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severe depression

Bipolar II Rant from a Bipolar I

Ranting on Bipolar II

For starters – this is a pure opinion piece.  I am going to rant a bit about Bipolar II.

I read a lot of bipolar “stuff” – articles, study results, chat boards, Facebook pages – a lot.  Recently, once again, I have become irritated by the use of “Bipolar II”.

I recognize that Bipolar II is a DSM diagnosis that indicates that a person has cyclical periods of depression alternating with Bipolarity in Hellhypomania.  I know that is true – and that the diagnosis must fit some people. Bipolar I, on the other hand, is defined as cyclical periods of depression, alternating with manic episodes.  If you are a rapid cycler or have mixed state disorder – you are usually classified as Bipolar I.

My current irritation is with a story – not a celebrity this time – but an apparently real person from a news story.  The article reports that this particular woman had been diagnosed with Bipolar II when she was 20 and now 38, she is stable on a myriad of pharmaceuticals.  Fine.

The article goes on to say that she “experiences the manic phase” but mostly struggles with the severe depression, adding that she also has PTSD, anxiety and has been unemployed most of her life.  Let me repeat, she has manic phases, PTSD, and anxiety. She has always been unemployed (due to her psychiatric condition).  Doesn’t sound very stable to me…and doesn’t sound much like Bipolar II.

I have a problem with the fact that so many stories I read are about people who claim to have Bipolar II, and are careful to clarify that they don’t have Bipolar I.  Naturally, this would be a kinder, gentler form of Bipolar disorder.  A Bipolar disorder where we never bother anyone, get lots of stuff done in an organized fashion but sometimes get depressed.  A Bipolar disorder that makes us “better”.  Better than Bipolar I’s craziness – and even better than regular people.

I don’t live in that world, and I am not truly convinced that it exists.  I have known lots of people with Bipolar disorder – in fact, I used to go to a group just for people with Bipolar disorder.  Every single person there was initially told they were Bipolar II – and then once they got used to that… the real news came out.

Many of us were “high functioning”, many of us had “good jobs”, many of us were “organized”… except when we weren’t.  We didn’t come to the bipolar group because things were going great.  We had all had periods of depression, periods of extreme productivity and periods of crazy when we told the truth.

Bipolar RantIn my experience, people with Bipolar disorder don’t seek help.  They are driven to it – or dragged.  People are driven to help when they are depressed, and they are dragged to help when they are manic.  If they arrive when depressed, they don’t report the mania that gets them a Bipolar II diagnosis.  If they arrive when they are manic – they won’t listen to anything about “crazy manic depression” so they are told about how much better Bipolar II is.  They will take the diagnosis and take the meds.  Either way, the first diagnosis is probably going to be Bipolar II.

I could claim to be Bipolar II.  I could even get a couple of doctors to agree with me.  Most of the time, I am “high functioning” – except when I am not.  Bipolar I won’t ever lose the stigma if Bipolar II continues to be presented as “better” and people continue to be dishonest.

Take your meds!

Melissa Lind

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.

Bipolar Disorder Research Funding – Poorly Directed

Prepare yourself for a bit of a bipolar rant!

An article entitled “Bipolar Disorder in Youth Not as Chronic as Thought” in Medscape Pharmacists e-newsletter came across my email and while I was initially quite interested, I soon became annoyed.
Bipolar and Borderline (BPD)A recent study done at the University of Pittsburgh School of Medicine shows that bipolar disorder may not always be a chronic condition. While this may look like good news and you might see it pop up in the media as a big positive – cheerleader kind of thing, it really isn’t.

The study followed 413 children and adolescents who were 7 to 17 years of age and diagnosed with bipolar disorder at the time of study enrollment.  The patients and family members were interviewed about every eight months, for eight years.  What they found was that some of the patients were “ill” most of the time, some were “well” most of the time, and some were both ill and well.  Sorry, but that result isn’t astounding.

I find a couple of things wrong with the published results.

  1. They didn’t say whether the patients were stabilized on medication during the study – what medication, whether the medication was changed, whether the patients took the medication – in fact the publication doesn’t mention medication at all.
  2. The data collected was based on “interviews.”  Sorry, but being bipolar inherently predisposes you to lack of complete transparency.  Bipolar patients are likely to hide and lie – whether it is purposefully or subconscious behavior, it is a known problem.
  3. The patients were ages 7 to 17 when entering the study, meaning they were 15 to 25 at the end.  Many of the patients went through puberty during the study and what pubescent child or the post-pubescent adolescent is truly stable…or honest for that matter.  Interviews with the family may have partly balanced this but we also know how “well” our families may know us…some, not at all.

What I did find a little more relevant was that the patients tended to be “well” more of the time if they:

Though true, this is not astounding either.  It is easily recognized that if your family has a history of mental disorder, you are more likely to have a mental disorderBipolar disorder and substance abuse go hand in hand, and sexual abuse makes nothing more manageable.

Incidentally they also showed that patients would be more stable if they:

•    Had less history of severe depression, manic or hypomanic symptoms
•    Had fewer subsyndromal episodes

So basically, if the patients had a history of fewer episodes, they would have fewer episodes……really?
Not discounting the fact that any academic attention given to bipolar disorder, especially in juveniles should be welcome, I am disappointed because the study results didn’t show anything.  This is all information that anyone could guess – and the funding for mediocre “non-results” could have gone elsewhere.

This sort of news can easily lead to an “it will go away” thought process, lack of medication and lack of attention to and acknowledgment of the real and long-term challenges that a bipolar patient can face.  Yes, let’s all believe that bipolar disorder is not a chronic medical condition… let’s undo all the progress that has been made.

