Back. With Meds that Stabilise Me.

Yup. After twenty years, I’ve finally got meds that stabilise me. Well, I’ve been stable for the last 3 1/2 months, which is far longer than anything else has ever worked. 

I’m currently taking  Carbamazepine (Tegretol) – about 200 mg in the morning, 100 mg twice during the day and 200 mg in the evening. 

I have no idea why the meds are working. But it is working for me, and I’m not going to complain. I’m just happy that my mood swings have stabilised, and that I can get on with my life.

So yay!

Books for Bipolar Persons

So I’m in an Indigo bookstore in Toronto. And it’s wonderful, maybe I’ll spend the rest of my vacation in here. 

Anyhoo, apart from checking out my favourite authors and the entire Sci-Fi section, I thought I’d check out the stuff on being bipolar.

And their collection is okay. And they have books about being bipolar, and ones on how to cope with depression.

But here’s the rub. My first impression was that we need a lot less text in the books.

If we’re depressed, the information is too much, too dense. Overwhelming. We simply won’t be able to absorb it.

If we’re manic, we can’t focus, and we need information served in bite sized pieces. 

Our books on coping really need to be written like those in the Children’s section. Just a few big words per page, with lots of colourful diagrams, and elephants and tigers, and called “My Big Book of Bipolar Disorder” or “Teddy learned to Cope with Mania and You Can Too!!”, and be 15 pages long.

Then we may be able to read them.

Ideas for Staying Stable

I think I may have found a way of staying stable…and it seems to be as simple as getting enough sleep. Yes, this does sound as if either (a) I’m a new age hippie caught on the newest fad or (b) it’s too good to be true.

But it does work, and seems to work as well as or better than any of the drugs that I have taken to stabilise my moods. In fact, getting enough sleep is the only thing that has ever stopped me from falling into a depressive mood. None of the medications have ever did that. In addition, getting enough sleep also seems to prevent me from getting the manic highs.

It does seem too good to be true, doesn’t it?
So here are the disclaimers.

So far, I have started this only four weeks. However, with my continuous rapid cycles, four weeks represents two hypomanic episodes and two depression episodes. So far none have occurred. Not even a mild mania or depression. For me, the results have been dramatic, and very noticeable to those around me.

We all react differently to each drug, and drugs that are effective for one person will not work for another. I am assuming that getting enough sleep will follow the same pattern and that not every person will find that it works for them. However, my intuition is that getting enough sleep is likely to have a higher success rate in keeping people stable than any drug.

I am unfortunately unable to hold a clinical trial to test my theory (and I hope that some researcher will). In the interim, if you try this, can you let me know if it is successful or if it didn’t work for you.

I don’t think it will work if you are currently depressed. Depression imposes its own odd sleeping patterns, and when we are depressed we sleep well in excess of what is normal. I don’t think trying to impose an regular sleep cycle will make much of a difference.

It may work to stabilise you if you are manic. However, I have my doubts that a high energy manic person will be willing to go to sleep early for a number of nights in a row and be able to sleep a regular number of hours. Basically, it should work if you do what I suggest, but you’ll have a difficult time doing which I suggest.

I think getting enough sleep will work best if you start when you are currently stable or almost stable. This way your sleep pattern is close to normal, and you have enough control to actually go to bed on schedule and get up when the alarm clock wakes you.

You need to be consistent. And getting a full night’s sleep every night is much harder than it appears.

My experience is that just two nights of not getting enough sleep is enough to start the destabilisation process. It’s that easy for things to go awry. I have tried this before, and those attempts have failed because of the night that I stayed up late to finish what I was working on, or to watch one more episode of Law and Order on television. Or just saying that I can get up late on Sunday so I can have a night out on Saturday.

It don’t work so. Consistency is the key.

This

So – this is the magic solution, right? If I get enough sleep, my world will right itself and I won’t be bipolar again and I can just get on with my life. Yes?

Well, I doubt it’s quite that simple.

13 May 07

We all tend to aim to try to get stable and then to stay stable. But it’s important to realise that getting stable and staying stable are two very different things and you need two different strategies to handle them.

Well, three strategies, one for getting stable from mania, one for getting stable from depression, and one for staying stable.

Don’t assume that whatever you are doing to get stable will necessarily continue working to keep you stable. Once you become stable, you must keep on monitoring yourself just as much as if you are manic or depressed.

It is worth the effort to do the things that keep you stable because if you destabilise, it can take weeks and months to get back to being stable.

So much for the pep talk. What can you actually do to keep stable?

If your medications work, keep on taking them. Do not stop them just because you are feeling fine. This is not the flu and you are not taking aspirin. You are feeling better because you are taking your meds. Stop, and you have a good chance of having your mood swings begin again.

However, you shouldn’t rely only on medications. They are not foolproof, and the concept “If you take your medication, then your moods will be stable” doesn’t work. Do not expect to keep the same old habits as you used to and expect the medications to work to keep everything in place. Chances are, they won’t.

Changing habits doesn’t require you to change your life. But once your are reasonably stable, consider trying these to see if they help you to stay stable.

Sleep
My experience is that getting a good night’s sleep is one of the best ways to stay stable, and about as effective as drugs. Aim for 7 1/2 to 8 hours of sleep every night.

The reverse effect also appears to be true. Not sleeping enough seems to be one of the major factors in causing me to destabilise.

This sounds good, doesn’t it? It’s cheap, doesn’t have physical side effects, and is a really good excuse to get up late every morning. And everyone says getting a good night’s sleep is a good thing.

It’s also extremely difficult to put into practice consistently.

Think about it. When is the last time you had 8 hours sleep? When is the last time you had three consecutive nights of 8 hours sleep?

If the plan is to get up on a morning at 6:00 am, then you have to be in bed by 10:00 pm. That means if you are watching movies on television they have to start by 8:30pm. It also means no meeting friends for dinner at 7:00 pm because you’ll never get home in time for ten; no late nights out on the town; leaving early at parties (or before they even start); no trying to finish some last minute paperwork after the kids are in bed; no going to bed at ten and having sex (go to bed earlier).

