Sunday, October 31, 2010

The Shame of postpartum Depression

This weekend I had a long conversation with a good friend of mine where she told me for the last year she had been dealing with postpartum depression. And so I asked her if she remembered last January that I sat across from her at a table and told her my story about getting the baby blues around week 6 and then slowly creeping into depression. It crept slowly and really was a postpartum depression. It was a depression for me that was different than my bipolar depressions of not getting out of bed.

It was a depression of feeling worthless, constantly feeling like a bad mother, feeling lack of joy when I should have felt lots of joy. I was weepy for no reason. I was irritable with my husband. And sometimes I just wanted to run away. Far away. I had no desire to see my friends or to talk to them.

And yet during that year I did have many times where I did have joy and pride. I have always felt my daughter is amazing. I love her more I knew was humanly possible. And I feel more loved than I could ever imagine. It is unconditional on both ends in a way that I have never felt before. She makes me a better person, every day.

So back to the original point of this post. My good friend has heard me share some of my experience with depression and I told her that if she ever felt that way she could reach out to me. Email, call, facebook, whatever. I would be someone who would listen & understand.

She didn't call. She didn't email. She didn't chat on facebook.

She was too embarrassed.

I have to wonder -- why do we feel so embarrassed about postpartum depression? It is so common. Perhaps if we would TALK about it we could we could get rid of the shame, the embarrassment and the world of moms would be a better place.

Wednesday, September 29, 2010

Pets for Bipolar Disorder

A great non-medicine treatment for bipolar disorder PETS! I have to admit to being a cat lady. I have 4 cats and 1 iguana. My cats make a huge difference in my life. When I'm depressed one of my cats will snuggle up with me and it does make me feel better.

There was a great video on WebMD's Bipolar TV about Pets for Bipolar Disorder. What I learned was there are Therapy Dogs for Bipolar disorder. Dogs trained to help you remember to take your medicine at the right time. Dogs that have been trained to recognize signs of an impediing panic attack. And therapy dogs are typically covered by insurance.

Watch the video here

Here's an article on the DBSA website about therapy dogs.

Friday, July 23, 2010

Bipolar and Other Brain Disorders - Cluster Headaches, Migraines, Seizures

Sorry, I've been absent from this blog. After my last post I've had some health issues - not related to my bipolar disorder. Actually, somewhat related as it is a temporal lobe problem - which is thought to be in the same region as some of the bipolar issues. At the end of May I woke up with the worst pain I've ever had in my life. It felt like my head would explode. I thought it was the worst migraine I'd ever had.

So I took some Excedrin migraine. That didn't work. I called my doctor and got her to call in a prescription for Imitrex. I took one. It didn't work. I waited and took the second dose. I seriously began to think I was going to die. It would get better and then would come back hours later. It was intense. I have never felt so much pain ever. I've broken bones, I had a baby, nothing compared to this.

And so early in the morning my doctor told me to go to the ER. So I called 911 and got an ambulance trip to the hospital. I had a CT scan. Nothing. They gave me pain killers. And then of course since I'm bipolar for some reason they thought I needed a psych consult. The psychiatrist once he saw me immediately discharged me and said I was fine and I needed to see a neurologist.

In the next 3 days (this was over the weekend) I went to the hospital a total of 4 times. I eventually had a spinal tap and other testing which was all normal. And eventually got into a neurologist and was diagnosed with cluster headaches. Cluster headaches (nicknamed "suicide headaches") are a rare type of headache that are said to be the most painful medical condition known to man. Lucky me.

My migraines which were in remission for years have returned and I'm getting tension headaches regularly too. Severe headaches are like bipolar disorder the can be in remission for years and then can be triggered.

The cluster headaches were like clockwork. Within 45 minutes to 1 hour of going to sleep I'd wake up with the most intense pain I'd ever felt. Needless to say I started to fear going to sleep - which of course for an insomniac is bad business.

