Friday, August 29, 2008

Wellness Activity: Political Involvement

While this isn't a political blog, I believe it's a sign of wellness to participate in the world in which we live, to fight for what we believe in, and to be a part of the larger community. Last night, I was so proud of my candidate for president that I'm announcing my support right here and now. I'll be back on Monday. Have a happy and healthy weekend!

Thursday, August 28, 2008

Wellness Activity: Badminton

I've mentioned before how important I think exercise is for healing. And while I try to walk as often as possible, I've really missed competitive sports. I've been an athlete since I was a child. I've played tennis since the age of four. And while I quit for years at a time, it's like riding a bike: you never forget how.

While I haven't felt like playing tennis, I recently decided I wanted to learn how to play badminton, and signed up for it at my local community college.

My first class was on Monday, but it was more of an introductory class. Yesterday we actually played, and it was truly wonderful. Many of the classes I've recently taken have been new to me, which is part of their allure. I had determined that at this stage in my life, it's fun to take courses in which I have no background; it's exciting to learn something that's either new or which I've always wanted to know, but somehow don't.

But badminton is another story. The skills I've got from tennis apply. Instinctively I know where to be on the court. While hitting a shuttlecock is quite different than hitting a tennis ball, it's so much fun I can't stop smiling.

A few days ago I started feeling a bit blue because of the change in the weather. And, for some reason, I didn't feel like increasing the time I spend walking. I have been slightly concerned, but since I continued to go to class, I knew it wasn't a huge problem. Still, I do know how important aerobic activity is for decreasing depression.

Well, yesterday after playing 90 minutes of badminton, I felt great. I loved being in a college gym again, I loved the fast play, and I loved the fact that I beat another student who is 40 years younger than I am.

Who knows? Maybe I'll do a study on competition as a method of beating depression!

P.S. The graphic isn't me. I need to lose a bit of weight before I'm willing to post a picture of myself wearing shorts!

Wednesday, August 27, 2008

How We Respond When People Seek Help

On Friday and Sunday, I responded to two emails from Josh, someone who's never commented on my blog before, but asked for advice about depression. Not only did I spend a lot of time writing him a list of recommendations, but many of you did as well.

I have no idea whether Josh will pursue the suggestions we recommended, but I've thought a lot about people who ask for advice. During the eighteen months I've written this blog, I've gone out of my way to respond to people who ask for advice. My reason is that when I was so sorely in need of advice during my sickest moments, there were few people who responded.

I contacted doctors who had written books on depression and lived in Los Angeles and they never returned my calls. I wrote the president of an Orthomolecular organization who lived in San Francisco, and he never returned my email.

During a period in which I was so sick I didn't see how I could survive--and my doctor was not at all responsive--I emailed a few friends and acquaintances who had contacts within the psychiatric community, asking if they could recommend anyone who might help me, and they ignored me. One time I contacted a woman who'd written a book on yoga and depression, and she said she didn't know anyone in Los Angeles, but I could come to her very expensive workshop in another city.

Ultimately, I was stunned by these people's callousness, because throughout my life I have helped friends and relatives as well as total strangers. If I know people who are sick, I volunteer to do whatever I can for them. I have recommended doctors to people I barely know. I have offered to research my friends' illnesses. I have driven people to doctor's appointments and visited others at the hospital.

For the last eight years of my mother's life, my husband and I had her over for dinner every Sunday, and when I was depressed and couldn't entertain her, I drove over to her house and served her dinner. I visited my mom at least three days a week and was always willing to come over when she called.

The only people I don't help are those who "cry wolf" over and over, and people who won't do the least bit to help themselves. But I've never refused to offer advice and encouragement to strangers as well as loved ones.

What they do with my advice or my willingness to help is another matter. I often wonder about people who ask for advice, and then don't respond at all. Not even a thank you. And I'm surprised by people who seek advice and yet ignore it because it means they'll have to stop denying they have a problem and start dealing with it.

But despite all that, I will still offer to help...because so few have been there for me when I needed them.

Tuesday, August 26, 2008

Searching for Meaning

Years ago I realized I was repeating the same patterns over and over again. I'd try really hard to identify a new job or career, and once I started working, I'd hate it. While the jobs were prestigious--I started out as an NBC Page, worked at KNBC news for three years, then became the Arts and Antiques Editor for Architectural Digest magazine and so forth and so on--I didn't feel the work was meaningful. So, I'd quit and seek out the next opportunity.

Even after my first book, Job Search Strategy for College Grads, was published, I didn't feel satisfied. Maybe it was the topic of the book or perhaps it was my concern that I was a "one book author," but I constantly worried about finding my "life's work."

In retrospect, what was so distressing about the process, was that once again I felt like I was the only person who was having these problems. Every place I worked, everyone else seemed to like what they were doing far better than I did. No one else ever said, "Gee, I think this is a waste of my time. Surely I was born to do something more important than this."

It was just like being in college all over again. None of my other friends transferred to another university because they were unhappy. No one ever said, "Why am I in college if I don't know what I want to major in?" None of them ever quit college for a year to travel in Europe and then work for a presidential campaign.

It seemed like I spent my life with people who either knew what they wanted to do, found meaning in environments I found meaningless, or never asked themselves the important questions: Why am I here? How can I contribute?

All these years later, I'm sorry my path was so difficult and strewn with so many depressive episodes. But I'm quite certain that I wouldn't have been happy if I had walked through life with blinders or sought money and prestige rather than meaning.

As difficult as things were, I wouldn't be who I am today if I hadn't continued to search for the answers to my questions. My pain and suffering might have been mitigated. I might not have had to fight existential demons. But I never would have found the light at the end of the tunnel.

