Anxiety about discussing BP w/pdoc & wondering what "normal" is?

I'm new to this forum and I've noticed there's also a few new people here too. From what I understand, it's okay to start a thread to talk about how you're feeling or get feedback. (Someone please correct me if I'm doing it wrong.) I'm writing this about how I feel about my week-old BP dx and asking for some feedback from those of you who have dealt with this for longer.

I'm filled with anxiety right now. Seeing my psychologist tomorrow for the first time since getting my BP I dx last week, and telling her the official outcome of the neuropsych eval I got. I've had a great therapeutic relationship with her for the past four years, she's seen me at rock bottom of my PTSD and back, and has been invaluable this year in helping me battle my depression. I've even discussed with her my suspicions that I might have BP in the past (problem with that is I didn't see her when I was last hypomanic because I felt I "wasn't depressed any longer"). I trust her immensely, and I know she will be the same steady rock for me that she has been in the past.

All that considered, I'm just so nervous about actually saying the words to her tomorrow and I don't know why. (Both my pdocs won't get the official neuropsych report until the end of this month.) Maybe it's something about it feeling so "final," or maybe this is all just really sinking in now. I've spent the last week reflecting back on my life and realizing times where I was definitely experiencing mania and hypomania. I just honestly always thought my hypomanic state was my "normal," and my depressions took me away from that, and that's where I was always trying to get back to. It's very disconcerting to look at yourself from an entirely different perspective, and realize that you've had it all wrong this whole time.

Just reread Kay Redfield Jamison's "An Unquiet Mind," and it reminded me that BP tends to get worse if untreated. I've realized also this week that a couple of "rough nights" I'd chalked up to having too much to drink a few years back were actually psychotic mixed episodes. After doing some more research about BP I, I've also realized that I occasionally have mildly psychotic thoughts that I've always found super intrusive, distressing, and always hated, because they're usually violent images that I have no idea where they came from. That, obviously, is not good, but I am a little relieved that there seems to be a reason for the thoughts, at least.

So, now I'm just feeling lucky that there hasn't been anything worse or more damaging that has happened to me or anyone around me since my last identifiable psychotic mixed episode. The worst has been my unrestrained spending, hypersexuality getting me in trouble, and episodes of uncontrollable rage which destroyed two good friendships (though I also question how good of friends they were if they saw me in such a state and didn't think something was wrong, having known me for many years). Now, very ironically, I'm almost thankful that I've been mostly severely depressed for the past year and a half, because it means that the time bomb ticking on my next manic episode hasn't gone off, and maybe with the right medicines, it won't go off, or at least won't be as much of an explosion when it does.

At the same time, man, I HATE my depression. I hate everything about it, I hate the hopelessness, the sheer amount of energy it takes just to do the most basic things, all while pretending to be fine to the outside world, just to get by with work and school, coming home and collapsing from exhaustion. The sleeping my life away. The irritability, the agitation, the lack of emotion, the worthlessness, the stigma, the pain, everything. I really want it to go away and never come back, and the last time it came back with a vengeance the beginning of this year, I had believed that I'd "finally beaten it for good" after starting Wellbutrin XL last August. It really hit me hard that no matter what I do, it's never going to stop coming back, and seemingly without any warning. At least now I know why it keeps coming back after feeling great for awhile!

I am nervous about making medication changes because of BP, but I realize this is something that needs to be done to help myself. I've done a lot of research on the various medications available so I'll feel comfortable talking with my psychiatrist about them when I see him Friday. I know for sure that I can't keep taking Abilify, even at 2mg it gives me the most annoying muscle twitches and makes me feel flat and emotionless. I don't want to be a zombie, I still want to feel like me. I think that's what I'm most scared of—that the medications are going to make me feel less like myself and more like...something or someone else. I'm hoping I can find the right blend of medications that will help me feel something like "normal," which I honestly am clueless as to what that would be. Not hypomanic and not depressed, somewhere in between? Happy, but not omgI'msohappyIcouldscream? I can't imagine life without feeling my emotions as intensely as I do, and always have.

