. My body felt alien to me.

I spent my sophomore year focusing on school and trying to get used to my new life on medication. I had some friends on a cycling team who knew that I had quit playing soccer, but not really why, and they asked me to ride with them the upcoming summer. After a couple of rides they told me that I was really good and asked me to join the team. So, I joined the team, but something was still off physically, and I knew it. After not performing as well as I would have liked in the first few races, and also having unpleasant problems with dehydration, I decided to quit taking lithium. I told my teammates that I had manic depression, as it was called at the time, and that I had decided to quit taking my medication because it slowed me down too much. My athletic performance improved almost immediately. After discontinuing lithium, I usually placed first, second, or third in my races and was ranked third in the Midwest in women's collegiate cycling. My team also won the Women's Little 500 bike race, which was very exciting! However, I was having trouble concentrating, and feeling very restless, unstable, and pulled in different directions, and also experiencing psychosis at times, so after not graduating on time, I decided to start taking lithium, quit racing, and focus on my studies. Of course, I ended up gaining weight and suffering physically. I did not enjoy feeling slowed down, but I thought it was the price I would have to pay to get on with my life, and I finally graduated.

After graduating, it seemed like the best thing to do would be to continue to take my medication, even though it felt like a weight was tied to my feet when everyone was encouraging me to swim. I was not only physically slowed down, but I also experienced cognitive dulling. When I moved to Louisville, where I still live, I started seeing a new psychiatrist. I remained in his care for 16 years because he had a good reputation, my parents had chosen him for me, and it is really hard to find a good, or even decent psychiatrist. He seemed to believe that I needed to be heavily medicated.  At my most highly medicated, I was taking 1800 mg. lithium, 400 mg. Lamictal, 600 mg. Seroquel XR, Ambien to sleep, and Provigil for alertness (which didn't work for me). It felt like way too much medication and I was exhausted all the time. My life was out of balance. Work was my focus because I had little time or energy for anything else. My psychiatrist was resistant to making changes to my medication, insisted that I take lithium, and told me that he would not continue to treat me if I quit taking lithium, as he considered it to be the cornerstone of my cocktail of psychiatric medications. I consulted with a lawyer to discuss filing a lawsuit for malpractice, because I felt I had been turned into a zombie, and she did some research and told me that I was taking enough medication to knock a horse over. Instead of going through with the lawsuit though, I let it go and quit taking my medication without consulting with my psychiatrist. I lost 60 pounds in a year without trying that hard, and felt better, but I ended up becoming manic and being hospitalized again. After that hospitalization I told myself I would take my medication no matter what, and I did. I still had severe mood episodes and I developed serious side effects: hypertension, borderline metabolic syndrome, and sleep apnea. I also gained a tremendous amount of weight. When I was diagnosed with bipolar disorder, I weighed 130 pounds, and after taking medication for close to 20 years, I was up to 278. I had gained 148 pounds. My weight had more than doubled.

After suffering a terrible depression, having ECT, and ending up on disability, I finally decided that the seemingly substandard psychiatric treatment was just too much for me to handle and I couldn't take it anymore, so I found a new psychiatrist. She is a woman who is a few years younger than I am and she understands my concerns about weight gain and side effects and agreed to help me change my medication since I knew I could not just quit taking it myself without serious repercussions. I had educated myself about withdrawal from psychiatric medication and I found that many medications have withdrawals that mimic symptoms of bipolar disorder. She agreed to let me taper off of lithium. When I did, I experienced a bout of hypomania, but I also lost weight, was not thirsty all of the time, my hair became thicker (it had been falling out for years at that point), my psoriasis began to clear up, and I felt sharper and had more energy, and started becoming more active and taking better care of myself, and with alternative medications, my moods began to stabilize.

I have kept regular appointments with my new psychiatrist since 2010 and my health has improved a great deal. I no longer feel extremely slowed down by my medication and it is easier to work, cook, clean, exercise, socialize, spend time with family, go to doctors' appointments, and to appointments with my therapist. I have realized that in the past I waited too long to seek treatment too many times. Mania, psychosis, anxiety, paranoia, and depression can overwhelm me pretty quickly both mentally and physically. I need to take action and get help from my psychiatrist and therapist before I get swept into a downward or upward spiral.