Of course you can get up later if you stay up late, but that’s usually not practical on weekdays. And getting up later will mess up your morning schedule, which is also likely to cause you to destabilise.

The thing about using sleep to keep you stable is that it has to be consistent. You obviously don’t have to do it every single night, but it should be close to that. The more nights you miss the full 8 hours, the less effective using sleep as a mood stabiliser is.

Conversely, if you have just a few hours sleep on consecutive nights, you should definitely monitor how you are feeling over the following few days to ensure that your moods don’t start fluctuating.

You can’t just decide to get eight hours sleep every night without planning it. We have all pretty much tied ourselves into lifestyles where it is impossible to do everything we want and still get enough sleep. You have to think about how you plan to sleep given your schedule and what you intend to give up doing to make it happen. Do not pretend that you will still be able to cram everything into less time.

One of the major things that will need to be sorted out is leisure time. Dinners with friends need to be scheduled earlier or become lunches. You need to go to the movies earlier. If you are meeting a group of friends on a Saturday evening, expect to be leaving early. If you have kids, let the spouse handle them after your bedtime.

If you do have to stay up late because you are invited to a wedding, or there is a play you want to see, or you just want a night out, or it’s Thanksgiving evening, you must schedule it in. And you must ensure that the day before and after have your regular sleep pattern. If you have two engagements on two consecutive nights, you should forego one.

It’s a bit tough, but then life’s tough. And if you remain stable, you are actually on average more likely to go out than if you destabilise and get stuck home depressed for a month or two.

If you use the late hours as the quiet time for yourself, you need to figure out an alternative. See what you use the time for – destressing, having a cup of tea, doing household accounts, talking with your partner, reading, snacking – and see where else it can fit in. If you use the late hours for relaxing, consider using your exercise time as your personal time instead.

When you start going to be earlier, you may find that you can’t get to sleep easily. That’s probably normal as your body hasn’t adjusted to the new rhythm yet. Try any of the usual recommendations for insomnia, but don’t give up just because you don’t like lying around in bed.

You may find out that you are going to bed earlier than everyone else, including your kids. There’s nothing wrong with this. But whatever you do, never stay up later than everyone else. The chances that you will stay up until 2 am and then destabilise rise substantially.

C. always keeps an eye on me to make sure I go to bed on time, just like keeping an eye on me to make sure I take my medications. If C. goes to bed earlier than my usual bed time, I go to bed too because I’m not allowed to be the last one to go to bed.

Whatever you do, do NOT sit on the sofa and turn on the television. It’s too easy to watch Law and Order until midnight. You are better off in bed.

Something to keep an eye on. If you regularly need seven hours of sleep, and you find that you are suddenly sleeping eight hours, check to see if you are becoming depressed. You could have just had a tiring day, but with our mood swings, it’s always worthwhile to check to see if our moods are wobbling away from normal.

Variations:
I’ve been talking about 8 hours of sleep. But if less does you just fine, it’s ok. You’ll know you need less sleep generally if you keep on getting up an hour or 30 minutes earlier than you expect. However, if you are sleeping less than about 6 hours, you probably aren’t getting enough sleep.

The Fine Print:
Sleeping tends to keep us stable. But if we are manic or depressed, our sleep patterns bear no relation to normality. I’m not sure that trying to implement a sleeping pattern while manic or depressed will help make you stable (but then again, it couldn’t hurt).

Waking Up Early
You are likely to find that if you start going to bed early, you are awake at 5:00 am. Instead of tossing and turning in bed grumbling, take advantage of being awake.

My experience has been that getting up before everyone else is a good way to start the day unstressed. You don’t have anyone to deal with, the house is quiet, and you don’t have to start the mad morning rush just yet. It’s a peaceful empty space to inhabit with no other people to deal with. It’s absolutely wonderful.

And it does your mood good. I think we all need about 20-40 minutes of quiet time on mornings to let our moods settle into normality before starting the day’s rush.

It’s also a good time make yourself a cup of tea / coffee / hot chocolate and sit at the kitchen table and plan how the day is going to be. We need structure in order to cope well, and setting up how the day will be allows us to get through the day more easily.

The quiet time and the planning of the day go a long long way in keeping us from being increasingly stressed as the days go by. So we stay more stable.

This quiet time can take the place of your quiet time at the end of the day. If you come home from a long day, instead of trying to relax and unwind when you are tired and stressed (and no, sitting in front the television is not unwinding), go to bed early and wake up early to have your quiet time – you’ll be refreshed and you’ll enjoy the time more.

If you are a morning person, you are probably alert enough so that you can do household accounts, etc.. I tend to use this time to write e-mails and update the website.

Do not lie down on the couch and turn on the television.

You can use the time to do anything else you want, so long as you set aside the ten minutes or so to plan the day. This includes stretching, yoga, a bit of housework, even a morning run if that’s your thing (after you planned your day, it’s can also be a good time to sneak back in bed and jump your partner). However, on the days when you don’t do what you planned to do, do not feel guilty and stressed. That would pretty much invalidate the whole point of having the quiet time. If you didn’t do the yoga, it’s ok, really.

If you are rising early, remember that getting a good night’s sleep is more valuable than waking up early – if you have to drag yourself out of the bed, stay in it and go back to sleep.

However, if you are pretty consistent with waking up early, and you don’t do it for a few days in a row, check to see if you are slipping into depression.

With a little luck, by the time the other people start rising, you’ll have started into the day’s rhythm smoothly and peacefully.

The Fine Print:
I have no idea if this will work properly in countries with winter, where you wake up to a cold house. If you are doing this, ensure that you are comfortable – warm robe, fuzzy slippers, hot chocolate, etc.. Getting up and being cold and miserable does you no good; you are better off sleeping. But still see if you can wake up 15 minutes earlier to make the plans for the day.

Exercise
Like sleep, exercise seems to work as effectively as antidepressants in keeping me stable. And the best part is that it doesn’t take a lot of exercise to keep stable – it’s not necessary to be running five miles every day.

