Friday, November 21, 2008

Thoughts on Bipolar and Depression Healing

Since today is Friday, and I'm ready to move on next week and write about something new, I'll end this week with my thoughts about why I initially got so angry about the natural healing webcast, so that I can be done with it and move on.

1. The fact is that having been diagnosed as bipolar in 1993, and having read more than 100 books on the topic and related subjects, and having spent 15 years researching this topic, I can't recommend one book on bipolar wellness that I think is uplifting or helpful and I feel the same way about depression.

2. I believe there is something so fundamentally wrong with current treatment practices that it makes me very angry. I don't believe most psychiatrists ask the right questions during the initial consultation, request the right tests (In fact, how many of your psychiatrists had you tested at all to see if there are health issues that might be contributing factors?), or spend the time to determine why you're depressed (again, if your first presentation was mania, it's a different issue and not one I know about), whether there are unresolved personal issues, whether you have personality traits that are contributing to your illness, whether you have the skills to handle stress, whether your personal relationships are satisfying, whether you enjoy your work, whether you're aware of the causal factors that trigger depressive episodes, whether your diet is a good one, whether you exercise on a daily basis, and so forth and so on.

3. I believe most of the treatment guidelines have been developed in mental hospitals where the sickest people are seen rather than in discussions with people who are highly functional.

4. As far as I know, there is no bipolar or depression wellness program in the universe, which offers an optimal program. I've written about this before and even developed the outline for one on another site.

5. As far as I know, there are no ongoing national or international studies to determine whether medication truly works, what the side effects are, how people feel about taking it, what long-term health problems it can cause, which medications are most effective, and/or whether the people who are "true" success stories take medication and/or use alternative methods of healing.

6. As far as I know, there are no ongoing national or international studies to determine whether alternative treatments work, which types of treatment are most effective, which are an absolute waste of time and money, and so forth and so on.

7. It is becoming increasingly difficult to find truthful information on healing practices because so many doctors, mental health professionals, and consumer groups receive funding from the pharmaceutical industry.

8. It is almost impossible to find true success stories of people who have "overcome" these illnesses and are living "normal" lives. (Perhaps my definition of "successful" differs from most.)

9. It is very disturbing that so many people seem to want to make a profit off other other people's pain and suffering.

10. There are few bipolar and depression sites and blogs that provide upbeat, uplifting information on healing that is truly effective. In the few cases where people do recommend medications or products, it's a profit-making venture and difficult to determine whether it's just another hype.

Thursday, November 20, 2008

When My Behavior Is a Bit Off

(I originally posted this last night, and have changed the opening paragraphs.) Yesterday was a better day although I'm embarrassed I responded so harshly to the Natural Approach to Healing Depression webcast. While my disappointment was genuine, and there was good cause, I usually try to seek some distance and perspective before I write an angry post or email.

Gianna talked with Troy, the fellow who worked on it, and has written to say she now has a different perspective. I would agree that it was the wrong venue and will play far better on You-Tube. I still feel the press release was misleading, and the materials were simplistic.

Having said that, I've been reading James S. Gordon's book, Unstuck, Your Guide to the Seven-Stage Journey Out of Depression, and it's really good. While I'm only half way through it, he discusses issues that few other psychiatrists are aware of, and I'll write more about it.

So, my revised opinion is that there is probably a value in seeing the rest of the webcast series or waiting for it to play on You-Tube. Gianna says the episode on meditation--which she has previewed--is "well done."

I've noted on my mood charts that during the last few days, I've been too emotional, my judgment seems slightly impaired, I find myself getting irritated at small things, and I don't feel like talking.

Sometimes, when I feel like this, I try to use different modes of expression. On Sunday, I took my camera to UCLA and spent hours shooting photographs. A few of my favorite are: 1. A sculpture in the sculpture garden. 2. A detail of a stone totem pole. 3. Powell Library, where my parents used to hang out so many years ago. 4. The sun going down on the central quad.

Hope you like them. Have a nice day!




Friday, November 14, 2008

Depression Quotes

Because I'm feeling under the weather, I've decided to provide some depression quotes, most of which I found on Depression Recovery Life. Have a happy weekend. See you on Monday.

"In the midst of winter, I finally learned that there was in me an invincible summer."
~Albert Camus

"It is better to light one small candle than to curse the darkness."
~Eleanor Roosevelt

"Many of us spend our whole lives running from feeling with the mistaken belief that you cannot bear the pain. But you have already borne the pain. What you have not done is feel all you are beyond that pain."
~Khalil Gibran

"When women are depressed they eat or go shopping. Men invade another country. It's a different way of feeling."
~Elayne Boosler

Thursday, November 13, 2008

Adjusting to a Depressive Episode

While I had intended to continue my posts about managing a depression, I'm not able to at this point. I'm not feeling well and it's taking too much effort. I'll continue the discussion when I can. Yesterday was one of the worse days yet. After taking the Adderall, I had the energy to get out of bed, but as I've mentioned before, the medication doesn't make me happy.

I couldn't go to my badminton class, and I realize now that I'll have to drop the class even though there are only a few weeks left. The additional dose of Adderall puts too much strain on my heart for an activity that requires so much effort. And I'm unable to socialize with so many people right now.

In the past, quitting badminton or some other activity would have made me feel bad. Now, I realize it's okay. Rather than feeling bad that I have to quit, I've decided to feel happy that I was able to play for the last few months...and will be able to continue in spring when I feel better and stop taking Adderall.

That said...I spent six hours doing the one activity that I know I can always do when I'm blue, which is gardening. Probably the better description is lawn maintenance, because I spent hours trimming bushes, weeding, and raking. We have Eugenia trees in the backyard and they have these red berries that fall all over the lawn and wreak havoc with everything. So, raking them was a perfect chore for me.

After all these years, it's nice to know that I can always garden (or do home improvement chores outside) during the difficult times. And rather than feeling bad that I have to quit other activities and become more insular, I can feel happy I've figured this out, feel grateful I'm still productive, and thankful that I live in a climate where the sunlight helps me heal.

P.S. Mariposa has said that a Vitamin B complex really helps her during the difficult times, and today she's written an entire post about it that I found very helpful and quite interesting. It's something I intend to pursue and I so appreciate all her effort in writing about it.

Wednesday, November 12, 2008

Managing a Depressive Episode (Part 3)

For me, the most difficult part of managing a depressive episode is dealing with people. When I was working full-time it wasn't a problem. My depressions weren't as bad then and I was able to do what I needed to in order to succeed.

Having worked in television news, for two different colleges, for a magazine, and for a number of other organizations, I never really had difficulty dealing with my coworkers. But I imagine other people have had different experiences at work.

What I do know is this: During a depression, I'm far more sensitive and my feelings get hurt more easily. I feel more vulnerable, and it's difficult for me to deal with unpleasant people. I don't feel like being as social and I'm glad that for the last 20 years I've worked as a writer, which is a solitary profession and doesn't require as much social interaction--even in an organizational setting. When I'm depressed, it's far more difficult for me to listen to criticism about something I've written.

Knowing these things about myself was an important coping mechanism. I realized that the people around me hadn't changed, but I had. So...I tried hard to pretend things didn't matter even when they did. I tried not to show hurt feelings or to respond to irritating people. I didn't act defensively if a client wanted to make corrections to my copy.

So, for much of my working life--before I began taking medication and everything became so much worse--I could work in an organizational setting even through I was experiencing a low-level undiagnosed depression. As many of you know, it took 25 years for me to get a diagnosis, so quite honestly, I never knew what was wrong during the "low periods." I didn't know I was clinically depressed. I just thought I was unhappy at work, and that I hadn't found my true calling.

Years later, after the diagnosis and the medication, the depressions got far worse. But, by then I was freelancing. For the most part, what that enabled me to do was to set up meetings when I felt well, and work at home when I didn't. The biggest problem in those days was to try and sound "normal" rather than "wounded" on the telephone. When I truly wasn't well and couldn't attend meetings, I pretended I had the flu or some other physical illness.

For years, I had the same clients and that helped tremendously. Since I had built up a relationship with people for many years, and since they knew the quality of my work, I had far greater flexibility than I might otherwise have had. When the medication wreaked havoc, and the depressions became intolerable, my ability to work greatly diminished.

