Mindful Eating for Bipolar Disorder & Exercise

"How do different foods affect mood? It’s an important question when you are trying to keep bipolar disorder in balance, and one that science has been striving to answer—with varying results.

"The current consensus seems to be that no one food is as important as good eating habits overall." 1.

1. https://www.bphope.com/mindful-eating/

This is the way I am getting back into shape.  Back around 2004, I started a diet not unlike what's described in the link above- salmon, whole grains, natural peanut butter, lots of fruit smoothies, no alcohol and very little caffeine.  I rode my bike every other day and lost 60 pounds.  Now, I am on the same track to lose the Zyprexa (and Depakote) weight.  So far, from my highest, I've lost 15 or 20 pounds.  I've been walking and riding my bike this Spring- and what a gorgeous Spring it has been!

As much as I would like to eat salmon and/or take fish oil supplements for the Omega-3's, I have developed a seafood allergy since 2004: even the smallest amount that touches my lips or tongue and I immediately swell up.  I have an epipen and benedryl just in case.  Why do I say 2004?  Well, that was about the time that I not only lost weight, but 2005 is when I had elective surgery and ended up with multiple pulmonary emboli- blood clots in my lungs.  I was told I couldn't take judo anymore, and I was diagnosed with bipolar disorder and started on Depakote.  I have a vivid memory of taking my first pill- a large, gray-blue-ish oblong tablet- and thinking "Once I take this, I'm going to gain weight..."  I tried jumping back into judo a year ago, but I was too out of shape and everything felt wrong with the large amount of extra weight. 

Now, I hope to lose the weight first and then go back, brisk walking and bike riding.  What's more, I am doing all this to cure myself of fatty liver disease.  I have an appointment in August for a check-in.  So far, my clothes fit better but the scale won't budge.  Time to step up my game!

Saw Psych. Nurse Practitioner

Saw pdoc this morning. She doesn't think I'm at baseline still so she put my seroquel up to 400 and added Haldol 2 mg. She mentioned the hospital but said "you don't want to go there, do you?" Uh... Not unless I HAVE to! So my symptoms are still speedy in general, impatient driving, writing in my blog nearly daily- sometimes 2x/day, still believe what I said about being one with the universe... She said something about being hypomanic after asking if I've had any hallucinations. (No.) Maybe that was just a question. Now Ive forgotten how much Seroquel to take! I have 200s at home but just picked up 300s at the pharmacy. I know it can't be 500...At any rate, she is still trying to "knock me down". She also said that I always teeter on the edge medwise.

ETA: its 300 total Seroquel. I called.

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I thought I'd update on how my appointment went this morning. I'm not sure what my nurse practitioner was thinking really but she did say something about hospitalization- then said I probably didn't want that. So she changed my meds- if this doesn't work, I'll have to be hospitalized just to get my meds right- to keep Seroquel the same, Rexulti the same, and add Haldol- a low dose for now. A chemical straightjacket, that's what I'm ingesting! She also commented that I walk a thin line with psych meds in general between what cocktail works and which doesn't. 

Bipolar Disorder & Migraines

"Most studies support that migraine is associated not only with bipolar disorder but also with major depression, panic disorder, social phobia [8, 9], drug abuse [10], suicide, and neurological and internal diseases too, for instance stroke or hypertension [11]. " 1.

"Vice versa, according to a review of literature of McIntyre et al. [12], subjects with other neurological diseases, such as epilepsy or multiple sclerosis, seem to have a higher occurrence of bipolar disorder." 2.

"There is no proven treatment regimen for migraine with comorbid bipolar disorder, so that pharmacological therapy is still a matter of trial and error. Nevertheless, some remedies seem to have effects on both of the diseases, but one must be wary of purchasing the benefit of a remedy in one disease by worsening the other." 3.

"Migraine is an important comorbid disease in bipolar patients. It not only strengthens the cause of bipolar disorder but also worsens the recurrence rate with regard to depressive episodes. Bipolar II patients have a higher susceptibility of having comorbid migraine." 4.

"Approximately 4% of the population suffers from bipolar disorder, but bipolar illness is seen with increased frequency in the migraine population.³Studies have indicated that from 7.2% to 8.6% of migraine patients fit the definition for bipolar spectrum.^3,4 Conversely, several studies have indicated an increased risk for migraine in patients with bipolar spectrum disorders.5,6 One study indicated that in bipolar patients, 14.9% of the men and 34.7% of the women had a lifetime occurrence of migraine.⁵ Additional studies of the bipolar population resulted in a lifetime migraine prevalence of 39.8% for men and 44% for women.<sup>6" 5.

