Category Archives: Meds

Mood and Life Choices Intersecting

asMid January through early February I spent in the hospital. Yes. Again. My psychiatrist was adamant we need to find another way than bouncing in and out of the hospital. I agree! The changes we agreed upon were staying with friends if I didn’t feel safe. That would allow me to ride the wave of emotions longer without using the hospital before I need it. And it would provide a chance for me to trust myself to keep myself safe. These things seem basic and “Why didn’t you try them before?” We have, but not with the same rigorous energy to keep me out of the hospital. The bouncing this time was ridiculous.

In other news, I’m still in physical therapy after shoulder surgery in early December. It still hurts, and the exercises seem to make it hurt even more. This pain has kept me from getting back into the pool for water aerobics. I’m too concerned about damaging the progress we’ve made. I could go to the gym and focus on the lower body. I’d be moving and re-establishing the habit of going to the gym. The water aerobics classes that are best for me are in the evening. But going to the gym in the afternoon and evening uses up any available energy. I’m a better morning exerciser.

A real factor in the exercise department is that I’m depressed and low energy from the depression. Any extra energy anywhere is like pulling teeth. So even though there is concern about hurting my shoulder in the pool exercises, the going-to-the-gym option seems less of an option because I am depressed. I already feel bad about myself. Now I can have guilt for not exercising added to that. Another real factor is that my drugs keep me hungover for most of the day too. And yet another┬áreal factor is that I made the decision I’d rather be healthy than skinny. That doesn’t help motivation to get back to the gym. I do still want to work out, but I’m less concerned with weight loss. Might be a mistake, but my mood affects the decisions too. I’m still trying to manage the mood. How am I supposed to manage pain and weight loss too, when my energy is zapped and I feel horrible about myself anyway?

One foot in front of the other in a boring life right now.

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Winter Mood Problems

snowflakeWow, it’s been a while since I blogged. Sorry, dear readers.

One reason is that I met someone special and we are beginning to share our lives together on a more permanent basis. The process is slow because he also lives with mental illness, and putting us together means my or his illness can interrupt plans to spend time together.

Another reason is that I had shoulder surgery in December. I’m now in physical therapy and function is getting better, but strength is still elusive. All in good time.

The major reason I haven’t written in a while is that I have struggled with my Christmas delusion (that I am bringing Jesus to the world and have a special mission to bring unity or hope or joy to the world). Fortunately it only showed up a week ahead of Christmas Eve. I was on haldol to keep me in this plane of existence, but I did experience psychosis from time to time when I was not in touch with reality.

I went off the haldol – as my doctor indicated – when the delusion passed. Unfortunately my mood tanked and I ended up in the hospital for a few days before the new year. Putting me on low dose haldol brought my mood back to mostly stable so I went home for the holiday.

Then last week my mood tanked again – no trigger. So frustrating. So shameful to me to have to go back to the hospital for no apparent reason. Especially after only 10 days. No med changes were made, much to my chagrin – fix something! I thought. Suicidal thoughts eased up as did my depression, and I was discharged on Friday. Another short stay! Hooray!

Now, it’s been a couple days. I can feel the suicidal thoughts again building up steam. I can feel my mood tanking. I don’t want to go to the hospital again, but I feel it coming up again. It seems the only time I stay out of the hospital are the times I mostly seem “up” which means hypomanic or manic, usually the summer. And I hate the summer. I’d rather be in the hospital then, than the rest of the year when I like the weather better and can find some solace in the times of the year.

I don’t know what to do now. I committed to teaching middle school at church next week. But I might be in the hospital again. I see my psychiatrist tomorrow and she may send me there. I try to make plans and my mood always wins. This is so freaking old. And I always feel ashamed when I walk onto the adult unit – again. Why can’t I take care of myself? And it’s hard to explain to a new person in my life. Though being in and out of the hospital shows part of the story.

 

Eighty Days In

My longest stay occurred from early March to late May. I was mostly confident I could discharge since I was going to a friends’ house to stay and daily spend some hours at home for a couple weeks.

