IS YOUR BIPOLAR DEPRESSION AND/OR PANIC/OCD TREATED?
This is long, but that's only because I've learned a lot about this topic. Symptoms of these disorders can seem very mysterious.
First, my story:
I have always been pretty depressive. ADHD also, treated since the early 1980s (Dad is a psychiatrist). Obsessed about my flaws, mistakes, and the misfortunes or consequences that I just knew were always lurking right around the corner. I always got nearly perfect grades. Part of the way I stayed sane was by playing every sport I could learn to play, and by knowing that I was a sharp guy.
Junior high was (what else?) hell.
During my freshman year of high school, my two best friends moved away, and my grandfather--to whom I was very close--died. Senior year, I learned that I had a sun-sensitive depression called Seasonal Affective Depression Syndrome (SADS). Very easily treated by sitting in front of an extremely bright full-spectrum lamp for about 45 minutes daily. I will discuss that later.
Stuff happened. My new best friend (whom I had actually known since grade 2) died a horrible death at the hands of Muscular Dystrophy. His eulogy was given by a Christian fundamentalist, who told us all that it's not quite good enough to be a good person; you'll still go to hell unless blah blah blah. This wonderful person--with whom I never once discussed religion--was sent off with nary a single word spoken to his credit, and he deserved a lot.
Went to college. First Xmas break, parents got divorced. Grades suffered briefly; graduated. Degree in Mathematics. No idea what to do with it.
Got married to the most wonderful, amazing woman ever minted. Almost learned that marriage means a lot more than I thought. Struggled for 4 years to figure out why I was sometimes a gentle, caring, romantic husband, and other times a totally unreasonable (albeit nonviolent), selfish, self-centered asshole who didn't listen, constantly felt judged, couldn't apologize, and looked for things to resent about everyone. The transition between the two states was totally unpredictable, imperceptible to me, and very quick. It made my poor wife miserable.
I love her more than my life, and yet I could not control this problem. Over time I learned to prevent myself from saying mean things and speaking loudly, but those were just symptoms. I was terrified of hurting her, which made me terribly anxious. I felt horrible when I did, which made me hate myself. Since I knew myself to be well-meaning, guilt about anything I might have done "wrong," or "bad" made me feel defiant ["I can't always be wrong, because I am not bad."] , which flipped the switch quite often. Wash, rinse, then repeat.
Went back to school. Made a good friend, with whom I lifted weights and discussed "life." One day, after an extremely rotten evening brought about by what I've described, my friend and I had just finished doing a heavy leg routine. Nothing happened. No pain, no popping noise, no sudden discomfort. Nothing. In fact, I broke my personal record. Then we went our separate ways for the day.
Dave, who would earn his PhD a few months later, and take a job 1,000 miles away, sat at his desk. I sat at mine. At the end of the day, he felt fine. When I got up, my knees no longer worked. In a matter of hours, they went from capable of bearing 400-pound barbells without complaint to incapable of bearing my bodyweight without pain. Both knees went bad simultaneously, and in exactly the same way ... right after nothing happened. Ever hear of a sports injury like that? Me neither.
Nearly 3 years later, they were still not right. They felt hot to the touch, and creaked like rusty hinges. I could feel a grinding sensation. Horrible pain. I had to use orthotics, and could hardly walk even then, despite that I was taking the same anti-inflammatory drug that is prescribed for sufferers of severe arthritis. Some days, it was excruciating to do nothing but just sit stationary.
All signs seemed to point to arthritis due to knee injury. It made sense; I played basketball constantly, ran, and lifted heavy weights with my legs on a regular basis. The only problem with that diagnosis, strangely enough, was that MRIs and CT scans of both knees were 100% normal. No torn cartilage, no bone spurs, no problems with ligaments ... nothing. Just horrible, inexplicable pain all the time. I saw an orthopedist and two sports medicine doctors, both affiliated with the Johns Hopkins School of Medicine (i.e. they were good.) I tried everything: braces, ice wraps, compresses, body awareness techniques, physical therapy, zero-impact exercise, chondroitin (which made my problem worse), acupuncture, and even injections of fluid directly into my knee joints (avoid this experience if at all possible) to reduce friction. The injections helped some, but the problem persisted, despite no apparent ailment.
That was just before I got into graduate school (Chemical Physics). Ten days before classes started, my wife hit her head at work. She sustained a serious concussion, and was bed-bound for a full year, dizzy all the time, with headaches, nausea, neck pain ... the works. Theoretically (and thankfully), she would recover fully. Meanwhile, I had zero time, piles of impossible homework, equally difficult exams to study for, and classes to teach ... and my knees were still defunct. I was impossible to live with.
