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.

Alternate theory about Depression, Bipolar Disorder

The TL;DR version:
Mania and Depression are NOT opposite sides of normality. Instead, in mania is the brain signals (chemical / electrical) speed up slightly more than normal. So far so typical. The new bit is that in depression the brain signals speed up even more than in mania. The mind can’t cope with the even higher signal speed and starts shutting down, giving rise to depression symptoms.

If you are one of the persons who can’t get their depression under control, talk with your psych about using an anti-epileptic / anti-manic to see if that can help. I’m currently using carbamazepine (Tegretol, Equetro, Epitol, Carbagen, Carbatrol, Teril) and it seems to work to work for me. But I’m sure there are other anti-epileptics that can work.

 

The Long Version (still being expanded / edited)
For most of us the modern antidepressants don’t work so well. I’ve long thought that the medical model for what mood swings are, is inaccurate. Not wrong, mind you, just not the full picture. That’s why the meds don’t work so well – we are not quite shooting at the right target, as it were. Compare this to diabetes, where the medical model is pretty well understood, and treatment works very well.

Ok, what’s a medical model. It’s the model of what happens inside of you – the complicated chemical and electrical interactions that happen inside of you. Think about your car engine. How it works is a physics model or an energy model which describes how we get the energy out of the gasoline and put it to work in moving your car.

The depression and mania medical model describes what the brain does to get from you thinking about doing something to you actually doing it. And it’s a lot more complicated than your car engine. Lots. When you think about doing something, you don’t just go “I shall do….”. Feelings about doing it, considering the effects of the action, wondering what other people will think, etc., all get mixed into the decision of “I shall do…”. We assume things are simple because we do them effortlessly, but it’s not. The brain and how we think and how we do things is very very complicated.

I think that bipolar disorder, or mood swings, or depression, or mania, is really a fouling up of the “I shall do…” mechanism. It’s not really about sadness, or feelings. But because these things are entangled in the “I shall do…” mechanism, they also get affected. And because our feelings are visible to others or because that how we, er, feel, that’s how we describe what is going wrong.

Here’s what I think is going wrong.

Before I go further, I’d like to distinguish between your  brain, which  is the squishy thing in your head – and your mind, which is the part of you that makes decisions, thinks, feels; the part of you that is your consciousness, your you. I’ll need the distinction in the explanation that follow.

I think that bipolar disorder, all of it, is our brain signals increasing beyond typical. Let’s assume that for a normal person, the brain signals have a certain signal speed, which we shall call the standard speed. When the brain’s signals are working at standard speed, then your mind works just fine (well, not yours if you are here reading this blog, but normal people). There can be a bit of variation on the standard speed, but the normal person’s brain has safety mechanisms that keep the signal speed at something close to standard.

In bipolar people, the safety mechanisms for regulating the brain signals don’t work well.

In mania, the brain signals speed up a bit. Not a whole lot, just amped up a bit. Here’s where the mind / brain distinction becomes important. So, the brain is not working quite properly, but the mind, the part of you that is you that makes decisions etc., is able to compensate. The mind still works. You still function. Of course the mind is making some slightly weird interpretations of what is going on because the increase in brain signals speed is providing wrong information to the mind, skewing what it thinks is going on around it. Slightly, because we still see the world around us as normal people do.

The increase in brain signals is also skewing other things, like feelings, and judgments, and decisions that the mind is making / feeling. Which the mind can’t exactly realise because, you know, wrong signals and feedback. Ask a manic person – if they stop to reflect, they may understand intellectually what they are doing may be not quite right, – but it feels right  / normal to them.

In depression, and here’s where I depart from accepted medical models, the brain signals speed up even more. At higher speeds, the mind can’t cope – it can’t compensate enough. The mind starts shutting down, piece by piece, until you’re in bed under the covers not wanting to talk to anyone. The body still works, but the mind, well, that’s barely there. You’re barely there.