2016-01-18 21.08.16I was overwhelmed with my first time back at home, even with friends there. And then again today when there alone. It’s filthy, with even just one cat living there alone. I guess she really does need staff to look after her. I called a cleaning service but they are booked out till the following week, which is probably the case for most places. So, I’m looking for teens who need spending money. ­čÖé I can’t do this alone. I’ve got to keep asking for help. I spent 80 days institutionalized. Living on the outside takes some time.

Some details about my time inside. My doctor increased my mood stabilizer and lowered my anti-depressant. That led to a depression that led to a suicide attempt. So we spent 6-8 weeks coming back up from depression. Then we tried a different mood stabilizer cocktail. That didn’t seem to help. Then we added an additional anti-depressant to help the one I was already on. That would take 4-6 weeks to kick in, and we figured I’d be out before it kicked in but ECT would speed up the process. So I tried one ECT again and called it quits. It’s just not for me. Never got results from it anyway. And as it turned out, I was in the hospital the 4-6 weeks needed for the second anti-depressant. Meanwhile I’m taking heavy duty prns to handle anxiety and agitation. Finally got a day of stabilization without having to take haldol or thorazine on a huge increase of mood stabilizer. I got sent home with haldol and accompanying drugs just in case.

Whirlwind, right?

All the while I’m in daily group therapy with a very good therapist. And we uncovered the shame and anger and embarrassment of being in the hospital again, of having and living with bipolar and having to ask for help. Lots to talk with my regular therapist about.

For about 9 weeks I felt like this:

Death is not. It is nothing

I am not. I am nothing.

I don’t want to die. I want to die.

Make it end. Make the thoughts of hurting myself end.

Make the emotional pain end – anger sadness.

I am less than human because of them – thoughts, feelings.

I am pain, a hemorrhage of negativity.

No one understands unless they know this darkness.

Black hole, sucked into nothingness from images of gruesome death.

 

Am I romanticizing it, or speaking truthfully from a hurting being?

I am not thinking of others.

Their pan will be deep and unending.

I will not be in pain anymore.

Whose pain is worse?

Do I deserve to be less human because others will have pain?

 

One Week Done with DIY Residential

It’s been about a week of the DIY Residential Program. Following the strict schedule has been moderately easy. Dealing with suicidal thoughts has been HARD. As happened at my residential therapy experience in February, and is happening again – a rather normal reaction – I felt challenged by the material and resisted what my therapist and group therapy and classes presented. I’m resisting the ACT requirement of Committed Action toward your values, because I’m not at all sure I want to live or have a meaningful life. I think I’m just resisting and I’ll eventually break through, provided I don’t end up in the hospital first.

I looked up on the internet overdosing on my many medications, I called a suicide prevention hotline (1-800-273-TALK – they are amazing!). I keep a bag packed in the car in case I need to drive to the hospital. My support system has been life-saving, and I’m so sorry for dragging them through this horrible journey. Partly it’s because I don’t have residential staff to talk to about the terrible things I think about or see in my head, so I’m sharing them with my support system, local and national. Y’all have been great at encouraging me to keep moving forward and not follow through with the thoughts and visions. But as one of the images below says, I feel like I’m on a never-ending treadmill of suicidal voices and visions that I use defusion on every time they come up. Which is A LOT. In the middle of conversations, in the middle of reading, when I’m laughing at something someone said or at a funny show. Any time I’m alone, or with people. There they are, waiting for me to give in this time.

I started a new workbook that is specifically for using ACT with depression. I have high hopes for it. Until in one early chapter it makes the claim that depression is only a little bit biological and almost all about how we respond to situations – emotional avoidance or fusion with unhelpful thoughts. I’m still open to what it says, as clearly I need new ways of coping. But even though I’m depressed, I feel like I’m depressed more from the suicidal thoughts than I am in the traditional sense. I still get up and do everything I’m supposed to do as though I am following my values. But I still feel numb and separated from life, which is a feeling associated with depression. I’m avoiding feeling the emotional pain of suicidal thoughts? or what the suicidal thoughts are trying to tell me? (that I want things to be different? that I want to be strong again? that something needs to change?)

I also think I’m lying to myself in a couple different ways.

