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Bi-polar

I wrote a post not long ago about my despair and depression. I went to the doctor Thursday, and I have been diagnosed as very likely a sufferer of bi-polar mood disorder.

http://en.wikipedia.org/wiki/Bi-polar

So here come the drug trials. The doctor went over the options, and my head is spinning. Anti-depressants plus mood-stabilizers--so many different brands each with their own side effects.

Anyone here bi-polar? I would ask on a pscyhiatry forum but I tried that before and something about me makes them angry with me (I ask pointed questions they already have decided the answers for, I guess).

My worry is that my boss has now observed me out of the office for a solid week, and I have not been able to explain to him the reason why. I have doctor's notes, etc. But I still fear I may be fired.

The last time I went through a depressed episode, I asked for a week of un-paid vacation. I explained to them at the time that I was suffering burn-out. Obviously, while that could have been the problem, it is more likely I was going through a depressed swing.

I worry that I will be cast onto the street. I'm getting the paperwork ready to dip into my savings, just in case.

I read somewhere that the majority of work disability cases have to do with mental disorders. I am positive my disability insurance expired after I left my last job six months ago.

What do people do when they have such mental attacks? Is this how people end up homeless?
Permalink anon for this 
January 22nd, 2006
Do NOT take SSRIs if you are bipolar and get a new doctor if he recommends it.

True bipolar responds to anti-psychotics like lithium. It also responds to cognitive therapy, which is really what I think you should be looking at first.

In general, it is a bad idea to get psychiatric diagnoses from a family doctor. You need to see a Psychologist specializing in cognitive therapy and get a diagnoses from him.
Permalink Art Wilkins 
January 22nd, 2006
Oh on homelessness, the #1 triggering event for homelessness in men is the loss of a partner, through whatever means. Bipolar isn't going to make you homeless, but it might make you difficult to live with.
Permalink Art Wilkins 
January 22nd, 2006
Yeah, the med for bi-polar is lithium, not anti-depressants. Also, it doesn't sound like you are bi-polar. Bi-polar people pull kitchen knives out on their mothers, not get depressed at work. Depressed, yes. Bi-polar, no. Of course you could be both, but you didn't describe any bi-polar behavior in your previous posts.
Permalink _ 
January 22nd, 2006
Is it possible you're manic depressive instead of bipolar? One thing to do - look at the symptomology for mania - IMHO it's pretty straightforward and would help figure if you're swinging or simply depressive.

"I would ask on a pscyhiatry forum but I tried that before and something about me makes them angry with me (I ask pointed questions they already have decided the answers for, I guess)."

FWIW, this is standard operating procedure for internet forums.

Philo
Permalink Philo 
January 22nd, 2006
"Bi-polar people pull kitchen knives out on their mothers"

Huh? Typical bipolars I know are creative artists who have very dark periods. Bipolars only become psychotic and kill people if they take SSRIs, because it destabilizes their brain chemistry.
Permalink Art Wilkins 
January 22nd, 2006
Philo, my understanding is that bipolar == manic depressive.

Are people confusing bipolar with schitzophrenia?
Permalink Art Wilkins 
January 22nd, 2006
the OP has never described any manic episode that would point to bi-polar. as far as the kitchen knife goes, my cousin is bipolar and did exactly that. perhaps it is atypical. but, usually if you are bipolar, the "high" mood swing makes the person so annoying that they are impossible to be around. Extreme hyperactivity, being supertalkative and overbearing, extreme ego primping, never sleeping, etc. Is that happening to the op? Maybe but he never mentioned it.
Permalink _ 
January 22nd, 2006
No, actually I thought the same thing, but I didn't know for sure if there was a line between bipolar and manic depressive, or if they were synonymous. :)

I *do* know the treatment for manic depression is different than the treatment for straight depression.

Philo
Permalink Philo 
January 22nd, 2006
The kitchen knife suggests a psychotic episode. Is there a possibility they were on crystal, or taking ssris at the time? Violent psychosis is not typical for bipolar. The delusions of grandeur et al from the mania as you descrbe is very typical, but there can be less severe levels.
Permalink Art Wilkins 
January 22nd, 2006
"the treatment for manic depression is different than the treatment for straight depression"

Yes and this is important to know. Many family doctors do not know this, which has led to a number of tragedies.
Permalink Art Wilkins 
January 22nd, 2006
he may have been on SSRIs. not sure. I think he was mis-diagnosed for quite some time.
Permalink _ 
January 22nd, 2006
Any competent psychologist or psychiatrist should be able to make the diagnoisis, they don't have to specialize in cognitive therapy.