Melissa Lind

Academic attention given to bipolar disorder should be welcome!

Mental Health and Grief

Grief and Mental Health – When the Two Merge

Grief is something that we all experience at one time, or another.  The stages of grief – sometimes explained as 3, 5 or 7 different stages – are pretty well known and include shock, denial, anger, sadness, acceptance in some order.  Most people will struggle but eventually come to some resolution with no prediction as to how long that will take.

Resolution of deep sorrow can be made much more difficult when a pre-existing mental illness is imposed.  A severe loss can trigger a relapse of virtually any mental illness, even when the illness was well treated, and the patient was stable.  Patients may relapse into severe depression, bipolar episodes, panic attacks or a return of obsessive compulsive behavior.  If the patient was not well stabilized, the whole apple-cart can be upset.

Depressed and Suicidal GirlEven the most mentally healthy person can become unstable if unable to resolve the feelings caused by painGrief has been known to result in clinical depression, lasting for a long period which can lead to extreme difficulties and even death in the case of suicide.  The problem comes in a case where one becomes “stuck” at a certain point – usually during the agitation period.

There is a saying;   “depression is anger turned inward.”  The existence of anger over an extended period can cause depression.

Anger allows us to have a heightened response to a threatening situation.  Anger fuels energy, giving us a false sense of power, but over time, the brain and the body run out of that same energy.  This can result in fatigue, emotional lability, and symptoms of depression.  In some cases, depression caused by grief may be resolved with grief counseling.

In other cases, however, depression may have become severe enough that medication may be warranted.  Clinical depression is characterized by:

•    Fatigue and decreased energy
•    Cloudy thinking
•    Feelings of guilt, worthlessness or helplessness
•    Insomnia or excessive sleeping
•    Irritability
•    Loss of interest in pleasurable activities
•    Body pain or digestive problems
•    Persistent sad or empty feelings
•    Thoughts of suicide

How different is this from grief – not much.  The only difference would be in how long it lasts.  Depression carries a high risk of suicide and if symptoms last longer than what would be considered “normal” – for any reason – you should seek treatmentMental Health ChaosDepression that is severe enough to interfere with normal activities for longer than four to six weeks should be treated – even if life circumstances explained it.  Counseling may work – or you may need medication for a short period.

If you have some known mental disorder, stay in contact with your mental health professional.  Most – and I did not say “all”, but most mental health patients find it difficult to self-assess, some find it difficult to be openly honest.  The only way to ensure that an episode of grief is resolved without severe consequences of going “off track” is to allow someone else to help assess your mental state.

Whether you are or are not a mental health patient, know that grief can cause mental illness and can worsen an existing illness – even if only for a short time.  It is not something to be dismissed or ignored as the risks are high.

Melissa Lind

Depression is Anger Turned Inward

Robin Williams – Another Life Lost Through Mental Illness

Another Life Lost Through Mental Illness

I recently wrote about “Celebrities and Bipolar Disorder,” many of whom are also drug addicts, alcoholics and suicide victims – but the recent death of Robin Williams has brought the issue of other mental health disorders including depression – and suicide to the front of my mind once again.

Of course, you know that Robin Williams died of “asphyxiation” – notable suicide by hanging. At first we were shocked, then sad as a great talent was lost. In a few days, many people will become angry at him. Many people don’t understand depression; some don’t even believe it exists.

Robin Williams - Depression KillsRobin – and I call him that purposefully rather than the more proper journalistic reference “Mr. Williams” or simply “Williams” – has made an impact on my life and that of my children. Like many people, I felt like I knew him. I haven’t seen all of the 80 movies he was in, but my personal favorites were the movies that were not comedies. He was a gifted actor and a tremendously funny man.

I said I “felt” like I knew him – but I didn’t. My children “feel” like they knew him – but they didn’t. I don’t know much about his childhood – other than that he was raised in a family where, though there was probably plenty of money, he spent most of his time with nannies or alone. He obviously had a brain that never quit – which leads me to believe he may have had ADHD, he certainly had troubles with substance abuse and he had periods of severe depression, one of which led to his death.

People are already questioning why such a talented man – who had given so much – would “go and do something like that.” Many of those people will feel like he was selfish – as many people feel like suicide is the ultimate in narcissism. Under all that hilarity, under all that spectacle, under all that talent, was a seriously sad man.

Never mind what we don’t know about his childhood, over the course of his life he had great success and tremendous loss, with the making of fortune and fame and the loss of loved ones and money. He ultimately chose to end the pain himself.

Metally Ill - Robin WilliamsDepression is not something that can be shared and Robin was a “smiler.” Even in my life, though I am not a “smiler” – when I am having great difficulty, I do not contact the people who matter. I do not call my friends; I do not call my family; I sit in my difficulties alone.

Like many comedians, Robin learned to be funny to cover pain and to cover loneliness – and to get attention that he craved. Mental illness is difficult to understand and even though we mourn his loss – we should reflect on who in our lives might be feeling the same pain.

Maybe – likely not, but maybe, if he had the kind of support he needed, if he had not felt like he always needed to be “on” he would not have felt the despair so strongly. Maybe if mental illness and substance abuse weren’t still stigmatized, maybe he could have gotten the help he needed.

Maybe, but maybe not.

Another famous actor – once said in a famous movie – “Momma says that dyin’ is a part of livin’… I wish that it wasn’t.” Unfortunately, some people feel they must choose to die early. Robin did.

Melissa Lind

Another famous actor died because of mental illness