Now that I have time to live a balanced life, because I am appropriately medicated instead of overmedicated, I focus on taking care of myself physically, mentally, and spiritually. I do not live a perfect lifestyle, but it is greatly improved from how I lived after my first breakdown, and for many years afterward. I work part-time and try to keep my stress levels low. I exercise, meditate, spend time with friends and family, and do volunteer work. Wellness is the focus of my life because if I am not well I can't enjoy anything or be of service to others.

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.

Weight Loss

From the beginning of my treatment for bipolar disorder, I've struggled with weight gain. Gaining weight has been my most bothersome side effect, with excessive thirst coming in second. I was diagnosed with bipolar disorder when I was an active, thin nineteen year old. I had been playing soccer since the age of five, as well as doing other sports off and on, and I was always fit. When I started taking lithium, the only medication that was prescribed to me at the onset of my illness, I gained 40 pounds in three months. Because of that, I quit taking lithium and promptly lost the weight. I had gone from 130 pounds to 170 pounds and I could barely run. I couldn't imagine living without running, although now I can.

I wouldn't take medication again until I was twenty four and realized that medication would probably help me move forward in my life, which it did, because about a year after that decision, I graduated from college and got a job. When I decided to take medication again, I knew I would probably gain weight. I fought hard against my appetite, and I always exercised as much as I could, and even participated in sports, but I still gained weight. I was considered to be a compliant patient. Gaining weight was really hard. Not only did I feel different and apart because of my diagnosis, I also felt that I had lost control of the body that I had taken good care of for my entire life, and that had always served me well. I became plus sized and had no idea how I should dress anymore. I also worried about my health. I lost my lifelong identity of being a fit athlete. It was depressing.

I quit taking my medication a few more times over the years, always to relapse and end up in the hospital. Every time I quit taking my medication, it was because I could no longer stand the weight gain, and I always lost weight when I quit taking my medication. When I was thirty two, and hospitalized because of mania, I told myself I would never quit taking my medication again because of gaining weight. That year I had quit taking my medication when I weighed 220. I was off of my medication for about nine months before I became manic, and I got down to 160 in that time, but then I ended up in the hospital.

Even though I quit taking my medication several times over the years because of weight gain, I took it long enough and consistently enough that I was always told that I was a compliant patient. I really hated the idea of being compliant. I felt like it was killing me, but I didn't know what else to do. I had the same psychiatrist from the age of nineteen to the age of forty, and he always asked me what was more important, my weight, or my mental health. He treated my concern about my weight like it was an issue of vanity. I was scared of what my weight was doing to my health, and the weight gain was also terrible for my self esteem.

Finally, the only rational thing to do seemed to be to find a new psychiatrist. I found a young woman who I thought would understand why I wanted to lose weight. She was reluctant to take me off of lithium, but by the time she decided it would be okay to do it, my weight had gotten up to 278 and I had been diagnosed with high blood pressure and sleep apnea. This seemed to be rock bottom as far as my weight was concerned. I never thought I would weigh anywhere near 300 pounds. Lithium was interfering with my weight and my sleep. My sleep study showed that I drank six cups of water during the night. I would wake up thirsty and drink water all night long. I don't think my psychiatrist took my reports of this behavior seriously until the sleep study showed how much I was waking up and drinking water, because of the intolerable thirst caused by lithium. She agreed to take me off of lithium slowly.

I had a bout of mania when I was coming off of lithium last fall,  but I stayed out of the hospital. Last spring I was hospitalized for a suicidal depression. It was debilitating and awful, and dragged on for almost two months, but I'm glad I didn't end up taking lithium again. I've been off of lithium for about a year and I've lost 54 pounds. I now weigh 224. I'm glad to be losing weight. 54 pounds lost is significant, but I still have a long way to go. I gained 148 pounds in the time since I decided to start taking medication for bipolar disorder. I always get mad when I think of it. I complained about the weight gain the whole time I was affected by it, and not much was ever done about it until my current psychiatrist decided to take me off of lithium. I knew it was medication that was making me gain weight, but my old doctor blamed my habits for the weight gain. My appetite increased. I was always hungry and thirsty, and I was also lethargic. It's terribly hard to fight those side effects. Now that I am no longer always hungry and thirsty, and I have more energy, I'm losing weight.

