Wednesday, March 28, 2012

Bipolar Meme

These "Memes" have been going around the internet on all different topics. I made these on bipolar.












Sunday, March 25, 2012

Psychiatric ER

(This is a very graphic post. Just FYI.)

Many of us have been to the regular emergency room, but fewer have been to the Psych ER (PER), otherwise known as Psychiatric Emergency Services (PES).

Of the handful of times that I've gone, most have been talking to me and LOTS of waiting! (LOTS!) I've seen people in there with security waiting in the wings. I've seen people locked into rooms with those double, vertical rectangular windows. I've seen people refuse to cooperate in the least with the staff. And that's all while I was waiting!

Mostly what they do is see if you're a danger to yourself (self harm or suicide) or to others. They do a triage like in normal ER- they take vitals and then ask you why you're there, and then they have a laundry list of questions that they ask EVERYone. If you are there because you plan on harming yourself, they give you a special ID band that beeps if you try to leave. They pat you down and do a wand test to see if you have any weapons. You give up anything that beeps AND your purse or coat and it gets locked up. Then you wait.

Eventually, you see the nurse and then the doctor, resident, and/or student. They ask you why you're there again and let you describe how you're feeling. They're looking for clues that will tell them whether or not you need to be admitted.

Only once did they think I aught to be admitted. I have hesitated to write this post because its very personal. Its hard to admit to myself, and thinking of friends reading this gets me nervous. There is still so much stigma about mental illness- and especially bipolar. Even a friend today said that he thinks bipolar is a bunk diagnosis because "everybody gets happy and sad". I kept my mouth shut, for fear he'd think less of me suddenly. The time I was going to be admitted started at LEAST earlier that same day. I was feeling very stressed. Very out-of-it. I had taken my youngest son out to Toys R Us and felt derealization taking hold. The colors were different and the hallways seemed bigger. In short, I felt like I was in a dream. I realized (ha!) that I was having derealization while still at the toy store, but figured I could ignore it. We went out for ice cream. We got home and my mother said something to me and I snapped. I screamed at her, swearing, couldn't control myself. Another family member jumped up and charged at me. I fell on the floor sobbing. (So not like me.) I was gasping and sobbing and curled up in a ball on the floor screaming that I was going to kill myself. My mother suggested I go to the hospital.

I called a good friend of mine to drive me to the hospital. He has done this every time I've been to PER/PES. He sits with me the whole time I'm there- which can be over 24 hours on busy nights- and chats and jokes with me. That night, we went in. I was triaged and talked with people. Apparently, they saw something in my answers that made them want to admit me. I said, "What's that mean- I go and sleep there and talk with people and take meds?" They confirmed this. I told them I didn't want to go. I didn't. I just was thinking that I didn't have my CPAP machine with me (helps my sleep apnea), and really, I just wasn't thinking clearly! I saw it as a question of "Would you like to?" And who would like to stay in the psych hospital? Nobody! So I said, no I wouldn't. They never MADE me stay. What they did do is call my friend in and asked him if he thought I was okay to go home and he said yes. But he wasn't there when the above happened.

So for now, I can't tell you what its like in the psych ward. In fact, another time I went in a week later, they said that getting a spot is very difficult. You'd think its like people that go to the ER get admitted and go upstairs, but in reality people from all over the state are flown in or ambulanced in and you might end up in another hospital in another city. In fact, its extremely likely that you will.

So for now, let's hope I can't update this with what its like to be in the ward, or to have my ankles and wrists in leather straps on a hospital bed, or any other number of things that happen in the psych. ward.

Its very important to go to the psych. ER if you are having suicidal thoughts or even ideation. What I know is that being in that state where you scream that you want to die is not the usual you. You are as scared and confused as the people around you. You may not truly wish to die. Its a terribly brain state and is pervasive and extremely difficult to self-remedy. In fact, I would say that the psych emergency room is the best place to go. Safety first. And friends and family are IMMEASURABLY helpful when you can't tell up from down or left from right.

Thursday, March 22, 2012

Depression & Bipolar Depression & Others

"I'm depressed." Everyone seems to say this, when they really should say, "I'm disappointed," or "I'm upset," or "I'm sad".

I don't get depression as often as I get hypo/mania. When it hits, I'm surprised. I suppose I shouldn't be: I was diagnosed with unipolar depression (a.k.a. "depression") that Zoloft and Paxil are advertised for) around 1997. At any rate, I was surprised this last time a few months ago. It seems like sadness, but I felt a pervasive anxiety and tiredness and my thoughts were all sad- I could only think sad things and probably even things that weren't necessarily that sad in reality seemed sad to me.

Sometimes I have felt sad on top of my thoughts being "normal". This is very strange. Crying and yet walking around thinking "Oh that DVD looks nice!" This particular episode only lasted an afternoon until I called my psychiatrist.

A similar episode happened when I just couldn't stop crying and had no idea why. My youngest son came into the room asking what was wrong and I really didn't know! Nevermind that I didn't know what to tell him, either. How do you tell your 8-year-old that you're crying like someone just died but there really is no reason?