How do you cope at work? What problems do experience when you're depressed? How do yo overcome them?

Tomorrow I plan on focusing on managing personal relationships during a depression.

Tuesday, November 11, 2008

Managing a Depressive Episode (Part 2)

During a depression episode, I have learned it's very important to reduce stress to its bare minimum. So...I look at everything I'm doing, the people I'm spending time with, and all other aspects of my life to see what I find most stressful, and what I can eliminate.

When I was working full-time, and had two annual six-week depressive episodes, it used to take all of my energy just to go to work every day. Although I was married, that was before we had a child, so my husband and I pared back social activities on weekends so I could rest, do my chores, and we could spend times together. Even when I haven't felt particularly well, I usually enjoyed going out to dinner and a movie with my husband, or spending time browsing in bookstores, or even going to museums.

Once our son was born and I worked part-time, he became our top priority. So again, if I had a low energy level, I still was able to work three days a week, and take care of him. When he was an infant and later a young child who took naps, I would nap when he did.

My husband has always been great about marketing and cooking. My chores are laundry and cleaning--and because my husband is neater than I am, and it matters to him--I've always tried to keep the house as clean as possible. For much of our lives, we had a house keeper come in once a week. But we haven't for the last eight years or so, and actually I'm one of the few people I know who finds house cleaning relaxing.

The most difficult aspect of dealing with a depression for me is being with other people--aside from my immediate family and my mother (when she was alive). And that's what I'll write about tomorrow.

Monday, November 10, 2008

Managing a Depressive Episode (Part 1)

In the last few years I've learned to think of depressive episodes in a new way. Rather than feeling there is nothing I can do about them--aside from taking medication and hoping it works--I now realize there's a lot I can do to minimize the symptoms.

In my case, during a depression, I take Adderall in order to get out of bed in the morning. For me, the depression saps so much energy that without the medication, I would sleep all day--until it lifts, and that's presuming it does lift.

However, unlike an antidepressant (when it's effective), Adderall doesn't make me feel happy, it just gives me energy. So, it's really important for me to start my day quickly and get out and about or at least begin moving.

First thing, I eat protein for breakfast, which is something I need. I also drink one cup of coffee. I need it as a stimulant although I only drink one cup a day. If I take more than 30 mg. of Adderall, I can't drink coffee, however, because the extra dosage gives me a "bad" stomach and the acidity of the coffee is too much. In that case, I eat yogurt for breakfast because it's soothing and I eat whole wheat toast for roughage.

During a depression, it's particularly important for me to make lists--before I go to bed--of what I'm going to accomplish the following day. When my son was younger, and when I worked as a freelance writer, I made different kinds of lists. Early on, I learned that depressive episodes affect my memory, so I made sure that I listed all the tasks I needed to do for my son, husband, and my clients.

Now that my son is older and I'm semi-retired, my lists are different. While I go to class twice a week, and while I am writing a book, I have far more freedom to do what I want during the day. But if I'm not feeling terribly well when I awaken, it's very important to know what tasks I want to accomplish, or what activities I want to participate in, so that my days are pleasurable, and yet I also feel I'm doing what needs to be done.

What I've learned is that if I have activities lined up, I'm always happier. If I complete tasks, I feel a sense of accomplishment. If the weather is good--and it usually is in Los Angeles--it's very important for me to spend part of the day outside--whether it's weeding, gardening, doing home improvement chores, or exercising. Sunlight is a key element of my wellness program, and the earlier in the day I spend time outside, the better I feel.

Unlike years past, the book I'm working on is a long-term project, and I don't have a deadline. So...I don't have to spend time indoors writing every day. And for me, that's very important. I spent about 20 years writing indoors--working at least eight hours a day--and I now know that it contributed to my depressions.

At the time, I was happy I could work even though I felt depressed. What I didn't know was how important sunshine is for my well being. Now that I do know it, I make sure I get enough sun to "melt the blues."

(to be continued)

Friday, November 7, 2008

Mood Charting a Depression (Part 3)

Now that I've mostly explained the evaluation process, I'll show you what my mood chart looked like for yesterday. Once again, because I use my Day-Timer, I've got my day set up in hours. So, if I awaken at 9:00, like I did today, I just write in the word "awakened" at 9:00. But since I can't seem to scan the mood chart and have it work, I'll give you an approximation.

9:00 Awakened. Took 30 mg. of Adderall and went back to sleep.

9:45 It wasn't enough so I took 10 mg. more and felt fine within a half hour.

Breakfast: Had one egg, and whole wheat toast.

10:30-12:00. Wrote my blog post this morning, answered emails, and posted on a few other blogs. Folded laundry.

12:00-1:30. Reread chapters of Winter Blues about diet and exercise. Wrote marketing list for tomorrow. Called two local swimming pools and learned I can swim laps as well as participate in exercise programs. Checked out bikes and piano keyboards on Craigslist. Have an appointment tomorrow to see a keyboard.

Lunch: Tuna salad with avocado and a piece of cheese.

1:30-3:00. Decided to weed instead of painting the garage.

3:00-6:00. Worked on book.

Dinner: Stir-fry chicken with vegetables and noodles. Popsicle for dessert.

7-9:00. Watched Seabiscuit video.

9:00-11:00. Wrote blog, answered emails, finished reading The Friday Night Knitting Club.

Diary
I felt much better today. I think it was because I now have a plan, which I've begun implementing. I'm really excited about the piano keyboard. I know that music is an important wellness activity for me, and I've been wanting to learn piano for some time.

I'm also excited about swimming. The downside is that I need to buy a new bathing suit and I'm not thrilled about how I'm going to look in it. The upside is that swimming is very relaxing for me, and it's a great aerobic activity. If I can join an exercise class, that may be the impetus I need to make myself do it a few days a week. If I can find a used bike and begin riding the other two days, plus two days of badminton, that should be all the exercise I need.

I think my new diet should work out well. The concentration needs to be on protein and vegetables and I need to eat much less carbohydrates. Rosenthal recommends snacking on nuts and string cheese, which I like.

I'm still not pleased about taking 40 mg. of Adderall, but the side effects weren't as apparent today. And I'm concerned that now that I've begun taking Ativan (even 1/2 mg.), it will be difficult to go off it. Still, I slept much better last night and that may account for feeling better today.

Medication
40 mg. Adderall (Perspired a bit, made smacking sounds with lips, but didn't have shortness of breath.)
1/2 mg. Ativan (The low dosage didn't make me awaken feeling slightly depressed or groggy.)

Sleep
Slept 8 hours last night.

Bipolar Symptoms
Didn't feel depressed or hypomanic today.

Thursday, November 6, 2008

Mood Charting a Depression (Part 2)

I was going to write more about all the components I evaluate, but I've decided to try and summarize the process. The way I usually do this is by writing lists, and coming up with action items. While I shared my process on Tuesday, perhaps this post is more to the point.

1. Trigger. My depression started in October because there is always a seasonal element to it. So, my first step is to reread Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder by Norman E. Rosenthal. I've read it before, but I need to read it more carefully now.

In skimming the book, it's clear that October is a "start" date for some people suffering from Seasonal Affective Disorder. The reason my mood worsened a few days ago was that we set the clocks back for Daylight Savings Day, and that is also a problem for people with SAD. So...that's clearly the trigger.

2. Medication. While increasing the Adderall to 40 mg. has helped, it also presents problems. The increased dosage causes symptoms I don't have with lower dosages, including shortness of breath (periodically), increased perspiration, dry mouth, and certain hypomanic behavior (if I don't monitor it carefully) in the later afternoon.

Also, I can't fall asleep until 1:00 or later, and I don't sleep as well. For the past two nights, I've awakened in the middle of the night feeling very depressed (something that hasn't happened to me in years). Last night, I decided this was a real problem and I took 1/2 mg. of Ativan, which solved the problem. While I dislike taking this medication, it's better than the alternative, which is feeling terrible.

My goal is to come up with wellness activities that will allow me to reduce the amount of Ativan I'm taking, and eliminate the Ativan.

3. Diet. I need to read the chapter from Rosenthal's book on Diet, and come up with a new marketing list. I've skimmed that chapter and I know I need to begin eating more protein in general, particularly for breakfast, and I also need to try and eliminate sugar. He also recommends snacks, so I'll go and buy string cheese and nuts, which I enjoy, and which can help.