Manic Depressive *is* bipolar personality disorder. It literally means going from one pole (depression) to the other (mania). Depression is also known as unipolar personality disorder. There's Biploar 1 and Bipolar 2. Bipolar 1 has large mood swings, and Bipolar 2 has less intense manic phases. I'm going on memory here, but I'm 99% sure I'm right.

Cognitive-Behavioral Therapy (CBT) is a popular & effective treatment, the drugs are really only meant as a stopgap solution, just meant to stabalize you so you can get back to work in the short term while you get some other therapy. The relapse rate for drugs alone is pretty high, but if you get CBT, the long term prognosis will be much better. I don't know the percentages offhand, but I'm going to say it's probably in the range of 1/3 long term success with drugs, and 2/3 with CBT.

There are some who believe that mania is what made this country what it is. It's part of what inpsires people to do great things - big business, great art, etc., so enjoy the company you're in and learn to work with the phases, how to keep yourself in check when you're manic while still getting all sorts of stuff done, and how to shore yourself up when you're depressed.
Permalink MarkTAW 
January 22nd, 2006
OP --

First of all, good on you for getting help. The biggest problem with mental illness is that people tend to let it go untreated. You've made a good start.

I agree with whoever upthread said that you should find a psychiatrist to work on your treatment with. A GP may be able to give you a diagnosis, but you want a specialist to figure out what meds are appropriate.

If you're bipolar (or manic-depressive -- same thing), the biggest issue is usually that you'll want to go off your meds when the depression eases up. Don't. Many bipolar folks find that they miss the manic phases (which as I undersand it are a log like being on cocaine). You're actually more likely to do yourself lasting harm when you're feeling invincible than when you're curled up in bed, unable to move.

Good luck.
Permalink Boofus McGoofus 
January 22nd, 2006
Also, I don't know what health care & social services are like where you are, but I know someone who's on disability for having bipolar disorder and having a slipped disk. I don't know which is the most important for the disability, but I believe having bipolar disorder formed a big part of her case for getting disability.
Permalink MarkTAW 
January 22nd, 2006
this is unhelpful, but since it is ?off I thought i'd make an observation.

I grew up in North Dakota, where people in general seem to have one mood, all the time. Since moving to California, bipolarity seems to be the default condition of 50% of the population The other half is afflicted with either meglomaniacal optimisim: "I WILL make a billion dollars by age 24" or chronic apathy: "it totally sucks living with all this sunshine in the redwoods by the mountains by the beach. i'm so bored".

Since nothing seems to alter my mood, I've been accused by many native californians that *I* need to take meds, because there is obviously something wrong with me because I'm not either crying in bed or flying off the handle all the time.

my response is usually "people take meds because they want to be like me" which usually doesn't go over too well.
Permalink _ 
January 22nd, 2006
Heh. I have to put up with "Dude, what's wrong?" if I'm not smiling and cracking jokes. I'm not *allowed* to have a "normal" day.

Laughter is free
But it's so hard to be a jester
All the time
And no one's believing
I'm the same when I'm bleeding
And I hurt all the time deep inside
Permalink Philo 
January 22nd, 2006
For what it's worth, I was a manic depressive and suffered psychotic episodes. It's not the "normal" behaviour pattern for manic depressives, but neither is it unheard of.
Permalink Mat Hall 
January 22nd, 2006
Of the psychotic symptoms, hallucinations aren't that common in manic depressives, but delusions (irrational beliefs) are. Delusions of grandeur when in a manic phase, and "nobody loves me" type stuff in the depressive phase.
Permalink MarkTAW 
January 22nd, 2006
anon for this:

Are you a she?
Permalink Not Berlin 
January 22nd, 2006
I was diagnosed as being bipolar, and was given lithium and rispradol against my will while I was hospitalized. Those drugs totally messed me up. I am saying this solely based on my personal experience, but

THOSE DRUGS ARE TOTALLY INHUMANE AND SHOULD NOT BE GIVEN TO ANYONE FOR ANY REASON

I am referring to any drug that messes up the neurotransmitter level in your brain, not just lithium, rispradal, and geodon (the ones I was given).

Lithium is, literally, poison. The dose is carefully measured to make sure it isn't lethal, but strong enough to dampen your senses. Long-term use causes kidney damage.

