Bipolar Tip: Winning at Your Next Pdoc Visit!

A lot of us with bipolar disorder think appointments with the psychiatrist rate somewhere between hell and a trip the dentist chair.  Anxiety, trust issues, differences in treatment beliefs, and communication difficulties can interfere with your medication management appointment.

On top of that, in less than 20 minutes you are expected to provide an update of your condition, explain symptoms, address intrusive thoughts, moods, make sure prescriptions get refilled, clearly recall important facts and events, discuss emerging or persistent issues, manage meds and doses, navigate convoluted billing and insurance practices, and maintain good composure.  Whew!

That means no weird laughing moments, tangential comments, or other unusual gestures.  Remember, you are dealing with an individual with the power to have you involuntarily committed to the friendly neighborhood psych hospital!

My Perspective

Okay, I need to say that I do not believe the patient/doctor relationship should be a win/lose or us versus them mentality.  Rather, it is better for all if the patient and doctor work together building a healthy, supportive, and respectful relationship.

Try to consider your treatment successes as wins for your doctor as well.  It should be a win/win partnership as they say.  If lowering your lithium levels made it more tolerable while still keeping your moods stabilized, then it's reason for both of you to celebrate.  Here is a writeup on my last psychiatrist visit back in January.

Approach

Because drug treatment can be effective and therapeutic it is in our best interest to make sure it goes well.  Assuming you are on good terms with your doctor, there are three straightforward things you can do that will make you feel like a winner after your next appointment:

Roles.  It is important that roles are understood. Good communication requires each person to know their respective role in the patient/psychiatrist relationship.  My preference is to have the patient take the lead role.  I believe this because (a) you are the best interpreter of the effects from prescribed drugs; (b) you will add value to your treatment program from increased participation; and (c) you will receive higher quality treatment overall.

Responsibilities.  And the winner is, You!  Because it is your life and you are the lead of your patient/doctor relationship, you should be acceptable with being the responsible party for your mental wellness.  You should also acknowledge and remember that you are ultimately responsible for your behavior.  Become committed to better mental health for yourself and be prepared to put forth effort required to do so.  It really is imperative that you take the drivers seat on this.  You should be the lead.

The Plan Man

I have a three step plan for making sure your consultation with your pdoc is effective.  The plan below is the same one I use for my psych appointments.  It is brief and simple, but gets results.

1. Prepare.  Write down any and all questions/concerns you can think to ask.  Go through them and get rid of the ones that aren't really necessary.  Pick a reasonable number (like 3) that you want to talk with the doctor most about.  Unless this is your initial evaluation with a new pdoc, there won't be enough time for too many topic items.  Think about these questions and concerns ahead of time.  It only takes five minutes to do this.  If you can go further, try to get some time for a quick internet search about each question.  This will make the appointment even more worthwhile.  For more on planning and preparation go to this Mayo Clinic bipolar webpage.

1. Perform.  Arrive at least five minutes early in a presentable manner.  Play your role as an empowered mental health consumer and think of your pdoc as your personal service provider, which they are.  Be engaged in the conversation.  This is your health at stake here!  Take notes on important items for later review and reminder.  This is where your committment to being mentally healthy will make you shine!  Your doctor will notice this and be more willing to work with you.

1. Persist.  Do any prescribed follow-on activity from your doc as prescribed.  Remain in contact in case you have any adverse health effects, issues with medication, or worsening of bipolar symptoms.  Be assertive if necessary.  Assertiveness is healthy.  It involves standing up for your rights and respecting the rights of others at the same time.  
2. Never, never, never quit!  Don't give up on your treatment in between appointments!

Execution

Here are some things to consider as you talk with your treatment provider.  You need to be prepared to address these issues and still maintain a good relationship.

• Is he or she okay with not playing the lead role?  If not, what will you do?  I haven't had problems taking the lead role.  Most doctors prefer a patient that takes an active role in their treatment.

• Are we in agreement concerning my issues and questions?  How does this get resolved if they are not?  Be prepared not to get everything you want all at once.  There are probably valid reasons why your provider is not in agreement with you.

