Stress and Bipolar Disorder

Happy New Years everyone!  Here comes 2012!

We all know too much stress can make your life a living hell whether you have a mental health issue or not.  As someone with bipolar disorder I know that my manic or depressive symptoms become heightened under stressful conditions.  I experience a loss in ability to cope. 

Stress is the result of the inability to adequately cope with an environmental input or stressor(s) of some kind.  A stressor could be going to the store, an uncertainty about your job, or winning the lottery. Stressors can be good or bad, significant or nonsensical.  

Checkout a bad stress situation here!

In the lives of folks with bipolar disorder, stress is usually a pretty bad dude.  Our mind and body seem to have an added challenge processing and adapting to incoming stressors (negative information) in a way that it is not harmful to us.  I also think our resiliency to stress is somehow less than those that are without a brain disease.

I know of a guy with bipolar disorder who was in the position of assistant pastor for his church.  He had a bachelor degree from a reputed seminary school and a masters in theological studies.  All seemed fine I suppose, but at some point the stress in his life caused his bipolar symptoms to become unmanageable.  He became debilitated to the point where he could no longer hold his church position.


He had held the position for three years.  He attributes the loss in function to bipolar.   

Too much stress for someone with bipolar, if not properly dealt with, can eventually cause a depression or manic episode.  I think some of it is that bipolar people are, in general, more sensitive than the rest of the population.  I also believe some of us have coping skills that are lacking when it comes to managing stress.  I know I do. 


That's it for now.  I'd write more but I'm too stressed out.

Bipolar and Disability Retirement

Well folks, the time has come.  After 17 years of being an environmental engineer I am now unemployed due to events from my last manic episode.

I had three manic spells during the time I've been working as an engineer.  I managed to climb out of the aftermath of the first two episodes by the skin of my teeth.  But this last one did me in.  I'm guessing some of you have had similar experiences.

So, after some consideration I decided to apply for disability retirement benefits.  I'm trying to get the benefits for the debilitating effects of bipolar disorder.  Long-term depression and anxiety are my incapacitating enemies these days.

I don't know how much I will get if approved.  I figure the most I'll get a fraction of my previous pay, which won't be enough for my current living costs.

Therefore, I still need to find other sources of income or I must start drastically reducing my standard of living.  I can just see myself now, living in a trailer by the freeway.  Not!

Social Security has this cheery blurb on their website: "While we spend a great deal of time working to succeed in our jobs and careers, few of us think about ensuring that we have a safety net to fall back on should we become disabled.  This is an area where Social Security can provide valuable help to you."  This makes me want to go out and buy a t-shirt that says I'M DISABLED.  Well, not really.

One good thing is that the application process can be done completely online these days, which saves you the hassle of making copies, mail, and delivery to the local SS office.  The less time spent dealing with the post office or a case worker the better.

For SS disability you must demonstrate you (1) can not perform the work you used to do; (2) can not adjust to other work because of your disability; and (3) expected the disability to last for a year or longer.

Today I'm working on the part where I report specifics about my disability.  They say it should only take 90 minutes to complete.  Yeah, right.  It's going to take that much time just for me to locate all the information they ask for.  I can see this is going to be fun.

Have you applied for disability before?  What was your experience?

Merry Christmas

Merry Christmas everyone!  Hope you are having a great time this season. -- Jeff

Why Blog? Why Bipolar?

As a new blogger with bipolar disorder I run into roadblocks from time to time.  I also run into dead ends.

It's the ability to navigate around roadblocks and to quickly turn around at dead ends that makes someone successful.

After cruising the web, reading other people's blogs I found that successful bloggers all have the following in common:

• they love to blog about their chosen subject(s)
• they are motivated to the point that blogging is a passion
• they provide original, informative content
• they blog as themselves, not someone they are trying to be

As I was struggling to decide on content for my next post I asked myself some hard questions:

1. Why do I blog?
2. Do I love to blog?
3. What are my goals for this blog?

Why do I blog?  I blog because I am passionate about beating the bipolar disease.  I blog because I enjoy sharing my experiences with other people like me. I blog because I like writing.  I blog because it is fun!

Do I love to blog? YES! I thoroughly enjoy creating content and getting it out there for people.

What are my goals for this blog?  This question made me stop and think.  What are they?  I know I originally started writing as a form of therapy.  My goal was to achieve a therapeutic benefit from writing.  

That goal is being reached as I continue to write. But another goal has jumped in: exceptional content.  I blog to provide excellent content to my readers and for myself.  I blog to fill an empty spot in the blogosphere.

That empty spot is sharing my perspectives, opinions, analysis, and experiences.  The spot is filled as I produce information, tips, links, resources, insight, and inspiration.  A medical text on bipolar does not inspire someone to keep fighting the disease.  But the stuff I create sure can!

Today I was staring at a dead end.  I was thinking that I provided no value to readers.  I questioned the content I am providing.  This is where I was when I got up today.

I bet every blogger gets that mindset at one time or another.  In that state of mind you absolutely can not produce worthwhile content.  You will not enjoy it.  Your writing goals will not be present.  Blogging will feel like work, not something you love to do.
____________________________________________________________________

Fast forward to the evening.  I'm finally out of that awful space!  I'm not doubtful anymore!  I know I provide value to readers out there, IMHO.  I want to blog right now! 

I'm not sure what exactly got me out of my funk.  Some of it was reading successful blogs out there.  Some of it was asking myself those three questions.  A subtle but real exodus of depression symptoms certainly helped a lot.

The bottom line is I love blogging!  I like thinking about topics, researching things, and connecting with people.  Blogging is an excellent way to express who I truly am to the world!!  So, cheers to blogging everybody!