What is the difference in the model mean? Well, for the first part, we aren’t bipolar. We don’t have two sides of the same coin. We have a disorder that increases through a tolerable variation (mania) to an intolerable variation (depression). And it’s based on brain signals. In many ways we are similar to epileptics – their manifestation is in the body and ours is in the brain.

The second thing is that anything that slows down the brain signals should help. I’m betting that’s why MDMA and other drugs that tend to make us laid back appear to work for depression. Because they slow or brain signal propogation. But it also means that anti-epileptic drugs may work as well for depression. As they say in the ads on TV, ask your doctor.

 

 

Forties, Vision, and Moodswings

Yeah, so if you’re like me, somewhere around the late thirties, you started to hold the restaurant menus a bit further away to read them. Same thing in the supermarket. And you started to joke about it with your friends -“Oh my God we are getting old, we gonna need glasses soon!” And you eventually did get the glasses that you didn’t use much, and left lying around, and grumbled that they were never where you needed them.

And then one day you realised that you couldn’t read anything without the glasses. Actually couldn’t. Everything was blurred. Remember what a shock that day was.

Well, here’s what. Apparently mood swings also take a turn for the worse in the forties. It has happened to me and some of my friends. Our evidence is anecdotal, but it’s worth watching out for. The change seems to take place somewhere between about 42 and 46.

Here’s what happens – the manic episodes get shorter and more infrequent, and the depression episodes get longer. There may be less time between the depression episodes as well.

If you are like me, and your habit is to use the manic episodes or the normal periods to make up for all the stuff you didn’t do in the depression periods, this change in the mood swings will create havoc. There simply isn’t any time or energy to make up for the lost depression periods.

Like vision, this problem also sneaks up on you. The depression episodes don’t seem to get worse or deeper, they just last longer. You are aware that you are spending more time in depression and that you aren’t catching up as before, but at any given point, it doesn’t feel critical. It just feels like stuff you’ve been experiencing before, just a little worse. You might even tell people that, yes, things are a bit worse than normal, but still under control. Because it feels that way.

Even when you realise that that you are starting to lose ground, there may be no obvious answer what to do next. The patterns I had used to stabilise my life were precarious enough without experimenting and changing them. I mean, the situation was not going well, but experience had shown me it could be a lot worse.

It took me about a year to even realise that my life was ever so slowly spiralling downhill again. Then for another 6-8 months I just left everything as they were in the hope that my old manic / depression patterns would reassert themselves. Which of course didn’t happen – the increase in the length in the depression periods  / decrease in the time between them seems fairly permanent.

Once I realised my life was slipping downhill again, I kept telling my friends I would become a grumpy old man with sixteen dogs, screaming ‘ger orf my lawn!’ to the neighbourhood boys. It was a kind of a call for help, or as I thought of it, an accurate extrapolation of my situation if I couldn’t find a solution. I started trying to find alternatives for my old habits, but it was hard because the depression episodes made it impossible to be coherent and logical about what might work and what might not. Or I just didn’t do anything because I was depressed. You know.

Meanwhile my life fell apart again, just as much as it did during my massive meltdown when I was 31. Just this time I was aware of what was happening and it happened in slow motion. It’s had the same level of fascination as watching a bullet pass through a water balloon in slow motion, and pretty much the same level of destructiveness. I’m currently on part time work. One good thing is that my family has been very supportive.

The blog has been at a standstill for a while because I have been trying to find a solution. I’ve been trying new drugs, and new habits, and new ways of thinking about work and daily habits, and well, something seems to have worked. Or maybe a few things. I’m not entirely sure. Heck, I’m not entirely sure that anything worked, and it’s possible I may be in one of my ‘not depressed’ phases. But my current feeling is ‘whatever’.