4. Sunlight. I've got to begin spending more time outdoors each day, starting today. So, I've talked with my husband yesterday and he's going to buy paint for the garage door, and I'm doing to start painting it today. We've come up with a list of other outdoor projects that I can work on for the next few months.

While Rosenthal recommends a light box and a dawn simulator, I've tried both and neither works for me. However, we have done other things to the house that make a difference. When we recently remodeled, we bought new shades for the bedroom, which make it much brighter. We've repainted the interior in a warmer white color (and I have noticed the difference). We have a much lighter carpet, which also makes a difference.

Action Item: I need to read more about light therapy.

5. Exercise. While I discussed this on Tuesday, I need to check out the hours of the indoor swimming pools in the neighborhood, and check online to see if I can find a used bike. Also, I need to see what exercise classes are available through Emeritus College. I will need to buy a new bathing suit (Ugh!).

6. Wellness Activities. In the next few days, I will look at my list of wellness activities to determine which ones I feel might help.

7. Research. I realize that while I have spent years researching depression, bipolar mood disorder, and related subjects, I have spent very little time researching Seasonal Affective Disorder. So, I'm going to begin researching this topic so that I can put together a SAD Wellness Program for myself. Also, I will see if I can identify online sites as well as blogs that deal with SAD.

8. Finding a Doctor. A number of months ago, I had intended to write to Dr. Rosenthal to determine if my initial diagnosis should have been SAD rather than bipolar disorder. Then I decided it didn't really matter because since I'm not big on labels, I felt my wellness activities would apply to SAD. But now I realize it's important to meet with a doctor who specializes in SAD to see what, if any tips, that person might have. So, I will contact Dr. Rosenthal to see if he has a recommendation.

9. Health Insurance. While this is the topic for another post, about five years ago we had to drop my health insurance because we could no longer afford it. We were paying $12,000 a year because the only insurance we could get was through HIPPA--since I had a previously existing condition. And that insurance was not only exorbitant, but it barely paid for any of the services I used. They paid only $33 for a $100 psychiatric visit. I applied for a less expensive policy and it was denied. I never went to arbitration, although I should have.

Anyway, as a result, I have not seen a primary care physician in five years and have not had a physical in ten years. (I do regularly go to my gynecologist, and I do see a psychiatrist a few times a year.) But I want to have a full physical examination as well as covering myself for catastrophic illness. So I need to take care of this.

10. Setting realistic goals. Since my list is fairly long, I need to come up with a realistic "To Do" list. It is as follows:

Thursday. Begin reading Winter Blues again. Plan to finish it by the weekend. Start painting the garage door. Use diet chapter in Winter Blues to write marketing list. Begin eliminating sugar in my diet. Walk around park every day.

Friday. Draft letter to Dr. Rosenthal to get a referral. Begin finding SAD sites/resources. Market for new items for new diet. Go online to see if I can buy a used bicycle. Buy a bathing suit.

Saturday. Send letter to Dr. Rosenthal. Go to the library and to a bookstore to check out books on Seasonal Affective Disorder. Draft letter to insurance company seeking arbitration.

Sunday. Send letter to insurance company. Look at what I've learned. Redo my "To Do" list. Evaluate how I feel after spending more time outdoors each day, increasing my level of exercise, and changing my diet.

Wednesday, November 5, 2008

A Feel-Good Story

Since I felt so much better today, it was easy for me to get out and about and do what I needed to do. After I voted for the president of the United States (and yes, my candidate won), I went to get my hair cut from a new hair dresser.

As she and I were getting to know each other, she mentioned that she had taught music in the Los Angeles school district for nine years, and that she played the keyboard, and sang. And I told her my story about performing at my mother's assisted living facility (before she died), and my love of music. I mentioned the music theory class I had begun but had to quit because it moved far too fast for me, but I said I'm looking for another class at Emeritus College next semester.

And then she said, "I've got two boxes of song books that are for beginners. Would you like them?"

"Yes," I said. "I'm so thrilled. I'm semi-retired and I could never afford a collection like this one."

"Oh, I'm so glad," she said. "They've been sitting here for months and I've been looking for someone who would like them as much as I have. This is how I learned to play the keyboard, but I haven't used them in years."

There must be 100 books, and they are just the ones I would have chosen. It is a perfect way to learn how to play the keyboard, and to learn to read music. And it seemed like it was a gift from God.

I love it when people are so kind and generous and expect nothing in return. After a few days where I felt so down, it was a godsend to have someone reach out and help me pursue a goal that is a key component of my wellness program. It truly made my day!

(Tomorrow, I'll continue my series on mood charting a depression.)

Tuesday, November 4, 2008

Mood Charting a Depression (Part 1)

Last night, I had decided not to post this week, but this morning I realized there might be a value in publicly mood charting this depression. I know there are people who can't seem to do it, and the value of it for me is so helpful, that perhaps it might help others.

As I've mentioned before, I use my Day-Timer, which is an organizing system, but I could use any calendar. What I like about Day-Timer is that I can see the hours of the days and notice changes. That said, I'm going to figure out a way to share the information, if not the actual format.

I do use categories, and they sometimes change. I also use part of the page to keep a quasi-diary. What I intend to do today is to provide the background so that from now on, I can chart without all the explanation.

When a depression hits, I find it's important to look at what I'm doing to determine how I'm feeling, what wellness activities I can add to the mix, which ones aren't working that I need to change, and to determine an action plan. The following is part of my evaluation.

Medication
In the last month I have had to increase the Adderall from 10 mg. to 40 mg. (today). That is the highest dosage I've taken in three years. The negative aspect of Adderall (for me) is that it has no residual effect, and a short-shelf life. Yet, I can't use the extended release version because my mood naturally elevates during the day and with extended release it becomes way too high as the day progresses.

So, unlike an antidepressant (when they work), it's not an ongoing feeling of well-being. Rather, I feel awful every morning when I awaken. If I have an appointment, I have my husband awaken me an hour early so I can take the Adderall and go back to sleep. For me, if the dosage I'm taking is going to work, it kicks in within 45 minutes. If not, I have to raise it and I only do it in 10 mg. increments because I know that taking too much is as bad as taking too little.

The worst side effect is a shortness of breath, but that is usually the result of too little Adderall in my system. I felt that way for part of yesterday. Also, it produces a sort of dry mouth and I tend to unconsciously make sucking sounds (not exactly the right description, but close) with my tongue. Since I'm aware of that, I keep hard candy or sugarless cough drops in my purse.

In the past, taking Adderall during the day has necessitated taking Ativan at night. But, because the withdrawal from Ativan is so difficult and takes so long, I am trying to remain off it. The bad news is that I'm staying up too late (until 2:00 a.m. last night), but since I'm not working and my son is grown-up, I can sleep until 10:00 if I need to.

Exercise
Exercise is an important antidote for helping me sleep at night. However, yesterday was a very difficult day and I was unable to attend my badminton class. I'm hoping to go on Wednesday. The problem is that increased Adderall does place a strain on my heart and I'm not sure if aerobic exercise is the right thing to be doing. But since I no longer have a primary physician I trust, I'll have to research this further.

I know it's important to exercise every day, and I have no patience for walking when I feel like this. However, I might enjoy it more if I do it with a group of people. I'm going to check out Emeritus College to see if they have a walking group I can join. Walking with a partner doesn't work when I'm feeling blue because I'm not interested in chatting.

Last weekend, I spent hours outside cutting down trees that were hanging over the garage. The combination of sun and physical activity is important for me. If I continue to feel this way, and if the weather remains okay, I'm going to paint the garage door, which would be a good project.

Action Item: I need to explore other forms of exercise. It might be a good idea to find an indoor swimming pool. That's a more gentle activity. Riding a bike might be appealing, but I'd have to buy one. I need to think of what else I might enjoy doing.

Diet
Because I've been feeling so tired, I have been eating too much. While I know that protein is very important for me during a depression, I need to pay more attention to portion control. I'm far better off eating five small meals a day than three larger ones. I've been snacking too much late at night and eating too many potato chips.

Action Item: I need to reread the chapter in Winter Blues about diet.

Supplements
I don't believe in taking supplements without discussing them with a doctor because of my experience with the megavitamin quack years ago.

