Can You Learn to Limit the Impact of Your Next Break?

This post was inspired by a recent post at SpeakingBipolar.com.

About 30 years ago I met a psyche doctor who told me the more often you have a break, the greater the likelihood of having a break again. This was directed at the highs and lows, and this doctor requested me to go off alcohol which I have for 30 years and caffeine (which I did for 12 years and then stopped). Knowing this propensity was a great motivator in seeking and obtaining good self care including meds and other forms of care over the years. I tend to call this managing risk. If I manage or minimize the risk of one break, in theory I am (or am I?) managing or minimizing the risk of that or a similar break occurring again in the future.

This seeking good self care and med management and risk management did not start immediately for me but did begin once I was on Clozapine in 2008. This was my bottom out low is as far as it goes time.

Using this logic if it is accurate means that in some respects if I can “learn” from a prior episode, I am more likely to be successful in staving off or managing severe bipolar symptoms the next time. One success begets more success.

So how do you get to the place where you are learning not to break from current or on-going trauma? How can managing a current break help to minimize the risk of a future break? These are steps that I take. They don’t always work 100% of the time but they do help me learn to go around an episode and/or lessen its impacts and/or avoid another one head-on that is so severe that hospitalization is required. This has been the case since 2008 — fourteen years.

  1. I keep a journal of thoughts and self care and regular activities and feelings on a daily basis. A quick sentence or two for each day is all that is needed. I share the journal with my therapist.
  2. I get psyche meds prescribed from a psyche doctor and stay with the regimen. (In the past I have not done this.)
  3. If the regimen is not working I negotiate a change with the doctor.
  4. I keep in regular contact with my therapist. I seek to be as transparent as possible. Secrets tend to create a life of their own.
  5. I read my journal back to myself and see if I am acknowledging and managing triggers or not. This requires knowing what my triggers are like poor sleep, taking too much on in the day, talking down to myself, limiting that internal critic and so forth.
  6. Also I give myself credit for making baby steps in my journal. Perhaps I did not walk 2 miles every day for a week but did walk 2 miles for 4 days last week. Tell myself how much progress this is. Give myself credit for baby steps instead of listening to the critic talk that I am not doing enough.
  7. I get as much exercise as my mental health will allow. I start with small steps like a half mile walk and gradually build up to 2 miles plus. Or practice yoga with a class or on my own.
  8. Tire out my body in order to tire out that mind.
  9. I reach out to my support circle and let them know how I am feeling. Sometimes just acknowledging how I feel tends to diffuse the tension. It helps me to know others are aware I am having an off day.
  10. Eat well if and when I can. Avoiding empty calories. This includes accepting body image impacts of taking meds – ie. weight gain.
  11. Reach out to a friend I haven’t talked to in a while. Arrange a time to meet and walk or just enjoy talking with that person over the phone.
  12. Remind myself that there are always those who are struggling as much if not more than I am. This does require being part of a community. A church community, a mental health community, an on-line mental health community, a neighborhood community? A community hit by hurricane Ida? I seek to reach out and make some sort of contribution to the communit(ies)I am a part of. It helps me to know I can be of help to others even when I am not at the top of my game.
  13. Finally, be kind to myself. It is not my fault I have bipolar disorder. It is not my fault that certain consequences and behaviors trend to follow that diagnosis. I have to learn to forgive myself for sometimes “crazy” or ill-conceived acts. Ill-conceived acts here refers literally to acts I have taken while ill. I seek to forgive myself as readily for those acts as I seek to forgive others.

What do you think? Do you think we have any control over the propensity to have a full-fledged breakdown over time? If we cannot entirely steer clear of it can we at least learn to experience less dramatic highs or lows? Does this argument erroneously assume that the patient has the power to learn a better outcome or is the outcome already set in stone?

Sleep: When is too much of a good thing or not?

When I was in the early stages of bipolar disorder, a gap of 2 nights sleep was a trigger that I might need to be hospitalized for bipolar disorder or go to my sister’s house for in-home care.

Some 25 years later, I find that sleep is also an indicator of how I am doing with the bipolar. If I have interrupted sleep or sleep less than 7 to 8 hours, the next day is a struggle and a warning sign for the next few days to come that things are fragile.

In semi-retirement and as an empty nester, I allow myself more sleep than I normally would. I go to bed around 9:30 or 10:00pm and wake up between 8:00 and 10:00am the next day after several interruptions in the night. I know some people might see this as a sign of depression. I actually don’t. I have come to rely on the good nights sleep with clozapine since 2008. And this sleep generally helps keep me feeling relaxed and less anxious through the day. It is not a cure-all for anxiety, but being well-rested does mean I am less likely to expect the worst in whatever situations cross my path that following day.

