Reducing the Costs of Mania

Jerry Kennard is a psychologist Interested Chartered Psychologist Dr. Jerry Kennard is a psychologist, freelance writer & consultant.... Send Message Subscribe: Jerry Kennard

Tuesday, October 27, 2009
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It may be something you said, or something you did, but nearly everyone who experiences hypomania or mania has a story or two about the darker side. Grand plans, risky investments, financial donations, hurtful comments, affairs, turning to drink, aggression, these are just a few of the possibilities....

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Untitled Comment
Roni
Wednesday, October 28, 2009 at 11:17 AM

My husband was diagnosed earlier this year as BP2 and looking back over our 19 years together if we'd have only known then what we know now, especially financially. I would have realized that his business ventures which he was so excited about and hyped about starting - only to fizzle out a few months into it, would have saved us a lot of money and heartache. But live and learn right!! Now we're both learning how to handle this disorder and all it carries with it. We've decided he can't handle anything financial and that's for the best. Medication has been a God-send so far, he seems to really be doing well and I only wish we would have pursued it earlier, but he had to come to the conclusion himself. There has been other things to the "darker side" as you called it, but now that we know what it's all about we can attack it head on. Forgivness is a key factor in a BP relationship and as the spouse I've learned not to take things personally (and it's actually gotten easier with time). Resources like this help so much as well. Take Care!! Roni

Untitled Comment
Winston Smith
Wednesday, October 28, 2009 at 08:18 PM
Jerry, I remember learning in Business Law years ago that most laws are based on what "the common man" would do. This theoretical person represents what a common person would do in a common situation. I think you are using this "common man" persona to represent the perfect bipolar person that, realizing their symptoms are iminent, makes plans to guarantee the threats are minimized. If only ... During my mania episodes, I repeat the same situations over and over. Even though I am very aware of my history, I am convinced that things are different this time. I am incapable of slowing down and rationalizing my actions. This time is different because (a) the timing is right (b) it's a great deal (c) I can do it so no one gets hurt (d) it's not dangerous or (e) don't worry, I have everything under control. When I'm manic, nobody can stop me from doing what I know needs to be done. You won't talk sense into me, because you don't know what I know, and I'm unable to explain. If you hide my checkbook, I'll find other ways to get money. If you hide my car keys, I find another mode of transportation. If you push too hard, I'll push back. I'm on a mission, and you will not stand in my way. The world of mania is lonely, and that's just the way we like it. Peace to you, Jerry, and thanks for the excellent writing. You're our champion on the front line. God bless, Winston C. Smith Jr. My present med "cocktail" has settled my mania for now, but I miss it. I miss the late nights, the voluminous writing, the grandious plans and the ability to solve unsolvable problems. I miss the ability to talk any one into anything. Manic episodes can do a lot of damage, and usually leave some kind of ruin in their wake.

re: mania/hypo mania
S
Wednesday, October 28, 2009 at 09:44 PM

The only comment of yours I disagree with, Jerry, is the one about "taking medication." Do you not realize a mania or hypo mania can occur when one is completely compliant w/the recommendations of the pdoc as far as meds?? It has happened to me several times. I will get excited about a trip, travel through a couple time zones, be excited to see my friend which means I don't sleep (yet I am taking my meds & the HIGHLY sedating ones as I have problems w/insomnia), but they did not prevent a hypo manic episode from occuring!!

I did "everything right" in taking meds, etc.--unless it is wrong to try to have some quality of life & visit an old friend (80 yrs. old at the time; actually a friend of my mother's who committed suicide from bipolar when I was 15--but this friend "befriended" me after my mother's death as she lived in the states then, too, & I SO needed a friend so--give that up so I won't get excited? Isolate further than I already have? What am I supposed to do??). I don't have many friends--uhm--any?? Besides her & she just passed away at 85 yrs. old.

That trip triggered a 5-month hypo mania (which felt great, of course, & my over-spending did not inflict harm on my family, luckily, as my husband has a good job) & I got over-enthused about projects & groups & causes & then after that 5 mos. of sleeping about 2-3 hrs. a night & feeling on top of the world (I could actually feel a physical kind of adrenaline coursing through my body--a thrumming or excitement & anticipation of GREAT things to come) my husband made a negative comment & I overdosed on my meds--simple as that--mania gone & sucidical depression appeared within minutes (I do have extreme emotional dysregulation which Dialectical Behavioral Therapy is helping me a lot to oveercome).

