Furious Seasons

December 05, 2006

Whatever Works

I had planned on doing some other posts for today, but since a few readers have asked for it as in right now, here is my own personal self-help, self-awareness, stay-out-of-the-psych-unit, any-fucking-port-in-a-storm guide. I want to caution that this is a highly personal approach developed over 18 years--it probably only makes sense for me. My bipolar disorder isn't your bipolar disorder, and I am highly self-aware--an "expert patient" to use what's becoming a popular term. I prefer "bipolar OG," but whatever. I should stress that I am not addressing schziophrenia, psychoses and pacic attacks. Maybe another day. But, if this helps others as a starting point, then goodie. Adapt and improvise, people.

In no particular order:

1. Have a good relationship with yourself. Know yourself. You may also find this useful for life in general.

2. Have a good relationship with your doctor, therapist, counselor, etc. If you don't, get another one. And, remember, they work for us, not the other way around.

3. Have a good relationship with your family, lover, friends, booty call, whatever.

4. Have your finances squared away. Rich, poor or middle-class, it's imperative that you don't have financial worries hanging over your head. Money is one of the biggest triggers I know of. I have seen a sudden overdraft reduce people into the foulest depressions...over $50.

5. Have a good working knowledge of your moods, triggers and so on, as well as a good sense of the warning signs of an on-coming mood shift. For example, when I feel myself getting agitated and pissy, I know that I am about to head into some nasty depression. When I am suddenly smoking more than a pack a day, I know I am off for hypomania.

6. Act on your mood shifts before they act on you. I've gotten pretty good at heading off descents into depression, or at least into deep depression. I haven't had an actual DSM-approved manic episode in many years. Hypomania? Oh, I roll with that. But that's me.

You need to know what works for you. Here's what I do, and, yes, I realize that my methods are unconventional, but they are preferable to the alternative:

a. Realize that you don't have much time to work with. You must take action as soon as you recognize what's up. It is not time to fuck around and wonder if it'll pass. It might pass for a few hours, only to come on like an anaconda 6 hours later.

b. Eat. Food can shut down screwed-up moods faster than anything I know. It's not a cure, but it beats falling into crisis mode. And I am not talking good nutrition here. I will take an apple or, alternatively, reheated corned beef hash over an episode of depression any day. My research indicates that corned beef hash works longer than an apple!

c. Keep an emergency med on hand. This is something for people to work out with their individual docs, but you ought to be able to make a case to them that you know what you are doing and can be trusted with a small script of whatever to knock the bad stuff down. It beats having to call the doc in the middle of the night or go to an ER.

From the mid-90s through about 2000, I used to have a small bottle of Mellaril around. That's one of the old school antipsychotics that's fallen out of fashion. But 40 mgs. of Mellaril can knock down manic spins, rapid cycles and spirals into depression. It can help you sleep as well. Unless you are really manic, then you need to take other measures. But for heading things off, it's pretty good dope. You won't want to take it for more than a couple of days.

I think that Seroquel, in small doses, is now a pretty good substitute for Mellaril. At least for me. When I know I have no other choice, then 50 mgs. of Seroquel is a fabulous option. Yeah, my head will be all foggy in the morning, but whatever. See, I told ya' I had nice things to say about atypicals!

I am also a big fan of Ativan (lorazepam) and its benzodiazapine cousins. These are also highly-addictive drugs and must be handled with care. You don't want to have to beat a benzo addiction is what I hear on the street. My doc lets me have a script of 15 1 mg. pills. I take one when I feel the universe turning against me or when I feel the onset of agitation, and I can almost always beat whatever is going on very quickly. If not, then it's time for Seroquel. I find that if I need to take an Ativan--and I stick to 1 mg, no more--for more than a couple of days in a row, then I know it's definitely time for Seroquel.

7. Sleep. You must sleep. Obviously, Seroquel and the like will help slow you down enough for shut eye. In addition, turn off the TV. Read until you are bored if you must. Make sure your bedroom is completely blacked-out.

8. Limit sudden noises. When I am in an agitated state, there is nothing that triggers me more than sudden noise. Ear plugs help. So does a quiet part of town. So does not leaving things on the floor that kitty can play with all night. Turn off the phone, if you must.

