Bi-Polar

‘Down Days’ or normal life?

What are ‘Down Days’?

I follow a mental health blogger, Natasha Tracey, and, while some posts don’t resonate with me every time, most of what she talks about I can identify with completely.

Many people will refer to being ‘down’ and they do not have clinical depression or a Bi Polar diagnosis. Sadly, these comments do not help those with serious mental health conditions as they trivialise what is, for those of us with such disorders, something debilitating and immobilising.

In her latest blog, Natasha talks about someone referring to ‘Down Days’ and she makes the point that hers are not days but more likely weeks and months. You can read her blog here and, if you find it of interest you can follow her and receive updates in your inbox.

http://natashatracy.com/bipolar-disorder/down-day-bipolar-mean/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+natashaTracy+%28Bipolar+Burble+by+Natasha+Tracy%29

I, too, don’t have ‘down days’. I know immediately that my mood has dropped. It will follow a period of busyness, project building, possibly excessive spending which, at the time, seems absolutely necessary but, in the time that follows, reality tells me that I did not need whatever it was I spent my money on.

I used to ruminate about recent spending but have learnt over the years not to take off labels, to keep receipts and seriously consider returning items, if that is possible. If I decide to keep some dubious purchases, I have discovered that a few months or a year or two down the line these items can be used and are not a waste. If you suffer from this behaviour, take heart that all is not lost.

But back to ‘Down days’. I recently had an email from a ‘friend’ who referred to her ‘highs’ and ‘lows’. She does not have Bi Polar or mental health issues. Her ‘high’ was related to a holiday or some success and her ‘low’ was linked to losing a relative to cancer. And this is where the boundaries between what is normal and what is a serious mental health condition become blurred. Hers were the ‘normal life’ happenings with natural emotional responses. Mental illness is something else altogether.

I do wish those who do not have mental health issues would not trivialise the emotional states of those who do by referring to themselves, as if they suffer the same states. They do not. The extremes with Bi Polar are so great that normal living becomes almost impossible. A high state can result in losing sense of reality and psychotic symptoms such as believing you can achieve the well-nigh impossible or drift into some paranoid state whereby one believes the people waiting on the street are police about to arrest you, when in fact, they may be Jehovah Witnesses discussing where next to visit. The ‘crash’ that follows a ‘high’ involves much regret at spending or actions taken and are far deeper than simple ‘down days’.

I know that some people suffer rapid cycling and can experience both high and low states in one day or in a few weeks but most people with Bi Polar will go through a period of wellness when their activity increases, their happiness is unbounded, optimism is high and life is good. That is fine until the mood slips slightly higher and the behaviour is more erratic.

The low period that follows such a ‘high’ period is not just a ‘down day’. It can suddenly envelop you in total inertia, lack of motivation and anxiety which can lead to an inability to get out of bed each morning. Even when up and moving, the brain and body are so slow that taking a shower is a major undertaking and simple activities such as making a cup of tea become increasingly difficult. The weight on my shoulders is so great that, after a cup of tea and a small breakfast, I am so exhausted I have to lie down and this repeats itself through the day as I try to overcome the lethargy and feelings of ‘walking through treacle’. Minor day to day happenings can appear insurmountable.

I dread the warning sign that I am sinking low as, unless I am very lucky and can stop it in its tracks, I know I am in for at least a month, possibly two when normal life will cease. It is, as I have said, more than just a ‘down day’, more like a ‘down month’. Luckily my medication means that I rarely go into deep depression for longer periods and I employ strategies to bring me back to a fully functioning human being. However, I am not complacent. I know that I could sink for longer periods as I did in the past.

But I have had help and advice, counselling and support.

So I know the following:

SLEEP is the key. If necessary I will take a small dose of Zopiclone for a few days to regulate my sleep pattern. I can increase my medication slightly .

RELAXATION is absent but must be reclaimed. I have a reflexologist who also has trained me in ‘tapping’ techniques. One or two visits will set me on the path to recovery.

EXERCISE is vital. Mornings are rubbish so an early lunch and then a long walk in the afternoon is called for. I combine this with sitting in the sun watching the waves roll in – the joy of living at the seaside.

CREATIVITY is absent so I try to write in my notebook each day. The entries make sorry reading later but I do include TO DO lists and the POSITIVES of each day. Re-reading these entries demonstrates how each time I sink low I need to explore why this has happened and how I can reclaim my equilibrium.

YOGA is essential for my wellbeing but is something I have often neglected before this phase. I start with 20 minutes on a blanket and try to increase it each day. This can strengthen the muscles which when we are inactive become weak.