Action items: However, I need to check out Duane Sherry's blog, Recover and Discover, to see what he recommends. Also, I found a new blog by Dr. Gabe Mirkin and he recommends checking Vitamin D levels, which makes sense to me.

Music Therapy
While I know that playing music is a very important part of healing to me, I also know that when I'm depressed, my accordion and Autoharp are too loud, and my recorder is too high pitched. The best instrument is my electric guitar, although I've lately thought that I'd like to learn how to play keyboard.

Action Items: Continue checking Craigslist to see if I can find a cheap keyboard. See if there's a guitar class I might take.

This is only part of my process, but I need to go vote and get a haircut. So, I'll continue this tomorrow.

A Picture's Worth a Thousand Words

Dear Friends,
Sometimes, when I'm feeling under the weather I need to concentrate on healing rather than writing about it. So...for the next week, I plan on sharing photographs I've taken instead of posting. I hope everyone has a happy and healthy week! If you live in the United States, don't forget to vote today!

Susan
P.S. I don't intend to spend much time online so while I will moderate comments, I won't be visiting other blogs until next week.

Santa Monica



Monday, November 3, 2008

Handling a Low-Grade Depression

Despite all my best efforts I am experiencing a low-grade depression, and have been for the last month. What's different about it this year is that I'm accepting it for what it is, and I don't feel bad that I've got it.

In years past, I've been very disappointed that I've done everything "right" and still experience a seasonal depression that usually lasts from October through March. But this year, I've said to myself, "It's okay. The Adderall is working at 30 mg. You get up every morning and live your life despite the depression. You're still playing badminton twice a week even if you have to force yourself to go sometimes. You're still playing music. You're going to volunteer at the pet rescue organization.

"You're continuing to write your blog. You're doing your household chores. You're actively participating in your son's and husband's lives. You're participating in the presidential campaign--albeit with a small effort. You're learning about digital photography. You're spending time outdoors every day. You're walking, and listening to music. You're reading, and learning how to knit.

"You're recognizing your limitations and accepting them, but you're fully engaged in activities you enjoy. You're spending time with people you find uplifting, and for your own health--you've stopped spending time with people who aren't.

"This isn't a bad depression. You may not have a high energy level, but you're neither terribly tired nor do you need to nap. You're pacing yourself better than you have in the past.

"Maybe, the answer is that you finally realize it's okay to have low-energy periods. You no longer feel you have to apologize to people for experiencing these lulls. You no longer have responsibilities--either work or a young child--that require you to be 'up' all the time. A change in mood truly doesn't have to be a problem as long as you're feeling okay about it."

How do you handle low-grade depressions? What are the greatest challenges? What tips and advice can you give to others?

Friday, October 31, 2008

Wellness Activity: Volunteering

I spent last night volunteering and it made me feel really good. In this case, I volunteered to make telephone calls for Barach Obama at the home of someone I didn't know, but who lives in my neighborhood. I'm not sure how much I accomplished, but the camaraderie was very satisfying.

In the last year, ever since my mother died, I haven't volunteered. When she was alive, I spent the last two years of her life playing my Autoharp and singing at her assisted living facility once a week. Once she died, I thought I'd be able to go back there and sing again, but it makes me too sad. And while I could do the same activity at another senior facility, I spent so much time playing and singing for my mother that I'm not sure if I'll ever be able to do it again without feeling sad.

Still, as Dr. Bernie Siegel says in 101 Exercises for the Soul: A Divine Workout Plan for Mind, Body, and Spirit, "Volunteering is very important for creating a meaningful life. It helps you define what you are here to accomplish by actively doing it. For this exercise, choose one way to volunteer in your community, and make it more than a one-shot deal. Think about what the right form of service is for you. What skills do you have? What do you enjoy doing? Who would you like to serve?"

When I re-read this chapter, I realized that rather than continuing to wait and hope that I can sing for seniors without feeling sad, it's time to find another activity. As some of you know, one of my dogs died last December, and the other died a few months ago. I miss them terribly, but I promised my husband that we'd wait for at least six months to adopt another dog.

So...I've decided to volunteer my time at a local animal rescue organization. That way, I can walk dogs, which I miss doing, and have dogs to love, which is something that makes me feel good.

What volunteer activities do you do? How does it make you feel?

Thursday, October 30, 2008

Ten Worst Side Effects (Part 2)

The following is part of a excerpt from my eBook: Bipolar Depression Unplugged: A Survivor Speaks Out. It is copyrighted material and may not be copied.

5. Head Sweats. While I know that some people on medication get body sweats, I experienced head sweats, and they were awful. If I had been more like Pollyanna (which I’m not), I would say how grateful I am that it was just my hair that got drenched.

4. Hand Tremors. It’s difficult to laugh at this one. I was taking two medications that caused hand tremors and the combined dosage made the tremors increase from imperceptible twitch-like flutters to the full arm movements of a symphony conductor.

3. Weight Gain. During the worst of my illness, food was my only pleasure. I made do with Ruffles® potato chips, blue cheese, Stouffer’s® anything, Dryer’s rocky road ice cream, homemade nachos, popcorn with melted butter, whipped cream on everything, Fritos®, and cases of 7-Up®. I gained thirty pounds and felt that I looked like Jabba the Hut from Star Wars. How depressing is that?

2. Brain Drain. I developed a condition called cognitive memory loss where I not only forgot words and phrases, but entire paragraphs. I would be talking and in the middle of the sentence, I would abruptly stop and have no idea what thought I was seeking. During this period I, who have always prided myself on my quick wit and verbal acuity, spoke like Lenny in Steinbeck’s Of Mice and Men.

1. Hair loss. At the time, perhaps because Silas (and a lot of other psychiatrists as well) was unaware that a high dosage of Depakote causes hair loss, he didn’t warn me in advance. The one constant in my life is my hair. It has always been brown, thick, and straight. Sometime during my illness, my hair began thinning. But one morning I awakened, looked in the mirror, and it had become gray, fine, and curly. This was the final insult!

* * *
At the beginning of June‚ I decided to stop taking medication once again. Perhaps there is one moment when your body rebels and says‚ “I’ve had enough. I can’t take it any more. In trying to change your biochemical imbalance‚ you’re creating more havoc than I can possibly fix. I’ve given you side effects to signify that we’re in a crisis mode. I know you’re a bit dim-witted these days, but what more must I do to grab your attention?”

Honestly, I’ve always been suspect of people who hear internal voices. Since it’s another one of those mentally ill indicators‚ let me state for the record that my body didn’t actually talk to me. My decision to stop taking medication was an analytical one based on the lack of efficacy of the medication and its debilitating side effects. Besides, it was a good time of year to try some other form of treatment. Before my never-ending bout with rapid cycling began, July and August traditionally had been good months.

In my next session with Silas, I explained what I intended to do and why.

“There are no studies to confirm that any alternative treatments work,” he said in response.

“Surely, I couldn’t feel worse than I already do,” I answered.

Silas shrugged, paused for a moment to look at me, and then recommended a reasonable schedule for withdrawing from the medication. After I wrote him a check, we shook hands, and he wished me luck.

For the first time in months, I left his office with a bounce in my step. As I walked down the hall toward the elevator, I smiled, looked upward to acknowledge Alexander Pope, and then straight ahead as I pressed the elevator button and silently said, “Hope springs eternal in the human breast; Man never Is but always To be blest.”

Wednesday, October 29, 2008

Ten Worst Side Effects (Part 1)

Although I had intended to write a post about "negative self-talk," I'm tired and decided to post instead about side effects from medication. It seems like a number of people are having difficulties these days, and I thought you might be entertained. The following is an excerpt from my eBook, Bipolar Depression Unplugged: A Survivor Speaks Out.

FYI...After a few comments from readers, I decided I needed to add a caveat, part of which I explained in my response to PJ. From the moment I began taking medication, I was sick almost every day for six years with the worst imaginable side effects. (And once I stopped taking it, it took almost four more years for my brain to heal itself.)

I believe there are three ways to deal with adversity. First, I could rant and rage and spew forth my misery--which has never made me feel better and certainly wouldn't have been pleasant for my husband, son, and the people I care about. Second, I could write serious pieces about how I'm feeling--which I do in my journals when I need to. Third, I could poke fun at my situation, and use humor as a method of healing.

