anxiety

Bipolar and Being Incapacitated by Anxiety

→ June 21, 2017 - 9 Comments

Bipolar and Being Incapacitated by Anxiety

I know that anxiety is not a symptom of bipolar disorder, but many with bipolar disorder also suffer from anxiety, whether it’s an official anxiety disorder or not. And when my anxiety gets really bad, which it has been lately, I become absolutely incapacitated by anxiety. I, literally, sit on the couch unable to move to do anything. And writing or working is right out. Anxiety causing an inability to act is having a devastating effect on my life.

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What Does – and Doesn’t – Help When Someone is Anxious

→ July 1, 2014 - 20 Comments

What Does – and Doesn’t – Help When Someone is Anxious

Today my anxiety really flared up. I suddenly found I had less time to get to a bus that took me to a train that took me to another bus that took me to a hotel. And if I missed that last bus in the chain, there wasn’t another for five hours. And I still had to pack and get dressed and eat cake and just, in general, get ready.

And this freaked me out – or, put another way, this created some instantaneous, nasty stress and anxiety. My mother tried to help with the anxiety. It didn’t work.

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The Value of Rest in Bipolar Disorder

→ January 29, 2014 - 40 Comments

The Value of Rest in Bipolar Disorder

I’ve been super stressed lately. I have so many deadlines and I’ve been working on so many projects and I have so many requests to process it’s unbelievable. And, in clear Natasha fashion, many of these things were left to the last minute due to time constraints (and admitted procrastination). Oh, and it was my birthday on Monday which I nary had a moment for.

On top of all that, I had a speaking engagement yesterday. This speaking engagement was for the Bipolar Disorder Society of British Columbia. I do many presentations for them but recently the presentation was changed at their request. No problem, but trying out this new material and fitting it into the existing timeline (which can already run long) was making me nervous. And, while usually I give this presentation to teens, this time I was giving it to teachers. This, too, was making me nervous. Teachers can be a bit critical – trust me.

Really, there was no reason to be nervous, but, secretly, I’m nervous before pretty much every speaking engagement. Luckily, no one ever knows this (except, of course, for you) but the nerves are there.

My “Normal” Bipolar Anxiety Plus Massive Stressors

So, you put my “normal” bipolar anxiety with the massive stress I was under, plus the nerves I was feeling and my anxiety was off the flipping charts.

And when things are like that, I know that one of two things will happen. The stress and anxiety will either make me hypomanic or depressed. In other words, massive stress will destabilize my mood. Period. Yes, I know it’s coming, and yes, I do it anyway. Just call me an overachiever (or masochistic).

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Dealing with Fear and Anxiety in Bipolar Disorder

→ October 18, 2013 - 23 Comments

Dealing with Fear and Anxiety in Bipolar Disorder

Tomorrow I’m flying off to see some family I don’t know at all. Oh, and my dying father. I won’t get into the specifics but suffice it to say I’m scared of family in general and my father is in a very bad way.

So at the moment, I’m being eaten up with fear and anxiety.

My mother says to me: “But I know you know how to handle that sort of thing.” And I say, “Yes, it’s a wonderful drug called lorazepam.”

I was only half joking.

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How a Person with Bipolar Thinks

→ June 26, 2013 - 713 Comments

How a Person with Bipolar Thinks

This is an interesting question: how does a person with bipolar disorder think? Of course, it’s hard for me to compare it with your average person as I have bipolar disorder. I don’t have the two thought processes in my one brain to compare.

This is not to say that we all think the same way; nevertheless, I do have some ideas on how people with bipolar disorder think that seem to stand out amongst the “normals.”

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Linky-Madness, Drugging Children and Anxious Hat Makers – 3 New Things

→ August 25, 2011 - 4 Comments

In my line of work I come across the most obscure information, which is why I love sharing it with you. This week’s three new things about mental illness include:

  • A weekly mental health link-party
  • How scientists want to drug children who might get a mental illness
  • How hat makers used to experience social phobia

How could you not want to know the details about that?

1. What I Like – Madness Mental Health Linky

I’ve been participating for a few weeks in the Monday Madness Mental Health Linky over at the WordsinSynch blog by Shah Wharton. As the name implies, there are fresh links every Monday.