To stop the cluster I was post on a 6 day cycle of steroids which of course carry a strong warning not to give to people with mood disorders or insomnia. (Hmmm....) So then I had to go on zyprexa. In the two weeks I gained 25 pounds. Luckily the zyprexa kept me from getting completely manic.

I'm stable now. I'm on Topamax for the headaches (interesting that an off-label use is also bipolar disorder).

Anyway, I really like my new neurologist. One thing I like is she thinks all of these things are at their root related. The bipolar disorder, the headaches, the family history of seizures, Huntington's, etc. I just have faulty brain wiring.

But more importantly - she's not a drug pusher. Drugs are just one part of my treatment. Another part is self-care. It's working on the stress and sleep through meditation and acupuncture. It's eating right and exercise. All things I believe work for keeping me mentally healthy will also keep the headaches at bay.

Another interesting thing ... the number one treatment during the acute attack of a cluster headache - oxygen. And so at 31 I am like an old person. I have an oxygen tank next to my bed. When I have a headache I reach for my oxygen mask. Amazingly within 10 minutes it can reduce the headache - no medicine can take away the headache like that.

Oxygen therapy is good for migraines too ... it doesn't completely take them away but it does lessen them.

And finally a good website for medication information - The Good Bad & Funny About Neurological Medications

Beware it may make you laugh or cry.

Sunday, May 16, 2010

Deplin - A Wonder Blue Pill Vitamin

As I've written about I've been on the mental health roller coaster for most of my life. I've done the anti-depressants, the tranquilizers, sleeping meds, epilepsy meds, mood stabilizers, anti-psychotics, a-typical anti-psychotics, therapy. Pretty much you name it I've done it except for ECT. I've done that involuntary hospital thing too ...

Two weeks ago I started Deplin. It may be my next wonder pill. It's not a true pharmaceutical. It's a purified form of Folate - Folic Acid. I've long been on higher doses of Folic Acid. When you're on epilepsy meds like Depakote & Lamictal they know those drugs inhibit the bodies ability to process folate. When you're pregnant you need even more folic acid to ensure less birth defects.

Technically Deplin is L-methylfolate. In a normal person's body folic acid breaksdown and the final compound is L-methylfolate. Research shows some people with depression and schizophrenia have a genetic problem breaking down folate. It is further compounded by the drugs we are on.

Deplin can only be gotten with a prescription. It is classified as a medical food supplement so pretty much all insurance companies refuse to pay for it. It's funny they'll pay for Abilify, Zoloft, Seroquel, Lamictal, Celexa, etc. but not $77 for Deplin.

This shows just how screwed up our health care industry is. My insurance company in the last 10 years has spent money on lots of drugs, some therapy, hospital stays ... but they say no to Deplin - this $77 prescription is what is replacing 3 prescriptions. Seriously, UnitedHealthcare what a failure.

I throughly believe when treating bipolar disorder we need to stop masking the symptoms and start addresses the problem. Apparently I don't metabolize folic acid the way normal people do. They I get on drugs that make that worse. Then I get more depressed. Seems like $77 is worth a lot more than all those drugs I used to take.

For the record could be coincidence or could be my regular cycle. But the Deplin was started when I was deeply depressed and now I'm doing great. It's been only a few weeks ... we'll see.

If you're currently pregnant please speak to your doctor about folic acid. During my pregnancy I took 3G (not the standard 800-1000mg) so doctors prescribe up to 5G of regular folic acid for pregnant bipolar women.

For more information about Deplin for Depression see:

Deplin for Depression website

Novel Therapeutics for Depression: L-methylfolate as a Trimonoamine Modulator and Antidepressant-Augmenting Agent
(very scientific article for neuroscience journal)

UPDATE: You can get a 20% coupon on Deplin's website:

Also, get your doctor to prescribe the 15mg and you can cut it in half to take 7.5 mg a day. The 15mg and 7.5 mg cost the same amount!

Wednesday, March 31, 2010

A lifetime of experience - how can I help you?