"</sup>Recognizing bipolarity in headache patients has a significant impact. When bipolar disorder is not recognized, these patients often are given antidepressants alone, with predictably poor results. While of some benefit, these medications generally are not effective for the bipolar spectrum and may trigger mania or hypomania. The presence of bipolar illness complicates the treatment of RCM. Mood stabilizers that help both conditions, such as lamotrigine or sodium valproate, are important. Atypical antipsychotics—quetiapine (Seroquel, others), olanzapine (Zyprexa, others), aripiprazole (Abilify), etc.—sometimes help both headaches and moods. Psychotherapy plays a vital role with these patients." 6.

"The most interesting finding was a substantial difference between patients with BDI and BDII, with migraine being clearly more prevalent in the BDII than in the BDI group. In our second study, 82% of the patients with BDII had migraine, compared to 27% of the patients with BDI (Figure). There is much evidence, including our own, indicating that patients with BDI and BDII represent two different nosological conditions (Coryell, 1996). Our results are similar to those of Endicott (1989), who found, among patients with major affective disorders, the highest frequency of migraine (51%) in patients having characteristics similar to patients with BDII as defined in the present study." 7.

"In two epidemiological studies, one from Zurich, Switzerland, (Merikangas et al., 1990) and one from Detroit (Breslau and Davis, 1992), a clear relationship between migraine and major affective disorders has been found (Breslau et al., 1994). In the Zurich study, people with migraine had a threefold-increased one-year prevalence of bipolar spectrum disorders (9% versus 3%), a nonsignificant increase in manic episodes and a twofold-increased prevalence of major depression (15% versus 7%)." 8.

"Several studies, both open and controlled, have shown that valproate (Depakene) has prophylactic effect in migraine, reducing the number of attacks, duration of headache and intensity of pain (Silberstein, 1996). Valproate thus has effect on the three main symptom groups in patients with migraine and comorbid affective disorders: headaches, mood instability and panic attacks (Freeman et al., 2002)." 9.

1, 2., 3., 4., https://www.hindawi.com/journals/crim/2012/389851/

5., 6. https://www.practicalpainmanagement.com/pain/headache/migraine/difficult-treat-chronic-migraine-bipolar-spectrum-personality-disorders

7., 8., 9. https://www.psychiatrictimes.com/bipolar-disorder/are-migraines-and-bipolar-disorder-related

How I got to 2019 with Bipolar Disorder

1988- age 16:  Felt "off" somehow.  Parents sent me to a psychiatrist who diagnosed me with nothing but being a "normal teenager".  My thoughts felt off some how.  I'd hear voices talking to me in the night.  I thought it was my sister but I'd check and she was always asleep in her room.

1997- Age 25:  While pregnant with my first child, I was diagnosed with depression.  I was filled with anxiety at times.  Prescribed Zoloft.

1999- age 27: again on Zoloft for depression and anxiety- my 2nd pregnancy was high-risk- had premature labor, hospitalization to stop labor, and 6 weeks of strict bedrest.

2000- Age 27:  One day I was in the bathroom and looked out the window.  In the sky were orange rectangles.  I'd look away but they were always there again.  I thought they were alien spaceships.  I called my husband in to look but he said there wasn't anything unusual in the sky.

2001-  Age 29:  Third pregnancy was also high-risk due to premature labor at 28 weeks.  Eight weeks of strict bedrest - as with my second pregnancy, I had anxiety and depression because of the premature labor and bedrest.  After I had my third child, I was seeing a psychiatrist who diagnosed me with post-partum depression.  I [trigger] had psychosis.  One day when I was in the shower with my 2nd child (age 2) I was washing her hair and saw my hands crushing her skull, blood and broken bone amongst hair and shampoo....[/trigger] My psychiatrist was a specialist in post partum depression but she never mentioned the psychosis.  I also had catatonic depressions.

2005- age 33:  Was walking my youngest into preschool one day, when I saw [trigger]a bloody scene before me: blood and spines and bones of the children thrown up against the walls everywhere...[/trigger] After I dropped my son off, I called my psychiatrist: she said not to go anywhere.  So I sat in my car.  Somewhere in there I was put on Celexa (as opposed to the zoloft I got in 2000).  I drove myself to Wendy's and went in.  I couldn't figure out what they did there.  I stared at the menu but had no idea what it said.  I asked myself what they did there but I really had zero idea.  I called my pdoc who freaked out and told me I shouldnt have driven.

2005- Age 33: I wandered around the neighborhood: everything was ultra real.  The smells, sights and sounds.... Somehow I relayed this derealization to my primary who sent me to another MD - he diagnosed me with premenstrual dysphoric disorder.

