When I started this Manic Depressive project, I said I wanted to write a post about what it's like for the family and friends of someone suffering from this disorder. It can be summed up in two words, “Challenging” and “Confusing”.
When the person you care about is cycling through their mood states and confused, how can YOU be anything other than confused? The challenge will still be there, but I'll try to clear up some of the confusion.
1st and foremost, YOU cannot “manage” your loved one's Manic Depression. Managing someone else's M/D is like trying to sight in a rifle while crossing the railroad tracks in a car with bad shock absorbers.
2nd Look into finding a support group for yourself. Other people ARE going through the same confusion and challenges you are experiencing.
Next, talk to your loved one. Sit down and ASK what you can do to help. Let them know you care about them, even though you may not understand exactly what they are experiencing. Tell them they have your support.
It may be helpful, for them and YOU to keep a log of behaviors and feelings they express at different times during a cycle of mania or depression. This can help in both their treatment and in recognizing the onset of a change in cycles. If the treatment provider is informed, s/he can makes changes to medications IF the symptoms are recognized early enough.
I also refer you back to the earlier post [from Sunday, October 5] where I listed things to know, things to say and things NOT to say to your loved one with M/D.
Keep in mind that your loved one's mood swings are NOT a character flaw or a deliberate effort to alienate you. This is an inherited disorder. They did not do something “wrong” and become M/D, they were born with the genetic coding for this disorder. It IS possible to cope with this disorder and regain functionality. It's hard work and requires an effort from all parties involved.
If you have any questions or comments you don't want to ask in the “Comments” section, you can email me at holly76209 at gmail dot com.
Thursday, October 16, 2008
Friday, October 10, 2008
Manic Depression Treatment Modalities
Recovery, as defined by SAMSHA (the Substance Abuse and Mental Health Services Administration/Center for Mental Health Services) (http://www.samhsa.gov/) is:
Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.
There are a broad range of treatments for Manic Depression. The best page I've seen is this one at the Depression and Bi Polar Support Alliance: http://dabsa.convio.net/site/PageServer?pagename=about_depression_treatmentmain . There are a TON, almost literally, of links on that page to cover every aspect of treatment.
The NIMH treatment page can be found here: http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml
I'd like to touch briefly on the treatments with which I have the most familiarity. Let me preface my remarks about medication by stating Psychotropic medicines should be prescribed by a Psychiatrist. While regular M.D.s CAN prescribe medicines to treat Manic Depression; Psychiatrists have more experience treating Manic Depression and are more knowledgeable about the latest medicines, drug interactions and and side effects.
Medications know as ”mood stabilizers” are on the front line in the battle against Manic Depression and its cycling feature. There are also anti-convulsant drugs that have mood stabilization as a side effect. For a list of medications please go to the NIMH's treatment page:
[http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml]
A caution about using anti-depressants to treat the Depression aspect of M/D. Studies, according to the NIMH have shown:
"that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, “mood-stabilizing” medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. "
The anecdotal evidence supports the assertion that people on antidepressants are more likely to have a more severe Depression when the manic period ends. I like to call This side effect “Rebound Depression.”
Psychotherapy/Talk therapy
Therapy can help prevent prevent inappropriate and negative behaviors. It can help the patient [and their family if involved in Family Therapy sessions] recognize the signs of the early stages of each cycle. Once this recognition is established, steps can be taken by the patient, family, therapist and psychiatrist working together to prevent a full blown episode of That aspect of the disorder.
The DBSA has a list of the benefits of therapy:
Understand your illness
Overcome fears or insecurities
Cope with stress
Make sense of past traumatic experiences
Separate your true personality from the mood swings caused by your illness
Identify triggers that may worsen your symptoms
Improve relationships with family and friends
Establish a stable, dependable routine
Develop a plan for coping with crises
Understand why things bother you and what you can do about them
End destructive habits such as drinking, using drugs, overspending or risky sex
Address symptoms like changes in eating or sleeping habits, anger, anxiety, irritability or unpleasant feelings
Therapy can also help you come to terms with the fact you will need medicine for the rest of your life. You CANNOT stop taking it because you feel better. That doesn't mean you're cured. If you go off of medication ALL your symptoms will return. You may be able to stop talk therapy once you've met your goals for therapy, but you will always need medication. The first medicine [or combination of medicines] you try, may not be the one for you. You may have to try several different medications before you find the one[s] that work for you. You may need to tweak the dosages over time, as well.