What things do you love?  How do you handle it when they seem so distant sometimes?     

7 Novel Bipolar Treatment Medications

This post is a brief overview of seven emerging or novel drugs for treating bipolar disorder.  This should not be considered a thorough analysis of the state-of-the-art in psychotropic medications. Most of these products have not finished being tested.

Your psychiatrist has probably not even heard of them.  So don't get too excited about seeing if they will work for you anytime soon.  I am posting this out of curiosity and hope for the future.  I think it is encouraging to know science is making headway towards more effective drugs with less side effects.

Current treatments for bipolar depression have a considerable lag of onset of action.  An alternative product with rapid antidepressant effects (hours or days versus days or weeks) is needed.  Ongoing research is promising with newer, faster acting drugs in the testing or approval stage.

1. Ketamine is a drug that has some clinical testing and appears to work well for treatment resistant bipolar depression.  It is fast acting and generally well tolerated.  An IV is used for administering the drug so you better like getting poked.  

It seems product development on this drug has stalled since it can cause hallucination and significantly interupts normal brain function.  Because of the ability to experience abnormal states ketamine is popular at underground parties and raves.

2. Oxycarbezepine is a derivative of the mood stabilizer carbamazepine (Tegretol).  It is being studied for acute mania, hypomania, mixed episodes, and rapid-cycling.  For now a lack of sufficient quality trials precludes us from knowing its effectiveness and tolerability. 

3. Riluzole is a novel chemical that is being studied for treatment of bipolar depression.  It is already an FDA approved prescription drug used to treat Lou Gehrig's disease.  Studies show it effective in treating acute bipolar depression alone or in combinations with other antidepressants.  The first large controlled trial of Riluzole is being conducted at the Yale Depression Research Program.

4. Tamoxifen has been evaluated for acute mania treatment.  Results from several trials demonstrate that it is both effective and well tolerated.  One researcher said that Tamoxifen isn't perfect but it fits the bill.  Is that an endorsement?  It is a promising antimanic drug but larger studies are needed before it can be sent to the FDA for approval.  Interestingly, the drug has been in use for two decades to treat breast cancer under the brand name Nolvadex.

5. Tiagabine is an anticonvulsant being studied for maintenance treatment of bipolar disorder.  It is already FDA approved for treatment of partial seizures under the brand name Gabitril and it is already being used off label for controlling anxiety.  As with most of these emerging treatments tiagabine needs better studies before a determination can be made as to its therapeutic potential for bipolar disorder.   

6. Saredutant is a promising neuropeptide being studied for treatment of major depression disorder.  Neuropeptides work on different neurotransmitter systems than conventional antidepressants.  Saredutant produced favorable results and is in clinical trials for long-term efficacy and safety.

7. Scopolamine.  Scopolamine showed rapid, robust antidepressant properties in clinical testing.  It is being tested for relief from both depression and bipolar depression.  It is interesting to note that this drug is already in use for motion sickness relief.  If it ends up working then you can go boating without puking or being sad.  

Research for drugs that can effectively treat bipolar disorder continues.  It is exciting to note they are finding chemicals that work much faster than what we are used to, showing effects in hours instead of days or weeks.  It is also promising that some of these medications are already approved and in use for other treatment purposes. 

The understanding of bipolar mood mechanisms is increasing. While promising solutions are being discovered it can be disappointing at how long it takes for them to get studied and approved for use.  However, we should be grateful for what we already have and hopeful that science will make enhanced meds that work even better.


Do you know of other medications being studied for bipolar treatment? 

Christmas In Bipolarland

Thursday 11-15-2001.  Boy, today sure started off slow . . . yep, depression.  First, I didn't wake up until 11:00 even though I went to bed pretty early.  Woke up to knocking on the front door.  It was my handyman friend.  Turns out he was in the neighborhood and his car was acting up.  He needed a place to check out his car and I live nearby.  That's what got me out of bed.

I feel crappy.  Need coffee.  Take meds.  Feed dogs.  Go to the bathroom.

Next, my ex-coworker friend (still my friend, I lost my job) stops by on his way to work.  He's got a million ideas and things in his mind, many about Christmas and all the family crap that comes up this time of year.  I listened. He was thinking and talking so much I couldn't get a word in so I kept listening.  Just paying attention to him got my brain going.  More coffee.

So with a little help from my friends I finally got moving.  I'm just now getting the mojo on.  Better late than never.  It's almost 1 pm.  I'm on my fourth cup of coffee.

Christmas is overrated.  It's our annual race toward Christmas and the end of 2011.  Things are getting tense out there for the Christmas shoppers still buying stuff.

In my family we've started a recent tradition of either (a) only getting gifts for my two nieces or (b) get them gifts and do a white elephant for the adults.  This year we're doing option (a).

I supported option (a) for a couple of reasons.  First, I blame it on the economy.  The unemployment rate is at 9 percent so we better hold on to our money and hold off on gifts.  Next, I remind people I recently became unemployed (temporarily retired is a good way to see it).  I get a lot of miles out of that one.

But truth be told, I prefer moderate gift giving because I'm just not motivated to shop, shop, shop and spend, spend, spend so I can wrap, wrap, wrap.  It's exhausting just thinking about it.  

I attribute my bah humbug attitude to bipolar depression.  It's here and is muddying up everything as usual.  Things I like to do are distant, unappealing and so is Christmas.

I just don't see any fun in going through all the work to get some presents for people - presents they probably don't even need or want.  All of the presents just become more stuff for others.  Future items to donate to charity or toss.

Christmas spirit.  I was over at a friends house this last weekend.  They had gone out and bought a bunch of lights and decorated their front yard as you can see from this picture.  He got up in the tree and spent who knows how long getting all those lights up.  I commend them on their spirit and intiative, but darn if I'm going to do that.

