Part one: On Guidelines for treating mixed episodes and rapid cycling in bipolar disorder – Beacons Of Hope: Thyroid hormone replacement and rTMS treatment.

My problem with my illness is not my illness per se, it has always been how the medical community thus far dealt with me as a series of isolated symptoms; instead of seeing me as a whole person.

Things have been moving on though. Let me tell you my story with this new treatment am on.

But before that, we have to talk diagnosis. We have to talk guidelines. We have to talk knowledge.

Looking back, the past three weeks seem like months.

My beloved husband researched and researched my condition over and over again. He wouldn’t surrender or admit that I won’t get better. He believed that there is a way out and that I could be cured. At least he told me “let’s have the honor of trying”, bless his pure heart.

Less than three weeks ago I was self admitted to another mental health hospital. I left the very same day. Surprise! Though practically no one understood, everyone accepted, believing I had some internal compass that points to truth. In fact, I was too restless for a single room and too “aware” to stay in a ward.

In a parallel world my husband had found a doctor in London at the London Psychiatry Centre who had very convincing arguments saying that he could treat my condition. In fact he already successfully helped hundreds like me. This brilliant man is called Doctor Andy Zamar. His attitude, bedside manners, and ultimate responsiveness to his patients make him deserve my deepest respect regardless of the outcome of my ongoing treatment. He doesn’t believe in the status quo and he bothers to read what

have written before him.

We first had a FaceTime consultation during which he made me read some research he had gathered regarding bipolar disorder. Specifically, he wanted me to read in black and white as he said how wrong it is to take antidepressants when one has a mood disorder. He made me read out loud the Maudsley Prescribing Guidelines in Psychiatry for those suffering of rapid cycling. It said loud and clear to “withdraw antidepressants in all patients”.

That my friend is an interesting finding. I have been given antidepressants by the medical community that treated me in the past three years. In 2017 Effexor led me to the emergency room trying to quit it as it was impossibly painful to deal with its withdrawal symptoms. Mind you it was done under medical supervision. But that is another story.

Later on in 2018 I began self medication when I quit lithium by myself – which interestingly I discovered does not work on its own in my particular case as per the guidelines. It has also lots of side effects I could not deal with. So I self medicated and started Prozac 20 mg for 7 months. I did that because I thought it would be a safety net that won’t let me fall into deep depression.

I was wrong, I couldn’t have done myself more harm unknowingly. I did rise into hypomania which inevitably led me to deep depression. When I went to see doctors just before meeting Dr Zamar, they advised and prescribed an increase in Prozac to 40 mg and this is when hell broke loose.

Doctor Zamar diagnosed me then with ultra rapid cycling bipolar disorder otherwise unclassified. I had hypomania turbo charged, as he explained with depressive content. Talk about suicidal thoughts!

Again I read during our call what described my state. Doctor Zamar was not reinventing the wheel. The paper is called Melancholia Agitata and Mixed Depression [Koukopoulos et al. Acta Psychiatr Scand 2007: 116 (Suppl. 433): 50-57. The paper is more that 10 years old!!

So on page 52 here is the “clinical picture of agitated depression” – it was describing me in a nutshell …

Melancholia Agitata and Mixed Depression
Melancholia Agitata and Mixed Depression p.52

So people someone was saying why I was committing suicide in ink…

Check this out

Melancholia Agitata and Mixed Depression
Melancholia Agitata and Mixed Depression p 53.

The last time Doctor Zamar prescribed antidepressants was in 2004. Say what you may. But isn’t it a million percent better to be safe than sorry?

This is a heavy post I know.

My final words are those of hope. Now that we know what not to do, the action he proposed is derived from new research based on thyroid replacement therapy and rTMS.

The treatment combo am doing is that I take on one side Olanzapine known as Zyprexa which is an atypical antipsychotic that is supposed to calm my hypomania.

Secondly I do rTMS or Repetitive Transcranial MagneticStimulation; a treatment that not only has enormous success rates for treating depression but it is virtually side effect free.

Last but not least, Doctor Zamar is using Precision Medecine Nd treating me as a person. We do weekly ECGs and blood tests. He takes my side effects seriously and he doesn’t brush them under the table. He listens. Mind you this post could sound like praise to him, which it is. But listen my friend, it is to everyone of us working with people. Stop being an ear and nose doctor and look at true bloody person you are treating.

