Saturday, April 19, 2014

The Brain-Blood-Barrier and bipolar medication?

It was during a casual reading that I first read about a very interesting physical attribute of man and animals.  It is called the Brain Blood Barrier, or BBB for short.  What is it?  BBB is basically the natural defense mechanism of the physical structure that allows certain useful substances into the brain and spinal cord while keeping harmful substances out.  Quite amazing, isn't it?  But why should it be of interest to us, and especially those who suffer from bipolar disorder?

If you get a chance to read some basic information about the BBB, you would notice what kinds of specific substances tend to cross it and what special circumstances make the BBB less than efficient.  Now, think in terms of bipolar medication!  There is fascinating information that raises interesting questions about it on the National Institute of Health web page about the Brain Blood Barrier.  Bipolar patients should rightly be concerned about the origins and treatment of their particular illness.  Haven't you thought of questions like: Why do I have bipolar disorder?  Could I have done something to prevent it?  How exactly is the medical treatment I receive affecting my brain and brain functions?

Granted, such questions are much easier to ask than to answer.  However, it is in the pursuit of answers to such questions that all the research and development in the psychopharmacology of bipolar treatment been done.  As patients we should be concerned about the practical implications of the treatment that we receive in the form of psychotropic substances.  What are some of those concerns?

  • How does bipolar medication specifically target the symptoms of the illness?
  • How can I be sure that the medication will target only the desired neurotransmitters and neuroreceptors and not anything else?
  • Why do psychiatric medications have unique side-effects?  Take for instance the list of known side-effects of Depakote.
  • How can side-effects of my medication be reduced or kept at a minimum while still maintaining a level of therapeutic effect?
  • How is the therapeutic effect of my medication really judged?  Is it by a certain level of medication in the blood-stream, by behavior, by social integration, or by all the aforementioned?
  • What other substances can produce the desired therapeutic effect of the medication I am currently on without the undesirable side-effects?
Don't you think such questions deserve a place in our treatment plan?  I think, they are absolutely crucial to the success of any bipolar treatment plan.  Often though, the problem is that the patient is already too overwhelmed to consider such questions and most doctors don't have the inclination to discuss these with their patients.  We can't expect all patients to have the same level of intellectual comprehension, but that doesn't make them any less deserving of care and proper treatment!

So I will repeat what is consistently said throughout this blog: Educate yourself.  Get the family involved too in education regarding bipolar disorder.  Ignorance comes with too big a price to pay!

Wednesday, February 19, 2014

Bipolar disorder and the eager desire to please others

When you walk into a room, others look at you and a smile appears on their faces.  You bring with you a quality that makes people feel good about themselves.  Others enjoy your company.  And you also feel good because, it feels good to be liked by others.  But not everybody is happy with you for the right reasons.  Some see you as one who is eager to please.  You rarely disagree.  You even say things that you don't agree with at heart.  Is it because you agree with everything the other person says or does?  Of course, not!  You are sensible in overlooking the minor disagreements and not making an issue of every little detail.  That's your good quality.  But is there something else along with it?  Are you afraid of disappointing the other person, fearing that your disagreement will spoil a good relationship?

Behaviors built over many years

People behave a certain way without giving much thought to it.  In their life, they might be lonely or very insecure.  They may be suffering from a very low self-esteem.  They could be lacking in confidence, and find relief through entertaining others.  So how did a bipolar patient become this way?

For most bipolar patients diagnosis comes much later than when the illness starts to affect them.  Acceptance comes later still.  By then, the illness has already had a significant impact on behavior.  And how wrong it would be to assume that, it is just the bipolar patient and his illness.  No!  During all this time he has lived among family and community, being treated a certain way.  As is so often the case, undiagnosed bipolar disorder means suffering in secret.  Suffering makes us strong.  Suffering can also bend the will where suffering doesn't break the will.  Not having a way of understanding the pain and absolutely no way of wishing it away, alleviating at least some of the pain can become a strong motivation.  Social rejection is extremely painful, especially when it seems to be coming for no good reason.  Pleasing others to keep them happy and somehow keeping a relationship going can seem like a good choice.  I don't think it is even very much a conscious choice.  With time, the behavior sets in and nobody gives a second thought, unless there is a reason to do so.