I 'm doing a lot of exercise - usually the equivalent of walking five miles or riding my bike twenty miles most days, and some days walking 10 miles or riding my bike 50 miles. I'm also eating well and eating less and less. I'm focusing on eating less fat, less sugar, less sodium, more fiber, and more potassium. This kind of diet is recommended for weight loss and also for control of blood pressure. So, I've lost 54 pounds, but I want to lose 84 more because I'd like to reach my target weight of 140. I'm very happy to be losing weight, but it's hard not to be upset that my medication wasn't changed until I became very overweight and developed health problems because of it. I try really hard to focus on the positive, on the progress I've made, and I'm glad my health is improving.

I was losing weight before I met my boyfriend, but it helps a great deal that he has a mental illness and also had the experience of being an athlete who gained weight because of his medication. He understands the struggle to tame an artificially insatiable appetite. His psychiatrist has also changed his medication to something that allows him to lose weight. We exercise and eat together almost every day, and we really help each other to stay on track. He became fed up with his weight gain after he had gained about 50 pounds and his psychiatrist worked with him to change his medication. His psychiatrist told him that he wasn't going to sit back and watch him get diabetes. I asked my old psychiatrist what would happen if I got diabetes, and he said I would just have to treat it. He didn't take my concern about my health and weight gain seriously.

I'm so glad that I decided to change psychiatrists. I'm currently taking 1200 mg. Trileptal, 200 mg. Lamictal, 300 mg. Seroquel, and 2.5 mg. Saphris. I'm slowly tapering off of Seroquel, down from 400 mg., in the hope that it will decrease my metabolic side effects, and allow me to lose weight faster. My blood pressure is lower, but my LDL cholesterol and triglycerides are still high. I will continue to eat well and exercise, and work to reduce stress, and hope for medication that works without negatively affecting my health. It might take me another year and a half to reach my goal.

Sleep Study

I've been having trouble sleeping for years. I'm 42 now and my insomnia started when I was about 14. The diagnosis of bipolar disorder at 19 explained my sleeplessness at the time. About 10 years ago, I started having sleep problems again. I had gained a lot of weight because of bipolar medications, and my psychiatrist suspected that I had sleep apnea. He referred me to a sleep specialist and I had a sleep study. It was determined that I had mild sleep apnea (too mild to treat) and I was told that I would get better sleep if I slept on my side, so that is what I did.

This past summer, I started to suspect that my sleep apnea had gotten worse. I was waking up about 6 or 7 times each night, that I remembered, and I didn't feel rested. Part of the problem was that I was taking lithium, and it was causing extreme thirst, which was compelling me to drink huge amounts of water, and I was in the bathroom all day and all night. I was so thirsty that I would drink more water each time I woke up at night. Whether because of my extreme thirst, or suspected sleep apnea, I wasn't getting good sleep, so I asked my general practitioner to refer me to a sleep specialist, and I let my psychiatrist know about it. My psychiatrist was very interested in learning the results of my sleep study.

My sleep study in October was disastrous. I got out of bed 7 times to go to the bathroom and drank 6 cups of water throughout the night. I only slept for 1 hour, although it seemed like I didn't sleep at all. During that hour, I stopped breathing 16 times because of sleep apnea. That qualifies as moderate sleep apnea and is considered serious enough to treat. I went back for another sleep study in November, and this time I wore a CPAP, a device that blows a gentle stream of air into the nose during sleep to keep the airway open so that you can breathe properly. I slept 7.5 hours and was getting at least 90% oxygen all night, which is in the healthy range of oxygen. It was determined that I would get my own CPAP, and I did.

In December, I met with a respiratory therapist and was fitted with a mask and learned how to use and care for the CPAP. At first, I was given a full face mask. After three weeks of sleeping with it, I decided that it was too uncomfortable, so I went back for another mask. This time I got nasal pillows and they are proving to be much more comfortable.

I was not really excited about using the CPAP at first, but now, at the end of January, I feel so much healthier and more energetic since I've been using it, that I believe it is worth the expense and awkwardness. Also, it is thought that if you have sleep apnea and bipolar disorder, using a CPAP can lessen your experiences of both mania and depression. As an added bonus, I even look better. My eyes look much more rested and my skin looks radiant. Now, in addition to considering it necessary for good mental and physical health, I consider it to be a beauty treatment, and that makes me feel more excited about wearing it.