At this clinic they do take swabs to send for genetic testing to stop wasting your time. As their website says there is no “one size fits all”. Genetic makeup therefore is very important in deciding treatment, knowing what works and what won’t and also knowing what would be tolerated. In psychiatry this saves light years.

I will be staying explaining in my following post the thyroid replacement therapy.Meanwhile I urge you to read this beautiful hopeful article published on their blog: Bipolar News – Millions could benefit from bipolar breakthrough #worldfirst

TBC

I am committed

I am committed to coming back to this very hospital

I am committed to receive every form of therapy there is under the sun

I am committed to doing whatever it takes to raise our children, see them graduate and organize their weddings

I am committed to loving and honoring my immediate and extended family in every possible way

Meanwhile I am finding my happy middle

It is a mirage

But I need to keep on looking

I will check out tonight if it is the last thing I do

I will come daily as an outpatient

I am committed to heal

I am committed to survive

I just checked myself in a few hours ago and now I want to run through the iron gates and never come back.

I cannot deal with my thinking, my needs, my wants, my moods.

Is this a magic spell?

Get me in here

Get me out of here

My patience is nonexistent and my insight is blurred with my tears.

End this torment for I am at the end of my rope

This song is on a loop and it won’t stop

TBC

Worry of hope – rapid cycling

It’s 5 am and I cannot sleep.

I am angry of myself. I am angry of the world. I am angry of hope.

I am supposed to try a new treatment soon. My mood changes more than I can handle. I am up and down at the same time.

I put on my trainers and went down for a walk.

Am writing and waking while listening to music. That is how restless I am.

I am worried it will fail

I am worried I will fail

I am worried I will fail them

I am worried they will fail me

End up my post with the usual

God grant me the serenity to accept the things I cannot change

The courage to change the things I can

And the wisdom to know the difference

TBC

You must know

Know that I love you since before I was born

Know that I loved you since before you were born

Know that you are my every reason for being

Know that I want to leave to set you free

I try and I fail and I try again and I fail and fall harder

Maybe this time it will work

In the world of rapid cycling

Hello everyone. Bla bla bla yes I haven’t written for a while, miss you, etc.

You know it is not me who is inconsiderate or rude: am rapid cycling.

Say what? Say one day am high as a kite (a small kite since am bipolar 2), and the next am digging a tunnel to the the after life (does that even make any sense?)

You get the picture. Am a yo-yo, I am a roller coaster, a bullet train with bad breaks.

I enjoy my ups and do accomplish a lot; especially if you count shopping as an accomplishment. I spend hours without eating (big high five since I tend to feed like a newborn every 2 hours). I even live on 5 hours of sleep and I am Eeyore on any other day.

Woke up at 6 am today (weekend here on my side of the world) and hoped into my trainers and on to the kettle and to my smokes.

Am sociable, am pretty, am smart and talkative. I love it.

I wrote this down to me Nour. Yes to me, for in a few hours I will feel like dirt is better than me. I will feel empty and useless and I will become a burden. I will get back to staring at the ceiling and doing nothing but dealing with suicidal ideation.

Today however I will kiss my kids, a lot and lots more. I will go for a long walk like the book says. I will have lunch with my beautiful loving family and I will dress to impress. I will put on my make up and my new earrings. I will take a selfie or two and hashtag them to mentalhealthawareness.

Meanwhile my rapid cycling friend; I freakin feel you. You are my hero.

Remember, for every down there is an up coming and heck yes we shall ride the wave and rise to the moon.

Bless

TBC

Call for interviews

As part of a bigger life project, I am conducting (anonymous) interviews on how to live/cope with bipolar disorder. Send me a message here or through my Facebook page if you are interested in participating.

Bless

https://m.facebook.com/happilydepressedblog/

You are not the problem; you are the solution

I have been away from writing for a while. It was a period of re-evaluation. I needed time to gather my thoughts before I share them with you.

Today, I want to talk about living in the now. I want to talk about living without fear. I want to talk about hope…

I want to talk about waking up without wanting the day to end. I want to tell you that it’s possible to enjoy life even if circumstances are not ideal.

