When Depression Creeps in Where Does Anxiety Go?

Soon after becoming an empty nester I have begun to experience some feelings of depression. This is understood as I have bipolar illness. But the depression phases of my bipolar history are fewer and less extreme than the mania phases. Since 2008 while prescribed clozapine, I have been experiencing mixed states that manifest themselves in acute anxiety.

In addition to just becoming an empty nester, there have been two recent deaths (in the past two weeks or so) in my social/family circles (both expected) and my Psyche doctor is experiencing severe back issues and lack of feeling in his feet.

So my question today is where does that long-standing anxiety go when feelings of depression are accepted as part of life’s challenges and puzzles? Is the depression the root cause of the anxiety? Have I been experiencing loads of anxiety because I have not been able to process sadness, pain, separation and depression?

I don’t have the answers to these questions right now. But it seems to me if I am going to come out of this series of mixed states, it is important to acknowledge the depression and allow it to pass. Perhaps then the anxiety will be less so. Any thoughts?

What Does It Look Like When Civil Society Is Threatened as Perceived by a Person with Mental Illness?

1. Politics is more a question of love versus hate instead of an identification of ideological differences.

2. A peaceful transition of power is shunned or completely denied by leadership.

3. Rights that were once attainable or available become threatened.

4. Leaders are noted and supported for their charisma more than their actual accomplishments.

5. Behavior at the national level looks more like kindergarteners hoarding the ball to take home rather than leaders with their heads in the game.

6. Communication about other people is reduced to name-calling and slurs on character.

7. Hate is a regular feature in communications and positioning that is generally directed at people who “are not like me.” This hate is often extended beyond words to actions.

8. Gun ownership and gun violence are condoned or encouraged as a means of protecting civil liberties.

9. Political differences between family members are so extreme that family relationships may become strained or damaged.

10. People are not willing to curb their actions even when political mechanisms are faltering or threatened.

Thanks for Being Part of the Solution!

Recently I wrote a very long email to my high school peers and included a recounting of what I thought were mental health / addiction challenges affecting someone in that group who died suddenly. After reaching out to high school peers and receiving a full gamut of responses including both positive and negative, I want to say how much I value this on-line “community” at this blog site where people can talk freely about mental health and addiction full-throttle or head-on.

Over the past few years, I have grown accustomed to talking openly here at this blog and at others’ blogs about mental health challenges I experience that include the full gamut of symptoms including mania, depression, mixed states, sometimes crippling anxiety, body image challenges, hallucinations, hospitalizations and others.

I just want to say thank you to those of you who are in this on-line “community” for helping to provide an atmosphere that allows people with mental health and addiction issues to talk freely without a whole lot of push-back or stigma. Ten to fifteen years or so ago, such an online “community” possibly or probably did not exist? Not sure when people started blogging about mental health? For me, following posts and posting posts is an important part of my self-care. I thank you for your contributions even if you are in the “reader” versus “reply/writer” category. Everyone plays a part.

Finally, thank you again for participating in this “community.” I believe that stigma reduction is a crucial by-product of the collective posts here at these blogs about mental health and addiction. Thanks for being part of the solution!

Various Interventions for Stress?

Plans to take my daughter to college next week are leaving me stressed with a capital S. I have scheduled an extra appointment with my therapist for tomorrow. I have gone up a little on my Clozapine. Perhaps not enough…? Everything feels very stressful. Making plans for wisdom teeth removal in December. Making plans to board the dog. Consider changing meds – this will be held off until September. Making sure my daughter is OK during move-in. Friends and family say this stress is normal when sending a child off to college. OK so it’s normal. Why do I feel so un-normal?

I have been taught not to be afraid to ask for what you need….. I am asking now for your understanding and support. The more “yeah it’s normal” s I get the better I think I will feel. Brother can you spare a dime? Or a least a word of support that this too will pass?

Does Anyone Have Information on Loxapine for Bipolar?

I am in the process of looking into a new psyche med. I currently use Clozapine as my main psyche med but it requires a monthly blood test and causes weight gain. I have also been on Clozapine since 2008 and wonder if its effectiveness is waning.

The drug I am considering is Loxapine which is structurally very similar to Clozapine. Both meds are used for schizophrenia mostly but have been successful in treatment of resistant bipolar which is my gig.

Does anyone have stories to tell about Loxapine for bipolar? Or for other off-label uses? Thanks in advance for sharing.

As an update: I talked to my doc yesterday about switching from Clozapine to Loxapine. He indicated it was not a good idea. And while I am somewhat disappointed, I trust his judgement completely. So there will be no switch to Loxapine. I am however still interested in stories of how Loxapine might have helped in your treatment if you have used before?

Thanks to all of you who have reached out here and before.

Night and Day – Living with Bipolar Disorder out of or in a Routine

I do not know if the experience is similar for other people with a serious mental health diagnosis, but I find myself to be very anxious and irritated when I am not in my regular routine. If I am able to function at a 9 or a 10 (on a scale of 1 to 10) while I am home, I am able to function at a 5 or a 6 when I am out of town and out of my routine. And that is just for domestic travel and travel to a familiar spot. If I have to travel to someplace new or abroad I would have to rate myself even lower due to the adjustment and/or the jet lag and jet lag recovery. As an aside, I have discovered that melatonin does help tremendously with jet lag.