I recently after being completely vulnerable in a group found out someone needed me. Her niece was diagnosed bipolar and unwilling to get treatment. I have written her a long email to reach out and help her. I would like to share that here.

First off remember this when she says hurtful things when she has horrible behavior you did not cause it and she cannot control it. My husband has known me for 15 years. He still does not sometimes get this. It is a hard concept to logically understand. She will continue to hurt you emotionally, but she doesn't mean to. And when she is better she will be sorry for her actions. This is a physical disease this is not just a psychological problem. I sometimes to this day feel like I am too weak of a person, I am not smart enough, I am not strong enough, I caused this. I know logically that I did not do these things to myself. I didn't choose to be bipolar. It just is. It is what it is. I can only move forward - I can help myself and others. (Sorry to sound preachy this is the most important thing for you to learn and is based on a lifetime of experience!)

OK. Let me share that I totally relate to so many things in this story.

I first attempted suicide at 16. Since then I have at various levels actually attempted at least 3 times. One with pills, once with a gun (thank god I it misfired (didn't go off) and that I didn't try again. I am blessed that my husband loves me. At 16 he saved my life - I was actually about 1 hours away from death. I was in a coma. He was 20 and heard something in my voice and drove about 100 miles an hour to get to my house from Orlando to Melbourne. I did not call anyone and say I was going to kill myself and I did not leave a note. I had carefully planned and research how I would do this for at least two years. I was hospitalized for 3 days by the Baker Act (Florida law that you are a danger to yourself or others and get locked up in a psych ward). Long term I got PTSD from that experience got better and then got worse.

I suffered from this so much that everyday of my life since I was about 13 or 14 I wanted to die. And I am not exaggerating every day at least once to this day I think about it. I plan how I could do it and succeed. Some days it is worse than others. When I come to those calls at a zero I am probably thinking about it multiple times. I seriously can spend an entire week in bed.

I was misdiagnosed for over 10 years. That misdiagnosis made me get worse. The disease progressed for longer and I have gone through so much turmoil. There is what is called the kindling effect the more times it happens and the more often it happens the more likely it is to happen in the future and the more it will happen. You have to break the cycle. I have broken the cycle many times. I was once told by my current doctor that I would never last more than a year without a relapse. I lasted 5 years. I was once told by my current doctor that I should never have children cause I can't handle it and it would be detrimental to a child. Years later he supported me and I actually went off all medication during part of my pregnancy. I tell you this because although there is NO cure for this condition ever. There is recovery. It's like a cancer remission. In her lifetime it will get bad again and it will get good. The goal is less bad than good in quantity and severity.

Unfortunately from these descriptions she sound like bipolar I. And perhaps with rapid cycling. This is serious. Bipolar disorder is a spectrum. The diagnosis changes over time. I was once bipolar II (less severe) and am now bipolar I, I was once not a rapid cycler and passed to no cycling passed to ultra ultra cycling, bake to ultra cycling. The goal of course is to first get out of ultra cycling, return to rapid cycling, return to no cycling. What I do know is that I will never pass back to Bipolar II. Not really possible for me. And I accept that. I know the facts and statistics and know that I have the power to make it better but need to accept that in this lifetime it will not go away.

I do believe that one day there will be a cure. They are researching genetic DNA issues to find a cure or a test. For 10 years scientists worked on identifying the genetic mutation and specific disease that causes Huntington's disease. It is a severe genetic brain disorder that leads to death. It is very bad. It is worse than Alzheimer's disease. I currently have a 1 in 4 chance of having this. I have debated for years getting my genes tested. Unfortunately getting the test would reveal my mom's status and since she currently is not symptomatic she doesn't want to know. It does not skip a generations.

I tell you this because the 1993 breakthrough of identifying that specific gene has helped the current research on the bipolar gene. They have been researching the bipolar gene since 1988. Because of you -- I signed up for the study this evening. I will be undergoing blood tests through John Hopkins university. Once they can identify the gene they can more quickly develop treatment and eventually know how to reverse the gene. So there is tremendous hope.