Unfortunately, many people with bipolar disorder gain weight from the medications, and that causes other health problems, like sleep apnea. There is a possibility that if I lose weight, I will be able to sleep well without the CPAP. Getting to my ideal weight is my next quest. When you get good sleep, you have fewer stress hormones in your body, so it is easier to lose weight.

Since I've been using the CPAP, I've lost 23 pounds. This is probably also the result of a medication change. When my psychiatrist learned, from the sleep study, that I was waking up and drinking water all night, she substituted Trileptal for lithium. I've been asking psychiatrists to take me off of lithium for years, but this was the straw that finally broke the camel's back. I'm also taking Lamictal and Saphris to control my bipolar disorder and I'm doing very well. I'm stable and alert and feeling much more optimistic about the future than I've felt in years.

Temazepam

Since my 10-day hospitalization for mania, which ended in April, my psychiatrist has made adjustments to my combination of medications. I am now taking 1350 mg. lithium carbonate ER at night, 5 mg. of Saphris in the morning and 5 mg. of Saphris at night, 200 mg. of Lamictal in the morning, and 15 to 30 mg. of temazepam at bedtime, as needed, for sleep.

I just took my first dose of temazepam for sleep last night and I feel good today. I slept well, I did not have a medication hangover when I woke up, and I have been calm and productive all day. I'm thankful that my psychiatrist prescribed it, and I'm hoping that this will complete the perfect combination of medications for me. If it works, it will be the combination I have been hoping for for the past 23 years - one that lets me feel and act like my best self.

My former psychiatrist switched me from temazepam to Ambien about 7 years ago because, he said, Ambien was less likely to be habit forming. That didn't make sense to me, as I hadn't formed a habit, but he insisted that I needed to make the change, so I did, and I haven't experienced as much stability since then as I did before he made the switch.

I told my current psychiatrist what happened when I was switched from temazepam to Ambien, and she wrote a prescription for temazepam right away. Anyone who has bipolar disorder knows how important sleep is to managing the health condition. Some doctors avoid prescribing sleep medications, because they may be habit forming, and instead use other medications, like the antipsychotic Seroquel, for example. I tried to use Seroquel for sleep, but I felt very much impaired and overly sedated during the day. I made many more mistakes than usual, and always felt like I was ready for a nap. I'm happy that my current psychiatrist sees me as a unique individual and prescribes the medications that work best for me.

Many mental health bloggers shy away from writing about the medications that they take, but I don't. I've always been told, and I've learned through life experience, that medication is necessary for managing bipolar disorder, especially Bipolar Disorder I, the most severe form, and the one that I happen to have. Since I'm sharing everything else I do to maintain balance, and since medication is so important for that, I'm describing the medication that I take, and how my psychiatrist decides to prescribe it. She only likes to change one medication at a time, so she can evaluate how each one works in combination with my other medications. This can be a laborious process, but I feel that it is helping me to experience more wellness.

Every person who takes medication is a different person with a different lifestyle. There is no one size fits all in psychiatry - at least there shouldn't be. I'm not suggesting my exact cocktail of medications to anyone else, I'm just writing that it is what's currently working for me. Reading stories of recovery, including stories of people finding medications that work, has always given me hope. More than anything else, in writing this blog, I want to encourage anyone with a mental illness, as well as their friends and relatives, to hang on to hope.

Soccer, Swimming, Saphris, and Summer!

Things are looking up for me since my hospitalization last month. I've been back to work for almost a month, and I'm enjoying my days both at work and outside of work. I started playing soccer again, after a ten year hiatus, and I'm delighting in it. I look forward to the once-a-week game all week, and it inspires me to exercise every day.

Taking less lithium, as my psychiatrist has directed me to do, makes it much easier to play soccer, and also to stay hydrated. I started taking Seroquel in the hospital to stop my mania. I've taken it before, and it caused a lot of weight gain. However, this time, I snacked on low calorie foods whenever I had the munchies and ended up losing 7 pounds also probably, in part, to playing soccer again.