Monday, August 25, 2008

Our First Depressive Episodes

I plan on spending this week talking about depression. For those of you who've read my blog for some time, you know that my first depressive episode occurred when I was an 18-year-old college freshman in 1968. I was the wrong girl at the wrong university at the wrong time. Kind of like Doris Day at a Janis Joplin concert. A fifties girl in a sixties world.

In retrospect, choosing the University of California at Berkeley in the sixties was just too big of a transition. And I didn't have the self-knowledge to admit I'd made a huge mistake, so I stuck it out for a year. By then I was truly depressed (albeit I had no idea that what I felt was clinical depression) and thought something had "broken inside." Had I sought help, and had it been the right kind of help, I think my problems could have been fairly easily resolved.

What's important about that first episode is that I thought about it over and over for the next two-and-a-half decades. During that period, I did seek help. In fact, I saw six psychologists (for very brief periods), and one psychiatrist for somewhere between six to nine months.

No one diagnosed the first episode as a clinical depression nor the subsequent ones. About ten years ago, I read that stressful life events can cause depressive episodes. It was a huge relief. By myself, I came to realize the significance of that first episode--so I could finally be done with it.

Most of the literature I've read doesn't suggest how important the first episode is. But I believe it's terribly significant. What I realized years later was that I didn't have experience dealing with disappointment so when I was so disappointed at Cal because it wasn't what I envisioned, I didn't know what to do. I was afraid to tell anyone at the Student Health Center because I didn't want it to go on my college record. I didn't discuss it with my parents because I thought they'd be disappointed in me. And I didn't talk about it with my friends because all of them seemed to love college.

While I told every psychologist and psychiatrist about this episode, none of them ever asked, "What do you think caused it? How did you deal with it? Did you confide in your parents or your friends? If you did, what did they say? If you didn't, why didn't you? How have you dealt with disappointment since then? What events cause you to feel disappointed?"

You get the drift. My point is that I now believe that if I had only realized that I didn't deal well with disappointment, I could have changed my pattern rather than repeating it. Without that knowledge, I continued to deal with disappointment the same way, and for most of my life that was the primary cause of my depressive episodes.

I have often wondered if other people feel the same about their first depressive episodes. Do you remember yours? Has it had a lasting effect on your life or were you able to resolve it? Do you agree about the significance of your first depression?

Sunday, August 24, 2008

Best Advice on Depression (Part 2)

While I usually don't post on weekends, I would like to thank everyone who responded to Josh in Best Advice on Depression (Part 1), including: Gianna, PJ, Duane, Dirk, Merelyme, Naturalgal, Dixon, Marja, and Howard. As a way of seeking closure on this, I'm posting Josh's response, and my response to him.

"Wow. Thank you all for your support, advice and kind words. It means a great deal, especially during times like this.

"I spoke to my psychiatrist yesterday and described the difficulties I have been experiencing lately. It's anyone's guess whether he'll be able to help, but he's a nice man who seems to be genuinely concerned about his patients. That, in itself, is comforting.

"To offer more information about my ailments and current treatment, I am currently on Lamictal, Effexor and Zoloft. I have been on Effexor for two years at varying levels. It had been very helpful for a while, but it gradually lost its effectiveness. I've continued to take 150mg in case it still had a minor effect, nonetheless. Lamictal was added in February. I started with 25, then increased to 400mg eventually. Since it wasn't working all that well, it has since been reduced to 100mg. It will be eliminated as soon as possible, though I feel part of why I have been feeling so terrible lately is due to withdrawal. I'm going to take it slow. Zoloft was added only one month ago.

"The Doc suggested replacing Lamictal with Depakote, sticking with the Zoloft and continuing eliminating Effexor. I've become ambivalent to medications since they have largely been ineffective. Instead, I am convinced that I need to take matters into my own hands. That's not to say I will shun them entirely. I will accept the doctor's recommendations for a while longer - at small doses since I feel I've been overmedicated in the past - but vigilance in my daily life will impact matters more, I believe. It's going to be very hard, though. I had hoped to be given an initial push by medications, but I cannot count on them any longer.

"Another obstacle is obsessions of mine and, to a slightly lesser extent, compulsions. Cleanliness is a huge issue for me. It makes daily life rather difficult. If I am in the comfort of my own home, without any external influences, I am OK. It's difficult welcoming visitors or letting the outside world in, so to speak. The regimens I undertake are arduous.

"I have no idea how I will deal with the obsessions and compulsions. It would be wonderful if everyone else would change, but that's not likely. First, I need to achieve greater happiness. Other difficulties will partially improve as a result.

"Finding the time to exercise has eluded me in the past. Any free time I've had I would usually spend in relaxation because my days are typically so exhausting. I've been organizing my garage lately in an attempt to create a mini-gym. It still won't be the same as playing a sport, which I was always accustomed to doing, but I'll have to force myself. Anyone live in NJ? I haven't played hoops or challenged anyone 1 on 1 in ages.

"I've rambled on quite a bit, for that I apologize. I'll leave all of you with a few questions that I've struggled to find the answers to. Maybe someone will have some suggestions that will push me in the right direction. I felt better today than I did when I initially wrote, and I need to carry this sliver of momentum forward, as I cannot afford to sink any lower.

"I'm not a morning person, and am inclined to exercise at night when my boys fall asleep. Yet, as a person who has difficulty falling/staying asleep, doing so before bedtime is not a wise decision. How do I balance one against the other?

"I know some of the things I need to do to become healthier. How do I remind myself of these things in the midst of a hectic day?

"Once again, thank you all so much for your willingness to respond to my concerns. It warms my heart knowing that others care so much about the health of a stranger. Hopefully I can return the favor in some way. Finding this forum has been uplifting. The initial response by Susan meant a great deal. Subsequent posts by Gianna, Marja et. al. has overwhelmed me."