I have a few strings of lights I might throw on the frontyard shrubbery, but that's about it for the outside.  I did it last year but not this year so far.

And for the inside of my house I have three fake Christmas trees.  They were easy to setup because I never took them down from last Christmas.  I'll probably leave them up for next year as well.  The trees don't even collect dust - low maintenance, yes.

These trees and their decorations are sentimental to me.  They are decorated with a few ornaments and Christmas balls.  My mom made every one of them.  They're hand painted and kiln fired.

My mom passed almost two years ago.  We didn't have a Christmas that year or I wasn't paying attention if we did.  She was an important part of my mental health team.  She was a good, patient listener and ALWAYS available for me.  Not having mom here makes me sad this time of year.


The experience of this season is best for me when I become mindful, Spirit-filled, and focused on Jesus.  I ask what would Jesus do?  It's simple but effective.  It helps me to know that this life is just temporary.  It's like a training ground for the next life.

Sunday 11-18-2011.  Okay I'm back.  I thought of one more thing before I post this.  I need to say what I'm grateful for.  I don't know if I'll post about Christmas again or not so I'll say it now.  I am grateful for:

• a loving, supportive family
• awesome friends
• my health
• meds that work
• blogging 
• the awesome people I meet online

I wish everyone peace, joy and a great Christmas and New Year!

Medication Withdrawal Effects

I've been searching the web lately trying to better understand potential adverse health effects from psychiatric drug withdrawal.   Why can one person get off a psych med without hardly an ill effect while another will suffer for months during the process?  Hmmm, this looks interesting.

Each person's brain/body responds differently to drug withdrawal, just as each brain/body reacts differently to a new drug.  In the latter the process can produce adverse reactions we call side effects.  For drug withdrawal, troublesome symptoms are usually called withdrawal effects.  A more fancy term being used is discontinuation syndrome.

Withdrawal Effects.  Withdrawal from psychotropic medications can include flu-like symptoms such as fatigue, lethargy, aches, insomnia, diarrhea, nausea, and dizziness.  Some people become hospitalized because of the withdrawal process.  The experience can be horrible and last months or even years according to those who've been through a bad withdrawal.

In an online web forum one practicing M.D. was quite critical of the withdrawal effects from psych meds.  He lamented that there are some patients who's experiences are so bad that they end up deciding to stay on the drug, even when they have determined it has no therapeutic value for them.  They were stuck on a drug that wasn't working because withdrawal was too excruciating.  What's worse, some unfortunate souls in this situation continue to experience withdrawal effects even after getting back on the drug!

From an article on antidepressant withdrawal, the writer says withdrawal effects are more likely to occur (a) if you have been on the medication for six weeks or longer and (b) if you are within the first two weeks of the tapering off process.

Drug withdrawal symptoms are reported across the psychiatric spectrum.  An article in the journal Medical Hypothesis reports withdrawal effects in antidepressants, antipsychotics, lithium, and benzodiazepines such as Xanax.

I was quite concerned about withdrawal effects from the antipsychotic Abilify (aripiprazole) during my recent tapering off from it (see my last post on 12/12/11 about this).  I didn't do much research before stopping.  I just hoped for the best.  Fortunately things worked out well for me.

Some personal websites were particularly grave about the withdrawal effect.  I bet these folks are the unfortunate ones who have debilitating symtoms that can last for many years.

We certainly need more research in this area.  Without more information it is difficult to compare the risks and benefits of stopping.  Perhaps there are other medications or practices we can do to minimize the withdrawal effect?

One big step in the right direction comes from a new company adverseevents.com.  They are making it possible to readily find information about the toxic effects of medications including psych drugs.  Their process uses a propriety algorithm to extract data from the FDA's Adverse Events Reporting System (AERS) and assemble the information into a useable and understandable format for patients and healthcare professionals.

Paxil. One drug that kept coming up was the SSRI antidepressant Paxil (paroxetine).  According to a the Mayo Clinics Medical Edge Newspaper Column, Paxil is in a group of SSRIs that are the most difficult to quit.  This is because certain SSRIs are metabolized (removed from the body) more rapidly than other SSRIs.

In one blog post the author explains her experience with Paxil withdrawal effects.  Her reaction was so severe that they had to allow seven months for her to taper off.   Withdrawal effects included headaches, lethargy, depression, dizziness, the "zaps" (whatever those are) and nausea.  At the same time she says a close friend withdrew from Paxil with only headaches.

Adverseeffects.com reports withdrawal effect information about Paxil.  Data they have from consumers between 1/1/2004 to 6/30/2011 that shows withdrawal from Paxil has a hospitalization rate between 5 and 7 percent!  Wow, who knew?

I don't remember any withdrawal effects when I got off Paxil about 10 years ago.  Maybe I was too depressed to notice.  I remember I didn't respond well to the drug therapeutically.

Takeaway message.  The symptoms from tapering off vary a lot from person to person and drug to drug.  Trying to determine who will experience withdrawal effects and how severe those effects will be is really anybody's guess at this point.

We need to explore whether the long-term recommendation for bipolar disorder treatment should be indefinite use of psych meds?  Should medication for life really be the presumptive remedy?

Finally, when stopping a medication it is critical to work with your psychiatrist so that the tapering off period is as gradual as necessary to control the withdrawal effects.  You need to start low and go slow.

UPDATE: Meds Change Successful!!

This post is an update to my  ALERT: Meds Change post from the 11/16/11.  At that time I had just seen my psychiatrist the Friday before on 11/11/11.  I could of made it an 11 a.m. appointment and arrived 11 minutes late, but that would be silly.