Back about 10 years ago, I would have episodes of depression so bad that I was catatonic. I would lay in bed and stare straight out and not move- for hours. I suppose that was my way of "checking out". I'd sleep until 3 p.m., too, which was also a way of checking out; I'd prefer to be in the world of my dreams.

I also had postpartum depression all three times. I had antenatal (during pregnancy) depression, too, so this kind of melded together. My depression while pregnant was "situational"- there was a reason behind it, basically, and mine was high-risk pregnancies. I had problems with the pregnancies and had to be put on bedrest. Sitting around all day alone with "nothing to do" (because I'd already finished the internet!) is very depressing, especially when the world is just outside your window. The postpartum depression just seemed to start up pretty soon after the birth, though not right away. This is when I would cry, and some of it was due to having little to no sleep after my first child (15 minutes out of every 2 hours around the clock!) and some of it was just plain hormones. As I've already described, I had "horror movie hallucinations" after the last one was born. Somewhere after my middle child was born, I wasn't having depression at the time, but I hallucinated orange rectangles in the sky. I was sitting in the bathroom and looked out the window and clearly saw orange rectangles. I called my husband who said he saw nothing. The weird thing was that they were there when I looked outside and not when I looked inside. But I'm digressing into hallucinations, but I think these are related to post-partum depression- or at least they seemed to be at the time.

This last time I had depression (which I say isn't as often for me), I felt tired and slow and thinking increasingly negative and almost suicidal thoughts. (Save that for another post.) It went on for at least 3 weeks before I told my psych. dr. who prescribed Celexa. Antidepressants can have a paradoxical effect on bipolar people and "ramp them up". I'd been on it less than a week. I started bouncing and talking quickly and generally getting faster and faster until one day I was out with a friend and he said I really aught to call my doctor. We were sitting at a table at a restaurant and my legs were bouncy and my hands were figgity. I had a straw in one hand and was flicking it as fast as I could against the table, each end tapping in turns. My fingers were flicking against the table, too. I called my friend who thought I was very funny, but also said I should call my doctor. Even talking with him in the breezeway of the doors, I couldn't stop pacing, talking very quickly, or bouncing. I just HAD to move, or I'd feel uncomfortable. I COULD stop, yes, but not for very long and only when I put my mind to it. This is hypomania and one of the worst times I've been this "bouncy".

The other- more famous, I guess- part of bipolar depression is suicidal ideation. For me, this seems to be more situational. That is, some event will trigger intense emotions that I can't find a way out of and I'll feel I want to kill myself. (Separate post on this.) The ideation just means that you are thinking a lot about wanting to kill yourself, but you haven't tried it or made concrete plans to do it.

In my next post, I will post about suicidal thoughts, actions, and going to the psych. ER.

Wednesday, March 21, 2012

"Horror Movie Hallucinations"

There is a second type of hallucination which one psychiatrist dubbed, "Horror Movie Hallucinations". These are visions that aren't actual hallucinations in the sense of seeing or hearing things that other people can't, or more precisely, that you think are there but other people don't.

Before I was diagnosed, I was having a bad day. I was very agitated and easily upset. I began screaming. I left and took the kids to school. Everything went well until I had just walked my youngest to his classroom. I saw myself ripping the spines out of kids and throwing them against the wall- blood and all. I shook it off. The visions went away. Then, a minute later, I went to get a drink of water at the fountain and had yet another vision of smashing skulls. I shook it off again. When I got back to my car, I called my psychiatrist. (Different one than now.) She was worried about what I was telling her, and told me to not drive anywhere. She called me in a prescription for Celexa . No mention of bipolar was made.

Four years earlier, when my youngest was born, I'd had similar "horror movie hallucinations", but this time it was while I was showering my 2-year-old daughter. I was washing her hair and it was as if someone turned on a movie on top of real life: I saw my hands on her head, crushing through her skull, fragments, crushing and blood everywhere! I reported this to my psychiatrist (same as above) and I was told to keep on my Zoloft. This is the same year that Andrea Yates killed her four or five kids! My Ob/Gyn picked up on this and we had a heart-to-heart conversation.

I have since asked my current psychiatrist why my former psych doc never caught on to my bipolar- she didn't really answer me.

Normal hallucinations just play out as if they were real. They might come and go, but they seem like real life happening, rather than something playing on top of reality. The horror movie hallucinations come on quickly, too. One second you're seeing life normally, and the next a horrible vision plays in your mind and is projected into your eyes. They are scary and unpredictable. They go away on their own- or in my case, maybe the antidepressants helped to get rid of them. I'm still kind of miffed that my bipolar wasn't diagnosed earlier than it was- but then again, if I were and I were medicated, I might not have experiences with which to diagnose me. :)

"This Whole Place is Bipolar!"

My youngest son's teacher said this to me yesterday. "This whole place is bipolar." She meant the teachers in the school. She said there is a bit of upheaval going on with the new interim principal.