That being said I would recommend the following course of action for you, her family and your niece. This is based on my experience of knowing how to treat someone, how I need to be treated, etc. This is going to be a long-term hard work thing. You have to be prepared to take it one step at a time and understand that you can't fix it overnight or ever. You can however help her tremendously.

Numerous studies have proven that family support is actually more important that medication compliance. This is fantastic for you because even if she is unwilling to get help now you can this very moment be part of the solution.

Here are your immediate action steps:
1. Education. Please read the following blog - this is my story. Some parts are applicable to your situation. And this As you can see I started this almost 3 years ago. I started it before I got pregnant partially because I felt alone I searched and searched for information and I couldn't find what I needed. I have always been all about the research. It gives me hope and I want to share that hope with as many people as possible.

2. Recommended reading: Some is about pregnancy, some is about bipolar as a whole. This book: Taming Bipolar Disorder is great one of the best I've ever read: If you read it you will see me in it.

3. Attend a support group. I recommend Depression and Bipolar Support Alliance.

4. Think about therapy for yourself. This may be a hard step for you. It is a serious commitment of time and energy. In the long term it will help you and her. In this process you will learn how to deal with not only your situation and how it makes you feel as well as how to help her.

The goal of all this is to get her to take the following steps:
1. Hit rock bottom. This may sound horrible but if you hit rock bottom you get better. You understand the magnitude of the situation and you will get treatment. Everyone's rock bottom is different.

2. Education. The only way she will break through the denial is through a true understanding of her disease. She must accept the diagnosis and be willing to move forward. You taking the steps above will help her get to the point that she is willing to seek treatment.

3. Psychiatry & Medication - The only true course of action currently is heavy drugs. She needs to get on an anti-psychotic, she needs a mood stabilizer. She may need hospitalization. There are tremendous downsides to medication - side effects ranging from weight gain to temporary or permanent hand tremors to PTSD. All of these side effects can be managed and fixed. The outcome is better than the short-term side effects. And every person reacts to every drug differently. Please call my doctor Dr. Feldman see if he is taking on new patients. He is the best doctor I have ever seen.

4. Disability. Bipolar is a severe mental disorder and disability is possible. And I know she would qualify on the disability. Her financial situation will determine the amount and the length of time she is eligible. If she has too many personal assets there are strategies to move money to make this a resource that works. I can give you the name of people I know who have done this.

5. Exercise, Nutrition, Supplements. These are long term key to her recovery. But they are not an immediate fix. We can discuss this further. But basically the food she eats and the environment we are living in both culturally and physically is poisoning us. I sincerely mean that based on the research. Bipolar disorder and the severity is getting worse every year. It is worse here than in third-world countries, however we have better treatments. We have the possibility to have lasting change.

6. Suicide line. I've called before. They are really helpful. It is confidential. They can talk you down.

7. Hospitalization. You can get her committed right now. You are a family member. All you have to do is call submit a form. This at some point may be your only option if she doesn't get help soon. This may be the best thing to do today. Only you and the family can decide that. She will be hospitalized for 72 hours. In that time she will be forced to be medicated. She will attend support groups and one on one therapy. Be prepared that she may hate you for this in the short term. In the long term she will be grateful that you cared enough about her to take drastic steps.

Let me leave you with the following ... you have the power to change this for her. It will be hard for you. It will be harder for her. But she will get better ... and your help makes all the difference.

She is so lucky to have you in her life. I guarantee you that you through some action you have kept her alive this long. Your willingness to let her live with you probably has saved her life already. And I want to be part of your solution. I have touched hundreds of people. I have helped friends and family, I have helped people in support groups, I have helped people online through my blog and I have helped people through participating in clinical research studies which potentially can affect million. I am currently trying to get into 3 different programs. I am willing to help you in whatever manner can support you. I don't have all the answers but I am committed to helping you find them through my advice, through my willingness to let you vent, scream or cry, through my willingness to research drugs and new therapy options. Tell me what you need I will do everything I can to help you. And I sincerely mean that. Do not hesitate to call on me.