• Playing the lead role does not involve being overbearing or contentious.  Simply remain calm and present your ideas, question, and concerns.  Remember, it's supposed to be a partnership!

• Be reasonable.  Your doctor sees a lot of patients each day and they are human.  Forgive them if they aren't perfect.  But at the same time do not hesitate to change doctors if you no longer receive quality care. 

• Is this person really looking out for your best interest?   Are you in disagreement with your pdoc about treatment, uncomfortable for whatever reason, or just don't trust your provider.  These are valid reasons to consider changing doctors.

Conclusion

You really need to make sure your medical treatment is as good as it can be.  Medication management is a critical element of the journey to wellness.  Having an effective partnership with your psychiatrist will make your treatment a more positive and worthwhile experience.

Do you have any past visits to the psychiatrist that can shed light into the experience?  Horror story or a good example of a consumer/provider relationship?  Let us know by commenting below (you can do so anonymously).  Remember to have a good day and take your meds.

Bipolar and Continuous Change

Society is becoming increasingly connected and dependent on digital technology.  In all aspects of our lives we are changing alongside, together with, and within our digital world. 

Today's digital world imparts to us its own sources of change stemming from its characteristic of continuous innovation.  And we're also experiencing change at an increasing rate.  Meaning all this new technology is requiring us to change with it, at a faster and faster pace.

I don't know the relationship between change and bipolar disorder.  But I do know if change leads to excessive stress then it surely will contribute to more and worse bipolar symptoms.

Technology Innovation

Technological innovation is the process of developing, making, using, and disseminating better or more effective products, services, technology, or ideas.  It is the innovation component that drives change in society, economics, business, and people's lifestyle and quality of life.

Innovation in the computer industry has been and remains remarkable.  From my perspective, information technology really started taking off in the mid 1980s when my dad brought home the Commodore 64.  It was one of the first popular take home computers.  For me it went like this:

• 30 years ago, 1982 - I knew of computers and some of their capabilities.  I remember being fascinated by the ability for computers to talk to each other through the modem and phone line. 
• 20 years ago, 1992 - Universities, businesses, and some people had email.  All students had email accounts and many their own x86 PC (or Mac).  I got my first computer then. 
• 15 years ago, 1997 - Everyone's getting on the web.  Which browser should I use?   Everybody has at least one email address.  
• 10 years ago, 2002 - Now most grandparents and relatives have email accounts.  Internet utility, traffic, and web capabilities are clearly known and being utilized by businesses.
• 5 years ago, 2007 -  The new iphone brings the cell phone to the web.  Portable devices are making home PCs less desirable.  Social media is popular.  I thought it was a fad.  Wrong!
• 3 years ago, 2009 - I'm using my iphone during all waking hours.  It is ridiculous.  Wi-fi in use everywhere.  Facebook is at 150 million active users and starting to explode.
• Now, 2012 - I have 3 Blogger accounts, 2 Twitter, 3 Facebook, 3 G+, and 5 email addresses.  I have two PCs, a printer/copier/scanner/fax and my iphone for devices and wifi in my home.

Technological Change

It is clear that today we experience massive amounts of change because of technology.  Also, this burden of change is increasing as society becomes more interconnected and dependent on the digital world view.

Can it be that technological change is the primary driving source for the development of human civilization?  Think about all the areas in your life touched or even controlled by technology.  Car, work, communication, leis

As an example, consider social media.  How has your involvement with online social media changed over the years?  How has social media changed the way you communicate with your friends, relatives, co-workers, businesses, and other interests and communities?  Does any of this add stress or activate bipolar symptoms?

I saw a family at a table in our local diner.  They were all looking down and praying before their meal.  I thought to myself, it's good to see people are still grateful for their food.  But I looked closer and realized they were all looking down at their cell phones and texting!  Or were they sexting?

Change Affects Your Life

Changes in life and society from technological innovation can be helpful or harmful.  We tend to think of the benefits of change because innovation is associated with improved efficiency, comfort, convenience, and capabilities

For example, when I changed from a regular cell phone to a new smart phone I become more efficient (e.g., faster messaging), could now conveniently send and receive data through my phone, and I gain a tremendous amount of wireless computing capabilities.