Pdoc has stressed how I cannot go 3 nights without at least 6 hrs. of sleep a night or she will sedate me even further...

I guess my brain just doesn't function quite right going so long w/no sleep, but I LOVED every minute of the hypo mania. Now I'm somewhat "stable"--more on the depressed side & life looks like of blah, but I guess I can count myself as a success in that I am still alive (unlike my mother).

BUT PLEASE DON'T SAY BEING COMPLIANT ON MEDS WILL PREVENT AN EPISODE--NOT TRUE. That is laying guilt on the "victim", I believe, in that I followed doc's orders & was stable for 5 yrs. so why wouldn't I continue to be stable? Life, changes, lots of things seem to disrupt the stability DESPITE being compliant on meds. I didn't purposefully stop taking meds to become "manic or hypo manic." It just happened.

Sorry--bit of a rant here--sore subject, can you tell??

All my best to you, Jerry. Love your articles & learn a lot from them & esp. appreciate your compassion to others.

re: re: mania/hypo mania
tabby
Thursday, October 29, 2009 at 09:29 AM

S.. you are so right here.

I know several, who are staunch followers of all things dictated to them by their professional psychiatric folks... and who even sleep 6-8 hours every night AND they still have episodes of hypomania, mania, and even suicidal depressions.

Folks, who do not struggle with the illness or illnesses themselves, are quick to lay blame on someone tripping into a episode as that person obviously did not comply somewhere with a instruction given. They obviously did not take their meds correctly, they purposefully stayed up all night, they did not forsee into the future something happening and planned for it ahead of time, etc...

What many don't get is : the disorder(s) manifests, at times, regardless of what the individual does or does not do to prevent, manage, or heed it off at the entrance to town.

re: Untitled Comment
Jerry Kennard
Thursday, October 29, 2009 at 10:45 AM

Thanks for those kind words Winston and for providing such a useful and succinct overview of your situation. You are not the first person that I've come across who feels a great sense of loss at what must be a pedestrian and rather dull life compared with the sensations that accompany your mania. By contrast, I have a friend with bipolar who feels she gets nothing but grief, anger, tension and sleepless nights from 'her mania'.

And yes, my 'common man' approach to shareposts is something I do use quite a bit - unless of course I feel like writing about extremes. For me, one of the issues in writing shareposts is who am I writing them for? The audience is really quite broad (I suspect) but the most active comments seem to come from people living with bipolar. In a way I think it balances out nicely as the comments either refine, add or provide alternative perspectives on what I've squeezed in my 300 word allocation.

Nice to hear from you again.

Untitled Comment
tabby
Thursday, October 29, 2009 at 10:05 AM

It is interesting that you speak of med compliance as the first thing in warding off mania or hypomania. That seems to always be the main thing... "you must take your meds as prescribed and consistently". As if, this alone will be what prevents a episode from occuring. It doesn't, by the way.

It is true though that once someone feels better they generally do want to stop taking the meds that cause them to gain excessive weight, sleep all day and night, burn their thyroid, harden their kidneys, cause mental sluggishness, and leaves them with no desire to do anything. Yup... once someone feels "up" and "good" and wanting to get out and about in the daylight and enjoy life for a change... got some energy about them after so long of being blah and duh on the meds... they'd want to miss a few doses or go off them all together. Seems logical actually.

But wait... you can't do that. You have Bipolar and God forbid you feel "good" and "up" and have some energy and want to live one day. You might become hypomanic and irritable or manic and see angels and spend money and have sex with everyone and everything... you might. So... here take some of these pills and be drugged back down to feeling blah, gray, and whitewashed. There, that's a good girl or good boy.

Or

cause you've gone into hypomania or mania, though you've done everything precisely as instructed, and you are sitting there not understanding what is happening to you - you get

... "you obviously haven't been taking your pills have you? Yes, I know you say you have but if you've been taking them as prescribed we wouldn't be in this state now would we? Are you sure you've taken your pills today? Here, let's count the pills in the box and bottles and see... no, it's not that we don't trust you it's just that well... you wouldn't be in this state if you'd been taking those pills like you were told to do. Here, bring those pills to me and let me see them." and this comes from a nurse in the pdoc's office.

re: Untitled Comment
Jerry Kennard
Thursday, October 29, 2009 at 10:35 AM

We agree that a pill-centric world is a poor place to live! I know for a fact that faithfully taking meds will not necessarily prevent the onset of mania or depression. I don't think I present meds as a way of stopping or preventing these events (though in some people they may) but as a way that may help to prevent the frequency, duration and intensity of events. Maybe you disagree?

