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Bipolar Through the Years – Getting Your Diagnosis Right

Difficult to diagnose Bipolar Disorder?

I am not bipolar!  I am (insert other diagnosis here)

I received my first bipolar diagnosis when I was about 30… ish minus a few years.  I am 40… ish plus a few years, so for most of All About Bipolar Disorder20 years (yes I know the math doesn’t work out but this is a true story), I have known that I have Bipolar Disorder.

If you are bipolar yourself you will know that when I say “I have known” it really means “I was told”.  I didn’t believe it at first.  I thought of every other thing it might be and tried really hard to convince the therapist “that isn’t me… not really”.

As an untreated, newly diagnosed bipolar, I felt compelled to express clear objections to specific parts of the diagnosis that did not fit.  I was trapped by the details… a problem which I have often suffered – or more like, caused others to suffer because of.

Over the years and through several different diagnoses and many periods of “those” risky behaviors, going on and off various meds, wrecking certain parts of my life – and recovering once again, I find that those details don’t matter anymore.

I used to have a vitriolic reaction to the suggestion that I should want to be “normal”.  NORMAL, I said… I don’t want to be Bipolar TherapyNORMAL.  Normal is boring.  I was many things but boring was not one of them.

I no longer have that reaction.  My life would have been easier if it were normal.  I would have missed all the bright, scribbly colors.  I would have missed all the scary but fun stuff… but then maybe I wouldn’t have gotten so tired.  Maybe I wouldn’t have had to shut the curtains and hibernate.  Maybe I would have missed all the scary and dark stuff.

Anyway – as usual, I veer off of my topic.  Today, I am 99 percent sure that I am bipolar but I do reserve that remaining 1 percent – just in case.

Over those years – starting before (way before) I was diagnosed as bipolar – I sought treatment.  At 14, I asked my parents to take me to a psychiatrist because there was “something wrong with my brain.” They said “no, there isn’t” effectively telling me that I was just a mouthy, disgruntled, histrionic teenager – which I was, but I was also bipolar.

I often wonder what might have been if I had been treated then and do watch my kids for the same occurrence.  Unfortunately at that time, a proper diagnosis was highly unlikely and probably wouldn’t have changed much.  Except I would have felt heard – and I didn’t.  I do try to hear my kids.

Once I was able to seek treatment for myself, I was diagnosed with several other things long before they hit the jackpot.  The first was “dysthymia” – oddly, this diagnosis came in the middle of a severe depression.

Dysthymia for a bipolar

I was in college, just a hair short of being suicidal, and had to sit down one day and decide if I was going to kill myself – or study.  Serious DoctorLacking concrete plans and lacking a sincere wish to die, I decided to study – but I did go to the student health center the next day where a kindly graduate student decided I was dysthymic and would benefit from group therapy.  Being the mixed-manic that I am, I was in a temporary state of “not so bad” and failed to mention the depth of my despair.

I went to group therapy with a bunch of whining college kids and two well-meaning graduate student supervisors for almost a year.  To be fair, some of these people may have had real problems.  A homosexual boy who was still “in the closet”, a secret cross-dresser, a bulimic, a giant athlete with a sever anger issue and mommy problems… and a couple of other whiners.

I never once mentioned that I was hallucinating at night… or that I couldn’t keep my thoughts going in a straight line….or that I was living in a dark grey fog… or that despite all this, I still wasn’t sleeping.  My dysthymic self simply whined away with the others about parents, childhood, professors…it may have kept me from killing myself but mostly it was just entertainment.  It also kept me from failing out of college, as the dean of my college was informed that I was “in counseling”.

Major Depression for a bipolar

When I finally admitted the hallucinations – that got some real attention.  It also got the notice of a physician – and her medical Medical Doctorstudent who proceeded to ask me stupid questions like “how much LSD have you done?”  I also got a very “fun” visit to a sleep clinic — where the results were inconsequential even though my case was examined by a neuropsychiatrist – or a psychiatric neurologist – whatever that is.

Still, I got the diagnosis of Major Depressive Disorder… I still wasn’t sleeping – and people were literally terrified of me.  Describing me as agitated would be like saying the Niagra River is a stream.  Major Depressive Disorder.  They did give me meds though, stopped the hallucinations and got rid of all that grey fog and I managed to finish college.

Codependent for a bipolar

Moving on a few years on and off antidepressants and anxiety medicines – never feeling right….risky this, risky that….institutionalization (not jail or at least not this time, but still…).  After a particular disturbance, one “therapist” told me I was “codependent”… little did he know how dependent I was…or on what.  I ignored him.

The “intensive treatment” did get me the diagnosis for bipolar disorder which I denied, and did so for many years.  On and off meds, risky this, risky that…back on meds…off…on.

