Van Halen for Bipolar Depression Relief

A few months ago some friends and I saw Van Halen in concert. As it is with any event or trip planned in advance, I have concerns about the mood state I will be when I am actually experiencing the activity. It is seemingly impossible to predict what my mood state will be and whether my mood will be good enough so I can have some fun!

Since I was not drinking at the time I got the coveted duty of being the responsible driver for the group. In a way this is an honor. It gives me recognition of sorts that I am being victorious over alcohol, my arch nemesis of the psychoactive substances here on God's green earth.

The show was pretty good and I had killer time for sure. I liked the venue and lights. But don't be surprised if you hear a change in David Lee Roth's voice. It's starting to fade. No bueno!

I had some serious depression three days in a row leading up to the show. All sorts of negative self-talk was dominating my thoughts. The signs were pointing towards trouble ahead.

Beware What Your Mouth Utters: Humor for Friday!

I just have to get this out there. Below are several statements [reportedly - not confirmed but still hilarious] made by commentators at the 2012 Olympic Games. They have nothing to do with bipolar disorder, unless you include humor as a coping technique (which I certainly do:).

I hope everyone is doing well out there. I am getting back on my horse after a bucking bronco summer of mania and mess-ups.

My next post will be published Sunday. It's about depression relief by attending an enjoyable event. Hope you read it!

And now, the awesome gaffs and loose tongued tidbits from the expert commentators:

1. Dressage (horse jumping) commentator: "This is really a lovely horse and I speak from personal experience since I once mounted her mother."

2. Paul Hamm, Gymnast: "I owe a lot to my parents, especially my mother and father."

3. Boxing Analyst: "Sure there have been injuries, and even some deaths in boxing, but none of them really that serious."

4. Softball announcer: "If history repeats itself, I should think we can expect the same thing again."

5. Basketball analyst: "He dribbles a lot and the opposition doesn't like it. In fact you can see it all over their faces."

6. Soccer commentator: "Julian Dicks is everywhere. It's like they've got eleven Dicks on the field."

7. Tennis commentator: "One of the reasons Andy is playing so well is that, before the final round, his wife takes out his balls and kisses them."

Have a great weekend!

Jeff

My Extended Scopolamine Trial: Searching for Effective Treatment of Bipolar Depression

I became curious about scopolamine last winter when I began reading about it as a novel and possibly rapid and effective antidepressant. I wanted to try it. I wrote about a short scopolamine test I did back in February, but it was inconclusive.

Since the test did not give me answers I still wondered. Could scopolamine be one of the missing pieces to the enigmatic bipolar depression treatment puzzle?

This post is an account of a longer 12 day scopolamine experiment I performed on myself in August. It was under the perfect conditions: (1) I was in a severe depression and (2) I had a valid reason for my doctor (not my psychiatrist) to write a prescription for it! Take that Ms. psychiatrist!

Grace During Mania? The Daniel Story Part I

This first post is an ongoing story of how I am being led to help another bipolar sufferer. His name is Daniel and he is in his late twenties.

I met a him in a not-by-chance manner last month just outside a neighborhood grocery store that I frequent. He was in bad shape I could tell. He approached me in a frightened but composed manner and had just one request of me.

I hesitated briefly and then said let's walk for a while and you can tell me your request. I quickly learned he was both homeless and bipolar and had been on the streets for the past several months.

Oh boy I thought to myself, what have I got myself into? I'm sure you have had a experience where you wanted to help someone but felt it was not achievable or worse, doing so could impact you and your life in a bad way!

A Friday in the Bipolar Lives of Me

So this past Friday I am having a typical slow start to my morning (it can take an hour for me to "get up" each day). My usual not-so-great bipolar depression mood is present. Blah, dead countenance, not much hope. I say to myself, "Another gray day, what the hey!"

But this doesn't last long. Things quickly changed when I got a call from my Dad. He said someone just called him saying they have my wallet! Now I have some anxiety to go along with my mood.

Oh no, not again!

This at least the 6th time I've lost my wallet. The mere thought of having to notify all those institutions and creditors that have cards in the wallet does not do well for one's spirit. How many times has  this unfortunate experience happened to you?

Computer Calamity Creates Confused Countenance

I'd like to share with you a real life potentially problematic problem of powerful proportions that I faced just the other day. It is a modern age problem that, should it happen to you, will create intense feelings of helplessness that suck.

It's when your computer crashes! It happened to me Saturday afternoon. My laptop was attacked by a gang of renegade programs and evil code. They took over and rendered it useless!

Furthermore, this electronic mayhem was starting to activate my bipolar symptoms and mood-states. Not good. Head for the hills!