During periods of adversity, my sense of humor has always been my saving grace. However, it only works for me when it is coupled with a game plan for finding ways of resolving problems, and a willingness to engage in a wide variety of other wellness activities.

* * *
Ten Worst Side Effects
During the next 18 months, I alternated between depression and hypomania, and Silas (my psychiatrist) recommended the following medications in different combinations and dosages: Ativan, Effexor‚ Depakote, Lithium‚ Descipramine‚ Imipramine, Klonopin, Tegretol‚ Verapamil‚ Wellbutrin‚ and Zoloft. They call this cocktailing medication, surely a bad choice of words when 60 percent of manic-depressives abuse drugs and/or alcohol.

The only way I could bear this dreadful ordeal was through humor. To entertain myself‚ I compiled a David Letterman list of the ten worst side effects. I must admit that I didn’t include sexual dysfunction because it seems like such a personal disclosure, but suffice it to say that many psychiatric medications affect your sex drive. Having revealed that, here is my list in reverse order:

10. Vomiting. This symptom can be thought of as morning sickness for the mentally ill. Many antidepressants cause nausea and/or vomiting (in which case you should call your doctor). The drag is that it doesn’t go away after the first trimester.

9. Dry mouth. At the worst stages, I felt like I was walking around with a tampon in my mouth.

8. Flatulence. I never knew this word until I read it years ago in The World According to Garp by John Irving. But let me tell you that a farting woman is far worse than a farting dog.

7. Constipation. It used to be that every morning after I ate breakfast, read the sports section of the newspaper, and had a cup of coffee, I would have a bowel movement. I always thought that my regularity was caused by my disgust at the bad behavior of professional athletes who are getting paid so much money that it makes me “shit.” Once I started taking medication, I was lucky if I had a bowel movement every five days. (Yes, I know there is medication for irregularity but enough is enough!)

6. Sleeping Problems. The only people who worry more about sleep than manic-depressives are new parents and narcoleptics.

(to be continued)
The preceding piece is copyrighted material and may not be reproduced.

Tuesday, October 28, 2008

Is the Glass Half-Full or Half-Empty?

My husband and I just returned from a lovely three-day vacation to Morro Bay, California. As I mentioned last week, he was participating in a painting workshop, and I took my digital camera, which I'm learning how to use.

We arrived Friday afternoon and the weather was spectacular--warm and clear. The next two days the area was socked in with fog. On the second day, I tried taking photos in the fog, and they were so-so.

At first, I felt sorry that I hadn't taken a photo of Morro Rock the first afternoon when I could see it so clearly from the balcony of our room and could also show the fishing boats and bay. But then I realized that I have the same attitude about photography as I do about wellness. I see the glass as half-full rather than half-empty. What that means to me if that if something I'm doing doesn't work, I try something else.

So, I drove out to Morro Rock and realized that if I shot upward, I could capture one perspective--even though the top was fogged in (Photo 1). And if I hiked around the other side, I could get a shot where there was no fog (Photo 2).
However, I didn't think the second shot was as interesting so the question was: What else could I shoot? And while I'm not a great bird enthusiast, the area is known for its birds. So, I took a bunch of shots and particularly liked the one where there bird is "talking." (Photo 3).

And when I had tired of the birds, I drove to a different part of town, and there were some wonderful trees, and I loved shooting them.

As I was thinking about my experience, I realized this: For me, the glass is always half-full. That's the way I live my life, and that's why I've been able to achieve wellness. The older I get, the more I know that the only way I can only retain wellness is by being with people who feel the same way.

Wednesday, October 22, 2008

Psych Central Award

Dear Friends,
Although I'm still on vacation, I was pleased and surprised to learn that Psych Central considers this one of the Top Ten Bipolar Blogs. The others are listed here. See you next Tuesday.

Susan
P.S. Congrats Bradley!

On Vacation

Dear Friends,
In addition to our mini-vacation, I need a few days off from blogging. I'll be posting again next Tuesday. Hope everyone remains happy and healthy! As always, I like to leave you with a smile, so once again, I offer the graphic from the Cattlemen's Stress Test.

Susan

Tuesday, October 21, 2008

Small Changes

In her book, Inner Peace for Busy People: 52 Simple Strategies for Transforming Your Life, Joan Z. Borysenko, Ph.D., discusses change. She writes, "Psychologist Ellen J. Langer discovered that people who try new things are healthier and happier than those who stay in a rut. Even choosing a different route home from work benefits you. In her book, Mindfulness, she makes the point that variety keeps us engaged in life.

"You might be able to zone out if you've taken the same route a hundred times, but if you're on unfamiliar turf you have to stay tuned in. Tuning in encourages curiosity and results in a more adventurous life. An acquaintance of mine chose to drive a new way to work one day and got rear-ended in a traffic jam. But all's well that ends well. She married the man who slammed into her.

"This week, try making two small changes every day. Take a different street to work, turn off the television for an evening, go to a restaurant that serves exotic food, change your brand of toothpaste, smile at someone you don't know, show up at work wearing Groucho Marx glasses, go to a different supermarket, get a more daring hairdo, eat dessert first, or buy or borrow a piece of clothing that you never wear. The possibilities are endless.

"At the end of the week, reflect on what these little changes produced. Then think about your life. If you're in a rut, identify one small step you might take toward change. There's a whole landscape to explore once you leave the beaten path."

FYI...This will be an easy assignment for me since this weekend my husband and I are going away for a three-day painting workshop at a beach community about four hours away. But if anyone decides to try this...let us know what you do!

Monday, October 20, 2008

Happiness

The more I write this blog, the more I think about relationships with other people, and the older I get, I believe there are some people who seek happiness and others who don't.

"Is happiness a skill that, once acquired, endures through one's ups and downs?" asks Mattieu Ricard, a Buddhist monk and author of Happiness: A Guide to Developing Life's Most Important Skill.

"There are a thousand ways of thinking about happiness, and countless philosophers have offered their own. For Saint Augustine, 'Happiness is a rejoicing in the truth.' For Immanuel Kant, happiness must be rational and devoid of any personal taint, while for Marx it is about growth through work. 'What constitutes happiness is a matter of dispute,' Aristotle wrote, 'and the popular account of it is not the same as given by the philosophers.'"

How does Mattieu Ricard define happiness? "By happiness, I mean a deep sense of flourishing that arises from an exceptionally healthy mind. This is not a mere pleasurable feeling, a fleeting emotion or a mood, but an optimal state of being. Happiness is also a way of interpreting the world, since while it may be difficult to change the world, it is always possible to change the way we look at it."

Do you believe that people choose to be happy? Is it a personality trait? Or is it a skill they acquire?

Friday, October 17, 2008

Top 10 Wellness Activities (6-10)

This is the second part of the list of top 10 wellness activities that I regularly pursue.

6. Reading uplifting books on healing and related topics. One of my constant activities is reading a host of uplifting books on healing, spirituality, wellness, and related topics. There are always wonderful tidbits I pick up, which I either may not have thought about before, or which I've learned about but forgotten. I'm currently reading: If the Buddha Got Stuck: A Handbook for Change on a Spiritual Path by Dr. Charlotte Kasl. I wrote about it a few weeks ago and as I mentioned, the author provides simple yet sound advice.

FYI...I no longer read any books about bipolar disorder or depression. What I learned a long time ago was that most books on the topic (and for years I read everything that was published) are so negative and downbeat that they're not at all helpful. I am now firmly convinced that if I read and think about wellness, I'll be well. But if I dwell on illness, it will make me ill.

7. Keeping a mood chart and journal. I've written about this many times and there is no need to belabor it. But I still keep a daily mood chart and journal. The journal is helpful because it enables me to chronicle my life. And while I no longer need the mood chart to figure out patterns of behavior, and things that trigger depression, I do know that if I ever take a downturn, the mood charts will allow me to figure out why.

8. Eating nutritional food. This is a no brainer. We all know "we are what we eat." I'm blessed because my husband is a wonderful cook and he's the one who markets and cooks. But, we both know we feel better if we eat nutritional food. It's not that I don't occasionally eat junk food, but not on a daily basis. I also know that, for me, drinking water is very important. I carry a water bottle with me (a metal one so I don't contribute to planetary waste by using plastic bottles), and probably drink about eight glasses a day.