There are however a few points to keep in mind. One of the first is that the exercise is better done outside, as opposed to being in a gym or on a treadmill at home.

I’m not sure entirely why this should be so, after all exercise is exercise. But being outside does make a difference – apparently just having nature around us works to make us feel better – less stressed, calmer, and more stable.

So if there is a park nearby, or if you live in a nicely wooded suburb or in the country – that’s the place to be when you are exercising. Even better, if there is a pond or a river or a lake close by, find a path that carries you by it. Being by water also seems to work to make us feel better.

I’ve moved houses a lot, and even before I realised it made a difference, I always instinctively chose to live near water where possible, and always near a park.

However, if you can’t make it outside, then exercising in a gym or at home works.

The second point is that this exercise is for keeping your moods stable. It is not about increasing how far or fast you can run, or about having the best time for swimming 30 lengths in the pool, or lifting the heaviest weights you can, or about winning your opponent in golf.

It is also not about improving your cardiovascular capacity or about burning calories to lose weight.

You can certainly add in any or all of those goals if you like. But you must remember you are piggy backing them onto the main goal of keeping your moods stable. If you do not, you are setting yourself up for disappointment. More on this later on.

You can choose pretty much about any exercise you want, but walking or running are the easiest to prepare for. And having something that is easy to prepare for makes a difference.

Remember, being stable doesn’t mean that your moods are stable. It just means that your moods don’t swing so intensely that you plunge into depression or go manic. But you are definitely going to have good days and blah days and really blah days.

Your exercise program has to be able to accommodate the fact that you will not always be at or near your peak. In fact it has to accommodate that there are days you’ll be lucky if you just get out of the house.

My experience is that you need an exercise program that has at least three levels of intensity. One of them is the standard intensity – you get out, you have a good run, you perhaps push yourself a bit, and you come home feeling satisfied that you had a good day.

The second level is for the days you are feeling blah. You still have the ability to get out and exercise, but you know that you aren’t going to do great. But that’s ok. Remember the idea isn’t to get faster or stronger, it’s to keep your mood stable. Even a middling or just passable intensity of exercise will work fine to keep your moods stable.

The third level is for when you don’t want to leave the house or exercise and you have to fight to drag yourself out of the house. At this level, anything goes, just so long as you get out of the house.

So how does that translate into an exercise program. Well, for me, standard intensity would be two circuits around a park near my house, making sure that I time the circuits to ensure that I keep up to speed. On these days I challenge myself to see if I can increase my overall speed and decrease my overall times. Total time for running would be about 35-40 minutes.

On blah days, I live with the fact that I’m going to have to struggle to make one circuit, but I figure that’s better than nothing. On this circuit I feel tired and my breathing is laboured, but I know that I can definitely make one circuit because I usually do more than this. Total time would be about 25 minutes.

On really blah days, I don’t even bother with putting on running shoes or shorts because it takes too much effort. I just go for a walk around the block in anything I have on – jeans, t-shirt, slippers. Or even work clothes. While this probably will never count as exercise, remember that’s not the point. The point is trying to stabilise your moods – and a 10-20 minute walk can help in making you feel better.

When I used to swim, my program was 30-40 laps on a standard day, 20 laps on a blah day, and a walk on the very blah days.

You don’t need to exercise every day – 3-4 times a week is fine. But going for a 10 minute stroll every day is always nice. If nothing else it gives you a 10 minute time out of your hectic day to relieve stress. Come home and before you settle into the evening activities, drop all your stuff and go out for a walk. Work clothes are fine – you aren’t supposed to get all hot and sweaty on a stroll.

While any form of exercise can work, the more preparation stuff you have to do before you start exercising (including getting to and from your exercise location), the less likely it is you will exercise. That’s why I tend to prefer walking or running – they are low preparation – although there have been days when putting on my running shoes was too much effort.

I’m not sure if having an exercise partner helps. On the one hand, having someone you are supposed to meet can provide you with an incentive to get out there. On the other hand, it also adds in another layer of complexity and preparation. Try it and see if it works for you – but don’t feel as if it is your fault if it doesn’t work.

I don’t think it matters if you exercise on mornings or evenings. Personal preference and scheduling probably matter more.

There is one final benefit to exercising. If you get fitter, or you lose weight, you’ll feel better about yourself. This increase in self image can also work to stabilise your moods, or to provide you with additional strength when you are feeling low. But, the reverse is also true. If you aim for getting fitter or losing weight, and you are unable to do so because of your mood swings, you are going to feel frustrated and your image as someone who can succeed will decrease. Be very careful that you do not set yourself up for this failure.

Always remember that the point of the exercise is to keep your moods stable. If you eventually run a marathon or if your waist size drops by three inches, those are great side benefits. But don’t start off aiming for or expecting those benefits.

Rigid Organisation of Time – Get up at the same time, dress at the same time, go to work at the same time, go to sleep at the same time.

This provides a basic ordering to my life. If I drift from the this pattern without an obvious reason, it is an early warning signal. And the structure makes it easier fo

Friday Afternoon Blues

Friday afternoon is one of those times  when it’s really easy to have your mood swing down or up.

Maybe you’re the (bipolar) kind of person who at the end of the week comes home, drops the bags on the floor, and lets out a deep sigh that the hectic week is all over and you can take your well earned rest for the next two days. If you are, you might be setting yourself up for a bit of depression.

The tendency to let everything go and just veg is a dangerous habit for us. When we try to switch off from our thoughts and responsibilities and plans for a little while, we often swing a bit too far in that direction and we have great difficulty getting up off the couch, or from in front of the computer to start back doing the little things we have to do next.

And bingo!, depression episode.

This kind of falling into depression happens very swiftly, measured in an hour or three, so by the time we realise it, we are too depressed to be able to do anything about it.

It particularly happens if you drop everything and (a) decide to sit in front of the computer to surf the internet, or (b) decide to sit in front the television and end up watching the four back to back episodes of “How I Met Your Mother” and then switching to “Eureka” or “Americas Funniest Home Videos.” And next thing you know, you don’t want to get up to meet friends for drinks at eight.