I am not tied to the schedule of ten to twelve hours per say. I do get up and go to early doctor’s appointments and the like. I just like being completely exhausted of the need to sleep. If I can put it that way.

Precursor to “Grandiose Thinking”

This is an addendum to a prior post. Please be advised that this post could be a trigger for escalating thoughts or grandiose thoughts.

I was often rewarded particularly by one professor in my school work in college for making connections between things that were not necessarily apparent. Seeing these “connections” was at the time part of my academic prowess and landed me graduation with honors. That professor indicated among other things that I had “preternatural abilities” in my observations.

As I look back on it now, I see these academic exercises as somewhat of a breeding ground to years later experiencing grandiose thinking. If making these connections meant I would get an A or an A+ on a paper in college, that was evidence (to me) that my connections between seemingly disparate concepts were “correct.” I am not really faulting the professor here which I might, but I am saying I got really good positive feedback for making these “connections” while in college. Perhaps if I had gotten C’s on these types of papers or assignments I would not have felt that my escalations of thought were well-grounded in reality nor laudable nor applaudable. Perhaps I would have been less inclined “to go there” in my thoughts.

At this day and age some 40 years later, I can usually see when I am escalating in my bipolar thoughts. This escalation does not bring me good grades nor a feeling of well-being or accomplishment or safety, but rather it creates difficulty in managing my bipolar thoughts and my bipolar disorder and might just be what has sent me to the hospital these several/many times over the years. Three cheers for being the B or C student?!?!

More on Safety and Bipolar Thoughts (updated)

Please note: This post may trigger people who escalate in thinking from a small manageable thought to large-scale or world-wide impacts and import or grandiosity. The post includes some discussion on the topic of grandiose thinking.

In my last post I talked a lot about anxiety and depression associated with bipolar illness. I concluded that safety is a number one issue for me. Safety that I did not experience as a child. Safety that I did not experience in college.

To be fully transparent about safe and unsafe, I have been exploring my thoughts around safety both physical and mental.

For me, I experience fear pretty readily for things impacting my body like fear of heights, fear of motorcycles, fear of downhill skiing. But my relationship with my own thoughts does not show such a clear division between safe and unsafe thoughts.

As a person with bipolar illness, I have very often “allowed” my thoughts to escalate from a very specific topic to world-wide impacts. I believe it is part of the bipolar disorder to escalate thinking at level 2 or 3 out of 10 up to 11 and beyond. What was an small observation about priorities or concepts at the local level quickly escalates to a topic of global import (in which I perceive I am involved). I believe that tendency is often present in a grandiose thought processes.

Today I want to talk about what those escalating thoughts do to me. While it is my nature to escalate because of the bipolar, I do not always feel safe in doing so and more often than not do not regularly want to escalate. In this post and later posts, I would like to explore my ability to “choose” the extent of escalation in my bipolar thoughts. Upcoming in other posts, I would like to talk about how it may be a choice to a certain extent to let thoughts escalate instead of practicing living in the here and now.

If I can see my pattern of escalation over the years, am I not armed with the ability to leave those initial thoughts alone at a “safe” level and not make everything about a crisis or drama on the worldwide stage?

This is all I have for now on the topic of safety. Will follow-up as this work-in-progress continues in the upcoming weeks.

Addendum: I was often rewarded particularly by one professor in my school work in college for making connections between things that were not necessarily apparent. Seeing these “connections” was at the time part of my academic prowess and landed me graduation with honors. That professor indicated among other things that I had “preternatural abilities” in my observations. As I look back on it now, I see these academic exercises as somewhat a breeding ground to years later experiencing grandiose thinking. If making these connections meant I would get an A or an A+ on a paper in college, that was evidence (to me) that my connections between seemingly disparate concepts were “correct.” I am not really faulting the professor here which I might, but I am saying I got really good positive feedback for making these “connections” while in college. Perhaps if I had gotten C’s on these types of papers or assignments I would not have felt that my escalations of thought were well-grounded in reality nor laudable nor applaudable. Perhaps I would have been less inclined “to go there” in my thoughts. At this day and age some 40 years later, I can usually see when I am escalating in my bipolar thoughts. This escalation does not bring me good grades nor a feeling of well-being or accomplishment or safety, but rather it creates difficulty in managing my bipolar thoughts and my bipolar disorder and might just be what has sent me to the hospital these several/many times over the years. Three cheers for being the B or C student?!?!