Tabby, it sounds like you've been through some frustrating experiences with people who perhaps should know a little better. As you of course realise, treatments for bipolar are better than they used to be, but you'd be hard pressed to think of them as sophisticated.

Move along technology!

the chorus of medically compliant bipolar sufferers
rseymour
Thursday, October 29, 2009 at 04:51 PM

I can generally control brief episodes of hypomania with pills... in fact this last Saturday I was up till I got on a plane at 6:30AM... I wrote a guitar part and song that night, which most people I've showed it to think is a pretty good tune. I got on the plane, took what would be my night-time medication dose, flew from west coast time to east coast time and... well, everything worked out.

But! I've had 4 psychotic manic episodes in the past 4 years, and some of those sprung out of being relatively medicine compliant... and wouldn't stop if I did take my meds. I've been on 1000mg of seroquel in a hospital with no serious effects. It is strange to think of such powerful drugs not being able to silence mania completely, but ... they don't always. An injection of haldol will certainly stop me in my tracks, but I don't really have a syringe of that handy at home... and I figure if I dosed myself like that I'd probably wake up with a nasty bruise, etc. from where I'd left the needle in... ;-)

Preventing mania seems to me to be... at the very least extremely hard... simply because when it's happening you don't want it to stop... and for me I can often stop it at brief hypomania, but when it's really really going... I'm almost always gone. It's hard to define exactly when this point of no return happens, but knowing my specific symptoms seems to be the only hope.

Here's the song (55 seconds long, but kinda neat):

http://soundcloud.com/rseymour/getting-done

the chorus of medically compliant bipolar sufferers
rseymour
Thursday, October 29, 2009 at 04:53 PM

I can generally control brief episodes of hypomania with pills... in fact this last Saturday I was up till I got on a plane at 6:30AM... I wrote a guitar part and song that night, which most people I've showed it to think is a pretty good tune. I got on the plane, took what would be my night-time medication dose, flew from west coast time to east coast time and... well, everything worked out.

But! I've had 4 psychotic manic episodes in the past 4 years, and some of those sprung out of being relatively medicine compliant... and wouldn't stop if I did take my meds. I've been on 1000mg of seroquel in a hospital with no serious effects. It is strange to think of such powerful drugs not being able to silence mania completely, but ... they don't always. An injection of haldol will certainly stop me in my tracks, but I don't really have a syringe of that handy at home... and I figure if I dosed myself like that I'd probably wake up with a nasty bruise, etc. from where I'd left the needle in... ;-)

Preventing mania seems to me to be... at the very least extremely hard... simply because when it's happening you don't want it to stop... and for me I can often stop it at brief hypomania, but when it's really really going... I'm almost always gone. It's hard to define exactly when this point of no return happens, but knowing my specific symptoms seems to be the only hope.

Here's the song (55 seconds long, but kinda neat):
http://soundcloud.com/rseymour/getting-done

Reaching
southernangle1
Thursday, October 29, 2009 at 05:03 PM
My name is kathlene , I have a 14 year old daughter that is bipolar , i have tryed alll most everything . Where does moms go to talk to someone about how to help my daughter help herself .And Keep me from loosing my mind . Thank kathlene

re: Reaching
S
Friday, October 30, 2009 at 10:58 PM

  
Mom: Try looking for a local chapter of NAMI (National Alliance on Mental Illness)--nami.org.

They have a class called "Family to Family" which is very informative & you'll meet other parents who are facing the same kinds of things. There is a lot of support there & you can share resources & ideas. This is a 12-week class (2 hrs. a week, I believe; free of charge as are all their classes for family members & "consumers"--term that is often used for those w/the mental illness).

They have another shorter class specifically aimed at those w/young children & teens w/mental disorders called "Basics." I believe that is a 6-week class.

They also offer support groups for family members (I've directed many family members to these resources--I volunteer a lot for NAMI--and they find them invaluable & provide vital info. & advice on how to handle difficult situations & the sense of not being alone when your child is suffering & your family is suffering is a great relief).

They have stated a new support group for consumers called "Connections", I think. It is not yet available in our town, but I heard the national director speak at a NAMI conference recently & it is growing very fast as they are training "veteran" consumers to lead the groups.