Many, many thanks.
Dear Josh,
I'm glad to hear from you, and you're welcome. I, too, was delighted with the response of my readers, many of whom have become good friends. It makes me feel really good that so many people responded to you--with such empathy, compassion, and good advice.

In terms of the medication, it's difficult to know why things work and then "poop out." But, in my experience and in reading other blogs, it's fairly common. Gianna has recently withdrawn from Lamictal and you might want to read her post on her blog about it--if you haven't already. As Howard has written, Depakote works for him--at a much higher dose than he was originally taking. With all medication, finding the right dose is critical and very personal. What works for some people doesn't for others. Dosage is something that most psychiatrists should have a handle on.

After reading what you've written, I wonder if you're being treated for Obsessive Compulsive Behavior as well. While I don't know anything about it, your daily routines would suggest it's an issue for you. While I dislike labels, I do believe that knowing we are "presenting" certain behavior is the first step in identifying patterns that impede wellness. After that, it's much easier to research the condition, and find ways of controlling unhealthy behavioral patterns in order to diminish or eliminate the symptoms.

In terms of exercise, I've learned it's as important as taking medication. So, I treat it as a critical part of my wellness program rather than an optional activity. What that means to me is that just as diabetics take insulin, I exercise. Hopefully, your home gym will work. But perhaps it's equally important for you to find a YMCA or other venue where you can shoot hoops. Personally, I have always felt that athletics (rather than exercise machines) can be a truly healing activity. I enjoy the socialization, competition, and exercise.

When you write you're not a "morning person," have you read about Seasonal Affective Disorder and Winter Blues? If not, it's another important topic to explore and one I will write about next week. After all these years, I am now convinced that my "illness" truly is SAD rather than bipolarity. I'm currently rereading Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder by Dr. Norman Rosenthal, one of the preeminent researchers in this field and someone who suffered from this malady and overcame it.

In terms of sleep-related problems, there is a lot of research on the importance of sleep in bipolarity, as well as depression and seasonal affective disorder. You might want to start at the Sleep Research Society, and go from there. This is a topic I don't know a lot about, but since it's a very important part of wellness, I'll be researching it and writing more about it in the future.

When you ask, "How can I remind myself to do healthier activities in a hectic day?" I would recommend meditation or deep breathing. One of my favorite book for handling stress is The Relaxation and Stress Reduction Workbook, which I think is a great resource. When things get tense and I'm with other people--I excuse myself and go to the bathroom. While I'm in the stall, I take a few minutes to breathe deeply, and it truly works. This book provides great advice and you can learn important stress reduction techniques.

I also recommend keeping mood charts (I've written a five-part series on this) because I believe it's critical to understand your behavior, figure out what triggers stress or depression, and identify recurrent patterns so you can change them.

From my own experience, I know that changing behavioral patterns, and incorporating wellness activities into my daily life "cured" me. The medication provided me with the feeling of well-being that enabled me to pursue wellness. But the "cure" was centered around making lifestyle and behavior changes.

Josh, finally, I guess my best advice is to recognize that whether or not your original depressive episode was caused by external factors over which you had no control, I believe we can control the present. Behavioral and neural patterns that impede wellness can be changed, stress can be regulated, and symptoms for most illnesses can be diminished--if you're truly devoted to pursing wellness.

All my best!


Friday, August 22, 2008

Best Advice on Depression (Part 1)

Josh left the following comment on my post, Bipolar II. Because I wrote the the post a few days ago, I was afraid he wouldn't get many responses, so I've decided to post his comment in the body of my blog. He brings up so many important issues that it's difficult to address them in one post. So, I'll write an overall response, and will focus more on the topic of depression next week.

"I came upon your blog earlier today and can say with confidence that I will continue to read regularly. It's been helpful to read the testimonies of others, and has also provided me with some helpful suggestions.

"I've suffered from depression for the last sixteen years or so - half of my life. It had been manageable by making healthy choices in life, but that has not been so the last 4-5 years. I've been spiraling downwards and am desperately trying to recover happiness and peace of mind.

"One year ago, I sought the advice of three different doctors, hoping to achieve a common diagnosis. One suggested bipolar disorder, the next was somewhat certain that the symptoms fit while the last was absolutely certain. All the while, I did not fear a diagnosis of that sort. Something was wrong and I wanted to get well.

"Since the initial diagnosis, I have made very little progress toward achieving greater mental happiness. I've tried many different anti-depressants along with a few mood stabilizers such as Lamictal, Depakote, Keppra and Zyprexa. Several medications were helpful for a very short span of time, but none have continued their effectiveness, which has left me extremely frustrated. What is more, I can barely remember who I was before things started to deteriorate so badly.

"As I mentioned earlier, I have suffered from depression for a long time. Terrible bouts were sometimes triggered by external factors, some of which were in my control (poor performance in school, relationship problems, etc.), but often they were not (passing of my father at a young age). Depression and melancholy were just facets of my life I had come to accept. Peaks were always followed by troughs, very much like an ocean wave. The last several years, however, the waves have come at a much more rapid pace. Daily or weekly mood swings have become typical.

"I don't know what to do anymore. There are no clear paths to choose from. I feel very much alone. There are plenty of people that care about me, but none that can help me. My wife does not understand what I feel on a daily basis, which has created a great rift between us. I have two young, wonderful little boys, from whom I shelter my problems as best I can, but I can't do so 100% of the time...especially during times like these when I'm in such a deep valley.