Anyway, so much for self pitying monologue. For those of you out there,

  • Your mood patterns may change when you enter your mid-forties. Not a lot of evidence here yet, but it’s worth looking out for. Check to see if your depression episodes are getting longer, or that you are starting to have a more difficult time keeping up with your day to day activities than you did in the past.
  • Can I solicit the experience for those of you who have passed through your forties. Is my experience unusual, or did you go through something similar. Comments please.
  • For those of you in your forties, fifties, or more who did go through what I described, how did you cope with it? If you made it through this period with your job intact, and you didn’t become a recluse, then you did better than I am doing. Could you share your experiences, advice, tips, please.

Much appreciated.

In case you are wondering, it’s real, and we aren’t crazy

“We all tend to think of the problems we are going through as some sort of personal failing – you know, if we tried harder, or if we worked better, or if we fixed some past problem in our childhood, then we can beat this. The problem is that mood swings are disease, a real disease. They aren’t just a passing phase or a down period or a character defect. They are as real a disease as diabetes or astigmatic vision.
 
We also tend not to like the idea that we might have a ‘mental’ disease, mostly because so many of the associations with this are negative. But mood swings don’t make you a crazy person. They are just a set of annoying symptoms that get in the way of living your life. They don’t stop you from graduating university, or succeeding in your job, or having friends, or being well respected. You don’t suddenly turn forty and get an axe and go on a bloody rampage. What you are is, well, pretty normal like everyone else. Just with a set of annoying symptoms that you deal with. Think of people who get migraine headaches, or with peanut allergies, or who get bad hay fever. It’s more like that.”

Featured on Facebook

WP_000702I’m seeing a massive spike in traffic on the website since I was featured on the People of Trinidad and Tobago facebook page.

First off, thank you all for the comments on the facebook page. Much appreciated. Also, for those of you who asked questions or e-mailed me, I will be responding over the rest of the weekend (after the Costa Rica / Netherlands match). Feel free to comment on pages or send me a note.

Second, while I had been thinking of restarting posting on the website, I hadn’t done it. However, the positive energy I’m getting from being featured is acting as a spur. I’m back.

The next post will be for parents – your teen might be acting strangely – should you be worried about mood swings or are they just being normal teens. And what might you do to check this out. Should be posted by Tuesday or so.

Thank you all.

 

 

Holidays, Mania, and Depression

Us bipolar persons do not do well at holiday time. We just don’t.

I’ve written about what you could do if you are manic or depressed during the holidays (it says Thanksgiving, but the ideas are the same). Worth reading, including the comments.

This 2013 Holiday season is particularly long because the holidays fall midweek. For those of us with mood swings, the danger time starts today Fri 20 Dec 13 and goes until about Mon 6 Jan 14.

The real trigger for mood swings is that the holidays interrupt our regular schedules – and the inconsistency tends to leave us out of sorts and vulnerable to changes in mood. My personal experience has been that stretches of open / unoccupied time tends to lead to depression and late nights tends to trigger mania. And they can swing back and forth over the holiday season. You mileage may vary, but hopefully you know what triggers your mood swings.

People and family gatherings don’t appear to trigger mood swings, but they can make any depression or mania you have much much worse.

Here’s the major rule for Christmas – DO NOT START OR ENGAGE IN ANY ARGUMENTS!!!
Got that? I don’t care if you think you’re right – don’t do it. Nothing good will come of it.

If you have a sibling, child, or partner who is depressed – it’s okay for them to not participate in family gatherings. Do NOT try to force them to take part – you’ll be torturing them. If they don’t appear on Christmas day to open presents with the rest of the family, the excuse is “John couldn’t make it, he’s not well”. You have the whole rest of the year to see them.

Generally good ideas

1.
As best you can, keep your schedule as close to normal as you can.

2.
Don’t try to do too much. Moving from one gathering or house to another all day long, is not a good thing. Leave time for you to take a breather on an afternoon. Alternatively, don’t stay all day by family – leave before it begins to drag on and you’ve overeaten.

Take a time out and go for a 15 minute walk outside sometime during the day.

3.
Don’t spend long periods of time by yourself. Meet with some friends for a coffee or an ice cream or a beer. Go with someone to a movie.

