My Bipolar Disorder - Career Update

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

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

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

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

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

Moving On

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

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

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

Things I've Done

I've accomplished quite a few things since becoming unemployed back in 2010.  Things I have done during this period of underemployment that have helped me move on:

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

Now that my situation has stabilized for the time being, I can focus on resolving the manic mischief from summer 2010!  More to come on this!

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

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

Scopolamine for My Bipolar Depression

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

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

Background

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

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

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

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

Scopolamine Findings

Based on what I have uncovered I find the following observations to be of interest:

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

The Scopolamine "Test"

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

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

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

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

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

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

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

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

Scopolamine: Final Analysis

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

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

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

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

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

More Disability Retirement for Bipolar Disorder

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

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

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

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

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

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

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

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

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

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