For those of you who have had success with your medication therapies, what does "normal" or homeostasis feel like to you? Do you still feel like you're "you," or do you feel you've had to trade off parts of yourself in order to maintain balance? Do you notice a marked difference in the processing of your emotions with and without medication?

Thank you in advance for any feedback anyone can provide. I'm slowly sifting through my life and putting these pieces together, and this forum has been a surprisingly amazing source of comfort, even though I've only had my dx for a week. It's hard opening up, but this is making me realize I need to look at everything as a possible symptom, and not just the things I feel are "clinically relevant." I really thank anyone who takes the time to read and reply to this.

I am also interested in the feedback anyone can provide to Double Edge. I was not given an official dx, however my Pdoc hinted around it...I guess she knew I was not ready to hear it. She is slowly removing meds for depression and added Latuda 5 days ago. I know i am suffering from a mood disorder. When I read up on that med I guess it confirmed my thinking. I will know officially today when I directly ask her. I, too, am concerned about med changes and how it will effect me.

Thanks for posting something so self-reflective- I really appreciated the observations about your friends not helping you when you were clearly in need & in a manic state. Giving up on certain friendships has been the hardest part of my illness.

First and foremost- it took me a long time to get the right med combination. When I was initially diagnosed- I felt very emotionally flat and as though I lost a big part of my personality. I wasn't even sure if I would be able to drive a car again because the medication left me so fatigued. In my case- I had a major psychotic break and spent four weeks in the hospital. I needed to get the extra rest to re-set my mind and decrease the probability of having a manic episode. It took me four months of being heavily medicated to having my dosage levels drastically decreased. From there, I was able to decrease again at 10 months post breakdown.

So really make sure that you are keeping your p-doc updated on side effects and how you're feeling about the medicine. But keep in mind- the medication may be able to be switched to something with less side effects once you allow your mind to re-set.

When the medicine started to work the way it was intended to- I found myself missing the racing thoughts. The world really slowed down and I didn't have a lot to replace it with (lost friends, didn't really have any meaningful hobbies that I could focus on) I really thought that they allowed me to be ahead of the game. It took me a while to accept that my racing thoughts were an involuntary response and they weren't something that benefitted me. That my accomplishments were in spite of the racing thoughts, not because of them.

Hope this helps you!

I can totally relate! I too thought my mania was normal and that pesky depression was my only problem. Also, my depression sucks to the point I will do anything to avoid it . I have always thought everything bad came from it while only good came from"normal" times. In reality, most of my lost jobs came during " normal" times and spiraled me downwards into horrible places that leads to my depression! When medicated, I do struggle-I miss "normal" me and do feel flat, it's always been hard for me to stay on my meds because of it. Good luck, I hope you find a balance that works for you.

Thank you so much for sharing your story. It's nice to know I'm not the only one who feels this way. I found it really interesting what you said, that "[your] accomplishments were in spite of the racing thoughts, not because of them," and that you missed them at first. I have a love-hate relationship with my racing thoughts. When they distract me to the point of barely being able to read, or constantly interrupting me, then they're obnoxious. But when I'm in that hypomanic state (formerly known as "normal"), it feels... well, normal. I can't imagine them not being there, I can't imagine things being quiet. I'm not quite sure what I would do with myself, to be honest. I guess I have a long way to go in experiencing and understanding life without symptoms of BP.

In talking with my pdoc today about it, she did say a major cause of medication non-compliance with BP I is that hypomania is hard to give up because it feels good. And indeed, my memories of my hypomania are good ones, I remember feeling absolutely great. Up until this point, I have been living my life thinking things are "normal," because it's my baseline, all I've ever known, either depressed or feeling great. But pdoc also pointed out that's probably why my MDD has been so treatment resistant, because of the failure to account for the BP component (aka, mood stabilizer). So hopefully, the right mood stabilizer will help bring me up to a "slightly elevated, contented level (her words)."