Reading can do the same thing too, but my experience it isn’t as likely to pull you in. Any other task / habit you have that doesn’t have you moving much and is fairly mindless can act the same way.

Now, regular people procrastinate too. But for us bipolar people, procrastination and depression are right up next to each other. So close that we have a hard time telling them apart until of course, we realise that we are indeed depressed.  If you’re bipolar, procrastination is warning signal that perhaps you need to get your ass moving before you do fall into a depression episode.

 

But what happens if you do want take a breather from the hectic pace of your week?

Well, do something that keeps your body moving. Go for a walk. Carry the dog for a walk. If you are up to it, grumble as you put on your sneakers and go for a short run or ride. Trim some plants in the garden. Go to the mall and window shop. Amble in the park and people watch. Meet up with some friends and play some small goal football. Do your stretching or yoga routine, even if you do a halfway job of it. Whatever you do, do not stop moving.

At the very least, drop your bags, keep on your work clothes, put on some comfortable slippers, and go ambling (not power walk!) around a block or two in neighbourhood for 10-15 minutes. You should be able to have the energy to do at least that. With a little luck you’ll return in a less hectic frame of mind and a bit better able to handle what you need to do next.

Do not use this time to worry or fret. Enjoy the scenery. Smile at a few people.

When you return, stat doing some of your routine tasks, but do not get ramp back up to a frenetic pace. Keep a calmer, more measured rhythm. And if you have too much to do, drop some of the tasks you were planning to do and put them off for another day. Those tasks can wait. It’s also ok to be late to meet people or have your whole schedule slide a half hour or an hour.

Basically, learn to one of those laid back people who so irritate you at the moment. Laid back isn’t the same as irresponsible.

 

Experiment 17 and18 Jul 12 (Days 3 and 4)

Weight:  174.2 lbs (So a bit of real weight loss. To see if it continues)
Drugs: None today. 1 regular coffee at 8.30 am and another at 11.30 am. A glass of wine with parents at 10.30 pm.
Productivity: High all day. Slightly unfocused after about 7 pm, but still got big things done.
Moods: Felt good in the morning. Started getting the ‘oh my god’ mild mania from about 6 pm.
Slept night of the 17th from 12:45 am to 4:45 am.
[Info for 17 Jul 12. Notice how this list is getting longer. ]

Right, today I’m not going to write up the whole day schedule like I did before. I’ll just be repeating myself. But there are some issues, good and bad, that are immediately starting to show themselves.

First off, the 2 hour concept seems to be working. Knowing that I will have to finish the current task in a short while tends to keep me focused on what I am doing. Two hours is long enough to get real work done without getting pulled in too deep. Of course it’s handy to get lots of small tasks done too.

There are tasks that take longer than two hours. I’d recommend that you break it up such tasks into multiple 2 hour pieces and take at least a half hour break between them, or spread the task over days. Remember, if you are coming out of depression, whatever you are trying to get done wasn’t done for a long time – taking an extra 2 days or week to complete it won’t change the overall picture.

I will do a post specifically on time management and how to try to coordinate a schedule when you feel overloaded and overwhelmed and when your moods are dragging you to do things in ways that make life more difficult for you later on.

The second thing is that I set up what I thought was a decent schedule for yesterday (17th). Here’s what it looked like after walking dogs and getting changed for the day:
8:30 – 10:30 Work at home
11:00 – 1:00 Office
2:00 – 5:00 Visit aunt who was ill
5:00 – 7:00 Walk and feed dogs
Then go for an hour at the pub, come home and write blog etc., and then go to bed by about 11 pm or so.

Here’s what happened
8:30 – 10:30 Work at home
11:00 – 1:30 Office
2:00 – 6:15 Visit aunt who was ill
6:15 – 8:00 Walk and feed dogs
My schedule for dealing with the dogs became rushed and finished later then expected. I visited my parents as promised sometime during the day, but when I got home later I had a headache, so I didn’t get a chance to finish my blog post for the day, and I still had all the paperwork and tasks to follow up on from the day before.

Now it wasn’t a bad day. I’m happy I visited my aunt and I’m glad I spent more time than I planned with her, and the day had been productive. In fact right up until 6.15 pm, it was a really good day.

However, I had to rush to walk the dogs before the sun went down, and that started to trigger the sort of manic “oh my god, I’m not doing everything I need to do” sensation.

Basically what I found out yesterday was that us bipolar persons have to be careful when we start rushing to get things done. Rushing affects our mood swings badly. It doesn’t trigger mania or depression – it’s not that critical. But the rushing sends us into the mindset of “things are going wrong, I need to fix…!!!”, and if we keep with that mindset, we will start to do the kinds of things that will trigger a mood swing episode.

It’s like the rushing is the first step on a hillside that could cause us to tumble down the rest of the slope.

Luckily, we can take a step back. What to do? It’s ridiculous to say not to rush at all – after all, I did need to walk the dogs before sunset yesterday. There will always be cases and times when we do need to rush.

What we can do is to be aware of how the rushing is affecting our moods. If you start feeling as if  (a) you don’t have enough time to do everything, or (b) you have too many things to do and no time to do it, or (c) too many things feel as if they are coming at you all at once, then you are in the mindset for your moods to start going wrong.

The answer is not to feverishly try to get more done. That doesn’t work!  The more you rush, the worse you make things!

The answer is to start dropping tasks now! Here’s what – not everything will  get done today or tomorrow or this week. Live with it.

“But….”, you might start to say.
And I shall interrupt Yoda fashion with “Drop! There is no ‘but’.”

Yeah, there’s lots to do. And you might think it needs to get done because it is important. But before you start down that line, remember that when you were last depressed, none of the tasks that you now think are so important got done. So…most of the things can wait another day or two. Or a week. Stop trying to make unreasonable demands on yourself and stop trying to put yourself in a situation that will trigger mood swings.

You might think “But I’ve been doing so well in the last few days, let me do stuff while I can. Especially to clear the backlog of undone things.”  Well…..not a good way to think.