DAYLIGHT is another essential. Sitting outside in the daylight, walking or gardening all helps.

DEEP BREATHING – also used in yoga – helps anxiety and aids relaxation.

LISTENING TO MUSIC is a recent addition to my strategies. Listening to classical music has been found to have positive effects on the brain. Uplifting music and dance tunes can also help. You may find yourself singing or jigging away, perhaps even dancing. Creating your own music ie playing the piano or another instrument can take you out of yourself.

As a writer, I need to WRITE but this is hard at these times. This when I turn to blog posts such as this which I hope will help others. One thousand words is an achievement. Of course, I would prefer it was a chapter in a long abandoned novel but it is keeping the creative writing juices lubricated.

COMMUNICATION – is so important, with family, friends but is one of the hardest parts of the illness. Keep TALKING even if only to yourself while out walking. I try to talk to someone every day when I am out for a walk. It keeps me connected.

Depression is often a state of disconnectedness where we have lost some of our ability to relate to others and the world around us. However, it will return. It will pass.

What helps you cope with these low periods?

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Bi-Polar, Uncategorized

Suicide in those with Bi Polar

Living at the coast I am well aware of the power of the sea and how it should not be underestimated but in coastal areas there are other dangers, one of which is the accessibility to cliffs for someone wishing to end their life.

Recently this happened near to where I live. The person was Bi Polar and had stopped taking her medication a week prior to the incident. The dangers of ceasing taking medication when one is Bi Polar are profound. A friend whose Bi Polar son passed through a difficult phase, was advised by a doctor to cease taking one of his mood levelling medications. Within weeks he had committed suicide with devastating effects on his family.

It is easy for me as a compliant BPD sufferer to say we should never, ever cease taking our medication even if we feel particularly well. In fact this is the dangerous point in this most evil of diseases. Sufferers pass through a well phase, feel they can cope with anything and stop taking their tablets. The effect is to cause a sudden sharp dip in mood when the person will become suicidal.

While not wanting to cast an opinion on the role of relatives in this case, those close to the patient should be alert, particularly if they appear resistant to taking medication which is common. If you have a relative who appears reluctant and complains that the medication makes them drowsy and complains about other side effects, this relative is probably vulnerable to believing he or she can do without it.

Those close to me know I am such a fan of my medication they need not worry. This is because for years my non-aware GP failed to refer me for psychiatric help despite the fact that I had received regular checkups at my previous address and all this was documented on my notes. The result was a few years of miserable times coupled with manic highs when I risked much financially and fell out with people. When I was finally referred after the intervention of my partner’s GP, I was put on Quetiapine and immediately felt the effects (once the initial dizziness and muzziness had passed). Eight years later and this has changed my life. I sleep well – Quetiapine has a sedative combined – and the regular sleep has made a difference. Whereas before I had weeks without sleeping or only sleeping 2-3 hours and long periods of early waking – that awful jump start at 5am and the sinking feeling in the stomach that reminds you how depressed you are – I now sleep a regular eight hours and wake refreshed. At night, I fall asleep quickly which prevents rumination and anxiety.

I am not saying it is all plain sailing. There are difficult life events and periods when I may wake on and off and wake up anxious but I use Mindfulness and take a herbal remedy such as Kalms for a week or so until  the symptoms subside.

Years ago I often had suicide ideation – when you do not make plans but the idea is there that one day you might use that way out but this has passed. This is partly because of the medication and partly that I have seven grandchildren and made the decision some years ago that I would not want them to live with the knowledge that their grandmother had taken that route out of life. I want to be a role model for them so they have been my salvation.

My writing is also my therapy and absolutely free. I make sure I write something every day even if it is only a diary entry – when low sometimes the creative juices dry up. However, depression is common amongst writers and research has not established whether it is because depressed people turn to writing as therapy or whether writers are more vulnerable. It is a solitary occupation so writers need to have networks to keep up social interaction.

I feel intense sadness for the family of the person who chose to jump from our nearby cliffs. I can only guess at their heartache and the possible guilt they may feel that they did not recognise the signs or take any action. In mitigation I would say that Bi Polar sufferers are canny hiding their symptoms and mood swings. I am sure that, in this case, the nearest relatives were kept completely in the dark. We are quite private people. We may talk a lot at times and disclose much but we do not wish to burden people with tales of our darker mental states. Also those who sink to such low levels become quite secretive and quiet.

It is therefore no wonder that relatives find themselves unable to prevent such a tragedy. Beyond investigating if medical intervention and monitoring was sufficient – and lets’ face it the mental health services are in disarray with lack of funding, all of which is a disgrace to our present government –  all I can say is they should take some comfort from the fact that this was an action of choice albeit an unfortunate one.