Despite the effort involved in finding the medicine[s], it's worth it when you fine the correct one[s] for you. The depressions are so much less intense and the mania is just enough to give you energy and creativity without causing the negative aspects of a full blown manic episode.
Another important aspect of treatment is a Thyroid Function test. According to NIMH, many Manic Depressives have abnormal thyroid functioning. Too much or too little of the hormone secreted by the thyroid can play hell with the patient's mood and cycling between moods. If necessary, get the medication and take it.
In some rare cases when medication and therapy are ineffective, ECT [electric convulsive therapy] may be utilized. The NIMH says:
In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.
Even though Manic Depression is what's called a “long term illness” it can be treated. It IS possible to find recovery. The DBSA website :
http://dabsa.convio.net/site/PageServer?pagename=home
contains many links with suggestions that can help a newly diagnosed patient, a patient who has been diagnosed at sometime in the past, and family and friends cope in effective ways with this complex disorder.
If you are a Patient, take comfort in knowing there ARE many resources and solutions available to you. If you are a family member or friend looking to help, there are many strategies and methods you can utilize in supporting the patient. Both websites I've used for my references contain more links to help. Use them, and the sites they refer to as starting points on your personal journey to recovery. It IS possible.
Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.
There are a broad range of treatments for Manic Depression. The best page I've seen is this one at the Depression and Bi Polar Support Alliance: http://dabsa.convio.net/site/PageServer?pagename=about_depression_treatmentmain . There are a TON, almost literally, of links on that page to cover every aspect of treatment.
The NIMH treatment page can be found here: http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml
I'd like to touch briefly on the treatments with which I have the most familiarity. Let me preface my remarks about medication by stating Psychotropic medicines should be prescribed by a Psychiatrist. While regular M.D.s CAN prescribe medicines to treat Manic Depression; Psychiatrists have more experience treating Manic Depression and are more knowledgeable about the latest medicines, drug interactions and and side effects.
Medications know as ”mood stabilizers” are on the front line in the battle against Manic Depression and its cycling feature. There are also anti-convulsant drugs that have mood stabilization as a side effect. For a list of medications please go to the NIMH's treatment page:
[http://www.nimh.nih.gov/health/publications/bipolar-disorder/treatment.shtml]
A caution about using anti-depressants to treat the Depression aspect of M/D. Studies, according to the NIMH have shown:
"that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, “mood-stabilizing” medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. "
The anecdotal evidence supports the assertion that people on antidepressants are more likely to have a more severe Depression when the manic period ends. I like to call This side effect “Rebound Depression.”
Psychotherapy/Talk therapy
Therapy can help prevent prevent inappropriate and negative behaviors. It can help the patient [and their family if involved in Family Therapy sessions] recognize the signs of the early stages of each cycle. Once this recognition is established, steps can be taken by the patient, family, therapist and psychiatrist working together to prevent a full blown episode of That aspect of the disorder.
The DBSA has a list of the benefits of therapy:
Understand your illness
Overcome fears or insecurities
Cope with stress
Make sense of past traumatic experiences
Separate your true personality from the mood swings caused by your illness
Identify triggers that may worsen your symptoms
Improve relationships with family and friends
Establish a stable, dependable routine
Develop a plan for coping with crises
Understand why things bother you and what you can do about them
End destructive habits such as drinking, using drugs, overspending or risky sex
Address symptoms like changes in eating or sleeping habits, anger, anxiety, irritability or unpleasant feelings
Therapy can also help you come to terms with the fact you will need medicine for the rest of your life. You CANNOT stop taking it because you feel better. That doesn't mean you're cured. If you go off of medication ALL your symptoms will return. You may be able to stop talk therapy once you've met your goals for therapy, but you will always need medication. The first medicine [or combination of medicines] you try, may not be the one for you. You may have to try several different medications before you find the one[s] that work for you. You may need to tweak the dosages over time, as well.
Despite the effort involved in finding the medicine[s], it's worth it when you fine the correct one[s] for you. The depressions are so much less intense and the mania is just enough to give you energy and creativity without causing the negative aspects of a full blown manic episode.
