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Wednesday, February 29, 2012

My Bipolar Disorder - Career Update

This post is an update on significant changes happening in my career right now.  I'd say that this career changing period I am in is a "major life event."  It is the type of event those with bipolar disorder are supposed to watch out for.  

In addition to messing with mood and emotions, major life events generate added stress, use our resources, and consume energy.  These changes can have a profound impact on your bipolar symptoms!

It is very important to be vigilant and keep an eye out for changes in bipolar symptoms during times of significant change.  It's better to try and manage or control these symptoms rather than allowing them to trigger a manic or depressive episode.  

Not to far back I mentioned I was terminated from my last job as an engineer.  Well, I've settled my appeal with my former employer and things have changed.  The biggest change was to have my reason for departure changed from "terminated" to "retired due to medical reasons."  Much better.

Negotiating a settlement agreement was the right thing to do.  I wasn't getting anywhere with my appeal against my employer's decision to terminate me.  At best I would have had an opportunity to work at my old job (or similar), but this would have taken many moons.  I decided it is better to get it over with and move on!

Moving On

Now I'm in an adjustment, learning, and exploring mode.  I'm getting used to waking up whenever I want even knowing I should have a strict sleeping schedule to help contain bipolar symptoms.  I like the freedom.

On area of exploration is writing.  I enjoy writing a lot so why not check into it as a career?  I've been doing exactly this for the last six months or so.  I'm still unsure about a writing career so I will do some more research and learning about the writing biz.

For now, writing and blogging is helping me keep a daily routine, be active, and have a sense of purpose.  This is worth it regardless of writing career outcome.

Things I've Done

I've accomplished quite a few things since becoming unemployed back in 2010.  Things I have done during this period of underemployment that have helped me move on:
  • Attended seminary school, enrolled in religious studies.  I took two courses and stopped.  It didn't jive with me. Too intellectual.
  • Completed an online course on internet writing and marketing.
  • Quit drinking alcohol (this was huge)
  • Created a blog.  It has helped in many ways.  I use writing as a therapeutic mechanism.  It really helps my mood and stuff when I write.  I also benefit from the interactions with the bipolar community.
  • Learned that you don't have to drive your car to work everyday.  You can work from home.
  • Figured out work from home requires discipline but the freedom is bitchin dude.
  • I've come to appreciate the need to have something to do!  Tennis anyone? 
  • Learned how to stop spending money excessively and reduced my monthly cost of living by hundreds 
  • Prepared my disability retirement application documentation (not a trivial process)
  • Worked on my "emotional sobriety" (new term).  It means to maintain an emotional balance
  • Remodeled my bathrooms (had to do it)
Now that my situation has stabilized for the time being, I can focus on resolving the manic mischief from summer 2010!  More to come on this!

So, what major life events are going on in your life now or are expected to happen?  What are you doing to cope with any added stress and energy drain from it?

Finally, I ask that you take this weeks poll - How long from first symptoms to diagnosis?  It means how many years were there between the time you first noticed bipolar symptoms and when you were "officially" diagnosed bipolar.  It took over three years for my diagnosis.  I first sought help in spring 1994.  I knew something was wrong but couldn't figure it out.  It wasn't until summer 1997 that I received my official diagnosis from the attending psychiatrist at the psychiatric hospital. 

Saturday, February 25, 2012

Scopolamine for My Bipolar Depression

I wrote a post back in December about seven mostly promising new drugs for antidepressant treatment.  Of the seven I am now looking towards scopolamine as a possible add-on to my current medication treatment.

For the record, each day I take Wellbutrin (450 mg), Cymbalta (120 mg), Lamictal (300 mg), Xanax (0.25 - 1 mg), NAC (2000 mg), multivitamin, fish oil, (300 mg omega-3 fatty acids), and aspirin (81 mg).


Scopolamine has been shown in limited clinical testing to provide rapid, robust antidepressant effects for depression and bipolar depression.  The drug works much faster than SSRI type antidepressants, taking only hours instead of weeks to reach therapeutic levels.

However, it is not approved to treat depression or bipolar depression. Scopolamine is approved for use to control motion sickness and to reduce post operative nausea.  It is most often delivered transdermally (through the skin) using a special patch - a membrane-moderated transdermal drug delivery system.

I read through some online user reviews and ratings of scopolamine.  Not surprisingly, the effects from the patch varies from person to person.