Even though this sucks on so many levels. I sometimes think this is a blessing. It is my calling to help people. I have a very powerful gift and one day I will figure out the right combination of how I can help more people.

With much, much love,

Sunday, February 28, 2010

New Blog - Bipolar Motherhood

I've started my new blog - Bipolar Motherhood. Check it out.

Pregnancy and Medications

I get a lot of email asking if and how much medication I was taking during the pregnancy and if I felt it affected my daughter. So I wanted to post about this important topic.

First, I want to start out by saying I believe that every bipolar woman has to make the choice for themselves whether to take psychiatric medication during pregnancy. I primarily hear three things:
1. The mom-to-be doesn't want to take any medication
2. The OB/GYN or psychiatrist has told them to get off all medication during the pregnancy.
3. The mom-to-be doesn't think she could last the whole pregnancy without medication.

This is a very personal issue and decision that should be made with lots of planning.

Here's my story. I have bipolar I disorder with psychosis (which means I have been through psychosis in the past not that I am currently with it). I firmly believe that medication keeps me well (or at least helps me stay better). Given the severity of my past episodes I didn't think it was wise to stay off all medication during the pregnancy. I have been criticized by a few women for this choice, but my gut and instincts said for me it was the right decision. I did however not want to be on medication during my first trimester which is the riskist time for birth defects. I planned for about 8-12 months before getting pregnant to lower my medications so that I would not abruptly stop them when I became pregnant.

I was all psychiatric medications during my first trimester. The only drug I took was Zofran for my hyperemesis (excessive vomitting). When I reached my second trimester I went back on Lamictal and remained on it to this day. I did not think that I would stay well during my pregnancy without the medication -- I didn't want to risk a relapse.

I don't think that my daughter has had any problems from the medication I was on during the pregnancy or breastfeeding. In fact she is ahead of the curve on pretty much everything. She's amazing.

I'll write more soon ...

Thursday, February 11, 2010

Safety of Polytherapy Anti-convulsants (mood stabilizers) During Pregnancy

The North American Antiepileptic Drug Pregnancy Registry is pleased to announce findings on the comparative safety of some combinations of anticonvulsant drugs. We have previously published our findings regarding phenobarbital, carbamazepine, valproate and lamotrigine taken alone as monotherapy. Since we have analyzed the rate of malformations in infants for each of these specific drugs when taken alone, we wanted to investigate the effect they might have on the prevalence of major malformations when taken in combination.

A common perception in prescribing anticonvulsant drugs during pregnancy is that the combination of two or more drugs harbors a greater risk of major malformations.

Read the full study on drug therapy during pregnancy

Wednesday, February 10, 2010

BlueLite Therapy, Dark Light Therapy?

I've spent a lot of time researching the different light therapies this past month. I have decided I really need to take a more natural approach to my treatment. Even though I've been on multiple mood stabilizers, antidepressants and even an anti-psychotic I still have not been able to get my cycles under control.

I haven't really talked about this much here, but I really do believe that to this day the effects of my pregnancy have not been corrected. Let me explain. Prior to becoming pregnant I was completely stable for 5 years and on only one medication daily (Lamictal) and as needed sleep meds (Ambien & Sonata). I had to wait till I was really stable before I felt confident that I could have a baby. I honestly felt a little like I was "cured" after having NO mood issues for 5 years.

Prior to my stability I had a severe manic episode where I went into psychosis. My official diagnosis has been Bipolar 1 with Psychosis. I remember my psychiatrist once telling me that statically with the severity of my illness I would most likely even on meds relapse at least every two years if not more. And that over my lifetime I should expect a worsening of the disease. He also told me that I should consider adoption and not biological pregnancy. It was a devastating diagnosis.