Bipolar or Not, Things Keep Moving

If you read my blog much you know I went into a not-so-good manic state from mid-May through the beginning of July. One consequence of the "fall out" from the manic period is that I have not been writing posts and doing "the blog thing" like I had been.

Well, I'm not out of the woods for sure, but I want you to know I'm trying my best. I've been battling depression since the last manic episode ended. It came on just as fast as the mania departed.

I have been battling all sorts of contrived stories and lies I unwittingly tell myself.   The thought distortions are present in every area of my life but they are particularly nasty in the realm of blogging. I say things to myself like:

God of Hope - This Bipolar's Right Hand

My Christian faith edifies my soul in ways that help me keep my bipolar symptoms in check and under control. This is being demonstrated to me now. I am in a much better place than when I wrote about faith last March.

I am in a place of increasing bipolar depression following my recent twin peaks manic episode. It's a fight against what seems inevitable. After every manic episode I have had there has been a follow-on deep depression.

These post-mania depressive episodes are not simply periods of sadness, remorse, guilt, or low self esteem that pass after a short time. They are long (years) periods of all consuming depression that rock my core.

Manic Twin Peaks

Well, I thought I was coming off mania when I posted back on June 19th. It turns out I had another manic run lasting about two weeks.

I thought I was coming off the last mania but it seems it was just the lull before another storm. I came crashing off this entire manic episode starting on July 4th. It was my worst Fourth of July ever.

Maniacal Activity But I'm Back!

After I crashed in late May and early June things responded and came flying back in a flurry of obscure but quite fun activity.

It came on like a tornado. It came out of nowhere and touched down long enough to draw attention but not long enough to cause mayhem.

The awesome news is that I bounced back from the twisting manic fury in record time without much undue burden on the family and friends I rely on so much.

The conversion from mania to the normal realm can be tricky. My infallable pattern is for major depression after mania.

But this time I'm BACK!  No major depression so far!!! Praise to God that I lived through another one! 

Mired in Bipolar Depression Lately

Hi everybody! I want you to know I have been intending to post for many days now. I am not posting as much as usual for a couple of reasons:

1. I put too many things on my plate for the month of May (and beyond) and
2. I am getting dips into depression that make writing near impossible.

You Are Here

You know those directories in the mall that show you where you are within the mall. Well, mine says within the mall of moods you are in the basement. The path to ground level is not well defined. Thick, grey concrete walls everywhere.

I am coming out of a few days of strong bipolar depression. I started this post yesterday but was overwhelmed by the suffocating mood state and had to stop.

Severe depression symptoms of sadness, irritability, rumination on negative things, anxiety, and guilt are the major offenders. And these things come with an unwelcome decrease in functionality from poor concentration, confusion and lack of clarity, mental dullness, and fatigue.

Writing Depressed

I find it extremely painstaking to write when I'm significantly depressed. I know there are some folks that write from a depressed space and benefit from it. I continue to try this but have had little success.

Topics I have previously decided on developing seem lackluster at best. The inspiration needed is so distant and insufficient in this perverse melancholic state.

What now?

I hope and plan to be writing more again very soon. I'm going to slow down with my activities, goals, and expectations and work on taking each day at a time.

I am reassessing my goals and plans. I am getting my expectations more in line with my current state. But for now, I'll be struggling to catch up with ongoing obligations for many days.

I hope you all are doing well. And if it's bad for you right now just do what I'm doing, hanging in there!

A Few Days in My Lives

I just returned from a refreshing camping trip to Lake Casitas. It's in Southern California and an easy drive from my house. They have over 400 campsites of all types in more than 10 separate campgrounds.

Friends

I was fortunate to spend time with quality friends. You know, the ones you could spend hours upon hours with talking, joking, and carrying on. The kind you hope stay in your life forever.

There were friends from the old guard and some newer. In all there were 11 people, four dogs, and four campsites that were all next to each other. We had a large buffer and plenty of camping, cooking, and recreating.

Great Campsite - Kingfisher #25

Friends and Bipolar

Most of them already knew of my bipolar disorder. A married couple I met once before did not know. When around good friends the subject of bipolar or mood states rarely come up. I'm fine with this. I'm also fine (most of the time) talking about my disorder. I just go with the flow on this topic.

My symptoms were mostly well behaved this weekend. I checked out early (10 pm) Friday night from fatigue and fairly heavy depression symptoms towards days end. After sleeping for 11 hours I got up and then took a three-hour nap Saturday afternoon. This made it so I wouldn't crap out early that night. So, besides seven hours with pretty bad symptoms the outing was mostly symptom free. This was not possible just three months ago!

