[shadow2000]

Hello everyone,

It's been more than three years since I last posted to the forums on this site, but after having struggled with symptoms that have been pretty severe for much of the time that's passed since I made my last post, I've decided to return to the forums on this site and to begin regularly posting to the bipolar forum. I never posted to the bipolar forum on a regular basis when I posted to the Psych Central forums in the past because I was diagnosed with other mental health conditions during those periods, but with it being the case that I was just recently diagnosed with bipolar disorder for the second time since my problems with mental illness began more than 20 years ago, I'm planning on spending much of the time that I'll spend using the forums on this site reading and posting messages here on the bipolar forum.

To give all of you an introduction of sorts, I'll start by saying that I began experiencing significant mood disorder symptoms in the late spring of the year 2000 after I overworked myself to the point of depriving myself of sleep and enduring very intense stress on an ongoing basis for a period that lasted several months before the onset of my symptoms. The depressive and manic symptoms that I've been experiencing over the years have done a lot to impair my ability to function and have been so much of what I've been struggling with over the course of my adult life. There have, however, been times since I first sought treatment for my mood disorder symptoms in the spring of 2002 when the treatments that I've utilized have reduced the severity of my symptoms in a way that's made it possible for me to accomplish at least a good number of the things that I'd like to achieve and would otherwise likely be able to accomplish. Even though my symptoms have worsened in different ways for various reasons over the course of the last 20 years, many of the periods when I was able to accomplish much of what I wanted to accomplish occurred during the 2.5 years or so when I was diagnosed with bipolar disorder the first time around (which occurred between early 2003 and the fall of 2005) and utilizing treatments that were focused on reducing the severity of depressive and (hypo)manic symptoms.

But for the 15-year span that occurred between the fall of 2005 and the day last month when I was once again diagnosed with bipolar disorder, the treatment professionals that I saw for my mental health problems gave me diagnoses other than bipolar disorder to explain my mood disorder symptoms. And even though it's hard to know the extent to which the quality of my treatment outcome during the years when I diagnosed with recurrent major depressive disorder, schizophrenia, and schizoaffective disorder instead of bipolar disorder was a result of having been diagnosed with conditions other than bipolar disorder and having followed treatment approaches that were in line with the other conditions, I will say that my treatment outcome during those years was mostly very poor. When I was diagnosed with bipolar disorder the first time around and following a treatment approach that focused on reducing the severity of depressive and (hypo)manic symptoms, my symptoms mostly weren't very severe, and I was working and/or going to school most of the time during that period. But other than during the earliest part of the period when I was diagnosed with recurrent major depressive disorder, my symptoms were mostly quite severe and were bad enough to completely interfere with my ability to work when I was diagnosed with recurrent major depressive disorder, schizophrenia, and schizoaffective disorder. Following treatment approaches that focused on reducing the symptoms of recurrent major depressive disorder, schizophrenia, and schizoaffective disorder didn't ultimately help me with so many of the worst of the symptoms that I was experiencing, and the antipsychotic medications that I took when I was diagnosed with schizophrenia and schizoaffective disorder worsened the severity of some of my symptoms in a way that was so big that I actually found following an alternative treatment approach that didn't involve taking any pharmaceutical medications for about five years to be not as bad as following an approach that was centered on taking antipsychotics.

For a while, it looked as though there were basically two possible outcomes for me with the mental health problems that I had and the treatments that were available: one that involved contending with mental illness symptoms that were very intense and most certainly disabling and utilizing alternative treatments that would only do so much to reduce the severity of my symptoms, and a second that involved utilizing medications that significantly reduced the severity of some of my more intense symptoms while also doing a lot to exacerbate how badly disabled I was by the problems that I was experiencing with my brain health. But after spending enough time looking at how my symptoms were without pharmaceuticals, I started to suspect that the reason why there seemed to be no better approach to managing my mental health problems other than two options that both involved a very poor outcome was because I wasn't focusing on the right mental health problems. Once I realized that the symptoms that I was experiencing still revolved around the depressive and manic symptoms that were part of the diagnosis of bipolar disorder that I had received more than a decade into the past and that what I was experiencing more than anything else was an ongoing mixed affective episode, I started to think that there indeed was an approach to managing my mental health problems beyond the antipsychotic-centered approach that seemed to basically worsen things for me overall and a more alternative approach that does far too little to reduce the severity of some of my more intense symptoms. What was this approach? Basically, it was an approach that focuses on using mainstream treatments and other treatments as needed to reduce the severity of the main symptoms of the most prominent mental health condition that I actually do have -- and that condition is bipolar disorder.