Unfortunately, trying madly to catch up is not a bad way to think either, especially if in the past you have used mania to catch up with undone stuff. I’m suggesting not to do this because you will set yourself up such that when the next depression episode happens, you will not be prepared for it. The goal here is not to do as much as quickly as possible, but to not get depressed for as long as possible. Dropping tasks now to do them later allows you the time and space to relax – and more importantly to plan how the next few days will go, including slowing to think about how you are feeling now and what you plan to do to head off the next depression episode.

Bottom line – if you get caught up focusing on getting the daily tasks done, you’ll forget to focus on keeping from getting depressed. So if your schedule starts to become overloaded because unexpected stuff happens, look at your list of tasks and start marking the ones you will do on another day. It is perfectly reasonable to call people and tell them you can’t do something. Very very few things are so critical that they must be done today. It’s ok to put off stuff to keep your today schedule at a reasonable non-rushed pace.

The third thing is that I designed my schedule for my typical day. However, my days are not yet typical – I only got out of depression 4 days ago, and I’ve got tons of little things to sort out. It’s only after those things are sorted out that I will have a typical day. As a result, although there is nothing theoretically wrong with my schedule design, I can’t use it as designed yet.

Or rather, I can use the structure, but I cannot assume that two hour time periods will be used for what I had written. For example, the slots this week labelled “exercising” can’t be used for exercise. I have to use that time period for trying to find the top of my desk under all the paper on it, or to reconcile the backlog of bank statements. Or to visit people I have to reconnect with. It doesn’t mean I don’t want to exercise, it just means that it will happen next week or the week after. I need those time slots now.

When your life comes back into order in the next 3-4 weeks (or in this case for me, I’m projecting 3 months), you can use the schedule as you designed it.

The same applies when unexpected things happen, like yesterday when I stayed longer at my aunt than I planned. What it means is that some activity later in that day will need to be dropped – I didn’t go out with friends yesterday evening as planned. I didn’t like dropping that, but it had to be done to allow me to do the stuff in the other time slots that I wanted to do more.

You will need to keep aware of how your schedule is actually shaping up compared to how you planned it, and adjust accordingly. It is perfectly fine to drop activities or planned time slots if it will stop you having to rush to get everything done.

The fourth thing is related to the third thing. I completely forgot that every time you do a task, you generate follow-up activities such as recording what happened, filing, planning the next tasks related to the one you just finished, and so on. The problem is that I have far more than the average number of tasks to do at the moment (remember – coming out of depression). As a result I have way more follow-up activities than usual. So much, in fact, that I’ve had to grab all the time slots I planned for restarting office work, and instead use those time slots to organise and do all these follow-up activities.

So although I started doing a bit of office work on Mon and Tue, I’m going to have to drop it again until next week Wed or Thur, by which time I should have caught up on the follow-up activities. I don’t like dropping the office work for a week or more, but I comfort myself by thinking that I did expect that getting my schedule back in order would take about three months and I’m still only on week one. So I’m not out of line with my plans yet. And the office work wasn’t done for the last 4-5 weeks – so it can wait another week.

Ok. I am a bit guilty. But I’ve decided that I’ll just say ‘meh’.

The fifth thing is that under my current schedule, I’m to spend more time each day with the dogs than doing office work. Somehow, I don’t think that’s right.

Well, I am going to have to change the schedule a bit. But the good thing is I don’t need to do it today or tomorrow. Or even sometime until next week. By giving myself enough time, measured in weeks, to recover from the depression episode, I can correct scheduling issues gradually instead of having to make sudden changes. Besides, the dogs like all the attention.

Related to this is that my schedule simply cannot accommodate the assignment of a time slot to each of the six areas of my life each day [(a) Dogs, (b) Exercise / Health, (c) Social / People, (d) Office Work, (e) Website, (f) House / Garden]. There aren’t enough time slots daily, and it doesn’t make sense to do everything everyday.

It does mean that instead having a schedule that repeats daily or even every two days, the schedule pattern is likely to repeat every two weeks. That’s a complicated schedule to design. So although I currently have a good schedule that has me being productive and not getting depressed, it’s not a completed schedule. Over the course of the next 4-6 weeks I will have to add in stuff that I am not currently doing, and tweak and tweak until it is all comfortable. And I probably will make mistakes and have to fix them.

But all of that is ok. I know I’ve just come out of depression. Everything will not magically become better – I will have to painstakingly rebuild my schedules and habits. But I feel like having a depression episode is a bit like breaking a leg – just as there is a recovery period after the incident for healing the broken leg, so too I need a recovery period for healing the mess the depression episode caused. In this case I figure it’s going to be about three months before I can tell people I am healed (well, until the next depression episode), and I bloody well expect them to cut me some slack. People don’t tell people wearing a cast to go play football.

.

.

(note: the next post on the blog will be Sunday and it will be about time management / scheduling. But I need to take a day or two to answer e-mail)

Managing your Life so as to Not Get Depressed (Addendum)

This is a continuation from the post I did on the 15 Jul 12, and adds in more partial fixes that seem to work. They are:

  1. Trance Music (Techno, EDM). Yes, truly. I have no idea why this works or even why it might work. But it seems to. I haven’t tested it yet, but this could have the best antidepressant potential of anything I’ve tried. Check it out if you can stand it.
  2. I’ve found the following items to enhance good moods – (a) cocoa, (b) cinnamon, (c) vanilla, (d) nutmeg. This is not an endorsement for eating 2 bars of chocolate a day – I’d recommend using cocoa and sweetening to taste. Otherwise, it doesn’t hurt to sprinkle any of these things on your beverages, or in food. And they seems to be scent based rather than taste based, so use them in a way that it can be smelled – hot chocolate, vanilla soy milk, cinnamon flavoured hot apple cider, a dusting of vanilla or nutmeg or cocoa or cinnamon on your coffee or cereal. Even scented candles work. If you consider this, be aware that most of these things come in sweet food, so be aware of your sugar intake.
  3. Pepper kind of works to increase moods. But pepper is like alcohol (for mania), it comes with so many side effects that it’s hard to recommend it. And too much pepper, apart from burning your mouth, will trigger mania like symptoms while the burn is on, which is not terribly helpful either.

