Bipolar check-in #47

That was very sweet of you, whatever. It is so sad when our pets are sick. You are a good egg!

it never fails to amaze me

10 A.M in the morning and I have nothing to do for the rest of the day

I'm hot though. sheesh. when today started it was quite cool, but I think I may put my fan on

if I'm doing nothing all day I'd rather sit here and feel comfortable than sit here and sweat

I'm quite concerned about my psychiatrist. I received an email from him, early this morning, saying that he is in the hospital and must cancel our appointment that was set for tomorrow. He apparently had a severe urinary track infection that advanced to the blood stream (urosepsis). They tested him for covid and that was fortunately ruled out. I care about him a lot and this, of course, makes me nervous. He was going to be going on a long vacation soon. I'm not sure how this situation will affect that. If he goes through with the vacation after release from the hospital, he may or may not schedule anything to replace the appointment. He did write that he would be in contact with his patients regarding medications, etc. He usually always has a backup psychiatrist for emergencies.

Hubby and I will be heading to Philly in a few hours for his appointment, in an eye hospital. As I wrote yesterday, I don't plan to actually go in. They now have extra procedures in place for covid (taking temps, hand sanitizer, of course masks, etc.) It's likely that many in that whole area take more precautions than in most, since there are other hospitals very nearby. We always see hospital staff walking around. Perhaps it won't even be that busy in the area. A number of blocks below that street are all gold shops (Philly's Jewelers' Row), which are likely not even open.

I just sort of quit my job. It started this morning in the break room when someone who’s already high risk to covid said “this mask is driving me crazy” then started taking it off and coughing. I controlled myself around her but then in the backroom I asked for gloves in my size and their were none. Then someone else coughed. So I started talking to the manager about how uncomfortable I was with the social distancing. She didn’t exactly validate my feelings so I asked to talk to her in the office where I really chewed her out. I mentioned people taking off their masks and the lack of social distancing and no equipment. And I mentioned being transgender as well. She did give me a pair of gloves when I went in the back but they were too big and also 2 right gloves. I tried working but I was uncomfortable with how angry I was and how I had talked to the manager. I’ve never been like that at work before and I’ve never spoken like that with a manager. I only get like that with my therapist and my mom. So I talked to another manager and said I needed to leave because I just couldn’t deal with it. I told him I’d take a leave. But I just didn’t want to quit on the spot.

It was the social distancing and the coughing and masks but I was also very uncomfortable with how I was acting and I honestly do not think it is appropriate for me to be working when I am like this.

I think it's great that you spoke up, Mountaindewed. After reading your story, I would have spoken up, too. They need to hear such feedback.

From what I have seen, California's covid cases seem to be greatly on the rise again. Not on the decline. See US coronavirus map: Tracking the United States outbreak That fact should bring with it some common sense. It's a shame that it doesn't always. Most people in my state were extremely vigilant in lowering the numbers. Many New Jerseyans can be tough folks, yelling at strangers to put on a mask or leave. That may seem harsh to some, but it surely helped. Most people in my state DO know someone who got covid. Many know a lot of people. You're right not to treat it casually, or like a hoax. By the way, California just took the #2 position for most cases in the US, after New York. New Jersey had been #2 for a long while.

Is it at all possible for you to work from home? If so, would you consider asking to work from home for a little while until the covid cases are on the decline again?

I'm proud of you for standing up for yourself and your rights. It sounds like it was a very uncomfortable environment. In Mass, its getting more and more lax in public, and I'm getting more and more uncomfortable. I think you are one of the heroes that make it safer for the whole. I certainly believe it. You keep up the good fight. And good for you for staying strong. Hurrah!

So sorry about your pdoc, BD. I will add him to the prayer list. Have fun in the City of Brotherly Love!!

Good for you for speaking truth to power, MD.

We are having record case numbers each day here now, after months of very low numbers.

Slept pretty well and just getting going with some tea here. Have pdoc in a few hours. Doubt we will change anything, even though we prolly should. Oh well. We shall see.

Hope everyone has a nice day!!!

I talked to my pdoc this morning. She's lowering the tegretol for a bit to see if that stops the itching and the rash. She's not too concerned about the rash. She said to take benadryl for the itching (which is all over, not just at the rash site). We will eventually go back up on the dose but a lot slower than what they did in the hospital.
I feel like screaming. I feel a little better after talking to my pdoc, which is weird because that never happens. Maybe because I feel like she listened for once. I have therapy later today. I'm not going to give it any effort. It's just not helpful no matter what I say or do. All my effort is going into group where they're actually able to help me and I can show up or not show up at any time.
Every time I do something I feel like I've recently died and the afterlife is just continuance of life. This is bothering me.

Thank you, bpcyclist! You're really sweet for doing that.

My husband passed on an article he found online. I think that given the conversation about coronavirus in posts above, it might be appreciated. It's a lovely sight in a beautiful theater in Barcelona, Spain. It's purpose is also one to be admired. During this period of lock down in my state, I feel I've more closely connected with nature. Fewer cars/trucks on the road, less pollution, easier time to hear the many sounds of nature that were previously drowned out by the clamor of street and air traffic. The real heroes of this period there, will be given a gift of life.

NPR Choice page

Sorry, spikes. I hope tht rash is better soon.

So, you are having some sort of derealization type stuff, is that accurate, do you think? Is that what you mean by that last sentence? That you feel like you are now in an afterlife? I have gotten this before when I was super psychotic. It was very unpleasant. Sending you support and peace!!!

