Wednesday, April 7, 2010

Newly Diagnosed with Bipolar or Depression? Protocol for Best Treatment

Prepared for my workshop:

by Ruth Z Deming, MGPGP
Former Bipolar Patient
Conquering Bipolar Disorder and Depression
Doylestown Hospital Health and Wellness Center
Easton Road
Warrington, PA
May 1, 2010

Take heart! In this, the twenty-first century, treatment options for people with bipolar disorder couldn’t be better. The powerful combination of medication and psychotherapy will get you off to a good start. Lifestyle changes will also be of tremendous help, as will joining a support group for much-needed emotional support. Sure, the illness is challenging but millions of people have figured out how to live successful and productive lives and so can you. Begin, from this day forward, to think positively. Make “yes, I can” your motto.

First, a word of caution from the authors of the 2010 book Facing Bipolar: The Young Adult’s Guide to Dealing with Bipolar Disorder. They write, “We can almost guarantee that without [a good treatment] foundation in place… your treatment will be on shaky ground and future relapses will become more likely.”

Unlike heart disease or diabetes, it’s hard to find the proper protocol for good treatment once you’re diagnosed with a mood disorder (depression or bipolar disorder). That’s why I’ve written this handout. Treatment for mood disorders leaves much to be desired. A correct diagnosis may take up to 9 years. That's because (1) psychiatrists do not ask the right questions in the initial psychiatric evaluation or (2) because the individual has begun their bipolar life with depression. The mania has yet to emerge.

Patients go on and off their medication because they are frustrated or don’t understand the concept of “staying on their meds.”

Sadly, meds often "poop out" or stop working, so it's back to the drawing board to find meds that work.

Nonetheless, when you find yourself a good psychiatrist and good therapist, chances are excellent you’ll get your life back and will go on to fulfill your dreams. Our support group New Directions is testimony to that.

PART I: Diagnosis and Terminology

First, what is your diagnosis? A surprising number of bipolar patients do not know what category of bipolar their illness falls under. I was diagnosed with Bipolar One, the kind with true mania and psychosis (delusional behavior, out of reality). Bipolar Two is comprised of hypomanias (intense energy, lack of judgment, ability to do lots of work). Both One and Two are usually followed by depressions, which may be quite severe, or suicidal depressions.

Here is a more thorough description of the symptoms. You may have some or all of them.

- TRUE MANIA AND PSYCHOSIS -- “hyper” or too much energy: out of control behavior, delusional (“I believe I’m Jesus”), paranoid (“people are following me”), lack of sleep, rapid stream of talking, thinking, total disorganization, anger, hypersexuality. Almost always requires hospitalization.

- HYPOMANIA – “hyper” but able to control yourself with effort –- a heightened sense of being that includes too much energy, lack of sleep, ability to be very productive. Doesn’t require hospitalization but our behavior is extremely annoying, if not downright intolerable, to loved ones. Symptoms—and do note the word ‘symptom’ because this is not normal behavior – symptoms can be moderated with a great deal of effort until they subside completely, either on their own or preferably through additional medication.

The hypomanic individual must slow herself down, particularly their rapid-fire speech. This can be done! Take deep breaths. Force yourself to stop and sit still. ALLOW a support person to remind you to relax and breathe. Discharge excessive energy through fast walking, moving furniture, digging in garden.

- DEPRESSION -- lack of energy, negative thinking, sleep and appetite disturbances (too much or too little). Depression is an inadequate word that can scarcely convey the anguish a person is going through. The swell of negative thoughts produces beliefs such as “I’m a loser, I’m a failure, nothing I do is right.” In severe cases a person wishes they were dead, thinks about suicide, or plans to kill themselves.

Depression can arrive by itself or can follow a “high.” Rule of thumb: the higher we go, the worse the fall.

A MIXED MANIA includes features of both mania and depression.

PART II: Getting the help you need

Okay, your illness is upon you. You can no longer ignore it. You are going to get help. What do you do?

1 Make an appointment with a psychiatrist. Go to someone highly recommended. Support group members offer good referrals. Your new psychiatrist will most likely put you on medication to “stabilize your moods.” Keep a journal and write down all the meds you’re on and what effects they have on you. Expect “trial and error” to find out what works for you. It may take awhile, or not, but with perseverance your doctor will find the right meds for you that make you feel “like yourself.” Your active participation is necessary. You and your doctor are partners.