Food
Apart from the above, food doesn’t seem to make any difference to how I feel –  my eating habits tend to follow my moods rather than causing them. So there is no particularly good eating pattern – just eat as healthily as you can following standard nutrition guidelines. Really, there is no magic food or fruit.

Sleep Deprivation
I’ve found that not getting enough sleep (about 4 hours or so) in a night triggers a manic mood the following day. Most of the time. It’s not a fully good thing – I’m also sleep deprived so for the first hour I act like an irritable zombie. A manic irritable zombie. But once I catch my stride, the day tends to fall into place, though by about 6-7 pm, I start feeling tired.

This only works if I am now heading into depression. It doesn’t work so well if I’m already depressed since the depression sleep patterns and moods tend to override the manic trigger.

How to use it – be aware of your moods and if you realise you are heading into depression, decide to stay up until 2 or so and get up the following morning at 6. Set your alarm or have someone wake you up (tell them you’ll be very grumpy). Do NOT go on the computer after 11.00 pm. Read or watch television. You can go out, but no more than 3 beers – sleep deprivation plus hangover plus mania really are not a good combination. And of course you have to be careful the following day and make sure to not act on any manic tendencies. But it can be used to head off an impending depression episode, at least for a while.

Exercise

Exercise is a complicated one. As far as I can tell, exercise doesn’t seem to stop me from getting depressed. However, if I am doing a good exercise routine, I feel good about how I look and about myself generally. So although the exercise itself doesn’t seem to work to cause my moods, it seems to enhance all of the other fixes that do allow me to keep from getting depressed. Do it because it’s the healthy thing and because it makes you feel good.

Note this however, I like doing adventure racing (running, cycling, kayaking, swimming and random other stuff), and I can get good at it, but only for short durations 2-3 hours. If the training starts heading into the 4-6 hours (yeah, it can), there is a high chance that the exhaustion from the long duration events will trigger depression.

Pets
I have three dogs. Over the last six years, their ability to prevent me from getting depressed and to pull me out of depression is exactly nil. Worse than that from my view is that when I am depressed they get only minimal maintenance (which is ok, but not great) and very little affection or attention (which upsets them a lot). There are many reasons to get a pet, so getting one is up to you. But I wouldn’t recommend getting a pet to help you with the mood swings – it’s adding a daily commitment for 10-15 years with very little benefit to stabilising the moods.

Experiment 16 Jul 12 (Day 2)

Weight:  175 lbs (the 2lb decrease is just water loss because I’m more active, but still nice)
Drugs: None today. 1 double espresso from 5.30 am to 3 pm. 1 espresso at 8.30 pm.
Productivity: High.
Moods: Slightly manic in the morning to normal by about  3 pm for rest of day.

4.40 am
Wake up.
It took me a while to crawl out of bed when the 4.30 am alarm sounded. I must admit that I crawled back into bed after letting the dogs out into the yard, but then I thought “this is silly” and got up. The fact that I can think that means I am no longer depressed. I happen to like 4.30 am because I’m a morning person and because that’s not a particularly abnormal time in my country – adjust your wake time to suit yourself.

4.40 am to 5.30 am
Put on dog walking clothes, washed dishes, read my daily schedule and pictured in my mind how I thought the day will go. More cleaning and neatening up.
Because everything is in disarray. Brushed my teeth today before 9 am – yay! By the way, there were days last week when I neither brushed my teeth or bathed for 2-3 days because it was too difficult to do so  – that’s more like what depression is, not “sadness”.

Two noteworthy things here – (1) I use washing the dishes as an indicator of how capable I am – if I can’t get my act together to wash dishes, then it’s likely going to be a bad day. You will probably find it helpful to have a few “indicator” tasks like that on a morning to allow you to gauge your mood. Making the bed, preparing lunch, sweeping the kitchen, or any simple routine task will give you an idea of your ability to do things and your concentration. Your coordination while doing them will also give you an idea how manic your are. (2) Having a daily schedule and being able to picture it in your mind is critical – if you don’t have that, you are likely to spend the day doing somewhat random things, some of which might be useful. I rank this as high on the things to do on a morning – think about it while going for your walk and if you didn’t write it the night before, write it as soon as you get back from your walk.

I should have gotten out of the house and gone for walk before doing all the little tasks, but at 5 am it’s pitch black outside. Can’t walk dogs until it is light. This is just a quirk on my morning routine – I recommend you go for the walk immediately after pulling on clothes and stuff on your feet.

5.30 am to 7.00 am
Walk dogs.
You don’t have to spend so much time on your walk. I just do it because I’m me. A 15-30 minute get out the house should be fine. One of the benefits is that I really like being in the park and seeing all it’s changing moods.  Don’t forget to think about what you want to do for the day while enjoying the scenery.

7.00 am to 9.00 am
More neatening up around the house. Went shopping because there was no laundry detergent and other household items.
It’s incredible how much things fall apart when you’re depressed. Kept to my rule about not getting on the computer. More stuff packed away. Pumped up tyres on bicycle. Now to figure out when to use it. Changed.

9.00 am to 11.00 am
Did some office work.
The two hour idea appears to be a good one. Having a clear deadline a short two hours away forced me to focus on the project and not fiddle around. Though I did go on facebook for about 5-10 min total.  Project not done, but then I didn’t expect it to be. This was a proof of concept and it is a good start.

11.30 pm to 12.30 pm
Scrounged lunch from Mum.
I’m passing by my parents daily because I did it regularly in the past. Need to restart doing this, and passing by them allows them to know I am doing okay. And I get food.

12.30 pm to 3.00 pm
Paid bills, made bank deposits, sorted out credit card, went pharmacy.
This should have been time spent doing office work, but I need to get these things sorted out. A useful rule – one of the first things to do coming out of depression is to (a) pay outstanding utility, loan, and credit card bills (b) deposit any cheques you got and (c) find out your bank balances. I’d schedule a day to do this, and I need to automate payment of more of my bills.