Disordered Talk

I talked to Adrian, the husband of the couple I didn't know so well, about bipolar some. He's studying to become a nurse so he knew more about psychiatric disorders than the average person.

Talking with him was interesting and engaging. Turns out he knew some things mental, including the areas of Pharma, adverse effects (e.g., withdrawal effects) from psych meds, and even the beneficial effects from the cannabinoids in marijuana. I haven't had a conversation at that "level" in a long time.

Life

The take home point here is the extremely positive effect friends can have toward living a full life. The wonderful connection and personal interaction with close friends is refreshing, relaxing, and fun!

There was just one thing missing. I mean everything went really well for sure. But I could of used a little more cowbell. You see, I got camping fever. And the only prescription is more cowbell!

And the Depression Dragon Comes Calling

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Did you know that May is Mental Health Month. May was designated by Congress in 1949 as the month to raise awareness of mental health conditions and mental wellness for all. It has become apparent that mental health and wellness is essential for a person’s overall health. And we should remember that effective prevention, mitigation, and treatment of bipolar symptoms is possible. It is true that people can recover from mental disorders and live full and productive lives. This post is dedicated to the Mental Health Month of May.
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Well, leave it to my bipolar depression and its minions to interfere with a perfectly good out-of-town trip. I drove up to San Francisco last week to visit an old friend for a few days. We planned on catching up, hanging out, and discussing business ideas and whatnot (remember, I’m still unemployed yet semi-retired).

Depression Dragon Appears

The depression dragon came calling on the day I drove up to the Bay Area. I felt it descending upon me around 1030 that morn. The sky was gray. I was at my father’s house dropping off my dog before heading out to NorCal. Nothing against my father it just happened that way. Just sayin.
Also, I was very tired from staying up all night. I had spent the night busily reading and thinking about some things that my friend and I intended to discuss. 

It was exciting material, I was motivated, and so I kept on working through the wee hours of the night. Time flew by like it does when you become engaged in something you enjoy doing.

Funky Friday

I slept 18 hours straight on Friday, not getting up until 5 pm. It was one of my marathon depression slumbers. So much for talking shop that day. We’ll catch up this eve and tomorrow I thought.

But that was not to be the case. The bedeviling depression dragon had come home to roost for a time. He dwelled amongst me all evening. The feelings from ruminations over nonexistent yet “impending doom” kept me pinned on my back.

Saturday

I awoke Saturday at a reasonable hour with no relief from depression symptoms. As per all depressions to this extent I had diminished capabilities, limited cognitive functioning, and a pathetic level of self worth. I was not in a good state for having lively, engaging conversation about future possibilities.

Mother’s Day

The last day of my visit was on Mother’s Day. This didn’t help my poor mood matters because this day inevitably brings up memories of my mom, usually sad. She passed on January 2, 2010.

So, after a splendid lunch with my longtime friend and his family and a short nap I departed.

My thinking about the visit on the drive home was disappointment at first. I was disappointed I didn’t have the needed access to my mind during my trip. I was robbed of important things like memory recall, attention, and a fluid mind. Never mind executive functions like planning and strategizing.

Instead I was stuck with no go neurotransmitters, nasty neural network cobwebs, and gelatinous blobs of gray matter. It’s enough to make a Jewish mother say "oy."

Dragon Departure

After talking with my friend illegally on my cell phone while driving home I felt better. I told him I was disappointed and why. He acknowledged that and was glad I communicated the matter. He knows I fight this demonic dragon each day and I’m stronger on some days over others. This helped me relax.

I slept well Sunday night. The dragon left his roost during the night.

So as things would have it my mind and mood came back on Monday. There is still a little depression, but this much I can deal with.

The wackedness (new word, pronounced wa’ ked ness) of this bipolar depression of mine continues to amaze me. No sooner than when I get a grip and think recovery is moving forward, I find myself wallowing in the mire once again.

Final Analysis

So, was this experience a failure? Not by a long shot. I had a wonderful time hanging out with my friend and his family.

Regardless of the whims of serious depression we managed to discuss several issues and ideas. It just wasn’t to the depth and detail I was hoping for.

The work stuff and ideas will come as they do. I’m trying not to put unnecessary expectations on things. This just adds stress. And stress can very easily become a trigger for and aggravator of bipolar symptoms.

As I said to my good friend, “Sometimes you just got to be the tortoise in the race.” It takes time and patience when you are taking over the world.

So what are you in life? A tortoise or a hare?

NAMIWalks 2012 a Success!

Hello everybody! I'm out of town right now but wanted to let you know how last week's NAMI fundraiser went. It was awesome!

Eleven of us on team "Walking on the Wild Side" walked the walk, so to speak. It was an idyllic sunny day in Southern California.