Fast forward 5-6 years and my doctor thought having a biological baby was no problem and he even weaned me off all meds for my first trimester. He told me he has never seen a patient that had recovered as well as I had. This was a huge triumph.

Fast forward to two years after having my daughter and I had postpartum depression and then began a rapid cycling. I am now classified as a ultra rapid cycler - it's not a good diagnosis to have.

And back to our scheduled programming -- Light Therapy

I've gotten the 'Philips goLITE BLU Light Therapy Device'. I've been using it everyday for about 2 weeks. And I notice a huge difference in my energy level and mood. I am a big believer in the blue light.

Here is some interesting reading about Light therapy.

Tuesday, January 12, 2010

Are Antidepressants not any better than the placebo effect?

Interesting article in the New York Times about an antidepressant study which concluded that antidepressants aren't any better than the placebo effect for mild to moderate depression.

Before you Quit Antidepressants

My personal experience with antidepressants has not been that positive, granted I have bipolar disorder and not major depression.

As a teenager I was on Prozac, and looking back I'm not sure that it did any good. At the time I was diagnosed with major depression and an anxiety disorder. Bottom line: I attempted suicide while on Prozac.

Later I was on Paxil and it lead to severe mania with psychosis. Which is no surprise since it is risky to put bipolar patients on antidepressants without a mood stabilizer.

Later I was on Wellbutrin and had a seizure.

I was recently on Zoloft and my depressions got worse not better.

What is your experience with antidepressants?

Thursday, January 7, 2010

Sun Exposure and Exercise as Treatment Options

The past 7 weeks has been very challenging for me. When I look back I realize that almost all Nov/Dec for the past 6 or 7 years has been a major challenge. This year I threw into the mix stopping meds right before Thanksgiving. It may not have been the best timing, but I don't regret that decision.

This year I suffered from varying levels of depression for most of December and had some mild hypomania for the second half of Nov. Throw into the mix all the family obligations, holiday hoopla and you have a recipe for disaster.

My psychiatrist's solution was to suggest going on Geodon or Lithium or Seroquel. All of which I have decided not to do. Why? Even though I have had big problems for the past few weeks, I'm not willing at this point to put more medicine in the mix. Don't get me wrong, I'm not anti-medicine. I'm still on Lamictal daily Ativan and Sonota as needed, however I have been trying to keep those at a minimum.

My doctor's latest thought is that I might have problems with Seasonal Affective Disorder. So his recommendation is that I sit in the sun for 30 minutes a day, every day, regardless of the weather. Another option is to get a light box. The problem with the light box, seen here, is that they have been known to switch people who have bipolar into mania. So instead I'm sitting in the sun, well this weekend I wasn't because it was way to cold - so I need to find a sunny window somewhere for times like these. Luckily I live in South Florida which is normally warm and really sunny.

The other thing my doctor has "prescribed" is more regular exercise. I've written about exercise many times on this blog. I'm a big believer that exercise can be a better treatment than drugs ... and the research shows that to be true. Here's an excellent article about bipolar disorder and exercise from McMan Web. In that article they talk about a study which showed that study participants who were put on a exercise regimen had lower relapse rates than people taking Zoloft for depression.

Anyone who knows me knows that before having my daughter I used to exercise 1-2 hours a day 6 days a week. And since I had my daughter I certainly haven't maintained that level of disciple. Back then I was stable for 5 years only on Lamictal. Now I wonder if it was really the exercise that kept me sane.

So my New Year's Resolution, 30 minutes of sun and 45-60 minutes of exercise every day. And to keep on track I've got a chart that lists the week and a column for exercise and for sun. And everyday I get a star when I do them. The chart hangs right above my daughter's potty training chart.

This year I have vowed to staying mentally healthy my top priority. I really would love to have a second child, however I know that I can't do that if I keep up my current cycle of depression and hypomania.

So here's to a new year, with new goals.