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.