2005- Age 33: I was sent to a psychiatrist.  I was diagnosed after a bit with "Bipolar NOS" and put on Depakote.  I gained 50 pounds.  Previously I was a regular judo player and very fit.

2013 (?)- Age 31:  I changed pdocs somewhere in there and at the psych emergency services was put on zyprexa.  I was diagnosed with "Bipolar 1".  I've had various pdocs since then.  And many bouts with psychosis and mania and a bit of depression.

2013 (?)- Age 31: Somewhere in there I met my current pdoc and moved clinics.  I've gone through so many antipsychotics its not even funny.  Mood stabilizers too.  Pdocs have toyed with the idea of schizoaffective disorder but it goes back and forth.   Still hallucinate a lot.  I just got out of my worst Manicepisode a few weeks ago. (May, 2019).

2012-2017- Ages 40-45:  Oh and not to forget the 4 or so times since 2012 that Ive been  hospitalized in a psych hospital for up to 10 days each.  These include once in about 2014 when I [trigger]attempted suicide by taking 30 benedryl.  I was in the regular hospital and then the psych hospital following.[/trigger].  Hallucinations become severe and more often.  Delusions plague me.   Mania catches up with me and I almost had to be hospitalized.  Paranoia.  Not as much depression.  Lots of anxiety at times.  Lots and lots of med trials.  Difficult to find one I agree with.  Bouts of akathesia- at least 3.  A couple times my psych nurse practitioner talked about hospitalizing me but she didn't- I got a med change instead.

DSM-5 and Bipolar Disorder/ Bipolar Symptoms

"The "Diagnostic and Statistical Manual of Mental Disorders" (DSM) is published by the American Psychiatric Association and contains the formal requirements for classifying and diagnosing mental illnesses. You will often find references to both the fourth and fifth editions of the DSM. The DSM-IV was published in 1994 and the DSM-5 replaced it in 2013.

"The importance of the DSM is that it contains diagnostic codes for mental illnesses, similar to those for physical illnesses. For example, if a doctor orders blood tests and gives you a paper to take to the lab, the lab may insist that there be a diagnostic code on the order because they have to provide it to your insurance company. It's the same with mental illnesses: a psychiatrist can't simply tell your insurance, "This patient has bipolar disorder." He has to give them a specific code for the type of bipolar disorder."

.....

• "Axis I - Clinical Disorders (including bipolar disorder)
• Axis II - Personality Disorders and Mental Retardation
• Axis III - General Medical Conditions
• Axis IV - Psychosocial and Environmental Problems (stressors)
• Axis V - Global Assessment of Functioning"

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"For adult bipolar disorder, there are now five possible diagnoses:

• C 00 Bipolar I Disorder
• C 01 Bipolar II Disorder
• C 02 Cyclothymic Disorder
• C 03 Substance-Induced Bipolar Disorder
• C 04 Bipolar Disorder Associated with Another Medical Condition
• C 05 Bipolar Disorder Not Elsewhere Classified

Changes include:

• Elimination of "Mixed Episode." Instead, a manic, hypomanic or depressive episode can be specified as "With Mixed Features," a specifier with its own definition in the manual.
• The Bipolar II diagnosis in the DSM-IV excluded a history of mixed episodes. This exclusion has been removed, an important change.
• In addition, a subtle change is that the word "abnormally" was not included in Criterion A for a hypomanic episode, while it was in Criterion A for a manic episode. This brings the full criteria for the two distinct types of episodes much closer together."

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"Current Diagnostic Criteria for Bipolar Disorders and Episodes

Until the DSM-5 is actually published, the official diagnostic criteria are:

1. For Bipolar Disorder:

• Bipolar I Disorder
• Bipolar II Disorder
• Cyclothymic Disorder (Cyclothymia)
• Bipolar Not Otherwise Specified

2. Episodes:

• Manic
• Hypomanic
• Depressive
• Mixed (eliminated in the DSM-5)"

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Verywell Mind

Bipolar disorder isn't just about having mood swings. It's a serious mental health condition that used to be referred to as manic depression.

According to the DSM-5, the guide used to diagnose mental illnesses, there are two main types of bipolar disorder that can be diagnosed based on the severity and nature of their symptoms:

• Bipolar I – Individuals with bipolar I experience at least one manic episode in their lives. Although not required for the formal diagnosis, the vast majority will also experience major depressive episodes during the course of their lives.
• Bipolar II – Individuals with bipolar II have at least one hypomanic episode (a less serious form of mania) and at least one major depressive episodes.