We raised $2,680 for our local NAMI chapter! Overall, over $100,000 was raised for our local NAMI affiliate with more than 1000 walkers participating. 

I want to say thank-you to all who contributed by walking, donating, and being with us in spirit. You guys are great!

My Bipolar Life in a Blog Post

Not including the intense, short-lived manic episodes and fleeting periods of normalcy, most of my life since my teenage years has been spent fighting bipolar depression.  

I was diagnosed with Bipolar Disorder in August 1997, while being held against my will in a psychiatric hospital by a 5150. A 5150 is a section of the California Welfare and Institution Code, which states a person is required to be hospitalized if they are considered to be a threat to themselves or someone else and/or are gravely disabled.  

I would say I may have been gravely disabled (whatever that means), certainly not a threat to anyone. Of course they didn't ask my opinion. 

I have been blessed to make it up to this point. It has taken brains, willpower, and help from above to make it. AND I get a lot of help from a good pdoc and psych meds, a good psychologist, supportive family, and understanding friends.  

Shortly after my 1997 manic episode I had a major depressive episode that lasted three years. By the time I got to a more "normal" state I had cleared up all the financial, social, and work-related messes I'd made. My "normal" state was probably more like dysthymia (a chronic, low-level depression that lasts for at least two years) that lasted until 2002.

By May 2002 I was doing well at work, it was spring, and I had a girlfriend.  No problems, right? Wrong.  

The girlfriend insisted there was nothing wrong with me and I did not need to take my meds. I argued for weeks that she was wrong. I had bipolar disorder and pretty much everyone knew it. So, to prove her wrong, I stopped taking my meds in May. Houston we have a problem.

Shortly thereafter we all know what happens. Since I was off my psych meds I went manic in a matter of days. This manic trip was more bizarre and damaging and exciting than my 1997 episode. I did some fun stuff, but also had delusions, anger, and the symptoms associated with unbridled mania: a flood of racing thoughts, tons of energy, little or no need for sleep, rapid speech.

I was Supermanic: faster than a pissed off bartender; more powerful than an upset badger; and able to escape from bad situations in a single bound. The depression dragon feared the sight of me. I felt invincible (a bad thing).

That fun ride landed me in the hospital twice that summer. The first was a 72 hr hold (another 5150). The second was voluntary, but I left early AMA (against medical advice). I was stabilized and I got bored so I left. Plus the head doctor was being a dick. He tried to get me committed for another two weeks. It was a nice try, but I beat him in mental health court.

Following the years of depression after Mania 2002 my symptoms began to recede by 2005. I was mostly stable from 2005 to 2010. I wouldn't say recovered - more like remission from most of my depression symptoms. 

In early January 2010 my mom died. I was devastated. I was drinking hard at this point. I was drowning my sorrow over my mother's death. And then my pdoc up and retired on me in March with no advanced notice.  

By May I'm a little hypomanic maybe (definitely). By late May to late June I found myself in a manic phase once again. But this time it's without a psychiatrist!

I couldn't work. I got approved to take all of June off for medical reasons. I ended up resigning for medical reasons in November 2011 and I haven't been back to work since. I'm calling it my retirement transition period. 

Anyway, there you have it. The cliff notes version of my life from when I was first diagnosed (1997) until now. It is my life during the time bipolar dominated all else, as it does now.

Present status. I live in a house with two dogs for roommates. Currently I am in a 17 month treatment resistant bipolar depression, with a splash of anxiety.  I am on meds and participate in one-on-one psychotherapy. Dogs, sun, blogging, family, friends, and faith continue to provide me strength and sense of purpose as I struggle to live with bipolar disorder. 

I hope you are blessed with the kinds of things that contribute to a stable bipolar existence. If you continue to struggle with the disorder please be patient and do not give up.  There is good reason to remain hopeful. Many people with bipolar learn to cope and live quality lives despite the demons and depression.

My Cymbalta Withdrawal - Review of the Trilogy

I've blogged about my ongoing withdrawal from the antidepressant Cymbalta since I started tapering doses on March 20. In that time I've written three posts sharing my experience with the most recent being "My Cymbalta Withdrawal - Return of the Mind."  

This post is a review and summary of the first segment on my journey to 0 mg/day so far. But with a twist. I am inserting characters and adding plot that represents the Star Wars series.  Why not, right?

The Trilogy

1.  Withdrawal Wars. In "Withdrawal Wars" we find our hero, Duke Taperwalker, at the very beginning of the discontinuation process when he went down from 120 mg per day to 100 mg per day. We come to find out through the master obi-one-clinician that he needs to clear himself of the toxic antidepressant before he can begin to clearly access the Life Force.