My appointment was from 2 to 2:20 p.m.  I hate those 20 minute "medication management" type visits.  I feel I don't have enough time to process all the information and make good decisions on how to move my treatment program forward.

30 mg Abilify Tablets

Anyway, I have been working with my pdoc since 11/11/11 to reduce and eliminate Abilify (Aripiprazole) from my medication regime.  The good news is that I was successful, yay.  I'm now Abilify free!

The dose reduction went like this:

1. On 11/11 reduced Aripiprazole from 30 mg to 15 mg each evening.  Just break that tablet in half and swallow.  
2. On 11/23 reduced from 15 mg to 7.5 mg each evening.  You should of seen those pills as I broke them into four pieces using my fingernails.  I don't think they were meant to be broken up like that.  They wanted to stay whole and complete.  But the good doctor said do it so I did. 
3. On 12/7 I stopped taking Abilify completely.

I've been off the drug now for five days and things are going okay.  I still have my moderate depression which can range from mild to severe depending on the brain biochemistry flavor of the day.  I notice that I'm less tired in the morning and find it easier to get out of the darn bed each day.  This is an important daily ritual for me.  If I'm not out of bed by 9 a.m. then it's likely the whole day will be shot.

Most importantly I experienced no withdrawal symptoms.  I am very pleased with my divorce to Abilify.  It's going to save several hundred dollars over the year and I don't have to put up with its whiny, sleepy side effects.

Dopamine Receptors Impacted by Abilify

Now I'm stable with moderate depression taking my three psychotropic meds, including Xanax as needed, up to 2 mg per day.  I'm taking 60 mg Cymbalta, 450 mg Wellbutrin, and 300 mg Lamictal daily.  Each day I also take 300 mg of Omega-3, a multivitamin, and 325 mg of aspirin.

I've been taking the aspirin for the last couple weeks after reading an article by James M. Greenbelt on how inflamation in the brain can make you insane in the membrane.  He says, "It appears that inflammation and the complicated collection of immune system chemical messengers called cytokines play and important role in brain function and may cause psychological symptoms."

Not really a raving review for addressing brain inflammation but the article makes sense.

Another study was more promising, especially for people like me that have treatment resistant depression.  He states, "A study involving depressed patients classified as non-responders supplemented each patients standard antidepressant treatment with the addition of aspirin, an anti-inflammatory.  More than 50% of these patients responded to this combination treatment.  At the end of the study more than 80% of the group responsive to the anti-inflammatory went into remission."

Now that's what I'm talking about.  Remission.  Wouldn't that be awesome.  It's too bad there's not a similar study/trial evaluating aspirin as an add-on med for bipolar depression.

I think I'll keep taking the aspirin each day and see if it makes my brain feels less inflammatory, whatever that feels like.

N-acytelcholine (NAC) molecule

I'm not sure what to do next.  I can try and reduce or eliminate another pharmaceuticals.  I'd go after Cymbalta next.  I know I'd be a fool to get off the Lamictal and I respond well to Wellbutrin.  I can not attest to the effectiveness of the Omega-3 and multivitamin.  I think they make such a small difference in my mood that I can't tell if they are doing anything.

I also want to try the supplement NAC (N-acytelcholine).  I wrote about it here.  I am okay with the unidentified but likely low risks it poses.  Yes, that's it.  I'm going to stay with my current meds mix until my next pdoc appointment in January.  We'll discuss taking NAC at that time.  I think she'll go for it.

In the meantime I will enjoy my new found alertness and wakefulness.  I hope it lasts for awhile.

Bye bye Abilify.  That's one less box car of meds riding on this precarious, crazy train called me.

Jeff's Top Bipolar Sites

Today I give you my favorite bipolar disorder web sites. I went through my bookmarks and scouted additional sites for this post, but I'm sure there are many excellent sites I missed.

To make it easier for me I selected only one site from each of the following seven categories: personal, educational, government, research, support, reference, and psychology.. Each site has some unique content, an educational component, and added value for bipolar information consumers (you).

I didn't include sites that are for bipolar news feeds, blogs, pharmaceuticals, chat/discussion rooms, clinicians, activists, or mental health professionals. I did not include search engines, which are valuable in and of themselves for locating bipolar disorder information.  And I tried to stay away from sites with heavy advertising or a strong commercial bent.

LucidInterval.org - Personal.  Award winning site written by a fellow with over 30 years experience living with bipolar disorder type I.  It is focused on surviving acute bipolar episodes written purely from a personal perspective, appropriate for the newly diagnosed and those of us striving for stability. Consists mostly of a series of short articles peppered with helpful reference links supporting the author's viewpoint. The site is easily navigated, contains well thought out content, and has good sections on recommended books, online guides, and web sites.

LivingManicDepressive - Educational.  An award winning website maintained by a bipolar type II individual since 1997.  The site is very thorough in subject matter.   It includes everything from dealing with medication to how to handle a relationship with a depressed partner.  It is good for the "newbie" bipolars and seasoned veterans alike.  The great part is the tone of the site.  It's not written in dry medical terms, but in the living, daily grind of our lives, from someone who has suffered from bipolar disorder.

National Institute on Mental Health - Government.  The best government (U.S.) site for your average, everyday bipolar sufferor.  While focused on research, the site's bipolar area also provides good base of information for consumers including statistics.  Site uses video, audio, podcasts, news feeds, e-newsletters, blog, booklets, brochures, and fact sheets.  All material is free and downloadable.  Authoritative source.

PubMed - Research.  A massive repository of high quality scientific articles related to bipolar disorder and other medical issues.  Site has information on research, studies, analysis, clinical trials, and medical perspectives.  Good site for researching meds and bipolar disorder phenomenon.  Articles are usually highly technical but are of a peer reviewed journal quality.  Abstracts to articles somewhat comprehensible by non-scientists.  Some articles available free.