Bipolar Mania Symptoms

Manic episodes last at least seven days. Hypomanic episodes involve the same symptoms, but the individual's functioning isn't markedly impaired and psychotic symptoms cannot be present.

Symptoms of a manic or hypomanic episode include:

• Decreased need for sleep
• Talking excessively
• Racing thoughts
• Being easily distracted
• Physical agitation and relentless movement
• Increased sexual desire
• Impulsive risk behaviors (including gambling and lavish spending)
• Grandiosity or inappropriate behavior
• Irritability, hostility, or aggression
• Delusions or hallucinations

Bipolar Depression Symptoms

During a depressive episode, an individual may experience the following symptoms: 

• Crying for no reason or prolonged periods of sadness
• Feelings of guilt or hopelessness
• Loss of interest in activities that usually give you pleasure
• Extreme fatigue, including the inability to get out of bed
• Loss of interest in your health, nutrition, or physical appearance
• Difficulty concentrating or remembering things
• Sleeping excessively or difficulty sleeping
• Suicidal thoughts or an impulse to self-harm

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From: https://www.verywellmind.com/what-is-the-dsm-5-379955

And: https://www.verywellmind.com/bipolar-disorder-symptoms-and-diagnosis-379962

How Have You Been?

One Sunday after church, the priest was saying hello to people as they left through the front door.  I was going another direction but he saw me and said "How have you been?  I haven't seen you in quite a while".  I had no real excuse for missing so much church- I'm in the choir too!  So I blurted out "I've been having a hard time with my bipolar disorder".  That shut him up.  I absolutelt HATE when I say something like that and FRIENDS go "Awwwww...." as if I were a little kid who'd lost their favorite toy.  I've often toyed with the idea of replying to ignorant comments with "I've been okay."  (Lie). [Trigger]Then, "I just got out of the psych hospital because I took 30 Benedryl at once."[/trigger]  That should keep them from asking again!

Life Stress and Kindling in Bipolar Disorder

"According to Post’s (1992) influential kindling hypothesis, major life stress is required to trigger initial onsets and recurrences of affective episodes, but successive episodes become progressively less tied to stressors and may eventually occur autonomously."

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"Is the longitudinal association between life stress and mood disorders static or variable? This question is especially important given data suggesting that risk of episode recurrence increases as a function of the number of past episodes (Kendler, Thornton, & Gardner, 2000; Kessing, Andersen, Mortensen, & Bolwig, 1998; Post, Leverich, Xing, & Weiss, 2001)."

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"A developmental psychopathology perspective highlights the importance of a changing relationship between genes, neurobiology, stress, and psychological factors in determining illness course (Miklowitz & Johnson, 2009). Consistent with this, Post (1992) formulated the kindling hypothesis of mood disorders. The basic tenet of the hypothesis is that major psychosocial stressors play a greater role in the initial episodes of a mood disorder, as compared to in subsequent episodes. The kindling model offers a developmental psychopathology perspective on the dynamic relationship between stress and affective episodes."

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"The kindling process occurs via functional and structural changes in neural activity (e.g., enhanced neuromodulator synthesis) that lead to sensitization of brain tissue. Post (1992) likened the evolution of stimulated to spontaneous seizures to the shift from stress-triggered to autonomous affective episodes in mood disorders."

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"Both electrical/chemical stimulation and psychosocial stressors can impact gene expression, imparting long-lasting effects on the organism’s reactivity profile (Post, 1992). Thus, in relation to affective episodes, life stressors may play dual roles: 1) an acute pathophysiological role, and 2) a stimulus that leaves long-term vulnerabilities, thereby lowering the threshold of stress required for episode recurrences. Moreover, mood episodes themselves may exert lasting effects. Through a combination of episode-related decreases in neuroprotective factors and increases in neurotoxic influences, individuals may be vulnerable to additional cellular damage with each successive episode (Post, 2007). Thus, as a function of psychosocial stressors and episodes themselves, lasting changes occur in neuronal functioning that mediate future stress responses (Hlastala et al., 2000)."

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"Therefore, according to the kindling hypothesis, major life stress is required to trigger initial onsets and recurrences of affective episodes, but successive episodes become progressively less tied to stressors and may eventually occur autonomously. "

From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072804/

Still Manic after Seroquel?

Just coming off mania but even still I sing all kinds of harmonies to The King's Singers in the car - loudly and in tune!- while my son keeps saying "Mother- STOP". Of course , I don't. The whole time that we are driving I do this. And I still feel that I know the secrets of the universe- and still feel foot-loose and fancy-free. Nothing bothers me! As far as depression is concerned I either don't have depression or I've blocked any memories of it.