Reason to reconsider the eager desire to please others

Do you believe in right and wrong?  Do you believe in dignity?  Do you believe in love and respect?  If the answer to those questions is yes - a truthful yes to even one of those questions - we cannot blindly be led by a desire to please others.  The "friends" we make by being a people-pleaser are like mist that disappears once the sun comes up.  It's not worth it.

Time and energy spent in building our character is a worthy investment.  There is one way we can make sure our investment is not choosing our associates wisely.  Real friends are honest.  If they can respect us for what we are, they will, and we them.  They won't be the kind who quickly compromise their values to please us, nor should we be that way.

Pleasant relationships with others are very desirable.  Let's not be so controlled by that desire though, that we waste our valuable lives in the unhealthy desire to please others at all costs.

Don't leave bipolar disorder untreated

All the good thinking could come to naught if the underlying problem is left untreated.  The problem is bipolar disorder, the illness.  Getting medical treatment is absolutely necessary.  That means going to a psychiatrist, and taking prescribed medication.  As health improves and the patient regains control over his life and thoughts, confidence returns.  I cannot emphasize how important that confidence is.  It is not arrogance.  It is recognition of worth that every human being has.  When that recognition is part of how we see ourselves and others, we can have truly healthy relationships.

Sunday, February 2, 2014

Whom do you believe, when you can't trust your own mind?...
A man who has gotten used to seeing himself in a broken mirror doesn't really know what he looks like.  He would not know himself different from the distorted reflection unless he saw himself in a mirror aright.  Bipolar disorder, when active, is an experience of distorted perceptions.  Distortions in perception come and go.  Whether it is mania or depression or somewhere closer to either pole, the uncontrolled emotions are bound to have an effect on clear thinking processes.  This effect might not be immediate, but with time it is bound to reveal itself.  The ability to admit a limitation is, a strength.  Recognizing a specific limitation can lead to seeking a remedy.  What remedy thus exists for distorted perceptions in bipolar disorder?

What you do beforehand is most important

Do you have a support system?  Who do you count on?  Do you think, you would need help or be able to get by without it?  The answer to the last question deserves an answer first.  There is a need for a support system, consisting of a number of people.  These can include family, friends, members of your faith, treating doctors, a fellow worker, a neighbor, and your lawyer.  The idea is to spread out the number and kind of people who can provide support in times of need.  Each person is different.  Each person would have his or her own strengths and weaknesses.  You might find yourself more comfortable talking with one about a particular matter, while another might be able to help in another area.  We also relate differently to different people.

Building a support system takes time.  Time is needed to know others and be known by them.  Time is needed for trust.  All meaningful relations need time.  Assuming that you have been able to build a support system over the months and years, then what?  Please consider a question:  How would you feel if someone came to you only when he needed something?  You would consider such a person selfish, wouldn't you?  Out of love, we can continue helping another person, but we can't escape feeling some time that such a person is basically too needy or selfish.  So what's the point?  The point is, human relationships are meant to be mutual.  There is something a bipolar patient is able to contribute, even during the bad times.  Let's take an example.

You visit your doctor.  You have been seeing him for a few years now.  A professional relationship exists, but also a relationship on a human level.  Your doctor isn't feeling well.  It can happen.  You sense it, but you don't know why.  So you ask him.  He tells you, that he might require a minor surgery after a couple of weeks.  Then you go through the customary way of how an appointment goes.  Now just imagine, how you doctor would feel if he receives a call from you after the surgery, asking him how he is feeling?  He might be surprised, but wouldn't he appreciate that you made a quick call just to check?  That's a good thing to do.  And in everyday life, a simple thank you or sorry goes a long way; not because we want something in return, but because we value the other person.

