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Saturday, December 31, 2011

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.

Tuesday, December 27, 2011

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?

Sunday, December 25, 2011

Merry Christmas

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

Thursday, December 22, 2011

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?     

Tuesday, December 20, 2011

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? 

Sunday, December 18, 2011

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!

Thursday, December 15, 2011

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  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. 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.

Monday, December 12, 2011

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.

Friday, December 9, 2011

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. - 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.