Saturday, December 1, 2007

Question About Manic Depression and Medication

This week, I received this letter in the mailbox. I've underlined the key questions and terms.

I was talking to a friend recently and although I'm generally a completely manic person, (my doctor called me hypomanic) I've been going through a huge personal transition that has its stresses and I've been feeling down occasionally.

My friend then used the term "manic depressive" and said that was what I was experiencing, and though I never recognized it myself, I know she was absolutely right.

My question is, if I'm generally just hypomanic, what's the harm in me just going through life being unmedicated and an overachiever?

If I really focus, I CAN do normal things like sleep and maintain routine, I'm just channeling my inner terrier, is all. Honestly, anti-depressants saved my life a couple years ago, and I'll always keep the possibility of Lexapro in reserve as a life-preserver, but generally, is it possible it's okay for me to be hypomanic and not drive others crazy and still have a fulfilling life? I mean, could I fall in love and have a happy life and not just annoy the crap out of other people without relying on pharmaceuticals, or is this an unrealistic hope?

Well, first of all, let's make sure we're all on the same page with our terminology. Manic Depression, while a vastly more descriptive term for what's actually going on with the emotions, fell out of favor with Mental Health practitioners at the beginning of the Politically Correct movement in the late '70's and early '80's. It was replaced with the term Bi-Polar Disorder.

Personally, I prefer the term Manic Depression. I think it describes the disorder in a more understandable fashion for client, family, friends, and any interested party. Besides, I've been involved in the Mental Health field long enough to see the pendulum swing to both extremes in a lot of areas. And, besides, that what this writer calls it. A provider of advice, counsel, therapy should always be guided by the "client," so that's what I'll call it.

Now, first off, you mention stresses caused by a personal transition. Stress can often bring on what is called "cycling" in someone with Manic-Depression. Cycling is the transition between the mania and the depression. Most people with this disorder, when looking back, [and isn't hindsight a wonderful diagnostic tool?] realize their symptoms began to manifest during their teens and early '20's.

Before that time they may only have experienced depression. Therefore when the manic side of the disorder began, especially, if it was "hypomanic" as in this person's case, they may have, experienced the mania as a period of what they perceived as normalcy. And who wouldn't want to feel mania after depression. Hypomania brings energy, creativity, a feeling of being on top of the world. After the sadness, lethargy and mental sludge and memory lapses of depression, who wouldn't welcome the ability to think one great idea after another?

The problems begin to arise when those wonderfully creative thoughts begin racing through your mind and you cannot control them. The problems begin when you begin to make really BAD choices about spending too much money, drinking too much booze, taking too many drugs, having sex with too many people or in inappropriate places. These are what can happen with unmedicated Manic Depression.

What is MOST important about making the decision about whether or not to start medication is to do a realistic inventory of your life. Are your decisions being influenced by your mania? Are you making good decisions, and by that I mean are the decisions you are making impacting your life in a negative or positive way? Are you financially stable, or has your mania caused you to overspend to the point that you are in a financial bind? How about your use of alcohol or other drugs? Are you endangering your health with the use of too much booze, or too much food or too much of any substance? Do you drive when you are impaired, thus endangering yourself and others? Are you having sex with people you don't know or don't know well? Are you having sex when you're drunk or otherwise impaired? Male or Female, HIV, HepC, HepB, STDs, love is fleeting Herpes is forever.

If you answered "Yes" to one or more of these questions, you need to be on some type of medication. Being medicated doesn't mean you will give up the energy, the creativity, the ability to think. You won't lose your "inner terrier" if you start a course of mood stabilizing drugs in combination with anti-depressants.

It may take some tweaking to find the right combination of the right drugs for you. But with all the research being done by pharmaceutical companies, new drugs hit the market almost monthly. The problem with being afraid of taking medicine, is that you may not recognize a problem until you're hip deep in it. Denial is an awesome coping mechanism, but it's not always the most productive one.

So, yes, you can go on being unmedicated, IF you are self-aware enough to do an inventory on a regular basis. But, would you walk on a sprained ankle, if support in the form of a brace was available? Would you walk around with hypertension when there was medicine to control it if dietary changes alone weren't bringing it down into a safe range?

I see a lot of clients who think that once they stabilize, they don't need their medicine anymore. Not just Manic Depressives, but all across the Neurotic board, and most of the psychotics, too. They view their mental health issues as something they can control through an effort of will. What I see is someone who doesn't have an understanding that their disorder is FIRST an imbalance of neurotransmitters in their brain, and then a disorder of psychology caused by their individual circumstances. Until the brain chemistry is under control, through the use of modern chemistry, any counseling, behavior modification, therapy, or spiritual intervention is ultimately less than effective because it only treats symptoms and not the underlying biological disease. Some, the lucky or smart ones eventually "get" it, find the right combination of meds and stay on meds, making changes as necessary. And changes will be necessary. The brain is a living organ, it adapts and changes over time. Changes in medication are inevitable.

Manic Depression, left untreated, will usually get worse. Sometimes it takes years. But in most cases, it does get worse. Especially as the client ages, as stressors multiply, as women give birth, approach menopause, as men reach their mid-life crises and own hormonal changes. Doesn't it make sense to be prepared with your own arsenal of medication already in place?

Please feel free to contact me again if you have more questions.