After my mental illness diagnosis had been schizoaffective disorder for more than 12 years with me not having seen any psychiatric treatment professionals during the last five of those years, I sought psychiatric treatment last month and clearly conveyed the idea that I thought that being in a mixed affective state that involves experiencing a mixture of disabling anergic depressive symptoms and manic symptoms with psychotic features was what explained the worst of my mental health problems. In addition to diagnosing me with obsessive-compulsive disorder, which I suspected I had, the psychiatric physician assistant that I saw (and the psychiatrist that she works with) basically confirmed the suspicions that I had about still having bipolar disorder and diagnosed me with that condition. The physician assistant prescribed me Lamictal at my first appointment with her, with it having been the case that the medication had done something to reduce the severity of my manic symptoms when I had taken it previously and also seemed to carry a relatively low risk of neurological side effects (which I was particularly concerned about because parkinsonism is something that I experience). My response to Lamictal when I tried it last month was unfortunately quite different from what it was the time that I took it previously, with it having been the case that Lamictal seemed to worsen my manic symptoms in a way that was plenty big just a few days into my trial with it. I discontinued Lamictal earlier this month after having spent very little time taking it because it seemed likely as of the time that I discontinued the medication that my manic symptoms were either going to stay as bad as they were at that point or get worse with more time taking Lamictal.

When I went back to see the psychiatric physician assistant that I see about two weeks ago, she prescribed me Depakote ER. I've been taking a low dose of Depakote ER (250 mg) since the day I was prescribed it, and even though I haven't noticed anything huge from the medication since I started taking it, I will say that my cognition and manic symptoms have improved in a way that's quite significant for what I can expect from the dose of Depakote that I'm taking. Also quite significantly, there isn't much that I have to say about how the medication seems to be affecting me that's negative. I know that it's still pretty early into my trial with Depakote ER, but I'd have to say that the response that I've had to the anticonvulsant mood stabilizer in the two weeks or so that have passed since I started taking it has probably been my best response to a psychiatric medication in more than 14 years. The response that I'm having to Depakote ER is definitely far different from the responses that I had to antipsychotic medications, which always involved some of my symptoms getting worse in a big way, even if the medications also did a lot that was helpful. Along the lines of what I've written, the improvement that I've been noticing as far as my symptoms are concerned since I started taking Depakote ER is far from what I'm looking to ultimately achieve with the treatments that I'm using for my mental health problems. However, I'm very optimistic that Depakote ER will do a lot to bring about the bigger improvement that I'm hoping to achieve in my mental health with more time on the medication and larger doses of it.

In the time that's passed since my main mental illness diagnosis was changed back to bipolar disorder and since I also started following a treatment plan that focuses mainly on reducing the severity of (hypo)manic and depressive symptoms, my treatment outcome hasn't been entirely positive. As part of the process of following the approach to treating my mental health problems that focuses mainly on relieving my mood disorder symptoms, I experienced a worsening in what were basically the main symptoms that I needed to address with the first medication that I tried (Lamictal). But with it being just a little more than a month since I was diagnosed with bipolar disorder most recently, I'm already responding to the treatments that I've been using in a way that's quite a bit better than how I responded to the treatments that I used when I was diagnosed with schizophrenia and schizoaffective disorder. With the approach to treatment that I'm using, I'm actually responding to the mood-stabilizing medication that I'm taking with few negative effects, and I think it's very interesting that I'm able to say this so soon after having been diagnosed with bipolar disorder this second time around when the only times I've been able to say something similar during the course of the treatment of my mental health problems were when I was diagnosed with bipolar disorder previously and early into the period when I was diagnosed with recurrent major depressive disorder (i.e., not at any point when I was diagnosed with schizophrenia or schizoaffective disorder). It is, of course, the case that it hasn't been long since I received my most recent bipolar disorder diagnosis, but I will say that at this point, it's looking likely that having the right mental illness diagnosis for my main mental health problems is mattering in a big way for me.