Trusting the other person and sharing authority

"You don't seem well.  You don't seem to be thinking right."  Imagine, someone just said those words to you after you have described a brilliant plan to buy something.  Granted, it doesn't sound polite.  It's a bit harsh!  But it could be out of concern.  At the time you might not be too keen to listen to criticism.  It is possible, this other person is seeing something to be wary of, and you are not?  What would be the best way to find out if that's the case?  Reason about it!  How does a person reason?  Reasoning is not arguing, whether you have bipolar disorder or not.  If at that time or preferably at a later time, both of you are able to give reasons why making the purchase is or isn't a good idea, then that is much better.  However, the most important thing is not just how sound the reasons are; the manner in which reason and counter-reasons are presented is just as important.

What about those times when you can't trust your own mind?  Then you would have to share a measure of authority with the one you trusted in advance.  Your psychiatrist for instance, the same one with whom you can share a joke, can also hold you against your will in the hospital when a critical situation calls for it.  We hope, such a time will never come, but it can.  Your family member sitting at the dinner table, the one with whom you share food and say a prayer together, can also secretly inform the psychiatrist if you refuse to take your prescribed medication.  Would it be considered a conspiracy?  It can feel like that at the time.  With the return of senses and once the anger has abated, it can look like a reason to thank your family members.  They were looking out for you, because they want to see you alive and happy.  Of course, they too should have proved this over time, not just in a crisis.  And your love for them, should also prove enduring, not only when they agree with you want.

Recognizing the early signs

The loss of mind - even temporarily - is a very scary experience.  The best chance we have as bipolar patients is through a training to recognize the early signs of the rise mania or depression.  Sometimes bipolar disorder can progress quickly and almost undetected.  Sometimes a serious episode can be precipitated by a sudden trigger like lost sleep or a stressful incident.  The chemical imbalances in the brain can kick-in rapidly, especially for bipolar patients suffering from rapid cycling bipolar disorder.  Education, training, support - all these need to be done before the illness strikes.  Then we can hope to endure and survive even those times when we can't trust our own mind.

Friday, January 24, 2014

Negative thoughts and brewing anger toward others

What do you do when negative thoughts about someone start to trouble you?  What do most people do?  What is a common suggestion?  The generally good advice is, to distract oneself.  If it is not possible to do anything about the cause of the problem, or if it possible to do something but only at a later time, then it makes sense to distract oneself.  If a person is able to stay occupied and keep his thoughts focused on something constructive, even if it be the common household chores, chances are that the negative thoughts will soon subside.  We will have simmered down and become better able to cope with what is troubling us.  We might really be able to put many things behind us and move on.  That would be just great!  However, bipolar disorder presents unique challenges.  Those who do not suffer from this ailment might find it difficult to grasp.  That is at least one reason why, it is good to understand what particular challenge is faced by those with bipolar disorder who seem to find it particularly hard to get out of their minds negative thoughts about other people.

How is your sleep?

Is sleep important in a person's ability to cope with stress and negative thoughts?  Sleep is very important!  It is important for everyone, but especially in the case of bipolar disorder.  Sleep related problems are probably the most common health issue that comes tied in with the bipolar illness.  There are several types of sleeping disorders.  When benign methods fail and it gets too serious, medication may have to be prescribed, altered, or proscribed to rectify the situation.  One must speak to his psychiatrist when there is an evident sleeping problem.  And questioning a patient about sleep should be mandatory to every psychiatric appointment.

What normally happens with bipolar patients is that, they are not able to get sleep on a consistent basis.  Either there is a problem falling asleep, or even if a patient is able to fall asleep he wakes up too early and is unable to get back to sleep.  Now during all those waking hours, tossing and turning in bed, the mind naturally wanders.  One night is bad enough, but when this phenomenon starts to repeat itself consistently, it can get serious quite fast.  Usually it is followed by a hypomanic or manic episode.  With racing thoughts, it becomes far more difficult to control what one thinks and what one says.  It becomes very easy to be offended or irritated by others, when at other times the same person or event might not have bothered us.  Lack of sleep exacerbates the issue as a bipolar person goes through what is commonly called rumination - the act of going over-and-over-again about some issue in his mind till that negative thought completely takes over.  The resulting anger when directed toward self or someone else is very real in the mind of the bipolar patient.  This anger is usually far out of proportion to the original cause.  Sometimes there isn't even a cause!  Instead of addressing sleep, the anger and the object of anger becomes the focus.