The majority of people commenting say that the patch (scopolamine) works much better than OTC motion sickness medicine they have tried.  Some people wrote of side effects after removing the patch, mostly headache, nausea, dry throat/mouth, and blurred vision.  Most people say the side effects are worth the benefit of not getting motion sickness.

Scopolamine Findings

Based on what I have uncovered I find the following observations to be of interest:
  • Intravenous scopolamine can be a rapidly acting, effective antidepressant.  Additional information is needed to asses the efficacy and tolerability of transdermal delivery.
  • Scopolamine treats unipolar and bipolar depression.
  • Scopolamine can be taken in several forms including orally, intravenously (IV), and transdermally (through the skin).
  • Side effects concerns include memory impairment, dry mouth, nasea, drowsiness, blurred vision, and headache.
  • Scopolamine works better for women than men.  That seems odd?
  • Scopolamine for depression treatment still requires further study to determine therapeutic dosages, delivery mechanisms, side/withdrawal effects, and other relevant factors.  There needs to be more data with statistical relevance (e.g., larger sample sizes) analyzed for treatment efficacy and tolerability.   
The Scopolamine "Test"

So, after digesting several scopolamine studies and other web sources I decided to give it a go!

The scopolamine I received was through the skin (transdermal) by a patch.  This patch has the brand name Transderm Scop and requires a prescription in the U.S.  In Canada they are available from pharmacists without a physician's prescription.  Yay!

According to the package a Transderm Scop patch contains 1.5 mg of scopolamine.  The1.5 mg of scopolamine is programmed to deliver 0.5 mg per day over three days.  This is the approximate equivalent of a 72 hour continuous intravenous infusion at 5 micrograms per hour.  According to fellow blogger Garth Kroeker, a patch dose ". . . would roughly approximate the IV doses [4 micrograms per kilogram) used in several studies . . ."

I didn't have any patches handy but my friend had an extra patch and gave it to me.  It expired in 2001 so I'm hoping it still works.  This clearly is not a scientific study!

I applied the patch at 10 am.  After about 30 minutes I felt a little nausea.  This could be from an empty stomach with psych meds and coffee?

Wow! It's been an hour and I just realized pupil in my right eye is huge!  The left is normal.  I've been rubbing my right eye.  Maybe I got some scopolamine in my eye!  I hope this goes away.  My vision seems fine.

I looked on for side effects related to vision.  There was a mention of unilateral dilation being reported suggesting "some ocular events may be due to inadvertent contamination of the eye when there is failure to wash the hands after drug application."

Well that makes sense.  I didn't wash my hands with soap and water after applying the patch.  Note to self: keep scopolamine out of eye and try to follow directions better.

Scopolamine: Final Analysis

Well, results are inconclusive.  The patch had no noticeable therapeutic effect for me.  Also, there was very little trouble (if any) with side effects or withdrawal effects.

I wore it for the directed 3 days.  I wore it an additional 4 days out of concern of withdrawal effects.

The big questions are whether the expired patch I used was effective and if I received a therapeutic dose.  I would guess the patch was ineffective and I didn't receive enough scopolamine.  Need to repeat test.

My next move is to obtain some patches that haven't expired and try this again.

By the way, my dilated pupil returned to normal by the third day.

Wednesday, February 22, 2012

More Disability Retirement for Bipolar Disorder

I recently wrote about my decision to apply for disability retirement within the Federal Employee Retirement System.  As you can imagine, there are many steps involved in producing the documentation for a disability retirement application.

To begin with, the required documentation is extensive: Application for Immediate RetirementApplicant's Statement of Disability, Supervisor's Statement, Physician's Statement(s), and Agency Certification of Reassignment and Accommodation Efforts.  I am responsible for getting these processed, assembled, and sent off for application review.

In this post I am going to provide a look into a specific, essential element of the disability retirement application process, the Physician's Statement.  This part needs to be carefully prepared for a successful application.

A Physician's Statement is really a request for the treating physician(s) to provide the information necessary to complete "Medical Documentation Requirements".  These requirements direct the physician to provide the following information: (1) a comprehensive history of patient's medical condition(s); (2) copies of tests and examinations; (3) diagnosis of patient's condition; (4) assessment of condition status (static, changing, estimate of recovery or remission); and (5) any restrictions placed on patient activities.