Also, DBSA (Depression & Bipolar Support Alliance)--DBSAlliance.org (I believe) offers support groups for both the consumers & family members (usually meet together for a bit at the beginning; then they separate so you can vent if you need to without your daughter hearing & she can do the same!).

Finally, your daughter is very lucky to have such a caring mother. There ARE many new treatments & much more knowledge about bipolar in teens these days. As I mentioned in my earlier post, I started having problems at 15, but was not given any kind of psychiatric help even after a suicide attempt & the boarding school I was attending said I had to stay out for 2 weeks (I'm presuming they told my father to get me some kind of treatment during that time), but since he had gone through so much w/my mother's severe & at that time untreatable bipolar, I guess he was just sick of the whole thing & actually just got very angry at me for overdosing on my room-mate's Valium, ending up getting my stomach pumped, & disrupting his life by having to be in his "care" (was actually just left alone as he went about his usual business) for those 2 weeks.

I think one of the current thoughts is that if you can get the teen on proper meds at the onset of bipolar you can PREVENT the occurrence of future episodes & minimize the intensity if they have one & the duration of that episode. Each episode of depression (that is the most devastating for me as my depressions are VERY severe & life-threatening) or mania takes a long time to recover from & erodes one’s sense of control over his/her life & interferes w/that person pursuing his/her passions, goals & dreams.

BUT even though I had a really rough time basically from my teens, I have been able to have 2 wonderful children (who both had severe periods of depression that needed meds & therapy & one had to take a medical leave from college for a semester for treatment). Yet they both have advanced degrees & are working full-time (lawyer & civil engineer). One is married (33 yr. old). 30-yr.-old son is still having fun w/lots of great friends & rewarding work & travel.

My husband (who was actually my boyfriend from that boarding school when I had my 1st severe depression & suicide attempt) has been the main reason I've been able to hang on & pursue a good quality of life & raise such great friends. He will sit up w/me all night if I am in a bad state.

I only got the dx of bipolar when I was about 43 (55 now) as I was going to GP's. Finally changed to an internal med doc who immediately thought I was in a mixed state (severe agitation & depression combined) & she sent me to a pdoc right away. So now am doing much better & had to cry when my kids expressed such joy at seeing ME able to experience more peace & joy & not so much turmoil in my soul.

re: Reaching
S
Friday, October 30, 2009 at 11:08 PM

Mom--I am so sorry my reply has all that "junk" at first. I think the last line of the "junk" is the beginning of my comment. I have to write in Word & copy & paste as I am in a rural area right now & my wifi goes out frequently & I get so frustrated trying to retype everything again & again. I think only half of my reply went through anyway ( I AM long-winded) so will try again--please forgive me for all the additional junk...

Jerry--Can you tell me how to coipy & paste a comment from a Word document that somehow doesn't translate here w/all that junk??

re: re: Reaching
S
Friday, October 30, 2009 at 11:13 PM

  
Both NAMI & DBSA are supported by memberships & donations so if they are helpful for you, you might consider a donation or membership.

Therapy in conjunction w/meds is HIGHLY recommended. I went to so many therapists who just commiserated w/me about what a rough childhood I had, no wonder I felt unloved & had low self-esteem, etc. but I never accomplished anything—like improve my thinking patterns & coping skills NOW. Spent a lot of time & dollars until finding my current therapist. Try to find a therapist who specializes in bipolar & provides cognitive behavioral therapy or dialectical behavioral therapy (more like a class w/a manual & homework & such; this is what I do w/indiv. therapy w/the same therapist who leads the group, but DBT classes/groups usually have more people w/a borderline dx & they can sometimes have extreme behaviors you may not want your daughter exposed to such as cutting, anorexia, other eating disorders & even DID--sometimes called "multiple personalities”--and people w/a borderline dx usually come from abusive backgrounds so you may not want your daughter exposed to descriptions of that which may occur during the group).

Education is really important. Besides the classes I've found books very helpful: Bipolar Disorder for Dummies by Candida Fink, M.D. & Joe Kraynak (his wife has bipolar) & books by Julie Fast. Many others, but I can't think of them off the top of my head as I'm lucky enough to be on vacation so not at home to look for other titles, but the support groups & classes & just plain amazon.com should be able to give you a good start. Also, bpmagazine is excellent. They have a web site w/many of their articles (bphope.com) & I think they have an on-line support group for both family members & consumers.