ADHD for a bipolar

A few years later I was pregnant (married too, woo hoo) and had to go off the meds.  After I had my kids – the doctor that I saw said that I was ADHD – not bipolar.  Still not wanting to be bipolar, I took the prescription he gave me….which was of course an amphetamine.  Well that worked well – nuf said.  To be sure, my kids are fine.

Bipolar HeartbeatEventually, I came to reality and the bipolar diagnosis and back to the right meds.   This has required honesty.  Honesty with health professionals and honesty with myself and it requires taking my meds.  I am tired from all the bright squiggles and the darkness.  I do want to be normal.

Now, as a bipolar, I get to watch my kids and see if they have “it” or something else.  Either is scary, both are scary but I hope I will be more help than my parents were.  I still take my meds but I also still retain the right to act on the 1 percent in case something better than bipolar disorder comes up.

Psychologically and Physiologically Addictive Medications

Are antidepressants psychologically or physiologically addictive? – Kind of – but not in the way that you think!

For many years, most of the medical community have held steadfast to the idea that antidepressants were not “addictive.” But many Prescription Pain Medicationof those, not in the medical community or those with no personal experience of drug abuse or psychiatric illness, were convinced that those happypills were subject to abuse.  In fact, both were wrong.  Antidepressants are not “abusable“, but they are sort of “addiciting“.

To be clear – antidepressants are not subject to abuse.  They do not produce a “high” or anything like intoxication.  There is no immediate reward for taking antidepressants; in fact, one of the most troublesome things about antidepressants is that they take several weeks to actually work.

However, there is a difference between “abusabledrugs and “addictivedrugs.  Addiction is generally thought of as a psychological illness – in the way that marijuana and cocaine are psychologically addictive.  There is little evidence that either drug is physiologically addictive.  The body does not become dependent on the drug… the brain may – but not the body.

On the other hand, some medications are physiologically addictive – without being psychologically addictiveHormones are an example of this.  Once you start taking hormones (such as estrogen replacement), your body will adjust to the presence of the Psychologically Drug Addicted Dreammedication – and if suddenly discontinued, will not function normally.  There are many other examples of this, but you get the point.

Drugs like heroin, alcohol, and tobacco are psychologically addictive – but they are also physiologically addictive.  In addition to the brain “wanting” them, the body “needs” them to function normally.  If you suddenly take away the heroin, a severe withdrawal syndrome will begin.  If you suddenly take away alcohol – you may have seizures and a number of life-threatening conditions.

Prescription pain medications and anti-anxiety agents, when taken inappropriately can also be both psychologically and physiologically addictive – like heroin and alcohol.  When taken as prescribed, they are often still physiologically addictive.

Back to the antidepressants.

Certainly, years ago, sudden withdrawal of prescription antidepressants was known to be dangerous. But, with the development of selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil, and many others, most people have believed that there was no chance of physical addiction, and there would be no withdrawal.

Over the years, I would hear about people who complained of “withdrawal” symptoms which I dismissed – like most people in the medical community.  Many of these patients also had a myriad of complaints – generalized pain, foggy thinking, and other things that were considered to be indicative of a hypochondriac or chronic complainer.  Turns out maybe I was wrong.

SSRIs and other “next generation” antidepressants CAN cause withdrawal symptoms.  Some (not all but some) patients may experience symptoms of withdrawal such as Anxiety.

  • Anxiety
  • Anxiety and irritability
  • Depression and mood swings
  • Light-headedness and dizziness
  • Fatigue, headache and flu-like symptoms
  • Electric shock sensations
  • Loss of coordination, tremors and muscle spasms
  • Nausea and vomiting
  • Nightmares and difficulty sleeping

Most people don’t experience these – or have only a mild reaction.  Unfortunately, even “tapering” down won’t make that much difference as the symptoms may take a long time to go away – but the withdrawal is real and shouldn’t be dismissed!

Melissa Lind

Depression in Children

It may not seem possible, and most people don’t want to think about depression in children.

Different from developmental disorders such as ADHD or Autism Spectrum Disorders and different from mental disorders such as Schizophrenia, which have obvious symptoms, Depression can occur in children.

Childhood DepressionUp until about 20 years ago, depression in children wasn’t widely recognized.  It wasn’t that the depression didn’t exist; it was undoubtedly just that we didn’t know about it.  Two decades ago, even if the child was aware that “something” was wrong, the parents, teachers, and other adults were likely to dismiss it as a “stage” or “phase” that the child was going through.