Rispradol has horrible side effects. I was unable to think at all. I had a compulsion to sleep all the time. It is a strong anti-spasmodic and messes up your bowel movements. I was unable to read. I was unable to sleep or dream (even though I had a compulsion to sleep all the time; it was sleep without rest). I was unable to have sex.

Geodon is just as bad, except that instead of having a compulsion to sleep all the time, I had a compulsion to constantly walk around in circles. It messes up your heart rhythm cycle, giving a risk of heart attacks.

Scientists do not really understand how these drugs work. They were discovered by trial and error. They notice that they give these drugs to patients and symptoms subside. They do not consider the possibility that symptoms would disappear on their own in a few days. They do not consider the horrible side effects.

I have no doubt that any academic studies promoting these drugs are likely forgeries. They ignored the horrible side effects. It is probably a case of professors selling out for grant money from drug companies.

When I was on Rispradol and Geodon, I complained to my psychiatrist about the side effects. My psychiatrist said that the side effects were in fact symptoms of my illness, and NOT side effects of the drugs. I know now that they were in fact side effects, because I stopped taking the drugs and the symptoms went away.

Those drugs are extremely addictive. I stopped taking them, cold turkey, against my doctor's advice. After much convincing, I managed to get my parents to go along with this plan. Several months of horrible withdrawal symptoms followed. It involved uncontrollable shaking, gradually recovering my senses and my abilitites. I am finally fully myself again. The withdrawal looks very much like Parkinson's disease. I am lucky I was able to convince my parents to not bring me back to the emergency room, because they would have just put me back on those drugs. I really hope I wasn't permanently damaged by those drugs. I suspect not, but I'll never be 100% sure.

You should read up on "Tardive dyskinesia". There's about a 1-2% cumulative chance, per year on those drugs, of developing PERMANENT uncontrollable muscle spasms.

My advice for anyone having a manic or depressive episode is to try to wait it out. My experience has been that, with no drugs, it goes away in about a week. Get a regular psychiatrist, the kind who you talk about your problems with, and NOT the kind who will prescribe drugs.

If you have already started taking those drugs, I regret to say, your life has been horribly messed up. Your psychiatrist is going to resist any attempt for you to quit taking them. It is going to be several horrible months of withdrawal if you ever want to recover your former self. When you complain of side effects, they will just keep switching drugs or adding new drugs; your psychiatrists will *NEVER* consider taking you off the drugs altogether.

What happened to me was that I saw a multi-million dollar crime at work. I was working for a trading firm, writing options trading software. The program had a ton of bugs, and was losing a lot of money. My coworkers, boss, and boss' boss were lying to cover up the bugs, refusing to let me fix them. They asked me to implement a feature that I saw was going to lead to a huge loss in a short period of time, and I came to the conclusion that the program was designed to lose money on purpose. They had another program somewhere else that knew what this trading program was doing, and was taking the other side of the program's losing trades. I complained to the CTO that I thought a crime was occurring. He did not take my complaint seriously. I didn't realize until later that the reason he didn't take my complaint seriously was because he was probably in on the scam (I was pretty stressed out, but still, he should have taken my complaint seriously.) I did eventually file a complaint with the SEC against my former employer, but I have no idea if it was taken seriously. In any case, the CTO did commit a crime for not taking my stealing accusation seriously and not reporting it to the government.

Anyway, the whole experience was so stressful that I didn't sleep at all for several days. Since I was living on my own, without any close friends or family, I called 911 for help and I was admitted to the mental ward, against my will, and forced to take those drugs. Based on a doctor who examined me for just 2 minutes, I was given those horrible mind-destroying drugs. They didn't even attempt to talk to me to find out what was bothering me (although I was quite upset at this point).
Permalink Anonymous 
January 22nd, 2006
I don't know about the other drugs, but lithium is a salt. Certain doses are toxic, but all it does is stabilize glutamate levels in your neurons. Everyone I know that has been on lithium said it was extremely helpful for fixing their condition. (and making them much fatter)
Permalink _ 
January 22nd, 2006
Yours is not an uncommon experience.
Permalink Art Wilkins 
January 22nd, 2006
Before I finish reading this whole thread, I went to see a PSYCHIATRIST, not a family doctor.

His diagnosis is tentative, but he feels pretty sure. I do experience highs, but not nearly as severe as the lows.

I did not go into detail because I am a regular here.

After seeing the doctor, I thought about my past and my own efforts at self-medicating. The psychotherapy would probably not work in my case. I am pretty sure it would be short term benefit only, not long term. I am pretty sure what I have is a chemical imbalance.