National Alliance on Mental Illness - Support.  NAMI is the U.S.'s largest grassroots mental health organization.  It is dedicated to building better lives for Americans affected by mental illness.  Easy-to-understand information in a variety of formats (articles, videos, magazine, e-newsletter, blog) about mental illnesses, health care, diagnosis, treatment, and recovery.  NAMI operates quality programs, support groups, discussion/focus groups, and advocates strongly for its community.  Non-profit web site run by mental health professionals.

WebMD Bipolar Disorder Health Center - Reference.  A plethora of easily understood information on bipolar disorder diagnosis, medications, therapies, and treatments.  Information is available in a variety of formats: video, articles, slideshows, news feed, newsletters, discussion groups, tips, tools, support communities, and complimentary website resources. It is run by a for-profit company so it has some advertising.

Psych Central - Psychology.  The internet's largest and oldest independent mental health network and psychology web site.  Good organization and indexing of information and resources.  It has articles, dozens of blogs, robust medication library, e-books, direct advice from experts, support groups, timely news, clinical trials research, and recommended outside resources.  Reliable, relevent, and trusted source of a lot of psychology related information devoted to the general consumer.  It is run by mental health professionals, not affiliated with a company. Has advertising.

Do you frequently use any of these websites?  Maybe you have some favorites of your own you can tell us about.  Or maybe you have a site(s) from a category not covered here that you are dying to let people know about.

kNACk for Bipolar Depression

I enjoyed reading Natasha Tracy's blog post on the use of NAC (N-acetylcysteine) as a low cost add-on for treating bipolar depression.  The post got me thinking.  I decided to take a closer look and see if I should use NAC in my own treatment program.

The fundamental problem is there are few choices of medication for effectively managing bipolar depression.  One article states, "Given the failure of almost all modern trials of antidepressants in bipolar disorder to demonstrate efficacy, and the limited efficacy of mood stabilisers in the depressive phase of the disorder, this is a major unmet need."  I never knew we were so hosed.

State-of-the-science

A 2010 comprehensive review of clinical trials and other data was performed to assess NAC effectiveness.  The review's tepid conclusion: "bipolar disorder treatment outcomes may potentially be improved by additional use of [NAC] with conventional [psych meds]."  They also urged caution when interpreting the large effects of several isolated studies, as they have not yet been replicated in larger trials. Okay, so now what.

One article studied NAC efficacy as an add-on for maintenance medication.  The authors studied bipolar individuals with moderate depression.  Results showed a "robust [drop] in depression scores with NAC treatment."  That sounds better.

In another study, NAC was given to 75 depressed bipolar patients at 1 gm twice a day in combination along with their usual bipolar medications.  The results showed a significant improvement in mood, global functioning (whatever that is), and social/occupational functioning.

How it works

NAC is a precursor of glutathione and works to replenish depleted sources of glutathione in the brain.  Low glutathione levels in specific brain areas are linked to mood disorders, particularly schizophrenia and bipolar disorder.

Anything else?

Finally, in regards to risk one journal article concludes:  "While dosages, pharmacological strategies (monotherapy versus augmentation), and long-term risks are not fully evident, NAC appears to be a promising, relatively low-risk intervention."  I can live with that.

Conclusion: Go for it!

The supplement appears safe at the oral doses given in the studies.  And according to Ms. Tracy's blog post NAC is inexpensive at $25 per month and readily available over-the-counter!

Now, how should I go about doing this?  First, I will get buy-in from my mental health team - which consists of my parents, psychiatrist, and a few close friends.

This should be straightforward forward, I hope.

And I need to decide if I'm going to stay at 15 mg/day Abilify (recently reduced from 30 mg/day) or try and get off it completely.  I'm leaning towards just getting off the stuff.  I haven't noticed anything negative since the reduction a couple of weeks ago.

What about the dose?  Well, one study administered a dose of 1 mg of NAC twice per day on moderately depressed bipolar individuals.  I would say I'm mostly moderately depressed so I'll just use that dosage.

So, I'll check-in with my mental health team, dump the Abilify, and start taking NAC. Stay tuned!

Anybody else take supplements for bipolar depression?

DISCLAIMER: I am not a trained mental health professional.  This post is my opinion only.  Do not change or adjust your medications without first consulting your psychiatrist or other mental health professional.

Bipolar Depression Clouds

A friend of mine stopped by recently.  He brought up the concept of a mind cloud.  The mind cloud is the aggregation of all one's thoughts (beliefs, ideas, concerns) that are in your mind at any given point in time.

Within the cloud are distinct thoughts.  For example, the thought about my need to take my car to the mechanic.  Another example could be a persistent negative thought from my inner voice that says to me "I am not good enough".  I call these individual thoughts cloudlets.

What he had been working on lately was identifying problem cloudlets, separating them from each other, and analyzing them using self-taught psychoanalytical techniques and other mind Jedi moves.

His intent was to address each cloudet separately, but also in the context of his overall cloud. I am intrigued by his self-taught ability to break-out individual cloudlets and analyze them for what they are without being overly impacted by the general mood of his mind's cloud and other problem cloudlets.

Dark Clouds

I'm going to venture and say the mind cloud of someone experiencing bad bipolar depression is dark and consists primarily of negative cloudlets.  And I'll go so far as to say this cloud feels like a thick, gloomy fog that just will not lift.

During bad depression I find it extremely difficult to breakout bad cloudlets for analysis like my buddy.  These negative thoughts are intertwined with each other and are overshadowed and impacted by the overall negative disposition of the mind cloud.  Almost all of my cloudlets become contaminated with the mind cloud's overall black mood.