"I appreciate the approach of Susan and many of the contributors to this blog regarding mental illness. I've always enjoyed meditation, self-awareness, the beauty of our natural environment and many other healthy options as a way to achieve peace and happiness. Those measures have not been helpful to me for some time now, which is why I sought the help of medical professionals. I feel like if I can just raise my head above water long enough I can fight my way out of this because I now understand some of things I need to do to ensure happiness. I have not been able to overcome that initial hurdle, however.

"Any help or insight that anyone can offer is greatly appreciated."

Many thanks,
* * *
Dear Josh,
My heart goes out to you. I know how tough it is to have young children and suffer from depression. I can't imagine how difficult it is to have to deal with these episodes, and also to try and hold your marriage together at the same time.

As I've mentioned in the caveat to my blog, I am not a doctor nor do I have medical experience. However, I will be happy to offer advice based on my own experience, and I'm hoping my readers will as well.

None of the mood stabilizers or antidepressants worked for me. The only medication that has worked for a number of years (although I only take it when I'm in a depressive episode) is Adderall, which is a stimulant. Five years ago, a new psychiatrist prescribed it for me because i had been in a year-long depressive episode and my former psychiatrist had prescribed a ton of different medications--none of which worked.

With Adderall, my depression lifted within one day. I must tell you that I do not respond to medication like anyone else I've ever read about. At the time, I began taking Adderall, I was considered a medication-resistant rapid cycler. When you say that your moods are shifting daily, it's quite possible that you are currently rapid cycling.

What I've read in dozens of books about bipolar disorder (as well as books about depression) has never rung true for me. In my case, the rapid cycling (frequent mood changes) was actually caused by medication. I'm not sure about you. None of the mood stabilizers had any effect. For the first three years after my diagnosis, Zoloft worked during my depressive episodes. But then it pooped out, and has never worked again.

From my own experience, I believe that sometimes--in a deep and ongoing depression--the only immediate relief can be provided by medication. At least, that has been true for me. However, the other strategies I use work (for me) on a long-term basis.

While I haven't had great luck with therapists, I also believe it's critical to talk to someone who can help you. I believe it's important to know what triggered your first depressive episode, and what triggers them now, and find ways to resolve things.

I also believe that stress plays a huge roll in exacerbating this illness. So, it's terribly important to find ways of relieving stress. A few wellness activities that work for me are deep breathing, neural path therapy (a form of deep breathing), meditation (my own method), and playing music. I play the harmonica and recorder for stress reduction and as a kind of Zen breathing exercise. I sing for the same reason, and I play the Autoharp.

I also believe that exercise is critical. The last time I researched it, I found more than 80 studies that show that exercise is far more effective than anti-depressants for long-term healing from depression.

There are other people who read this blog who have "cured" themselves. Jazz from In Pieces is one. Marja from Roller Coaster has effectively managed her symptoms. Gianna from Beyond Meds is working with a Orthomolecular psychiatrist, whom she truly believes in. Annie from A Psycho-therapist with Bipolar is another good resource. And Duane from Discover and Recover provides a lot of information in his blog.

I guess if I were to prioritize things, I would do the following: 1. Find a therapist or counselor with whom you can talk about how you're feeling, and with whom you can resolve any immediate problems. 2. Whether or not the diagnosis is bipolar disorder or depression, the first priority should be to stabilize things and get the fog to lift. For me, medication can do that. 3. If you're feeling well enough, I would start an exercise program immediately, even if it's just walking--and I'd do it every day.

4. I'd also get involved in all the other activities you've done in the past to promote wellness. 5. I'd have a physical examination to make sure the depression isn't caused by something physical. Long-term depression can wreak havoc with your immune system. 6. Diet and nutrition are really important as well. Naturalgal provides information on this in her blog as does Duane in Discover and Recover. 7) If you check out my other blog, Bipolar Wellness Program, I provide some other ideas. 8) Marja has found wellness through medication and spirituality, and prayer is shown to be an effective "antidepressant." 9) Dr. Deb is a psychotherapist and often provides good information. She's got an interesting post about hope therapy in her blog right now.

10. In terms of developing a sense of community, writing a blog is great therapy. I see you've got a page for a blog, but haven't yet posted on it. Actually, your first post could be your letter to me. If you post it on your blog, I can note it here, and people will start visiting. I believe that developing relationships with other people who have been in your shoes is a great way to learn about other wellness activities, meet people who can relate to what you're going through, and lessen your feeling of isolation.

Finally, know that these episodes always end and there is hope at the end of the tunnel! Best of luck. I will spend next week writing about various aspects of depression with you in mind. I hope some of my ideas and thoughts are helpful!


Thursday, August 21, 2008

Accepting Personal Responsibility

In 2003 when I met with my doctor of integrative medicine to see if I could finally get a handle on bipolarity, we had a great first meeting. As I've mentioned before, she asked good questions, she listened, and most of all, she saw no reason why I couldn't get well.

I knew I liked her and trusted her from the moment we met. It's an intuitive thing with me. But she confirmed my immediate impression by her behavior--the way she treated me as an equal, her willingness to learn about bipolarity, and her admission that while she wasn't a psychiatrist and had never treated anyone who suffered from bipolar disorder, she believed that illness is about a system that's out of balance, and she saw no good reason why we couldn't resolve things.

As the meeting progressed, my primary concern was whether she would take me as a patient. At the time, she was primarily a researcher and was only seeing patients on a limited basis. But, before I left she confirmed that she would handle my case.

A few months after I began working with her, I asked her a question that had been on my mind since our initial meeting. "How do you decide which people you'll treat?" I said.

"It depends on whether I feel I can help them," she answered.

"And what are the criteria?" I asked.

"The most important criterion is whether a person blames others for his or her illness," she said. "I'm not saying people create their illnesses. But in all my years of working with people, the ones I can't help are those who blame everyone else for all the bad things that have happened to them. They never accept personal responsibility for anything. Not only are they difficult to work with, but I've learned that they never change...even when they're dying."

