Bi-polar Type 2?

I am type 2, a "fast cycler" - it makes me mostly depressed, but often I'm also experiencing elevated or manic moods at the same time, which paralyzes me and yes, I get the voices in my head too.  I used to, I mean.  That hasn't been a problem since I started getting treatment.

My first doctor did what Bonita's did - his response to everything was to add on more meds and up the dosage.  I was on five meds at one point, gained 80 pounds, and then I had a major car accident.  I still don't know why I ran off the road, but I'm more than half convinced it was a new med he was giving to me.  I've tried it a few times since then but it has the same effect each time - it gives me vertigo, makes me dizzy, and I start losing big chunks of my short term memory.  It was bizzare.

After the wreck I tried to go cold turkey on the meds but that was horrible.  Never again.  I found a new doctor who said I didn't need all those meds, just one or two basic meds and a good therapist.  That is the route I'd recommend for sure.  Actually, what I'd recommend is a meds doctor, a therapist, and also a behavioral/occupational therapist if you struggle with depression.  If I ever entered the work force again, that's what I'd do.  I worked with an occupational therapist after my accident and some of the things he suggested just to overcome pain, have also worked for the crippling depression symptoms.

Be really careful with anti-depressants.  It's different for everyone so you can't go by what works for me.  I am super sensitive to drugs, so I take a minimal dose of Depakote, and such a small dose of amitryptiline that my new doctor didn't even know it came in that dose. 

I did lithium but found after a while that it was just redundant with the Depakote.  When I first was diagnosed, I was put on Zyprexa because as I said I did have a very "busy" brain - not constructively busy.  And I'd get weird notions.  I remember the first night I took all of that stuff.  I took it and the relief was so immediate that I stood up and said, "Gotta get to bed" and if Patrick hadn't led me there I would have fallen on the spot.  I was that exhausted from all the mental stuff.

But once all that cleared out, and I got some help working with things behaviorally, I didn't need all that.

I recommend a couple of basic books on BP - books, not the internet.  Familiarize yourself with the various symptoms and learn to talk yourself through them.  I had a friend who told me, "When you feel like you could take a tiger by the tail, your meds are working."  And that's true.  You know how everything seems to bother you right now?  Upsetting, depressing, irritating, distracting, annoying, enraging?  That was me five years ago. 

I couldn't keep friends because although I'm a really nice person, I'd blow my top over something stupid and tick people off and there I'd have yet another set of Former Friends.  Now I have the ability to take a step back, remember it's Not All About ME - if necessary swallow my pride and apologize, give ground, let off the pressure - all these things that most people know how to do instinctively. 

How many out there think I'm a really reasonable, nice, easy going person?  I'm not naturally this way at all!!  I wonder whether people are surprised when they meet me and I talk fast, forcefully, gesture wildly, and am very excitable.  But I've retrained myself now so that it's almost a habit (I break loose every so often but most of the time I realize I've got to GO and come back when I am feeling better) to be calm when I have a chance to think about it.

I NEVER go on chats.  Or do anything real time if I can help it - other than face to face conversations where I can remember easily that there's another person there and read their signals that they are bored, or nervous, or irritated, or want to say something themselves.

Absolute necessities to control your symptoms behaviorially:

1. Sleep is a priority.  (this from someone who is at this moment writing at 1 am)  For you, this is like a diabetic controlling sugar intake or a celiac sufferer watching gluten.  It's very hard to recover from the cascade effect of a single night's sleep cut short.  And conversely, you will be amazed at the difference in your moods, that going to bed at a regular, early time will make.
2. Eat breakfast.  No kidding.  This will help your moods and also stabilize your internal clock so that early bedtime is easier.  Sometime with protein is best.  If you have no time in the morning, and want to eat healthy, try those protein bars.  If healthy is not an issue, there's lots of pocket sandwiches, frozen omlettes, biscuit and bagel sandwiches, to check out in the frozen food aisle.  Whole Foods has some slightly better choices too.  :)
3. Take a multivitamin and fish oil.  You need 1200 mg of EFA - but don't do the "EFA only" brands - they are highly processed.  Just like with the dogs, look for a brand that is free of metals, and contains the whole fish body oil.  Again, it's amazing how much difference the fish oil made for me. 
   
4. Don't take "mood stabilizer" supplements of ANY kind.  Most of these contain either St. John's Wort or SAMe - both of these are very dangerous for those of us with BP disorder.  Sleep aids are okay but I get "hooked" on these really fast. 
   
5. Exercise in some way.  Best is a complete program where you get outside some, do some cardio (outside or in), do some weight training (I just do lifts with a set of five pounders), and a stretching/toning set.   Pilates helps me because it emphasizes biofeedback and posture - both of these make you aware of how you are feeling.  Anything that puts you "outside yourself" and helps you see yourself in an objective way, will help you monitor and alleviate your symptoms.
6. Have a game plan.  If you feel bad, have some code words to let those around you know you are in trouble.  I just literally tell Patrick "I feel bad." and he is supposed to signal that he understands, by giving me a hug.  Sounds silly but Patrick thought before that my telling him was good enough.  You need clear signals when your brain in going in circles and the rest of the world looks like it's a million miles away, and going at a snail's pace.  I also have a girl friend, who when I had a major incident last summer and didn't tell anyone, threatened to come yank me out of bed if I ever did that again.  So I write and tell her I feel that way and she makes sure I stay in touch.  That has made a world of difference too.
7. Have some backup drugs.  Ask your doctor for something you can take if you just feel so awful that you want it all to go away.  I have the option of doubling my Depakote for one dose.  It makes me sleep for a little bit, maybe an hour, and then I feel like I've got some perspective again when I get up.
8. Be careful if you hear yourself using absolutes and exaggerations.  Try to say exactly what you mean, except for humorous effect.  If you get in the habit of culling from your speech all the "The only way I can" and "He never does" and "I am the only one who" - you might find the world much more tolerable to live in.
9. Beware of taking on too much responsibilities.  Be aware of your limitations and try to act as if what you can get done at your worst time, is what you can always get done.  When you feel good, do short projects that never get done, like cleaning out a closet or organizing your tax records.  I know what you really want to do is go turn the world on its ear, but it's a never ending trap to succumb to that feeling.  Instead, try to figure out how to forward those world-shaking plans when you are feeling blah.
   