  1. I keep saying I want to die and need this life to be over. But I keep asking for help and I keep doing the positive things such as taking care of myself, exercising, socializing, going to the hospital to be safe, etc. Those are things that seem to say that I want to live and I want things to be different, not that I want to be dead. I really like the thought of being dead though. I’m very fused to that idea and I use a lot of defusion techniques with that one. So the lie is that I want to die, when my actions say I want to live. Which is what my therapist says too.
  2. I’ve started saying that I no longer have viable options for killing myself since the information I got about overdosing looks like I’d just end up waking up in the ER or ICU with heart and liver and other damage, or if I took enough I’d have seizures and a heart attack. Not the go to sleep forever image I have in my head.┬áAnd I’ve mostly given up on slicing my arms or throat open after talking with people who have and still ended up waking up in the ER.┬áSo, the only plan that would really work involves a gun and I don’t have access to one, which everyone says is a great thing. It seems that I don’t have viable options. But I think I’m lying to myself, because maybe a heart attack from too many meds wouldn’t be so bad. I’m totally irrational on this lie. I really don’t think I’d do anything, I’d rather die from something that took my life and I didn’t have to do it. I just really want to be dead, which is the subject of Lie number 1 above.

With all of these lies and thoughts I’m continuously using skills to defuse from, to make room for them to just be, and just be words and just be pictures and not be imperatives I have to follow. I’m doing the right thing according to everyone in my care team (about 6 people, plus a bunch of auxiliary people when I’m in the hospital). I just still really want to be dead. And out of pain. It hurts a whole heck of a lot to feel like there is a black hole in the center that is slowly, tortuously sucking you dead into its center.

2015-11-22 14.24.34

 

2015-11-22 14.42.23

Lower Than Ever

So, I went to the hospital the day after the last post. I continued to spiral down to the lowest depression I’ve ever been in, or the lowest in a very long time. I had two suicide plans with details worked out down to the minute. My care team reassured me they would keep me safe and keep holding me up when the suicidality moved on and I was left with crippling depression.

As it turned out, during the hospitalization at the beginning of the month, my two mood stabilizers were increased. I came down from a dysphoric hypomania, had stability for a couple days, then tanked. The mood stabilizers were too strong and we had to let up on one of them to get me back to some stability. Then when the increased stabilizer had been down to its previous level for several days, the doctor increased my anti-depressant slightly, since a slightly larger increase than that had sent me into a dysphoric mania. Yes, I’m very sensitive to meds.

This whole fiasco of the last 12 days started with a too aggressive approach to my mood stabilizers, which, naturally, my doctor wouldn’t totally own up to. Yet he knew. My life is now in a deep depression, deeper than what is even normal for me for the change in season at the equinox (which was yesterday).

Today is my 40th birthday, and I’m very depressed. I’m more than a little suicidal and trying to take it off the table. I don’t want to go back to the hospital, AND I know it’s there if I need it. I’d like to find some meaningful activities that will begin to bring me joy that will help the depression feel a bit better until the drugs have a chance to do their thing when it is as therapeutic dosage in a couple weeks. Right now the activities I take part in, while meaningful to the outside observer, feel like treatment activities to keep bipolar at bay. I’d like to just be me. I need to figure out who that is.

A Mid-Winter Post-Xmas Depressive Episode

No one knows if my depression is the result of coming down from December’s mania (which is often followed by a depressive crash), or if it’s just mid-winter and part of the common mood cycle of becoming depressed in the winter. Yet here I am depressed again. As expected by my mood cycle predictor seen here.

I’ve been depressed for a few weeks now. It’s miserable, as depression is. Until now, suicidal thoughts were passive: “I hope I don’t wake up tomorrow,” “I wish I hadn’t woken up this morning,” “I wish I was dead.” No plans and no visions, just passive, sad thoughts. Not normal by any means, of course, but nothing to get in a tizzy over – for me.

I have skills that keep me safe. Not happy, but safe. I keep to my routines and schedules and keep meeting up with friends. Doing this anchors me during the waves of feelings. They keep me moving and remind me of life. I still feel sad and low energy and passively suicidal, but I’m making it through one moment at a time.

The depression has been lifting a little bit as I convince my psychiatrist to reduce my anti-psychotic med now that I’m not delusional or manic. (She finally admitted that I looked and sounded over-medicated. Sometimes I’m the one that knows more about me than my doctor…) I’m back down to pre-manic levels of the anti-psychotic and I’m feeling more energy but not less sadness. And, right on schedule with the sadness and hopelessness of the meaninglessness of my existence, suicidal visions have kicked in where I envision hurting or killing myself. They are at the intrusive level when they jump into my thoughts unbidden no matter what I’m doing, even in the middle of a conversation.

