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.

Mood Transitions

I was manic in March and April, and then I was hospitalized. When I got out of the hospital, I had been stabilized enough to travel from Connecticut, where I was visiting my sister, to Kentucky, the state I call home.

Now it's early July and, looking back, I realize that I was hypomanic until a few weeks ago even though I was no longer in a crisis situation. I really don't enjoy being manic because my increasingly erratic behavior eventually becomes frightening to myself and others. I also don't like hypomania because it is a step toward both mania and depression for me, but sometimes it's hard to identify. In our society, we are rewarded for high energy and productivity, so sometimes what may seem positive can really be negative.

I was very active after I got out of the hospital, which seemed good since I'm trying to lose weight. It didn't take much to motivate myself to exercise and the things that usually seem hard, like waking up early in the morning, seemed effortless. I broke up with my boyfriend when I was manic, for good reasons, but it didn't really phase me until a few weeks ago, when I closed the storage unit I had opened when we moved in together, and brought everything back home. I felt a sadness and a loss of control as I unpacked and tried to decide where to put everything. I knew that I shouldn't miss him, but I did. At least I missed his companionship.

It struck me that I'm single and may possibly be for the rest of my life. I began to worry about living independently and taking care of myself. Ever since my diagnosis at the age of nineteen, organization, especially of my living space, has proven to be challenging for me. I'm trying to solve this problem by paring down my possessions to the bare minimum. The process of sorting through everything stirs up many memories and mixed feelings and living in a mess, although it is temporary, is disconcerting.

Anxiety had nearly immobilized me for the past few weeks. A couple of good friends helped me realize that my world wasn't ending, I was just overwhelmed. They assured me that I could take care of myself and helped to distract me from my fears by encouraging me to have fun and think about other things. I'm very fortunate to have supportive friends. They have both been through trying times, but have not experienced mental illness. Their insight helped me to understand how a "normal" person would think and pull themselves out of my situation. I quit the negative thinking and started to feel much better.

A few days after I started to feel better, I had an appointment with my therapist and told her about all of the mood changes and the anxiety I had experienced. She helped me to realize that I always feel uncomfortable when I go through mood transitions. Sometimes recognizing a problem is the first step toward overcoming it. Although I don't want it to happen, I can pretty much guarantee, based on my history, that I will become manic sometime in the future. Next time I come down from a mania, I can reflect on the fact that mood transitions are hard for me, and maybe that will help me to push through negative emotions and anxiety more quickly.

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.

A Break from Reality

In March, I was having trouble with my boyfriend. We were arguing a lot about what I considered to be very small things. Then, after a sudden betrayal of my trust, I broke up with him and didn't look back. Also, at work, I was facing some moderate stress. In addition, the season was changing from winter to spring. I often become hypomanic when the days grow longer and the temperatures start climbing. I felt like I was speeding up, but I was still sleeping, though, as I now recollect, not very much. I had made a promise to my psychiatrist that I would call her if I started missing sleep. I wasn't exactly missing sleep, but I was racing through my days and not sleeping as many hours as usual. I had things to be upset about, but I felt good anyway. Maybe it would be better to describe it as energized. I was enjoying the sunny weather, and I felt productive - likely more than I really was. It's hard to describe this time accurately, because I was moving through it in a blur. It was almost dreamlike. As I look back now, I am sure I was hypomanic.

The day after I broke up with my boyfriend, the owner of my company, as well as the president, came to ask me questions about my breakup, my work, and my mood changes. They said they had noticed that I was acting different (hypomanic). They had seen it before, a couple of years past. At the end of our discussion, they told me that they would be giving me paid leave for as long as I needed it to "get healthy". I knew that I was hypomanic, but I was still sleeping (for the most part). My parents had plans to go visit my sister in Connecticut the next day. It seemed like the perfect opportunity to see my sister and nephews and rest. I felt like all I needed was rest, and then my hypomania would subside. So, I left, with my parents, for Connecticut, the next day.

As it turned out, when I got to Connecticut, I didn't rest. I barely slept at all. I woke up before everyone else, at the crack of dawn, and would quickly put on my clothes and start walking to the town center and all around the town. I would come back around noon and meet my family for lunch. They left the back door open for me. I think I probably walked at least 5 miles each day and some days I think I walked about 7 miles. I would describe my walking as roaming and exploring.