Just a small example and then I'm done.  Driving is still physically exhausting for me because of leftover stuff from my accident and other medical conditions I have.  But, previously, driving was mentally exhausting.  From Point A to Point B, Becca Shouse was the ONLY Champion of Justice on the road.  It was a terrible responsibility and it made me tired, depressed, and wiped out mentally.  Not to mention full of rancour towards my fellow human beings!

It's all different now.  I can totally laugh at anything that is not dangerous, and for someone being reckless, I can feel sorry for the danger they are putting themselves in, without feeling personally irritated at them. 

Good luck!

sillysally

I was curious if anyone has had to deal with this or known others who have.

I just wanted you to know that you are not alone in this.  I've gone thru periods of depression needing medication and also I did therapy for some time too. I still suffer with a lot of anxiety especially social anxiety that effects me every day.  I thought after I lost weight it would resolve itself but it didn't. 

Becca you made some excellent observations and suggestions ! That if for no other reason is why the Internet is a Good thing!  IN a group therapy session you would have been interrupted several dozen times preventing you from getting those important points across. Although Heaven knows we BPs normally have a group session going on in our heads all the time.

I think it is extra important to stress the statement of how meds affect everyone differently.  Amitriptyline always gave me awful nightmares.. I mean really , really vivid ones.  I would be awoken by my husband telling  me I had been crying or pleading in my sleep. Ambien CR caused me to sleepwalk and go on  line to shop for bizarre things . Most of the others simply made me so hung over groggy in the morning I could barely get up. The antidepressants, and I am not exaggerating when I say I think I may have tried them all ( !! ) normally intensified my manic lows.  Lyrica which made me feel more "solid"  also makes me gain weight , a week on Lyrica and despite being able to exercise and sleep better means an extra 10 pounds.   I have great difficulty taking supplements, after a week or so I begin to struggle swallowing them and keeping them down. That may be long ago memories I don't really know. Iron which I have never been able to take orally was always administered by injection during my pregnancies.  I have a daughter who is currently on Lithium and it seems to work well for her.  But again there is that old weight gain problem.  As she and her family live with us I can watch her food cravings go over the top.  She will not eat "diet" sweetener foods, instead she  thinks she is cutting back by eating an entire bag of frozen brussel sprouts with lemon butter.  In her thinking it is a fat free veg so it should be limitless.... I point out the butter is a problem  and fat free does not mean calorie free.

Social stress , agggggh I am so there I would hang out in your corner of the gym because I would know you might understand !  One shrink called me a painfully shy extrovert.  So afraid  of other's , I throw myself in the middle of things hoping against hope this time I would relax and feel less pressure, that never works. Like jumping in the deep end of the pool and hoping no one realizes I dog paddle.  I have a collection of sure fire conversation starters and remind myself if all else fails get them to talk about themselves.  I am so much more comfortable in my own space. I avoid negativity when I can as it is catching.  And when around a grumpy person I love I try my hardest to think first about their own aches and pains allowing me breathe better . BPs are notorious for starving their own brain of oxygen by forgetting to regulate our breathing.   I watch simple sugars and caffeine . Self medicating is common with BPs, miss using alcohol,  OTC items like benedryl or nyquil . If I need to sleep now I a muscle relaxant like Flexaril. It will buy me 4-6 hours of decent , pleasant dream sleep.  I can count on one hand the number of journal entries in the last year that said I slept well. 

Regular day to day stress is an issue too , BPs spend most of their lives "Fixing" , things, people whatever.  Or deep manic moments "judging" , others yourself.  I avoid the "If Only" game it really feeds the voices in my head.

And let's touch on voices.... some days they are no more than your own very rapid thoughts, others they are distinctly different.  You need to learn to recognize them.  The darker more dangerous voices can be dealt with it you know them.  But the more joyful and light voices are a problem as well. If I am manic high I focus on cleaning or playing with the kids and avoid the mall and stores. I can and have spent several thousands of dollars in a day when swinging manic high.  

And on the topic of short term memory loss,  I have that as an issue more and more. my original reason for having the doctor put me in the hospital was I could not things and people.  I lost 3 years to the drugs, and gained a swiss cheese memory and involuntary muscle spasms including restless leg syndrome. Reading which has always been a passion for me became painfully difficult. And I have to force myself to try to finish a book without reading paragraphs over and over .  More side effects of the drugs that were supposed to make me feel "normal".

Since it is 3:40 I had best post this and try once more to sleep.  It is going to be a long  few days if I miss too much sleep. I have baskets to take up the  Host Hotel in the AM and it seems I have been roped into helping display all of the club Silent Auction baskets. keeping busy, just have to keep busy to avoid feeling stressed....

Bonita of Bwana

Great advice, Becca! Pretty much the same thing we try to encourage our patients to be aware of and work on in the community. People who maintain heathy habits are MUCH less likely to end up in a crisis situation and need hospitalization than those who rely soley on the meds or therapy. Heck, it's good advice on healthy living for anyone, bipolar or not!