So the prognosis for your daughter most likely is excellent though finding the right meds, providers who will work w/all of you in a collaborative manner & treat you as a valuable part of the treatment team will be a challenge (at least it was for me). I had to go through several pdocs until I found a psychiatric nurse practitioner who is very caring, helpful, got to know ME as a person—not just my illness & is willing to work w/me as an equal partner.

She helped me get rid of my paranoia & delusional thinking & is willing to help me eliminate some meds & decrease dosages of others as I am learning better coping skills through DBT & as I am getting older I am getting concerned about being on some meds that have not been tested long-term in the elderly. If I have any symptoms return, I am willing to go back on the medication to curtail that. Treating bipolar is in flux (for me, at least). I don’t know many people that are put on a medication or combo & stay on that for the rest of their lives (though I was on the same med cocktail for 5 yrs. until I had a hypo mania then deep depression).

From that experience I learned I had to watch for “signs” that an episode might be coming. Has my behavior & attitudes changed such as more talkative, greater energy & less sleep, joining lots of clubs & organizations, recklessly over-spending money, getting “fixated” on one project to the exclusion of my family, etc. points to mania; depression is easy for me as I “go” fast into suicidal thinking & I want to start smoking again!! That is a unique signal to me that I need to call my meds provider & talk to her.

I’ve also taken classes that are offered through NAMI, Mental Health America & other organizations. A couple good ones are Mary Ellen Copeland’s WRAP (Wellness Recovery Action Plan) where you learn to build a “toolbox” specific to you for your individual symptoms & necessary measures to keep yourself stable & to have a good quality of life & learning how to handle stress, etc. & another is IMR (Illness Management & Recovery).

All my best to you.

re: re: re:Apologize again for all the junk
S
Friday, October 30, 2009 at 11:17 PM

I think the last line of the junk is the 1st line of my comment. Hopefully, Jerry will be able to tell me how to do it from a Word document (copy & paste) so all that cr*p doesn't appear.

re: re: re: re:Apologize again for all the junk
Jerry Kennard
Saturday, October 31, 2009 at 09:01 AM

Hi S,

I think all the coding is a result of pasting your comment directly from Word. The way to avoid this is to type your comment directly, or prepare it on Notepad (You'll find this in your 'Accessories' folder. Notepad does not have any background coding.

Med Compliant
Mike
Thursday, October 29, 2009 at 05:28 PM

Jerry,

I am with you. While drugs may NOT prevent mania or hypomania....my personal experience is they do help. Mania does come on sometimes...even though I am cosistently taking my medication, but if I STOPPED taking the medication...I can only imagine what whould happen. Likely a visit to the emergency room. I am a BIG proponent of strict regimentation of medication. Each to his own....but my meds always help. Best of luck to all.

MB

Impulse buys
KMP50
Thursday, October 29, 2009 at 06:56 PM

Unfortunately in terms of finanaces, I have my major credit card memorized.....

Reducing the Costs of Mania
scooby
Thursday, October 29, 2009 at 06:57 PM

Managing money is a sore spot for many of us with bipolar disorder, and when I look back at the many years I have lived with bipolar disorder, the manic episodes have been far more costly than the depressions.

I find participation in support groups has been a help and I've been exposed to some novel ideas for handling finances with one's spouse. As the problem often involves overspending, a couple could make an agreement that any expenditure over a certain amount must be discussed with the partner.

Another amusing solution (there's humor in everything) is with the misuse of credit cards and solving the urge to quickly buy something. The idea is to give up all but a few credit cards and then freeze them in the middle of a block of ice. The idea is that by the time the ice melts, one may have had sufficient time to rethink things.

Manias often are the more destructive of the phases of this disorder, and the aftermath of a disorder often involves what is termed "damage control." Helping the passage through this phase with cognitive-based therapy has proven helpful for me, as well as participation in 12-step groups and working the steps around personal inventory making and, importantly, making amends where appropriate. The right sponsor is the key.

quieting the storm
dark angel
Thursday, October 29, 2009 at 07:17 PM

hey...i am sorry to say that i don't get alot of support here at home...some, sometimes,...but? so i have taken over my own spending by deleteting all shopping cookies and throwing out all shopping coupons. i AM still having problems with my deprssions, suicide and all...my mother just screams at me for it!--she is a bitch about me when i am so suicidal because i get so angry and she doesn't help!! well i love being on the darker side when i am not angry. i like my poetry and writings. but...well i...don't know what else to say??

darkangel

Becoming our own advocates
GeekStyle59
Thursday, October 29, 2009 at 07:38 PM

First, my heart goes out to all of you for I know the same pain and suffering.