In addition, he and I discussed lithium and some other effective drugs. He thinks lithium would be a good possibility for me, but because my highs are not extreme, he is being conservative in his recommendation and not starting with lithium because of possible side effects.

He is not 100% on whether I am just a depressed person or am bi-polar, so he is TRYING celexa, an SSRI, on me to see the effect. If I am bi-polar, obviously I will not respond well to it.
Permalink anon for this 
January 22nd, 2006
Boofus McGoofus says:

<<<Many bipolar folks find that they miss the manic phases (which as I undersand it are a log like being on cocaine). You're actually more likely to do yourself lasting harm when you're feeling invincible than when you're curled up in bed, unable to move.>>>

Yes, I will miss the manic phases. They aren't quite like being on cocaine for me (almost though), but are still wonderful.
Permalink anon for this 
January 22nd, 2006
Art says:

<<<You need to see a Psychologist specializing in cognitive therapy and get a diagnoses from him.>>>

Psychologists are biased. If you do not believe in God, or have lifestyle differences, most of them do not seem to know how to deal with that or give advice. I actually had a cloud move over the room when the therapist asked me about my religious beliefs; I said "I don't believe in such things." Immediately, to her, I was a lost cause. No lie.

You are very lucky if you find a good psychologist. I have seen four over my lifetime, no results.
Permalink anon for this 
January 22nd, 2006
<<< Get a regular psychiatrist, the kind who you talk about your problems with, and NOT the kind who will prescribe drugs.>>>

I used to think that. But I am approaching a mature age now and the effects are harder to run away from. A week here and there away from work WILL get you fired.

On Monday, I am going to have to explain this to my boss. I really do not want to. I really do not want to have to grovel to keep my job because I cannot be there 100% like normal people.

Now I know why people take drugs. I used to think they were weak, or not willing to do things like exercise. Not so, necessarily. After years of fighting, I am broken down.

Do this fight long enough, you will see it progresses, the problem doesn't back down, ever.

Conforming to what society wants from us is easy if you want the same things. I do not want the same things the majority of you want (outside of the basics) and so I am different and so I must take medicine to cope.

That truth is the saddest thing of all. I cannot beat the system, so I must become a zombie to stay in it so I can eat and have a roof over my head.
Permalink anon for this 
January 22nd, 2006
The first thing to do is line up the people who are going to help you. As Art Wilkins said, a family doctor/general practioner isn't really qualified to diagnoze bipolar (I wouldn't be thrilled with them diagnozing regular depression either). In fact psychiatric disorder diagnosis is really tough - I have a close family member who has been going to the director of psychiatry dept. here at UMass for over three years, and the diagnosis has never been pinned down with certainty. (Bipolar, depression, schizoaffective, schizophrenia and secondaries of body image disorder, oppositional defiance disorder, ADHD, OCD. I think the psychiatrist gave up with a precise diagnosis and is focused on treating symptoms.)

So the first thing is to get hooked up with a good psychiatrist (not to be confused with a psychologist, though if you have both, that's even better). And, yes, a therapist/psychologist. Consider letting a few close family members or friends know your diagnosis too; they can help in identifying manic episodes better than you can. There are also support groups in major cities which are good at providing resources and perspective.

Secondly, not everything people say in a forum like this is up to date. Lithium is principally for severe manic episodes not maintenance treatment (it's often prescribed to schizophrenics for that). SSRIs *are* currently prescribed for bipolar though there is an above average chance of mania with them. But it's never going to be a perfect choice - the risks of mania by taking them for most people are lower than the risks of depression by not. SSRIs are not prescribed without mood stabilizers however.

Here are recent guides for psychiatrists, kinda technical, ...

http://www.psych.org/psych_pract/treatg/quick_ref_guide/BipolarDisorderQRG_04-15-05.pdf

and

http://www.psych.org/psych_pract/treatg/pg/Practice%20Guidelines8904/BipolarDisorder_2e.pdf

Cognitive behavioral therapy can be helpful. But what's really helpful is CBT and medication. (Also the more depressive you are the more helpful it is; the more manic the less helpful.)

As far as dealing with your boss: if you go to the doctor's often, your boss will figure out something is wrong. You do not need to tell him what, fight the urge! (given the stigma of mental disorders, it's best not to tell him). It's an illness and you're handling it - that's all they have to know. Concentrate on getting your job done, rather than worrying too much about what they think of you (attributing extreme beliefs about oneself to others - either overly favorable or overly negative - is a manic symptom).