You will not likely find a person who owns a smart phone dwelling on its harmful elements.  Can you see someone saying that they are worried because their new smart phone is going to take jobs from U.S. workers?  How about someone saying that their modern cell service hurts small business because the industry has become monopolized?

Innovation significantly effects the mental illness health care industry with new drug development; greater knowledge from research and clinical practice; mobile apps for capturing and analyzing mood data; and improved communication. 

Within 24 hours I can get my blood tested in my home town, take a flight to Paris, access my results from my iphone from Europe, analyze the results with my new iphone medical app, and comment back to my doctor about my latest theory about thyroid levels and bipolar symptoms (which I quickly researched from my iphone).  Amazing.

Bipolar Impacts

Don't think for one minute I'm going to try and explain how technological change impacts those suffering with bipolar disorder.  There are too many significant other factors like family, health, relationships, environment, genetics, occupation, stress, and medicine.  This makes it difficult to understand the true impacts from change.

I do know impacts from technological innovation are positive or negative depending on the person and their circumstances. Negative effects might be social isolation/withdrawal, increased anxiety, or a decreasing attention span.   Positive effects could be increased social interaction (online at least) and increasing self-help power to the individual. 

Technology Trap 

Regardless of anything you do, technological innovation will continue to change you, your life, society, business, and culture.  Tomorrow will never be the same as it was or is today.

The modern view seems to prefer trying to keep pace with technological innovation.  They say we can solve the problems of man and surely correct any associated "negative external issues" from technology development and advancement.  This means as a society we collectively agree to continue changing and evolving at the rate of technological innovation.  

Survival is the catch 22 of our technological landscape.  If you do nothing, technological change will continuously reduce your skills until you are absolete.  If you participate, then you are now an indentured servant to the 24/7/365 technology innovation process.  Welcome, to the matrix.

Using social media as an example again, you should certainly expect continued, rapid innovation in social media that will inevitably bring significant change.  How much it affects you depends on your relationship to social media.  If you do nothing you will be like the old folks now that don't use a cell phone.  

For those in the marketing and social media industry, it is now about how well you adjust, adapt, and survive with the continuously evolving technology.  For someone who likes to shop online that means they will be able to friend, +1, and tweet their favorite stores. 

Moving Forward 

It is no secret that we are in the middle of lot of change and societal evolution.  Nobody knows where all of this is going or what impact these changes are going to bring.  Society has collectively come to an agreement that technology is necessary and we will adapt to its changes.

Since we are expecting continuous change to happen, it is a good idea to stay "tuned in" to changes going on in your life.  Be ready to embrace change in a positive, proactive way.  Educate yourself areas important to you and use your knowledge to better navigate the change.  Finally, be aware and mindfully manage your life challenges, especially your mental wellness.

Bipolar Treatment Update - Withdrawal Wars

Changes are underway with my treatment plan.  I'm getting off of my antidepressant Cymbalta (duloxetine).  I've been on the drug for over 5 years now.  The reason for withdrawal is not for side effects, but for efficacy and safety concerns.


Cymbalta  

I've determined Cymbalta is no longer helping my bipolar depression.  And I recently discovered there are serious adverse effects from taking both Cymbalta and Wellbutrin (bupropion) at the same time, which I do.

I used an online drug interaction checker tool from Medscape.  It said "Serious - Use Alternative duloxetine + bupropion duloxetine increases toxicity of bupropion by unspecified interaction mechanism. Serious - Use Alternative. May lower seizure threshold; keep bupropion dose as low as possible.  Oh, my.


Psych Meds

• Cymbalta:  Remove.  Starting 3/20/12 I am tapering from 120 mg/day to 60 mg/day over three weeks (20 mg decrease each week).  Evaluate, then continue tapering until 0 mg/day.

• Lamictal:  300 mg/day.  No change.

• Wellbutrin: 450 mg/day.  No change.

• Xanax: 0.9 mg/day. Slight increase in use.

• Abilify: Completed withdrawal in December 2011.