Is that how you would describe your state of mind now with the right rx combination? Do you feel slightly elevated, or do you feel kind of drowsy? You describe your initial medication as fatiguing, and once it started working as intended as slowing the world down. I'm afraid I'm going to slow down so much I won't be able to keep up with my workload. I can't fathom how I can get things done, but then again, I don't know how I manage to get things done depressed as I am now, it requires an extraordinary amount of energy just to pretend things are okay for work and school, resulting in crashing the moment I get home. Maybe if I can get that to stop, things will seem easier to manage. I hope.

Thank you again for sharing!

I can definitely relate to what you're saying. Last night, I sat down and wrote down every suspected manic and hypomanic episode that I could specifically recall, in chronological order. I realized that I lost three jobs in a row, all for attendance issues, and always when I was feeling up, never depressed. It's just so strange looking back at my life through the lens of a person with bipolar. Really makes you look at your decisions a lot differently.

I'm sorry to hear it's hard for you to find your balance with your meds. I understand that's a struggle for many, and one I'm not looking forward to grappling with myself. I hope you can find the right variables to keep you feeling good and not flat!

I resisted medication for years because I thought it would take away parts of myself or change my personality. It turns out that the parts it takes away, like the severe depression and paranoia, are mostly parts I really didn't want in the first place.

I suppose I'm slowed down a bit from hypomania, but those states were rare for me anyway, and my thoughts are still quick and racy a lot of the time. I certainly still feel like myself. I do wonder if I'm actually under-medicated because I still have some breakthrough symptoms.

"Normal" days do feel more peaceful than they did unmedicated, but it's not really a huge change. I certainly still feel things and my cognitive functioning is as good as ever.

It's interesting to reflect on this. When I first started meds I noticed that the constant chatter in my mind stopped. It was odd to get used to the quiet. I was worried it meant I lost some of my mental edge or that it changed me. It didn't change my values and beliefs, certain core thoughts were still there, but it quieted down the racing thoughts.

I have had my disasters in my manic stages. I don;t care if I feel flat, it beats losing everything I love because of poor behavior. I take my meds and get along with them.
I feel in recovery now and feel pretty "normal". I am not overambitious, but am filling up my life with worthwhile things since my two year depression. It's a gradual process, but I do NOT want to go the hypo. I'm just too old.

Thank you for your feedback. You make a good point, about the medication taking away things you didn't want in the first place. Just thinking back on the past seventeen years (based on first known manic episode), I've definitely been depressed a lot more than anything else, so if I can get rid of that, I think that would be beneficial. It's good to hear you feel your cognitive functioning is unchanged, I always worry about that with new medications. It's nice to know you still feel like you have your feelings too. Thanks a lot for sharing!

I really wonder a lot about this myself. I've always had racing thoughts. Even when I'm depressed, which is an odd feeling, because it's like everything else is moving in slow motion but my mind. My body is exhausted and can't keep up with my mind while it's running like a faucet.

Did you find that it was easier to concentrate once things quieted down? That's a problem for me a lot of times, I can't stop thinking, so it interferes with my reading and makes it take much longer than it should. Doing away with that is the only real benefit I can hope for with dampening down the racing thoughts. Otherwise, I really don't know what I'll make of it. Thank you for sharing your thoughts on this, I appreciate it.

I'm sorry to hear about your unfortunate manic episodes, but glad to hear you feel that you're in recovery. You make a good point... it's a trade off between what you know to be destructive or not feeling emotion as intensely. In that perspective, it might be worth it.

It's been four years since my last manic episode, at least I THINK... ever since PTSD in 2010 my memory has been spotty across that time period, and it's very likely some of the crazy spousal arguments I've had since were in the throes of a manic episode, where I became out of control and even violent. I just don't remember those times very well. So I really don't know.