3.00 pm to 4.00 pm
Got home. Started writing blog post.
I got on the computer to early – did not do enough other things first! However, I did pack away all the stuff I purchased first, and I needed to get on the computer to update my records on all the bank / bill  stuff. So slapped myself on the wrist, but – I do need to make sure this does not happen often or I’ll slide right back into my old habit of sitting at the computer for 5 hours. The price of stability is eternal vigilance – stick to the rules!

Also, notice how long it takes to write a blog post. And I ain’t done yet.

4.00 pm to 6.00 pm
Walked dogs. Fed dogs.
At least the dogs got me out of the house and doing something else. The littlest can use her nose to give a mean jab in the ribs when she figures I’m not doing what’s right by her.

6.00 am to 8.00 pm
Out for a beer and reconnecting with friends.
Meeting friends and reconnecting. This is part of getting back into the process of having a balanced life just as much as doing office work is.

8.00 pm to 10.00 pm
Passed by brother
It looks as if I am doing a lot of visiting people. That’s because in the early stages of getting out of depression you do need to connect with people and just say ‘hi, I’m around again’. Getting back into doing ‘work’ type things takes a bit longer.

I’ve actually divided my life into about six areas which are, in no particular order – (a) Dogs, (b) Exercise / Health, (c) Social / People, (d) Office Work, (e) Website, (f) House / Garden. When I’m coming out of depression, I try to restart each area one by one because jumping into all at once is too overwhelming.

Generally, I tend to restart areas in the following order (1) Dogs, because they are underfoot, so it’s easy; (2) House, including accounts, because it’s there and I need to get the place back in order. But I don’t restart big projects yet; (3) People, because I need to reach out to parents, siblings, partners, close family, and close friends. The wider meeting people doesn’t start yet; (4) Website, sometimes. This time it’s high priority for me; (5) Office Work, again to get back in it a bit. But I’m not doing a lot in office stuff yet; (6) Health, mostly diet, because I always need to lose weight after a depression episode. (7) Exercise, but attempting regularly scheduled exercise is hard to organise immediately coming out of depression; and (8) Garden,  I currently have something that’s not quite a jungle.

The important thing is to not try to do too much at once. You’ll want to, to catch back up, but all you will really do is overwhelm yourself with tasks and then feel guilty that you are failing again when you don’t do them. This has been a bad depression run – I’m expecting that it will take closer to three months to get everything back in decent order.

10.00 pm to 12.30 pm
Home. A bit of housework, petted dogs, planned tomorrow, wrote blog. Sleep at 12.30 am.
I’m spending way too much time with the dogs. I did spend the time planning tasks for tomorrow – a critical thing. Writing the blog take quite a while.


Experiment 15 Jul 12 (Day 1)

Weight:  177 lbs (about 25-30 pounds too heavy)
Drugs: None today.
Productivity: High, but not manic high.
Moods: Normal in morning increasing to some mania in the night.

6.30 am
Wake up.
[This is late for me, and not quite on my planned schedule. But the best laid plans of mice and men etc. I just start the day the way I planned it. If everything is running about 30-40 min off sync, then so be it. No rush, no stress. Also it helps to build in spare time in your schedule so you can catch up on the “missed” time]

6.30 am to 8.00 am
Walked dogs. Collected my caffe latte grande on the way back.
[I literally roll out of bed, put on old clothes, gather dogs and leave house. Total time between waking up and out of house is about 5 minutes. I forgot to brush teeth, didn’t do it until I returned.]

8.00 am to 9.00 am
Realise that I can’t use the noisy dog blow dryer too early on Sunday morning, so have to wait to bathe dogs. Spend some time setting up for bathing dogs and some time on computer.
[I wanted to get on the computer as I soon as I got back from walking dogs, but held off. New rule, I’m not allowed on the computer after waking up or returning home until I have done 5 little tasks around the house. Will see how that works.]

9.00 am to 1.00 pm
Bathed the dogs. And dried them. They of course promptly went to play in the rain.
[Remember, I came out from depression yesterday. While bathing the dogs I had neither the manic energy nor the high effort feeling of depression. I just did what I need to do. Nice. Calm. Yay!]

1.00 pm to 2.30 pm
Parents passed with lunch. Bless them. I explained to them what I was planning to do for the next three months, adjusting for the sometimes less than helpful comments and the fact that my dad was dozing off. Still, they are fully supportive of me and my plans and it’s hard to ask for more than that.

3.00 am to 4.30 pm
Wrote the Blog Post on Managing my life to Not Get Depressed.
[I really shouldn’t have done this. The plan was to work on ordering my accounts, which are a bit of a mess. And I shouldn’t have spent more than 1 hour. Still it did take about 90 min to write the blog post, and I really wanted to get the information down while I still remembered what I had discussed with parents. So, decided that exchanging one task for another is ok. Note how I am trying to keep everything at no more than 1-2 hours before moving on to a next task.]

4.30 pm to 6.00 pm
Walked dogs.
[In case you’re wondering, my friends think I treat my dogs like supermodels. All this time with them is not too far out of normal. Note also that I stopped working on the computer and left the house to do something else. Which is why I walk the dogs twice a day.]

6.00 am to 7.30 pm
Fed Dogs. Updated my task list. Started on this blog post.
[Again, as I got home, I wanted to get on the computer. As per rule, did other little things and fed dogs first. Updated my task list for things completed / not completed for today. Then started in on this blog post. Still have to go out for a drink, deal with accounts, organise my task list for tomorrow (will write more about this on a separate blog post). So, not doing exactly as I planned, but moods still good, which is the important thing.]

