This is the third post in my series on the In Our Own Voice talk I prepared/am preparing/will always be preparing for NAMI (National Alliance on Mental Illness).
Click here to read the prequels...
Part 4: Treatment
I found that being treated for Major Depressive Disorder when I actually had Bipolar Disorder was particularly NOT effective. I had found antidepressants to be sporadically effective... but I was also only taking them sporadically so it was hard to tell whether they were doing anything for me.
Once I made the decision to really deal with my mental health issues, I embarked on the long (and neverending) journey of finding the appropriate treatment plan.
The first step toward stabilizing my bipolar symptoms was beginning to take a mood stabilizer. The mood stabilizer that I am taking is an off-label use of an anti-seizure medication commonly used to treat bipolar symptoms. As a bonus, it has some anti-depressant qualities as well.
The goal was to make it less likely that I would have manic or depressive episodes, or that the episodes would be less severe. I think of it as providing me with a smaller roller coaster... a kiddie roller coaster with the highs not so high and the lows not so low and the changes not happening in such rapid succession.
Keep in mind that for me that by "highs" I do not mean an excess of happiness and joy. It meant an excess of irritability, rage, boundless and unfocused energy and sleeplessness. "Lows" meant being chronically tired, afraid to leave the house and very withdrawn from friends/family/coworkers.
I have what is referred to as "rapid cycling" bipolar disorder, which means I have more than 4 mood episodes per year. I am likely "ultra-rapid," because sometimes I cycle in the course of one day from hypomanic to Depressed and then back again.
This type of bipolar disorder can be particularly difficult to treat because you use different medications to treat Depression or hypomania. Many anti-depressants can provoke manic episodes. And the one time I was on an anti-manic medication it made me cry constantly.
There is quite unfortunately not one pharmaceutical treatment plan that will work for everyone with bipolar disorder, and even when you find a good combination of medications... they may not continue to work. This means that as part of my treatment plan I maintain regular contact with my Psych Nurse Practitioner who prescribes my medications.
I am currently taking only a mood stabilizer. I have a one-month supply of an "atypical antipsychotic" that I can start taking if my Depression seems to be settling in. My instructions if that is the case is to start taking the medication and call to see my Psych NP as soon as I can get in.
Another important part of my treatment plan is having a team of mental health professionals helping me navigate what is working and what is not. I see a Behavioral Health Nurse Practitioner who prescribes my medications, and a psychologist who works with me using Cognitive Behavioral Therapy.
When I was in the first phases of treatment (while still trying to figure out the appropriate medications) I had weekly visits with my psychologist. Now I only see her on an as-needed basis when things are not going well and I am having a hard time putting my CBT skills in play. I meet more regularly with my Psych NP who not only monitors how well my medications are working, but will let me know if she thinks I need to schedule with my psychologist.
It has been vital to me to have a treatment plan that includes more than just medication. Nobody would ever tell a person with heart disease to just take heart pills and change nothing about their lifestyle. The same is true for mental illness.
The non-medical parts of my treatment include regular exercise, scrupulous attention to getting enough sleep, and eating healthy foods. I was surprised at how effective making these changes was in improving my mental health. I had never thought of mental health as being part of overall health... but your brain is part of your body and needs nutrients, rest and exercise too.
I was dismayed to find that eating vast quantities of Belgian chocolate, sitting around the house, and staying up all night watching science fiction shows was NOT the key to recovery.
Quaker, teacher, parent,