What Does Your Brain Tell You When You're Depressed?

One of the fun parts of hypomania for me (I use the word "fun" sarcastically) is that not only do I get depressed, anxious, and revved up at the same time, usually my depression and anxiety are the things that get revved up.  So my brain goes a mile a minute, but it's going a mile a minute about how horrible I am, what a bad person I am, and how I'm going to hell.  See?  Fun.

The hell thing is a recurring thought; every time I get hypomanic, that's what I tell myself, over and over again.  I'm  lousy person, a lousy parent, ugly, fat, and worthless, and my ultimate punishment (as if having these thoughts isn't punishment enough) is an eternity in hell -- whatever that is.  I know a lot of this can be chalked up to Catholic guilt, but I think it's more than that, too.

I think when you're depressed or anxious, your brain seizes on the most convenient negative thought possible and replays it and replays it like Elf on TBS at Christmas. I'm still working on how to get it to stop the replay; as far as I can tell, it's not as easy as pushing a button.

Does your brain tell you something over and over again when you're depressed?  Is there a thought on replay in your head?  Have you figured out how to turn it off?  If you have, more power to you.  If not, join the club.

Psychiatric Synergy

I've been thinking a lot lately about psychiatric synergy (for lack of a better term).  In other words, when are you merely a collection of symptoms, and when are you something greater (or worse, as the case may be)?

For example, when I was hospitalized last month, I went through the admission assessments, as always, to figure out what to put on the admissions forms for diagnosis/reason for admission.  One symptom I had been displaying at the time that was a little bit odd for me was excessive irritation and anger.  My "breaking point" was very low, and it didn't take much provocation for me to lose it and have a full-on temper tantrum.  At one point I got angry at one of my kids, and I inexplicably took it out on the freezer; before I knew what I had done, I had emptied the freezer in one manic tantrum, its contents strewn all over my living room.  There were peas everywhere, and my husband found a package of butter two weeks later behind a chair.  On a positive note, my five year old painstakingly picked up all the peas without being asked, and it kept her busy for quite a while.

In general, I'm not prone to tantrums, especially since I started taking antidepressant and antipsychotic meds.  So when I was being admitted to the hospital, I felt the need to mention this incident and a few other similar incidents to the admitting nurses.

I'm sure that psychiatric nurses and psychiatrists are trained to be facially neutral when talking to patients, but it seems like there are a few "key words" that make them light up like a Christmas tree when they hear a patient mention them.  "Tantrum," "rage," and "anger" seem to be some of those words.  They hear that I have a problem controlling my anger and it's like a big checkmark on a mental list, and you can almost feel them tuning out anything you have to say after that.

Now, I agree that trashing my kitchen is a little bit of a red flag that something is wrong.  What bothers me, though, is the fact that nobody bothered to ask what else was going on in my life.  I was trying to potty-train a three-year-old; trying to deal with two kids' birthdays in three weeks, still recovering from gall bladder surgery, gearing up for Christmas, etc.  In other words, I had a lot of other stress-inducing incidents going on in my life, so maybe it was premature to chalk everything up to mania/hypomania/mixed-mania-depression.   But the nurses seemed to seize on those incidents like dogs with bones.

This isn't the first time something like this has happened, when I dropped a "keyword."  Just mention either of the words "adopted" or "divorce" to a psychiatrist, and you can see the mental gears clicking into place.  Add in any--even minor --issues with alcohol, and you'll be lucky if you ever get out of that office.

I don't deny that our experiences make us who we are; but why are some of us "mentally ill" and others are just "stressed out parents"?  I know a lot of people who would have temper trantrums after telling a three-year-old to sit on the toilet, then five minutes later having to clean poop out of her underwear for the umpteenth time.  Why do I get stuck in a mental health facility for a week and get my brain zapped with electricity, and other people get taken out for sympathy margaritas?  I admit, I was the one who brought up the incidents, who told the nurses about getting angry.  Perhaps what is most telling was that the incidents bothered me -- I didn't like trashing my kitchen, I don't like yelling at my kids.  But, for better or for worse, I have three little kids, and they can be irritating.  What level of irritation is "normal" and what is cause for concern?  Some days I wonder how any mother of little kids can get through a day without a serious dose of Xanax.