Another important aspect of treatment is a Thyroid Function test. According to NIMH, many Manic Depressives have abnormal thyroid functioning. Too much or too little of the hormone secreted by the thyroid can play hell with the patient's mood and cycling between moods. If necessary, get the medication and take it.
In some rare cases when medication and therapy are ineffective, ECT [electric convulsive therapy] may be utilized. The NIMH says:
In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.
Even though Manic Depression is what's called a “long term illness” it can be treated. It IS possible to find recovery. The DBSA website :
http://dabsa.convio.net/site/PageServer?pagename=home
contains many links with suggestions that can help a newly diagnosed patient, a patient who has been diagnosed at sometime in the past, and family and friends cope in effective ways with this complex disorder.
If you are a Patient, take comfort in knowing there ARE many resources and solutions available to you. If you are a family member or friend looking to help, there are many strategies and methods you can utilize in supporting the patient. Both websites I've used for my references contain more links to help. Use them, and the sites they refer to as starting points on your personal journey to recovery. It IS possible.
Wednesday, October 8, 2008
Treatment Blog in the Works
I'm workin' on the installment for this project about treatment options.
Just wanted y'all to know that.
Just wanted y'all to know that.
Sunday, October 5, 2008
Answering Comment Questions
Anonymous said...
How do you help someone with bipolar disorder? No insurance. Psychiatrists here are about as sane as Freud.
Well, Anonymous, there are a LOT of ways to help. The Depression and Bipolar Support Alliance [http://dabsa.convio.net/site/PageServer?pagename=about_helping]
has this list:
Helping Someone With A Mood Disorder
Mood disorders such as depression and bipolar disorder (also known as manic-depression) affect millions of people. Their family members and friends are affected too. If someone you love has a mood disorder, you may be feeling helpless, overwhelmed, confused and hopeless, or you may feel hurt, angry, frustrated and resentful. You may also have feelings of guilt, shame and isolation, or feelings of sadness, exhaustion and fear. All of these feelings are normal.
What you need to know:
Your loved one’s illness is not your fault (or your loved one’s fault).
You can’t make your loved one well, but you can offer support, understanding and hope.
Each person experiences a mood disorder differently, with different symptoms.
The best way to find out what your loved one needs from you is by asking direct questions.
What you need to find out:
Contact information (including emergency numbers) for your loved one's doctor, therapist, and psychiatrist, your local hospital, and trusted friends and family members who can help in a crisis.
Whether you have permission to discuss your loved one's treatment with his or her doctors, and if not, what you need to do to get permission.
The treatments and medications your loved one is receiving, any special dosage instructions and any needed changes in diet or activity.
The most likely warning signs of a worsening manic or depressive episode (words and behaviors) and what you can do to help.
What kind of day-to-day help you can offer, such as doing housework or grocery shopping.
When talking with your loved one's health care providers, be patient, polite and assertive. Ask for clarification of things you do not understand. Write down things you need to remember.
What you can say that helps:
You are not alone in this. I’m here for you.
I understand you have a real illness and that’s what causes these thoughts and feelings.
You may not believe it now, but the way you’re feeling will change.
I may not be able to understand exactly how you feel, but I care about you and want to help.
When you want to give up, tell yourself you will hold on for just one more day, hour, minute - whatever you can manage.
You are important to me. Your life is important to me.
Tell me what I can do now to help you.
I am here for you. We will get through this together.
What you should avoid saying:
It’s all in your head.
We all go through times like this.
You’ll be fine. Stop worrying.
Look on the bright side.
You have so much to live for; why do you want to die?
I can’t do anything about your situation.
Just snap out of it.
Stop acting crazy.
What’s wrong with you?
Shouldn’t you be better by now?
The National Institute for Mental health has a list of suggestions for finding services
and the DBSA has a list of suggestions called "Choosing a Provider" and Professional Referral has tips on what to remember when choosing a provider of Mental Health Services as well as links to resources.
http://dabsa.convio.net/site/PageServer?pagename=empower_resources
I hope these links help...and I'll comeback to discuss this in more detail later.
How do you help someone with bipolar disorder? No insurance. Psychiatrists here are about as sane as Freud.