Duke had high hopes since he has made it off several psych meds without invoking the wrath of the Discontinuation Syndrome. He's thinking Cymbalta withdrawal will go smooth and last less than six weeks or two months max. Our protagonist is not aware of the evil biopsychoneuropharmacology that lurks in the not-so-distant future. 

2.  The Syndrome Strikes Back. In "The Syndrome Strikes Back" post we find Duke eating a little humble pie.  The withdrawal from Cymbalta took a turn for the worse. He has been overpowered by the Dark Side and is experiencing severe symptoms from the evil warlord Darth Depression.   

It started at the beginning of the second week when they dropped Duke's dose to 80 mg per day. The psychmed rebel fighter began experiencing severe depression, which became mild by the end of the week. During the third week the depression became severe again, but this time worse than the prior week! And the fourth week was like the third. 

Even though young Taperwalker stayed at 80 mg per day, he continues to experience attacks from Darth Depression.  

So, we leave our hero devastated and trapped by the intensity of withdrawal symptoms. The Syndrome has regrouped and attacked with ferocity.  What now?  Where will this perilous journey lead him?
    
3. Return of the Mind. In "Return of the Mind" we find Duke pleasantly surprised and thoroughly relieved by the remission of Darth Depression. However, drug recon data and recent Cymbalta withdrawal symptoms indicate this is going to be a long and arduous process.

The episode starts at a point where the withdrawal from Cymbalta took another big turn. This time for the better! It is near the end of fifth week and he remains at 80 mg per day. Duke has actually had as much as six days in a row with only mild depression!!
It looks like the kid might be stabilized with intermittent, mild depression. He has remained in communication with his rebel leader psychiatrist, Dr. G, on a weekly basis throughout this withdrawal process. 

At the end of the fifth week the Executive Council of the Psychmed Rebel Alliance was convened to decide what to do next. Even though it was not clear what direction Duke's withdrawal symptoms were heading, the recommendation was to stay at 80 mg/day for a few more days and see what happens. It turns out that was a good move!

It is now the end of the fifth week of this episodic battle to get off Cymbalta. Duke Taperwalker has defeated the Discontinuation Syndrome once again!  His mind is clearer and his mood is significantly better. The psychmed rebels are enjoying an extended period of peace between the dark and light sides of the disordered universe. There is hope once again in the Pharma Galaxy!

What's Up Cymbalta What's Up?

I have had better moods lately because we paused the campaign to rid my body of Cymbalta. I've been at 80 mg per day for over five weeks now.

My psychiatrist wants me to stay at 80 mg for an unspecified period of time, but I'm wanting to press on, but respect for her recommendation resulted in a compromise. I agreed I would stay at 80 mg per day for four weeks and at that time evaluate my progress to determine whether to lower my Cymbalta dose or not.

Changing the Minds of America at NAMIWalks 2012

Dear Readers,

I'm writing to tell you about an important event I am participating in. It is the 2012 NAMIWalks. NAMI is the National Alliance on Mental Illness. NAMIWalks are the main source of annual operating funds for local NAMI chapters across America.

I am on a late entry team, Team BipolarXpress. If you in a position to support my journey to change minds one step at a time, then please go here.

NAMI - National Alliance on Mental Illness

NAMI is the largest education, support, and advocacy organization serving the needs of those whose lives are touched by these serious mental disorders.  This includes persons with psychiatric disorder, their families, friends, employers, the law enforcement community and policy makers.  

The NAMI organization is composed of approximately 1100 local affiliates, 50 state offices and a national office. Each year NAMI works to break down barriers and improve services with those with serious mental illnesses, such as Bipolar Disorder.

The Good

NAMIWalks is an effective way to educate and advocate others about psychiatric disorders. The goals of the NAMIWalks program are: to fight the stigma that surrounds mental illness: to build awareness of the fact that the mental health system in this country needs to be improved; and to raise funds for NAMI so that they can continue their mission. And NAMI does this at no cost to them!

The Bad

It seems like mental illness strikes almost every family in some fashion. Yet, because of the stigma attached to it and the discrimination that surrounds it, it is difficult to find appropriate assistance. NAMI works to ensure assistance is available for those that need it!

The Ugly

The ugly part of this whole mess is the suffering of those with psychiatric disorders, their caregivers, and concerned friends and family. While we don't have cures for the disorders, there exists ample resources in this country to make the lives of each person affected by Bipolar Disorder much more bearable.

In my view the only real ugliness out there is the crime that all people affected by the disorder are not on the road to wellness!

Will You Support Our Cause?

If you would like to help our cause please visit my event walker page. It features a link so you can sponsor me online. Donating online is fast and secure. No donation is too big or small. Even a donation of $10 (their minimum) is a personal VOTE for our cause!  