There were several reasons for that way of thinking, such as:

  • A belief that children didn’t get depression – adolescents were dismissed as “moody,” younger children were dismissed as “difficult.”
  • Medication available for depression wasn’t appropriate for children due to severe side effects.  Newer antidepressants were not available until Prozac was approved in 1988 for adults.  These medications known as “serotonin specific reuptake inhibitors” (SSRIs) were not approved for children until 2002 and to date, only Prozac is recommended for depression in children though Zoloft and Luvox may be used for Obsessive Compulsive Disorder (OCD) in children.
  • The long-term effects of depression were not yet known.  Depression at any age can contribute to chronic diseases such as diabetes and heart disease.

Today, we recognize childhood depression.  About 11 percent of children have experienced at least one episode of childhood depression before the age of 18, according to the National Institute of Mental Health. Normal behavior can certainly vary from child to child and from age to age – as children are prone to “stages” that they will grow out of.  But if a child has an extended period of depression – it is something that should be properly addressed. Such serious issues should not be taken lightly.

Juveniles (those up to age 17) often have different symptoms of depression than those common in adults.  Children with depression may be excessively sad and lethargic, but depression may also show as:

  • Complaints of illness
  • Refusal to go to school
  • Clinging to a parent or caregiver
  • Excessive worrying
  • Sulking
  • Grouchiness
  • Anxiety
  • Acting out at school
  • Excessive negativeness
  • Feelings of being misunderstood

Depressed FeelingsThese symptoms are occasionally experienced by most children as they are growing up, but when symptoms persist for several months or interrupt normal activities and development, more investigation is needed.  One needs to find out what the cause may be.  If a child is being bullied – he or she may not want to go to school.  If a child complains of illness – it may truly be sick.  On the other hand if these events occur over and over, you need to discuss the problem with a doctor.  You may also need to see a child psychiatrist or psychologist.  In some cases, therapy may be warranted but in other cases, the child may benefit from medication suitable for depression.

In any event, you should not ignore symptoms of depression or any other mental illness signs – but investigate them.  It may be that your child is “going through a stage”, but it may be more serious.

Children complaining of illness may be depressed!

Panic Attacks and Anxiety

Suffering from anxiety disorder and have panic attacks?

Do you have anxiety?
Are you constantly worried?

We all probably know that anxiety is a normal part of life.  That horrible feeling of anxiousness is something that can happen to all of us from time to time — and with good reason. However, many people suffer from anxiety without any valid reason — regardless of how correct the reason for the anxiety seems to them.

Anxiety can cause a host of other mental health problems.
Child AnxietyFirst, when the brain is stressed, the body’s immune system fails to function properly. Things like this leads to illnesses. Second, anxiety can prevent one from living life to the fullest. And, finally, stress can lead to full-blown anxiety attacks, otherwise known as panic attacks.

A panic attack might feel like a heart attack. In fact, when one suffers their first panic attack, this is what they think that it is, in most cases. They will usually seek out medical emergency services. A lot of the symptoms are often the same as a heart attack. The person may feel chest pains, have trouble catching their breath, become dizzy, feel nauseous, and also feel completely out of control.

AnxiousLuckily, you won’t die from a panic attack — even though you can’t be convinced of that when it is happening. Even better news is that panic attacks can be prevented. Medication can be prescribed, relaxation techniques can be used, and counseling, in the form of Cognitive Behavioral Therapy (CBT) can be sought.

Your doctor will most likely prescribe an antidepressant for your anxiety. However, antidepressants take about three weeks to become effective, and during this time, you may discover that you are more anxious than you were before. Panic attacks may become more severe during this time.

For reasons mentioned, your doctor may also prescribe a benzodiazepine. The benzodiazepine will effectively take care of the anxious feelings, and help to prevent panic attacks. However, this is not a safe long-term drug, as antidepressants are. Therefore, after about three weeks, your doctor will most likely discontinue the benzodiazepine, and continue with the antidepressant. Naturally, CBT will also be recommended.

Panic attacks are very real — and very scary. If you suffer from panic attacks, know that there is treatment out there, and with that treatment, you can avoid future panic attacks.

Stress and Anxiety – Is There Any Relationship? (Free PDF)

Panic attacks and anxiety disorder sufferers

Obsessive Compulsive Disorder – OCD

Collecting, Organizing, Checking, Washing…. Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder.

OCD - Bug ObsessionIt is composed of two parts: Obsession and Compulsion.  Obsession is the portion of OCD that occupies your thoughts such as excessive concerns about cleanliness (my kids call this germophobia), extreme social fear, fear of harming someone, preoccupation with organization or other intrusive thoughts that create anxiety.  Compulsion is the physical manifestation of needing to do something about the obsessionsCompulsion results in behaviors such as ritualistic behaviors like excessive hand washing, repeatedly checking to make sure the stove is off, counting steps and other extreme behaviors such as hoarding.

OCD the Good
Once I while participating in a wedding, I was attending the rehearsal dinner at the home of the bride whose mother made the appetizers for over 200 people.  I was amazed at her management skills that made her capable of preparing appetizers from a single kitchen – right up until the time that when looking for the restroom adjacent to the laundry, I opened the pantry door.