I want to share with you today my insight about a previously feared decision that I was very hesitant to make.

I was hesitant to live.

My fear blocked me. Doubt was consuming me inside out. I didn’t like the present (my illness) , I regretted the past (my recent diagnosis with depression and bipolar disorder, my genes, my upbringing…), and worried incessantly about the future (relapses, pain, facing myself or even another day).

This topic was my obsession. I thought of nothing but bipolar disorder. I was not sick with the disease, I was the disease itself. I couldn’t put a distance between me and “it”. Bipolar was the boss of me, and I didn’t know any better.

Little by little my dissatisfaction with the situation kept building up. It was sort of an unconscious rebellion surfacing. With hindsight, I understand why I opposed certain hospitalizations and certain drugs or doctors. I refused over and over again to be numbed. Because when I get numb, I forget why I am in this situation in the first place.

I knew something was amiss.

The healing system I surrendered to was treating my symptoms and not my illness.

Traditional psychiatry attempted to take my pain away without telling me that I will also lose myself in the process.

I have been aware for a while that my condition is psychological but to a big big extent also physiological.

I couldn’t accept that my childhood, no matter how sad it was could still affect me some 30 years later. I couldn’t accept that moving from one country to another is enough of a reason to have me sedated by force while I was trying to escape from the ICU after a suicide attempt.

What couldn’t they see? What is being told to me by this suffering? Why is my family witnessing this? Is it all coincidence? Is it all in vain? I was a mental health practitioner at some point, how could I be the patient now? What happened to me???

As my rebellion became my revolution, I weaned myself off drugs. But that was only the beginning. Slowly my cognitive abilities came back. Not all, I still have memory blockage, or loss. I lack concentration sometimes too. But in general I can tell you with confidence that this is my brain. Those are my feelings. This is my reality.

I began to put 2 and 2 together and made some parallels- and those made and still make sense to me. They might not be universal truths; but is there such a thing?

I thought that each hospitalization began with a series of blood tests. Why do they keep on saying that there is no bio marker for mental illness!! A lie. A big fat ugly lie.

I don’t know about you, but I would rather have a half truth than none at all. The medical community has knowledge about biological, pure physiological imbalances that accompany depression, or any illness to that end.

People just take the easy track and stop investigating, or they don’t want to claim responsibility. Tell me why is my sedimentation rate (ESR) abnormal? Why is my vitamin D so low? Why is my thyroid imbalanced? Why did I bleed for weeks with no end between my periods staining every surface I touched before I was diagnosed? Hormones anyone? My ferritin was low, my proteins were in the wrong values. Soon after I started treatment I began to have bad cholesterol. Is my mother the reason for all that? Or is it rainy Paris? Or maybe my then 2 extra kilograms?

I was prescribed “vitamins and supplements” yes, but no one ever told me that they would be key in healing me if taken religiously and monitored regularly. I was told not to miss my antipsychotics, my antidepressants, my anxiolytics; those drugs that alienated me further and further from me, from those around me and most importantly from the truth.

I was told I need to play sports and bathe when I was pinned to my bed by drugs. Yes yes, exercise is good for depression. Not once was I told that there is a link between what goes into my body (food yes food!) and my physical or psychological condition.

Not once was meditation mentioned. Not once was yoga mentioned. Not once was even coloring-in mandalas brought up. Just take the drugs and come back for more. I was offered psychotherapy, but I didn’t give it much importance then. I think now it was because I felt to a huge degree that talking about my problems wouldn’t make them disappear.

I realized that no matter the good will around me is, no one would help me but me. I decided to take charge of my life.

At 38, I finally decided to become an adult.

I will listen to the medical community orthodox or not, because yes they do have insight. But most importantly, I will now forward listen to myself. I started to believe in me. I started to believe in my cognitive abilities surfacing and my instinct.

I knew I am no longer Bipolar Disorder. I am Me.

Simply put I began to circle around the idea of inflammation. I knew that illness meant imbalance and imbalance was often caused by inflammation. I also thought that inflammation is not only physical but psychological. I thought I would enforce a way of doing – a way of living – that is anti inflammatory.

When you are ready, the stars align. Without being esoteric, when you buy a red car you start seeing red cars all around you. When you brain focuses on a certain topic, you see it in plenitude.