4.
Finally, the holidays are not the end of it. The instability echoes for 2-3 weeks after the holidays, so if you have mood swings, you are more likely to slip into depression or mania in January. All the things that you do to protect yourself in over the holidays, you have to continue in January.

 

Have a happy holiday.

Charting Moods

pic0015 Data0001 Weight

The graph above charts my weight from about October 2011 to the end of February 2013.  Do you think you can tell when I was depressed? And when I wasn’t?

Here’s a hint. My ideal weight is about 150 lbs. I really try to be at that weight, but whenever I’m depressed I eat no end of junk food.

Got it now?

You can see a larger chart if you click on it, but you’ll need to use the back button on the browser to get back to this post.

The chart show a number of things. Just by looking you can see by the weight gain that I was depressed in Jan/Feb 2012, as well as April, June, Sep/Oct and December 2012. If you look carefully, you’ll see I was depressed in Dec 2011 and July 2012 too. And a few shorter depression episodes too.

You’ll also notice I can add weight annoyingly quickly – as much as 7-10 pounds in a single month-long depression episode. Thankfully, I’ve also learned the technique of losing weight safely and quickly.

The chart has more subtle information too. If I am depressed, I don’t keep any records at all because I just can’t get around to it. You know, the ‘I just can’t’ depression symptom. It’s not noticeable in the little picture, but if you check the big picture you’ll notice the dots that represent real data points are frequently missing. More than that, they’re missing each time I get depressed and my weight increases.

This matters. I can use the missing information / dots to very accurately chart my depression episodes. Here’s how it works. I measure my weight first thing every morning and write it down. This is a very reliable habit – so reliable that the only thing that stops me from tracking my weight daily is, well, depression.

So apart from the weight information, I can use the start and finish dates of the missing  information to get a very accurate  measurement of when my depression episode was and how long it lasted. If you check the chart, you can see that I had depression episodes in May and August 2012 as well, even though there was no weight gain (2012 was an awful year for me, by the way).

The bottom line is that you can use other indicators such as tracking weight to get information on your depression episodes. It doesn’t have to be weight. I use my credit card for most purchases, and it turns out that I can track my depression episodes by when I buy KFC and Burger King, because I only eat these when I’m depressed and I eat them frequently when I’m depressed.  This won’t measure to the fine detail as my daily weight data, but I can track my depression episodes on my credit card bill.

I’m pretty sure that you have some habits that you only do (or don’t do) when you are depressed. If this is true, and if they come with stuff that is measured – like my weight notes or my credit card bill – then you can use those as a stand in or proxy for determining when your depression episodes were.

Also, you may think from the graph that my notes on my weight are super neat and well ordered. They aren’t.

In fact, they kinda look like this…

WP_000448

The information is on a standard stationery notepad, and I keep it on the kitchen counter where it is very easy to access. I keep a pen with it to because if I have to look for one, I may not bother to write anything down.

It’s very messy, with scribbles and bad handwriting and coffee stains and information that I thought I would keep but didn’t actually do (the weight stuff is in the rightmost column). But it’s there, and that’s the most important thing.

Just Diagnosed as Bipolar. What Next?

So you recently got diagnosed with Bipolar Disorder.
What should you do next?

The answer to that could fit an entire book. But here are some pointers.

I’m going to assume that you ended up at a psychiatrist either because over time your life had degenerated into a bit of mess, or that you had done stuff that was sufficiently, er, awesome that your family insisted that you see a psychiatrist. In either case, I’m assuming that (1) the daily organisation of life is in a bit of shambles right now, (2) that you have a lot of stuff to catch up on or fix because lots of things have gone wrong in the last few months, (3) that you don’t exactly understand what your diagnosis of bipolar means, but you know you are not crazy.

Let’s start with the last one first.
Bipolar Disorder is a physical illness, just like an ulcer is a physical illness, or like diabetes is a physical illness.

We can call it a mental illness because it is happening in your brain, but that just determines location, just as we can say an ulcer is an abdominal illness because it is happening in your abdomen. Mental in this case does not mean imaginary.