The comprehensive history of patient's medical condition is the most important of the "Medical Documentation Requirements."  Comprehensive history must include detailed information regarding symptoms and history, past and current physical findings, hospitalizations, and results of laboratory studies and therapy of this condition(s).  It should provide a discussion of patient compliance with therapy, response to therapy, and plans for future therapy.

The comprehensive history section also requests documentation showing specific information to show why this patient is not able to perform his or her duties.  This is a key portion since it directly addresses an eligibility requirement, specifically that the applicant is unable to perform useful and efficient service because of disease or injury.  It is absolutely necessary to establish a cause and effect relationship between a bipolar symptom(s) and compromised, adverse performance of a specific job element.

The application examiner wants to see a direct connection between my bipolar symptoms and a compromised work function.  For example, my Physician's Statement explains the poor memory and limited concentration from bipolar depression decreases my ability to read, analyze, and comprehend technical reports (an essential job function).

This example establishes a direct link between my disease-related impairment (cause) and its negative impact on work functioning (effect).

Well, if you are still with me then you can see that the disability retirement process is very involved indeed.  I've only focused on a single item of one area of the application.  It should be evident that a successful application requires careful, purposeful preparation.  This is why some folks hire attorneys specializing in disability retirement cases.

I am trying it alone.  I am doing my own research and preparation.  We'll see what happens!

Wednesday, February 15, 2012

Bipolar Depression - Make Hay While the Sun Shines

Anyone who has experienced bipolar depression will tell you symptoms from this condition can be agonizing, persistent, and debilitating.  And it is known that bipolar depression episodes can last from a few weeks to years.

Depression Makes Activities Difficult

The severity and duration of my current bipolar depression makes doing things difficult.  Both simple and complicated activities can seem insurmountable.

A simple task like writing a letter or calling somebody becomes dreadful and meaningless.  My bipolar depression symptoms (e.g., low self esteem, hopelessness, lack of purpose)  impact my ability to be functional.

Complicated activities are worse.  In these cases the depression symptoms related to cognitive impairment (memory problems, concentration difficultly) become troublesome.

Frustrated, unmotivated, low confidence, hopeless, tired, anxious.  These are some of the rotten characteristics that are present when I try to do things during severe bipolar depression.

Low mood, fatigue, difficulties thinking, and social withdrawal often converge to make writing this blog terribly difficult.  I am concerned when I don't have motivation to write.  I abhor being unable to think clearly.

It's as if a worthwhile idea comes along for consideration but is rapidly consumed by clouds of negative thinking.  The thought of the idea becomes tainted by the negative  It's like a seedling that has no chance to survive much less flourish in a harsh environment..  

When I'm too depressed blogging starts to feel like a job.  Deadlines and stress and makes blogging even less worthwhile.  Maybe I'll give myself a raise.

When The Fog Lifts Git-R-Done

My best strategy for my current situation is simply to get as much done as possible when feeling better.  By feeling better I mean there are fewer and less intense depression symptoms.  For example, during times that I feel better I can focus and concentrate better.  This enables me to write and do other tasks.

When feeling better the depression partially lifts and my mood improves.  I feel like doing things and I have the gumption to get on and do it.  I need to git-r-done.

The expression git-r-done came from the South in the 1990's.  Apparently it was developed by a small group of redneck white males who wanted to actually accomplish something in life.  According to git-r-done, ". . . can be said before a task is completed to motivate them, or after a task is completed to celebrate."

During these times of reduced symptoms I can actually begin to enjoy things again.  Writing becomes purposeful.  More chores get done. I have increased energy.

It's not hypomania.  It's my bipolar depression symptoms that are greatly reduced.  I am functioning at a higher level for sure.

But it doesn't last.  This preferred state exists only a few hours or days at a time.  I am then relegated back to the severely depressed and less functioning me.

My troubles functioning while severely depressed can seem so insurmountable.  I ruminate on the fact that there is no cure.  I am tempted to believe that things will always be this bad when I know this is not true.

There is hope.  I have been high functioning before, for several years at a time.  I need to focus on getting back to those days.  Meanwhile, I'll just git-r-done as best I can.

Friday, February 10, 2012

Disability Retirement for Bipolar Disorder

I've been working on my disability retirement application lately.  I am applying for disability retirement from the Federal Government through the Federal Employee Retirement System (FERS).  My medical reason for retirement is bipolar disorder.