[push]Anyone can contribute a useful mental health link. Shah features her own work or the work of others and then lists useful links.[/push]

(No offence to Shah, but the layout is awful and kind of hard to understand.  Here’s how it works: Simply read the Monday Linky article and at the bottom there are featured links. Below that is the “blog hop” where the reader-submitted useful mental health links are posted and below that you can enter your own link.)

Click. Read. Enjoy.

2. What I Don’t Like – Drugging Children (or anyone unnecessarily)

Drugging Children with AntipsychoticsI could just leave it there but what I especially don’t like is the drugging of children who might get a mental illness. This is one of the troubles with that fad diagnosis I mentioned last weekpsychosis risk syndrome. While we do, honestly, know what puts a person at risk for psychosis, that’s a far cry from actually being able to accurately predict who is going to get a psychotic disorder.

For example, I know smoking puts you at risk for lung cancer, but you still might not get it. (Although smoking’s a lot more clear cut than psychosis. Don’t smoke. Seriously.)

In this study, people age 15-40 were to be given an antipsychotic (quetiapine) to see if it would delay or prevent the onset of a psychotic disorder like schizophrenia. And – here’s the kicker – up to 80% may never get the disorder anyway.

So I ask you, is it worth exposing a 15-year-old to a powerful antipsychotic associated with an increased mortality rate on a guess? I think not. (More next week.)

3. What is Just Bizarre – Hat Makers, Mercury  and Anxiety

Think you have social phobia? Do you make hats?

Excessive shyness, embarrassment, self-consciousness, timidity, social-phobia and lack of self-confidence are components of erethism, which is a symptom complex that appears in cases of mercury poisoning. Mercury poisoning was common among hat makers in England in the 18th and 19th centuries, as they used mercury to stabilize wool into felt fabric.

(From Wikipedia, where else?)

See you all next week for an attempt at a smarter and better me.

PS: Have you entered to win yet?

Mixed Bipolar Disorder – How to Treat Mixed Mood Episodes

→ August 23, 2011 - 23 Comments

In the final installation of my mixed moods series, I talk about how to treat mixed moods in bipolar disorder. If you need a refresher on mixed moods in bipolar 1 or bipolar 2, see the first three articles in this series:

Treating Mixed Moods in Bipolar 1 – Mixed Mania

We know most about treating mixed moods in bipolar type 1 as that’s what has been classically defined as a mixed mood in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Because mixed moods in bipolar disorder type 1 are considered a type of mania, one could think of treating them in the same way bipolar mania is treated. Typical mania treatments include:

  • Lithium
  • Some anticonvulsants
  • Antipsychotics (normally atypical)
  • Benzodiazepines (for acute anxiety, commonly seen in mania and mixed moods)

Often a combination of an anticonvulsant and an antipsychotic is used.

FDA-Approved Drugs for Treating Mixed Moods in Bipolar 1

Since mixed moods are defined in the DSM, there are specific medications approved by the Food and Drug Administration (FDA) to treat mixed mania. FDA-approved drugs for treating mixed moods in bipolar disorder type 1:

  • Carbamazepine extended release (Equetro)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Risperidone (Risperdal)
  • Asenapine (Saphris)
  • Olanzapine (Zyprexa)

Bipolar Type 1 and Mixed Mood TreatmentWhy lithium didn’t make the list I’m not entirely sure;* because, as I’ve mentioned, mixed moods and acute anxiety carry a significant risk of suicide and lithium seems to have a particularly strong anti-suicide effect.

Electroconvulsive therapy (ECT) is also indicated for the treatment of bipolar disorder mixed moods.

Treating Mixed Moods in Bipolar 2

As I mentioned in the article on mixed moods in bipolar disorder type 2, mixed moods can either have hypomania or depression as the primary mood. This primary mood then, dictates the type of treatment chosen.

Treating Mixed Hypomania

According to this two-part Psychiatric Times article by Steven C. Dilsaver, MD, mixed hypomania in bipolar type 2 can be treated similarly to treating a mixed mood in bipolar type 1.

Specifically noted is the concern of acute anxiety during mixed hypomania and the fact not all patients readily admit to psychological and physical symptoms of anxiety. However, this is critical information to your doctor and should always be offered, even if not specifically asked.

Other mixed hypomania treatment tips include:

  • Comorbid (co-occurring) anxiety may decrease the effectiveness of mood-stabilizing agents, so benzodiazepines may be a better choice.
  • Not treating anxiety aggressively can reduce overall long-term treatment outcomes.