I'm not quite sure what she meant. Lots of people seem to throw around the term "bipolar": Sometimes they mean "Crazy"; sometimes they mean "unpredictable"; sometimes they mean "wild mood swings"; sometimes they mean "mentally unstable". The meanings change with who is saying it. I was taken aback. I thought to myself, "Hey! I'm bipolar. How dare you bandy the term around!" Its like saying, "That person's a drug addict," whisper whisper... Scenes from movies must play in their heads - a woman screaming and saying incoherent things; a jab of Haldol given in a hurry and then the person slumps over... who knows. Even television portrays bipolar people in the stereotypical extremes. On House a few years ago, the title character got admitted to an old-style mental hospital. His roommate? A bipolar man! What was he like? VERY VERY VERY bouncy and never stopped talking. Granted, he also said he refused to take meds, but if this fictional character really didn't take his meds, he's LUCKY that he just got very talky/bouncy. He likely would've had psychosis and suicidality at some point, or even major depression. THAT would've been interesting to watch - especially derealization. Hollywood: Work that in, would ya? But back to what I was typing. If this teacher would've thought, she would've remembered that I told her once that I'm bipolar and edited herself.

At any rate, if someone is angry in one part of the day and then happy the other part, does that make them bipolar? Probably not. I will say again: Bipolar is NOT just "really happy" and "really sad". During one of my episodes- the one where I was going to leap off a balcony at the grocery store that I mentioned in a previous post- I was walking around town completely detached. Nothing seemed real. I talked with people, but it was as if they were in a parallel universe. As if the two universes were on top of each other but we couldn't communicate. I did manage to talk with the owner of a record shop about my record collection. He said, "Wow! Do you have a degree in this?" What a compliment! And yet, that state helped me to remember and list off all of these facts in the back of my brain. I doubt he noticed anything different about me- after all, he didn't recognize me from any other time I'd been in. I've never gotten so psychotic or detached that I actually go arrested. (That's possible.) I've been to the psych ER, though, and almost was admitted. (Future post.)

So next time you are feeling frustrated, or having a bad day and crying, or you get good news after the bad day and feel elated, please don't say to the world, "I must be bipolar!" Or the next time you feel like punching someone in the face, or the lady in front of you at the grocery store checkout line is slow as tar in January, don't say, "Damn! I must be bipolar!" Count yourself lucky that- more than likely- you're not.

Money

This is a touchy subject for everybody. Especially in the last 5 years.

Mania tends to make one lose inhibitions, and depression to ignore problems. One day, you think you're on top of the world and can afford to max out all your credit cards, and a month later the bills come and the guilt hits. And the month after that. For some people this means $15,000 in a year or two; for others its that much in a MONTH!

Its a horrible problem for anybody, but for bipolar people, that lack of checks-and-balances - literally- is a huge deal. I've heard of others who have had friends give them loans or family members cosign for things. Most of us aren't that "lucky". I say "lucky" because once you do that you are forever "attached" to that person in a more intimate way than you probably were before.

Mania can make you feel like you not only WANT every book of your favorite author, but NEED them- NOW and maybe to go on a vacation, buy a new car, or any other big item. "Lucky" for me, I don't have a lot of money and the great credit I had was shot on tummy tucks, trips, and various other "fun" things.

Is there a bill that says "All those with bipolar are forgiven their debts?" Nope. Not unless they added to the "Lord's Prayer", or Obama somehow gets really empathetic with us.

Its just gonna take one of three things: 1. A miracle 2. Winning the lottery. 3. bargaining and paying the bill collectors. I've only heard of once someone giving a loan for debts and then not asking for it to be paid back. That was many years ago and I'm all-the-more surprised to this day.

Hunger & Getting Fat

Nobody likes getting fat. Our society says that fat is bad. So what happens when the vast majority of drugs for bipolar seem to make you gain weight?

Its a terrible choice we have to make. When I first went on a drug for bipolar, I was told that I likely would gain weight. I remember holding the bottle of pills at the doctor's office building and looking at my svelt body and back again at the bottle. I took the pills. Depakote. Known for causing weight gain. I gained 50 pounds.

Eventually, I switched to a more-weight-neutral drug, Lithium. I didn't gain as much. Then came the antipsychotics.

I was off and on so many of them because of side effects. I was in an "off" period, when I started hallucinating about six months ago as of this writing. For other reasons, I ended up the psych ER and was put on Zyprexa. I'm still on it. It works very very well. But it also makes you want to eat. Its not a normal hunger. Its an internal "I'm-missing-something" feeling. Its like you're a newborn baby again and need to eat every two hours. Its that Zyprexa goes in and not only makes you more hungry, but it is obsessed with storing every bit of fat it can, AND it makes you more tired so you want to sleep about 14 hours a day, when you get your dose upped.

So how is this a good thing? I've asked my therapist and my primary doctor about switching meds, but I just get side-stepped. There are meds that you can add to hellp with the weight gain, but usually you get told you need to exercise more. The plain truth is that I can FEEL how my body has changed in the way it works- even though exercise is still good for me in every other way. I just had a rhythm going with food and exercise before the drugs. And after the drugs, even with exercise it has been different. As things change, I will update this topic.

UPDATE: I saw my psychiatrist yesterday. She prescribed Metformin, a diabetes drug. I don't have diabetes, but there's some thought that it helps you not gain weight on antipsychotics. Supposedly, I should've started them at the same time, but we're giving it a try anyway.