Even if the psych providers know all the stuff beyond meds alone, they sure haven't shared it with me. I spent three years searching, researching, and learning all I could about the disorder. After many, many years of only the suicidal depression, feeling manic again was all that some of you have written about already -- a breath of fresh air, of feeling the sunhine at last. Who wants to give that up?

I would go off my meds and go higher and higher into grandiosity -- only I didn't know that what I was experiencing WAS grandiosity! I was going to help many other people with bipolar disorder because I was so much better now. Life stresses were at an extreme and I went even higher as the meds I was given weren't working.

Then lithium entered my life, but I felt so flat and lifeless again (I have mixed episodes). My body has always responded very quickly to the right meds, which is partly how I know that I've found them. But once manic again, I missed the mania terribly when meds controlled it because it was the only time I felt alive. Skip a day of meds without even meaning to and back up I'd go, then continue without meds until I began to feel scared that the mania would never leave after reaching its dark side. Often that would be 3-5days. Pop a lithium and down I'd come to flatness again within 24-48 hours.

I talked to my pdoc about the possibility of "managed manias" which I explained as not going more than 3 days without meds (provided I could keep track). She said the danger of that is continuing to do it could easily result in the meds one day just not working anymore and that scared me more. I became compliant as fully as I could (some days, I'd just forget or couldn't remember if I'd already taken them). Pill boxes were suggested. It worked fine until it was time to refill them again and I couldn't find the energy to do it. Back up I went and then filled the pill boxes again until filling them became more of a hassle than I could bear since there so many pills (I now use an empty pill box only; when I take my meds, I simply open up hole for the given day of the week so I know later on those days when I can't remember whether or not I took them).

Along the way, though, I began to notice early and earlier signs of a mania coming on (usually, but not always, in response to a stressor) and I began to learn how to use self help and lifestyles management tricks and techniques to control these early signs. When I became aware of these early signs -- whether I was being med compliant or not at the time -- I'd really want to let it happen, but more and more frequently I became aware that I had a choice about what to do and I began to choose all my tricks and techniques more often. On top of that, after reading An Unquiet Mind I picked up on the fact that Kay Jamison Redfield had gone for periods of time at a lithium level of 0.7 while I had been led to believe that a level of 1.0 was almost a requirement. I tweaked my meds just a bit, but didn't even tell my pdoc until after I came back with a 0.7 twice in a row. She was about to increase my lithium until I told her no and explained what I had done, but that I felt better that way for not being in the depths of flatness. Another med I simply stopped (not a great idea, by the way) after my hairdresser commented on how thin my formerly incredibly thick hair had become. When I asked her opinion as to why it was happening, she suggested that it might be a med. Back to research. Presented my findings to the pdoc who poo-poohed them. I went off the med (not my lithium), began to feel better again and, after months, some fullness returned to my hair, but not before I had developed a balding spot. Oh, vanity, thy name is woman! But it worked.

Then I developed severe swelling in my lower limbs. Pdoc ordered tests and shared, as she always does at my request, with my primary care doc. Primary care doc said it was the lithium. I went off. Turned out not to be the complete answer, which we are still working on, but I felt better and retain my lithium as a "when needed" med along with my antipsychotic and antianxiety meds. Otherwise, I am only on a pediatric dose of Abilify and 20mg of Lexapro -- and I feel pretty decent and have a quality of life I'd been severely lacking. I am even very re-involved with 2 highly interesting -- to me -- hobbies: photography and genealogy.

My approach requires constant vigilance and diligence on my part. The early warning signs of my manias I was able to connect with the initial onset of major life stresses. My research and learning provided me with the knowledge that, for us who have bipolar disorder, stress seems to bring on a highly exagerated physiological (bodily) response. Sometimes I don't recognize it until my back is sore with the incredible tension which develops in the upper part of the middle of my back. When I realize it is there, I ask myself how bad it is. Is this something I can begin to approach with meditation and stretching exercises? Or, has it already progressed to the point of needing a quicker fix through one of my "as needed" meds to be followed with meditation and stretching? Or do I need an emergency trip to my pdoc. (I have yet to have to go to the emergency room like I did in the past, although even something as simple as posting a comment on this site brings on a stress response in me.)