My doctor's answered confirmed my own hypothesis, which is that I am my own best healer. At the time, it was a feeling I had, although I wasn't clear about the degree to which I believed it. Now, I think it's the critical component of my ability to heal.

I've always known that when the going gets tough, I can always count on myself. When I was so sick and so fearful of bipolarity--because I worried that other people's behavior could so stress me out that I'd get sick--I sometimes forgot about my inner strength.

But now I know that while there are people whom I don't choose to have in my life, or those whose behavior truly annoys me, it's not what they do that matters, but how I respond to what they do.

And the blamers will always blame. The people who have a thousand excuses for what they aren't doing, will continue to have their excuses. But those of us who understand our own power, and truly believe in ourselves, will get well because we know we deserve it!

Wednesday, August 20, 2008

Getting Positive Reinforcement

A few days ago, when I wrote the post, Depression Behavior: Personal Hygiene, I was gratified to get such positive comments. And it made me realize how little positive enforcement I received from five different psychiatrists and some of my relatives and friends during a decade of severe depressive episodes.

I have always prided myself on the self-discipline I exercised, and the hard work it took to try and achieve a high level of "normalcy" for my husband and son during these depressive episodes. In addition, I worked so hard to achieve wellness, that even though I wasn't initially successful, I felt I should have received positive reinforcement for my efforts.

Instead, I felt abandoned by so many people--a number of whom had previously been near and dear to me. They made it quite clear that they considered me a failure because I couldn't "cure" myself. And others tried to take advantage of my illness for reasons only they can understand.

Yet, despite their negativity and bad behavior, I tried my very best to maintain my self-esteem, which has always been high. Despite healers who didn't heal, charlatans who pretended they could help me, but couldn't, and friends and relatives who tired of my disappearance from sight for months on end or others who felt I was self-absorbed because it took all of my energy just to stay alive, I survived, and now flourish.

Yet, a part of me is still angry and disappointed for the way I was treated for so long. So, you can't imagine how good it felt to receive praise from my fellow bloggers. I would like to thank Naturalgal, KJ, Jazz, PJ, Catatonic Kid, and Nancie for commenting on this post. Every time I reread what you wrote, I smile!

Tuesday, August 19, 2008

Bipolar II

From the moment I was diagnosed as atypical bipolar II, I tried to find information on how to heal myself. In retrospect, what hampered me most was my psychiatrists' insistence that my illness was biochemical. In fact, ten years later I read that psychiatric researchers had no idea what the causal factors for bipolar depression were, nor how to treat it.

When I realized that all BIPS (bipolars)--whether they come to this illness from mania or depression, and whether they suffer from psychosis or not--are treated with the same medications, it makes no sense. To me, it is like giving all diabetics insulin, whether they need it or not.

In the end, I decided I wasn't "treatment resistant" at all. I had just been given the wrong medication or perhaps I truly wasn't bipolar, and that's why the medication didn't work. It's quite possible that initially it was a misdiagnosis. In fact, I've never read about anyone else who was diagnosed as bipolar II because she/he suffered from two six-week-depressive episodes a year and was cheerful the rest of the time.

What I do know is that the medication I was given made me worse from the get-go. I'm not sure how malpractice is defined but it would seem that if you take a person who is depressed approximately 85 days a year and in the very first year you make her sick 365 days a year, and then you tell her she is non-compliant if she doesn't take the medicine that is making her worse, this is malpractice. What do you think?

If you're bipolar II, has medication worked for you? If so, what works? If not, how are you healing yourself?

Monday, August 18, 2008

Depression Behavior: Personal Hygiene

Last week I read two posts on two different blogs, How Is Bradley? and Catatonic Kid, about personal hygiene during depressive episodes. Since I feel very strongly about this topic, I decided to write about it.

Having survived more than 120 depressive episodes, I feel uniquely qualified to write about the importance of maintaining personal hygiene during depressive episodes. I believe that being depressed is no excuse for not maintaining personal hygiene. As awful as I have felt--and there have been times when I was lucky to survive--I have always brushed my teeth, and almost always showered, blow-dried my hair, and gotten dressed--even if I only changed into sweat pants, and went back to bed after my son and husband left the house.

For those of us who are parents and spouses/partners, I believe it's our responsibility to try and achieve a certain level of normalcy for our families, if not for ourselves. It's difficult enough for our spouses/partners and children to have to deal with our depressions, but to have to deal with someone who is unkempt and doesn't even try is far worse.

In my case, when my son was in elementary school, no matter how bad I felt, I forced myself to wake up in the morning, shower, and dress, and make his lunch, and his breakfast before my husband drove him to school. On my worst days, I usually felt well by 2:00 (it rarely lasted the entire day), and I would shower again, get dressed, and drive to pick up my son.

While I may not have felt well enough to chat with other moms who were waiting to pick up their children, in the worse case scenario I still forced myself to stand across the street, and cross when I saw my son get out of school. Because he's an only child, I also forced myself to arrange play dates so my son would have someone to play with--even though I wasn't feeling great.

I believe it was this self-discipline that enabled my son to have a fairly normal childhood, and for my husband to feel hope that at some point our lives would return to "normal." When I see the divorce rate among BIPS (bipolars) and when I read comments by children of BIPS, I feel like I've done the best I could--under the circumstances.

And I also want to say that I believe, no matter how bad we feel, we need to try and put ourselves in our childrens', spouse's/partner's, relatives' and friends' positions. How would we feel about living with someone who doesn't bathe because he/she is depressed? How would we feel about someone who doesn't do everything possible to try and elevate his/her mood by maintaining certain standards of personal hygiene?