Everyone in my sister's town seemed extremely friendly, and they greeted me warmly. It's a small town, so I'm sure that many people knew that I didn't live there. The highlight of my time there, was the first morning, when my sister and I went for a walk on a beautiful beach near her house, but I spent most of my walking time by myself. I would first walk to Starbucks, the earliest place to open, and I would talk to the people there who were getting coffee before work. Everyone in the town seemed so kind. When I looked at their expressions, I felt like they were sending me secret messages. I felt really welcomed, loved, and taken care of. It was beautiful, but I know I was imagining a lot of what was going on.

We went to the Easter service at my sister's church the day before I was supposed to fly home. While I was in church, my mother, who was sitting behind me, grabbed my purse and moved it. I was extremely irritated by this, as I didn't understand why she had disturbed me. So, in the beginning of the service, I reprimanded her, not quite yelling, but speaking to her loudly and harshly. I then quietly walked out of the church and started walking around town again. I went back to Starbucks, and, surprisingly to me, because it was Easter Sunday, it was crowded. After I drank a couple of iced herbal teas, I began wandering again.

After church, my parents called me. I agreed to walk back to my sister's house and then we went to a special Easter Sunday Brunch at a nice restaurant. After the church incident, I was on edge whenever I had to deal with my mother. We were supposed to fly home the next day. I was becoming increasingly agitated and upset. A couple of hours before we had to fly home I realized that I was going to lose it on the plane if I had to fly back home. I asked to go to a hospital. A few minutes later, my sister drove me to Yale-New Haven Psychiatric Hospital where I was admitted because of my manic behavior and my delusions of people psychically communicating with me.

When I arrived in the psychiatric emergency room, it was discovered that although my lithium level was low, I had lithium toxicity. The reason my lithium level was low, is that the lithium toxicity was causing extreme thirst, and I was drinking huge amounts of  water to quench it. Because of this, lithium was being washed out of my system. So, I was put on water restriction for 24 hours and when my lithium level was taken again, it was toxic, because I hadn't been allowed to drink nearly as much water as I had been drinking before.

The psychiatrist in the emergency room explained that I would have to take less lithium, or even no lithium, and add an antipsychotic medication to prevent further episodes of mania. When I got out of the emergency room, where I stayed for three days, I was admitted to the psychiatric hospital, where I stayed for seven days. The psychiatrist in the hospital decided to lower my lithium dose from 1800 mg. to 1350 mg. He then ramped me up to 400 mg. of Seroquel and kept me on 200 mg. of Lamictal. I felt better and better each day.

When I was in the Yale-New Haven Psychiatric Hospital, I received the best care that I have ever received in a mental hospital. It was such a relief to be listened to and taken seriously as a human being. I had been complaining of my extreme thirst for about two years, including another time when I was hospitalized in Kentucky. My complaints were always dismissed, even though I had measured how much I was drinking each day. I told three doctors about this, and I told them I was drinking about eight quarts of water every day, and they just told me that nobody knows how much water an individual needs, so I should just drink when I was thirsty.

When I explained this treatment to a nurse at Yale-New Haven, he became incensed and yelled, "What are they, retarded? Nobody should be drinking eight quarts of water a day. You could have died! Your organs were failing!" All I can say, is that is the difference between mental health care in Kentucky and Connecticut. The only person in Kentucky who noticed my extreme dry mouth and irritated tongue was my dentist, and she considered it to be a problem worth addressing, so she gave me some special mouth spray to use (Biotene). It did help my mouth, but it didn't take away my thirst. I just told her that my doctors had advised me to drink whenever I was thirsty, and I was doing so, but my mouth was always dry anyway. Doctors in Kentucky don't believe you when you say you're drinking eight quarts of water a day, but your mouth is still parched. In Connecticut, it is considered (correctly) to be a medical problem.

I love Kentucky, but if I ever have a serious medical problem again, I'm going to Connecticut for a second opinion. Kentucky is not known for its brainpower. We are among the least educated states in the country. There are many reasons why people choose to live here anyway, but one of them, is that if you are educated, it's much easier to get a job here than places where there is more competition. I've always considered Kentucky to be a backward state, but I have grown used to it, and have had many good experiences here anyway, and have made many good friends whose companionship I treasure, but I often feel that if I hadn't been stricken with a severe and persistent mental illness, I would have left right after high school and never come back.