What does it mean to be so tied to a routine? Doing things like taking meds, going to bed, waking up, taking morning meds and taking noon meds are all things that function pretty much on their own when I am at home. I am more or less on auto-pilot with these activities. When I am out of town, I have to create this structure that punctuates my day at several intervals. Things go wrong or even slightly wrong and I have upset the apple cart. Everything starts to tumble and there I am trying to pick up all the apples. Little things like eating dinner at 8:00pm instead of 6:00pm gets my evening off to a rocky start. Things like placing my meds in a different location than I am used to can be a form of stress as well. Sleeping in a strange bed can also be a pain. Having to get somewhere early in the morning is also a challenge as my day starts around 8:00 or 9:00am at home.

I have often thought that because of my bipolar illness I have damaged my hippocampus in some way due to all the trauma over the years of accelerated and then slowed thought processes. So there may be a real medical explanation for all this routine dependency. As I understand things, the hippocampus helps orient you through time and space and helps you keep pace with your general well-being. Getting to a new location that used to be a breeze now with hippocampus damage may seem a daunting task. I have trouble with spatial sense of direction which is one of those skills you need when you are traveling in a new or relatively new spot. This was not the case when I was in my twenties and thirties. This is also one of those problems that is self-fulfilling. The more I tell myself how difficult it is to get somewhere new, the harder it becomes.

So much for loving to travel. I much prefer to be at home in my own routine however boring that may sound. What about you? Do you find that routine is a critical element of your functioning or can you pretty much establish your day and night in a new place without much thought or effort?

Do you stockpile meds?

In the US under my insurance you can usually get meds refilled about 3 days earlier than the full month that they are covered. This allows me to create a med stockpile month upon month when those three days earlier to pickup are multiplied times twelve over the course of the year. I also tend to keep at an old prescription dosage amount even if that dosage has been changed/reduced. To explain, say my doctor originally prescribed me with 500 mg of Clozapine and then over time I reduced to 350 mg. My doctor keeps the prescription at the higher level in case I need to go back up.

The result? I tend to stockpile meds which drives my husband crazy. But for me it means being ready for a sudden trip out of town or having meds in place when I am on summer vacation. My insurance does not do vacation overrides. Not sure why. So if I need meds filled during vacation I need to use GoodRX coupons the week prior to leaving town. GoodRX allows you to fill prescriptions with a discount and they do not care whether your insurance says it’s time to fill or not. It used to be that my pharmacy would do a vacation override but I think the problem is with my current insurance.

I have also been told that you can ask your doctor to send the prescription to a pharmacy out of town (where you’ll be vacationing) and that that pharmacy will fill the prescription. But I have also been told that that fill is up to the pharmacist’s discretion. Don’t want to wait until I am out of town and have run out of meds for that to happen!

So, what do you to to be sure you have meds before vacation or before traveling in general? Do you have a stockpile like me? Does your insurance do vacation overrides? I have been told that even if you can get a vacation override it is only for once in the calendar year. Are you blessed to have universal healthcare that doesn’t penalize you for filling early? Or do you use something like GoodRX to get a prescription fill a little early before you have to leave for out of town and use that coupon for filling the med outside of insurance approval windows?

I have made a mistake

Recently I have been informed by a classmate that another classmate of mine has died. I ran into the later classmate about 10 years ago while he/she was working at a local coffee shop. Later I contributed to an account/fund to help him/her get through what appeared to be a rough patch due to illness.

When addressing my high school classmates last week I suggested that this person might have been suffering from illness including depression or addiction. Come to find out he/she did have a history of addiction. And that was made known at his/her memorial service.

While I was supposing about my classmate, I wrote a personal account of my struggles with bipolar illness so as to take the secrecy out of anything this other person might have been suffering. It has been somewhat to very destabilizing for me to share this story with classmates for the first time in about 40 years. It has also been destabilizing to realize I was wrong for sharing/supposing private information about this classmate even if it was well-intended.

In any case, I know now it was wrong to try to identify depression or addiction on my classmate’s part. The story was not mine to share. And even if I did mostly tell my story it was wrong of me to link that disclosure to his/her memory.

All in all, I feel like I f*&^%#ed up badly even though my intent was to take away stigma associated with behavioral health including addiction issues and other health concerns.

I just want to say…..

I just want to say for the record that I am feeling very worried about where the Supreme Court is going and its role in creating further divisions among people in red states and people in blue states in the US. I have a general feel of unease migrating toward anxiety or extreme anxiety when I think about where we are as a nation in the US including the prevalence of gun violence in everyday life. I try to put a happy face on it saying at least we have a “functioning” Court system where other nations do not. And that is important. But my anxiety still runs high when I think about how we are going to heal the divide that is currently among us. I don’t see a way out. And that scares me. Am I the only one worrying about this? Or is it just better placed out of sight and out of mind?

Happy Fourth of July to You!

These days I am quite thankful to be living in a place where Freedom is at the core of human experience for the most part. As a person with mental illness, I am happy to have some rights but perhaps not all I wish for. To be fair, I am somewhat to very dissatisfied with the direction of the Supreme Court in this country right now, but I have to say at least there is a Court that exists and exercises its authority to ensure rights for the people however different my interpretation is. I would say that the Supreme Court is not acting in a way that supports my beliefs but I am thankful that we have three branches of the federal Government and somewhere along the way there is or must be accountability. I just hope these recent Supreme Court decisions do not get us here in the US further divided between blue and red states. We have enough divisiveness already! Happy July Fourth to us all regardless of color of skin or color of state!