Part of me thinks that the fact that I am concerned about the incidents means that I've got at least a marginal grip on reality.  Isn't that was Lucy says to Charlie Brown in A Charlie Brown Christmas?  Something about "as they say on TV, the fact that you think you need help means that you're not too far gone" (I'm paraphrasing).  But it annoys me when every little personality quirk or flaw takes on heavy meaning, when maybe it is just what it is -- a bad day, a bad minute, an overstressed instant.  It's like I can't lose my temper without it taking on some huge meaning.

In other news, I have my last "acute" ECT treatment tomorrow (which means 3X a week).  After that I'll probably start on "continuation" treatments, which  means once a week for a month, then "maintenance" treatments, which is once a month for a while.  I'm really, really looking forward to being done with these things.  I do think they've helped, but they're a monumental pain in my ass (and head). 

And I finished another Kuku doll, and am currently blocking my headwarmer.  I had been meaning to make myself some fingerless gloves for a while, but I was at the Gap last night and found a cute pair or cable-knit gauntlets for $8 -- I couldn't buy yarn for that amount of money.  So, Merry Christmas to me.

Hello, Mania, my old Friend....

...and since it's 3:30 a.m. and I'm writing a blog post, it's obvious I've come to talk with you again.

(and if you don't get the above cultural reference, you're too freaking young.  Go get Simon & Garfunkel's Concert in Central Park and report back later).

So while I was in the Lindner Center, the doctor there put me on a new, fun drug called Geodon (generic name:  ziprazidone).  It's an atypical anti-psychotic (AAP), much like Seroquel or Zyprexa, but it's a little bit newer and the side effects don't seem to be as bad.  For example, Seroquel and Zyprexa both cause insane weight gain, Zyprexa worse than Seroquel, and I've gained like, 50 lbs on Seroquel over the past five years.  Yeah, okay, I also had four pregnancies and three kids in those five years, but I'm gonna blame it on the Seroquel anyway.

Geodon is actually not a new drug, but apparently it seems to be used more often when other AAPs haven't worked.  I'd never heard of it when the doctor put me on it, and I feel like I'm pretty well-versed in this stuff. The nurse had me sign a release for it with the rest of my meds when I first got there, and she told me that it was a drug that they usually inject you with when you get really psychotic and they can't control you, and they almost certainly wouldn't have to give it to me.  Two days later, the doctor calmly informed me it was goinng to be part of my regular routine (in a capsule form, not an injection).

Apparently, it's marketed by Pfizer, and they were involved in a federal case a few years back that included being fined by the FDA  for marketing Geodon and three other meds for "off-brand uses."  To the tune of $2.3 billion.  That's with a "b," not an "m."  Here's an article from a medical fraud advocacy group that says that Pfizer got what they deserved, and here's another article from Forbes saying the whole thing was ridiculous.  I'll let you decide.  But the point it, maybe the drug is sort of unpopular due to public opinion reasons, I don't know.

Essentially, though, the doctor at the clinic took me off my virtual pharmacopeia of drugs I was on when I went in (lithium, Zoloft, Seroquel, Lamictal, Buspar, and an occasional Ambien and Ativan) and wanted me just on lithium and Geodon.  In fact, she said that a sort of "perfect storm" of occurrences led up to me being hospitalized, with the icing on the cake being the Zoloft, causing an agitated mixed-mania state, that was causing hallucinations, delusions, and suicidal thinking.  I'd been on Zoloft for six years, so Zoloft and mania or Zoloft and mixed-states was never on my radar.  I was taking all of my normal drugs in relatively low dosages, except the Zoloft.  I mean, I'm depressed -- give me an antidepressant, right?   Seems logical.  But it turns out that none of the meds were really helping, and some of them were actually hurting. Antidepressants can actually be pretty bad for bipolar people, but I've never had any obvious problems with them before, so I've stayed on one after another after another (you name it, I've been on it) for years.  This is actually a pretty major problem for some people, but I'll talk about that another time.