Last week, when I went to see my psychiatrist, she suggested that I replace Seroquel with Saphris. The last time I tried Saphris, I was depressed, and I felt that it made my depression worse. However, I wasn't taking Lamictal, at the time, which I am now. So, I started Saphris about a week ago, and I feel great. Last night, I played better soccer than I've played so far this season, and I felt more coordinated. Also, I'm more alert and have not needed as much sleep as I did when I took Seroquel. I'm back to sleeping 7 or 8 hours instead of my usual 10 hours when I was taking Seroquel. I've heard that Saphris is a "wonder drug" for some people, and I'm hoping that will be the case for me.

Every year, I look forward to the beginning of swimming season, and this year was no different. I had a great time swimming at my condo pool for the first time this year. My conditioning for soccer consists of walking in hilly places, swimming, and taking a spinning class. I'm still going to the YMCA for swimming workouts, but my condo pool is so nice for a peaceful dip after a long, hot day, and sometimes, if I'm inspired, I swim some extra laps. This happens more often as the water warms up. I absolutely love to swim in a warm pool with the sun shining down on me!

It's definitely summer in Kentucky. The temperatures have already reached the mid nineties. I don't have any big plans for the season. It's hard to save money for a vacation, as I'm collecting Social Security Disability, and only allowed to work part-time. So, I'm working on being patient and appreciating the simple things in life, such as spending time with friends and family, and enjoying the sunny weather and lazier days.

Luckily, in my town, there are lots of  inexpensive things to do--art festivals, neighborhood fairs, free and cheap musical performances, etc. I have a lot to be thankful and grateful for, and I'm happy that I'm getting back on track. Someday, I hope that I'll be stable enough to start working full-time again. But, for now, I'm going to take advantage of the extra time that I have each day, and work on strengthening myself, both mentally and physically.

Recovery

From 2002 through 2007, I experienced the longest stretch of recovery that I have experienced since I was diagnosed with bipolar disorder in 1989. I believe that  this recovery came about as a result of the medications I was taking and the ways I was trying to improve my life, but I wasn't focused on it, it just happened.

In 2002 I went through an upsetting breakup. Afterward, I decided  to put my energy into my work, my education, and my friendships. I wasn't thinking in terms of preventing a relapse of bipolar disorder at all, but I ended up concentrating my efforts into some areas of my life that contributed to my wellness.

Although I had been compliant with my treatment for bipolar disorder for many years, I still had not fully accepted my diagnosis. I secretly hoped that I would grow out of it, or it would just disappear. By 2005, I had earned a Master of Arts in Teaching and had been teaching for almost two years. At that point, it seemed like I had my life under control, so I asked my psychiatrist to make some changes to my medication because of some side effects I was bothered by. In hindsight, I realize that this wasn't the best idea, because the changes increased the likelihood that I would become unstable. That is how psychiatry works though. Everything is done through trial and error, because the brain and its disorders are still poorly understood.

Teaching was my life and my life was becoming more and more unbalanced. I was putting all of my energy into work. The hours I worked,  as well as the sedation caused by my medication, made it very difficult for me to exercise, something that has always contributed to my wellness. When I got home at the end of the day, I was exhausted and rarely ate anything more nutritious than a microwave dinner. I spent most nights preparing for my next day at school and then reading until I fell asleep. I spent less and less time with my friends. My students and coworkers brought me joy, and that sustained me for a while, although my life away from school was taking a steady downturn.

In 2006 I found out that I had developed workplace-related asthma because toxic black mold was growing in my classroom. My allergist advised me to transfer to another school because he felt that it was unlikely that my school would clean up the problem anytime soon. I took his advice and transferred to a new school in 2007. My health habits had been slipping while I worked at my old school, but when I entered my new environment, where I didn't know anyone, and was also an unknown, I quickly fell into a deep depression. My classroom was immaculate, and my asthma disappeared, but I was overwhelmed, became unable to work, went through shock therapy, and qualified for Social Security Disability. Everything I had worked for seemed to slip away so quickly. It was the biggest wake-up call I have ever experienced.