9. Praying. Since this is a secular blog, I rarely talk about religion, but I do pray with regularity. I'm so very grateful I'm well and I frequently thank God. One of the best books I ever read about praying was written by Malcolm Boyd, a family friend who's a gay Episcopal priest. In Are You Running with Me, Jesus? he talks about prayer as being conversations with God. You don't have to read a prayer book. You don't have to be in a church or temple. You can just talk to God when you're running, cooking, or doing your daily activities. (While I'm Jewish, I share Malcolm's attitude about the importance of communicating with God in a casual way.)

10. Stress reduction and relaxation techniques. Many of the things I do are somewhat related to stress reduction. If I'm tense, I do breathing exercises or blow my harmonica. If I'm worried about something, I take a walk. If I feel a bit down, I clear my mind, and think about all the things I'm grateful for. If I feel unhappy, I watch an upbeat film or listen to music I like.

Most of all, I concentrate on feeling well. Over time, I have learned that life is too short to dwell on negative things or spend time with negative people. I have always been an optimist by nature, and even when I was ill, I felt hopeful that some day I would be well. Now that I am, I feel so lucky and so grateful that I hesitate to waste a moment of my time with people who don't have a positive outlook on life.

Thursday, October 16, 2008

10 Top Wellness Activities (1-5)

"When I'm feeling blue, all I've got to do, is take a look at you." Actually, these lyrics are from A Groovy Kind of Love written by Phil Collins in 1988. In my case, when I'm feeling blue, all I need to do, is engage in any or all of my top 10 wellness activities.

1. Badminton. This is my newest activity. The fact is that aerobic activity is great for healing depression. But it's also fun for me to be taking a class at a local community college so I can play with 18-20-year-olds. I'm getting better each time, and it feels great that I've reclaimed my athleticism.

2. Sunshine. While there are lots of books discussing the benefit of light therapy, the moment I feel a little under the weather, I go outdoors, and stay there for awhile. If I'm in the mood, I take a walk. In the old days when I was very depressed, I would just shuffle to the yard and sit in a chair for ten minutes with my face facing the sun. If I felt a bit better, I weeded. There's sort of a Zen-like quality to mindless weeding. If I had a lot of energy, I did home improvement projects.

3. Playing a musical instrument. These days, I am playing the accordion, electric guitar, Autoharp, recorder, and harmonica. While the word "playing" may be somewhat of a misnomer, the fact is that even when I just strum the Autoharp, blow in and out on the harmonica, and do scales on the accordion, I feel so much better. But, since playing instruments is truly a delight, I actually try to spend an hour a day playing an instrument and singing songs as well. There have been numerous studies showing the value of music therapy.

4. Gardening. Again, horticultural therapy has been found to truly help people feel better. Maybe George Bernard Shaw was right when he wrote, "The best place to seek God is in a garden. You for dig for him there." Or perhaps it's just a connection to nature that is so soothing. But, even if I just spend 15 minutes watering flowers, it makes me smile.

5. Blogging. We all know the value of writing to heal. I believe that blogging to heal is equally important. First of all, it's just a wonderful sense of accomplishment to post five days a week. Second, it allows me to share information with people who might find it helpful. It also enables me to connect with people through writing rather than talking. And I feel that sharing information on bipolarity as well as wellness activities is highly beneficial.

Tomorrow, I'll list five more of my top wellness activities.

Wednesday, October 15, 2008

How to Be Well (Part 2)

I guess the real question is: What does it mean to be well? For me, the definition of wellness has evolved over time. I used to think that being well meant being "completely normal." I figured that once I'd beaten this illness, I would never evidence any bipolar symptoms again.

This year I decided to redefine what wellness means to me. While I feel good most of the time, I still sometimes have symptoms. As I've mentioned before, a few weeks ago, I began to have a very low energy level, which made it difficult to get up in the morning. Since Adderall works for me, I'm now taking 10-20 mg. every morning so I have no difficulty getting up.

The only problem with Adderall is that it sometimes produces a low-level hypomania. Again, for me, all that means is that I have a higher energy level than normal. In days past, that would mean that I talked too much, too fast, and too loudly, and sometimes felt irritable, and wasn't very patient. However, now that I know these are symptoms, I work hard to alleviate them.

So, I've decided that I still consider myself well even though I have to take Adderall, and I have a few symptoms that I try hard to mitigate. By coming up with a more realistic expectation of what constitutes wellness, I can feel like I've made great progress.

One of the difficulties of bipolar disorder--as far as I'm concerned--is that there aren't enough success stories. And maybe one of the reasons is because the goal is "total normalcy." But, what is "normal?"

I know plenty of people who aren't BIPS (bipolar) who feel depressed and remain so for months at a time. I know lots of non-BIPS who talk too fast, too much, and too loudly. I also know lots of non-BIPS who are irritable, impatient, and sometimes downright hostile.

In fact, I'm sure we all know people whose behavior appalls us, but who aren't concerned about it at all. Do you ever wonder why certain "normal people" don't monitor what they do or say, why they never apologize for their "bad" behavior, and why no thinks they're sick when they act out?

So, I figure that my self-discipline in controlling things is a sign of success. I'm proud that I'm so conscientious about keeping mood charts. I think it's great that I have a daily diary of what I accomplish, how much medication I take each morning, how my energy level is throughout the day, how much exercise I do, and note what time I go to bed at night, and any behavioral patterns that concern me.

When I was diagnosed as a BIP in 1993, I would have been thrilled if my doctor had said, "You're atypical bipolar II, but don't worry about it. I've got patients who take a small amount of medication, but are so disciplined that their condition hardly affects their lives at all. They keep mood charts and participate in a wide array of wellness activities and truly have their situation under control."

Tomorrow, I plan to write about my top 10 wellness activities!

Tuesday, October 14, 2008

How to Be Well (Part 1)

As I drove to my badminton class yesterday, I thought about how grateful I am that I can commit to a biweekly class for 18 weeks. Two years ago was the first time in a long time that I could enroll in a class and attend every session.

One of the problems with frequent depressive episodes was that for the longest time I didn't know when they could hit. Unfortunately, I hadn't yet realized that my lifestyle and my response to stressors was contributing to these episodes. But now that I've figured things out, it's truly a joy to be able to sign up for classes I like, and participate in a host of activities.

In the last few weeks, I have spent time with a number of friends and acquaintances who are out of sorts, seem somewhat lost, and aren't truly engaged in activities they enjoy.

In some cases, they're retired or semi-retired. (Some are employed, but after decades spent working at the same career, they've lost their passion and their interest in it.) A few are taking a break for medical or psychological reasons. But, the commonality is that there is no order to their days. They seem to have forgotten--or perhaps never knew--how to balance their lives. And they don't have a sense of mission as to why they're on the planet.

After a few days spent with people like this, I began feeling a bit under the weather myself. If there's one thing I truly dislike, it's being with people who are lost or drifting and either won't admit to themselves that they have a problem, or won't try and seek a solution.

In the bipolar world, it's easy to blame everything on medication and doctors who lack insight. In life, there seem to be many people who are seeking someone else to blame--whether it's their childhood, a former spouse, a lack of money, or their situation in life--whatever it may be.

As far as I'm concerned, no matter what the causal factors, ultimately we're responsible for finding meaning and happiness in our own lives. For me, that's what wellness is all about. And that's what I intend to write about this week.

Stay tuned!

Monday, October 13, 2008

Anatomy of a Depressive Episode

I originally posted this on Saturday, but I'm posting it again because I believe it's an important topic to discuss. My response to Kelly on Friday was about ways to try and deal with a depressive episode in the work environment. And my list of five recommendations was geared to trying to help her feel better as soon as possible in order to be productive at work.

However, Friday night when I was sleeping (I have many of my best ideas when I'm dreaming), I realized that in focusing on depression and work, I didn't discuss some of my other theories about the nature of depressive episodes. Thus, the reason for this post.

I believe that depressive episodes usually have some sort of triggering event. In my own history of more than 120 depressive episodes, this was always the case even when I wasn't aware of it. And the cause was usually stress.

So...what I recommend to everyone who is suddenly feeling worse and whose medication is no longer able to mask the symptoms is this:

1. Keep a mood chart (I've written about this many times and you can check my archive for my recommendations on how to do this). Try and figure out what is causing your current depression. Is it work-related stress? A relationship problem? A seasonal problem? A medical problem? etc.