Supplements

NAC: 2000 mg/day, started two months ago. Not sure of response really.  Will continue during Cymbalta withdrawal; fish oil - 300 mg/day; multivitamin; aspirin; and caffeine.


Additional Information

• Psychotherapy.  My therapy sessions are going well.  I go once a month.  This therapy gives me a clearer sense of what's really going on with me and I receive helpful feedback and insight.
• Withdrawal effects.  I am concerned about possible adverse effects from Cymbalta withdrawal.
• Supplement interactions.  Possible adverse health effects from supplements with psych meds.  I need to figure this out myself.

Conclusion

I am continuing to actively manage my medication treatment. I have some alternative/novel antidepressants I am interested in trying after Cymbalta withdrawal.  However, the pdoc is not so hot on it.  Something about side effects and hallucinations or something.

I am fortunate.  Because of high tolerance to psych meds I am able to use them and stop them with minimal adverse effects.  But who knows with Cymbalta?  This could be a protracted, agonizing period in my life like it is for an unfortunate percentage of those who suffer severe (sometimes debilitating) withdrawal symptoms.

I don't expect that, but then again this could be just the beginning of my fight against adverse withdrawal effects.  Could this be the start of "Withdrawal Wars?"

Time for a Closer Look at Faith

I have been a little concerned about my faith lately.  It seems to have retreated from the level it was six months or so ago.  This post is an effort to clear up some faith stumbling blocks and move forward.

Background

I look at the subjects of religion, faith, and spirituality from two perspectives.  I am a scientist by training so I prefer using scientific methods and objective evidence to understand things.  However, it is the analysis of my experiential (subjective) accounts that eventually overrules any unresolved issues or limitations I have with empirical evidence.

I belief in God, Jesus, and the Holy Spirit.  In my world view the Christian God as represented in the Trinity is truth.  My faith is at a level where I am comfortable not knowing answers to questions like "How did man arrive on earth?"


Questions

Questions, skepticism, and sometimes outright doubt are common during my day. I think this way mostly when I am depressed.  The doubtful thoughts vary from simple misunderstandings to almost outright attacks on my fundamental understanding of Christianity!  I often wonder why I have so many doubts and suspicions when I try to understand Biblical truths?

For example, consider salvation.  Out of the 7 billion people living on earth today 2.3 billion are Christians.  So what happens to the 4.7 billion non-believers?  One interpretation maintains the belief that all people are accountable to God.  They believe the Bible promises that everyone who truly seeks after God will find Him.

In a blanket statement manner they say if a person truly desires to know God, God will make Himself known.  I haven't fully reconciled this one.  I mean, what about the people living on such and such island that have had little or no contact with the western world and Christianity?  What about those who have been socialized and indoctrinated into another religion or spiritual belief system?  Are they really all destined for
hell?

My Walk

My spiritual walk is completely different than it was just one year ago.  I don't attend church regularly.  I pray less.  I rarely read Scripture.  I do believe, however, that the Spirit lives within me and helps me deal with bipolar symptoms.

Last year I was going to church weekly, praying throughout the day, reading Scripture all the time, and even studying at a Seminary for a degree in Theological Studies.  Today, I have not attended church since January, I pray each day but a lot less, and I haven't read the Bible in weeks.

I have been declining gracious invitations to attend church and participate with other believers.  I am truly grateful for my brothers and sisters in Christ reach out to me. I want to acknowledged them and I pray that they experience an unfettered path towards greater spiritual awakening and understanding.

My Faith

These days instead of focusing on living a Spirit-filled life, I find myself looking for "proof" God exists.  After I receive my "proof" I move ahead, only to be followed by the nagging thought "Does God love me?" Instead of trust I have doubt.

As you can imagine, my state-of-faith greatly impacts my day-to-day outlook and emotional health.  When Spirit-filled I walk with freedom and ease knowing God will provide and protect me at all times.  This is healthy.  It leaves less room for anxiety during the day.

Way Forward

I do see a way forward from here.  Before this however, I need to remind myself that I'm okay exactly where I am.  Sure, my relationship with God has changed some and I am less Spirit-filled than than I've been at other times.  But I still relate to Him and worship Him.

