Computer Calamity Creates Confused Countenance

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

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

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

God of Hope - This Bipolar's Right Hand

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

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

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

Manic Twin Peaks

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

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

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.

Court Kills Mood

I appeared in court this morning.  I have some court matters that stemmed from my bipolar mania during the summer of 2010.  

Going to court really affects my depression, as I suppose it would to any other depressed person.

I drove to court this morning in a moderate/mild depression and left with more like a severe depression.  Being in there for two hours, listening to all the cases, and just sitting in that environment was a real bummer.  

In court you have things to listen to and see.  All of it is negative.  I would look over to the inmate cell and wonder what the heck they did to end up in jail.  I look to the judge and watch him ram cases through the system at rapid speed.  I'd see the bailiff constantly surveying the people to make sure they were quite.  No cell phones please. 

I watched and listened to all the attorneys, conferring with their clients, practicing their best manners when talking to the judge.  Some of those guys and gals strut around the courtroom as if they own the place.  That bothers me.

I left the courtroom, walked to my car, and drove off in a haze of negative thinking.  Now everything I saw, experienced, or thought about had a dark tint to it.

I was less patient with traffic when driving home.  I turned on the news and it all seemed hopeless, like it's all a waste of time.  I mean who cares if a dude dressed like a Walmart greeter person was actually a thief who stole four big screen televisions?  This isn't helping at all.

I often take a nap when things get like this.  I get sleepy, feel fatigued, and things look hopeless.  I just want to escape.  In the past I would probably grab some beer, but I quit that over a year ago.

So now I am writing about that experience.  It is helping me get clearer, seeing more of the big picture.  I get some momentum to keep carrying on.

I wonder how it's all going to work out?  Acquittal?  Guilty?  What is God's role in all this I wonder? Is this a learning process?  Is this supposed to help me stay on the right track?  

I just want to get over this but it's dragging.  Most of it is my attorney's fault because he has felony cases that take a higher priority.  Now we're looking to March 1st as a possible trial start date.  

Moral of the story: do your best to stay out of trouble.

7 Novel Bipolar Treatment Medications

This post is a brief overview of seven emerging or novel drugs for treating bipolar disorder.  This should not be considered a thorough analysis of the state-of-the-art in psychotropic medications. Most of these products have not finished being tested.

Your psychiatrist has probably not even heard of them.  So don't get too excited about seeing if they will work for you anytime soon.  I am posting this out of curiosity and hope for the future.  I think it is encouraging to know science is making headway towards more effective drugs with less side effects.

Current treatments for bipolar depression have a considerable lag of onset of action.  An alternative product with rapid antidepressant effects (hours or days versus days or weeks) is needed.  Ongoing research is promising with newer, faster acting drugs in the testing or approval stage.

1. Ketamine is a drug that has some clinical testing and appears to work well for treatment resistant bipolar depression.  It is fast acting and generally well tolerated.  An IV is used for administering the drug so you better like getting poked.  

It seems product development on this drug has stalled since it can cause hallucination and significantly interupts normal brain function.  Because of the ability to experience abnormal states ketamine is popular at underground parties and raves.

2. Oxycarbezepine is a derivative of the mood stabilizer carbamazepine (Tegretol).  It is being studied for acute mania, hypomania, mixed episodes, and rapid-cycling.  For now a lack of sufficient quality trials precludes us from knowing its effectiveness and tolerability. 

3. Riluzole is a novel chemical that is being studied for treatment of bipolar depression.  It is already an FDA approved prescription drug used to treat Lou Gehrig's disease.  Studies show it effective in treating acute bipolar depression alone or in combinations with other antidepressants.  The first large controlled trial of Riluzole is being conducted at the Yale Depression Research Program.

4. Tamoxifen has been evaluated for acute mania treatment.  Results from several trials demonstrate that it is both effective and well tolerated.  One researcher said that Tamoxifen isn't perfect but it fits the bill.  Is that an endorsement?  It is a promising antimanic drug but larger studies are needed before it can be sent to the FDA for approval.  Interestingly, the drug has been in use for two decades to treat breast cancer under the brand name Nolvadex.

5. Tiagabine is an anticonvulsant being studied for maintenance treatment of bipolar disorder.  It is already FDA approved for treatment of partial seizures under the brand name Gabitril and it is already being used off label for controlling anxiety.  As with most of these emerging treatments tiagabine needs better studies before a determination can be made as to its therapeutic potential for bipolar disorder.   

6. Saredutant is a promising neuropeptide being studied for treatment of major depression disorder.  Neuropeptides work on different neurotransmitter systems than conventional antidepressants.  Saredutant produced favorable results and is in clinical trials for long-term efficacy and safety.

7. Scopolamine.  Scopolamine showed rapid, robust antidepressant properties in clinical testing.  It is being tested for relief from both depression and bipolar depression.  It is interesting to note that this drug is already in use for motion sickness relief.  If it ends up working then you can go boating without puking or being sad.  

Research for drugs that can effectively treat bipolar disorder continues.  It is exciting to note they are finding chemicals that work much faster than what we are used to, showing effects in hours instead of days or weeks.  It is also promising that some of these medications are already approved and in use for other treatment purposes. 

The understanding of bipolar mood mechanisms is increasing. While promising solutions are being discovered it can be disappointing at how long it takes for them to get studied and approved for use.  However, we should be grateful for what we already have and hopeful that science will make enhanced meds that work even better.


Do you know of other medications being studied for bipolar treatment?