Right. So what you were diagnosed with is a physical illness.  Since you need to understand what it is like, it’s handy to have comparisons. It turns out that the features of the illness bipolar disorder are similar to the features of asthma or to diabetes. Be careful of what I am saying here. I am not saying that bipolar disorder is related to either asthma or diabetes. What I am saying is that they share very general commonalities.

These commonalities are:

  1. If you have it, you probably have it for life. You generally do not get better from asthma or diabetes or bipolar disorder.
  2. But that’s ok, because in all three of these illnesses, you can take actions which minimise their effects so that the quality of your life is pretty good. The actions may include
    1. Taking medication,
    2. Adjusting the way you do some of the things you currently do
    3. Avoiding some things you currently do or might want to try.
    4. Adding in some new things to your daily activities
  3. In all three cases, you need to be aware of the symptoms to look out for when things are going wrong, and you need to learn to monitor yourself for these symptoms. And you need to know what to do when the symptoms appear.
  4. In the case of bipolar disorder and diabetes, one of the symptoms of the physical illness is a change in your moods. If you deal with the underlying physical problem, the moods right themselves.

So. Your diagnosis is for a physical illness which messes with how you feel. You aren’t crazy. You aren’t imagining things. You are not creating problems out of nothing to get attention or irritate other people.

If someone says your are making things up, it’s like them saying ‘Oh, you are making diabetes up. Your diabetes is just in your mind. Get your act together and snap out of it.’ Any comments like that are medically nonsensical, show a thorough lack of understanding of the illness, are insensitive to you, and most annoyingly, don’t really help you at all.

Right. So I’ve hopefully made you feel a bit more comfortable about being bipolar. So what do you actually do next.

Step 1: If your life is currently in a mess, stop stressing over the things that need to get done.

Well, ok, your life will still be a mess. However, the only way you can sort it out is piece by piece. You will probably have about 3-10 things which have gone critical and you need to deal with immediately, but you’ll still only be able to sort them out one by one.

Make a list of the critical items. Then start dealing with item 1 on the list.  Try to not fuss about the items you aren’t doing. You will get to them.

If you worry about the tasks you are not doing, chances are you will begin to feel panicky.  Worse, you may feel as if there is too much to do and you can’t possibly cope. In either case, your feelings may trigger you to fall into depression or into doing nothing at all. So the plan is to try to avoid worrying or stressing about things which are not done.

Great. I’ve said this, but it is surprisingly hard to do. But try.

Here’s something to think about that might help. If whatever you are worrying about hasn’t been done for a while, another day or two will usually not make a difference. If there are no critical deadlines, you can not worry about it for the next day or two.

Step 2: Ask for Help in sorting out Critical Tasks.
It may be that you want to sort out one of the things that needs to be done, but you are embarrassed that you are so overwhelmingly late about it. Or you might not feel like you are ready to deal with people or strangers. Or you might feel like the person on the other side will laugh at you or shout at you or criticise you in some way.

Believe it or not, how you are feeling is an aftereffect of the depression. The sensation of not wanting to deal with people is often an indicator that you might still be slightly depressed. You will eventually learn to cope with low levels of this feeling and get your stuff done, but in the early stages – like for the next 6 months or so – it is perfectly reasonable to ask people to help you.

Good people are parents, siblings, or good friends. They will ask why you can’t do it for yourself since you will look perfectly competent to them. Your response can be something like “I know I should, but I’m still slightly depressed and it feels as if the people on the other side will shout at me. It’s making it impossible for me to pick up the phone (or visit the office, or….). I’ve been told this happens with the mood swings. I need your help. As my moods get better, I’ll be able to do it myself.”

They’ll look at you funny, but they’ll probably help. If the situation requires your presence, ask them to come with you and be the person talking to the customer representative.

Step 3: Start plotting your moods. If you don’t know what is happening to you, you can’t fix it.
You’ll need either (a) An appointment book which has 1 day per page or (b) a notepad. Either works. I used to use an appointment book, but now I use a notepad.