Well, Anonymous, there are a LOT of ways to help. The Depression and Bipolar Support Alliance [http://dabsa.convio.net/site/PageServer?pagename=about_helping]
has this list:
Helping Someone With A Mood Disorder
Mood disorders such as depression and bipolar disorder (also known as manic-depression) affect millions of people. Their family members and friends are affected too. If someone you love has a mood disorder, you may be feeling helpless, overwhelmed, confused and hopeless, or you may feel hurt, angry, frustrated and resentful. You may also have feelings of guilt, shame and isolation, or feelings of sadness, exhaustion and fear. All of these feelings are normal.
What you need to know:
Your loved one’s illness is not your fault (or your loved one’s fault).
You can’t make your loved one well, but you can offer support, understanding and hope.
Each person experiences a mood disorder differently, with different symptoms.
The best way to find out what your loved one needs from you is by asking direct questions.
What you need to find out:
Contact information (including emergency numbers) for your loved one's doctor, therapist, and psychiatrist, your local hospital, and trusted friends and family members who can help in a crisis.
Whether you have permission to discuss your loved one's treatment with his or her doctors, and if not, what you need to do to get permission.
The treatments and medications your loved one is receiving, any special dosage instructions and any needed changes in diet or activity.
The most likely warning signs of a worsening manic or depressive episode (words and behaviors) and what you can do to help.
What kind of day-to-day help you can offer, such as doing housework or grocery shopping.
When talking with your loved one's health care providers, be patient, polite and assertive. Ask for clarification of things you do not understand. Write down things you need to remember.
What you can say that helps:
You are not alone in this. I’m here for you.
I understand you have a real illness and that’s what causes these thoughts and feelings.
You may not believe it now, but the way you’re feeling will change.
I may not be able to understand exactly how you feel, but I care about you and want to help.
When you want to give up, tell yourself you will hold on for just one more day, hour, minute - whatever you can manage.
You are important to me. Your life is important to me.
Tell me what I can do now to help you.
I am here for you. We will get through this together.
What you should avoid saying:
It’s all in your head.
We all go through times like this.
You’ll be fine. Stop worrying.
Look on the bright side.
You have so much to live for; why do you want to die?
I can’t do anything about your situation.
Just snap out of it.
Stop acting crazy.
What’s wrong with you?
Shouldn’t you be better by now?
The National Institute for Mental health has a list of suggestions for finding services
and the DBSA has a list of suggestions called "Choosing a Provider" and Professional Referral has tips on what to remember when choosing a provider of Mental Health Services as well as links to resources.
http://dabsa.convio.net/site/PageServer?pagename=empower_resources
I hope these links help...and I'll comeback to discuss this in more detail later.
Wednesday, October 1, 2008
Signs and Syptoms of Manic Depression
The below was shamelessly copied and pasted from http://www.nimh.nih.gov/health/publications/bipolar-disorder/symptoms.shtml
Keep in mind, while readin' this that some folks are MIS-diagnosed as depressed when their manic episodes are mild or what's called “hypomanic.”
I'm going to put my comments and observations in a different font and color from the NIMH text.
Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
Increased energy, activity, and restlessness Lots and lots of energy leads to lots of activity. But the restlessness can cause a person to start multiple projects when they're manic, then never complete them because the depressive cycle hits.
Excessively “high,” overly good, euphoric mood
Extreme irritability Snapping turtle sound familiar? How about rantin' and ravin'?
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can’t concentrate well See the above comment under energy.
Little sleep needed
Unrealistic beliefs in one’s abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive When combined with poor judgement...bad things can happen
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior As if they no longer have a censor feature in their brain.
Denial that anything is wrong Because no matter how bad it IS, there are also positive aspects to Mania. More about that later.
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
Lasting sad, anxious, or empty mood lasting is the Key word in this clause.