9. Get the hell away from the computer. I don't know what it is about computers and the 'Net, but they are the stimuli from Hell. Turn them off. Now.

10. Continue taking your regular meds. Even if you don't think they are working well, sudden med shifts can cause more problems than you'd think. This is something to take up with your doc. After things chill out a bit.

11. Get out of the house. Unless you are on the verge of punching everyone on the street, you need to get outside and break your indoor, isolating vibe. Preferably several times a day. If you have to drive to get anywhere, then be really careful. You don't need to be triggered by some dumb ass cutting you off at a stop light.

12. Realize that this will pass. And life will go on. And it'll be alright.

13. Don't harm yourself. Don't take down certain objects of injury and stare at them. It's a bad idea. Just ask Kurt Cobain. Don't cut yourself. Don't do any of that shit. Symptoms are temporary. Death isn't.

So that's my casual list of emergency self-management tricks. It is not inclusive and does not address things like rampant paranoia and the like. There are a few other tricks, and maybe I'll get into them another day. So what do you guys think?

If anyone wants to know how successful this approach has been for me, consider: In 18 years, I have never been in a psych unit (except as a reporter) and I have never wound up in a jail (except as a reporter). Not that I haven't been acute enough to go to a hospital, but I am just very good at riding things out for a couple of days. And convincing friends and cops that no, they need to give me a few hours and let me take things down a peg or two on my own.

It works for me. What works for you?

Comments please.

Posted by Philip Dawdy at December 5, 2006 12:01 AM

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Comments

Thanks for that Philip, just sharing regardless of individual techniques is something in itself. Helps with the alienation. Alienation is a big part of it, feeling like a subhuman thing that no one could possibly relate to.

I'm visited by psychotic (guilt-ridden) depressions, and it takes my will. I don't care about anything, and my cognitions are all about failure and moral decline. You're right that the Net beckons and it makes things worse, but it's the only activity that takes me out of it, but I tend to find blogs and communities that make me feel more guilt-ridden, and I leave comments that reflect that sense of self. Oh, and reading an ex-lover's blog is a real good way to fuck yourself up, but once found it's impossible to ignore. Especially this time of year. I will remember this post of yours next time I notice myself going that route.

I also notice I'm in trouble when my hygeine starts to slide. Coming out of the shower fragrant and clean helps. Playing Dylan helps Feeding my cats and noticing that. That for 12 years my 2 cats have never gone a day without food and water, so I'm more functional than I think. It's my cognitions that do it, that tell me living is pointless, they inhabit me so I don't argue or try to eliminate them, I just try to add better thoughts, and remember they're all just thoughts, the good and the bad, they come and they go, my job is to last through them.

Posted by: flawedplan at December 5, 2006 02:53 AM

You are pretty damn strong. I'm not sure how I could exhibit that kind of strength. These days, I'm lucky if I can avoid a psych hospital. In 10 years, I've been to psych hospitals twice. I guess you've never tried suicide but I struggle with suicide a lot - it's mainly impulsive behavior, not planned - and that's what lands me in that kind of state.

I'm in between meds (effexor and lamictal) and my sleep has been awful lately. So I'm even more tired and worn out, which makes me susceptible to the highs and lows of my manic-depressiveness (more depressive than anything else though). A lot of those things sound like they would work (especially Ativan - love that med) but for me, the biggest is sleep. And if I can't sleep, I get all haywire, which is what I'm struggling with now.

Posted by: Marissa Miller at December 5, 2006 07:23 AM

This is fantastic, thank you Philip.

I can add what I did last night in my firestorm inferno that was happening in my brain:

1. took 75 mg of seroquel
2. made sure that's all I took (as in no extra pill-popping-unwanted-joyride-in-AMR-to-ER)
3. ate a piece of bread on my way to bed
4. wrapped the covers around me like a cacoon so I wouldn't move.
5. comforted this rookie brain with a fact, that I could not hurt myself as I slept, that the meds were going to help me sleep, and that morning always comes.

I already do not have a TV in the bedroom and now that I think about it my mind started winding up when my blackout shade broke and I had to put up a cheap thing that let's in too much light in the morning.