There, staring at me were over 100 spice containers, of all the same brand, all the same size and all angled at a precise 45-degree angle so that the labels were all pointed exactly at my head.  I was so dumbfounded that I continued to stare and found that on the other shelves there were precise pyramids of 5 cans each of various vegetables – all the same brand, all the same size, with all the labels facing exactly the same direction.

Lining the floor were plastic bins, spaced 2 inches apart…exactly, containing 3 bags each of a variety of pasta, flour, rice…. all of course the same brand, carefully placed in the bin, with the label in exactly the same location.

This is OCD at its best – at least for others.  She had an obsession and a compulsion that created this superbly organized pantry.  Likely though, even this “good” OCD manifestation took up a lot of her time – and had a negative impact on her daily life and that of her family’s.

OCD is not always at its best however and can result in the opposite – hoarding.  I don’t have to go into this but if you haven’t seen it, you should watch “Hoarders” or “Hoarding, Buried Alive” for some insight.

OCD the Bad
In addition to situations like hoarding, OCD can also interfere with life in other ways.  I have a cousin with OCD, who before he was medicated, found himself unable to leave his driveway due to fears that he would back over a child with his car.  This caused him to spend hours – literally hours every morning starting the car, looking in the rear view mirror, getting out of the car to look behind it, getting back in the car, looking in the rear view mirror, getting out of the car….  He eventually found himself unable to work.

Obsessive Compulsive Disorder - OCD Confused MindOthers have found that OCD has limited their lives in similar ways.  Howie Mandel, a well-known comic, has talked about his Obsessive Compulsive Disorder.  It prevented him from appearing in public for many years, in part due to social fear but also due to fear of infection.  Even today, while his disease is “under control,” he does not ever shake hands or allow others to touch him.

How do I know if I have OCD?
A lot of people have rituals – such as specific routines before bed.  A lot of people have extreme concerns which may consume thoughts for a while – such as excessive concerns over money.  The difference in “normal” rituals and “normal” concerns is that they don’t typically impair normal life and they don’t become paralyzing.

Thoughts and behaviors that might indicate OCD:
•    Repeated thoughts or mental pictures about things such as
o    Germs
o    Dirt
o    Intruders
o    Violence
o    Hurting others
o    Embarrassment
o    Disorganization
o    Religious beliefs
•    Repeated behaviors such as:
o    Washing hands
o    Disinfecting surfaces
o    Locking and unlocking doors
o    Counting
o    Repeating steps over and over
o    Keeping unneeded things
o    Excessive grooming
•    Lack of ability to control or stop unwanted thoughts and behaviors
•    Repeated behaviors provide temporary relief from anxiety that is caused by obsessive thoughts
•    Repeated behaviors don’t provide any pleasure other than temporary relief
•    Spending at least 1 hour a day on thoughts and behaviors, creating a negative impact on daily life

The International OCD foundation reports that it takes around 15 years for most people to be diagnosed.  This may be due to hiding of symptoms – but it may also be due to lack of awareness of both the public and health professionals.

What can be done about OCD?
OCD can be treated – it usually cannot be cured but can be controlled.  First line treatment for OCD includes working with a properly trained therapist – most beneficially, one who is trained in cognitive behavioral therapy (CBT).  CBT uses “exposure to” unpleasant stimuli, carried on to the “what if” stage.  “What if” I touch that faucet without disinfecting it?  “What if” I get into the elevator without opening the door 10 times?  The “exposure” period is followed by “response prevention” where the patient chooses NOT to perform the behavior that the “exposure” usually causes.  Over time, the obsession and compulsive thoughts and behaviors become more manageable.
In other cases, medication may be needed – usually given in combination with CBT.  Some antidepressants (not all) will help with OCD.  Anti-depressants that have been shown to help include:
o    Luvox (fluvoxamine)
o    Prozac (fluoxetine)
o    Zoloft (sertraline)
o    Paxil (paroxetine)
o    Celexa (citalopram)
o    Lexapro (escitalopram)
o    Effexor (venlafaxine)

Other medications may also help but have not been “approved” to treat OCD.  Doctors who have found them helpful may use them regardless of whether they are officially approved to treat OCDMedications such as Cymbalta (duloxetine) have been reported to be helpful – and some patients may benefit from short-term use of anti-anxiety agents.

It is important to know that all medications may cause side effects and you should tell your doctor about any other medications you are taking.

Melissa Lind

Obsessive Compulsive Disorder (OCD) is a mental disorder characterized by intrusive thoughts that produce anxiety and by repetitive behaviors aimed at reducing that anxiety.

Obsessive Compulsive Disorder can be treated!