Although many homeless people have mental illness, a diagnosis of one is not a sentence to homelessness. For one thing schizophrenia is more prevalent than bipolar among them - take it from someone who knows, it's very alienating to family members and friends - "why can't they just stop believing that bullshit?" we say. Mild bipolars can be fairly successful in fact (especially as businessmen). They do need to find a place that can accomodate their rhythms however (even under treatment). Plus the people out on the street have more sever illnesses and many have never held a job (your illness seems milder and more treatable).

Don't make homelessness into a self-fulfilling obsession.

Another thing to note is that your life will probably change under treatment. Hopefully the illness wll be managed. But the treatment itself will impose limitations on your life too. You're not like other people, so you can't necessarily do everything they can. You may need to have much more regularity in your life: even small disruptions in sleeping, eating, exercise, etc, disturb your moods more than an average person's. Substance use, like alcohol, (not just abuse) needs close monitoring. You may need to expunge stressful activities, like gambling or video games or a hectic work environment (even though they can make you feel good, the good feeling often overshadows insight and good judgement).

More than one psychiatrist has philosophized that the goal of treatment, all psychiatric treatment (and people's self-treatment too) is 'controlled hypomania' - a feeling of elation without recklessness. Good luck.
Permalink Spinoza 
January 22nd, 2006
Be careful you who tell this diagnosis to, there is a LOT of mis-information out there, and tons of people with agendas. You are about to discover that some of your "friends" will offer you all kinds of bad advice and will be more then happy to preach to you about how horrible you are and how you should stop "killing your self" with all your "unnesicary medications," referencing anecdotal stories of horror. Because clearly their isolated story is all you need, and clearly you can "just get over it".

For example, my significant other is pretty much textbook ADHD. You'd be amazed how many crackpots there are out there, both "professional" and your not-so-friendly friend who all have very uneducated, very biased opinions on how to treat ADHD - ESPECIALLY revolving medication and "morality."

You will find this bias true for all mental illness. For whatever reason there is a large, ignorant swath of our population apperantly think you can just "get over" mental illness and since it cannot be seen or touched, your mental illness is not real.

You need to become your own personal bi-polar expert. Read everything you can get your hands on that is in print; the internet is poor for this kind of information as it is too hard to seperate the crackpots from the experts. Make sure the stuff you read is is backed up with citations from reputable medical journals. Experts glady cite other work and will glady admit to what they do not know.

So, watch who you tell this to and educate yourself.
Permalink Anon 
January 23rd, 2006
Oh, and gleefully ignore the non-PhD anti-medication crackpots. They speak from ignorance, bias, and agenda; not education and fact. These very same neanderthals will be more then happy to tell you how "unsafe" you are for taking psych-medication, but then look the other way when you take blood pressure medication, or any of the other thousands very safe, well tested drugs in our pharmacopia.

If they didn't take 8 years to get their psychiatry degree and if they dont follow the latest research in their specialty of menal illness they are crackpots. Tell them to shove it. Plain and simple.
Permalink Anon 
January 23rd, 2006
I hang out sometimes in the criagslist psychology forum, and it's a strange, strange place. I defended the whole psychological/psychiatric profession to someone as being rooted in medicine, and they went on a rant about how they were kidnapped by NAZIs and kept against their will in a psychiatric ward and subjected to all sorts of horrors.

I'd seen this poster before, but I hadn't realized it was them I was arguing with. Whoever it was was obviously delusional, probably some sort of schizophrenia at work, and while there may have been some truth to what they said (I think in an earlier post they said the staff was Polish or something), it was distorted beyond all possible recognition.

I have heard stories of psychiatrists dismissing withdrawal symptoms as the return of illness, and going cold turkey, especially off of anything that affects your neurochemistry is typically a bad idea. You should step down your dosage the same way you step it up.

If you don't like your psychiatrist's diagnosis or prescribed treatments, you need to find someone who will work with you, and yes, it wouldn't hurt to become your own expert.

The main classes of drugs they will prescribe are tricyclics, SSRIs (Selective Serotonin Reuptake Inhibitor), MAOIs (Monoamine Oxidase Inhibitor) and some other category they lump everything that isn't one of the above in. I forget the what they call them, but the name simply meant "not one of the others."