NAMI is a 501(c)3 charity and any donation you make to support my participation in this event is tax deductible. NAMI has been rated by Worth magazine as among the top 100 charities "most likely to save the world" and has been given an "A" rating by The American Institute of Philanthropy for efficient and effective use of charitable dollars.

Thank you for your consideration and support!  Keep on truckin.

Jeff

Bipolar Wellness Plan - A Roadmap to Emotional Stability

Well, I planned on getting this post out earlier but ran into production problems. Specifically, I picked a topic that was over my head. I was writing about developing a wellness strategy for long-term, successful management of bipolar disorder.

My plan was to write a three part series of posts around (1) creating a well thought out bipolar strategy, (2) writing a plan that addresses elements of the strategy, and (3) implementation assistance. It makes sense to me. In my prior life as an engineer this is how we tackled all sorts of large projects and programs. The steps I would take to execute a large project/program were like this:

Step One - Strategy. A strategy is a set of related activities and actions designed to achieve a specific goal or achieve multiple objectives. The strategy document defines the issues, wellness elements, and directs you toward action required to successfully implement the strategy. It represents the "big picture" about how one intends to address a significant problem or run a new program. The strategy usually articulates goal(s) and purpose.

Step Two - Planning. Planning transforms the strategy into a series of steps that are taken to live a more balanced, healthy life. It is your map to achieving your strategic goals and objectives. It transforms goals into specific objectives. For example, using the goal of reducing depression symptoms, an objective could be to get the right amount of sleep and maintain the same sleep schedule every day.

Step Three - Implementation. Implementations assistance is key to realizing the goals and objectives previously defined in the planning and strategic documents. Implementation guidance is necessary for executing your plan from Step 2. For this step we used things like schedules, status reports, logs, and other tools to stay on course with what has already been planned.

After a few hours of researching and writing I didn't find much about developing a strategy for managing bipolar disorder. Hmmmmm. Instead I found that elements of a wellness strategy were being incorporated into health and wellness plans. In fact, there are books, programs, and training to help us make these plans.  So, I regrouped and decided to write this post about developing a Bipolar Wellness Plan (The Plan).

Bipolar Wellness Plan

A Bipolar Wellness Plan can put you in control of managing the disorder by providing a clear picture of how to take action that moves you away from disorder and towards order. It will help you create an environment that supports and prepares you and those supporting you for challenges along the way.

I used a helpful template from the Black Dog Institute to create my own Bipolar Wellness Plan. The Institute calls the template "MY WELLBEING PLAN to manage my BIPOLAR DISORDER."  I recommend it for starting your own plan. 

There are other cool things online.  The Black Dog Institute also has this introduction slide show called Staying Well with a Stay Well Plan.  

The Plan addresses several key areas including activities to maintain wellness, identification of things that could trigger a relapse of bipolar symptoms; and specific action items to take in the event of a relapse. It also identifies your medical team by name and number, 24 hour emergency numbers, current medications, and a medication contingency procedure.

Ideally, the Bipolar Wellness Plan should be discussed collaboratively with one's health professionals and friends and family that support you. I ran mine by my mother and good friend. They gave it a thumbs up, I think.

A Look Inside

I want to look at three of the components addressed in the Black Dog template: maintaining wellness, triggers, and relapses. 

The maintaining wellness section of the plan points the person towards seven areas: physical activity, sleeping, eating, alcohol and drugs, pleasurable activities, issues related to treatment, and other activities.  

I think "other activities" should be expanded. There are a lot of other areas that can influence wellness like relationships, spiritual, physical health, hobbies, stress and so on. I wrote down friends, family, my faith, hiking, and reading.  I think I will expand on this area.  

Triggers are important to be aware of. Triggers are external factors (e.g., environmental, psychological) that can set off an episode of depression or mania in someone. Stress, alcohol use, and ruminating about negative things are big triggers for me.

The section on relapses was straightforward. Simply put down what things you do that would be considered evidence of relapse and early warning signs of problems. I wrote excessive sleep, anhedonia, slow thinking, and withdrawn behavior are evidence that depression has returned.

Now What?

So, now I have an "approved" Bipolar Wellness Plan that should keep me stable when I get out of this 19 month (so far!) depression. The template recommends carrying a copy of the plan with you and giving it to all your health professionals and support people. I haven't done this yet. I'll put it on my list of things to do.

I was going to put my mostly completed Plan in this post but it is too big.  So if you would like a copy of my completed Plan shoot me an email at bipolarblogguy@gmail.com.