If you know someone who might have stopped taking their medication you need to speak to a medical professional ideally someone with experience and expertise in mental health. Some years ago, it was planned that there would be a point of contact in each GP surgery – a mental health professional or counsellor who could deal with distressed patients or worried relatives on a ‘walk-in’ basis. As far as I am aware this has not happened.

It is time for the government to place importance on mental health services with a view to preventing such tragedies in the future.

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JANUARY DEPRESSION

So today, Monday 19th January is reckoned to be the most depressing day of the year. Reasons given are that it is usually very cold, the Christmas spirit is waning and people are realising they have not kept some of their new year resolutions.

Let’s start with resolutions. Setting unattainable goals is a precursor to depression Those prone to this devastating mental illness may set targets in the thought that this will keep them out of the new year trough of despair. But failing to keep resolutions can lead to loss of self esteem, a feeling of failure and a sense of ‘here we go again’.

If you do want to set resolutions, make them simple and achievable. For someone prone to new year blues, this could be to ‘go to bed earlier’ and ‘to get up earlier’, the first helping the second resolution to be achieved.

Avoid closed statements in resolutions such as ‘get up at 8am’ which allows for no flexibility on a bad day. To be ‘in bed by 10.30’ will not work on a night when you have been to the cinema or have friends round.

Ideal resolutions would include:

  • Keep a diary and make at least one positive entry each day – something done or planned.
  • Write down three positive thoughts each day
  • Go for a walk each day for at least 20 minutes. Increase the time gradually.
  • Walk in the late morning when the sun is at its best and temperatures are mild.
  • Don’t economise on heating. Being cold can lead to confusion.
  • Arrange to meet a friend or friends at least once a week.
  • Join a group such as a painting group or walking group.
  • Avoid junk and processed food.
  • Eat fruit and vegetables every day.
  • Keep a mood diary. There are charts available but a range of -5 through 0 to +5 is the best. The one below is coloured. The green area signifies a normal mood, yellow is where the mood is higher but is not affecting function. Light blue is the ‘low’ mood area but again does not affect function. Dark blue at the foot of the chart would indicate deep depression. For those with Bi Polar the bright pink/orange would indicate mania.

Keeping a mood diary is useful if you need to see a doctor about your depression. However, you should be keeping a diary of events, encounters, stressful times, upsets etc so that this can be viewed alongside. For example, if you have fallen out with your partner one day, it would be perfectly normal for your mood to sink into the lower green/light blue area.

 As for the waning Christmas spirit, some people find this festive season stressful with family difficulties and reminders of those who are no longer in our lives for a variety of reasons. Try to plan some outings for January which will help ease your depression.

 For those who are physically ill or disabled, reading self help books and using social media to keep in touch with others should help mood.

 Let’s hope the rest of January is good for you.

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Overspending during depression and bi-polar highs

There is a common problem with those who suffer mental health problems that sometimes they get carried away with their spending and overspend often to the point of landing in debt.

It is a well known fact that we think that buying the ‘next thing’ will make us happy and using a £5 off voucher if you spend £35.00 in the supermarket is actually saving you £5 when, in fact, you are probably spending more than you would if you did not have the voucher.

I came across the article below which, forgive me if it is wordy, does explain some aspects of why we overspend. At this time of year when we are feeling drab and the nights are still closing in before 4.30 it is easy to think that going out shopping and buying something we have always wanted or a holiday that we see others enjoying will be the answer to our low mood.

http://www.getrichslowly.org/blog/2015/01/14/why-we-spend-are-you-falling-for-these-costly-biases/

I did read something about spending to make  ourselves happy. It is on a previous blog on happiness. Apparently we buy something and experience some temporary feeling of satisfaction so we think it has worked. In fact the feeling soon goes away and sometimes our mood can plummet when we realise that the purchase did not act as the magic bullet. The realisation that we have spent £x and got no long-term reward can send us into a decline of regret and evoke feelings where we ‘beat ourselves up’ for falling for this ploy once again. The temporary easing of our anxiety can bounce back to hit us full in the face, worse than before.

I am now subscribing to the minimalist theory. A few pairs of black leggings, a good pair of boots and a few tops and layers are seeing me through the winter. I have a lovely skirt I bought in the Mistral sale which I wear to go out and my previous purchases for winter come out occasionally. There is NO need for any more new clothes so the January sales will not be seeing me this year.

Try it and see if you feel better by NOT spending.