Great post, THANK YOU.

--stephany

Posted by: Stephany at December 5, 2006 08:31 AM

Re. Number 10 -- the only item on an otherwise super list that I think needs expansion. If your regular meds are making you feel like crap and chances are they are, talk to your doc and become self educated about coming off very, very slowly, and one at a time if you're on multiple meds, and staying off them for awhile before trying anything new (this is called washout and is routinely ignored -- takes much longer than the professionals -- or industry -- care to acknowledge). Just be sure you have the other lifestyle issues mentioned in this list in place and keeping those emergency meds than can be taken "as needed" and just occasionally -- very occasionally -- on hand.

Posted by: Sara at December 6, 2006 08:36 AM

How I stayed out of the ER: thank God for this list.

Here is what seriously kept me able to sleep in my own bed last night:

1. made an emergency phone call to doc, aggressive, told them it's there or the ER.

2. requested a PRN

3. Important to note* I let the doc know I was in bad shape, bad enough, that I was about to go to an ER. HONESTY with doctor.Don't be afraid to tell the doc you think you can fly off of a cliff and want to jump off of one at the same time.

4. *FOOD*. I looked at the calendar and realized I had seriously not eaten but a cracker here and there for ***12 + days.***

Doc got me started on new mood stabilizer, gave me a PRN, and I went home and ate pizza, which believe it or not, was hard to do.

5. Made a chart to check off box if I ate/eat meals during the day. This is important to emphasize, that I usually love food. Big Red Flag should have been to me, that I stopped eating, but I didn't notice. Thus now a chart, until appetite returns, I am getting aggressive with the food intake, and am having to make sure I get enough calories, which blows my mind.

This is a long post, but I want everyone reading that list to understand it really does keep you out of hospitals and/or the ER.

I also:
Got off of the computer.
Did not watch TV.
No more music on.
Went to bed at 730PM, dark and silent room.
Woke up calmer and first thing I did was eat food.

Posted by: Stephany at December 6, 2006 10:26 AM

Great post...a few things that have also worked for me at the beginning of a spiral:
1. Listen to peppy music that if it weren't for my declining mood would otherwise make me want to dance or spin around like a whirling dervish.
2. Call husband/friend/so and let them know what's going on. Have them remind me of what I've done other times in the past.
3. Go for a swim or hop on the treadmill even if I think I'll die in the process from lack of energy.
4. Sit by my Sun Lamp.
5. If it's time for bed, go to bed, but if not, do everything possible to stay up even if it means watching TV because I can't focus enough to read. Usually take small additional amount of Seroquel and/or Klonopin to make me sleep. Realize I will be zombie-like the next day.
6. Try to maintain schedule, e.g. eat at the same time every day, go to bed at the same time, get up at the same time. I can't emphasize how much structure helps me bounce back when I need to and how lack of it can throw me off.

Posted by: Laura at December 7, 2006 10:02 AM

I have come to realize that the people with the most sincerest forms of BPD are also the most intelligent. Does that make any sense to anyone but me? We are a group of well-read patients. I tire so easily of all the "I'm crazy! I'm bipolar! I am so goth!" kind of mentality out there. Sometimes, the internet makes things more difficult than the actually are. I am a nurse living with bipolar disorder in some cases so severe that I cannot do my job properly. I call in sick to avoid harming my patients. Not that I would physically harm them intentionally, but when my brain is divided, I am not giving them my full focus. I have lost so many jobs over the years from chronic absenteeism due to my illness. This brings me to wonder...why would anyone want to BRAG about their mental disorder? I suppose it is very cutting edge, very avant garde to be bipolar. Hell, it might even be cool or trendy...but not to those of us who truly suffer and are at its mercy.

I'm blathering. Thank you for this post.

CP.

Posted by: CP at December 10, 2006 03:10 PM

Have you read _Food and Mood_ by Elizabeth Somer? I can be pretty moody sometimes myself -- perhaps even cyclothymic -- and I've discovered that what I eat has an enormous effect on how I feel. I found that book to be very enlightening and think you would enjoy it very much.

Also, you probably already know about Omega 3?

Posted by: Jacqueline at December 11, 2006 07:20 PM