The current theories of depression and bipolar disorder, neurochemically speaking, involive having too much or too little of some neurochemical, either serotonin specifically or the monoamines in general. Too much leads to mania, too little leads to depression. I forget which is which, but one theory is just "too little leads to depression" and the other one is "too much leads to mania, too little leads to depression." The tricyclics, SSRIs and MAOIs affect the levels of these chemicals in the brain.

The SSRIs act by inhibiting the reuptake (think of it as recycling) of Serotonin into the transmitting cell, leaving more of it in the synapse to trigger the next neuron. The MAOI's act by inhibiting the chemical that breaks down the monoamine group of neurotransmitters. I forget how the tricyclics work, but I believe they affect the broadest range of neurotransmitters, and the fourth category does, well something else, as the name would imply (if I could remember it).

If I remember correctly, the SSRIs have the worst side affects, and there are certain foods you have to avoid with them, while the MAOIs have gentler side effects.

Hopefully that 5 minute overview will give you a place to hang all the information you're going to get over the next few months. I can get more specific if you want, and I can crack open the textbooks to clarify or verify anything, but of course, anything I say should be vetted through a professional.

I know you're convinced that yours is a neurochemical problem, but I wouldn't give up on the CBT. It may not "fix" the problem, but it can give you a framework for evaluating your thoughts and feelings so that you can at least work through them in a somewhat logical manner, which may be a comfort at times, and they have done brain scans of people who took drugs and people who have gone through psychotherapy, and they both showed similar changes. There is no thought without a physiological event, but nobody yet knows which causes which.

The Feeling Good Handbook by David Burns and, I think it's Authentic Happiness by Martin Seligman should cover the basics of CBT - cognitive distortions and attributional styles. I've browse the Feeling Good Handbook, and haven't read anything by Seligman yet, so there may be other better books in this area, these are just the ones I know about that I've heard are good.

One thing, though, you have to actually do the exercises for it to work. If you have a therapist, they'll do some form of them with you, but it's not enough just to know this stuff exists, you have to get out of your head and into reality. If you just read it, or just think about it, it becomes part of the swirling spiral of positive or negative thoughts that build without going anywhere. So do the exercises. When I was going through a tough time, I did some of the exercises in the Feeling Good Handbook, and to it did help "ground" me when I was lost in thought.

Good luck. I'm here to answer questions either publicly or privately, and I promise I'll say "I don't know" when I don't know.
Permalink MarkTAW 
January 23rd, 2006
You might find a psychologist (a good one, not like the one you mentioned above) helpful. Although you do likely have a chemical imbalance, talk therapy can still be a really useful way to learn what some signs and triggers are for your symptoms and to learn some coping mechanisms. What I mean is that, while it may not prevent you from having a manic episode, it might help you learn to recognize it sooner and might give you some tools for minimizing any destructive behavior that you might engage in.

Make sure that you have a psychiatrist who you trust and who listens to you. If you don't feel good about yours, find a different one. I was on an SSRI for a while which had the side-effect of causing night sweats. Rather than just pooh-poohing it, my shrink listened and agreed that we needed to change my meds so that I could get more than 2 hours of sleep per night. You want a shrink who will do that and not just say "oh, well, that can happen."

I agree with the folks above who said you need to do your own research. You also need to keep in mind that you have a medical condition, not some sort of personal weakness. Think of it as "diabetes of the brain" -- your body doesn't respond properly to the chemicals running through your bloodstream, so you eat right, maybe take some pills, and get it under control. It's not a one-way ticket to homelessness -- it's a medical problem that people are living with every day.
Permalink Boofus McGoofus 
January 23rd, 2006
"You also need to keep in mind that you have a medical condition, not some sort of personal weakness."

Yes, you HAVE bipolar disorder rather than you ARE bipolar. Maybe it seems like a trivial distinction, but it should be referred to that way. Noboday ever says "I am cancer."
Permalink MarkTAW 
January 23rd, 2006
MarkTAW -- I'm not positive, but I think you're backwards on the side effects for MAOIs vs. SSRIs. The MAOIs are an older class of drugs which had way more side effects than the newer SSRIs. I know that the SSRIs include Prozac, Zoloft, Paxil, and Celexa, all of which have pretty "minor" side effects (though they'll all kill your sex life).
Permalink Boofus McGoofus 
January 23rd, 2006
Second Boofus; eat right, live right. If your job is stressing you, find another one. Maybe not right now, but eventually. Stress is something to avoid if you have any kind of depressive spectrum illness.