In retrospect, having fallen off track with following an approach to treating my main mental health problems that focuses on treating the symptoms of bipolar disorder is looking like it was a huge mistake that likely resulted in me having struggled in a huge way with symptoms that caused a very significant level of distress and functional impairment for more than a decade of my life when things could have possibly been far better. Falling off track with focusing on treating my main mental health problems as the symptoms of bipolar disorder started in 2005 when I was experiencing very severe depressive symptoms with no hypomanic or manic symptoms to speak of. I was trying different antidepressant medications with varying results, but one thing that I didn't experience with the antidepressants that I was taking at that time was a presentation of symptoms that included mania or hypomania that were of any significance. With the focus in 2005 having been on the symptoms that I was experiencing at that time (severe depressive symptoms with no mania or hypomania to speak of), and with the diagnosis from the psychiatrist that I was seeing having been recurrent major depressive disorder, I started to drift away from the idea that I had much of a reason to worry about dealing with manic or hypomanic symptoms. When I did start to experience mania with psychotic features in 2007 as part of the mixed affective state that I've been in since then, the ideas that I had about my mental health problems were pretty far from the ideas that I had in early 2005 that focused heavily on me having bipolar disorder. Furthermore, even though I was experiencing symptoms that in some ways seemed to be manic when the mixed affective state that I'm currently in began in 2007, I didn't recognize the symptoms as manic symptoms because I seemed to be experiencing too much in the way of depressive symptoms for me to be experiencing mania. Even though I had read about mixed affective states around the time I entered into the mixed state that I'm currently in back in 2007, the descriptions of mixed states that I had come across didn't include enough detail to allow me to see the symptoms that I was experiencing as symptoms of a mixed affective state. So, in addition to continuing to focus on the depressive symptoms that I had been experiencing since the year 2000, I chose in 2007 to focus on the psychotic symptoms that I was experiencing at the time and ended up falling further off track from focusing on treating the symptoms of bipolar disorder than I had been before that.

I think that I bear plenty of responsibility for having fallen off track from the focus on bipolar disorder that I now think that I need, but I also think that many of the treatment professionals that I saw over the years bear a good deal of responsibility for me having fallen off track in the sense that I've described, as they missed many opportunities to identify mixed affective symptoms in me at times when I seemed to be pretty obviously experiencing such symptoms. Falling off track from focusing on getting our symptoms of bipolar disorder treated as the symptoms that they are can occur pretty easily. It seems that it happened for me for about 15 years, with results that included very severe symptoms and very significant functional impairment that might not have been nearly as bad if I hadn't fallen off track. I know that it's hard to predict what will happen as I continue to follow my current treatment plan, but I think there's a good chance that what I've experienced can maybe be seen as an example of sorts of what can happen to those of us with bipolar disorder if we stray from getting our mental health problems treated as the problems that they are.

The symptoms that I experience as part of the mixed affective state that I'm currently in have only improved so much since I returned to following a mainstream approach to treating my mental health problems (which I'm following alongside continuing to use alternative treatments that include curcumin, Rhodiola rosea, Korean ginseng, l-methylfolate, vitamin D3 supplements, sun exposure, and exercise) last month. I am, however, hopeful that my symptoms will continue to trend toward improvement the longer I keep receiving psychiatric treatment and as I return to seeing a talk therapist (which I'm planning on doing soon). I have in the past posted to the forums on this site to both receive support and be a source of support to others, and I've also used the knowledge that I have about mental health conditions to try to give those who post to these forums useful information with the responses that I've written to posts on these forums. I'm hoping that as more time goes by, I'll post to these forums more regularly once again (and hopefully with symptoms that are even better than they currently are) and make some contributions that at least many of you will find to be valuable.

shadow2000

[*Beth*]

Welcome back, shadow

Your journey toward diagnosis sounds like so many of our journeys. Long and convoluted. But what a relief, to finally have a clear diagnosis.

An aside- it's interesting to me that so many of us with BD also have a degree of OCD.

I also find it interesting that AP's caused more problems than benefit for you? I'm really curious to know more about that...what are some of the ways in which AP's caused problems?

[Soupe du jour]

Hi shadow 2000. Welcome back to Psych Central's bipolar disorder forum! I am happy that you wish to join us here.