More on Bipolar Depression and Anxiety

It has been about three weeks since my husband and I dropped my daughter at college in New England. There was one day out of about 5 that I was extremely anxious on the border of being non-functional. I have bipolar illness and do not travel well and do not do so well outside my daily routine.

Since my husband and I have returned from this trip I have felt depression kicking in and replacing some of my chronic anxiety. I have talked to my therapist about it and am currently exploring whatever linkages there may be causal or correlative between my depression and my anxiety.

Depression has a certain feel. Anxiety has a certain feel as well. I can tell the depression is coming on due to a generalized feeling of dread and a physical expression of being low energy or down in my mood. It is like a wet blanket all over everything. This feeling of depression is very different from my generalized anxiety. With the anxiety there is always something specific that I am worried about. The source of the anxiety has a specific source in mind: Did my daughter find out how to print her assignments? Is my daughter eating well and eating enough? Is she isolating or making friends? Are her finances for groceries in order?

However with the depression there is not such a direct connection to current events that are on-going in my daughter’s collegiate life. Instead, the depression appears to be me re-living my experiences and hardships in college and projecting them onto my daughter. The depression is not so much about what is going on presently and how can I fix it by being a helicopter Mom (stated objective is to move from this helicopter to supportive Mom) as it is a replay or reminder of events from my past that were not fun at all at the time I was in college.

My depression is all about me resurrecting or reliving past experiences that occurred to me and with me in college. During college was when my bipolar started so that may help to explain things.

The depression is a general malaise. The anxiety is tied to specific details of my life or my daughter’s life.

What does this indicate about the relationship between my anxiety and my depression? I have largely been somewhat anxious since I began treatment with clozapine in 2008. I have not really experienced a depressive state since that I can recall at this time. My current struggles from depression have really just started since we got home from dropping my daughter at college.

If the anxiety is generally topic specific, the depression and malaise are generally not so much so. The anxiety is hard to contain and hard not to push onto other people in my life including my husband and my daughter – as if this impacts my boundaries with each of them. The depression for the most part is not so invasive to boundaries as it is something I sit with while those around me continue with their lives.

I keep asking myself which is better and which is worse? If I am imposing my anxiety on others, that feels like a worse way of managing my health than experiencing my depression and allowing those feelings to occur so that feelings and emotions are not so much being projected on those around me. My depression like it or not is mine while the anxiety I experience is a state I extend to others in my life while not meaning to.

So what is the connection if anything between my anxiety and my depression? Is it possible that underlying all those anxious thoughts about school schedules, meal routines, printer access, train trips at Thanksgiving is a generalized experience of depression that is difficult to distance myself from because the depression echoes experiences of depression or uneasiness when I was in college. If I confront my demons about my own college experience more fully, will I be able to stop experiencing and therefore projecting that experience on my daughter in terms of anxiety checklists?

Can I learn to allow my own college experiences to flow through or wash through my emotional registrars and stand up and say: This was not a good time in my life (for reasons explored in other posts) and I do not wish this on anyone including my college aged daughter. If I can release these depressive experiences as I relive them on my daughter’s college timeline, can I be less likely to project my specific anxieties on my daughter? Is the depression the root cause of the anxieties? Or do they just co-occur? If I finally came to terms with what happened to me during my college years, would I be less likely to project worries upon my daughter or to extend checking behaviors to her.

Bottom line is that I did not feel safe when I was in college (for a variety of reasons outlined in other posts). Now some 40 years later can I just own the fact that I felt unsafe and that I currently do feel safe more or less. If I can recognize that safety is an issue of the past and not so much of the present, will there be less room for that litany of anxious thoughts about this and that specific thing to occur?

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.

Happy Easter Everyone!

Hello all. I hope you are having a great Easter Sunday or whatever holiday you observe (or don’t observe)! Today I am focusing on being grateful. Even though I have persistent anxiety from my bipolar illness I have lots and lots to be thankful for: my daughter’s health, my daughter’s achievements in school, my husband’s companionship, my Mom’s relatively good health, our new puppy, a psyche doctor and therapist who I trust and consider in my support circle , constant help and support from my sister, and the list goes on….

Can you find it in your heart to be thankful for something today? Even if it as simple as that cup of morning coffee? I hope so.

Have a super day!

Do you experience inertia surrounding your to-do list for the day?