Ironically, becoming disabled has enabled me to focus on my wellness. I think my problem with recovery in the past is that I just tried to forge ahead, without properly acknowledging and respecting my disorder. I have bipolar disorder and I can never forget that. I have given up the hope that it will ever disappear and have become vigilant about staying well. So few people, without the condition, understand the discipline it takes to live well with bipolar disorder. Things that are no big deal for many people, like staying up all night, or getting drunk, can lead to rapid mood changes, serious depression or mania, and the need for immediate psychiatric intervention, including hospitalization, for people with bipolar disorder.

Twenty three years after my diagnosis, I finally understand all that it takes for me to stay well. I have gone through a great deal of trial and error with medication, therapy, support groups, relationships, work, exercise, diet, and more. I have seen attitudes toward mental illness change in the years since I was diagnosed, and I think if there were as much acceptance when I was diagnosed as there is now, it wouldn't have taken me as long to reach my current level of recovery. My hope for myself is that I will be able to stay on the path of recovery, and my hope for others is that attitudes toward those with mental illness will continue to improve so that it will be easier for those who need help to get it. I also hope that more research will lead to a better understanding of all mental illnesses and also to better treatments, with fewer side effects, for those who are affected.

Growing Up

When I was growing up, I worked hard at everything. In school, I was told it was important to become well rounded. So, without really thinking deeply about it, that became my goal. I took accelerated and advanced placement classes, played soccer, tennis, swam, ran track, rode bikes, acted, sang, and danced in plays and musicals, and sang in my church choir. I enjoyed engaging in different activities, because when I was engaged, nothing troubled me.

The hardest thing about my childhood was that I moved a lot. By the time I was in high school, I had been to seven different schools in five different states and Canada. I expected to move every couple of years, and if I didn't, I felt that something was wrong, that I had been stuck in the same place for too long.

My parents were happy with my productivity and encouraged my interests. Then I got to college, and I had to choose a major. I started out as a theater major, which my parents strongly discouraged. My father wanted me to study business which, at the time, I  thought was much too boring. I was creative and considered myself to be unconventional, and didn't think I would fit into that school. I settled on journalism because I liked to write and take pictures, and my university had one of the best programs in the country. It seemed like a respectable enough path. I also had to choose a subject for my concentration, so I chose biology, because I had always found it interesting, and I imagined that I could work as a science writer. That was the first time I set major goals instead of just trying to excel at everything. Then, I had my first breakdown and dealt with the aftermath.

Shortly after I returned to my university, I applied for a prestigious scientific grant and got it. I was given money to study sensory perception in the mating system of a species of parasitic wasp. Exciting! I felt like a real adult. I was doing research! I had loved all of my science classes in high school, but I had never imagined myself working in a lab, and I had applied for the grant on a whim and couldn't believe I had actually gotten it.

One reason the professor in charge of the lab wanted to work with me, is that he hoped that I would help him with his writing, and I did. It was an honor. I couldn't believe he appreciated my help. After the initial excitement though, my attitude toward working in the lab changed. I was the only female and the only undergraduate in the lab. The professor treated me respectfully, but the other researchers hit on me mercilessly. I had never even considered that might happen. They were really geeky guys, and I was certainly not attracted to any of them. They were not threatening, they just became more and more annoying each day, and I started to feel claustrophobic in the lab.

Around that time, some cyclists, who were aware that I had recently quit the soccer team after a mental breakdown, tried to recruit me to be on their team for a big bike race held every year on my college campus. I told  them I was busy working at the lab in the afternoons when they wanted me to practice. One weekend though, I went on a ride with them and they told me that I had talent and that they hoped I would join their team. Shortly after that, I abandoned my research and started racing bikes. With the help of their coaching, I became really good at it, especially, I discovered, without lithium, so I was lithium-free for most of the rest of my college days. We won the big race on campus, and I won a lot of bike races on my own, and ended up being ranked 3rd in the Midwest Collegiate Cycling Conference in 1992.

Achieving success as a bike racer helped me deal with the pain of losing my mind, but I knew I could not keep winning if I started to take lithium. When I take lithium, it seems like my muscles just don't twitch the same way, and I can't push myself hard enough to win. I used to enjoy riding so hard that I could taste blood, and I am just not that intense when I take lithium. But I knew I needed the medication to live a productive life. When I was racing bikes, I didn't become extremely manic, but I was hypomanic, and also depressed and angry at times. I often felt disoriented and disorganized and there were some times when I couldn't remember things I had done recently, even though I hadn't been drinking or using drugs. The people around me were supportive and thought my spaciness, and unpredictability were, for the most part, funny, but I knew that I wouldn't be able to continue living in that fragile state and keep up with my adult responsibilities. So, because I was used to closing chapters of my life, I easily quit bike racing, resumed taking lithium, and eventually graduated with a Bachelor of Arts in Journalism with a Concentration in Biology, amidst very little fanfare.