Severe Manic Phase

I've been hospitalized for mania three times in the past ten years, the last time in 2010. This post is an account of a mania that occurred in 2002. I chose to write about this manic phase because I happened to have my camera with me a lot, and I took pictures that may help you to understand what I was going through. 

In this picture, I'm standing on a beach of  Lake Michigan in Chicago. I had recently started a new job and was hanging out with my ex-boyfriend a lot (didn't make much sense). Anyway, he was gearing up for a really busy time at work and wanted to visit Chicago before he became swamped. 

We decided to go to Chicago for the day and drive back late at night. It was a ten hour drive round trip. I know that lack of sleep can trigger mania in me, so I always try to make sleep a priority. For this reason, I was afraid to make the trip since it seemed unlikely that I'd get enough sleep, but my ex-boyfriend said, "Don't worry, you can sleep in the car on the way back," and I stupidly agreed to go. This picture was taken shortly after we got to Chicago, and I was feeling very happy and even-keeled.

I ended up staying up all night in Chicago and didn't sleep as my ex-boyfriend drove back to Louisville. When I got home, instead of sleeping, I decided to drive to my favorite part of town, park, and wander around. I didn't have any plans to go anywhere specific or meet anyone. I just walked around talking to strangers and taking pictures.

The people below are a very nice couple I met and chatted with at a coffee shop. I'm a friendly person, and I often make eye contact and smile at strangers, and even exchange pleasantries when appropriate. This was beyond that. I was engaging people in long conversations. I'm not sure what they thought. I'm lucky that people in Louisville are polite compared to many of the other places I've been.

After I left the coffee shop, I hopped on a trolley where I spoke with these young men.
 

When I got off the trolley, I met this man on the sidewalk.

I had quite a long conversation with these two guys, although I don't remember what we were talking about. The one with the beret asked me out for ribs. I got in his camouflage truck and he drove me about 30 miles from my parked car. We had fun eating ribs and drinking beer - by then I was fully manic and didn't take the "no drinking" advice from my doctor seriously. I don't recall any wild drinking, but I remember having a couple of strong microbrews.

After the ribs and beer, he invited me to his apartment and off we drove. When we got there, he put on some 80's music and started dancing. As I was taking everything in, I noticed he had a lot of knives on display. All of a sudden, I felt uncomfortable and realized that I wanted to leave. I asked him to take me back to my car and he did. I'm really lucky that he was a nice guy. 

You may notice that, in this picture, I'm still wearing the outfit that I was wearing in Chicago. I tend to wear the same clothes for days when I'm manic.

I thought this young girl selling candy was really cute.

The next day, I returned to the same neighborhood for more roaming. I was having some religious delusions that I can't remember very well anymore. For reasons that made sense at the time, I decided to walk into my church. The door was open and I found a few friends there and had this picture taken with one of them. I was wearing a t-shirt that says, "City of Louisville - 1778." I remember that it meant something special to me at the time, besides it being the year that Louisville was founded. It seems like everything becomes an important symbol when I'm manic.

After I left the church, I walked to a park with a large fountain. I left my purse on the ground and jumped into the water, completely immersing myself and imagining some kind of self baptism. I got out sopping wet and wandered over to a picnic area where I started talking to random people and families.

The family below was really nice. Reflecting on the situation now, I'm sure they assumed that I was mentally ill, homeless, or both. They were really soft spoken and gentle and offered me food and drinks. I stayed with them for a while.

When I left the park, I walked back to my car, which was parked several miles away, and drove back home where I made some potato salad to take to a party. I'd been up and active for many hours, but I still had energy at the party and remember having a good time.

I don't remember how I landed in the hospital, but I did. I was in for a week. I almost lost my job, since I had just started a few weeks earlier, but I talked them into giving me a chance to work, and I ended up working there for two years until I completed my master's degree and began teaching.

I asked my mother if she could remember how I ended up in the hospital in 2002. She said, "No, it all runs together for me." Hearing her say that made me realize, yet again, how hard it can be for family members to deal with the instability that bipolar disorder can bring, and gives me another, in a long list of reasons, to keep my commitment to staying well.

Although I don't remember how I ended up in the hospital, I can tell you that most of my manias have degenerated into hallucinations, delusions, paranoia, irritability, and uncharacteristically aggressive behavior. For an account of that, see Relationships. I'm sure the lack of sleep and drinking alcohol contributed to this mania, and I'm sure I missed some doses of medication during the days I've described.

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.

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!

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.

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.