What do we owe the people we live with and love? How can we expect them to "stand by us" if we let ourselves go and stop trying?

Friday, August 15, 2008

Pet Therapy

Yesterday I wrote about Lassie, and today I felt I should write more about pet therapy. On a site called Holistic online, I read the following: "Research has shown that heart attack victims who have pets live longer. Even watching a tank full of tropical fish may lower blood pressure, at least temporarily. A study of 92 patients hospitalized in coronary care units for angina or heart attack found that those who owned pets were more likely to be alive a year later than those who did not. The study found that only 6 percent of patients who owned pets died within one year compared with 28 percent of those who did not own pets."

After surveying a number of different sites, it's conclusive to me that pets truly do aid people who are sick. But what else do we gain from loving our pets?

For me, it was always unconditional love. During a depressive episode, no matter how awful I felt, how terrible I looked, or how "boring" and low energy others might have found me, my dogs licked me and vigorously wagged their tails as if I were upbeat, attractive, and a stimulating companion.

What pets do you have? In what ways do they enhance your life?

Thursday, August 14, 2008

What Would Lassie Do?

As I've mentioned before, when I want to read about doctors talking about wellness, I usually turn to those who treat cancer (Dr. Bernie S. Siegel), heart disease (Dr. Dean Ornish and Dr. Bernard Lown), and AIDS as well as cancer (Dr. Jerome Groopman).

Why? Because I find their writing about healing to be inspirational. They write books in which there are wonderful success stories. They have great insight about illness and wellness. They provide terrific advice. And some of them offer their patients cutting-age wellness programs.

Yesterday, I was tired because one of our family members is sick and has been hospitalized (and it's been emotionally draining), and I was looking for an uplifting book in my home library. I'd forgotten that I'd bought 101 Exercises for the Soul: A Divine Workout Plan for Body, Mind, and Spirit by Dr. Bernie S. Siegel. "Each chapter focuses on a different area of growth, from improving your attitude to finding inner motivation."

Dr. Siegel not only includes inspirational quotes, but he also tells vignettes about patients, and gives great tips and advice. The story that made my smile yesterday was in the chapter on pets.

He writes: "I always teach people that when in doubt--when you aren't sure what the right thing to do is--to remember WWLD. In other words: What Would Lassie Do?" (Lassie is a collie who starred in one of my favorite childhood TV shows.) "Lassie was always kind, loyal, protective, and motivated by love.

"Also, when dealing with others, I try to follow a veterinarian's expert advice for dog training. Use rewards rather than punishment, always show love, trust, and respect, and make a commitment to consistency."

Personally, I think that's great advice!

Wednesday, August 13, 2008

Massage Therapy

A major part of touch therapy is massage. As John Harvey Kellogg, physician, and natural-breathing pioneer from the Battle Creek Sanatorium wrote, "The first healing gesture of the mother is to reach out with soothing touch--massage. The first healers of the human race, thousands of years before the beginning of what we call medicine, used hands-on healing--massage. Massage is the most ancient healing art."

In The Healer Within: Using Traditional Chinese Techniques to Release Your Body's Own Medicine, Roger Jahnke writes, "As people begin to choose natural healing methods for their health care, massage emerges as one of the primary therapeutic modalities. Hospitals and even corporations are hiring massage therapists to enhance health, help increase productivity, and prevent the negative impacts of stress.

"Most of the newer comprehensive cancer treatment programs have begun to offer massage. Many forward-looking hospital systems have nurses on staff who practice 'therapeutic touch,' a special form of therapy using healing hands.

"Many millennia ago Hippocrates, the father of Western medicine, relied on massage as a key tool for healing. Both ancient and current master physicians in the Asian cultures frequently make massage their primary healing specialty.

"Massage is available in every hospital in China. while it is particularly satisfying to receive massage from a trained professional or even a family member, it is possible and very effective to do it for yourself as well. The best part is that this can be done at any time of the day or night, no appointment is necessary, and there is no cost."

FYI...I've been reading this book and learning how to do this self-massage, and it really does work. It doesn't compare to a massage I had in a bathhouse in Istanbul when I was 22 (that's another story), but it does help me relax.

Tuesday, August 12, 2008

Touch Therapy

I'm taking a break in my "Why I Am Well" series to discuss touch therapy, which I think is very important. Perhaps its effect became most obvious to me when my mother was repeatedly in the hospital, about 18 months before she died.

I had begun realizing that the more she was in the hospital the more disoriented she became. I already knew she had dementia, but for her it was initially more of a problem with her memory. Yet, this one time in the hospital, she clearly wasn't herself, and I really got scared. Although I was in her room visiting, she kept on saying over and over, "I need to call Susan on the telephone, and tell her I'm here." And while she knew who I am, explaining that she didn't need to call me wasn't helping.

What made matters worse was that no one was able to tell me why she was so disoriented, or what I could do to help her. The first few nurses were of no help; neither was her doctor. And a friend of hers who was visiting, and is a peer counselor, made matters worse when he said, "I think she's just not going to come back from this."

Don't you just hate people who give you such bad advice during a crisis?

What I have learned about myself is that during a crisis I intuitively know what to do. So, I brought my chair right next to my mom's bed, and began massaging her hands while talking to her in a quiet voice. I said stuff like, "Hi, mom, I'm here with you. You don't have to talk about calling me because I'm sitting right next to you. Why don't you close your eyes and relax (she clearly was agitated) and let me tell you about some of the things I love most about you.

"When I was a kid growing up, I always loved it that you wrote your column called Speaking from Cheviot. Do you remember how we used to feel like celebrities when we went into restaurants and to plays as well? I always was so proud of you. And do you know I think the reason I knew I could become a writer was because you never made it seem like a big deal...I loved all the poems you wrote my entire life...(and I began reciting a few I know by heart)."