Traveling Through Time Zones

For the Labor Day weekend, my boyfriend and I flew to Tacoma, Washington to visit some good friends who had moved across the country a few months earlier. We left the Eastern Time Zone on Thursday, September 1st, and my friends picked us up from the airport at around 11:30 p.m. Pacific Time. I was tired at that point, but also glad to see my friends, so, at their suggestion, we decided to go to a 24-hour diner to eat a very late dinner and catch up with each other. Shortly after sitting down at the table, I took my nighttime dose of lithium, plus some Benadryl, to ensure that I would get a good night's sleep. Whenever I travel, I am keenly aware that I cannot skip any doses of my medication, as missing medication, traveling, and changing routines, can all trigger unwanted mood episodes.

After our late dinner, we drove to my friends' house and I went to sleep around 2:30 a.m. Pacific Time, which was 5:30 a.m. Eastern Time (my time). I told my friends that I would need to sleep at least 8 hours before we woke up and got ready to take a nature tour in a nearby town. As it turned out, they needed just as much sleep after our late night, and we were operating on the same schedule the next day. I had a great day that day, but was very tired. We spent the next three days touring Seattle. By my third day on vacation, I felt that I had adjusted to Pacific Time. I slept well at night and did not wake up three hours too early as I had done for the previous two days. On the days that I woke up early, I just stayed in bed and tried to rest. I think that all of the exercise from walking and touring probably helped me to adjust the time change. We ended up having a wonderful, memorable, and stress-free vacation. It was great to see good friends and explore an area of the country that neither of us had seen before.

On Tuesday, September 6th, we flew back home. My boyfriend's mother picked us up from the airport at 11:30 p.m. Eastern Time. We both planned to go to work the next day, and it was hard for both of us to go to sleep that night since it seemed  like it was three hours earlier to us. We both worked on Wednesday, Thursday, and Friday. On Friday, we were exhausted and ended up getting into a big fight, which now, thankfully, is over. We agreed that we had both been overly tired. We spent last weekend catching up on things we had put off for the three days before, when we had been jet lagged. Now everything seems to be back to normal.

Traveling through time zones is considered to be an activity that can put people with bipolar disorder at risk of  having relapses. However, I would not let it stop me from traveling. If the opportunity for recreational travel arises, I want to take it. That being said, I would probably not take a job that requires frequent trips across time zones. When traveling through time zones, it is important to take all medications on time, to realize that you may not feel 100% until you adjust to the new time, and to give yourself the proper amount of time to recover after your travels. If you are traveling with others, I think it is best if they understand that you need to take certain measures, most importantly, getting enough sleep, in order to prevent mood episodes. Lastly, it is important to remember that the purpose of taking all of these precautions is to stay safe and have fun!

Thirst

When I first started taking lithium, in the hospital, more than twenty years ago, a nurse told me that the medication would make me thirsty, and that I needed to get used to drinking a lot of water. She would bring me pitcher after pitcher of ice water, and a plastic cup, and encourage me to drink.

Taking lithium means that I constantly have a dry mouth, with a salty, metallic taste, that I have never gotten used to, and that I almost always feel thirsty. I usually drink 4 to 8 quarts of water/liquid a day, depending on the weather and my activity level.

I drink a few glasses of ice water with breakfast, and then drink another glass of water with my morning medications and supplements. Then I brew two strong cups of  Bigelow's Green Tea with Pomegranate and take it to work in a large thermal mug. I also take an insulated bottle full of ice water. I usually drink less when I'm at work, because I'm busy, and prefer not to take as many trips to the restroom.

After work, I alternate between water and unsweet decaffeinated iced teas of different varieties. My current favorites are Bigelow's Decaffeinated Green Tea brewed with their Pomegranate Pizzazz, and Celestial Seasonings' Lemon Zinger.