Again, I have skills to deal with this level of misery. I use the previous skills plus I use ACT skills (Acceptance and Commitment Therapy), One skill is Thought Diffusion where I separate my actual self and behaviors from my thoughts (for example: thank my brain for the suggestion – it’s just trying to solve the problem of pain; or think of the thoughts as a jangling phone in the backseat of a car where I can’t reach it and I just have to live with the noise). Another skill is Radical Acceptance where I fully accept all of who I am and all that I feel. This skill reminds me that this is who and where I am right now, in this moment (Mindfulness, another skill). And I remind myself that all of these skills are helping me move toward my Values, a motivating factor for continuing to use the skills, a reminder that I want a future full of good things I value.

What I don’t look forward to is the nearly inevitable experience of the obsessive level of these suicidal visions. The thoughts become intrusive nearly all the time and I become exhausted from using my skills nearly all the time. I’m at the point that I’m not sure that I can keep myself safe because the thoughts have become desire and intent. To at least make them stop, at the minimum. ┬áThe thoughts have worn a groove in my mind and have enhanced my feelings of sadness, hopelessness, ennui, and now also feel helpless against the thoughts and worthless that I can’t stop the process with skills. There are not any more to use. I just need to be safe. And I head to the hospital.

I’m at DefCon 2 – Intrusive Thoughts. As I said, I’m not looking forward to the nearly inevitable Obsessive level that sends me to the hospital. I’m so tired, so very tired, of this.

9th Mood Shift in 5 Months

After my last post, I ended up in the hospital again with suicidal depression – mood shift #8 in 5 months. I’m so tired of having to go in the hospital. The reality is that my mood is shifting quickly. Perhaps since we found baseline in April, we are finally able to see how quickly my moods are changing. Perhaps I’m having a bad year. Others are having bad years too.

I got out of the hospital on Friday after Thanksgiving. The holiday in the hospital wasn’t the best, but the patients and staff made the best of it. We pulled tables together to eat as one group. We played games and watched a movie. The day’s schedule was that of a weekend, but there was a festive air. I had been stabilized by Wednesday and ready to go, but in consultation with my doctor, we decided to have me stay in the hospital for the holiday just in case not having anywhere to go would result in relapse. By Friday, I was ready to go and pushed the issue. And I got out. I had plenty to do over the weekend, and friends accommodated when needed. Thank you!!!

Then Sunday I felt a mood switch begin with moodiness and a slight mood dip, but then a delusion started and it grew. It was the one that I usually get at Christmas time, and this time it was 3 1/2 weeks early. I had premonitions of it for 1o days or so too. A mystical experience of the divine – God coming into the world and I had something big to do with it and a sense of euphoria and connection to everything. If you are religious, this might sound like a nice, healthy, or enviable experience. It Is Not! My brain tingles, my senses are heightened, and reality begins to break. The delusion can easily turn psychotic. And always, always, there is the crash afterwards into a depression, suicidal depression the last few years.

I called the next day – Monday – to get an appointment with my psychiatrist that day. By the time I saw her, it was an dysphoric mania (irritability, racing thoughts and so forth) with a growing delusion. When I saw her, she said we had a little time since I still knew my thoughts were a delusion. She boosted up my mood stabilizer and anti-psychotic, despite a history of not responding well to higher doses. We can always go down, “But,” she said, “We need to stop the mania.” I don’t think she’s seen me with a delusion as full blown as this one. Yay for me that it hasn’t been this bad in 3 1/2 years?

My therapist reminded me of the same things my psychiatrist said. Focus on good sleep, good food and exercise (hard exercise, from my therapist – more than I might otherwise do). And No Big Decisions. Get my friends on board with that one too, which I did.

So, 9 mood changes in 5 months. I think I officially qualify as a Rapid-Cycling Bipolar Disorder, Type I. Have to say though… I want off this roller coaster! I want out of being in the hospital! I want to stay away from the poles of suicidality and psychosis!