Ah, Barcelona... So perfect.

I was on my bike last night downtown in this city of 2 1/2 million and got to an intersection. Looked both ways, could see maybe a few hundred yards in each direction, and--nothing. No cars, no bikes, no pedestrians. Just, silence, right downtown at, like, 10 o/clock. So weird. So weird.

That is a nice result of all of this, for as long as it lasts.

I read a NY Times article today saying Americans may be banned from EU starting July 1. So my vacation in September is iffy. I don't blame the EU, though. Who really would (that knows what the reality is)?

Philly is hot and humid as all get out! RealFeel is 100.4 F (38 C). Oy! I brought two portable fans for my car.

I gotta give Wills Eye credit for taking safety seriously.

Went on a walk today. Long overdue. I've been watching the pregnancy folder of this couple on YouTube. They are famous for their vlog on theme parks- especially Disney parks. They just had a baby back in November so a lot of their current videos are at home- also because the parks are closed right now. Can you tell I like their channel?

Had my T appointment this morning. Went well. I talked a LOT. Two topics, though one of them was by far dominant. I'm having a ton of anxiety around the issues. I was going to say, "but aside from that"... but realized there really ISN'T much else going on in my head. It (the main topic) is the thing that keeps me up if I wake up in the middle of the night. GAH, I hate when thoughts go around and around in circles! It's exhausting.

I read this thread all the time (it's the main one I try to keep up with) and would like to send to all who are struggling.

Just had pdoc visit. We are going to try to up the AP for a few days, then, if that doesn't work, will have to add a stimulant, I guess. We shall see.

I'm confused and concerned about you. Why would your pdoc add a stimulant if the AP increase doesn't work? You say, in your words, that you're always very psychotic, so wouldn't a stimulant be counterintuitive? Also, I'm surprised your pdoc is saying, "well, we'll try a stimulant if this antipsychotic doesn't work in a few days." While antipsychotics can take a matter of hours or days to kick in, they typically take more than a few days. (See here: The “delayed onset” of antipsychotic action — an idea whose time has come and gone)

I think you need a new pdoc if he's not telling you to wait at least one week. As a doctor, you know that's wrong, especially since APs are likely not an effective way to treat bipolar depression for more than 6 months: Antipsychotic Treatment for Bipolar Disorder Not Always Effective After Six Months | Brain & Behavior Research Foundation

I'm not trying to come across as an @ss, but I think your pdoc's plan is not something that a psychiatrist would typically recommend for someone who is very psychotic all the time. Most research studies (especially those coming from the NIH, NHS, etc.) suggest using a mood stabilizer to help with depression. If mood stabilizers don't help, then an antipsychotic combined with an antidepressant is recommended. It's clearly stated here (WebMD)and here (Harvard University).

Thank you, blue. Yeah, not really sure I understood it all. He said my prefrontal D2 receptors are broken or something and the only way to fix that now is more Abilify or possibly a stimulant, if the Abilify doesn't do it. Not sure really about all the rest. He did say that in his experience, stimulants in low doses rarely cause psychosis, if ever. He says he has never seen that, himself. But i am just the messenger here. Maybe the Abilifry will work or something.

I have to agree with bluebicycle.....adding a stim is counterintuitive. Normally stimulants can cause psychosis in people prone to it, which is why my docs won’t let me touch them, thus my fish oil cure instead of a real med.

Have you had genetics done or something where he knows they’re broken? For me it’s part of the nmda pathway which feeds into dopamine that’s broken.

I guess I’m wondering if you have a genius pdoc or just a quack. The partial agonists like abilify work by binding strongly and still blocking normal dopamine while providing a little bit of stimulation. Stimulants just turn on the tap.

Yeah, dunno. He says in bp 1 people with anhednoia, amotivation, low energy, poor drive, that there are only three solutions, once the depression element has been maximally targeted. The only AD that has ever worked for me besides Wellbutrin, which I am on a highish dose of, is Cymbalta, but it makes me manic, so, no-go. MAOIs don't work, nothing else works. Ketamine would work, for sure, but I am self-pay and it is thousands of dollars a month. Ketamine is for sure the answer, for sure, but I just do not have the cash for it. It is beyond my reach. And those experimental alternatives are too dangerous.

So, those three solutions are Provigil/Nuvigil, which I cannot take due to side effects, optimizing this D2 receptor thingy with more Abilify, or a stimulant. There are no other options, other than to do nothing, he says. Obviously, as in all things with the illness, balancing one move in one direction against symptoms in another is always there. He does not want me to be unable to work, write, have a life of the mind. Does not want me to just sit around and exist. He was there when my depression was beyond out of control and I nearly died, repeatedly, and we all know that leads to the end for me. So, I am sure it is a risk, but he thinks the potential upside is worth what he feels is a low actual risk, based on his experience in this situation with other patients. Guess we will see.

So he’s more worried about balancing the depression with the psychosis when finding a med....have you tried brexpiprazole.? It’s a partial agonist at D2 too, related to abilify. Wellbutrin tweaks dopamine too so for some it can cause hallucinations, but clearly you need that tweak to get rid of the depression, thus the whole stimulant thing.

Mechanism of action of brexpiprazole: comparison with aripiprazole

Here’s a great chart of receptor activity by stahl for brexpiprazole ie rexulti vs abilify....they’re very similar so if the minor serotonin increase for th brexpiprazole isn’t what you want they’re probably about th same, but if you develop the need to move etc with the higher dose, the brexpiprazole could be better in the long run it’s got less of that.