When I work out, I either take water with me, or drink from the water fountain at the gym. When I go on long bike rides, I drink water for the first two hours, and then, after that, I drink Gatorade. When you take Lithium, you need to be very careful not to become dehydrated, and Gatorade helps with that. I've found though, that drinking Gatorade is not necessary if I'm exercising for less than two hours. 

This summer I read that 100% grape juice, from Concord grapes, has been shown to prevent metabolic syndrome, a precursor to heart disease, so I have happily added a tall glass of grape juice to my daily diet. At times, when I want something a little bit fancy, I enjoy 1/3 of a glass of cranberry juice, the kind made with 100% juice, and no added sugar, topped off with seltzer water and a squeeze of lime juice. I consider this to be really refreshing and kind of festive. And ice water with lemon, lime, or orange, is also delicious and thirst-quenching.

My drinking habits have changed over the years. I used to drink entirely too much Diet Coke and Crystal Light, and when I faced the fact that they weren't really quenching my thirst or enhancing my health, I decided to quit those drinks, along with artificial sweeteners, and I have been feeling better since then.

When I was 19, it was a big deal when my psychiatrist told me not to drink alcohol--especially right after I had been told that I had an incurable mental illness, and that I would have to take medication for the rest of my life. Many people think that it is no big deal not to drink, but many of those same people regularly drink alcohol with their meals, and at most parties. Alcohol is a huge part of our culture. When you are a non-drinker, it is hard not to feel like you're missing something. 

One of my old college friends invited me to her city, and, in the last phone call before I started my drive to visit her, she said, "I hope you can manage to have fun. My entire social life pretty much revolves around drinking." I will never forget that. It made me feel nervous, but, as I observed, she had been completely honest.

I used to avoid going to certain parties, and refuse invitations for cocktails, because, as I explained, "I don't drink." Now, I don't really talk about it much. I go out for drinks, and just drink water, cranberry juice, or Sprite. When I go to parties now, I usually take a non-alcoholic drink that I like, such as the cranberry-seltzer concoction mentioned above. I also like the natural sodas Izze and Cascal. And occasionally, I have slipped and have drunk alcohol. I have found that I can easily handle one drink, and usually two, but I have always regretted having more than two. I guess it's best to take medical advice, but it sure is hard to be perfectly compliant.

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 .

Lithium Refill

Just before going out for dinner with my boyfriend, I stopped into Walgreens to pick up my 90 day supply of lithium. Lithium has been around for a long time, so it is very inexpensive. This amount of generic lithium only cost $15 with my Medicare Part D prescription plan.

Lithium has helped me more than any other medication that I have taken for bipolar disorder, and it hasn't done as much damage, in terms of dangerous and unpleasant side effects, as some of the newer, more expensive medications. It helps some people with depression, but for me, it is especially helpful in preventing mania.

This is not widely known, but communities in different parts of the world have considered adding lithium to the water supply as a way of preventing crime and suicide, because it has been shown that in places where lithium occurs naturally in the water, people are calmer and happier. Of course that amount of lithium would be much smaller than the amount I take. I take 1800 mg. every night before I go to bed. That is four of these 450 mg. tablets. Lithium should be taken after eating a small amount of food containing protein and fat to prevent diarrhea that can occur if it is taken on am empty stomach. I usually take it with a small glass of milk or a piece of low fat string cheese and water.

As I was walking out of the drugstore with my new refill, I wondered how many pounds of lithium I have ingested in the past 17 years. When I got back to the car, I asked my boyfriend what he thought, and he said, "Ha! Probably enough to build a Prius." I appreciate his sense of humor.

Hypomania

This picture was taken in 2002. I had gone off lithium to lose weight and I did. I lost 60 pounds without much effort. I also ended up being hospitalized for mania and going back on lithium.

Lithium prevents mania, but does nothing for depression (at least not for me), which is why I also took Lamictal (and still do), a mood stabilizer that is more effective for depression than for mania. The two seemed to balance me out for a while, but I developed health problems from taking lithium and had to try (and am still trying) new medications. I consider my treatment for bipolar disorder to be a work in progress. As new medications are developed, I might try them if my current medication is not working well.

In this picture, I was hypomanic, meaning I was in the early stages of mania -- when it is more fun than scary.