Singing for a friend at Lunch

I went to lunch with a friend from our now-defunct lunch group. At the end of the meal, as I sat across from her, I was singing songs and explaining them to her. Drinking songs from the 17th century, an odd choral piece that included the lyrics, " A bird! A blue bird! A dead hawk rotting on a pole." And "Yellow, yellow! It is not a colour!" (I've forgotten what it is though!) Just singing happily along... This mustve lasted 10 minutes. Its 5:30- don't feel tired from staying up till 5:30 am and taking a couple-hour nap this morning. Now, I'm settled watching "Les Choristes"- a French film. I found it by accident years ago. Took my sox off- aaahh! FRESH! Lovin' dancing to the radio in the car- or the music in my brain- all those ear worms. At least today I didn't sleep the day away. Chemical straightjacket, indeed!

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Yellow, yellow, yellow, yello!
It is not a color.
It is summer!
It is the wind on a willow,
the lap of waves, the shadow
under a bush, a bird, a bluebird
three herons, a dead hawk
rotting on a pole-
Clear yellow!
It is a piece of blue paper
in the grass or a three cluster of
green walnuts swaying, children
playing croquet or one boy
fishing, a man 
swinging his pink fists
as he walks-

Carlos Williams. 

Set to music by Libby Larsen (1989)
Recoording in link below:
https://libbylarsen.com/index.php?contentID=240&profileID=1214&startRange=0

Still can't Sleep

Last night I was up yet again- watching "Office Space" for the 9000th time and looking stuff up on my phone. I was not tired one wink. And that's with 300 of Seroquel AND 100 of Trazodone on board. I did eventually make myself lay down - I'd read so much and refreshed the bipolar board every few minutes- that it was somewhat difficult to stop my mind racing. I mean, I found what appears to be the script to "Office Space" and read it. My newly-found fun habit is to make the top joints of my thumbs "crack". In fact, I couldn't stop cracking all the joints last night. So refreshing webpages and waiting for my joints to "refresh" so I could make them crack again while watching "Office Space" which I should have memorized by now. This is the fourth (?) Night that I,ve binged that movie all night?  I did take a nap around 5:30 a.m.

I want to go out but the maintenance man is coming to fix our ceiling at some point today. 

Oh yeah- still pleasure-seeking! I feel so alive, happy, unencumbered, free- like cool fresh air breathed in through my nose. Yesterday, I met my FWB buddy and yeah- its only enough for a few days then I want more.

Non-adherence & Antipsychotics

"These trials suggest that olanzapine is a viable option and an invaluable addition to the pharmacological armamentarium in the treatment of bipolar I disorder. However, this can often be mitigated by safety and tolerability concerns with this agent including weight gain and metabolic syndrome that warrants clinician vigilance and discernment that is imperative in today’s clinical practice. 1.
...

"Substantial advances in the recent years have fostered an expansion in the pharmacological treatment options for bipolar disorder, but optimal management of this devastating illness continues to remain an elusive goal. 1.

"The beneficial effects of atypical antipsychotics are often mitigated by an increased risk of metabolic abnormalities such as dyslipidemia, hyperglycemia, and diabetes mellitus in a population that is already at a heightened risk for metabolic syndrome and cardiovascular morbidity and mortality.

"Several agents used in acute and prophylactic mania treatment including lithium, valproate, olanzapine, quetiapine, and risperidone can cause problematic weight gain, which often can set the stage for non-adherence. Treatment non-adherence is a major concern in bipolar disorder with nearly half of individuals being non-adherent to psychotropic medication they are prescribed. Prudent practice demands a good risk benefit analysis in choosing an agent that is efficacious, safe and well tolerated when making clinical decisions." 1.

More here:
1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656294/

"Demonizing" Psych Drugs?

Member of a bulletin board says I'm "demonizing psych drugs".  My reply:

Its not "demonization"- its just information that I personally find scary. I can't just keep letting the state of my body go down hill if I can help it at all. Im only 47. I don't want to die yet- especially by continuing to keep my head in the sand- and especially of obesity-related causes; I already have pre-diabetes as it is, plus non-alcoholic fatty liver disease... Add to that the risks of heart attack, liver failure, high blood pressure.... among others from obesity, which traces back to the meds in the first place. Its just not a fair trade. They say bipolar people die, on average, 15 years earlier than they would have without bipolar disorder. And yes, some of this isn't all from obesity but a direct result of certain antipsychotics. That's scary. What does one do? A serious question