You have had such a long journey trying to find the right diagnosis and treatments. You're not alone in that.

Are you seeing your psychiatrist regularly? It's important especially when starting new medications. Do you think you might be hypo(manic) at this time? How do you feel mood-wise right now?

[shadow2000]

BethRags and Soupe du jour,

Thank you for your welcoming responses to my post. I appreciate the fact that both of you took the time that you did to read my post and respond to it, and I found the messages that both of you wrote to be supportive.

To respond to the question that BethRags asked, probably the biggest problem that I've noticed with antipsychotic medications is that they do a lot to impair my cognitive functioning, even though the overall effect that they exert on my cognition is mixed. It's also the case that basically all of the antipsychotic medications that I took significantly worsened my depressive symptoms when I kept taking them for long enough. It was even the case for me that two of the antipsychotics that I took (Seroquel and Geodon) worsened my manic symptoms and my psychotic symptoms in a way that was intolerable early into my trials with the medications, despite the fact that I'd still say that the antipsychotics that I've taken have generally helped to reduce the severity of my manic symptoms and my psychotic symptoms.

I found Abilify to be the most tolerable of the antipsychotic medications that I've taken and took the Abilify dose that I found to be the most tolerable (5 mg) for about 7.5 years. However, the years that I spent taking Abilify were very frustrating years for me, with the functional impairment that I experienced during that time having been very significant both because of how the medication affected me and because of the mental illness symptoms that I still had to deal with (mostly cognitive dysfunction and depressive symptoms) despite what the medication was doing. I tried taking a few other medications and a very large number of dietary supplements during the time that I spent taking Abilify to try to improve the treatment response that I had with Abilify, but I didn't succeed in doing much to improve my response. Another problem that I've experienced that's likely tied to having taken Abilify is that I've developed neurological symptoms that the neurologist that I see basically diagnosed as parkinsonism. It's been more than five years since I stopped taking Abilify, but the neurologist that I see has told me that he suspects that Abilify was involved in causing the parkinsonism that I still experience.

So, what I've written above basically sums up a lot of the problems that I've experienced in connection with the antipsychotic medications that I've taken. I still can't rule out the possibility that antipsychotics might play a helpful role in the treatment of my mental health problems at some point in the future, but right now, I'm focusing on trying other medications that are more likely to be beneficial to me (most notably the anticonvulsant mood stabilizers and certain antidepressants). I do think that the antipsychotic-centered treatment approach that I followed previously in some ways interfered with me getting the treatment that I needed for my mood disorder symptoms, but I can't be sure that following a treatment plan that involves taking an antipsychotic medication is something that I'll never do again.

To respond to the questions that Soupe du jour asked, I am seeing the psychiatric treatment professionals that I see on a regular basis. The main psychiatric treatment professional that I see is a physician assistant, but she works with a psychiatrist who was involved with diagnosing me at my initial appointment at the treatment center that I go to, and I can talk to the psychiatrist that my physician assistant works with if I need to. I have an appointment with the physician assistant that I see coming up in about two weeks, and even though I don't know what prescribing decisions the physician assistant will make, I expect that she will need to make several medication adjustments before I'll be able to get the sort of medication response that I'm hoping to achieve. So, meeting with the psychiatric treatment professionals that I see on a frequent basis certainly is something that I'm expecting to do early into the process of seeing the professionals that I'm currently seeing.

With respect to what Soupe du jour asked about how things are for me currently as far as my mood state is concerned, I think that I'd say that I'm in my usual mixed affective state that basically consists of experiencing manic symptoms that are superimposed over the anergic depressive symptoms that I usually experience. Some of the manic symptoms that I find to be particularly problematic are distractibility, psychomotor agitation, irritability, and racing thoughts, but the way I usually experience my bipolar symptoms involves me needing to contend with the symptoms that I listed above (along with depersonalization and derealization that I also experience) with a level of energy for my own conscious thinking that is diminished due to my depressive symptoms. I will say that even though I'm currently contending with the same mixed affective symptoms that I usually contend with, the Depakote that I'm taking is helping to improve my cognition and reduce the severity of my manic symptoms.

Thanks again to both of you for your responses to my post.

shadow2000