I recently finished my book about living with Bipolar Disorder. It’s the third book I’ve written about it. The few people who have read it have all been very complimentary about it. I’m going to post on here a chapter a day, so if you want to check it out you can. Today’s post contains the Epileptic Log. It’s just a play on words for the Epilogue.
I hope you like it and you enjoy reading my account, which is not graphic but honest. If you would like a link to the book then please comment on this post and I’ll send you a link 👍
I recently finished my book about living with Bipolar Disorder. It’s the third book I’ve written about it. The few people who have read it have all been very complimentary about it. I’m going to post on here a chapter a day, so if you want to check it out you can. Today’s post contains chapter 13.
I hope you like it and you enjoy reading my account, which is not graphic but honest. If you would like a link to the book then please comment on this post and I’ll send you a link 👍
So, if you are reading this and you suffer from Bipolar Disorder you will be able to understand. Please don’t think I’m being condescending but if you don’t then you’ll have to take 5 minutes to get your head around it. However, I’m just going to write about what it is like for me, and this will be different for everyone but it’s still relatable.
I take three different medications each day. An antidepressant, an antipsychotic and a mood stabiliser. Fluoxetine (Prozac) is my antidepressant, Olazapine is my antipsychotic, these two work well together, and then I have Lithium to stabilise my mood. So the Chemistry behind this is that I take one to stop me dropping into the deep depression and one to stop me going to the highest echelons of mania and then one of them secures my mood In the spectrum of 4-7 or so of my mood. To explain what it is I mean, Bipolar has a scale. Imagine 0-10 with 0 being the deepest depression and 10 being the highest high. These extremes are uncomfortable, uncontrollable and impossible to find anyway to live productively with. The medication enables me to get mood-shifts that don’t dip below a 4 or go higher than a 7. Don’t get me wrong, the mood shifts are still different than the norm and they have an impact on the way that you can live. However though, the mood shifts are really difficult to manage.
I have questions. A multitude of questions in fact. I have had a period of self harm (be aware that there’s a picture of my scars below this paragraph). I’m a Catholic, I told my Health Professionals that I understood from a community for Mental Health called the Mighty, that self harm could be attributed to the fact that the Devil gets into you via your weakest side. I’m right handed, yet I cut my right forearm with my left hand. Please let me know what you think?
I don’t have any routine. I get some semblance of one for about a week or less then I’m back to square one again. Firstly, sleep. I have a great deal of trouble getting off to sleep. I take Olazapine at night so you would think it would help. Also I’m coming off Lorazepam slowly as I’ve got a dependence but I’m thinking that it isn’t working as normal due to me being on it for three years on and off. I have stages though. Thursday just gone for example I felt really tired all day. I was up at 7am and went to the shop to get my parents their newspapers and bits they needed from the supermarket. I got back and went back to bed to watch TV, and I woke up at 7am this morning. That’s nearly 48 hours or so of sleep. I’m going to be honest, I felt horrendous when I woke up today.
The above picture may seem lighthearted to some but it’s not at all. I’m well aware that you have to adapt your demeanour to suit certain situations and then interacting with people. But also, you are managing the different personalities of yourself that you have when you’re in your own company.
Sometimes I find myself having a full blown conversation with myself that is one version of myself talking to another version of myself. “Please don’t do that again, I have to sort it out!?!”. It’d be nice to have an understanding about the situation from people that being in a situation where you have a conversation with yourself isn’t the crazy person’s action or something like that that is classed as weird, but it’s just something that makes me who I am.
Furthermore, I have multiple conversations with myself in my own head that happen every time I’m in the company of others but I don’t share these. I’m just hoping that you realise how it is the same as you do, it’s my imagination that’s just a little bit more prominent in my head than yours.