2 Get psychotherapy or talk therapy. Find someone who is attentive and caring and interested in you. Work on goals at each session: accept your diagnosis without shame, work through feelings of shock or loss after being diagnosed with bipolar disorder. Life goals such as better job, go back to school, get along better with mother or daughter.

Remember this: Your manic episode or your depression is a traumatic event. You have been severely traumatized, your brain injured much like being in a car accident. It takes time to heal. Talking is a way of healing the brain. Chemical changes take place in your brain cells the same as if you’re taking medicine. Never forget this!

3 Continue on with your dreams and let nothing stop you, though you may wish to change course. A respected doctor recently said to a young friend of mine after her severe psychosis, “You will never be able to work with children again.” This is so wrong, so ill-advised and disheartening. My friend was crushed. Of course she’ll be able to work with kids again. Another friend of mine had her psychosis after she taught a year of kindgergarten. Her own psychiatrist called her every day during her depression to get her out of bed so she could go back to school to work with her kids!

4 Practice a healthy lifestyle. This begins by making yourself a strict schedule. The bipolar brain is exquisitely sensitive to the rhythms of daily life and must be kept busy at all times. When busy during the day, you will find plenty of time to relax at night. But you must keep busy during “business hours” as this is how all brains are wired. If you get “down” on weekends, schedule at least one external event where you get out of the house. Don’t let your home become your worst enemy. If it is, find ways to leave home.

Healthy lifestyle suggestions include aerobic exercise to raise brain endorphins, healthy eating with plenty of whole grains, fresh fruits and veggies, fish and chicken, lessened intake of meat. Use supplements of omega fatty acids.

Your most important lifestyle change is having the courage to Say No to being around people who are not nice to you, who put you down, who make you feel bad about yourself, or who, just plain, don't pay attention to you. Surround yourself with loving individuals who see you for the unique, lovable soul that you are.

I, personally, have kept away from family members, left my husband, left friendships behind when I felt my inner soul was not being nourished, but, in fact, was being damaged. It may take weeks or months or even years to get over traumatic relationships but the sense of freedom and relief is tremendous when you've succeeded in breaking the bonds of unhealthy relationships.

PART III: Coping with the illness

Stopping a mania begins with recognizing it is there. Work with a partner -- parent, spouse, support group member -- to 'reality check' whether you are okay or not. If you're not okay, contact the doctor immediately. Take extra antipsychotic medication. Get parameters from from your doctor so you'll know what extra dose to take. Very important!

Put yourself on a STRICT SCHEDULE. The bipolar person is extremely sensitive to body rhythms and also the changing seasons. Most of us must keep busy every moment of the day during 'business hours.' This includes weekends, too. This involves scheduling ourselves so as to productively account for our time.

Otherwise we may be hit with sodden depression and sleep weekends away when we don't have the protective schedule of our work week.

Make a daily 'to-do' list. Also be sure to schedule your weekends. Usually by having at least ONE EXTERNAL EVENT for each day off -- in other words, an event to make sure you leave home -- you should be okay. Some people find it easier to have someone accompany them out of their homes. This is fine.

Pursue your interests and hobbies. A mood disorder is only one component of the whole person you are. Our brains are capable of learning every moment of the day. Sure, spend some time learning about your illness, but also pursue our wonderful world with hobbies such as photography, painting, writing or reading poetry. Journaling is extremely helpful in getting out your feelings.

Feelings must be discharged to people who understand you. Don't ask for trouble by talking about your condition at work. Or to people who don't understand the illness. You'll feel infinitely frustrated. That's why our group is here... our members are willing to talk about anything with you.

And, for pete's sake, don't say, "I'm bipolar." If you have cancer, do you say, "Hi, I'm cancer."

WHERE TO GET HELP

A couple of cautionary words. It’s often difficult to make an appointment without a rather long wait. You may have to wait as long as a month. But, then, you may need only to wait a week. That’s why it’s a good idea to have a list of possible doctors, call them, and go with the soonest appointment. Best referrals are from support groups or other patients.

There are two types of treatment centers: private and public. Private are more expensive but you may get quicker appointments. A private practice will allow you to see top psychiatrists. Check insurance requirements before you go. Some offices have stopped taking insurance.

Public treatment centers are known as community mental health centers. Your attendance is based on where you live. This is called your “catchment area” and it goes by county. At a community mental health center, you will probably see an intake therapist first. To me, this is a waste of time, but it’s the protocol. In no other field do you see an interviewer first and then return another day to see the doctor. Don’t be discouraged. Just be forewarned. Maintain a positive attitude.