It's hard coming out of depression, but it's good you're finding worthwhile things to do. I've learned to try to force myself to keep up my hobbies when I'm depressed, in spite of myself. Nice to hear it sounds like things are working well for you though. Thank you for sharing!

Did you hear anything back from your pdoc about your dx? Mine also suggested I try Latuda as well. How is it working for you so far? I empathize with your concern... I'd be terrified coming off my Wellbutrin, and I don't think I would be able to. I've honestly resigned myself to probably always needing to take anti-depressants. Who knows, maybe after I add a mood stabilizer, my depression will get better. I mean, it's better from last August when I started Wellbutrin, but it's definitely not gone.

Thank you for telling your story. I can relate very well to where you are right now. I was diagnosed over 20 years ago and self medicated for years. It worked for me for a couple of years but I ended up having to be hospitalized a few times and needed to start medication. I've been on everything under the sun with little success.

I went into a very deep depression while medicated about 3 years ago. I was hospitalized and given ECT treatments, again with little success.

I was started on lamictal about a year ago and started to feel better and had 6 months of stability but that ride ended in February when I went into a mixed episode that lasted 3 months. A very frightening experience.
I should say that I too had the same reaction to Abilify and was taken off of it immediately. Just over a month ago I was started on Latuda and the difference is like night and day for me. My head is clear, I'm becoming more social again after isolating for the last few years, I'm happy...I forgot what that felt like. My moods have stabilized, my fingers are crossed that it will stay this way. My energy is back and I'm hoping to go back to work after being on disability for the last 3 years.
So far so good.

It may take awhile to find the right med combo for you but you'll get there.

Good luck to you.

Wow, I am sorry to hear about your 3 month long mixed episode. That must have been extremely intense. I recall my experiences with two mixed episodes—and even as I'm typing this another scenario comes to mind—and all were terrifying.

So you've had positive results with Latuda, that's really great to hear! That must be a huge relief. That's somewhat, but to a lesser degree, how I felt shortly after starting Wellbutrin XL, but that quickly died off. Increased dosage, slight elevation that tapered off also. Still depressed, going on year and eight months now, with random hypomanic things interspersed throughout. Honestly, I have a lot of trouble recalling the past year or so, which I attribute to a PTSD relapse last October.

I realized I've been self medicating for years unknowingly. That's kind of a weird feeling to have about oneself. Well, I suppose it was always evident. Anything I did, I usually did to excess. I'm lucky worse things didn't happen to me or others around me. Example: driving 160 mph through a tunnel, solely because that was when the car redlined; did that multiple times with various people in the car), but sad other things happened (e.g., loss of two friendships, which were held as close at the time).

My pdoc suggested Latuda when I said I was thinking of Topamax. She told me she took it for antiseizure and it totally robbed her of her vocabulary. Horrible verbal recognition and recall. I want to try Topamax because its side effects, amongst being potentially relieving of bipolar depression, it also causes weight loss, which I feel I am "owed" having gained 20 lbs. thanks to Abilify. I know that logic might be ridiculous, but it was difficult from going to very active to completely inactive after a serious car accident, then having to utilize physical therapy to relearn how to engage muscles that just basically atrophied from non-use. And steroid treatments for back and hip injuries didn't help, either. Tried recently to get back into running only to almost immediately develop tendonitis in my previously injured hip. No more running for me, one of my previous major stress outlets. I really gotta get more exercise, it was always so stress relieving, even when it wasn't always pleasant.

Anyway, I feel I am rambling, and I apologize. Thank you for sharing your story, it gives me much to ponder as I prepare to speak with my psychiatrist later on today. Best of luck to you as well.

I have only been taking Latuda For less than two weeks. So far no side effects, but no big relief either. I did end up doubling my dose of cymbalta, so I'm not us what is going on. Pdoc keeps it vague to mood disorder when asked about dx. I hope to hear more tomorrow as she is filling out my short term disability paperwork.