Treating Mixed Depression

Mixed depression is particularly hard to treat as mixed moods often predict a lack of response to antidepressants, not to mention the fact that antidepressants can make hypomanic or manic symptoms worse.

A suggested treatment strategy for mixed moods in bipolar 2 with the primary mood of depression is the following:

  • Begin by suppressing hypomanic symptoms by using an mood stabilizer or antipsychotic (antipsychotics may work in 1-2 weeks)
  • Start medication at low doses and titrate (raise the dose) quickly – this is generally necessary due to the severity of mood symptoms
  • If depressive symptoms persist after response to the above medication, add a selective serotonin reuptake inhibitor (SSRI) antidepressant very slowly while watching for signs of hypomania – this requires very close monitoring and likely weekly doctor visits (impossible for some, obviously)

This is very similar to what many doctors are now recommending for bipolar disorder type 2 in general. First, stop the cycling (or hypomania) and see if that also corrects the depression. Avoid the use of antidepressants whenever possible.

Preventing Mixed Depression in Bipolar Type 2

How To Prevent Bipolar Disorder Mixed Moods

Obviously, no one can guarantee prevention of any mood, but there are some recommendations given in the article, as people with mixed depression are known to be at high risk for reoccurrence.

Tips on preventing mixed depression in bipolar 2 include:

  • Lamotrigine is the favorite prophylactic medication as it seems to prevent depression without being an antidepressant
  • Ongoing scheduled benzodiazepine doses can help prevent panic attacks^
  • A combination of an antipsychotic, plus lamotrigine, plus a benzodiazepine is often “highly effective” (words Dr. Dilsaver’s)
  • Lithium is known to be a highly preventative agent; however, in many cases divalproex (Depakote) is superior and has fewer side effects

Series on Mixed Moods in Bipolar Disorder

Whew. OK, there turned out to be a lot to know about mixed moods in bipolar disorder. I hope you learned something reading it as I certainly did writing it.

For your convenience, here are the links to the other three parts in the series:

——————————————————————————————————————————-

Notes

* I suspect there wasn’t enough money to be made on a generic drug to fund the studies, especially when doctors are going to use it anyways.
^ Yes, I know, long-term (sometimes any term) benzodiazepine use is controversial. Personally, I’m not against them and neither are many doctors – when used responsibly.

Reference

Psychiatric Times, Mixed States in Their Manifold Forms. Part one and part two.

Free Gift with Depression – A Tale of Anxiety

→ March 29, 2010 - 4 Comments

Anxious and DepressedAnxiolytic Isn’t Even in the Dictionary

I grit my jaw. I bite the skin around my nails. I pull at my hair. I bunch my fists. My breaths are shallow. I twitch and clench erratically.

I tell myself not to grit, bite, pull, bunch, twitch and clench. I tell myself to intake more air. Those instructions are followed. For moments. And then they’re not. While I wasn’t looking I started gritting, biting, pulling, bunching, twitching, and clenching all over again.

Anxious. Anxiety.

These are tiny, little words. The barely seem to warrant entries in dictionaries bloated with words like crunk (a type of hip-hop or rap music) and yogilates (a combination of Pilates and yoga), and yet somehow they have achieved great significance in my life.

Anxiety and Depression, Like Peas and Carrots

Anxiety and depression always come in pairs. The each cover half a sphere. How much you feel of each of them depends on your point of view of the sphere.

I was never an anxious person before. Or at least, I was never inordinately anxious, I think. But then came the psych meds and so the anxiety. Anxiety – the side effect that’s it’s own mental illness.

And now I worry. And I’m overwhelmed. Frozen with the fear of things not getting done . . . leading to the very obvious result of things not getting done.

Anxiety. A self-replicating organism.

Caffeine and Mental Illness and Caffeine Disorders

→ February 21, 2010 - 13 Comments

Caffeine and Mental Illness and Caffeine Disorders

Caffeine is the world’s most popular psychoactive substance. So many of us love it a la Starbucks, Tim Hortons or just out or our home coffee machine. Me, I love coffee and I’m a fan of caffeine too. Coffee’s the nectar of the gods and nothing will convince me otherwise.

It seems though, caffeine can actually hurt you. I know, I never thought my beloved coffee could harm me, but I suppose anything that you abuse, will abuse you back. So, here is everything you ever needed to know about caffeine, caffeine disorders and caffeine and mental illness but were afraid to ask.

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