Perhaps there are reasons for this period of skepticism.  Maybe it is an opportunity for my faith to grow?  I find the process of discovering answers to challenging Biblical questions makes my faith stronger!  It is action towards a better relationship with the Father.

Though I see a way forward, I don't have a particular path determined.  I am confident a path will show itself as I move along.  It is likely I will be in this "non-engaged" pattern for some time.  I'm not all that concerned.  It's only temporary and I know I'm being led by God regardless of which decisions I make or path I choose.  This is very reassuring and calming.

Conclusion

I do not see my current faith situation anything to be alarmed of.  It's not like I went back to agnosticism.  I'm still a Christian.  There have been change recently in my faith practices, but I still have faith.  I am asking more questions, but getting understanding at the same time.

My faith fluctuates.  I have periods of strong faith.  I have periods of doubt.  And I have periods of healthy skepticism.  They are all okay.  Each has benefits toward the development of the Spirit inside me.

I believe our personal faith and spiritual practices reduce the intensity of bipolar symptoms.  I hope we continue to see more and more people receiving real mental health benefits from their faith and spirituality. 850

Bright and Sunny Bipolar Afternoon

Ah, it's feeling like spring here in Southern California today.  It's a sunny afternoon without a cloud in the sky.  This has me in a light and jovial mood.  


My depression mutes much of the good mood.  I know it won't last forever.  But I'm certainly not complaining!




Anyway, I thought I'd find some things to laugh about and have done just that.  Here is some funny bipolar stuff I found from around the web.  Hope you enjoy! 

(1) You know you have bipolar disorder when:

• You can identify medication in the dark merely by shaking the container;
• Your drugs help you achieve reality, not escape from it; and
• You know more about mood disorders than your physician, yet still question your bipolar diagnosis.

(2) You know you have bipolar depression when:

• You have been told to “just snap out of it!” more than 3 times today already;
• Your "not talking" becomes the reason others want your antidepressant dose increased; and
• Instead of looking at the weather in the morning, you stay in bed, read about moon phases, work on your mood chart, count meds remaining until refill, and .

(3) You know you have bipolar mania when: 

• Your pharmacist (who you have on speed dial) stops trying to explain side effects of your meds, and starts asking you for information; 
• You can recite half of Homer’s Iliad and your bank account numbers, but can’t remember where you put your keys, car, or drivers license; and
• It's February and you’ve already spent the entire year’s budget.

After getting settled down for their first appointment the psychiatrist made the innocent mistake of asking the acutely manic patient how he was doing overall.  The excited individual replied, "I am fine.  I have bipolar disorder but I'm not crazy.  Crazy?  I was crazy once.  They put me in a room strapped to a chair in the middle.  That bugged me.  Bugs?  I hate bugs.  They drive me crazy!  Crazy?  I was crazy once.  But now I'm on seven psychiatric medications.  I take medication three times a day.  This constantly puts me in touch with the illness I have.  Do you know how that feels?  It drives me crazy!  Crazy?  I was crazy once. . ." 


A psychopath may think that 2 + 2 = 5 and could care less.  The neurotic knows that 2 + 2 = 4 and worries day and night.



After the acutely manic individual became relaxed and settled on the couch, the psychiatrist began the first therapy session. 

"I'm not aware of your problem." the doctor said.  "So perhaps, you should start at the very beginning."   

"Of course." replied the patient.  "In the beginning, I created the Heavens and the Earth..."

In a deep depression the patient says, "Doctor, doctor, I can't concentrate.  One minute I'm fine, and the next I'm blank!

Doctor asks, "Well, how long have you had this symptom?

Patient replies, "What symptom?"

Two psychologists were silently walking down the hall together.  One turned to the other and said, "Hello, how are you?"  Immediately the other thought, "What does he mean by that?  I hate when he uses psychology on me." 


If you are in a bipolar mania and want to avoid another 5150 (involuntary psychiatric hospitalization), then be careful what you tell emergency officials.  It is best to be selectively obscure, with clarity and sincerity when answering questions from police, emergency personnel, and mental health workers.  This will cloud their ability to recognize that you are delusional.