Best of luck with Latuda! I feel for you on paperwork requirements. I always hated dealing with all the paperwork when it came to the leave of absence I took from work during a PTSD relapse. It just feels... oddly degrading to have your mental and physical state reduced to a questionnaire, as if what you might be doing is lying—someone, somewhere, reading it and trying to poke holes in it. (This might be my general paranoia when it comes to insurance companies, having worked in insurance for seven years...thankfully, not anymore).

When I was given Cymbalta for nerve pain, it gave me consistently and noticeably dilated pupils, and made me feel like I was spaced out all the time, made my depression worse. But I have always responded horribly to SSRIs/SNRIs, and by all accounts, that was the mildest reaction I've had, probably on it being an SNRI. (Any SSRI = mania)

Hope it works out for you though! It's hard to find a good AD. I don't know what I'd do without my Wellbutrin. It keeps my depression out of suicidal range and away from total paralyzation from apathy, for the majority of the time. Hang in there and take care!

Sorry- lost this thread for a while. It is definitely a tough switch once you start taking the medicine- I remember how slow everything felt and I wondered how I would be able to do simple things. I was fortunate where I was able to take FMLA for the first 2 months of my medication- there is no way I could have handled my workload. So don't be hard on yourself if you're handling new medication + a demanding personal life.

Hang in there- for me- the first six months were really rough- it took me a while to get on the right medication dosage. Once I got on the right dosage- it felt like a light switch flipped again- where I was still able to utilize my natural talents. Racing thoughts / hypomania still occur- but the medication has put me in a much better position to recognize it and face up to it.

Hello,

This is a long post, so I am going to respond, in a few posts of my own.

As an alcoholic, I can tell you straight up that alcohol does two things to someone with BP -- 1) it helps quiet the mind until you passout, 2) it creates serious hypo/manic episodes.

Either way there are serious draw backs 1) I used alcohol to quiet my mind initially and it worked....helped me sleep....etc....until I was completely addicted, 2) this caused more and more of the alcohol induced manic events to occur.

Long story short, stay away from alcohol with BP.

Thank you for your response. I also have been fortunate in the past to be able to take advantage of FMLA and TDI. This time, though, I'm not so lucky: I have to finish a very overdue paper, take the GRE, start full-time school back up again, and work (thankfully, only 16 hours a week...but 6 days a week ). I'm so nervous about starting a new medication while so much is going on.

It's comforting to hear that you reached a point where the medication started to work, that "light switch" flipping on. It gives me hope that it does happen for people. Actually, that you still experience your hypomania is reassuring to me too—I don't know what yours are like, however mine have most always been positive feeling (though of course, got me into trouble as well). Maybe the meds will help keep some of that destructive impulsivity away and retain the "natural talents," as you say. Thanks for the advice - I'll try not to be too hard on myself. I just have to keep remembering it's all for the better. I can't ignore my illness.

Thank you for your feedback, it's funny you mention it. Along with my BP dx they said I also met critieria for "alcohol abuse," so alcohol has been weighing heavily on my mind lately. Alcohol and I have a longstanding relationship. See, when I was fifteen, my mom couldn't afford my private school anymore, and REFUSED to let me go to public school, convinced beyond reason that something bad would happen to me and that I would become "brainwashed by evolution" (she was fanatically religious at times... 99% she's non-dx'd BP). BUT, unbelievably, she would buy me liquor and cigarettes anytime I wanted. So I began drinking to numb everything. I wanted to do anything but feel. This continued until age eighteen, when I finally had my freedom (sort of, anyway).

I definitely do not drink anywhere near as much as I used to. There were periods of time in my adulthood, maybe between 23–25 years of age, where I drank almost every day, for perhaps about two years. Then I barely drank for years, only at the occasional social occasion, maybe one or two. I've done a lot of stupid things drunk, and I'm just lucky I never hurt myself or anyone else. Nowadays at 29, I drink not even on average once a month, though when I drink, I do binge drink. My pdoc suggested I limit myself to two. Problem is, I LIKE being drunk. Can't lie.