2. If your medication has worked well in the past and suddenly isn't, what has changed? Have you added a different medication to the mix? Have you changed the dosage of what you're currently taking? Are you noticing symptoms that you haven't before? Or, do you just think that your medication is "pooping out," which does happen.

3. Is it a seasonal problem? No matter how well I'm feeling and how happy I am, I always have a problem in the fall. While I make it a point to spend more time outdoors and increase my level of exercise, for the past number of years I usually have to go back on Adderall, the one medication that works for me. And this year is no different. I'm on a very low dosage of Adderall, but without it, I can't wake up in the morning.

4. If you can determine the trigger(s), or even if you can't and need help to do it, it is undoubtedly a good idea to talk with a counselor or therapist. Or if you decide that the way you handle stress is a constant problem, then I would recommend yoga, meditation, gardening, deep breathing exercises, and/or playing a musical instrument (which for me makes a big difference).

5. Try not to panic. In past years, one of the biggest problems I faced when I could feel a depression on the horizon (and I could pinpoint it within three days) was that I panicked. I don't mean that in the sense of a panic attack (I've never experienced one). It was just that I'd undergone so many depressions and they had become so debilitating that I was terribly concerned whether I could survive another episode. I believe now that my anxiety about the advent of the depressive episodes undoubtedly heightened their impact.

These days I know that my depressions (and I hesitate to use the word because it's not truly a depression; it's just a lower level of energy) are caused solely by seasonal change. I'm sorry they occur, but they are easily treatable and may only last a few weeks or a few months.

I know that Adderall works for me, and I have no hesitation in taking it. Since I can tell when the depressions end, I can titrate off it quickly with no ill effect.

Also, I also know that Adderall does have certain behavioral side effects, which I try to monitor. My mood rises during the day. If I don't monitor my behavior, I tend to talk too much, but since I'm aware of it, I try hard to make sure I listen to others. Also, if I'm a bit too wound up, I take small breaks during the day, and play an instrument or breathe. I am too enthusiastic, which I also monitor (While I don't find this to be problematic, I have learned that others do). And that's about it.

Over the years I have eliminated all other behavioral problems, including spending too much money, trying to "save" people who are needy, and participating in too many activities.

So, I guess what I'm saying is that in my case, my wellness activities cannot prevent Seasonal Affective Disorder. And since bright lights and a dawn simulator don't work for me, nor do vitamins and alternative remedies, I take Adderall, knowing that it causes a low level of hypomania. But...even this isn't a problem because I try hard to monitor my behavior, and prevent behavioral patterns that have been problematic in the past.

Friday, October 10, 2008

Depression and Work

Kelly wrote to ask what to do about work since she's feeling so depressed and her performance is suffering. This is a difficult question to answer. Initially I said that by the time my depressions were truly debilitating, I was already a freelance grant writer so it wasn't a problem.

The value of freelance work is that you can do it whenever you feel like it. Even though I had deadlines I couldn't miss, if I was feeling a bit under the weather, I could work later in the day or even at night, and for most of my career I didn't miss a deadline. Later, when the medication caused havoc, it destroyed my career. And while it was salvageable, I no longer was interested in grant writing. These days I'm semi-retired so it's not a problem.

At first I didn't think I could offer Kelley any advice about how to handle depression in an organizational setting. But the more I thought about it, the more I realized that I do have some suggestions. The problem as she stated it is that she's feeling so hopeless that it's difficult to motivate herself.

Kelly,
First of all, I'm wondering if you're taking antidepressants and why they're not helping you get rid of the "hopeless" feeling. In the best of times, it usually took 14 days for the antidepressants to kick in--that is when they worked. And once they worked, I felt 100 percent better and could motivate myself. (Later, they didn't work at all, but I'm an unusual case.)

I've read a lot about work and depression and many of the books suggest you should discuss your condition with your boss to see if there can't be some accommodations made, which will help you in the short term.

Given my own experience, I've got to say I disagree. About five years ago I took a part-time director of development job for a nonprofit organization, and did tell the boss about my illness (primarily because the salary was way below my usual fee and I needed to explain why I wanted to be paid more).

My disclosure initially enabled me to get the salary I wanted and to work the hours I wanted. But, about a month into the job, I learned that my boss was a real "nut-job" and had a history of taking advantage of the people who worked for her. When I tried to see if I could report to someone else within the organization, she used my illness against me by suggesting the problem was mine rather than hers. It's a long story, but it was very unpleasant. Ultimately, I had to resign because my health is my most important priority.

A few years later, I accepted a book editing position, and once again disclosed the illness because the author/client wanted me to work side-by-side with her for five days a week and I felt I could could only stand to be with someone for three days a week since I was only recently feeling well.

Although I did a terrific job editing the book, I had numerous difficulties dealing with this client. Again, she tried to blame my illness for our problems rather than her behavior (which I learned had been problematic with a lot of former employees). Since I'd already been through this once, and knew that my own behavior was very professional, and hers wasn't, I didn't allow her to take advantage of me. But, I felt that if I'd never mentioned the illness, I would have been better off.

So...having said this, my own experience suggests that disclosing the illness is fraught with problems. If other people have other experience with this, please let Kelly know.

Back to your original questions, which is how to motivate yourself when you're not feeling well, I guess I would suggest the following: 1. Talk to your doctor to see why your medication isn't working. 2. If you're not exercising, try to start. Aerobic exercise, which is truly difficult to start when you're feeling depressed, can ultimately make you feel better if medication can't.

3. Whether or not you're feeling motivated, there must be things you need to accomplish each day. While I don't know what kind of job you have, I do know that as a writer and grant writer, it was critically important that I make progress every day. So I wrote myself a detailed daily list of what I needed to accomplish. Whether I felt well or not, I slowly worked through my list. While I may not have been enthusiastic, that was less important than getting the job done.

4. The worst feeling in the world is letting things slide and hoping no one will notice. Ultimately they will, and the last thing you want to have happen is to have a less than stellar performance appraisal or be fired (in this economy). So, even if you decide not to disclose your depression to your boss, is there a colleague (or a therapist outside the work environment) who can help you figure out what you need to do to be productive until you feel better?

5. Also, I'm not sure if your work environment is helping to cause your depressive episode. If it is, you need to make sure you're talking to a therapist or counselor about the problems caused at work and see if you can figure out ways to improve things.

Since I don't know enough about your specific situation to give better advice, these are my top five ideas for now. If anyone else has suggestions, I'm hoping you'll provide them. Kelly, if we need more info to help you, let us know. All my best!

Susan

Wednesday, October 8, 2008

Does Bipolar Wellness Need to be So Elusive?

PJ's comment on yesterday's post caused me to write today's. She's only been diagnosed within the last year and wonders how long it's going to take to get well, whether she'll still have highs and lows despite medication, and I guess perhaps just wants my perspective on all this.

Dear P.J.,
I guess the best way to start out is to say that I can't be sure how things are going to play out for you. But I will give you my perspective, and hope that others will tell you how they feel. In my own case, you have to realize that I wasn't diagnosed until 25 years after my first depressive episode. And all that time ago, people didn't talk about depression. So while I had these two annual six-week depressive episodes, I had no idea what caused them.

A part of me is glad I wasn't diagnosed when I was younger because I wouldn't have wanted to wear a label when I was 18 years old. Unlike most people, I don't believe in labels and I don't believe in looking at mental illness and physical illness as separate entities. But while that's easy for me to say at 58, it wouldn't have been easy for me to figure out and say when I was in my late teens and early twenties.

So, while I did have these episodes for most of my life, I didn't feel like I was handicapped in any way. I have always fought for what I've wanted and mostly achieved it--even if it turned out that it didn't make me happy.

And maybe, since the career I ultimately pursued is writing--which is so personal and so fraught with rejection--perhaps I needed success in other fields to deal with the rejection and be able to transcend it. (But that's an entirely different topic of discussion.)

In terms of bipolar mood disorder, my own feeling is that medication will never be the full answer--even when it works. I strongly believe that if a person is feeling very stressed and disliking his or her job or having problems in his or her marriage, or having difficulties with friends and/or family members, medication can't solve the problems--and shouldn't be expected to.