I began to dig for links and for alternative remedies. I found that others – plenty of others- think the same. I hadn’t given alternative ways a serious thought before. Cancer healed by pure will and some plants? Yeah right!

I think that if you want to go alternative and drive off road, you cannot pick and chose. It has to be integral or better still systematic. Again that is me talking not science.

So it figures that turmeric or curcuma is a miracle drug that treats a wide range of problems relating to inflammation. It figures that I need to treat my candida problem that has been an integral part of my life for the past 10 plus years if I want to heal. Not one, not a single medical authority wanted to establish this link; as if I had several bodies or as if my organs were not related and living in the same ecosystem.

It figures there is a link. And yes, essential oils do work if taken long enough and right enough. It seems that the liver needs a proper cleanse to get rid of all the bad stuff we feed ourselves all the time. Otherwise healing would be in vain.

It figures that sugar and gluten can also be part of the problem, feeding regularly the inflammatory machine. The more you eat it, the more inflamed your body will be, and the more you will crave it. Funny, I consumed jar after jar of jam before my first hospitalization; a food that I truly dislike.

Activities are also inflammatory. Sitting hours in traffic jams is inflammatory. Dealing with negative people and draining meaningless tasks is inflammatory. Going for a walk is anti inflammatory and so is listening to music. Playing with the kids is anti inflammatory; trying to prove that I am right all the time is inflammatory. You get my point.

None of that would work alone. It is a system. A wholistic system that you create and you alone- it has to make sense to you.

The knowledge is there. I am no genius and you don’t have to be one.

We went through hell and back – all of us. Whether you lost a child, a limb, a job, or financial security. You are unhappy because you chose to define yourself as a problem. I Am The One without a Mother. I Am Bipolar Disorder. I am Divorce. I am Unemployment. I am Obesity.

While doing that we forget all the other things that we are, or aren’t! Yes you could be bipolar and it is sad, but you are so much more than that. And you are not so many other bad bad things.

The truth is there is always better; but mind you there is always worse.

So let us take a leap of faith and try to breath it out.

Say it out loud with me

I am not my illness, I am me.

I know this is not an ideal situation, but there is no such a thing.

I know I cannot control tomorrow, but thinking about it constantly won’t change a thing;

When I need help I will ask for it, but I am in charge of my existence;

I live for a reason; and that reason is to understand and free myself from suffering;

I am as happy today as I could ever be….

I beg you please to listen to yourself. Listen to your body. You are not the problem: You are the solution.

Bless

TBC

Choosing to live with the side effects of psychotropics – a life changing decision…

I saw my psychiatrist yesterday.

I told her about my “attacks” and she explained.

She told me that hormonal changes in female bipolar patients tend to send them over the moon sometimes. So what I am going through is not surprising. It is not a hormonal problem per se, it is just a confirmation that I have a mood disorder.

I asked if there is any biomarker that would tell us if I need a hormonal treatment to fix my mood. She said that there is currently no information on this. Surprise? Not really. So the only marker hormones wise is that of the thyroid gland functions. My numbers are not perfect, but not alarmingly different to cause such an imbalance.

My session was important despite the “negative” results. I now know that I need to make a big decision.

My doctor asked me about whether stopping lithium was due to hypomania and I said it was not. I would do this over and over again. The changes, the personality changes that most psychotropics cause me are just unbearable- to me. Again, this is such a personal matter that it would be straight stupid to advise anyone to quit or not. I am not preaching anything. I am just sharing my own journey, which might or might not be similar to yours. What is sure though, you might have gone through similarly difficult choices to make.

We agreed that my life as it is now is not fulfilling. The unpredictability of my attacks renders my illness a disability to me and to those around me. We are unable to plan anything. I struggle to be an adult, an independent person who requires little or no maintenance. I struggle to be there for my children as a full time mother. Career? What is that sir! Sometimes having a shower is already a challenge to me.

Having said that, my worst fear is hurting those around me. Till when can they deal with my unpredictability.

Till when will my husband take days off work, or leave the house with a feeling of apprehension not knowing if he will find me home when he gets back.

Till when will I have my father leave everything and stick around to be here just in case I cannot deal with the children. Till when will he hop on and off plans to come to an emergency situation beyond his or my comprehension? Till when?