Bipolar Depression Nags and Ninnies

I am going to present here commentary about my thinking on the subject of depression. It is based on my understanding of our culture's view of bipolar disorder and psychiatric disorders in general. I also make the distinction between bipolar depression and other forms of depression.

Bipolar Depression

It is good to remember that bipolar depression is different from other types of depression. From my understanding bipolar depression is more severe, longer lasting (chronic), and treatment resistant than major depression. Mild, moderate, or most situational depressions pales in contrast to the intensity and duration of a bipolar depression episode.

Bipolar depression is a severe form of depression that has a biological component to it. This means that there are actual, physiological changes that occur in the brain when experiencing severe depression. Changes include things like loss of neuron connectivity, low activity in regions of the brain associated with emotion, problems with specific neurotransmitters (e.g., Serotonin) and loss of brain mass in certain areas.

Severe depression goes way beyond how one feels. It also includes adverse impacts to a person's energy levels, motivation, thinking ability (especially concentration and memory), sleep, and sense of self worth.

Because I have Bipolar Disorder I experience severe depression essentially by definition.  And let me tell you it can be unbearably severe.  At one point last year I went into an extreme depression that required partial hospitalization in a two-week outpatient treatment program.  That was a first.

Nags

We all have nags in our lives.  People whom existence thrives on pointing out our problems and reminding you of how you could do this or that to improve.  

Whether it's your mother or a brother from another mother, nags kill mood, start rumination, and piss you off.  Sometimes you will have to tell them to talk to the hand.

Exercise nags.  Everyone is harping about how beneficial exercise is for fighting depression.  Are they excited for good reason?  Well, yes and no.  The problem is exercise is truly effective, but only for certain depressions.

Exercise is known to help people with mild or moderate depression.  It can make a significant impact towards a successful depression recovery in these cases.  Exercise keeps them happier than a flea in a doghouse.  However, this is not the case for recalcitrant bipolar depression.

I find myself doing more exercise as I my depression lifts.  This is the opposite of what is believed.  I exercise when I feel better, versus exercising to feel better as with milder forms of depression.

Exercise as a means to reduce the severity of bipolar depression is mostly poppycock.  This website says otherwise.  However, based on my experiences with this monster, I have consistently found that exercise just doesn't provide much therapeutic value to the severe forms of my bipolar depression.

Diet nags.  After exercise, diet is the most well intended recommendation I hear. In addition to restricting bad foods from your meals, diet in this context includes natural and synthetic supplements that are part of a person's daily intake.

As with exercise it is my conviction that diet has only a limited effect toward bipolar depression symptom relief.  While losing weight and avoiding bad foods is certainly a huge health benefit, the ability for diet to significantly alter mood does not seem to occur with me.

As I write this I am on a pretty crappy diet.  I eat only once or twice a day and usually late at night.  It's been like this for the last couple of years.  Interestingly, as my depression began to lift over the last couple of months I have had the same poor diet.  I try healthier eating from time-to-time, but really don't notice improvements when in the pit of a bipolar depression.  I have similar experiences with dietary supplements such as St. John's Wort, 5-HTP, peppermint, green tea, and others.  I even wonder how much help I'm getting from my current supplements: NAC, multivitamin, fish oil, aspirin, Benadryl, and Provigil.

I've had this diet for many moons now, including the time I've spent in this bipolar depression (21 months).  It may be different for others, but altering my diet on my diet does not noticeably improve my depression symptoms.

Snap Out Nags.  A common myth persists that people should be able to "snap out" of depression.  They think that depression is merely a result of someone wallowing in their grief or sadness.  They believe it can be cured simply with just positive thinking and adjusting one's attitude.

This is nonsense.  Depression is a serious medical condition arising from biological and environmental factors.  It is not a sign of weakness, laziness, or self-pity. 

Depression is a psychiatric disorder of the mind arising from changes in brain chemistry, neural networks, and function.  It is marked by prolonged periods of unexplained hopelessness, profound sadness, lethargy, guilt, and suicidal tendencies.

Ninnies

Ninnies are those people who are completely clueless when it comes to an understanding of mental wellness and psychiatric disorders.  This unawareness often leads them to stigmatize, discriminate, and reject the notion that mental disorders even exist - despite all of today's evidence showing otherwise.  

Further, misunderstanding is perpetuated by exaggeration, inaccuracies, and misrepresentations of mental disorders.  The two main sources for a lot of people's information is the main stream media and the entertainment industry.  News media, social media, and popular websites often present severe disorders in a simplistic, violent-ridden, and deranged manner. 

Since they have no experience with severe depression, Ninnies love to impart their wisdom for relief from what they consider is simply the case of the blues.  Although they have the best of intentions, their simplistic understanding of psychiatric disorders leads to giving suggestions and advice that sound more like accusations, condescension, and hogwash. 