Cloudlet Analysis

The key to relief for a depressed mind is learning the ability to separate negative cloudets for analysis.  The challenge is that cloudlets are elusive and intertwined with other cloudlets and the overall state of the mind cloud itself.

Once a cloudlet is analyzed, a solution or at least a way forward should materialize.  And during the process the original problem cloudlet morphs from being negative to being less negative, neutral, or even positive.

The impact of my difficulty separating unique, negative cloudlets is a inability to objectively analyze my cloudlets for what they are.  And forget about finding solutions.  I mean, how am I to delineate each cloudlet if I'm constantly being bombarded by negative cloudlets that are being streamed from my dark cloud?

Riders on the Storm

So, each individual suffering from bipolar depression rides a dark, stormy cloud that has mostly negative cloudets.  The challenge is developing the ability to address problem cloudets while riding that stormy mind cloud.

Do you identify with this concept where a depressed mind's overall, dark temperament will taint or contaminate individual thoughts?



Image by Vorakorn Kanokpipat

Bipolar for life! Really?

The vast majority of folks with bipolar disorder have been told there is no cure and they'll be on medication indefinitely.  I know I've been told this more than once by well meaning psychiatrists and mental health professionals.

photo by Salvatore Vuono

I happen to agree with them, mostly.  I don't consider myself well enough to even begin to think of getting off my meds these days.  I wish I was better off.  I want to say to people that I'm in a full remission.

But that is not the case.  These days I'm either depressed or sleeping.  I experience times with mild depression and other days I find myself entrenched in the dark mood.  Most of the time I live with moderate depression.

Nevertheless, I persist with the hope that someday I will be able to be completely free of psych meds while holding the bipolar in remission.  By remission I mean the disease is still there but it's not expressing itself in any significant way.

What are my chances of being symptom free without psychiatric medication?  I don't know.  But I do know that there are bipolar sufferers out there that have made it to a non-medicated state.  So there is some chance.  The possibility exists!

I'm not even sure of the steps I would take to get off meds.  Would I start decreasing all my meds (abilify, cymbalta, lamictal, wellbutrin) at the same time or one by one?  How fast should I get off each drug?  The psychiatrist knows this information.

This is a delicate area.  Nobody should attempt to go natural (off psych meds completely) without the supervision of a qualified mental health practitioner, usually a psychiatrist.  Hopefully friends and family understand but that is not guaranteed.

Please note I am not a mental health professional and I am not giving medical advice here.  I am just putting down my thoughts on the matter of being medicated for life.

Salvation in Corpus Christi

We (my sister, dad, and I) took a trip to Corpus Christie, Texas last winter.  It was a cold and damp trip.  But we managed to see everyone, including Jesus!  

I was in a bad place during that trip.  My bipolar depression was in top gear.  I remember dreading things like waking up, getting ready to do things, and doing them!  What a drag it was.  My salvation on that trip was having my eyes set on Christ.

Determined and committed to saving His children

We found him in front of this church

Most of us have or are enduring some sort of suffering in our lives.  It could be mental illness, cancer, trauma from an accident, termination from employment, addiction, loss of a loved one, chronic pain, severe financial hardship, homelessness, or a myriad of other causes.

Sometimes I think God allows people to suffer in order to appreciate things more.  For example, I was severely depressed yesterday but today only moderately so.  Right now I have much more appreciation for today's more moderately depressed mental state than I would if everything had been going super before now.  Even my morning (and afternoon, and evening) coffee tastes better!

Another reason for suffering could be because our life on earth is meant to be a training ground.  Life in heaven is eternity.  Perhaps we are supposed to use this short time on earth to develop our character and mettle.

One's experience of suffering could be a path toward the development of compassion and other forms of character such as the fruits of the Holy Spirit.  It is written in Galatians 5:22, "But the fruit of the Spirit is love, joy, peace, patience, kindness, goodness, faithfulness, gentleness, and self control."  Perhaps there is some fruit we are lacking that God wants us to develop.

A more significant reason for suffering could be to bring us closer to Jesus.  God could also be using the time to encourage non-believers to become saved.  When people's lives are going great they tend not to dwell on things like the afterlife since the here and now is so enjoyable.

But when we're crawling in despair we are more apt to reach out to all available sources of help, advice, and caring.  This includes God.  And I feel blessed knowing the Almighty is always available.  He longs to commune with us whether we are in Corpus Christie, our own hometown, or anywhere else.  Praise God!

Bipolar Twitter Chatter

If you search the "tweetosphere" using an online tool like tweetgrid.com you can find all kinds of interesting and funny stuff!  I did some searches using bipolar and other terms.  The results are humorous.

When I queried 'bipolar+partner" I found this tweet from on gal : "Umm, That Jog Was Relaxing! Thank God I Gotta Partner....But She So Dang Bipolar, Lol....Hope She Don't Quit On Me! ;)"  I'm glad we can all laugh out loud at our bipolar relationship issues.

A query of 'bipolar+weather' turned up: "Im so sick of this bipolar ass bitch Mother Nature she need to make her damn mind up. this weather #icant"  I guess this person wants winter to come yesterday.  The same query showed: "Wassup with this bipolar weather? #datshitcra"

After typing in 'bipolar+sandwich" I saw: "all i have eaten in the past two days is a roast beef sandwich. my appetite is bipolar."  Does this appetite cause the food to go up and down or high and low?  Two days is a long time. Maybe this person was on drugs.

'bipolar+toast' led me to a gent who tweeted: "Toast to all the men dealing with bipolar women all their lives. This my friend is for the birds"  Yep, that relationship is on the rocks.