So fact one; we know this cannot go on.

Fact two; there is no clear solution.

My dear doctor whom I respect so much suggested that I add a new psychotropic to my daily dose of Prozac.

Psychotropic drugs are medications that affect your central nervous system, changing how your brain processes information, such as altering your mood, thoughts, perceptions, emotions, and behaviors. Most psychotropic drugs are prescribed by your therapist or health care provider to treat a diagnosed mental illness, such as bipolar disorder or borderline personality disorder.

https://www.verywellmind.com/psychotropic-drugs-425321

You see I don’t have a conscientious objection against drugs. No, I don’t. The thing is with most drugs I feel alienated, weird… I twitch, I get nightmares, I get lethargy, restlessness, anxiety, and sometimes I even have suicidal thoughts that unfortunately led me to the emergency room more than once.

She said the new drug- Abilify– could help regulate my mood. The idea is to take it at 5mg – a super low dose – to keep my curves from skyrocketing or dropping at the speed of light. Sounds good yes. I would have to wait a few months to monitor the effect of Abilify on my mood and on my menstrual cycle.

Will it work? We have a fifty percent chance it does. Ok, side effects? For starters, it is prescribed to children. How bad could it be?

Then Surprise surprise, they said when they put it in the market that it does not make you gain weight. Oups! Mistake, she said it does in many patients and my readings confirmed a nice 10 to 20 kilograms of extra weight per year. Maybe at different dosages, but still. I won’t be able to tie my own shoelaces by 2020.

Ok. What else? Oh it varies greatly she said from one person to another. Reading suggests that the worst is in the beginning; like vomiting and the like. That does not scare me. What really scared me is that patients on this drug would complain of very low energy and of restlessness or need to move.

According to the official site of the drug,

ABILIFY may cause movements that you cannot control in your face, tongue, or other body parts. Tardive dyskinesia may not go away, even if you stop receiving ABILIFY. Tardive dyskinesia may also start after you stop receiving ABILIFY.

https://www.abilify.com/important-safety-information.aspx

They might get also compulsive behaviors such as gambling and binge eating, cholesterol and anxiety.

How are you supposed to fight depression with all this extra weight and without any energy, with twitches and compulsive behavior? Don’t tell me stop searching the Internet. I did differ from a wide spectrum of side effects before. They are as real as it gets.

Her idea is that my Prozac would have a counter the side effects of Abilify and things would balance out. Perhaps…

So my dilemma is simply the following:

Should I risk living with these unpredictable cycles and watch myself and my family losing our minds slowly; or should I take the drugs and lose myself little by little and become a deaf note floating around in a soundless world?

Can you relate? Did you go through the same? Can you throw me a bone here? What did you do? What would you do?

God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to kno
w the difference.

TBC

If I were

If I were at the hospital

I would wear my pyjamas all day

I would say good morning to everyone

I would wake up on time

I would have breakfast at the communal table

I would go for a smoke when the nurses say so

I would wear a nicotine patch To get me through the day, and I would be allergic to it

I would use the communal shower and dry up with a bed sheet; I would find hair everywhere and stay with my slippers on

I would wait for the doctor to pass by and say the daily bla-bla-bla;

I would play Sudoku- pen and paper sir not online

I would stare at my family’s portrait hung on the window and imagine them touching my face

I would move my chair around to be in the sun, seeking emotions and failing to find none

I would be disconnected; off the grid and not feel guilty about it

I would pretend it is doing me good to be here

I would take my blood pressure and temperature every day

I would talk to others about side effects of this or that

I would fancy getting better

I would know it is good for me, it has to be; it better be

I would feel guilty about the kids, my husband, my father; my kids, my husband, my husband, my husband, my father, my father, my father, my father….but my kids…

I would wait for 2pm when visits start, no no tears this time

I would wait for 7pm when I can call the kids and ask them to sing me a song, sometimes they would

I would give them imaginary baths and diners

I would blow imaginary kisses and I would make belief that I am tucking them to bed

I would kiss my husband good night and say a silent prayer, god let tomorrow be normal – one more day

I would beg for the drugs to black me out at 8pm

Dinner would be sprouts and more sprouts. Some borrowed olive oil here and some salt