If you haven’t already, see the link on Setting up a Mood Chart for more information on how to chart your moods. You can use the Signs of Mania,  and the Signs of Depression in determining your mood for the day.

Yes, the stuff you write will be scrappy and messy. Yes there will be days with no entries or partial entries. That’s normal.

It will take anywhere from about 2 weeks to about 1 month to get data that is useful in allowing you to make decisions or choices. Persevere.

Step 4: Take your meds.
They may or may not work, but it’s a good place to start. You can check this link on why you should take the medications.

Note that us bipolar persons have a terrible record of consistently taking medications. I strongly recommend that you ask someone living with you, or someone you see everyday, to be in charge of giving you the meds and making sure you take them.

There is no such thing as personal responsibility here – if we are depressed, we simply won’t be able to get our act together to take them.

Step 5: Ask family or a friend or two to act as your social interface.
This is related to step 2. Just as you would ask someone to help you sort out some of the critical tasks, it is handy to have one or two people to help you sort out the whole set of complications with friends and family.

It would be handy to have a family member who can tell others ‘They’ve been ill for the last two weeks (or six months, or…), that’s why you haven’t seen or heard from them” or “I’m sorry they couldn’t make dinner (or family gathering, etc.), they’re ill”.

If you have a friend who can do the equivalent for you with friends meeting, that would be useful.

If you are working, it can also be handy to have someone who will call in to say you are ill when you don’t make it to work.

Note that all of these arrangements have to be set up ahead of time. There will be times in the future when you won’t make it to a close friend’s party, or Thanksgiving dinner, or to work. In the first few months after diagnosis, you will very frequently miss these things. Having someone who can smooth things out a bit for you will make your life substantially easier when you do reconnect with these people.

Step 6: Just because you are diagnosed, you will not magically get better in two weeks.
This is a reminder to you. Things will get better, but it will take a while for you to get the hang of managing the moods. This is going to be measured in months, not weeks. And there will be setbacks. All of this is normal and not you being incompetent.

Assume it will take you the better part of 2-3 months after diagnosis to at put a stop to the process of your life unravelling. Yes, life will keep getting worse for a while after diagnosis. And then it will take more months to get things back onto something that you think is an even keel.

You will get frustrated and annoyed by the setbacks and length of time things are taking. That’s normal. But even as you do, have a little part of your mind thinking – “well, this is what I was told to expect.”

While you might be willing to accept that learning to cope will take time, your family will expect you to be back to normal quickly. You will probably find it annoying to have friends and family members who assume that now you are diagnosed and taking the meds, things are all hunky dory and back to normal . Meanwhile you’ll be struggling to keep thing afloat. Very annoying.

If you feel like shouting at these people, your response should at least include something like “I’ve am really ill and I’m recovering. My research indicates that having a depression episode (meltdown, nervous breakdown, etc.) is like have a major injury and takes months to heal. I may look physically ok, but that doesn’t show the real problems. I would really appreciate if you could stop assuming that I am back to normal.”

Step 7: The meds may not work very well.
The meds may not work very well. My calculations seems to indicate that there is probably a 66% chance that what the doctor gives you first will not work properly. Expect to be experimenting with drugs for a while. Check this link for my thoughts on drugs.

Step 8: You are in charge.
Now that you know that you have a physical illness, you can do something about it instead of wondering what the heck is happening to you. But here’s the important thing – it’s gonna be up to you to steer your course.

The doctors and psychiatrists and others are going to be resource people along the way, offering good advice and experience, but you are going to have to be the one deciding what to do next. Because you are the one who is going to see your illness every hour of every day, you are in the best position to make decisions.

Depression and Dogs

We’ve all heard about the healing and stress relieving power of pets. And stories from pet owners will always be full of the how marvellous and loving their pets are. I know, because I am one of them.

But do they help with stabilising mood swings? Can they help pull you out of depression? Should you get a pet in order to help with mood swings? Continue reading Depression and Dogs