Feelings of hopelessness or pessimism Hopelessness is also a suicidal precursor
Feelings of guilt, worthlessness, or helplessness helplessness is another suicidal precursor
Loss of interest or pleasure in activities once enjoyed, including sex A low libido is the counterpart of the hypersexuality sometimes seen in Manic episodes
Decreased energy, a feeling of fatigue or of being “slowed down” lethargy, to those unaware of symptoms, can be mis-interpreted as "laziness" instead of a legitimate symptom
Difficulty concentrating, remembering, making decisions
Restlessness or irritability which can also be a mania symptom
Sleeping too much, or can’t sleep the extremes and the difference between sleep patterns when in a Manic episode or on an even keel is the Key factor to this symptom
Change in appetite and/or unintended weight loss or gain As with the above, it's the extremes to look for
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury which is why a lot of people with depression are MIS-diagnosed as having Fibromyalgia. Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
Other sources, the Medical Library Association [in conjunction with NIMH, btw] also lists inflated self esteem, lack of self control and binges of eating or drinking as Manic Episode Symptoms. What NO source lists, and what many M-Ds are reluctant to sacrifice are the bursts of artistic creativity they experience during manias. To them, being medicated is the same as losing their Muse. Jamison writes about this aspect of treating Manic Depression in Touched with Fire: Manic Depressive Illness and the Artistic Temperament. She urges treatment that doesn't kill that fire in the process of "curing" the Disorder.
That last would be because there IS no "cure" for Manic Depression. There's treatment, but if you're an M-D, you're always going to BE and M-D. You may get the mood swings under control with medication, but you will need that medication for the rest of your life. Kinda like being hypertensive or a diabetic.
Okey, dokey. We clear on all that? I didn't think so.
Keep in mind, while readin' this that some folks are MIS-diagnosed as depressed when their manic episodes are mild or what's called “hypomanic.”
I'm going to put my comments and observations in a different font and color from the NIMH text.
Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.
Signs and symptoms of mania (or a manic episode) include:
Increased energy, activity, and restlessness Lots and lots of energy leads to lots of activity. But the restlessness can cause a person to start multiple projects when they're manic, then never complete them because the depressive cycle hits.
Excessively “high,” overly good, euphoric mood
Extreme irritability Snapping turtle sound familiar? How about rantin' and ravin'?
Racing thoughts and talking very fast, jumping from one idea to another
Distractibility, can’t concentrate well See the above comment under energy.
Little sleep needed
Unrealistic beliefs in one’s abilities and powers
Poor judgment
Spending sprees
A lasting period of behavior that is different from usual
Increased sexual drive When combined with poor judgement...bad things can happen
Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
Provocative, intrusive, or aggressive behavior As if they no longer have a censor feature in their brain.
Denial that anything is wrong Because no matter how bad it IS, there are also positive aspects to Mania. More about that later.
A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.
Signs and symptoms of depression (or a depressive episode) include:
Lasting sad, anxious, or empty mood lasting is the Key word in this clause.
Feelings of hopelessness or pessimism Hopelessness is also a suicidal precursor
Feelings of guilt, worthlessness, or helplessness helplessness is another suicidal precursor
Loss of interest or pleasure in activities once enjoyed, including sex A low libido is the counterpart of the hypersexuality sometimes seen in Manic episodes
Decreased energy, a feeling of fatigue or of being “slowed down” lethargy, to those unaware of symptoms, can be mis-interpreted as "laziness" instead of a legitimate symptom
Difficulty concentrating, remembering, making decisions
Restlessness or irritability which can also be a mania symptom
Sleeping too much, or can’t sleep the extremes and the difference between sleep patterns when in a Manic episode or on an even keel is the Key factor to this symptom
Change in appetite and/or unintended weight loss or gain As with the above, it's the extremes to look for
Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury which is why a lot of people with depression are MIS-diagnosed as having Fibromyalgia. Thoughts of death or suicide, or suicide attempts
A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
Other sources, the Medical Library Association [in conjunction with NIMH, btw] also lists inflated self esteem, lack of self control and binges of eating or drinking as Manic Episode Symptoms. What NO source lists, and what many M-Ds are reluctant to sacrifice are the bursts of artistic creativity they experience during manias. To them, being medicated is the same as losing their Muse. Jamison writes about this aspect of treating Manic Depression in Touched with Fire: Manic Depressive Illness and the Artistic Temperament. She urges treatment that doesn't kill that fire in the process of "curing" the Disorder.
That last would be because there IS no "cure" for Manic Depression. There's treatment, but if you're an M-D, you're always going to BE and M-D. You may get the mood swings under control with medication, but you will need that medication for the rest of your life. Kinda like being hypertensive or a diabetic.
Okey, dokey. We clear on all that? I didn't think so.
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