Eating is very important; all those naggy witterings about eating three regular meals, not snacking, making sure you get vegetables etc -- they're actually quite good advice.

I'd be tempted to tell management people as absolutely little as possible if you're in one of those "at will termination" places. Mental illness is something 1/3 of society gets, but for all that people seem to have astonishingly bad reactions to it happening to other people.

Apart from that the best advice I can offer is that if your medication isn't working, nag people until they switch it. Docs (of all persuasions) have favourite prescriptions which are the first things they dole out. Unless you complain if it's not working, you won't get them to have you try something else.
Permalink Katie Lucas 
January 23rd, 2006
I could easily have that one backwards. I hope qualified that paragraph with an "I think."
Permalink MarkTAW 
January 23rd, 2006
Sleep is also very important. A lack of sleep is a good predictor of depression. People who are sleep deprived are 4 times more likely to become depressed than average, and people with sleep problems are typically depressed.

Getting a good night's sleep every night is important. I know if I don't get enough sleep, I get a bit manic and a bit OCD.
Permalink MarkTAW 
January 23rd, 2006
actually, all along I knew who the OP is. Bored Bystander had linked to his website a few centuries ago. Just a guess, OP, isn't your site GW (abbreviating the full name of the website to protect your identity)?
Permalink Sathyaish Chakravarthy 
January 23rd, 2006
"actually, all along I knew who the OP is ..."

Nice. Outing the OP - or maybe someone unrelated - who wanted to remain anonymous. Or double anonymous as the case may be.

As for Anonymous (as opposed to the anonymous OP), my heart goes out to you. I know someone who had a very similar experience. A friend of mine got so worked up about an upcoming event that she didn't sleep for a week, finishing with a phsychotic episode and a stay in hospital. Eventually she begged me to come and get her and I had to drag literally drag her out. Needless to say the doctors were 'dissapointed' in that special, invasive way that mental health professionals can be. She was fine in a few days. Sleep deprivation and anxiety can mess you up more spectacularly than you could ever imagine and can look like many kinds of mental illness, but no trained doctor should miss the difference, ever.
Permalink Sleepless in Cyberspace 
January 23rd, 2006
The OP is really worried about losing his job/becoming homeless. There is some truth to this worry. But liquidating assests a few weeks after a diagnosis is probably overkill (that is, if he didn't have three months expenses in a liquid form already). In fact, the anxiety about loss of work and home can aggravate the illness and actually percipitate such loss (which will make the illness worse). The OP should find ways to put the worry in perspective.

The OP's afraid that if he's not functioning at 100%, he will become homeless. This type of either/or, black or white thinking is typical of bipolars. (Yes it's hard to recognize that some of one's own thoughts are byproducts of a disorder rather than of the immaculate self. A therapist will help you with that.) The fact is there are lots of jobs where one can be less than 100%; some would argue most IT full-time jobs (rather than consulting, self-employment) are like that, heh.

My close family member gets $380 a month in mental health disability, $80 of which goes back to the state in the form of medical insurance. There are residential hosuign options for folsk with mental disabilities too, but there is a many-months queue for them (your therapist can contact your state's Dept. of Mental Health, and get you a case worker).

The best way to stay off the streets is to keep a job, even if it will eventally have to be at a lower pay/lower stress level than the current one.

MAOIs (not SSRIs) are the ones which have strict dietary restrictions (no cheese, no red wine, etc). As far as antidepressants there are three classes - MAOIs, tricyclics and atypicals (which include the SSRIs): http://www.psych.org/psych_pract/treatg/pg/Depression2e.book-7.cfm#table1 .
The atypicals (usually the SSRIs - Prozac, Zoloft, Paxil, etc - first) will be prescribed first as they have least side effects. MAOIs and tricyclics are really brutal and kept in reserve for very severe cases. Also SSNRIs (selective norepinephrine reuptake inhibitor, too) like Cymbalta and Effexor are gaining favor as good atypicals.

However "antidepressant monotherapy is not recommended for bipolar." Either mood stabilizer or antipsychotics are probably necessary (atypical ones - Seroquel, Abilify, Clozaril, Zypexa, Risperdal, etc - have the least side effects and will be tried before the older ones like Haldol and Thorazine).

There is currently no way to tell which medication or combo of meds will be the best for any particular patient (finding genetic or phenotypical filters is one of the hot issues in the field). The only method is to keep trying - the chances are that one of the antidepressants and one of the antipsychotics will work with no or little side effects. Don't give up if the doc's first prescriptions don't work.