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Cognitive Behavioural Therapy (CBT)

Following other blogs and reading about how other people challenge their experiences of depression and bi-polar is helpful and one of the best websites and blogs is that written by Natasha Tracy http://www.natshatracy.com who has achieved recognition as an excellent mental health blogger. Indeed she has received awards for her work in raising awareness and fighting the stigma that still exists in our society. A recent post raised several questions about CBT so it is worth discussing the value of this here and how it can be accessible to all, not just for those referred by GPs or psychiatrists. Resources are still scarce for mental health intervention and the cuts cannot be helping. Somehow we all have to be our own mental health expert, our own doctor, our own psychiatrist. The afore-mentioned will not be there with you in the middle of the night or on a bad day. One has to wait for appointments and things often look different then. So what can be do for ourselves?

CBT is a method of changing the way we think about our experiences. Depression arises from negative thinking or what is sometimes known as unhelpful thinking styles. Those with depression have low self esteem and see their life experiences as black and white. For example, if someone you know passes by on the opposite side of the street without acknowledging you, the negative unhelpful thought will be that they ‘don’t like me’ or ‘don’t want to talk to me’. An alternative, more positive, thought could be ‘perhaps she did not see me’ or ‘perhaps she had something on her mind’ and, even more helpful, ‘next time I see her I will speak first’. This is the essence of CBT replacing negative thoughts with a more positive alternative – thought or action. It can be habit forming and before long you will realise you are doing it without thinking. To help me over a difficult phase I made some cue cards with my most usual negative thoughts written on one side and an alternative (even two) on the reverse. By reviewing these cards at low times I am reminded of how I can change my thought in the same way that I might use revision cards prior to a written examination.

Natasha refers to the process of re-wiring the brain and likens it to the negative thoughts making a groove in the brain which, when repeated, increase the depth of the groove until it is a ditch you can fall into. Negative thoughts can bring you down very quickly and none of us wants to fall into the pitch black ditch.

CBT requires no therapist  as you can work from books and websites and, if you understand the underlying theories and practice, you can work through it yourself. Of course, a face to face person will help and the more skilled the practitioner the better. I was referred for CBT about six years ago but found the counsellor let me indulge in free association and ramble through my life and present problems without any guidance. Because I was about to visit relatives in Bavaria, he told me I had  a really good life which showed his assumptions and lack of understanding of bi-polar and depression. These illnesses affect poor and rich alike, the lonely as well as those with families. His view and expressing it was unhelpful. He did eventually give me homework (this should have been from week 1). He asked me to list what I was proud of about myself. At last, I thought, we re getting to CBT but positive affirmations and raising self esteem is not CBT. He did not encourage me to make a diary of negative thoughts. In the end I did it myself after working through a DBT book.

You can borrow books on CBT from the library and also googling CBT will bring up websites. Make sure you choose a website which does not ask you to pay. There are plenty of websites which offer worksheets and information on the technique. All of this is free.

Here is one website. You will see it does advertise some books which cost money but it gives useful information for those seeking to understand more about themselves and their symptoms.

http://www.get.gg/cbtstep1.htm

WebMD is a good website. This is the US link to CBT and makes good reading.

http://www.webmd.com/depression/guide/cognitive-behavioral-therapy-for-depression

A book I now have on my bookshelf is Brilliant Cognitive Behavioural Therapy by Dr Stephen Briers.

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I am NOT everyone

The one thing that annoys me is the well-worn phrase ‘everyone gets down at this time of year’. No. Those with clinical depression or who suffer from Bi-Polar Disorder should not have symptoms dismissed in such a light off-hand manner. Those with mental health problems – and do remember mental illness does not go away – are vulnerable and if they express such feelings they need to be taken seriously.

One way I respond to such nonsense about winter depression is to remind people that I can go low at any time of year. It does not merely require bad weather. I can be low even if the sun is shining if my triggers have combined with a down cycle in the ups and downs of my bi-polar life. I have been known to be manic in the winter.

Why is there still so much dismissal of the invisible pain of mental illness? No-one dismisses the arthritis sufferer who finds the damp weather exacerbates the condition and causes pain so why trivialise symptoms which can be life limiting and life threatening?

There are a range of useless comments used by those who do not understand mental illness.

‘We all get down sometimes’

‘It’s all in your head’

‘think how lucky you are’

‘you can’t expect to be happy all the time’

There is a clear difference between being unhappy and being depressed. If you are unhappy but still functioning normally each day the chances are you are not depressed. If you are overwhelmed with inexplicable sadness, loss of interest in things that previously brought enjoyment and you are finding normal every day tasks difficult you should seek help.