If circumstances are beyond my control and seem likely to be ongoing for some reason, then I immediately call my therapist with a request to step up my visits. My pdoc and therapist are in the same agency and regularly update each other through their computerized notes. I am just coming out from underneath an ongoing stress that is resolving itself and my pdoc commented that she is impressed with how I have been asking for extra help whenever needed and using the other techniques, too. She also has come to trust my judgement when it comes to my meds as she knows I don't make any changes on my own without thorough research into the question at hand first.

The dialectical behavior therapy, as someone else has already noted above, has been another BIG help. The greatest problem with it, however, is that, even though I practice it as much as possible when stresses are lower, when a big, for me, stress hits me, I revert to old behaviors so that is still an ongoing battle. But the techniques do work when I can practice them.

My heart goes out to all of you because we've heard the old "well, you must not be taking your meds" and "are you sure you took your meds today?" comments so often that we begin to believe that that is all their is. Besides, docs of all kinds are human beings; many new meds truly are far better than the older ones; and the docs do get perks from the drug companies (and are, in my opinion, too quick to think that meds are the be all and end all of treatment along with "a little talk therapy"), so that the docs are pushing meds all too often to keep their perks intact. I even know people who are being refused treatment because they refuse to take any meds at all!

We are the only ones who can say, "No, stop! Let's at least try a little tweaking with what we know is working for me so that the other parts of treatment might have a better chance of working more optimally!!!" We know our bodies better than any doctor or any drug company does. I think we need to pay attention to those bodies -- of which the brain is just one part -- more than we have been told to. We need to study and learn all we can about our disorder. What has worked for others, and what are our early warning signs? We need each other even more than we need our caregivers (just that word sometimes leaves me with the feeling that we are being viewed as somewhat "less than"). Kudos to this site and to its newsletters for bringing us the news of famous poeple who live with the disorder -- both directly and indirectly (as in Glenn Close and Richard Dreyfus this week alone!) -- and sharing what has worked for them. But just your "average" person who has bipolar disorder has lots of experience to share and this is one great place to share it!

Untitled Comment
tabby
Friday, October 30, 2009 at 09:03 AM

Those who have longer bouts of mania and higher levels of it likely would say that mania is the most destructive of the phases. Those, like me, who have longer bouts of the severe depressive phases and deeper levels would say that the depressions are the most destructive... suicide is the primary killer amongst those with Bipolar.

My hypomania/mania, unless triggered by prolonged outside life stressors... are generally mild-moderate. They are primarily in the agitative, racing thoughts, built up internal sensation of pressure and needing to move and speak type things. Speech gets all garbled and thoughts get way too weird cause it's going all too fast for me to track. I laugh at everything, even inappropriate things, and I am game for all and every thing. I also have psychotic symptoms appear on occasion during these heightened periods (me have a man inside me head that tells me things and laughs at me - don't like him. No, me don't like him.).

Indiscretions typically are that I may spend $200 one weekend shopping and thus come up way shorter than usual at the end of the month and I feel pervasive guilt when realizing. Or, I made a insensitive though truthful comment to someone unknowingly that didn't actually provoke me. Or, that I told the boss precisely what I thought cause my inhibition to be shy, which in nature I am except when manic, went out the window and I spoke what entered my brain.

See, I gave up drinking and addictive drugs long ago and affairs? Never had. I get the pressure to scream and I go into my closet and do so. Or, I sit on the edge of my bed - get a pillow - and scream into the pillow while rocking furiously. I do this until the energy is expelled, the agitation and irritability is calmed. I hurt myself.. not others.

So.... the costs of my mania or hypomania as it typically is.. would be for me - not for those specifically around me.

It's the suicidal depressions that I struggle with primarily and I fear most. Yet, the inability to handle ADs makes medicinal treatment almost laughable. So, I rely on shear determination, willpower, therapy of many many many years, and most of all God.

re: Untitled Comment
S
Friday, October 30, 2009 at 11:38 PM

Yeah--the depressions are the most dangerous for me. I get into the suicidal mode very fast when depresed & have had many attempts & my mother did succeed at suicide after many atttemopt (bp 1, as well).

My manias are hypo manias & I don't get angry--maybe irritated more than I would & drive more aggressively (actually honked at a funeral procession when they had a long line of cars driving slowly w/police leading the way). Just get out of my way!!

I also join every group, club, cause , etc. My husband calls them my "crusades" as I get fixated on some wrongdoing & I am out to correct it, by God. Have even been on TV due to my speaking in front of numerous boards of companies, etc. due to my "crusades." They have all been great causes, but my being hypo manic made me get so overly involved that I neglected my family & spent way too much money supporting the cause.