There are some matters worth considering that have a profound effect on both, the quality and the quantity of our sleep.  These are:
  1. Are you getting enough sunshine?
  2. Are you getting exercise, preferably in the earlier part of the day?
  3. If you have to travel, especially across time zones, are you planning your trip while keeping your sleep cycle also in mind?
  4. Are you taking your medicine daily in the prescribed manner?
  5. Is your day too full of goals and activities?
  6. Are you drinking enough water throughout the day?
  7. Are you eating a high protein or difficult to digest supper late in the evening?
  8. Are you watching the TV or spending time on the Internet late into the night?
  9. Are you trying to solve problems, making plans, or thinking of solutions when you are unable to sleep?
  10. Do you procrastinate during the day and feel stressed later toward evening?
These were some of the things that immediately came to mind that tend to interfere with sleep.  What others can you think of?  A fundamental thing to keep to keep in mind is: When sleep improves, ability to cope with negative thoughts also improves.

How is your medication?

When medication is working optimally, it should help control the typical ups-and-downs associated with bipolar mood disorder.  When it is not optimized, bipolar medication itself can be a cause of negative thoughts and behaviors.  I know, there are many who feel that they are taking medication, and yet are on the verge of another episode most of the time.  It's like, bipolar disorder never really goes away; it is always working as an undercurrent beneath the surface.  This may be especially true for those who live in more stressful situations or suffer from a form of bipolar disorder such as rapid-cycling.  That however makes the role of medication - in addition to sleep and other coping mechanisms - even more important.  Even if medication cannot eliminate symptoms completely, if it can make episodes less frequent or more spaced out, that is truly worthwhile.  Please, be frank with your psychiatrist about how you feel.  You may have to work with him the extra bit and even then have to make some compromise.  The variety of medicines at the disposal of a psychiatrist has greatly increased.  This variety in choice is a mixed blessing, but with patience medication can be brought as close to optimum as possible.  With a more balanced and calm mind, it will certainly help us cope better with negative thoughts and the resulting stress.

How is your association?

It is fairly easy to see, if we associate with negative people it will beget negativity.  What is not always so easy to see is, who is a negative person!  Would someone who has genuine concern about the plight of others, is sorrowed by it, and speaks of it to you, be a negative person?  What if a person sees something realistically beyond his ability or admits a problem when there is one, be considered a negative person?  Would someone who makes us laugh now, but the consequences of his advice and habits is harmful in the long run be considered a positive person?  We can have a much clearer idea of positive and negative associates if we are ourselves clear about what standards to maintain.  In the day of Internet technology when social networking is so common, it is easy to have many "friends".  Many of these, we may never have known face-to-face.  Yet, we are influenced by what we read and hear, just as they are too.  Good and positive associates will not only help bring out what is good for now, but also in the long run.

Despite our best efforts, there will be some people who cause us to feel stressed.  It may be some personality trait, habit, or beliefs.  Even while we can be peaceful and flexible toward such people, we cannot compromise ourselves to the point of losing our identity.  Some people might even deliberately do and say things that cause us to feel stressed.  We would like to avoid such ones to the extent possible, instead of getting into fruitless arguments.


Living peacefully with others is really a skill.  It is not all skill though.  If we have a basic love for others, considering them just as human as we are, it would most often be possible to get by even when relationships are not great.  We could respect their right to make their own choices and live with the consequences.  We would certainly be wise to protect ourselves - spiritually, mentally, and emotionally - in the process.  As far as bipolar disorder is concerned, we can minimize our vulnerability by paying attention to important factors such as sleep and medication, and thus protect ourselves from the negative feelings of anger toward others.