7.30 am to 8.30 pm
Out for a beer.
[Noticed that I was starting to get manic before I left the house –  wanted to start fixing stuff in the house today or tomorrow – so much to do. I’m also having slight physical coordination issues. But…peace. Most of the stuff to be fixed hasn’t been done in the last month and a half, perhaps many months. A while again won’t make a difference. As per usual, one of the problems of coming out of depression is that it can push me up into mild mania. The energy is a good thing – the tendency to try to do a whole set of things immediately isn’t, because (a) I can too easily get caught up in a manic episode and (b) I’m still recovering from my depression episode dammit, I don’t need to feel like I need to get lots of stuff done now!

Had one beer and some food and came home. The beer did help take the manic edge off, but now I’m slightly drunk. But I did get out of the house and away from the computer. Purchased espresso coffee for tomorrow morning since the shop won’t be open before I finish walking dogs.]

 

8.30 am to 10.00 pm
Home. Got some accounts done. Planned day tomorrow. Finished this blog.
[Well, still capable of doing accounts, so that’s something. Didn’t start it until I had petted the dogs a bit, so followed rule about not immediately sitting in front of computer. Important to plan the day for tomorrow so that I have some idea how the day is going to work out. If I don’t do this, tomorrow is going to be a mess.

I’m realising how much stuff I need to catch up on and panicking slightly. But I can only do so much in one day. I will catch up on most of the things, but it won’t be tomorrow or this coming week. Better to be measured than running around flustered.

I did not do all the things I planned to do today. That’s ok, the day was filled with tasks that had high priority anyway, so it doesn’t matter too much. I only need to worry when I did not do everything because my productivity is dropping (depression) or because I scheduled myself to do way too much stuff (manic type symptom). In general, I’ve found it better to schedule a little less than a full day and if possible top it up with a few extra things. I feel better about myself because I got more done than expected rather than stressed about not doing everything I planned.

Have a headache caused by tension in my jaw. This indicates some mania. This is not a bad thing since it means that I will wake not wake up depressed tomorrow morning. But I’m expecting to have a restless sleep (but not insomnia), and I have to watch that the mania doesn’t swing any higher tomorrow.]

 

Managing your Life so as to Not Get Depressed

Just out of depression that started in full on the 7 Jun 12 and which I did not come out of until yesterday, the 14 Jul 12 (yes, I do keep records of a sort).

I’ve stopped looking for a cure, mind you – there is none. More importantly, for most of us the drugs will not be sufficient on their own to  provide ongoing stability. What I’m looking to do these days is to manage the mood swings in such a way as to not get depressed.

Since my mania is well controlled, I don’t bother too much about it these days. But my depression episodes leave my unable to do anything. Therefore, these days, my goal is: “Do not get depressed”. Really.

This is a big deal since I fall into the category of people who find little relief from drugs. However, I had a good run of stability (ie, not depressed) from October 2011 to Easter 2012. Here’s what I think caused it.

I have a bunch of things I do – none of which fixes my mood swings, but each of which adds a little bit to stability. Let’s imagine the perfect solution as a 100% fix, and anything above 60% partial fix keeps me from being depressed easily. What I’ve realised is that things I do, like drinking coffee, contribute to the partial fix. So let’s say coffee contribute about 15% to a solution. Not enough on it’s own to stop me from getting depressed.

But then I go a walk every morning when I wake up (I got dogs). That contributes another 5% to a solution. And I take my antidepressant, which adds about 15% to a fix. And hanging out with friends on evenings adds another 10%. And so on.

I think in October 2011, I had added enough of these partial fixes that I crossed the 60% mark and I stopped getting depressed so easily. And suddenly life got much better indeed.

Some things things to note.

None of the things I did were more than a partial solution, not even the medication. I needed to do a lot of separate things to get at least up to 60% fix. If you’re managing your moods, you’ll probably have to determine what are the list of things you need to do to stay above the “won’t get depressed easily” mark.

Also, dropping any of the things you do, even for a few days, can drop you below the magical “won’t get depressed easily” mark. In which case you’re back to being vulnerable again.

You’ll probably still get depressed. But hopefully not as frequently. This is not a miracle solution.

Right – what are thing that work as partial fixes for me. They are, in no particular order:

  1. Coffee: In the morning and in the afternoon. I use double espressos either as caffe lattes or americanos. You shouldn’t need more than 3 a day, and you can probably get by with less.
  2. Getting out of the house on mornings when I wake up: This is NOT exercise, this is a walk around the block or something. The purpose is to (a) keep you from sitting in front of the computer or picking up a book or doing something that will prevent you from getting your day started, (b) provides a quiet time for you to collect yourself, and (c) allows you some space to kinda plan what the first few hours of the day will look like. Hopefully you’ll return home with enough energy to start doing stuff for the day.
  3. Breaking up the day into pieces – ie – not doing the same thing for more than 1-2 hours. The problem is that heavy concentration tends to “pull you in”, which is a state that can lead to depression. If you are at work, take a 10-15 minute break and get a coffee or go outside for a smoke or something (pretend you started smoking to get an excuse). If you are at home, break up you day into pieces so you are not doing the same kinds of things for more than 2 hours. Do NOT get caught behind a computer or in a book or in a game.
  4. Keep moving. My experience is that the times I’ve said “I’m tired, I need to do something mindless” are the times when I am most prone to sink into depression. Especially when the mindless things are television, ‘net surfing or facebook, or reading. If you want to be mindless, go for a walk instead. That’s why on evenings when I get home, I immediately drop everything off, and collect the dogs to go for a walk. Better in the park than on the computer.
  5. Going to the pub on evenings: For some reason this works. Apparently hanging out with friends makes you feel better enough to jump start you the following morning. Earlier this year, I was joking that I had a choice of waking up on a morning depressed or drunk (yes, I drink moderately). I actually don’t recommend the drunk part, but, well, you get the idea.
  6. Taking your meds. Don’t stop taking them. They probably do contribute some part to the total solution.
  7. Being aware of how you are feeling AND telling the people around you. You can learn to become aware if you are heading into a depression episode and if you do, you can head it off before it becomes too severe. Telling people how you are feeling allows them to help you out if you need it.

Obviously this is the short version and there is lots more than just a quick list. I’m planning to experiment over the next 3 months and blog about what I’m doing. We’ll see how that goes.