Let’s hope the first person you speak to doesn’t say, ‘but, everyone …………’

 

 

 

So, before you use that common winter phrase again, think carefully  about to whom you are speaking. Is this a vulnerable person who could slide once more into a full-blown episode which requires hospital admission.

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Improving life

I have been taking an interest in an American website www.psychcentral.com. I found it via a link on Facebook or on another bi-polar blog. These blogs, far from being morbid and self-indulgent, are positive, uplifting and share much useful advice. A psychcentral blogger, Margarita Tartakovsky has written several articles. One of these is Ten Things to Improve Life and these are my interpretations. Her first is write a better story for your day. I say this can be on paper or in your head. I make a list of things to do each day such as exercises, yoga, walks and playing my piano. Reflecting on the positive aspects of a day is also a good idea so writing a diary – something I wish I had done throughout my life – where you log all the good things that happened – can make you feel better.

A more difficult item on her list is Identify what is keeping you stuck. This can be negative thinking or perhaps even another person. Low self esteem can prevent us doing what we need to do. I am stuck at present in ‘Writers’ Block’ although those reading this might think this is not the case. I have a novel that needs a ‘middle’ and lots of re-working and my view is that it is ‘in a mess’. When I looked at it recently I reckoned it was a load of rubbish. When my mood lifts, I may see that it is not so bad. Making myself write up my ideas from Margarita’s blog is releasing something.

Easier is go to bed earlier. I have been doing this for some time now and I do feel better when I am in bed between 10.30 and 11 especially if it means I have time to READ.

Also easier is participate in physical activity which you enjoy. I like walking and yoga so I have built this up in the last two or three weeks and it has made a difference to my mood. I hope to start swimming again in a nearby pool but the weather has been so wet, cold and miserable. This is a form of ‘being stuck’. If I could force myself to go I would benefit.

More difficult is to focus on ‘right now’ and be grounded in the present. I know people on Mindfulness courses. Mindfulness has been found to help with depression and negative thinking. Staying in the moment, without looking back or worrying about the future, really does help the mind to stay positive. I find that when I am writing I am purely in the moment which is, I am sure, why writing has been found to be so therapeutic.

Physical Action is another one of the Ten Things. Often anxiety and depression can make us ‘freeze’ and fail to do the very things that will make us feel better. Being pre-occupied prevents us from pushing on with pleasurable activities, leaves us confused and unable to make decisions which then leads us to feel angry with ourselves. ‘Just do something’ even if it is only a crossword or a Sudoku puzzle. Along with this improvement, however, we must ensure we set realistic and attainable goals. For example, don’t struggle with the Telegraph crossword if a concise one in another paper brings more success.

The seventh item was to reframe a situation in a more positive light. Margarita quotes the well-known saying ‘when life throws lemons, make lemonade’. When I am struck with a low period I try to tell myself it is nature’s way of making me rest and accept it instead of fighting it. I take my breakfast back to bed and have my laptop and a book at the ready. I reframe ‘not socialising’ as ‘my need for solitude’. Of course, it doesn’t work all the time but it is worth a try. However, it is a fact that over-stimulation is not good for those with bi-polar so the lows are often nature’s way of reducing stimulation. On a more basic level, if someone shows they do not want to be friendly, tell yourself that you are deciding you don’t want to be friendly with that person. When you suffer with Bi-Polar it is important to choose your friends and avoid those who cause aggravation. Decisions also need to be yours and yours alone.

Number eight on Margarita’s list is be grateful.  This, according to her, attracts positivity, opportunity and success. Writing down a list of ‘blessings’ has worked for me in the past. So often when we are depressed we forget what is good in our lives.

For control freaks, the next on the list is let go of what you can’t control. Sometimes we can’t see what it is that is holding us back or depressing us. Identifying what we can change and what we cannot change is key to combating depression. We might not be able to change a situation but we CAN change our attitude to it. Sometimes we cannot control something but we can manage it. This is true of Bi-Polar Disorder. We can’t control this as, even with medication, the brain will sometimes do it worst, but we can watch for Early Warning Signs (EWS) and be aware of triggers that either bring us down or send us into over-exuberance. Then we can take appropriate action. If we know we have ‘tried’ then we will not beat ourselves up about it.

Finally there is create an intention. After reading this, I decided to have some things on my TO DO list that could be prefaced by ‘I will ….’  However, somewhere we have to remember our realistic and attainable goals. Don’t say ‘I will …..’ if it is something that would be hard to achieve, expensive or detrimental to your well-being.

Good luck with the Ten Things. Visit Margarita’s articles on www.psychcentral.com and let me know how you do.

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