I’ve had people brand me as a nutter, weird, fucked in the head, not right etc etc and the best one – “it’s because of the Cocaine”
I’m the first to admit I absolutely love Cocaine. I have used it chronically from about the age of 20 until I my late 30s. I never had a feeling of being myself or completely comfortable from anything else. I have social anxiety too, I didn’t know this at Uni but when I was there I needed a pint of beer to relax. One to two to three to four then that wasn’t working for me. However, university is awash with anything you want. I tried Weed, Speed, Ecstasy and Cocaine. Cocaine worked for me. I worked out in my own experiment what it’s critical point was (the amount that it’s the most potent before becoming abused). It levels me out. Look it up, it’s an SNDRI, type that into Google and see on Wikipedia the chemistry of what it does.
Regards my medication. I have to take them every day. Does this make me an addict?
You fall and break your arm and the doctor puts it in a cast to make it as close to what it was as you can do. I go to the doctor and I’m given pills that make me into someone who looks like me, but in reality, it’s not me.
Dr. Vohra (my psychiatrist), I think now we have hit the bullseye with regards to the meds. However, I’d like to give you some feedback and input about it from someone who has lived it. Firstly, it’s going to be an opinion with a heavily biased psychopharmacological perspective. I was prescribed Mirtazapine at the start of my treatment. It worked wonders. I’m not sure how it’s classified now as a NaSSa or a an atypical antidepressant. I know though that it works on Serotonin and Dopamine. I was prescribed Sertaline after a while, maybe because my doctor thought it had become ineffective. The sertraline is an SSRI and with my history of substance abuse, I can only compare it to ecstasy or MDMA. I experienced tingling and sensations in my jaw which caused it to shake. After a couple of weeks this subsided, but it’s from then it made me feel awful. I was prescribed Tramadol at the time for sciatica and I subsequently had three epileptic like seizures. I professed to the health professionals that cared for me that I was on the two drugs and I was maybe experiencing serotonin Syndrome. This fell on deaf ears. I have since come off both medications and had no repeat incidents of fits.
As a result of this, I was awaiting my appointment with the psychiatrist and my GP prescribed me Depakote. It’s an anticonvulsant as you know and it’s strength of dose targets the ailment. It’s around 500mg for migraines, 1000mg for epilepsy and 1,500-2,000mg for bipolar disorder. It’s also used for schizophrenia too. So you can surmise it is a potent drug. I attended my second appointment with my psychiatrist after commencing Depakote therapy and I wasn’t able to speak to the psychiatrist. I wasn’t able to even grunt or shrug my shoulders. Medicated to the point of anonymity.
With a mood stabiliser like Depakote and an antidepressant like Mirtazapine, it causes a monumental shift in mood for Bipolar sufferers that are exaggerated to the extreme boundaries ever experienced. You are calm one minute then you’re orbiting the moon the next. You are more spaced out than Neil Armstrong ever was. I don’t fully understand how it works, but you have a drug to stop you going too high, another drug to stop you going too low, then a further medication to hold everything in place. Some drugs work in tandem with others to achieve this.
For example, I was on Depakote as a mood stabiliser. I was also on Quetiapine as an antipsychotic. These two however have the potential to be detrimental to each other and effect how proficient each one is in treating your problems. I know it’s not up to me to pick and choose what I take but if I’m taking something then I want it to be the best possible medication I can have.
I now take Lithium (600mg), Olazapine (20mg) and Fluoxetine (20mg). Olazapine and Fluoxetine work well together. Olanzapine is an atypical antipsychotic, just like Quetiapine I was on previously. The dosage for Quetiapine ranges from 200-800mg, at the end of my relationship with Quetiapine I was on 750mg a day. The pharmacist at my local chemists pulled me to one side as I went to pick this up to double check it was right. They’d never administered a dosage like it before.
So I’m taking an SSRI, so it stops my serotonin being recycled and keeps it in the part of my brain to be effective. I’m not sure of why this is but I’m taking atypical antipsychotic which effects my serotonin and with Olazapine it blocks my dopamine too. I don’t think Quetiapine does this. Dopamine is the pleasure monoamine that causes reward pathways. Cocaine for example hits every major monoamine in the brain and stops their re uptake to cause an overload of brain chemistry. Crazy isn’t it?!?!