So when the pdoc sent me home on Wednesday, I was on Geodon, lithium, and Xanax as needed (with the idea that eventually I'd get off of everything except the Geodon).   Three drugs seem like nothing, compared to my previous med cocktail.

The only trouble is...well, it's 3:30, and I'm writing this blog post.  Yep, seems like something is sending me into some sort of (at least hypo-)manic state.  I'm pretty sure it's not the Xanax, since Xanax usually knocks me on my ass.  But I've had three of them since 7:00 p.m. tonight, and other than the fact I can't see straight and I feel like my brain is rattling around in my head, I'm not at all tired.

I did do some web searching, and that shining bastion of research, Wikipedia, mentions that "Ziprasidone is known to cause activation into mania in some bipolar patients."  Thanks, Wikipedia, for that thorough explanation.  At least they list references; here's a link to one of the studies that supports this claim (there are a couple). I also found a couple of discussions online about "Geodon mania" that were asking the same questions.  Here's one; here's another.  God, I seriously love the internet.  You could do a search for just about anything and find a discussion about it.  Anyway, irrelevant.

Maybe it's the Geodon, maybe it's something else causing the mania, I don't know.  I've actually cut way back on my caffeine, so it can't be that, and the Zoloft is gone, so it can't be that, and I've been on the lithium for about six months...so I'm kind of at a loss.  I will mention, though, that the sleeplessness isn't the only manic symptom I'm experiencing, so this isn't just a case of insomnia. I won't elaborate, in case my husband reads this, but he'll know what I'm talking about when he gets my next credit card bill (sorry, sweetie). 

For now, I think some of the Xanax has kicked in and, while I'm not tired, I definitely can't see straight.  So I think my rant is at an end for the moment.  I hope you're sleeping, cozy in your bed, and not doing random research on anti-psychotic meds that you feel like a crazy person for needing to take. 

Oh, wait, I AM a crazy person. Oh well. Least I'm a crazy person with a credit card.  For now.

Court Case Update

The other day, I wrote about a trial going on outside of Cincinnati about a teacher accused of having sex with several of her students.  I wrote about it because the teacher was pleading guilty by reason of insanity, and her lawyers contended that she had bipolar disorder.  At least, I think that's what they were contending.  One article from ABC News had this quote:

[Her] lawyers defended her actions with explanations ranging from her vegan diet, the use of the antidepressants, blackouts from alcohol and even irritable bowel syndrome, claiming it rendered her unable to determine right from wrong.

An article in the local paper indicated the same thing, even saying that the lawyers cited Polycystic Ovary Syndrome (link goes to info about PCOS - I can't find the article now) as part of the problem.  It all seems very confusing, and appears the lawyers were throwing about anything they could think of out there as evidence (but that's just my opinion).  I mean, come on -- irritable bowel syndrome? 

After I wrote my post, I started thinking that maybe I was being short-sighted and judgmental.  I did a search about bipolar disorder and an insanity plea, and found this interesting editorial from the New York Sun, which basically says that bipolar disorder is a "mood disorder," rather than one of "cognition."  When a defendant pleads insanity, her lawyers must prove she didn't know right from wrong -- and that's something that bipolar disorder doesn't do.

I guess the judge in the case agreed, because she found the teacher guilty and sentenced her to four years in jail, with possibility of parole in six months.  Even though what she did was wrong, I think it's kind of stupid to send her to jail.  A few weeks ago, a local businessman who was found guilty of accounting fraud and bilking customers and employees out of money was sentenced to seven days in prison.  The difference in prison terms doesn't make sense to me at all -- but maybe that's why I'm not a lawyer.

On another note, my attempts to stave off my impending depressive crash after a few weeks of hypomania were futile.  The bottom dropped out on Thursday, and I'm still trying to recover.  I guess I'm more of a slave to my chemicals than I want to believe.