Two doctors opened offices in a small town and put up a sign reading, "Dr. Smith and Dr. Jones, Psychiatry and Proctology."  Some town members were concerned that the sign was too formal and proposed "Hysteria and Posteriors."  Both doctors quickly disagreed and proposed the catchy phrase "Schizoids and Hemorrhoids."  The town's mental health advocates felt this would be politically incorrect and suggested "Catatonics and High Colonics."  As soon as the controversy hit the papers thoughtful suggestions began rolling in: "Manic Depressives and Anal Retentives", "Minds and Behinds", "Lost Souls and Assholes", "Analysis and Anal Cysts", "Nuts and Butts", and "Loons and Moons."  Finally, after considerable debate they decided it would be "Dr. Smith and Dr. Jones, Odds and Ends." 

THE 10 COMMANDMENTS OF BIPOLAR DISORDER

1. Thou shalt not worship the bipolar condition.
2. Thou shalt not obsess over dangerous things, people, and places when severely manic or depressed.
3. Thou shalt not doubt, feign interest, or blame the holy chemical imbalance theory. 
4. Remember the ritual of taking your psych meds.
5. Thou shalt honor and not manipulate family or friends.
6. Thou shalt not kill or beat up anyone while in a manic fit, no matter how much ye really want to, or how much they deserve it.
7. Thou shalt not commit adultery unless in a manic state.
8. Thou shalt not throw and break stuff that does not belong to thee.
9. Thou shalt allow others to occasionally get a word in edgewise.
10. Thou shalt not covet other people's attention nor send crazy e-mails at odd hours of the night.


Do you have any good bipolar or mental health jokes?  If so, please comment here or you can send it to me at bipolartrail@gmail.com.  


Added 3-17-12.  A son and his father are traveling on the interstate.  There is a bad accident.  Both need medical attention.  The father, a schizophrenic, gets taken to a nearby mental hospital.  The son, believed to have early onset bipolar with schizoaffective tendency, was taken much further to a mental hospital for children.  The physician enters the room to attend to the boy and says, "I can't treat this child, he is my son!"  How is this possible?

I Read the News Today, Oh Boy

I read the news today, oh boy.

This is a lyric from the awesome Beatles song A Day in the Life.  It is a song that always resonates with me when I hear it.  It has bipolar-like highs and lows followed by periods of spacing out.

The tune is a first person account of a lonely guy's thinking day. He's an introspective and perhaps emotionally troubled fellow.  As he reads the newspaper he seems to be in a funky, depressed state where everything has less meaning.  You know, blah, regular, who cares.

He silently moves through life watching things and people.  When he's not being the contemplative observer, he drifts off and spaces out.  I can relate to that.  I space out in the middle of face-to-face conversations with people all the time.  Notice I said space out, not trip out.

So, in the newspaper he reads about a successful guy who's made it in life but dies suddenly in a car crash.  He expresses no emotion about the event, but ends up laughing about it even though it was a tragedy.

I do this sometimes during depression.  I feel unattached to my experiences.  I am numb to the world around me.  I find it really difficult to experience "genuine" emotions.  I find myself searching for the "appropriate" way to react.  Just another part of the pretense I put on for others because of bipolar disorder.

So, in a strange way tragedy can seem funny or comical to me .  Being able to find humor in the dark and gloomy is something that keeps me going.  Humor is one of my favorite coping mechanisms.

In my bipolar playbook the rule is go with whatever works.  Humor has a therapeutic value for me.  I would hate to think of where I would be without laughter and joking.

Friday I read about the bipolar flight attendant who freaked out an airplane full of people.  While it was clearly a serious event, I found myself amused as I learned about the incident.

American Airlines flight 2332 was taxiing toward takeoff from Dallas-Fort Worth when the attendant came on the the intercom to give preflight safety instructions.  But instead of the instructions she began speaking in a weird and incoherent manner, asking several times if they we're in Houston.  Uh, Houston we have a problem.