The other day I took the kids bowling and felt so self accomplished just as if I landed on the freakin moon

I am sitting by the louvre sipping my Bloody Mary with tears

People are standing up here and there trying to get a perfect picture

They bend and jump into strange angles to look like the pyramid is on the palm of their hand

It is all make belief, looking for the perfect moment

A tour guide has an umbrella up for everyone to follow her

Where else would they go I wonder? Isn’t this the perfect moment? To follow someone without thinking? Tick this box and that one. Been there, done that…

We talk and talk and talk and talk

We shut up and up and up and up

We should know better

I am writing compulsively, but you don’t have to read me

It is building up

I know myself, I wish I didn’t

Solve it; for you god brought me here in the first place

No shame; maybe some

No regrets; just a few

Oblivion where are you?

TBC

Solace, where are you?

I would like to shed my skin like a snake…

I would like to change colors like a chameleon…

I know that personal growth is not always linear.

I know also that sometimes you keep on suffering until you learn the lesson.

Things are more bearable during the day. Yet, when the sun sets, and as the sky becomes darker, there is little left to be done. The few chores of the day end one by one.

I sneak back to my corner in bed. I hold my phone and do nonsense. Minute after minute, tic toc. It is past midnight already. I count the hours I have left in bed, and dread facing the next morning. I will myself to sleep but know to well that this is not how it works.

Someone else got into the control center in my head and took over. I am equally lost between trying to fight and surrendering. They are the same.

I’d do anything if I could. Like walking on shifting sand I lie on this side then on that side seeking comfort.

I finally fall asleep but my dreams are no solace. Of course they are vivid. I stopped trying to know what is true and what is not. They are as real as it gets, and also as fake as it gets.

I usually fixate on things in my dreams. Small details, they keep on coming back. I wake up without any memory of what happened. Just a feeling of weirdness and abnormality. Too much brain activity or too little. All the same.

I find small feet cuddling next to mine. They are seeking comfort and safety in me. In me…

I wake up to the sound of the alarm and hit snooze. I wish I could escape from the responsibility of being me.

I wish I could let go.

I worry about my family and how they will react – again. Pity, love, empathy, boredom, anger, what again will they feel.

I can see my temporary paralysis turning beautifully into a handicap. Will I need to be taken care of again? Till when I wonder… Will I ever be an adult?

I don’t know what to do with every single second of my day. I listen to this song then forward to another. I watch this show and then another. I go out for a smoke then decide it is too cold. I want cookies and cheese at the same time. What the hell is going on.

You know I wish I had a timeshare at a mental clinic. How cool would that be? Hello yes, this is client 44087. I am calling for room 13. Yes, is it time already. Is it empty today? Sure, like last time yes. I would like to start with the locked up package first. And I insist, don’t let me out even if I beg you too. That’s it then. See you later. Oh yes, I know the drill. No sharp objects of belts. Thank you.

Perfect customer service.

A few weeks after, my skin would have shed. Yes I am a reptile after all. Why? Oh am also a chameleon and I change colors all the time. Only difference is this is not for adaptation like reptiles. It is a malfunction, a mutation if you prefer.

At the end of the day, survival is for the fittest…

TBC

The tunnel at the end of the light

I wake up and find out that the life I thought I had is slipping through my fingers.

I look at myself in the mirror and I don’t see me. My son tells me what is wrong with your eyes? He is three.

Where is my silent mantra? Where is my magical oxygen?

Like a broken record, or a bad movie that always has a sequel…

I am just a

Racing heartbeat

Cold limb

Thought with echo

Foggy brain

Shallow breath

Flushed face

Spent energy

Headache

Backache

Fear

Silent scream…

I ask myself. Are you coming back? Are you already here?

I can’t be. You left me, remember? You almost promised not to show up again…

Why is it always payback time? Didn’t you take enough through out the years?

I have nothing more to give or to give up. I surrendered everything. You took it all away.

I am hesitant again…

I am dizzy again…

I am in bed again…

One of us has to leave and it cannot be me. I told you this before. I cannot go, it has to be you.

These cycles are endless. They tell you there is light at the end of the tunnel. Sure thing. Can’t argue with that. But they fail to mention that there is another bloody tunnel right after the light.

TBC