"But you have so much to be happy about.  Look on the bright side"  They have no idea that depression symptoms include a strong and persistent flow of negative, distorted thoughts, where everything occurs dull, meaningless, grey, and blah.  Severe depression generates apathy where expressions of concern, excitement, and motivation are conspicuously absent.  It can also lead to anhedonia, where there is a lack of ability to experience pleasure. Although I am grateful and thankful for the good things in my life, in the state of severe depression they are seen in a distorted light where all things seem meaningless, of little value, and guilt-ridden.

My bipolar depressions lasts years. Those around me know this. So, when someone asks a simple "How are you?", I sometimes can not believe what I am hearing.  Of course I'm feeling bad, I'm not well.  Of course I end up telling a lie that I'm doing fine just to avoid any more discussion about my depressed state.  

When it comes to understanding, the folks that ask this question are  not paying attention or something.  MLK said it best: "Shallow understanding from people of good will is more frustrating than absolute misunderstanding from people of ill will." - Martin Luther King, Jr.

And then there's "I know how you feel." For most people this is b.s. plain and simple. Unless you are one of the 2.6% of Americans with bipolar disorder, you will have no way to relate to the depths and duration of bipolar depression.

I'm going to stop this post/rant. Something spurred me to write this and I'm not sure what it is. Until next time, live long and prosper.

My Cymbalta Withdrawal - Return of the Mind

This is my third post regarding the continuing saga of my withdrawal from the SSRI antidepressant Cymbalta.  It may be helpful to read my earlier posts on this topic: (1) Bipolar Treatment Update - Cymbalta Wars and (2) My Cymbalta Withdrawal - The Syndrome Strikes Back. 

Background

I have been on Cymbalta for six years.  It was added to augment Wellbutrin, my primary antidepressant, and improve treatment of lingering depression symptoms.

Although it worked for several years, I have come to believe that Cymbalta is no longer effective for me as an antidepressant.  It's known that antidepressants can be effective for a period of time (months or years) and then stop working.

Poop Out
  
A loss of effectiveness during antidepressant therapy can occur with most antidepressants.  A sustained, effective response from antidepressant treatment is not always achievable.  

Unfortunately, it's not fully understood what causes this so-called "poop-out" effect, or why it occurs in some people and not in others.  This effect could relate to the disease itself, pharmacological effects, or a combination of the two. 

Tapering - The Slow Withdrawal

I began tapering down from 120 mg/day of Cymbalta (a very high dose) on 3/20.  I dropped to 100 mg/day for the first week without significant problems.  

But when I went down to 80 mg/day at the start of my second week all hell broke loose.  It felt like a depression alien life form came and infiltrated my mind.  Since then I have had many days with mostly severe depression.  Not good.

Status

Well, my withdrawal from Cymbalta took another big turn lately. This time for the better! My depression has began to lift again. The intensity of my symptoms really dropped and since last Tuesday I've had mostly mild depression!! I remain in communication with my psychiatrist throughout this withdrawal process. We almost went back up to 100 mg/day at the beginning of last week because things were so bleak. On Monday we decided to stay at 80 mg/day for a few more days and see what happens.  It turns out that was a good move!
By the Way 

Adverse withdrawal effects and the discontinuation syndrome from Cymbalta are real.  They can be devastating to a certain percentage of users.  If I recall correctly this figure is in the 10 to 20 percent range.  Withdrawal effects are mostly overlooked by Pharma.  Because of this patients get taken by surprise when they try to get off the drug and experience a debilitating withdrawal process instead.

There are numerous papers, articles, and web sites that specifically address Cymbalta's under reported withdrawal effects.  Cymbalta Withdrawal Forums is a site I found helpful.  It used by folks dedicated to rooting out and addressing the adverse effects that can arise while getting off of Cymbalta.  Cymbalta Attorney gives you direct access to lawyers specializing in Cymbalta withdrawal and injury cases.  I'm sure they'd take my money, but I think I'll pass.  Cymbaltawithdrawal.net is another site that addresses Cymbalta withdrawal only.  It's not a good site but thought I'd include it for no specific purpose anyway.  

What's Next?

I will discuss my situation via email with my pdoc tomorrow.  Since things have lifted for several days in a row now she may okay lowering my Cymbalta dose some.  

I'm leaning towards remaining at 80 mg/day for another week to be safe.  This stuff is dangerous!  Also, we need to figure out how what the next tapering dose will be.  

Another 20 mg/day reduction in dosage is an overall drop of 25 percent.  Hmmm.  Maybe a bit much?  

How much would you decrease the next dose?