The alcohol-related mixed episode I so far experienced was also SSRI-induced, so I think the interactions between them made it even more out of control. But I can see how a far-too-drunken episode could quickly turn into a manic or mixed episode. I really feel I'm at a crossroads here: giving up alcohol, something that has been more pleasure than pain, thankfully. I don't know if I'm ready to give it up completely, but I'm willing to try to scale it back. Learning how to have a good time without being drunk. Baby steps.

Yikes, Double Edged. Sounds like you have a lot going on. To really ease yourself into the medication- here are some things you might be able to do that will help:

A). Limit your decisions. Academia is one of the most unstructured lifestyles there is. Build out your schedule as much as you can- designate specific time blocks for paper writing, grocery shopping, getting yourself to sleep, getting yourself up, studying for classes, when you eat. The more predictable and the more stability you can bring to your life while undergoing to the medication change will pay off in six months. Re-reading it, it sounds incredibly dull but just remember- you have a LOT going on right now.

B). Practice mood charting. Start to be able to pinpoint triggers that bring out strong feelings (either depression or mania)- and start to reflect and figure out how you can alleviate it.

C). Google "mindfulness"- you'll get some really neat articles about how to enjoy just being in the moment and slow your mind done. It doesn't require any adherence to a particular faith- they are just good meditation exercises.

Hope this helps! It will get better.

Thank you so much for these suggestions, they're really awesome. I have a huge problem with A, for sure, and I know I need to improve. The other day I put up a whiteboard calendar right by the front door where it won't be missed, to help with around the house stuff, which I constantly am forgetting. I rely on my Google Calendar on my phone for everything else, so I think I'm going to get super detailed and schedule myself time for all those things—homework, eating, studying. I've tried many times before with that level of structure, and it's only worked for a little while. I think it has to do with my moods, which leads into suggestion B...

Actually three days after I got my BP dx, I started charting my moods with this great app called "Optimism." Tracks moods, triggers, environmental stuff, area for freeform notes, really great. It spits out a handy bar and line chart comparing your moods, sleep, sleep quality, exercise, and coping ability for either 2 weeks or one month at a time. I'm planning on taking it with me to my pdoc appointments. So far I'm starting to notice what could be the beginning of a pattern... I'll really need a couple months of data to determine any real trends, but I'm hoping after one month I'll be able to make some inferences. This, oddly, has been one of the most comforting things that I've been doing to deal with my BP. It makes me feel in control of it, and it also makes it feel more objective, like I could be looking at data from anyone. It really helps to not get overwhelmed by it.

And C, mindfulness is awesome, I'm so glad you mentionted this to remind me of that. I try to practice it as often as I can... or used to, anyway. This is something I've gotten away from being so depressed, but you're right, I do need to build up that skill, as it will be very useful. In addition to home exercises, I used to practice yoga reguarly, which was basically 90 minutes of total mindfulness of every inch of your body. It was both relaxing and invigorating. Man, I gotta do these things again! Day by day...

That's awesome. I'll have to check out the Optimism app.

I started to self medicate as pretty young age....around 18years old....and haven't looked back for over 20 years....until recently....when I got sober...then all this 'emotion' crap hit me like a brick.

Even before 18 years old, I was taking Ritalin every day, which really just kept in a constant state of hypomania -- though neither my parents, doctors, nor I knew this....I was better behaved because I wasn't swing between moods, was always just "ON".

So I have been medicated for years....and when I cleared my system of all of these it was a shock to the system to feel ups-and-downs as severely as I did....and I think as time goes by these are getting worse...the extremes are...

But know I at least have something to go on, before ADHD dx only forced me over the top in my behavior...and drinking....

So....I didn't feel my emotions intensely because they were numbed for over 20 years....then it hit me....just as traumatic...