I started failing tests over material I understood. I found it impossible to study. Homework took forever. I failed whole classes. I miserably failed the graduate qualifying exam. All this despite that, at least according to IQ tests, I am quite well equipped. I am still a graduate student today only because the school broke the rules for me, and, in perhaps the most miraculous event of my life, the National Institutes of Health called me up to offer me a fellowship to pay for the education I had just lost all funding for.
I started getting pain and numbness in my wrists and forearms. My teeth would grind at night. My neck was an amazing mess of knots, and the muscles were in a constant state of spasm. The muscles in my neck and shoulders actually became shorter. My jaw popped painfully when I chewed. I was a total asshole to my wife. Everything I did at school turned to garbage. I was worthless around the house. Didn't want to do anything or see anyone. I hated myself.
And then one day, my therapist said the following: "Have you ever considered that you might have a mood disorder? Have you ever tried Depakote?"
Depakote is a drug used to treat Bipolar Depression. Turns out I have Type II. For this I was prescribed a newer drug called Lamictal; also a drug called Wellbutrin, which is an antidepressant. Within the span of a month, the knee pain I experienced while sedentary vanished entirely. If I was careful, walking and climbing stairs was painless. All numbness and wrist pain vanished. Still couldn't run or jump, but I wasn't complaining.
Still had horrible problems with anxiety. My anxiety used to be so extreme that my mind's coping mechanism was to just kind of zone out. I would stare blankly at the wall, or people's faces, or anything else, but maybe not really see it. It felt like my body was more of a suit that I wore. I was constantly missing things people would say to me. I was even more forgetful, and lost things even more often than an ADHD is expected to. I was "in my body" when I was having sex, and pretty much never, otherwise. People I didn't know would tell my wife about how I didn't "seem present." Almost every time there was a theoretical potential (or if it felt like there might be, or if I decided to interpret words in an uncharitable way) that I might have to admit guilt, I would just check out ...because I'm worth nothing to the world unless I'm always at my absolute best ... and "NO! I'm not a guilt-feeling, bad person. I try really hard, so I deserve some credit! I will get there if I try harder. I am the only one who understands me, so I can't count on anyone, including my own wife."
Cumulative collateral damage from 4 years of my BP cycling ultimately brought our marriage to the very brink of disintegration. As I write this, my wife lives in our house, and I am in an apartment, figuring out who the hell I am.
A couple of weeks ago I started taking a medication called Klonopin for panic disorder. Now I can wake up in the morning and want to do things, and I almost always wake up in the mood I was in when I fell asleep. That used to be impossible. I can plan to do things, and then actually do them. I can listen. Apologize. I have not felt pain in my knees since. Yesterday I played basketball. Basketball.
And do you know what makes my situation different from all the rah-rah stories you see on TV? I was a generally pessimistic doom-sayer all along. The whole time, I did nothing but bitch. If my head hadn't been up my butt so long, I could have avoided three long years of misery, plus I'd be 2/3 of the way toward my PhD.
Bipolar Depression and Panic disorders like General Panic Disorder and Obsessive-Compulsive Disorder are not the kind of things you can just "fix" by pure force of will. If such were not the case, I would not be writing this. I only just recently kicked anxiety, and it was because I sought treatment. Never felt better.
Know what else? Bipolar depression is so strongly correlated to suicidal tendencies that I have been refused life insurance because of it. Leaving a condition like that untreated isn't just a way to feel miserable; it's also a good way to stop breathing. In the lyrics of a song he recorded in 1993, entitled Frances Farmer Will Have Her Revenge On Seattle, Curt Cobain wrote, "I miss the comfort of being sad." Not too long after that, he turned a shotgun on himself. Recall that Cobain also wrote a song entitled Lithium. Lithium salts are used in treating Type I Bipolar Depression.
We interpret stimuli by filtering them through our senses; first we sense, then some part of the brain tells us what to do. Burn your hand on the stove, and a part of your brain just above the brain stem is what makes you to pull your hand back. No pain receptors in your hand? Your hand burns until you smell it. Despite what pop culture would have us believe, emotion is a sense--the social sense. Sad, happy, pissed, languid, etc., are all just different aspects of that sense, which we use to interpret the world, and hence, to determine how to react accordingly. Throw a kink in any one of the senses, and suddenly things work much differently. Ask anyone who has gone blind. Our society discourages the expression of certain emotions. Ever wonder why we like to shoot each other so much?
If your computer's CDROM drive breaks, you get a new CDROM drive. If the CPU goes, time for a new computer. Understand the analogy? The brain controls everything in the body, and only one kind of physician knows anything about it that doesn't involve knives. A neurologist will hook you up to machine, and tell you all about your brain waves and all about your nerves, because that's what neurology is about. When it comes to the health of the actual gray matter that controls those nerves, neurology will not give you answers.