Anyway, you get my drift. They key was to remind my mother of the things she used to do--memories that might click in--and bring her back to me, and at the same time stoke her hands so that she relaxed. Within about ten minutes, she became less and less agitated so I asked if she would like me to massage her head. When she agreed, I started doing that and talking less. After about 20 minutes passed, she opened her baby blue eyes, lovingly looked at me, and said, "Susan, honey, I'm so glad you're here. How did I get so lucky to have a daughter like you?"

For people who don't realize the value of touch therapy, I beg to differ.

Monday, August 11, 2008

Why I am Well (Part 3)

Before the end of my first meeting with Dr. Michaels,* my doctor of integrative medicine, she wrote a prescription for me to take a number of blood tests at the hospital. Because I was 53 years old at the time, one of the tests was to see if I was menopausal, but the rest were fairly standard--as I remember.

Personally, I thought it was a great idea. Because of the cost of my psychiatric bills in the preceding decade, I had stopped going to my general practitioner because we could no longer afford it. While this isn't something I would recommend, we had taken a huge financial hit because of my inability to work, most of the psychiatric costs weren't covered, and so the only other doctors I saw with regularity were my gynecologist and dentist. In fact, I had always been a very healthy person--aside from my depressions--and there was no reason to suspect otherwise.

Still, over the preceding ten-year-period I had taken 25 psychiatric medications, all of which were terribly risky in my estimation and many of which could cause long-term damage. One only has to read the information on them in The Pill Book, which had become my bedside bible of sorts.

And I'm still sure the medication wreaked havoc with my brain because it took four years (during which I took Adderrall and Ativan when I needed them, but nothing else) to regain normalcy. (Right now I'm off all medication although I wouldn't hesitate to use either again if I truly needed it.)

Anyway, my point is that I think annual doctor's examinations are critical, particularly if you remain on toxic medication. And I was relieved that Dr. Michaels thought to have my blood tested. As I remember, she was also checking my thyroid because an any irregularity in that area could have caused some of my symptoms. I have no idea what the rest of the tests proved, although she explained the results at the time. When the results came back, it wasn't surprising that I tested "normal" for everything.

Finally, as I was ready to leave, she said, "Can I hug you?" I'm big on hugging so I said yes. Since none of my psychiatrists has ever touched me at all unless I reached out my hand to shake theirs, I was really pleased.

Lest you think this is some kind of California touchy-feely thing, the fact is that "touching" has true medicinal value. In The Lost Art of Healing: Practicing Compassion in Medicine, Nobel prize winner Dr. Bernard Lown writes, "Lewis Thomas, in The Youngest Science, comments wisely that touching is the oldest and most effective tool in doctoring. This statement rings true for me. I am persuaded that touching a patient provides advantages to the internist, as compared to the psychiatrist who sits removed and merely listens.

"Touching is a way of gaining significant insights. Frequently the conversation at first is impersonal. The relationship with the patient often alters dramatically after the physical examination. The remoteness dissipates, supplanted by comfortable easy-going conversation. Material that was neither divulged nor suspected emerges without much probing. Questioning is no longer resented. A stranger a few minutes earlier opens up with intimacies usually earned only through long and trusting friendships."

Has your psychiatrist ever hugged you? Would you like him/her to or not? Do you believe that touching promotes healing?

*This is a pseudonym.

Friday, August 8, 2008

Why I Am Well (Part 2)

When I met with my doctor of integrative medicine, whom I'll call Dr. Michaels, it was a genuinely pleasurable experience. First, I liked it that her office was located in a major medical center, and it was for "regular" patients, not psychiatric ones. Second, each time I went, her nurse took my blood pressure and weighed me, which should probably be standard for all patients. Third, because she is a "regular" doctor rather than a psychiatrist, my insurance policy (which I no longer have) paid for 80 percent of the total, rather than $30 for a half-hour $100 psychiatric visit.

In our first meeting, rather than asking me questions that had no value whatsoever, Dr. Michaels' questionnaire was medical in nature. When Dr. Michaels and I met, rather than sitting across the room from me, she sat on a chair right next to me. Rather than taking notes while I talked, she looked right at me. And rather than feeling that I couldn't get well, I knew she believed I could.

What I knew about her before I went was that most people who found her were dying, she isn't a psychiatrist, and she believes medical problems--psychiatric as well as physical ones--are caused because our lives are out of balance.

When we talked, I learned she helps the dying achieve wellness or helps them to die more peacefully by coming to grips with life problems. I learned she would read all the research on bipolarity that I provided her. I learned she would treat me as a colleague in the process rather than a supplicant. And I learned she felt there wasn't any reason why I couldn't achieve wellness.

(to be continued)

Thursday, August 7, 2008

Why I Am Well (Part 1)

After being very ill for a decade, and spending most of the time researching bipolar disorder, which incidentally never made me feel better because everything I learned was so downbeat and depressing, I'm now well most of the time. The obvious question is "Why?"

The answer isn't quite so obvious, but I'll give you my best guesses. The beginning of my turn around was in 2003 when I learned that most of the 25 medications that had been prescribed to me over a ten-year period had never been clinically tested for their efficacy.

On the one hand, I felt like I had been sucker-punched. On the other, I finally felt that I could ignore all of the research, and all of the "phooey" I had been fed for so many years.

While my doctors (five different psychiatrists who were all highly thought of in Los Angeles) and research had confirmed that bipolarity was a lifelong illness, I decided it wouldn't be for me. While every author of every book suggested I needed to focus on my illness to insure that I didn't exercise inappropriate behavior, or that I should meet with a therapist to discuss how my husband and son could deal with their "oh so ill spouse and mother," I decided this was hogwash.