Early Consideration

I first considered FERS disability retirement (not to be confused with social security disability) probably ten years ago.  It was after my second visit by Mr. Mania.  I had managed to get myself on administrative leave for several months.  So, while I sat in my backyard and watched the grass grow, I began to contemplate how my disability affected my job.

Upon return to work I watched as the depression came on and settled in for a couple of years.  This deep and intrusive bipolar depression was making work unbearable at times.  Again I would wonder if my ability to work was compromised enough that I should look at disability retirement.

In the end however, I decided I could make it work.  I made it through that depression episode and became high functioning for many years, until recently.

Today's Perspective

After observing my last manic meltdown at work I have reconsidered my employment situation.  I now believe (most of the time) I am not entirely capable of managing my illness in such a way that will keep me continuously high functioning at my current job.

I need work that is structured differently.  I need the ability to work independently on a task by task basis.  I need to be able to work when well, which doesn't necessarily fit today's 9 to 5 paradigm (although that is changing).  My wellness and ability to function changes during the day and from day to day.

When I'm high functioning I can do a full week's worth of work, but just not in the regular work week routine.  I would benefit greatly if I had the ability to start and stop work as needed.


The future depends a lot on whether I am approved for disability retirement.  Since I'm still putting together my application, it will be several months before I know.

Meanwhile, I am considering work alternatives.  This isn't going well.  I struggle to find something that is both seemingly worthwhile and sustainable from an illness management perspective.  My depression is obscuring things that would otherwise be liked or enjoyable. What a pisser.

Sunday, February 5, 2012

Stigmatize This!

I was recently terminated (fired) from a long-term job I had with the Federal Government.  I was an environmental engineer, working full time, enjoying a mostly successful and somewhat fulfilling 17 yearlong career doing research and technology development engineering.

I was making a decent living with enough money to buy a house, own three cars, and maintain my single lifestyle.

I won't go into the details since we are appealing the decision to terminate, but my bipolar symptoms and urge to self medicate with alcohol combined to make my behavior and actions at work more than problematic.  Ultimately they pulled my security clearance, which is mandatory to posses for my position.

Without the clearance I could not perform my job duties and assignments.  You see, where I worked a security clearance is needed to login and operate computer system.  Since we do 90 percent of our work on computers and the internet, I was now unable to access my computer to do my work.

My main grief with the disciplinary actions is the necessity to hide my illness.  Because of this I couldn't get any support from management because they claim they weren't aware of my bipolar illness and how it can adversely impact work performance.

I was careful to conceal my bipolar manic and depressive symptoms throughout my career.  This wasn't easy with full blown manic episodes in 1997 and 2002.  I feared if the wrong person knew I was chronically ill from bipolar symptoms, then management could find out, and then my chances of promotion would be lowered.  Shit, I was stigmatized.

So every time symptoms arose that adversely affected my performance or behavior I could not give a reasonable explanation of what was going on.  Why did I yell at my supervisor in her office?  Maybe because I was experiencing severe agitation in a hypomanic state.  Made sense to me but not to everyone else.

It was the black sheep phenomenon.  I was the black sheep that didn't fit into the fold.  I experienced extreme judgments from my sometimes inappropriate or occasional bizarre behavior.  I always felt as if I didn't fully belong to my group of coworkers.  It was a deep sense of not belonging spread out over many years.

Anyway, I'm living on unemployment and some savings I had built up.  I have been working to keep expenses down.

So now I'm facing having to find a new career or another job in my field to support myself.  I've thought of all kinds of careers but nothing has jumped out at me.  Earlier last year I was enrolled in a seminary school but quickly determined that wasn't for me.

I suppose I should look at all this as an opportunity for personal and professional growth.  Maybe losing my job is a blessing in disguise.  Perhaps the silver lining is more fulfillment from a new career or livelihood that's just around the corner.

It is often said that as one door closes another opens.  Well, being in a state of bipolar depression for over a year now I don't even see doors or windows.  In fact I don't see or experience much at all.  I feel stranded in a dark room without the wherewithal to get out!

So, what is the moral of this story?   Should I have revealed that I had bipolar disorder to management and risked the stigma and other repercussions?  Should I have traded an explanation for my behavior with the knowledge of my disorder throughout my career?

I don't know what I should have done or what I should be doing now.  It's kinda a bummer.  But I do know one thing I'd like to do.  I'd love to confront my former employers and tell them: