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?

Interview of Bipolar Blog Guy

Introducing Bipolar Blog Guy.  Here is a recent interview that didn't happen between Bipolar Blog Guy and Snoop Dogg.


Dogg: Whass up mah nizzles!?

Snoop Dogg

Bipolar Blog Guy:  Who?  Me or your ma?  Oh me, right.  First Dogg, let me explain my blogging situation.  Blogging about having bipolar disorder while having bipolar disorder requires the ability to write while managing distractions inherent in the topic.  For example, if in the middle of a writing moment I so much as think about a topic like withdrawal effects from psychmeds, my mind becomes distracted and then bombarded and confused with negative thoughts.  The bad thoughts are associated with dysfunctional beliefs, perceptions, and attitudes.  These thoughts quickly send me to depression.  In turn, depression causes cognitive difficulties that make writing very difficult.  I find myself unmotivated without inspiration.  It's a bummer.

Dogg:  Now what am I to do if you was me and I was you?

Guy:  Well, I guess you would try and figure out how to deal with bipolar disorder since you would have it.  You might even look for new or alternative treatments or drugs out there?   
Dogg:  If the ride is more fly, den you must buy.

Guy:  Wait, what ride? Do you mean my ride is ghetto speak for bipolar?  I did not know that, amazing.  So you are saying that if I can get to a better ride (more fly) and it costs something, then I should buy it.

Bipolar Blogging Guy

Dogg:  Ain't nothin to it but to do it . .[pause, Dogg inhales smoke from a cylindrical glass device with water inside].

Dogg:  I tell the truth.  And I know what I'm talking about.  That's why I'm a threat.

Guy:  Huh?  Did you just say you are a threat?  To what?

Dogg goes off in his own world singing to himself "Rollin down the street, smokin indo, sippin on gin and juice.  Laid back with my mind on my money and my money on my mind."

Guy:  Okay, thanks Dogg!  Good luck with your money situation.

My Cymbalta Withdrawal - The Syndrome Strikes Back

Man, this has been a really difficult post for me to write.  I have been going through severe withdrawal symptoms (a.k.a. discontinuation syndrome by the medical community) from Cymbalta.  

The depression symptoms I experience keep me from writing.  My mind is dull and slowed with significant cognitive impacts.  Concentration, working memory, and attention is really messed up.  

I'm getting the “impending doom” type of anxiety.  It comes and goes.  I struggle to fight the barrage of negative thoughts.  Those suckers make the depression seem permanent, like it will never subside.  Fatigue, hypersomnia, and anhedonia (lack of interest, motivation, pleasure from normally enjoyable activities) are pervasive when my depression symptoms are this strong. 

The Situation

I have mentioned before that I am in the process of getting off Cymbalta.  It is the second of my two antidepressants.  I have been on Cymbalta for around six years.  It was added to Wellbutrin, my primary antidepressant, to help relieve lingering depression symptoms.

Although it helped my bipolar depression for several years, Cymbalta is no longer effective for me as an antidepressant.  It's well known that antidepressants can be effective for a long period of time and then stop working.  Unfortunately, it's not fully understood what causes the so-called "poop-out" effect, or why it occurs in some people and not in others.

Withdrawal

I discussed going off of Cymbalta with my psychiatrist, Dr. G.  She agreed and planned for me to taper off 20 mg/day each week from 120 mg/day (starting point) to 60 mg/day.  We would evaluate things at 60 mg/day and proceed accordingly.   

1st week (3/20-3/26).  Lowered dose from 120 to 100 mg/day.  Not much change except a little nausea.  Depression was similar to the week prior.  Depression was mostly mild during the week with a couple of moderate depression states.  

2nd Week (3/27 – 4/2).  Dose lowered from 100 to 80 mg/day.  Mood started okay but depression became severe by the second day (3/28).  Depression is moderate to severe for about two and half days at the beginning and mostly moderate to mild for the rest of week.

3rd Week (4/2 – 4/8).  Stayed at 80 mg/day.  This week was worse than the prior week.  I was severely depressed for four days in a row.  Depression began lifting on Friday night (4/6).  Certain symptoms are becoming stronger, like sadness and worthlessness.  Yuck. 

Status

I’m near the end of my fourth week.  The dose remains at 80 mg/day.  Like the two weeks prior I continue to experience days of severe depression.  This time it was five straight days for most or all of the day.  Today is Sunday and it seems like it finally lifting again.  I’m going backwards!   

Now What?

I’m sure glad we stayed at 80 mg/day.  It’s very likely the withdrawal effects would be worse if I had continued to lower the dose.   

I will email my doctor Monday with an update.  I’m not sure what she will say.  She may want me to go back up to 100 mg/day.

I’m going to bring up the idea of taking Prozac to control these Cymbalta withdrawal symptoms.  I’ve read this online in forums and articles.

One article I read today reports that Benadryl (dipenhydramine) helps with withdrawal symtoms.  I just started taking that today.

Summing It Up

Well, withdrawal from Cymbalta is not going as I'd expected.  I thought it was going to be without problems since I tolerate antidepressants well overall and I successfully got off Abilify several months ago.

Now I’m not sure what’s going on.  I just keep moving along.  I feel like Frosty the snowman when I tell myself “I’ll be back again someday.”  I will keep you posted as this perilous journey to de-Cymbaltanize myself continues.

Ketamine for Bipolar Depression Treatment

The debate continues over the best way to treat bipolar depression.  To a large extent, most of the antidepressants prescribed for bipolar depression are suspect with respect to their efficacy and tolerability.  

Looming in the background are a handful of emerging psychiatric antidepressants that demonstrate efficacy and rapid response time (hours or days).  I touched on this subject in a December post about seven novel treatment medications for bipolar depression.  In a post from last month I wrote about another potentially awesome drug, scopolamine.  I even tried it!

Meanwhile, the emergent drug ketamine has been studied in the scientific literature for the treatment of mood disorders.  Most studies focused on relief from major depressive order with only a few evaluating bipolar depression treatment.

Ketamine is a very rapid (as fast as 40 minutes) treatment for bipolar depression with acknowledged short term efficacy.  While its overall safety profile and tolerability seem positive, concerns about a few side effects (e.g., hallucinations) seem to persist.

Drug Background

Ketamine is used routinely as an animal tranquilizer and an anesthetic for surgery.  Unfortunately, it's also infamous for being used routinely in the recreational drug scene.  So, it comes with a bad rap to begin with.

The media recently published some curious stories about using ketamine as an add-on antidepressant for "difficult-to-treat" depression.  At the end of January NPR did a story about a severely depressed person's ketamine experience.  

I thought it glossed over the serious adverse effects. Also, this is an account of the experience of only one person who is not bipolar.  Bipolar treatment experiences are highly variable among individuals and unique for each brain.  Check out the story and you be the judge.   

The scientific literature affirms ketamine is a rapid acting and effective antidepressant.  And although the drug is well tolerated overall, some side effects still cause concern.  Potentially serious side effects reported are hallucinations, increased blood pressure, confusion, and respiratory stress. 

This is only some general information about ketamine.  If you want more facts and information check out my ketamine hubpage.

Ketamine Studies
There are dozens of scientific studies of ketamine going back 40 years.  However, most of the early studies were done to assess ketamine for use as an anesthetic during surgery, not as an antidepressant.

Fortunately, within the last decade or so there have been a good number of  studies involving ketamine for treatment of major depression, treatment resistant depression, and bipolar depression.

A recently completed trial showed a rapid and significant improvement in mood when using ketamine for bipolar depression.  It demonstrated rapid and significant improvement in depressive symptoms for the 79% of participants that responded to ketamine infusion.  Improvements remained significant through day 3.  The most common side effect was dissociative symptoms that occurred only at 40 minutes post-dosing. 

A 2010 study of 18 individuals having treatment-resistant bipolar depression found ketamine produced robust (71% responded to treatment) and rapid (response within 40 minutes) antidepressant effects from a single intravenous dose.  The researchers found ketamines effect of improved moods remained significant through day 3.   

Research in 2010 showed that multiple doses (6 infusions over 12 days) of IV administered ketamine (0.5 mg/kg over 40 minutes) administered to 10 treatment resistant, depressed individuals was robust (90% met positive response criteria) and tolerable.  Psychotic symptoms (e.g., hallucinations) were minimal and side effects are reported as generally mild.  However, three participants (30%) experienced "significant but transient dissociative symptoms."  Eight people relapsed between 6 and 45 days after ending ketamine treatment.  One had only minimal depressive symptoms for over three months! 

A 2006 trial used ketamine for treatment-resistant major depression.  The placebo-controlled, randomized, double-blind crossover trial concluded that ketamine is a rapid (less than 2 hours response time) and robust antidepressant when administered as a single intravenous dose.  The 17 trial participants were diagnosed DSM-IV major depression (treatment resistant).  Results show that 71% met response criteria and 29% were in remission (no symptoms) when measured the following day.  Also, following the trial 35% maintained a positive response for at least 1 week. 

Even with over 10 years of research on ketamine for treatment of depression, further studies are still required to better understand proper therapeutic dosages, administration methods, 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, tolerability, and safety.

Findings

1. Ketamine has established itself as a novel, rapid, and robust antidepressant with seemingly unresolved tolerability concerns;
2. Further trials are needed to substantiate earlier findings from some of the smaller studies; 
3. Additional trials are needed to investigate the possibility of using ketamine for longer treatment duration.  Specifically, the long term treatment that may be needed for effective acute and chronic bipolar depression treatment in some individuals;  
4. Clinical trials data is needed to develop dosing guidelines and administration techniques; and
5. A couple of side effects are still a concern, but otherwise ketamine is tolerated well.

Conclusion There are no safe and effective antidepressants available that have the rapid and powerful onset like ketamine.  We have scientific studies of the drug's mood changing effects going back over a decade.  It's not like ketamine is new to the block.  I think it's time to accelerate the advancement of promising treatments like ketamine. 

I'm not optomistic about ketamine's future.  Research and clinical trials are taking way too long.  It's reputation as a recreational drug doesn't help matters.  Ketamine could very well end up stuck in limbo between initial lab studies and your medicine cabinet    So, would you consider particpating in a ketamine study?  I know I would!  Take care friends and take your meds.

What It Takes To Blog Bipolar

Well, I have been blogging for nearly six months already, wow!   Over this brief but busy time I think I've learned a "fair" amount of what it takes to blog about bipolar disorder.  In this post I will take you on a basic tour of my blogging world and give you a sense of what its like to post on a bipolar blog (1). 

I'm certainly not a pro blogger and surely less blog savvy than the seasoned blogger.  However, I am knowledgeable about a few things bipolar.  I've spent a lot of time reading, researching, and experiencing bipolar disorder since being diagnosed in 1997.  

REQUIREMENTS.  Besides the need for a computer and internet access, there are no official requirements to blog online.  But you need to have a passion for writing about your subject.  Passion will provide the inspiration to keep the blog alive.  Yes there are other important attributes like persistence, stamina, and motivation.  But if you're inspired to do something then there's no stopping you!

CONCERNS.  There are concerns that I have to overcome when blogging about my bipolar experiences and beliefs.  Some of the concerns will stop me dead in my writing tracks.  

• Failure.  Afraid to fail?  Most people are.  I am.  This is a persistent thought, especially when first starting to blog. 
• Depression.  Writing is painful while severely depressed.  I  struggle each week getting my posts out.  On better days I write as much as possible and try to get ahead.  This allows me to have down days where producing content is just not there.
• Stigma.  Stigma towards mental illness exists.  I don't know whether it's getting better or worse but it is definitely out there!  You need to accept and cope with this.  It will come up while you blog.
• Privacy/Security.  How much privacy and security do you need?  You don't want to be accessible via your blogging web presence to your private residence.  Make sure blog and posts do not contain personal information.

BLOGGING.  Developing a blog post is a process with several steps.  Below are the steps I go through to publish a post.  Of course there are many more aspects to blogging that need consideration such as available time, access to a computer and the web, and more.  But these are the big ones for me.

1. Topic.  Choosing a topic is always a tricky step for me.  For each topic I ask myself will writing about it benefit my audience.  Is it interesting?  Is it useful?  Is it PG-13?  Is it legal?  Will this trigger a terrorist response from the Feds? 
2. Research.  This takes anywhere from no time to many hours depending on the topic.  If it's a post about my experiences or observations, then there's not much research involved.  However, a topic like "Scopolomine for Bipolar Disorder" can take 8 hours to find sources, research, analyze, fact check, and organize the information. 
3. Writing.  This takes up 75% of the time I put in each post, not including research time.  This includes writing and editing multiple drafts, incorporated graphics, including relevant links, formatting, proofreading, and more.  
4. Promote.  Yes I do some "promotion" of my blog posts.  It's a fact that you need to get the word out.  Otherwise how do you expect people to find and read your blog?  I manually tweet (there are autotweeting applications out there) on Twitter an average of 5 times each post.  I sometimes mention blog posts in bipolar disorder groups I belong to.  I also have a small email list that I send weekly updates to.  I don't have a facebook page, Google profile, or other social media accounts for the blog, yet.

Writing this blog was an excellent decision.  It positively impacts many areas of my life now.  My family and friends have taken an interest in my blogging.  This is satisfying.  Also, writing is therapeutic for me.  I get to work out my thoughts, concerns, and frustrations.  I really hope my writings help you in some way.

(1) I need to distinguish what I mean by blog.  For this post I'm talking about publically accessible bipolar blogs. 

Bipolar Survival Tip #2 - Avoid the Law!

It seems a hazard of life for some people is frequent interaction with the police and justice system.  And for those few people with bipolar disorder, staying on the right side of the law while trying to control bipolar symptoms and episodes is a serious challenge.

Sometimes I think we should just gather them all up and neutralize them.  Let's face it, staying clean, sober, lawful, and compliant with probation is overwhelming for some folks, even more so for those with bipolar disorder.  Should just put them in a big facility where they can be observed?  If so it should have nice gardens and water features.

Finding yourself on the wrong side of the Law is easier than you think. Of course the likelihood of being hassled by the badges is greatly reduced when you are polite and following the law.

I almost got a warrant one time because I forgot to pay a parking ticket.  It can happen to anyone.  So don't beat yourself up too bad if you do get caught.

I subscribe to the Chris Rock production below: "How not to get your ass kicked by the police."  I recommend you review this instructional video before proceeding.  The people in this video are not bipolar, except maybe the mad woman at the end.

HINTS

I have assembled some useful hints for ensuring encounters with the Law will be okay.  These are strongly suggested if you truly want to avoid negative interactions with the police.

Hint #1: Obey the Law.  I suppose a corollary to this would be "Don't Get Caught."  Bipolar and "normal" people alike get hassled every day for things like speeding, trespassing, and public intoxication.  The rules apply across the board.

Hint #2: Eliminate distractions.  Distractions impair your judgement, which you need when making drug deals or driving at high speeds.  Make sure you leave your woman at home if she's likely to be upset or angry.  Because a mad woman will say ANYTHING to get you in trouble!  I know a guy who got a parking ticket because his wife was ticked off about something that happened back at the house hours earlier.  They were parked and arguing but forgot to get out of the road.  They were stopped in the center turn lane.

Hint #3: Always maintain situational awareness.  The police are not on your side!  The badges are trained to skillfully and deceitfully manipulate you to say and admit things that will get you in trouble.  Keep this in mind while they are questioning you.  And if you think they're friendly, think again.

INSIGHTS

There are some insight I have to help you stay away from the badges and avoid having to wear their jewelry.

Insight #1: The Law does not always win.  I know of several friends who shall remain anonymous that have successfully fled, lied, evaded, avoided, and even climbed trees to escape from the clutches of the police.  So if you find yourself in a bind over an alleged infraction or violation, don't give up!  There may be a way out!
Insight #2: Develop impulse control.  If you value your freedom, then don't do crazy stuff that gets you in trouble.  There is an area of the brain (medial prefrontal cortex) that  inhibits impulse control.  It seems this area is less active for those having bipolar disorder.  Dr. Phelps shows there is a biological basis to impulse control.

Insight #3: Remember your rights and use them.  If you are in your house and they come knocking, then don't answer the bloody door!  Close your curtains, lock all doors and windows, and kick back inside until they get bored and leave.