There are days when I feel like getting things done and there are days when I don’t really feel up to doing much. This post is about the days when I don’t feel like doing much of anything.

I am a planner so I always have a list of things to get done each day more or less. Some days are busier than others. Some days are more motivated than others. This post is about the days that I don’t feel particularly motivated and/or may also feel that I am just not up to the task of going to the grocery or fixing a home-cooked meal that day.

So I am assuming we all know what inertia looks like on those days when the to-do list is not a source of help for organizing the day. Inertia looks like: I don’t feel like doing anything other than the most rudimentary things like caring for the dog or taking a bath or shower and maybe not even these items. Additional items on the to-do list are just more a source of stress than anything else. It is as if there is a pile-up accident on the highway up ahead and I am just caught in a huge traffic snarl and cannot get through the pile-up of vehicles (to-do items) up ahead on the highway. In other words, I just don’t feel like getting things done.

So what is it that can help with all this inertia and being caught in a multi-car pile-up (metaphorically speaking)? I have found that there is not a cure for this inertia. It rears its ugly head from time to time and does not truly disappear. I am certain it is a by-product of depression associated with my bipolar condition. But there are some ways of managing this inertia or countering it.

I find that if I can muster the energy to do just one small thing on my to-do list for the day like the simple act of emptying the dishwasher, I am all of a sudden ready to tackle another thing that is important but may or may not be on my to-do list for that day. And the trend continues to a third or maybe even fourth item on the list (or off). The key appears to be true to the idea of inertia. If I set my body in motion (by acting on the dishwasher) I have a tendency to keep moving forward (by either doing another item on my to-do list or some other task that may be equally important).

This also means being flexible with the items on my to-do list. I may be motivated to do items not on that list and need to be aware that doing these items is progress even if those items are not on the original list for the day.

Inertia exists in both directions. A body will stay at rest if it is put to rest. A body will be set in motion if there is movement. This idea of setting a body in motion really helps me get over the hump in my day and move onto the next item on my to-do list. It is a matter of changing the force of inertia for the day from a resting place to a movement place.

For example, I did not feel like doing much today and did not feel like going to the grocery store at all. I was able to get the dishwasher unloaded and felt afterward good about writing this blogpost and did. In the meantime my husband went for a short grocery run and I was somehow able to plan and prep for a nice home-cooked meal of marinated salmon steaks, couscous and cabbage. My day went from standstill to pretty busy and fairly fulfilling.

Does this inertia metaphor ring true for anyone else? What helps you to pick up your to-do items when you are not motivated to do so?

Graphic Visualization of Moods: Does It Help?

It is helpful to me to have a graph of my moods for the day and for long-term.

For bipolar illness it is pretty common to visualize two parallel lines with moods going up and down between those parallel lines. So a person with no bipolar disorder has the same set of parallel lines but the lines are only say 6 points apart – 3 up from zero and 3 down from zero. If 6 units wide is a “normal” mood range, a person with bipolar illness might experience a range twice that wide at 12 units – this is 6 units up from zero and 6 units down from zero. As I have said before, this image of more accentuated mood swings is a pretty standard way of talking about the highs and lows of bipolar illness. Also it has been said that bipolar illness mood swings are similar to normal mood swings – it is only a matter of degree. I might contest that assertion in that bipolar mood swings may be accompanied by anxiety and/or psychotic experience.

So if bipolar mood swings are say twice as high and twice as low as regular normal mood experience, what does the graph look like on any given day? For me there is a pattern to most days that is helpful for me to visualize. Generally, the first moment I wake up is the most anxious. I would start this day’s curve on the high end. As I take my morning meds and wake up to face the day, my mood starts to level out. Late morning and early afternoon are when my day starts to become more productive and with that my anxiety tends to get more under control. Dinner is often a chore to get together but typically this is something I enjoy, so the anxiety seems to be at a low point at dinnertime. After dinnertime is usually my time to watch the news and part of a movie or a TV series. This time is spent with my husband and is generally very relaxing – my anxiety is at a low point in the day. Around 8:45 to 9:15 on a weeknight I go to bed early. On a weekend it may be a couple of hours later. It should be mentioned that this pattern is generally the same whether or not it is a weekday or a weekend.

So for a visualization, my anxiety starts at a peak in the morning when I awake and typically falls as the day progresses. Depending on the day there may be small dips here and there as the anxiety dissipates or spikes here and there as the anxiety surges. By and large this curve maps the moods of my day. If I am able to get something done on my todo list in the mid day to afternoon timeframe, my anxiety abates pretty regularly. It is as if I have to get past a small spike in anxiety in order for that anxiety to continue to drop as the afternoon and the day progresses.