Saturday, January 18, 2014

Living with bipolar in an abusive family environment

Is living with bipolar disorder difficult?  People who have not experienced it cannot truly answer this question.  That would be true for any illness which is chronic and capable of inflicting tremendous pain.  But you would have to agree, illnesses related to the mind are in a category their own.  For there isn't another part of the human body which is both, so fragile and yet so strong at the same time as the human brain.  When an affliction of the brain - completely unpredictable as bipolar disorder is - the resulting effect on the thoughts and emotions cannot always be described in words.  Sometimes, silence explains better the pain than a whole library of books ever could.  In all this, may we never forget the caregivers, especially the family members, who provide the all-important emotional support.  At least, that is what we hope for.  But what would happen if instead of that support, there is abuse?  How could a person suffering from bipolar disorder deal with such a situation? Or can he?

An adjustment like no other

Have you ever traveled to a foreign land, the language of which you don't speak?  How lost and insecure does a person feel even if he speaks the language!  Bipolar disorder also has its own language.  There is the language of depression, for example.  Have you listened to a depressed person speak...really listened?  It can get taxing, right?  So just imagine, if the mere act of listening can get so tiresome, how much of a burden is the bipolar patient experiencing who has brought himself or herself to speak to you?  The honest truth is, when even one family member is afflicted by bipolar disorder it is a test of endurance for the entire family.  If other members of the family also are suffering from bipolar disorder............  Bipolar disorder is not 1+1=2.  The levels of complexity in relationships and communication follow algorithms not know to cold math.  I am making an appeal for empathy; empathy of the caregivers toward the bipolar sufferer and from the bipolar patient toward the caregivers, neither of which will ever be easy.  Both have to adjust, and it is an adjustment like no other.  Frankly, the process of this readjustment would never end, but with the right treatment it can get easier with time.

What if the family members are unwilling to make an adjustment

Real families stick together.  These families are guided by principles greater than just personal happiness.  Real love holds the family together.  If the love is gone, no amount of wisdom can compensate for it.

Still, life has to go on.  Under adverse circumstances a bipolar patient has to seek the means to survive.  He or she must get the needed help from somewhere.  Where can a patient turn to for this help?  Think of the following:
  1. Almighty God, our father, the most sure support: He should always be first on any such list.  He has given us life, and contrary to what anyone may opine, there isn't another who understands us or cares for us as God does.  Do we need proof?  There is no shortage of proof.  Much can be discerned from creation.  Look at how the birds, animals, and plants are made.  The "wrong" we see in nature is not because of God's poor planning, but the disobedience of man.  Explore this line of reasoning through the Bible and test it out.  So when we need support, we should pray to our father in heaven, provided first we are willing to know him as he is.
  2. Our friends: Have you found a true friend?  Then you have found something rare.  Never be unappreciative.  At the same time, remember that, both of you are imperfect people.  He or she will make mistakes, and so would you.  Continue to forgive, even overlooking the petty mistakes, and move on.
  3. The psychiatrist and psychologist: The psychiatrist would not be treating bipolar disorder if he does not insist on family involvement.  If the family does not want to get involved in the treatment, that is quite telling itself.  The same goes true for a psychologist.  The most practical help a psychologist can give is, becoming a neutral mediator between the patient and the family.  At the same time, the psychologist should provide education about bipolar disorder.  That would be excellent!
  4. Support group: The feeling of not being the only one in a crisis is, a very powerful comfort.  Besides that, associating with others who are successfully coping with bipolar disorder can teach us many practical things about survival.  A word of caution though: There are all kinds of people suffering from bipolar disorder.  Not everyone will be a good associate.  Some in fact will be downright harmful.  So keep an open mind, but not too open.
  5. Keeping a journal: I am pretty sure, you almost thought of this.  Keeping a journal is a very handy survival tool.  It calms the emotions.  A diary can never be the equivalent of a friend, but a diary is loyal like nothing else.  It won't disappoint you.  It will read back to you exactly what you wrote, even years later; but, how we read may have changed in the meantime.
Living with bipolar in an abusive family environment is beyond the realm of reason and thinking alone.  It has to do with emotions.  It has to do with the heart.  Bipolar disorder and bipolar medication affect the figurative heart, that is, the emotions.  It is critical to find support.  Support is available.  And you will recognize as time goes by, you are yourself a source of support to someone through your love for life and love for your loved ones.

After reading this post, please don't expect your symptoms to disappear altogether.  Endurance is, not a destination, but a road.