The single axis theory of depression/mania (that too much or too little of one neurotransmitter, whether serotonin or norepinephrine or dopamine causes the illnesses) is not currently favored. Prozac really killed that theory as it proved useful for the four malcontents (non-severe depression, anxiety, compulsiveness, social inhibition) and it only works on some serotonin receptors not others. It's really a cultural oversimplication (as calling serotonin the 'love chemical' in last night's episode of Grey's Anatomy).

Anonymous's post exemplifies some of the issues with bipolar/psychosis. Antipsychotics will dull the sensation of the self, the sense of power. There's an impulse to go off the medication when things aren't too bad. But being off the medication means being out of control (for someone with a disorder, that's a tautology) and often leads to an emergency situation. I've visited two different patients in ER psych wards and can say that a full blown psychotic state is not a pretty thing (pure evil is more like it), that forced medication is not taken lightly by the staff, and that these medications, like lithium, risperidone, clozapine, are more efficacious than not. It is simply not true to say "antipsychotic medications are inhumane." For one thing, side effects, like TD or sleep irregualrities, are not guaranteed (1-2% isn't bad). Secondly even the side effects are better than the psychotic condition itself. In other words, it's often inhumane NOT TO MEDICATE in severe cases of psychosis.

The rant against Anonymous' past employer sounds like a dystopic delusion with hints of narcissism (one gets a smell for these things after a while). Maybe it's true, I dunno. I do know that working on Wall Street is usually not a good idea for bipolars/schizophrenics (as Katie Lucas says, way too stressful).
Permalink Spinoza 
January 23rd, 2006
Okay, all this ass kicking made me go check my textbook.

Antidepressants fall into four major categories: tricyclics, MAOIs, selective serotonin reuptake inhibitors, and atypical antidepressants. \

The tricyclics (e.g. imipramine, trade name Tofranil) operate by preventing the presynaptic neuron from reabsorbing serotonin or catecholamines after releasing them; thus, the neurotransmitters remain longer in the synaptic cleft and continue stimulating the postsynaptic cell. However, the tricyclics also block histamine receptors, acetylcholine receptors, and certain sodium channels. Blocking histamine produces drowsiness. Blocking acetylcholine leads to dry mouth and difficulty urinating. Blocking sodium channels causes heart irregularities, among other problems. Many people have to limit their use of tricyclics becaue of the side effects.

MAOIs (e.g. phenelzine, trade name Nardil) block the enzyme monoamine oxidase (MAO), a presynaptic terminal enzyme that metabolizes catecholamines and serotonin into inactive forms. When MAOIs block this enzyme, the presynaptic terminal has more of its trasmitter available for release. The tricyclics are generally more effective, but MAOIs help many patients who do not respond to tricyclics. People taking MAOIs must avoid foods containing tyramine, including cheese, raisins, liver, pickles, licorice, and a long list of others. Tyramine combines effects with MAOIs to increase blood pressure, sometimes fatally.

The SSRIs are similar to trcyclics but specific to the neurotransmitter serotonin. For example, flouxetine (Prozac) blocks the reuptake of serotonin at the presynaptic terminal. SSRIs produce only mild side effects, mainly mild nausea or headache. However, they sometimes produce nervousness and are not recommended for patients with both depression and anxiety. Other common SSRIs include sertraline (Zoloft), Fluvoxamine (Luvox), citalopram (Celexa), and paroxetine (Paxil or Seroxat)

The atypical antidepressants are a miscellaneous group of drugs with antidepressant effects, but only mild side effects. They are often effective for patients who fail to respond to the other drugs. One atypical antidepressant is bupropion (Wellbutrin), which inhibits reuptake of dopamine and to some extent norepiniephirne but not serotonin. Another is venlafexin, which mostly inhibits the reuptake of serotonin but also somewhat that of norepinephrine and sleightly that of dopanine. A third is nefazodone, which specificlally blocks serotonin type 2A receptors and also weakly blocks reuptake of serotonin and norepininephirne.

etc. (Type-O's mine)
Permalink MarkTAW 
January 23rd, 2006
Thanks for all the information. I am slowly digesting it in small pieces.

I talked to my boss today. They really want me back and might be willing to cut my hours until I find a way to manage this better. Maybe I won't be homeless.
Permalink anon for this 
January 23rd, 2006

This topic was orginally posted to the off-topic forum of the
Joel on Software discussion board.

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