This post would be that much better if I could provide readers with a picture of what I am talking about — so sorry that my blogging abilities do not incorporate importing a picture of parallel mood lines on the one hand and an anxiety curve dissipating generally as the day progresses on the other hand.

Does this graphic description seem relevant for others with bipolar and/or anxiety disorders? What is the same and what is different about your mood curves?

What Does It Look Like to Be in Mental Illness Maintenance Mode?

This is just a bit of musing on being in maintenance mode with bipolar illness. At times, I have called this maintenance mode being in mental illness remission. Due to the specifics about what is illness remission and what it is not, I am choosing today to talk about where I am in my history with bipolar illness as “maintenance.”

What does bipolar maintenance look like for me?

  1. Being on a largely functional cocktail of meds that are monitored by a psyche professional. I adjust these meds slightly with the help of my doctor when I am going through extra stress or when stress is more manageable. I have been on the same basic meds since about 2008.
  2. Seeing that psycho-pharmacologist about every three months with monthly trips to the lab for bloodwork. It is important to me to be honest with my doctor and to have the type of relationship where I can work with him to adjust med levels when needed.
  3. Seeing the therapist about every 2 to 8 weeks. Every two weeks is if I am in a rough patch. Every 8 weeks if all is progressing well. Back in 2008, this was weekly. Mostly now it’s every 4 to 8 weeks.
  4. Not having to be admitted to the hospital for 2 plus years. For me this has been since fall 2008. I have been informed that not being hospitalized for a period of time, in and of itself, does not qualify as remission. But the stats seem important to me to include as at least one barometer of remission and/or maintenance.
  5. Having several activities like blogging, care of pets, walking or yoga routines that are by and large fulfilling if not enjoyable. I find that with the anxiety and depression that I experience with bipolar illness, my activities are sometimes fulfilling and sometimes not. Getting them done is what I count most. There is “enjoyment” or “satisfaction” in getting them done even if at the time, the activities themselves are not particularly “joyous.”
  6. Being able to manage day to day activities in the household. These for me include being supportive to my teen-age daughter, keeping my relationship with my husband current and vibrant, running the household, going to the grocery on a regular basis, getting a healthy dinner on the table each night, doing basic laundry and clean-up, caring for a new puppy. This does not require me to hold down a job which has been a struggle for me since 2005 or so or perhaps earlier.
  7. Seeking out regular contact with friends and contacts who are supportive of bipolar illness. I have had a neighbor who is close to me move about an hour away from where I live, so I could make some improvements in this area. We used to talk openly about stress and anxiety on regular walks. It would be great to resume this activity virtually if possible. Blogging also does help create a sense of community support. I have been blogging regularly for a couple of years and this is very fulfilling — both the reading and the writing of various posts.
  8. Doing something tangible to reduce stigma about mental illness. Instead of being the victim of mental illness stigma, I have found it empowering to write about stigma in my journaling and in my blogging. It is important to get out in front of the stigma and try to tackle it and talk about it before it becomes a big deal with big deal consequences. I have found it difficult to address stigma, but I also have found that talking about it and educating people who have no prior exposure to mental illness is important. I have just written a series of blogs about mental illness stigma and working as a project manager. Hopefully that perspective when shared may mean people who have no prior connection with mental illness can at least read about what it’s like to experience that stigma.
  9. Talking and educating people who have no connection to mental illness seems to be at the top of the list for me for stigma reduction. Stigma reduction does not happen immediately or overnight, more like a small, small drip into a large, large pond. Very small change but change nonetheless. Also to note, there is real danger of preaching to the choir about mental illness stigma. Most people who might follow my blog probably already think stigma is an issue. In stigma reduction, it is important to find ways of reaching people who are not yet educated on mental illness and its challenges.
  10. Finally, being in maintenance mode for me means being able to be kind to myself. This means forgiving myself for mistakes no matter how large or small. This means giving myself credit for accomplishments achieved no matter how small they may seem – like going grocery shopping for healthy food that day. This also means not comparing myself to others in a way that makes me feel “less than” or “more than.” Maintenance mode means being willing to accept constructive criticism from my support team even when that criticism is difficult to hear. It also means standing up for myself when the criticism may not be “spot on.”

Does anyone else care to share what mental illness maintenance might look like to them?