I feel disinterested in some activities that arise and my participation in my hobbies is wavering to say the least.
The one thing I can categorically say is that medication for mental illnesses might control the severity of the extremes a person goes through but it also stifles any expression a person has and you are bereft of any enthusiasm to be the person you are.
Perhaps the most difficult differential diagnosis to make is between Bipolar Disorder (BD) and Attention Deficit Hyperactivity Disorder (ADHD). Research shows patients treated for both ADHD and BD have thus far been positive. The majority have been able to return to work. Perhaps more importantly, they report that they feel more “normal” in their moods and in their ability to fulfill their roles as spouses, parents, and employees. It is impossible to determine whether these significantly improved outcomes are due to enhanced mood stability, or whether treatment of ADHD makes for better medication compliance. The key lies in the recognition that both diagnoses are present and that the disorders will respond to independent, but coordinated, treatment, since they share many symptoms, including:
• Mood instability
• Bursts of energy
• Restlessness
• Talkativeness
• Impatience
It’s estimated that as many as 20 percent of those diagnosed with ADHD also suffer from a mood disorder on the bipolar spectrum — and correct diagnosis is critical in treating BD & ADHD together.
ADHD or ADD
ADHD or ADD is characterised by significantly higher levels of inattention, distractibility, impulsivity, and/or physical restlessness than would be expected in a person of similar age and development. For a diagnosis of ADHD, such symptoms must be consistently present and impairing. ADHD is about 10 times more common than BD in the general population.
Bipolar Disorder (BD)
By diagnostic definition, mood disorders are “disorders of the level or intensity of mood in which the mood has taken on a life of its own, separate from the events of a person’s life and outside of [his] conscious will and control.” In people with BD, intense feelings of happiness or sadness, high energy (called “mania”), or low energy (called “depression”) shift for no apparent reason over a period of days to weeks, and may persist for weeks or months. Commonly, there are periods of months to years during which the individual experiences no impairment.
Making a Diagnosis
Because of the many shared characteristics, there is a substantial risk of either a misdiagnosis or a missed diagnosis. Nonetheless, when determining if it is Bipolar Disorder or ADHD, use these six factors as a guide:
1. Age of onset: ADHD is a lifelong condition, with symptoms apparent (although not necessarily impairing) by age twelve.
2. Consistency of impairment: ADHD is chronic and always present. BD comes in episodes that alternate with more or less normal mood levels.
3. Mood triggers: People with ADHD are passionate, and have strong emotional reactions to events, or triggers, in their lives. Happy events result in intensely happy, excited moods. Unhappy events — especially the experience of being rejected, criticised, or teased — elicit intensely sad feelings. With BM, mood shifts come and go without any connection to life events.
4. Rapidity of mood shift: Because ADHD mood shifts are almost always triggered by life events, the shifts feel instantaneous. They are normal moods in every way, except in their intensity. They’re often called “crashes” or “snaps,” because of the sudden onset. By contrast, the untriggered mood shifts of BD take hours or days to move from one state to another.
5. Duration of moods: Although responses to severe losses and rejections may last weeks, ADHD mood shifts are usually measured in hours. The mood shifts of BD, by DSM-V definition, must be sustained for at least two weeks. For instance, to present “rapid-cycling” bipolar disorder, a person needs to experience only four shifts of mood, from high to low or low to high, in a 12-month period. Many people with ADHD experience that many mood shifts in a single day.
6. Family history: Both disorders run in families, but individuals with ADHD almost always have a family tree with multiple cases of ADHD. Those with BD are likely to have fewer genetic connections.
Treatment of Combined ADHD and BD
Few articles have been published about the treatment of people who have ADHD and BD. One clinician reported, having seen more than 100 patients with both disorders, shows that coexisting ADHD and BD can be treated very well. It’s important to always diagnose and treat the BD first, as ADHD treatment may precipitate mania or otherwise worsen BD.