MITIGATION MEASURES

Sometimes, even with our best intention, we may inadvertently have a meeting with the men in blue.  Here are two things to keep in mind if you find yourself in the back of a cop car wearing their jewelry.

Measure #1.  Quickly remind them you are mentally ill.  I can not stress the importance of letting the helpful responding officer know you suffer from a mental illness.  If its bipolar disorder, then say you have bipolar disorder.  Establishing the fact that you have a serious mental condition will be the difference between a three day vacation stay at the local mental hospital or being arrested and charged with something like drunk in public or disturbing the peace.  In fact, you may be lucky enough to walk with nothing more than a warning.  I've done it!  Act a little bizarre if you have to or just feel like doing so.  It will bolster the mental illness strategy.
Measure #2. Shut the hell up.  That officer will write up shit you or your friends say and it will be used against you later.  You'll be mad and say stuff easily.  Got to stay cool.

Measure #2.  Pretend you are sober.  This can be difficult if you are three sheet to the wind.  But do try because you don't want the drunk tank.  You will freeze your butt off in there, they keep it really cold.

BULLSHIT OR NOT?

You be the judge.  The tactics may or may not have happened.  For the record even if they did happen I didn't do them.  I can't be sure of course, but I have a sense that they will be of some value to someone-somewhere-someday.  Below are two potentially stellar defense tactics for keeping your freedom when you could be over your BAC limit.  Maybe these will be demonstrated on YouTube someday.

BS? TACTIC #1. Attention Deflection for DUI avoidance.  If you find youself pulled over for questioning while having a 0.08 percent blood alcohol level or more, then make strategic observations or helpful hints to the officer.  For example, when pulled over and questioned if he had been drinking my friend said no, but that his buddies in the passenger seats were wasted and that he was called to take them home.  The officer assessed the situation, saw three drunk guys in the car acting silly.  My friend provided information and helped the officer quickly evaluate the situation and make a decision.  Simple enough and it worked.

BS? TACTIC #2.  The Hail Mary for DUI escape.  Try this.  It requires one preparation step: (1) keep a pint of unopened 80 proof liquor in your glovebox, next to your insurance, registration, and gun (if legal); (2) when approached by the officer keep your window rolled up and get the bottle of booze; and (3) in his presence open the unopened bottle and drink it all!  This will send your BAC through the roof and mask any previous suspicions of drinking.  IMPORTANT: Do not try this if you have a mad woman in the car with you.  A very upset woman will say anything to get you in trouble (see Hint #2 above).

This information is for fun.  It is coming from a non-criminal type guy.  It is not a substitute for attorney advise or experience from real life cop interactions.  Be safe, and take your meds.

Meth and LSD for Bipolar Disorder!

April Fools!!  Really now!  Such a notion, meth and LSD for bipolar disorder.  Those things probably cause bipolar disorder.  I'm not sure on that.  They definitely mess up bipolar symptoms, according to my friend Anon.  I think I'm going to remove this post after today.  I know I would be upset if I searched online for "Meth" and "LSD" and "Bipolar" and landed on this page, ha ha.

Last Week

I had bad depression last week.  I didn't write much because of it.  It's Saturday today and this is my first time writing all week.  The post last Wednesday, "Bipolar Tip: Winning at Your Next Pdoc Visit!" was written the week prior.

I spent most of my "useable" time this week researching ketamine.  It's has potential for use treating bipolar depression.  It's a powerful drug with strong antidepressant effects that has seemingly stalled in its development.  Look for a post on ketamine later this month!

Cymbalta Withdrawal

As I posted a couple of weeks ago I am currently getting off Cymbalta.  This is still the case, but I think I'm getting some  withdrawal effects from it.  I have been markedly lower lately.

My tapering plan from my pdoc planned for lowering my dose by 20 mg/day a week at a time.  I went from 120 to 100 mg/day with seemingly no problem during week one.  Tuesday I lowered my dose to 80 mg/day.  That same day my depression symptoms (mood, fatigue, tiredness) fell from mostly moderate to mostly severe and its been the same since!

So, it seems like my withdrawal from Cymbalta is not going to be as simple as I'd hoped.  I'll call up my psychiatrist tomorrow and figure out what to do.  

Have a great week!