COMMUNITY MENTAL HEALTH CENTERS

Bucks County

For information on center nearest you, call Bucks County Department of Mental Health, Warminster, at 215-442-0760, ext. 2.

- Penn Foundation in Sellersville, 215-257-6551

- Lenape Foundation in Doylestown, 215-345-5300

- Penndel Mental Health Center in Penndel, 215-752-1541


Montgomery County

For service nearest you, call Montgomery County Department of Behavioral Health, Norristown, 610-278-3642.

- Creekwood (serves Willow Grove and Eastern Montco), call 215-830-8966

- Central (serves Norristown & Central Montco inc. Plymouth Mtg, Bryn Mawr) call 610-277-9420
- Creative Health Services (Pottstown and Western Montco), call 610 326 2767
Penn Foundation of Sellersville, call 215-257-6551.

- NHS of Lansdale, call 215-368-2022

- Lower Merion Counseling Center of Bryn Mawr, call 610-649-6512


RESOURCES


National institute of Health (NIMH), nation’s research center for mental illness. Superb information available online, including videos. View www.NIMH.nih.gov

NAMI, the National Alliance on Mental Illness. For family members. Find a group near you! They offer the Family-to-Family Program, a teaching course providing info about various mental disorders.

- Bucks County NAMI – Call 866-399-6264. View www.NAMIBucks.org

- Montgomery County NAMI – Call 215-886-0350. View www.MontcoNami.org

TEC Family Center (Teaching and Education Center). Part of the Mental Health Assn. of Southeastern Pennsylvania, Philadelphia. Offers workshops on how to live with a person with mental illness. Call 215-751-1800.

New Directions Support Group of Abington for people with depression, bipolar disorder and their loved ones. Meets the first, third and fifth Thursday of the month from 7:30 to 9:45 pm at Abington Presbyterian Church, 1082 Old York Road at Susquehanna, Abington, PA 19001. Call 215-659-2366. View www.NewDirectionsSupport.org for comprehensive information.

Ruth Deming offers home consultations. She will meet at your home with all your family members to explain bipolar disorder and come up with an action plan to help families. In addition, two bipolar members will meet with your bipolar loved one to share the good life that awaits the bipolar person after diagnosis.

THE LUCKY SEVEN

We sat in a circle in folding chairs,
the lucky seven,
I was wearing a party dress that showed my curves
forgot to wear my panties, so kept my legs together.

Paul spoke. For the first time I liked him.
Not because he used to be a radio D-J or
his mother was dying in a nursing home
but because he banged his head against the wall
when his daughter hung up on him.

The newcomer was diagnosed two days ago.
He knew nothing about his illness.
Was 22, led the life of a gallant well-
dressed pimp
but now guilt pressed him flat in his chair
- a run-over worm.

I stared at him. Nice contrast of
ebony skin the color of a Chinese lacquer box
and peach-colored palms he clenched
in his lap.

He began his confession,
looking down and talking staccato.
I touched his shoulder. Keep some
secrets for yourself, I said. We don’t need to
know ev-ery-thing.

The dam began to leak and
Harry, who worked for a drug company,
talked about his rampant sexuality when manic,
laughed when he talked about the women he made love to,
the wife taking off with the
house and the kids.

The newcomer nodded.
You mean it happened to you, too?

It happened to all of us, I say.

Harry told about writing fifty pages of
notes only two months ago during his last mania.
”Hypergraphia,” I said, mouthing the gorgeous syllables of a
new word I’d just learned.
Mine, I threw away after 20 years hidden in the bottom drawer,
useless horseshit.

The newcomer wanted more symptoms.
I handed him a brochure. Everything has a
name, I said. Whatever you did, they’ve already
named it. They’re pretty smart.

Well, if they’re so smart, he said, why can’t they
fix it?

Well, they’re not that smart, I said.

The newcomer was guilt-ridden over his
sexual escapades. Used the word ‘evil’ to
describe himself.
C’mon, I said. Something big comes over us. We
light up. We glow. Arrive with a halo for godsakes.
We’re like lightning bugs in the dark. We blink.
Think of the evolutionary possibilities if you’re a
man. Populating your side of the mountain.

Paul, the guy I finally liked, talked about his old
man shooting his brains out.
Oh no, I thought, now we’ve gotta explain
we kill ourselves to the newcomer.

Derek, I said, turning toward him, there’s
something you need to know.

I know it already, he said. I was 9 when I first got
out the rope.

Hallelujah, brother, I said, slapping his hand.
You know everything now.
You can relax and start to enjoy yourself.

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