Outcomes for patients treated for both ADHD and BD have thus far been good. The majority have been able to return to work. Perhaps more importantly, they report that they feel more “normal” in their moods and in their ability to fulfill their roles as spouses, parents, and employees. It is impossible to determine whether these significantly improved outcomes are due to enhanced mood stability, or whether treatment of ADHD makes for better medication compliance. The key lies in the recognition that both diagnoses are present and that the disorders will respond to independent, but coordinated, treatment.
I should smile more
As for me
Personally I believe that I have a correct diagnosis of Bipolar Disorder. Due to the self harm, periods of no sleep or little sleep and the cycle of heightened mood to lowered mood. Furthermore the improvement of this condition through various medications has been a challenge. A Successful one though.
I am though aware that certain behaviour I display can be explained by an ADHD diagnosis. So I’m open to being diagnosed with bipolar and ADHD and I am open to receive any advancement proposed.
This is my understanding of what it is anyway: I have a restlessness and inability to sit still in some situations. If I’m not captivated by a movie or a tv show within the first 5 minutes, I will very seldom see it through.
When I’m given a task or choose to do something like research antipsychotic mode of action, I will plan meticulously and structure the learning process to be step by step and flow from part 1 to part 2 to part 3 etc etc. if I don’t understand something then I form a question for myself to ask to either a doctor, Julia (so can escalate if needed) or mostly I ask my local pharmacist. The questions are about simple occurrences of process that I have not fully understood.
This now means that I can continue with my research. This leads me on to another point where I am researching topics that I have an interest in. For example if I was asked to learn something about the pH levels the stomach has at certain points during digestion, I will tell you now that my application, aptitude and effort towards writing something up about it would be minimal thusly reflecting my understanding too. You only get out of something what you put in to it.
So with this in mind, I can’t willy nilly pick any old topic and research on it, nor can I choose a pretty, picturesque view and be excited about drawing a picture of it.
I’m an individual who has a passion for the things I hold close. Have an interest in. This covers all my life with parents, friends, music, films and tv, clothing and food and drinks. All the way across my spectrum of interest is my aptitude and application dedicated to what I love.
I can show less attention when I’m involved in a situation that doesn’t interest me. I’m sure if we watched a classic ‘Chick Flick’ movie with a lady friend, she’s all puffy eyed and engrossed with the storyline whereas I’m off thinking about what would happen if I gave a Shark some of my Lithium?
Lorazepam isn’t going to be given to me on repeat prescription and I know that. I’m just going to say though that the 500mcg in the morning stop the pre-day jitters and then at night, along with the Olazapine I’m able to get off to sleep and at the moment I’m get 8 hours.
I came off Mirtazapine and I was on 15mg tablets with have the most beneficial effects on sleep. They bind to certain receptors and then you sleep in a state that isn’t as deep as REM sleep in which they provide beneficial effects for your anxiety and depression as well as making it easier to fall asleep and then wake up, also you don’t experience the ‘hangover’ you have with Valium or Zopiclone et al.
I’m obviously going to wait until I speak with the specialist for the next step in the process for my medication and diagnosis. I believe that I am Bipolar with a comorbidity of social anxiety and ADHD. I believe that the ADHD behaviour is emphasised when I am manic and nullified with the depression. So to speak it’s a character of behaviour born out of my Bipolar.
As I write this I’ve no idea what the outcome will be for me or if my thoughts are being constructive enough for consideration.
Thanks to my learned knowledge about the Chemistry of Medicine I am able to formulate an hypothesis, propose a viable outcome then perform the experiment and then interpret the data to see if it concurs with the hypothesis or if it has any correlation between what I thought and what happened.
I’m possibly miles off with my understanding but if I am, I still have the fantastic opportunity to learn more. Learn why I went wrong and bridge the gaps of my understanding so that I can become the best person to have an understanding of myself.
That’s my goal! To be an expert in ME! My bipolar is only a part of me as without it, I wouldn’t be who I am today.
I’m a expert in Living with Bipolar Disorder already because I do it everyday. Now I just need to find a way to explain it to people!
My Bipolar Perspectives of a Unipolar World 