Knitting for the Holidays...and to Avoid a Crash

Since I'm back on the knitting train now, working on my entrelac scarf and another cool zigzag scarf, I was thinking of trying to knit some gifts for Christmas.  Last year I did a couple of scarves for my sister-in-law and for my mom (I'd post the patterns but I have no idea where they are), so I was thinking of doing some cute amigurumi dolls for my kids and for some other small family members.  I got one kit and I'll see how it goes, and how long it takes to make.  I made a cute "Sheldon" turtle a few years ago for one of my girls, and it took FOREVER.  I don't want to be too ambitious.

When I get in phases like this and have about sixty-seven different projects going, I really feel the brunt of my bipolar disorder.  One sign of bipolar disorder is having lots of unfinished projects.  Of course, lots of people have lots of unfinished projects and aren't bipolar, but I think with bipolar disorder, in a manic or hypomanic phase there's a certain urgency to start different things, all at one time.  I know I often start to feel pressured, and want to get lots of things done as soon as I can.  The problem is that after a little while of this kind of behavior (a few days, a week), I crash out and sink into a depressive phase.  This is a pretty common trait of bipolar disorder, too.

I'm trying to avoid that this time by pacing myself, doing a lot of deep breathing, and limiting my caffeine.  One of the most important lessons I learned the last time I had a serious depressive phase is that caffeine is NOT my friend.  I can have maybe one Diet Coke (my Achilles' heel) and a cup of coffee a day, and that's it.  It's better if I have none at all, but when my kids are demanding stuff and the baby is crying, I could do a lot worse coping-wise than grabbing a Diet Coke.

And I'm trying to make my knitting urge work for me, instead of against me.  Instead of getting frantic about finishing all these projects at one time, and starting sixteen new ones for Christmas/birthday/Tuesday gifts, I am trying really hard to focus on one (or two - let's be realistic here) things.  And if I can focus on a few things, maybe I can thwart the pressured thinking and thus thwart the coming depression. 


I guess what I really wonder is:  is the crash unavoidable?  Most of the stuff I look up online seem to just assume that after a manic or hypomanic phase, a bipolar person will inevitably fall into a depressive phase.  How much can I control, and how much does the bipolar disorder control me?  I guess we'll find out.

Family fun with hypomania

I actually have Bipolar II Disorder, which is different from Bipolar I because of the manic states.  With BP I, the manic states are much more...well, manic.  The person has delusions -- sometimes of grandeur, sometimes of paranoia, whatever -- and can engage in seriously harmful behavior or become detached from reality.

With BP II, the manic stages are milder -- they usually involve elevated energy levels, less sleep, rapid speech, and over productivity.  I've always called my hypomanic states my "creative times," because I seem to get a lot of ideas and want to work on art projects or write.

Recently, I've been in a hypomanic state.  I've felt very pressured to get lots of things done -- write a book proposal, tile my kitchen, paint the kitchen, clean the house, etc.  I've also found myself having racing thoughts and talking more than I should.  I also get irritated a lot faster.  I've been pretty productive, so I can't say that it's a totally bad thing. 

My biggest concern right now is what my kids are thinking.  Mommy's really productive right now, in a good mood (mostly), and around.  What happens when the hypomania wears off (which it inevitable does)?  Will they even notice?  Are they too young to try to explain this to?

In general, I want to shield my kids from the idea, and possibly stigma, of my mental illness.  But is that the best thing?  I did a little web research and found a few links:

Parenting with Bipolar Disorder, from Two Trees Media (the "Bipolar Disorder Experts," so they say)
How does a severe Bipolar parent affect kids?  From Livestrong.com (written by a "contributing copywriter")
Growing up with a Bipolar parent, from Associated Content

What strikes me from these articles isn't their content, but their lack of content.  Where are the articles by psychiatrists?  There are a lot of articles about the hereditary implications of being a parent with BP, but not much about the emotional impact. 

I'll have to do some further research and see if I can find some testimonials or researched info about this topic.

For now, though, we'll just keep having family fun (and productivity) with hypomania.