For the next three years, I also decided to stop reading anything about bipolarity, to refrain from visiting bipolar sites online, and to cease researching this disorder. And it was the best decision of my life. I dumped five trash bags of files I had collected on various aspects of bipolarity, and shredded a ton of personal material related to the illness.

Finally, I decided to stop seeing my psychiatrist and to begin seeing a doctor of integrative medicine. I was no longer interested in talking about illness. Rather, I had decided to concentrate on wellness. I was not interested in hearing my psychiatrists tell me all of the reasons why I should take medication or worry about my condition. I wanted to talk with someone who believed I could get well.

(to be continued)

Wednesday, August 6, 2008

Bipolar Biochemistry or Behavior?

I found our recent discussion on irritability to be very interesting, and I appreciate everyone's input. Marja brought up a topic that I'd like to pursue further. I think that one of the greatest problems in being diagnosed as a BIP (bipolar person) is if we start believing that every symptom we have and every behavior pattern we engage in is biochemical in nature.

There is truly no proof--as far as I know--that this is true. And I, for one, didn't experience most of the symptoms until I began taking medication.

Also, having read dozens of bipolar blogs in the last 18 months, I see patterns in people's behavior, and their responses to situations that might cause bipolar symptoms, but clearly are a result of negative thought patterns, low self-esteem, and an inability to share their feelings in an honest and open way.

What I don't see is a lot of introspection, and problem-solving. I don't read about people who are saying, "I keep detailed mood charts and I have learned that periods of irritability always follow hypomanias. Or "I get angry because I'm unable to tell people they've hurt my feelings, but I've been working on it." Or "I have difficulties with people because I don't feel good about myself...and I've working with my therapist or counselor on self-esteem issues."

And yet, if people would reread their posts, they would even see patterns in the behavior they've recounted. Personally, I think the best thing in the world for BIPS would be to assume more responsibility for their behavior, and stop blaming everything on their biochemistry.

What do you think?

Tuesday, August 5, 2008

Bipolar Irritability (Part 2)

In my earlier post, which I actually wrote in the late afternoon on Monday, and then republished so it would have Tuesday's date (which is when I said I was coming back from my vacation), I said I was quite irritable and wasn't feeling like responding to comments.

And there were a number of people who commented on this post, and I planned on responding this afternoon, but then I realized these comments necessitate another post. By asking the question about comments, I somewhat negated the importance of my original post, which was that I am learning to figure out why I get irritable, trying to deal with the causal factors, and attempting to come up with solutions.

For me, irritability, anger, and rage are huge issues. When I think of all the years I didn't understand they were bipolar symptoms, I literally want to cry. These days, some authors write about them as symptoms and I believe that's critically important.

The key questions for me, which few--perhaps no authors--answer are: Why do we get irritable? Is it because of hypomania or mania? Is it because our feelings have been hurt, and we don't know what to do with those emotions and so it comes out as anger, rage or irritability? Is it because we feel so deeply in general?

Or is it because we feel like we give so much during periods of hypomania (I'm not sure if it's the same with mania) that we're spent when the episode is over. And now we want others to give to us in return, but we don't feel they do--or at least not with the same passion we gave to them when we were hypomanic. All interesting questions, don't you think?

These were all things I thought about in the middle of last night, and I realized that responding to comments was a part of suddenly needing people to give back, rather than a problem with my blog or my readers. And writing about my irritability made it go away, and thus I can respond to comments, and it's now a moot point.

Having said that, I would like to thank all those who responded to this post, including Girlblue, KJ, Gianna, Bradley, Catatonic Kid, Robin J. Foote, Tamara, and Marja.'s how I feel about comments when I'm not irritable:

1. In the past I have responded to all comments because I truly believe that everyone deserves a response.

2. I no longer leave comments on blogs where people don't respond to my comments unless I have a personal relationship with them and we email each other offline, or they frequently leave comments on my blog.

3. For me, part of the value of blogging is developing a sense of community and that's why comments are so important.

4. My feelings do get hurt when people don't respond to my comments, or perhaps equally important, I feel it's a waste of my time. The point is that I only spend so much time online each day because as I've written before, it doesn't make me feel good to look at the screen for hours on end. And...if I take the time to respond to a post, it's because I want to show my support for the person who posted or to share information that I think might help. I truly dislike being ignored, and thus after commenting a few times and being ignored, I usually stop reading the blog.

5. However, now that I've read other people's point of view on comments, I'll think about the subject anew.

What's great about my earlier post and this one is that writing about something that was troubling me enabled me to heal once again. Thank you one and all!

Bipolar Irritability (Part 1)

One of the symptoms of bipolar disorder is irritability. In my case, irritability follows a hypomania. For me, June and July are usually hypomanic months, and thus, if it's August I tend to feel irritable. And when I'm irritable, I have less patience with people although I try really hard to remain patient with my friends and loved ones. As I mentioned in an earlier post, I don't believe there is any excuse for "bad bipolar behavior."

In terms of irritability, what I also find is that I have less interest in helping others when I'm irritable. So...when I review past posts, I find that it is usually around this time of year (or after other hypomanic episodes) that I decide I'll no longer write my blog. And when I realized that I haven't felt like returning from my blogging vacation, I tried to figure out why.

For the first time, I realized it's not the "posting" I don't feel like doing when I'm irritable, it's responding to comments. And unlike some other bloggers, I always respond to comments because I believe that if people care enough to comment, then they deserve a response from me.

Having said that, I also believe that I need to do whatever it takes to feel well. So...I have decided to come back from my blogging vacation, but to stop responding to comments until I truly feel like it.

My question to you is: Would you prefer that I "turn off" the comments capability or would you prefer to leave comments, knowing that I don't plan on responding...for now?