If you've not been to a psychiatrist, I think it's likely you have a very unrealistic impression of what you'd be confronted with. Here's what happens when I go see mine:
"Hi, Morgan."
Hi
"How are you feeling?"
I've got this tightness in my upper chest, and I have a hard time breathing sometimes. Also, I get numbness in my hands and arms up to the elbow, and have trouble sleeping.
"Do you hear voices?"
No.
"Feel like hurting anyone?"
No.
"Hurting yourself?"
No.
.
.
etc.
.
.
"I think you might have a panic disorder (closely related to OCD), and so I'm going to write you a prescription for 2mg klonopin daily."
Not much different from the foot doctor, when you think about it, and just like all physicians, psychiatrists are bound to strict confidentiality. You'll be asked if you see things or hear voices. You might get asked about how you've felt over the past week. You'll be asked questions about events in your life up to the present. The "Tell me about your mother..." stuff is media-contrived garbage, though. Furthermore, a psychiatrist is less likely to make you feel uncomfortable. Psychiatrists spend all day listening to people's bad experiences. It's hard to be good at that without a tendency to be earnestly compassionate and empathetic. Find a bad egg? Who's writing the checks? Fire 'em.
Think psychiatrists are just for crazy people? Think again. If my experience looks familiar, too, think again really hard, because you will not get better without proper treatment. Which sounds worse: exploring an uncomfortable possibility, or being constantly miserable for the rest of your life? How about a shorter life? Think hard.
IF YOU EXPERIENCE CHRONIC PAIN WITH NO APPARENT CAUSE
Did you know that chronic pain and the inflammatory response can be nothing more than symptoms of severe depression and panic/anxiety? Treating the panic wiped out 95% of my social anxiety, and now my knees work right again.
I am nominally in the know on this topic. Here is what I understand:
Stress, anxiety, and panic are linked to increased inflammatory response (which for me acted just like really severe arthritis), shorter lifespan, hypertension, clogged arteries, heart disease, decreased immune response, insulin resistance and Type II Diabetes, several forms of cancer, weight gain, depression, broken marriages, suicide, homicide, and most definitely insomnia. I think histamine response is in there somewhere, too.
The connection has its root in interactions between omega-3, -6, and -9 fatty acids, various derivatives thereof, and an elaborate mix of hormones and cytokines that do so many different things in so many different parts of the body, it is absolutely breathtaking. The material is not fresh in my mind, but I do recall that among the important agents are cortisol (aka “the stress hormone”), leptin (which, among many, many other things, advises the hypothalamus on the subject of whether your body needs more or less fat and/or sugar, and regarding what should be done with the same), norepinephrine (aka “noradrenaline”), somatotropin (aka “human growth hormone”), adiponectin (one notable among an endless list of cytokines), interleuken-1 (aka “the devil incarnate”), IGF-1(aka “IGF-1”), melanin, and I think dopamine (a neurotransmitter you've most likely heard if you have ADHD).
This phenomenology is the subject of a lot current research. I can't see the big picture, but nobody else can, either. I studied it (OK, mainly read about it--I was depressed ) for a time at the Kidney Institute in the National Institutes of Health, and I've had numerous conversations with my dad, the shrink, about the role it plays in psychological/psychosomatic symptomology. Therefore, I'll take the liberty of claiming I know at least something. Bear with me, because I'm coming to the point.
Do you drink much milk? Milk protein can turn the aforementioned biochemical skirmish into a fully-blown war. If you've tried everything else, and you believe I'm not writing this to amuse myself, then you might consider the conducting following experiment:
(1) Swear off of dairy in favor of soy, and then (2) go get yourself a ton of essential fatty acid supplements, (3) antioxidant tablets (esterified vitamin C, vitamin A, and, if you can afford it, CoEnzyme-Q), and (4) metabolite metal supplements (Calcium, Magnesium, Zinc).
As it turns out, recommendations based upon national averages apply to average situations. If these symptoms were average, they wouldn't be called symptoms, though, would they? Take about twice the the dosage recommended. Never, ever do this with B-vitamins, though, or you will likely reach a state of enlightenment that has nothing to do with nirvana.
The Omega-3,6, and 9 fatty acids are the most important part. FISH OILS are absolutely essential! Make sure you're getting at least 800 mg of eicosapentaenoic acid and docosahexaenoic acid daily (these are found in said oils). You'll be doing yourself a favor, too, if you eat a fair amount of tuna and salmon. Wolf down that sushi. Get yourself some folic acid and some gamma-linoleic acid, and take no less than 1000 iu of vitamin E daily. If you can find supplements with extended release, that's ideal. Your GI tract will throw away a lot less useful stuff that way.
If you're wondering whether I'm a bullshit artist--well ... goodfats.pamrotella.com/
I'm not.