One paper said she was "talking in a word salad" about some incredulous things, saying the plane has mechanical issues and that they should return to the gate because it is going to crash.  She ranted about the airline's bankruptcy organization, a friend who died in 9/11, some union issues, and her 23 year career as a flight attendant.

She was getting the passengers spooked with her scary talk.  But at the same time she told them they needed to go back for more ice!  Now that's kind of funny.

She was wrestled to the ground and escorted off the plane.  The crew was replaced and they departed 81 minutes late.  According to one passenger the remainder of the jaunt to Chicago went smooth because of "liberal quantities of alcohol" and saying "The attendants were nicer than I ever seen.  They completely ran out of alcohol."  Maybe they should keep tranquilizers on hand for emergencies.

I try not to feel guilty about finding humor in the situation, especially since I can see myself doing the same thing!  During mania 2002 I had my own kind of "talk salad" while on a plane from L.A. to Houston.

I remember talking to the passenger next to me about things like flying, crashing, 9/11, and probably a bunch of other stuff considered inappropriate for a plane flight.  He was in the Air Force and seemed to be fine with the conversation.  I don't think things were too bad because I kept getting served beer.  The attendants are quick to cut you off when you've drank too much.

Anyway, some people were definitely not kosher with what I was saying!  When we landed in Las Vegas to change planes the airline staff detained me.  They said I was saying things that were upsetting the passengers.  So they booted me off the connecting flight!  To the old lady that was scared out of her britches, "Sorry, it was an unintended manic moment."

The next day I was allowed back on a plane to Houston but not without a stern warning not to do whatever I did again.  They made me sit in the very back of the jet.  I suppose this was to keep me closer to the flight attendants for observation.  We made it to Houston on schedule without a hitch.

Speaking of Houston did you hear about Whitney Houston's blah blah blah . . .

I read the news today, oh boy.

Dire Straits with Full-Blown Bipolar Mania

About a week ago a friend in Oregon called me for some advice.  She was very concerned about her brother.  He unexpectedly showed up at her house in a full-blown mania.

Yes, we're talking all the good stuff.  He had delusions of grandeur, nonsensical ramblings, tangential references to God, and frequent, bizarre ranting about things from his past (presumably unresolved issues).  Along with the manic thoughts there were other tell tale signs like racing thoughts, fast/pressured speech, hyperactivity, agitation, pacing, confusion, and the like.

My advice was straightforward: (1) call 911 immediately, (2) explain to them that it is a mental crises so they bring in the mental health team, and (3) work with him to get either a voluntarily or involuntary hospital admission.  

As expected he was found a danger to himself or others and ended up in a 5150 (involuntary hospitalization).  I didn't get specifics about what happened.  I can only imagine.  

This was my first involvement in a mental crisis situation from the perspective of a concerned person trying to help a family dealing with a mental health crisis.  Prior to this my experience with mental crises was about me getting the 5150!

The hospital health team say he is slowly improving but the psychiatrist called for an additional two weeks of hospitalization.  They want more time for the medications to take effect.  Since he objected to the longer stay a mental health court will be assembled to ascertain whether he is okay to be released or should stay longer.

My experience with these mental health courts has been interesting.  Twice I found myself in a 72 hour involuntary hold for acute mania.  And both of those times the psychiatrists attempted to keep me an additional two weeks.

Well, I would have none of that, objected the physician's advice, and had the mental health court convene.  I did this twice and I won both times!

In each case I had already been treated for "blatantly" acute mania in the three days prior.  This caused my mania to subside enough for me to do my thing for the court.  I put on my "I'm okay" face, act mild mannered, acknowledge the behavior that got me hospitalized, express my concerns that I'm okay and do not need additional hospitalization, and answer questions from the judge.

As I said this happened twice, once in 1997 and again in 2002.  Each time the court was convinced I was able to take care of myself and should be released!  Yay, good for me, but I really wasn't fully treated, especially in 2002.

I don't know what the court's assessment of his condition will be.  If he can keep it together for 15 or 20 minutes and say the right things, then it's likely he'll be let go.  But if manic thoughts creep in during court he may be unsuccessful.  I am curious.