And finally 'bipolar+dirty' turned up this from an upset partner: " @starrahlicious worse was living with a skitso/bipolar dirty airhead dumb non spades player a liar a ho n fake plus a manipulator"  Tell us how you really feel.

ALERT - Meds Change

I'm making my first medication adjustment for my bipolar in over a year.  I'm reducing the Abilify I take by 50 percent from 30 mg/day to 15 mg/day in the evening.  We'll see soon how this works out, stay tuned.

Abilify was prescribed for my depression - specifically, it is being used as an add-on treatment for treatment resistant depression when an antidepressant alone is inadequate.  The exact way Abilify (or any other psychiatric medication for that matter) works is unknown. It is thought that it may work by affecting the activity of some key brain neurotransmitters — adjusting dopamine, instead of completely blocking it, and adjusting serotonin.  Okay, whatever.

I reported to my psychiatrist last Friday that some depression symptoms were not acceptable.  I was having too much difficulty getting out of bed and starting my day.  She said Abilify can sometimes make people groggy and get the "stuckness" feeling.

So, we decided reducing the Abilify was worth trying.  I was skeptical at first since Abilify was the last drug I added to my medication regime back in October 2010.  It was added at that time to curb an oncoming depression episode.  I do remember it helping some at the time.

With the current adjustment my new medication cocktail is: Morning - 450 mg Wellbutrin, 60 mg Cymbalta; Evening - 15 mg Abilify, 300 mg Lamictal, and 60 mg Cymbalta.  I also take a multivitamin and 300 mg of omega 3 from a fish oil capsule.  I'm glad the fish oil is in a capsule because it tastes pretty nasty.  Is this stuff the extract of fish guts or what?

Here's a mosaic of my current medication cocktail. ==>  ==>  That's all for now.  Join me next time for a look at bipolar disorder and stress!

If a Tree Falls in My Yard . . .

If a large part of my tree falls in my front yard, does it make a sound if nobody hears it?  I say no unless it lands on a car and sets off a car alarm.

When I finally got out of bed (it was bipolar depression o'clock, 4:30 pm I think) and went to check the mail Saturday I was surprised with what I saw.  A large branch from my front yard tree had snapped off and was lying across my front yard!  I was lucky it didn't hit my car parked less than 10 feet away!

Large Limb from Tree

We had some rain the night before, but I didn't think much it.  I mean it wasn't a big storm.  Will a larger storm bring down even bigger limbs and branches?  The entire tree? 

I knew this tree had the potential for mayhem.  Each year manageable sized branches fall during heavy wind and rain.  But never has such a large limb separated itself from the tree.

Besides giving me an excuse for not mowing the lawn, what should I do?  I have a big tree limb sitting in my front yard.  Should I cut it up, save the wood and hope this doesn't happen again?  Or should I hire a tree trimmer to trim the whole tree down to a manageable size?  I'm leaning toward the latter.

For sure I will relocate the car during storms until this beast of a tree is contained.  Knowing me I may just move the car over a little and pray a branch on that side of the tree doesn't land on my car.  Or maybe I'll swap out my truck with the car and take my chances.  I wonder how the truck feels about that?

Tree Clearly Dominates Car

Now the fun part of all this is that the tree technically belongs to the city of Ventura.  I believe they will come out and remove the limb for me.  A good example of tax dollars in action.  But from talking to them in the past I know they won't pay for a tree trimmer to come out and remove all the potentially dangerous limbs.  They leave you on your own with that one.

But alas!  I called the city at 10:20 this morning and spoke to a nice gal about clearing my fallen branch.  She asked for the address and whether the tree was impeding pedestrian traffic or not.  At this moment I thought maybe I should fib and say it was so I would be a higher priority for them!  But no fear, I told the truth and she apologized for any wait I might have.

Well, by 1:40 this afternoon the city had come by and shredded the fallen branch.  They also found a "loose" branch and pulled it down and shredded that.  I thought that was cool.  One of the city staff even apologized for the time it took and I told them not a bother.  I thought they were responsive.

Overall the experience was fantastic.  Nobody or nothing got hurt.  I got a limb cut off and removed for free.  And the city staff were very courteous and efficient.  Thanks City of Ventura (Parks Dept.) for your well appreciated work!

Japan to Attack U.S.

Did you know we will be attacked by Japan in the not-to-distant future?  Yes, but it won't be with bombs or kamikaze pilots.  The mode of attack will be onshore occupation of U.S. coasts and waterways by Japanese garbage!

Remember all the cars, buildings, tires, and junk floating on the coast of Japan after the March 11 earthquake and Tsunami? Well, all that stuff left Japan and is now conglomerated into one large trash patch floating in the Pacific Ocean.

How much trash is actually floating out there you may ask?  The size of the patch has been reported to be twice the size of Texas!  However, one recent report refutes the enormous size estimate.

It is chock full of durable things that float and do not readily degrade in the ocean environment.  The patch has assembled itself into a force to be reckoned with.

As for us in the U.S., we are screwed. It turns out normal ocean currents are transporting the mass of material across the Pacific towards North America.  Some of the debris is already 2000 miles off the coast of Japan on its way to get us.

The first assault will reach Hawaii sometime in early 2013.  Next, the patch will migrate westward until it hits the West Coast.  Computer simulations performed at the University of Hawaii shows patch trash will begin washing up on beaches stretching from Vancouver down through Oregon, Washington and to the tip of Baja California in 2014.

Finally, the what remains of this dynamic flotilla of trash will bounce off the West Coast and return to Hawaii for another visit.  Surfers beware. You may need to retreat on this one.

Gimmee The Picture Already

In the spirit of Andy Rooney (RIP) I am indulging in a little analysis and satire myself:

When sending images through email some people will link to a picture instead of putting the picture in an email as an attachment.  Why do we have to go to a website to see pictures that should already be in an email?

Let’s say I want to forward that picture from a friend to another friend. I can’t just forward the email because this friend isn’t in my yahoo mail account group.  So I have to copy the picture from the website to my computer and create a new email instead of just forwarding the email with an attachment to my other friend.

How many layers of stuff do I have to wade through just to see a picture that’s only 51kb?  I'm already getting an email of 23 kb’s for the picture preview and text that says look at this picture.  It just doesn’t make sense.

From one friend to another I will tell you, these layers of clicking and pointing, new window this new window that, are increasing bandwidth, which slows the Internet.  I mean T1 connections are obsolete and you can barely lay a secure VPN tunnel over public Internet connections.

Goodbye Andy, I sure will miss you.

Are we hit yet?

I wonder about the validity of scientists when they tell us we are safe from incoming space debris - the junk we left up in space from earlier missions.  This stuff is coming at us because years of friction slowed it down to lower and lower orbits, finally crashing into earth.  And the number is enormous - 20,000 pieces of space junk and growing.

Using my analytical capabilities and undiscovered evidence, I surmise that somebody is gonna get hit by some piece of space trash at some time in my lifetime. 

Our latest potential collision came on September 24th, 2011.  A 13,000 pound satellite came crashing down with some predicting a landing in the U.S.  A scarier thought is that the old satellite will break up into pieces!  There's now more of a chance of being hit!

Did you know they actually have a bureaucracy setup to "manage" space debris.  The military and commercial interests track this legacy of space trash as well.  The best NASA could say about our latest satellite encounter was there is a "low probability" of pieces of space junk landing in North America. 

As I said to myself on that suspenseful September day: Whew!  Glad that's over.  Now I can start worrying about the next fateful incoming piece of space debris.

My New Adventure - Internet Writing

I just signed up for an online course "Introduction to Internet Writing Markets" through my local community college.  I am working on developing my writing skills and business savy to make money with my writing talents.  I've thought of blogging for myself or others, grant writing, e-magazine articles, and even my own book! 

If anyone has ideas or knows of someone in need of a writer please let me know at facebook.com/karrhjd or twitter.com/karrhjd (I'm not ready to put my email up on the web quite yet).  For each subject area I will be sending out tips and trends on various topics.  For example, for this blog I may write up an article on the pros and cons of having a psychotherapist for talk therapy - something I have experience in.

For now blogging is my mode of choice for breaking into the Internet markets.  I'll probably be sticking to subject matter that I know something about, such as this blog and bipolar disorder.  But I will likely venture out into other areas through research and exploration.  Hopefully my online course will start me in the direction I should go.  Maybe I need a plan,  you think?

Some other subject areas I've been thinking about blogging are photography, summarizing and opinionating (new word) interesting or weird news topics (not just retweeting), Christianity and the Bible, and grant writing.  I'm sure there are many other areas I'm interested in that will show up as I move forward.  Thanks for reading!  Jeff

Today's Visit to Another Christian Church

Well, we "visited" another local church for an assessment and later discussion.  The church we invaded today was somewhat liturgical, a high church if you will (think fansy smansy with candles).  You see, my six friends and I are looking at the various local churches to see which ones fit us.  We are trying to find the "best" church for our worship styles and other factors.  If it fits we will join. 

A problem you may see right away is what if we each like different churches.  Well then if that becomes the case I say each goes to worship at his/her preferred congregation.  Following Christ is more important than following each other!  Also, since I'm single I'm totally free.  The two couples have to make compromises and sacrifices to arrive at a mutually agreeable church.  Ha ha.

It is critical that each of us feels comfortable with church doctrine, worship style, and overall church environment.  Is it closed in and dark?  Or are there majestic stained glass windows reaching up to the tall ceiling, revealing ample amounts of pure sunshine, with glistening angels gently gliding above you.  Are you inspired by the praise and worship experience?  Are the sermons Biblical?  Do you have a sense of the presence of the Holy Spirit?

Well, I'll tell you today's church didn't impress me.  Not that I'm a modernist or something, but the chapel and associated buildings were old.  The average churchgoer was old.  Not too many folks in my age range.  Next up, what is the doctrine like?  Well, I thought the doctrine we heard was sufficient to the topic discussed (what does that mean?).  I wish I could be more clear but the hour is getting late.

Finally, I had to assess the churches praise and worship.  Well, there you go again: the music was old.  We could barely read it on the overhead because they picked a poor background and font color for their Power point slides.  The church praise ministry consisted of two vocalists, a guy and a gal, and a piano player.  THAT's IT!  I couldn't believe it.  But they pulled it off.  They sounded pleasing to our judgmental ears.  Anyway, it didn't do much for me.  I think I'm hooked on the more contemporary, live music like they have at the mega churches.

Stay tuned and I'll write about my final selection!  This get up reminds me of the X-factor.  My friends and I are the judges and each church gets to try out to see if we like them.  We'll call it the Church-factor.

Home on a Friday

Well, I'm home on a Friday evening for the umpteeunth time this year.  It's actually becoming habitual I think.  It is consistent with my depression symptom to withdrawal from people and activities.  Rather uninspiring if you ask me.  So, tonight I'm committing myself to an enjoyable evening.  It might be difficult but I'll do it.  I need to remember: if you can't change the circumstances, then change the person going through the circumstance.  This is a good one for getting motivated to work on who you are being in the present.  The present is all we really have control over at any given time in our lives.  Think about it.  On that note I'm going to play (and enjoy) a online card game (not poker).  Take care all.