IF YOU HAVE CHILDREN
It's entirely possible that you gamble with more heads than just your own when you do not treat Bipolar Depression. BP can't but cause friction, disagreement, and irrational bouts of rage in a marriage (see above), which could only get worse with the added stress of children. One of the best ways for children to develop low self-esteem and deep-seeded, misplaced rage is to see regular displays of contempt and frequent disagreement between their parents--especially in their expression of love toward one another, and as disciplinarians. Further, according to both the books, and my experience BP disorder is characterized by periods of variation in mood, attention, and outlook. If mom or dad is all over the map during a child's formative years, sometimes kids can develop a tendency toward varying levels of antisocial behavior. It's called Reactive Attachment Disorder (RAD), and there are books about it. I'm told that Judith Viorst wrote a good one called Necessary Losses.
My brother and I had good parents, and so you'll hear no gory details from me. However, my brother became so impossible that the only effective way of preventing his self-destruction wound up being military school. These are the reasons I see a therapist every single week. I'm not a parent, so I hope I'm not sounding like a preachy, know-it-all dilettante. RAD fucked me up. No idea what your life at home is like, but I hear a lot of talk about these subjects, so I thought I'd just toss you a bit of FYI.
SUNLIGHT SENSITIVITY (AKA SEASONAL AFFECTIVE DISORDER)
Forgot to mention something extremely important: Particularly for folks who live in upper latitudes, who are therefore subject to more dominantly long-wavelength light for more of the year (gets worse the further you get from the equator). Sun sensitivity, is ridiculously easy to treat. You don't pop a single pill, you will notice the difference the very same day, and it will absolutely floor you how much of your mind seems to just exist all of a sudden.
All you need is a sun replacement lamp ( www.sunbox.com ). If you can't afford one (they are pricey), I might be able to make do with a cluster of a few of those blue full-spectrum light bulbs. Get up at exactly the same time every morning (6AM or earlier strongly recommended), no matter what; go for a walk and have a look around, and make a point of noticing things while you're at it. Then go sit in front of your light. I have this huge fluorescent thing that puts out a rather impressive amount of light, so for me it takes maybe 20-30 minutes each morning to get my head right. If you're just using bulbs, you may need to go a bit longer. The bummer with incandescent bulbs is that they're hot up close, but that's how it goes.
Sit CLOSE to the light, and let it hit you square in the face. I usually read a book or write while doing it, but even then I make absolutely certain that the light hits me in the face. In winter months, you'll find that you can look directly at the light from a very short distance without the least bit of discomfort. When I lived in the dorms during undergrad, people would walk past my room, and see me sitting comfortably right in front of a lamp that blinded them from across the room. It works very, very well, if you're interested, and it's just as important as the meds. Additionally, I find the 5:00 hour to be my favorite of the entire day. I am smarter, and get more done, and I am also in a happier mood. Sounds goofy, but there are a lot of biochemical pathways that rely on sunlight at specific wavelengths (synthesis of Vitamin D, use of the neurotransmitter melotonin, CoEnzyme Q, and some others), and it makes a much bigger difference than I ever would have imagined.
Humans evolved close to the equator, where sunlight is dominated by middle wavelengths year-round, and we have had a stable karyotype (genetic "format"
for 100,000 years. If you really understand Darwin's ideas, you know that that means we stopped evolving 1,000 centuries ago. At the equator, the sun comes up at 6 all year. Stands to reason that people who live there with no fridge, no Bisquick, and no alarm clock would learn to wake at sunrise, and then go find some yummies. That involves paying close attention to something (finding the berries, sneaking up on the giant sloth, etc.), which is akin to the morning walk. As people migrated north/south, their sunlight changed, but they did not (since they were not evolving). So their bodies wanted the sunlight they were used to at the equator, and they were getting something else. Pretty much everyone feels better with full-spectrum bulbs in all the indoor lamps, so perhaps it's a simple question of degrees of light-sensitivity. At a certain level, it's called Seasonal Affective Depression Syndrome (SADS).
Guess what SADS correlates very strongly with: BPII/anxiety.
YOU'LL GET BETTER HELP IF YOU EDUCATE YOURSELF
Re: How to find a psychiatrist who doesn't suck
panicdisorder.about.com/b/a/116908.htm
Re: Anxiety Disorders (General, OCD, Panic)
www.webmd.com/content/article/60/67106.htm
www.webmd.com/content/article/60/67150.htm
Re: Bipolar Depression
www.moodswing.org/treatments.htm#epa
http://en.wikipedia.org/wiki/Bipolar_depression
Well, that's it. Hope I've said something useful. It took forever to do so.
Best,
Morgan
Adding your comment:
How truly warm and fuzzy! 
I am proud of you! 