Then, for me, after being hypo manic (usually about 5 mos. w/about 3 hrs. of sleep a night & feeling GREAT) I would suddently spiral into a depression & suicidal behaviors.

I have "taught"--maybe "led" is a better word a 10-week class for "consumers" w/2 other trained consumers (NAMI sponsored) & I would get so involved that I spent hours (& lots of money) to make everything "perfect."

DBT is helpoing so much.

I WILL NOT do to my children what my mother did to me & my siblings (suicide).

A lot alike
GeekStyle59
Sunday, November 01, 2009 at 06:24 AM

S,

You and I sound a lot alike in our experience/improvements of bipolar disorder! Finding an equal partner for meds and therapy, jumping on the bandwagons of various causes (almost being on a mission for me), and finding the DBT groups very helpful. Thank you for putting it so well!

I do, however, find it helpful to live alone and stay out of what I fear will be another destructive relationship ( I have had 2 failed marriages, one of which was annulled) as I have, in the past "sold my soul" to those 2 men and lost me. DBT helps with that, but I don't trust myself. After being celebate for over 12 years, God is going to have to hit me over the hard in order for me even to consider another relationship!! Indiscriminate sexual behavior -- and its consequential effects on me -- has always been my most destructive long term behavior. I feel grateful that overspending has never been that much of a problem for me as it has been for so many others, including my older brother. I find financial stress extremely destructive and anxiety causing to my soul. When I am hypomanic and in the mood to spend these days, I limit myself to a $15-25 trip to the true dollar store in town -- on my strict SSDI budget, that is overspending for me!

re: A lot alike
otterlo
Sunday, November 01, 2009 at 09:58 AM

I take my meds but I still have depression and I want to die. I tried suicide once and it was a very serious attempt. I was so humilitated over the whole thing, however, that I made myself a promise that if I ever did it again, I would die without fail. I have made my will and done all that stuff...there is nothing stopping me now, except for the possible hurt I might leave to my son. No one in my family excepted me when I truly went downhill. Up to that point I had lived a pretty successful life. But I was once again exposed to some pretty bad abuse. Now I have PTSD and bipolar II. I am almost totally isolated now. I do go to therapy but it does not seem to help much. I am truly at a lose and don't know whatelse to do. I have good and bad days but I cannot substain my good days and I go back downhill very easily. I do not talk to anyone anymore about this.....it does no good. I even limit my talk to my therapist....I feel like a total failure and a looser.

re: re: A lot alike
GeekStyle59
Sunday, November 01, 2009 at 04:26 PM

Dear Otterlo,

I understand your feelings as I've been where you are. One of the first things that helped me get started on the still fairly long way to feeling better was to walk. I could no longer afford my car or I never would have done the walking. I was so tremendously out of shape at the beginning that I had to force myself to put one foot in front of the other, but I was sick of going through the ordeal of asking others for rides for places that I could really get to. What is now only a 15 minute walk to buy the cigarettes which motivated the action, at first it took me 40 minutes. Just a thought.

re: re: re: A lot alike
otterlo
Tuesday, November 03, 2009 at 12:17 PM

Thank you Greek Style....for years I ran and it helped a lot...and I walked..I need to get off my butt and do it again...thanks for your support..it really means the world to me and you have my support also...Peace and hugs, Pam

Untitled Comment
Anonymous
Thursday, November 05, 2009 at 11:17 AM

I have had bipolar disorder since I was sixteen and am not 37 and dealt with that darker side in mania for many of those years.

The worst times were when I wasn't on board with my meds and questioning my diagnosis after being diagnosed so young.

I am glad I no longer question and consider my meds a tool to aid in my recovery. It is not my only tool, but it is a primary tool. Others are a sleep journal and a mood journal to track just how well I am on a daily basis. And my WRAP plan, good nutrition, good social connections, etc.

As for reducing risky behaviors, I do not own any credit cards because it is a pitfall for me, but I consider everyone's choice to be individual and everyone's needs to be tailored according to their specific patterns and past experiences and availability to supports.

I am grateful to friends who understand sometimes in manic states it's the mania talking and not my true self and they have remained my friends through thick and thin. I have lost friends too. The road is long with mania and it is not for everyone and I keep this in mind. It hurts, but it happens. It makes me more grateful for the people in my life who can stay the course. It is a difficult, difficult illness. But Recovery is Real, does happen, and there are more tools out there now, places to help and support than there was when I was 16!