The family wants him hospitalized for another two weeks.  I can see why based on what they told me about his madness.  He (as with most who are involuntarily hospitalized) loathes the idea of more psych hospital time.  He probably feels "fine" according to himself but has not been fully treated for the acute mania.

I hope my experience with mania and involuntary hospitalizations provided information that was helpful to them.  It is terrible the family has to deal with the insanity of his bipolar illness.  It was good for me to experience the "other side" of mania, from the family's perspective.  

I've now seen a glimpse of what I put my family and friends through during my manic episodes.  I don't like it.  I am fully committed to never getting full-blown manic again.  It's simply to destructive and dangerous.  

Bipolar Disorder Physical Symptoms

People with bipolar disorder usually focus on their mental and emotional symptoms.  These can be dreadful for sure.  However, did you know mania and depression can cause physical symptoms to appear?

Similar to other symptoms, physical symptoms will show up according to someone's bipolar state.  Those who are less depressed will show fewer, milder physical symptoms.  And those who are less than manic (hypomania) are less likely to have severe symptoms.

Depression Physical Symptoms

Sleeping.  Change in sleeping patterns and quality is a hallmark symptom of depression.  There can be trouble falling asleep, difficulty staying asleep, or the opposite, excessive sleep.  I oversleep when depressed.  In a severe depression I sleep over 24 hours at at time sometimes.

Fatigue.  Fatigue and exhaustion are quite often associated with depression.  This happens even when someone gets enough sleep.  There's simply a lack of energy for everyday activities.  Fatigue and depression feed off each other.  People who suffer from fatigue are three times more likely to become depressed and people who are depressed are over four times as likely to develop unexplained fatigue symptoms.

Chest Pain.  Anxiety and depression from bipolar depression can contribute to chest pain.  Also, depression   increases your risk of heart ailments.  So, the pain could point to a heart or lung issue.

Muscle and Joint Pain.  Muscle and joint pain may be from depression.  Also, people living with chronic pain are at a higher risk of depression.

Back Pain.  The big D increases a person's risk of getting back pain.  Conversely, people with chronic back pain may become depressed.

Agitation.  Depression often brings on agitation and its associated symptoms of irritability and restlessness (e.g., can't sit still).  Depressed men are more likely than women to be irritable.  These symptoms can impact sleep quality.

Digestive Problems.  It seems that our brain and digestive system are intricatly related to each other.  Depression can cause the physical symptoms of nausea, indigestion, diarrhea, or constipation.

Headaches.  Headaches from depression can be chronic.  Also, depression increases likelihood of a migraine.

Weight or Appetite Change.  Depression can cause people to eat too much or lose their appetite.  This results in weight gain or loss.

Sex.  Depression might impact your sex drive and performance for the worse.  Antidepressants side effects can also affect sex.

Mania Physical Symptoms

Sleeping.  Less than three hours of sleep a night for several nights in a row may be plenty of sleep for someone in a manic state.  The greatly reduced need for sleep is a hallmark indicator symptom of bipolar mania.

Energy.  The elated mood and euphoria of mania is known to produce much higher energy levels in people.  In turn, this makes for more active, inappropriate behaviors such as the spendy $8,000 vacation I took on a whim.

Agitation. Manic individuals are unsettled and active by nature.  They can become irritable easily.

Sex.  Undesireable or risky sexual activity often arises from mania.  I plead the 5th on this.

Drug/Alcohol.  Mania makes individuals more susceptible to trying or improperly using street drugs, recreational prescription drugs, and alcohol.  Someone's alcohol or substance use may be to control the flood of racing thought caused by mania.

Summary

Physical bipolar symptoms receive less attention than emotional and cognitive symptoms but they can be quite severe.  Now that you know they exist you can be watchful for physical bipolar symptoms.  Keep notes on yourself and tell your doctor about any physical problems you may have at your next visit.  They may or may not be from bipolar disorder.  Your doctor may call for additional tests to rule out other possible causes of physical problems.

Have you taken our current POLL: How Long from First Symptoms to Diagnosis?  It's on the top left hand area of this blog.  Please do if it applies to you, meaning you "officially" have bipolar disorder.