If we're not getting exercise, which has been proven to be of greater value than antidepressant medication, then we're going to have problems. If we don't eat nutritional foods, then we won't feel well. If we don't attend to the spiritual aspect of our lives, then we will feel there's something missing. And if we don't continue to grow and evolve--and deal with the difficulties and darkness that's inherent in the very process of life--then we are going to have problems.

Medication cannot solve those problems. We need to develop an understanding of who we are and want we want. We need to develop skills to handle stress. We need to read about adult development so we can anticipate life stages. We need to deal directly with the people and situations that are bothering us so that we can resolve issues and figure out whether we want those people to remain in our lives or whether we will be happier without having them in our lives.

If people are psychotic, medication can help. If they are always so depressed they feel like killing themselves, then medication can help. If they hear voices, medication can help.

But, if they are rapid cycling and weren't before they started taking medication, they need to ask themselves if the medication is causing the problem. If they are hoping that whatever ails them is biochemical (whatever that truly means) rather than facing their true life problems, then their diagnosis is only a crutch and I don't believe they'll ever get well.

In answer to your question, "No, I don't think it needs to take years to figure all of this out." I did seek help when I was younger and saw a number of counselors and psychologists and I have never met less insightful people in my life. But I know that some people who are reading this blog do have counselors or therapists whose advice they treasure. And advice can come from friends and family members as well as spiritual advisers.

I guess my best advice is to say, "Whether we believe in labels or not, I believe we are each responsible for our own lives. And the disservice that a diagnosis can play--in my opinion--is that it suggests you aren't responsible for your life because you have a chemical imbalance. The truth is that diabetes or high blood pressure or cancer can be attributed to a chemical imbalance as well.

So I believe that whatever illnesses we have, we need to get the best medical care we can, but ultimately we can all be self-healers. We need to look inward as well as outward to figure out how to live our lives. We need to make sure we're not only living authentic lives, but that we are living lives that are satisfying to us...not to others.

P.J., I think if I had understood this when I was younger, I could have healed myself far earlier. I'm not sure why it took so long, but I still have years left to live so I'm grateful I've finally figured things out for now.

All my best in your journey!

Fondly,

Susan

Tuesday, October 7, 2008

Dealing Daily with Bipolar Disorder

Yesterday I received a comment from KJ whose husband suffers from bipolar disorder. She felt that my answer to Gianna provided her with hope, something she is truly needing at the moment. Since I have been well for some time, it brought back difficult memories of how different my life (and that of my family's) was for so many years.

I vividly remember how terrible I felt when I was so depressed I could barely function. Each morning I would awaken and hope that the new day would bring some sort of relief. I would wonder what I possibly could have done to have been punished so severely that I was in such terrible psychic pain. I prayed that I could survive that day and the ones to come.

I remember how hard I tried to create "normalcy" so that my son wouldn't feel he was part of an "ill" family. I tried so hard to attend school events even when I didn't feel well, and to drive on field trips so that my son would know I cared and wanted to participate as fully in his life as was humanly possible.

I worked hard to try and maintain my self-esteem even when I had gained so much weight on medication that I was embarrassed, or suffered such terrible hand tremors that I couldn't write a check, or had such awful head sweats that my hair was drenched and I looked unkempt.

I tried hard to continue my freelance grant writing career even though I was suffering cognitive memory loss and it took me twice as long to write grants and they weren't up to par, or I was so hypomanic that my behavior offended my clients. I forced myself to continue writing books even when I was unable to publicize them because I was depressed for a full year after they had been published.

I remember how disappointed I was when my doctors prescribed medication after medication that made me worse, and never were honest about their lack of knowledge regarding bipolar depression. And the sicker I got, the more they tried to make me feel like it was my fault rather than their incompetence.

So, KJ, I just want you to know that you and Joe aren't alone. Now that I'm well, I have no idea why I had to suffer for so many years. But I can only think it was because I can now provide some solace to others. And I hope that my success in achieving wellness will allow others to realize that wellness truly is possible.

Monday, October 6, 2008

Let Your Life Speak (Part 2)

As I mentioned on Friday, Parker J. Palmer's book, Let Your Life Speak: Listening to the Voice of Vocation, is one of my favorite books. Palmer's path to finding his true vocation hasn't been an easy one. He has suffered through a few debilitating depressions, and yet he is one of my favorite role models.

The reason is because it would have been easy for Dr. Palmer to have settled for careers that were prestigious but not satisfying. Instead, he kept on pushing himself to find his true purpose when others undoubtedly would have settled for less. The following quote is a continuation of the passage I quoted earlier.

"But before we come to that center, full of light, we must travel in the dark. Darkness is not the whole of the story--every pilgrimage has passages of loveliness and joy--but it is the part of the story most often left untold. When we finally accept the darkness and stumble into the light, it is tempting to tell others that our hope never flagged, to deny those long hours spent cowering in fear.

"The experience of darkness has been essential to my coming into selfhood, and telling the truth about that fact helps me stay in the light. But I want to tell that truth for another reason as well: many young people today journey into the dark, as the young always have, and we elders do them a disservice when we withhold the shadowy parts of our lives.

"When I was young, there were very few elders willing to talk about the darkness; most of them pretended that success was all they had ever known. As the darkness began to descend on me in my early twenties, I felt I had developed a unique and terminal case of failure. I did not realize that I had merely embarked upon a journey toward joining the human race."

Friday, October 3, 2008

Let Your Life Speak (Part 1)

One of my favorite books is Let Your Life Speak: Listening for the Voice of Vocation by Parker J. Palmer. Like me, Palmer's career has evolved over time and he has suffered from some painfully long depressive episodes. Like me, Palmer has found a career he finds satisfying. He writes:

"Most of us arrive at a sense of self and vocation only after a long journey through alien lands. But this journey bears no resemblance to the trouble-free 'travel packages' sold by the tourism industry. It is more akin to the ancient tradition of pilgrimage--'a transformative journey to a sacred center' full of hardships, darkness, and peril.

"In the tradition of pilgrimage, those hardships are seen not as accidental but as integral to the journey itself. Treacherous terrain, bad weather, taking a fall, getting lost--challenges of that sort, largely beyond our control, can strip the ego of the illusion that it is in charge and make space for true self to emerge. If that happens, the pilgrim has a better chance to find the sacred center he or she seeks. Disabused of our illusions by much travel and travail, we awaken one day to find that the sacred center is here and now--in every moment of the journey, everywhere in our world around us, and deep within our own hearts."

(to be continued)

Thursday, October 2, 2008

Persevering and Problem-Solving

When I wrote yesterday about persevering to achieve wellness, I should have mentioned that the second part of the equation is problem-solving. In a job search, which is the example I used, the key when you don't get hired is to figure out why, and to make whatever changes are necessary to be successful.

Sometimes, particularly for recent college graduates, it's may be a question of a crowded market-place, and a lack of experience. But sometimes, you know you didn't get hired because your resume wasn't compelling enough and you need to rewrite it or write a better cover letter. Or you didn't do a great job in the interview, which means you need to learn more about the questions you may be asked and how to answer them. Or you did a good job in the interview, but the people you used for recommendations weren't strong enough.

The key--whether it's applying for a job, or achieving wellness--is to figure out what went wrong and to determine what you can do to fix it. Persevering without problem-solving is a waste of time. To send out a resume over and over, which doesn't result in interviews is a waste of energy. To go on interview after interview and not clinch the job means the marketplace is getting smaller and smaller and you're still jobless.

To try and achieve wellness by continuing a process that is making you sicker and sicker is also a waste of time.

My advise is this: Try and figure out what is causing your depressions when you're well. Start an exercise program when you're well. Begin a mood chart when you're well. Participate in wellness activities--whether it's playing music, meditating or gardening--when you're well. That way, it's far easier to continue to pursue these activities when you're feeling slightly depressed.

The worst feeling in the world is to feel a depression on the horizon and have no clue why it's coming, and no course of action to deal with it.

In my own experience, depressions don't come out of nowhere. There are plenty of clues, if only we pay attention to them. And the worse time to try out new wellness activities is when you're beginning to feel depressed because that requires motivation and energy, which is in short supply when you're feeling down.

(to be continued)

P.S. My first published book was Job Search Strategy for College Grads, which I wrote with my undergraduate career counselor, and I used to write magazine articles on the subject as well as doing seminars.