The Bipolar Child, Part I: Reactions

Newsweek If you haven’t been reading the news recently, Newsweek magazine published a feature article on Max, a 10-year-old who struggles mainly with bipolar and attention-deficit/hyperactivity disorders among other mental illnesses. I read the article and was astounded at what Amy and Richie Blake, Max’s parents, have to contend with. I’m astounded at what Max suffers with.

The article was educational but for all the 8 computer pages that I printed, I didn’t read about Max; I read about his diagnoses:

Max Blake was 7 the first time he tried to kill himself. He wrote a four-page will bequeathing his toys to his friends and jumped out his ground-floor bedroom window, falling six feet into his backyard, bruised but in one piece.

He cried for hours at a time. He banged his head against his crib and screamed until his face burned red. Nursing, cuddling, pacifiers—none of them helped.

Richie carried his son to the backyard and tried to put him down, but Max shrank back in his father’s arms; he hated the feel of the grass beneath his small bare feet. Amy gave Max a bath and turned on the exhaust fan; he put his hands over his ears and screamed. At 13 months, he lined up dozens of Hot Wheels in the same direction, and when Amy nudged one out of order, he shrieked “like you’d just cut his arm off.” At day care, he terrorized his teachers and playmates. He wasn’t the biggest kid in the class, but he attacked without provocation or warning, biting hard enough to leave teeth marks. Every day, he hit and kicked and spat.

By 7½, Max was on so many different drugs that Frazier and his parents could no longer tell if they were helping or hurting him. He was suffering from tics, blinking his eyes, clearing his throat and “pulling his clothes like he wanted to get out of his skin,” says Richie. In February 2005, under Frazier’s supervision, the Blakes took Max off all his meds. With the chemicals out of his system, Max was not the same child he had been at 2. He was worse. … Off his meds, Max became delusional and paranoid. He imagined Amy was poisoning him and refused to eat anything she cooked. He talked about death constantly and slept little more than two hours a night.

During a recent appointment at Frazier’s office, he went into full-fledged mania. Laughing wildly, he rolled on the floor, then crawled over to his parents and grabbed an empty medication bottle, yelling, “Drugs! I’ve got drugs! It’s child safety!” Richie grabbed it back, Max screamed, Richie threw the bottle across the room, as if playing fetch. Max squealed and dove for it, then began to sing into the neck of the bottle: “Booorn to be wiiiiild …” Amy rolled her eyes: “Two kids.” And then: “It’s hard not to laugh.” (I’m not the only one who doesn’t think this is mania.)

All throughout the article, I couldn’t help but think to myself: Who is Max? Max without meds — does he have a personality? What does like to do for fun, even for short periods of time? Karate is mentioned — does he read? He has trouble writing for long stretches. He’s got a friend. What makes Max so charming other than the fact that he’s 10 years old?

(Image from Newsweek)

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Celebrity Sensitivity: Maurice Benard

This one’s for the women.

If you’re anything like me, sometime during the 90’s you watched the long-running soap opera General Hospital at one point or another. Well, remember bad boy Sonny Corinthos?

Maurice BenardMaurice Benard, the actor behind the character, has openly admitted to struggling with severe bipolar disorder and is a spokesperson for Mental Health America. While I’m not sure which came first (the chicken or the egg), Benard’s charcter, Sonny, also struggles with bipolar disorder on the show. In the past, I’ve read that he flew into rages so bad that he needed to be hospitalized and had to take time away from the set to recover. It’s only fitting that Sonny’s character — as ruthless as he is — shows a true side of Benard who seeks to educate viewers about the disorder.

Combined with his stressful career in organized crime, Sonny’s bipolar disease has caused him to routinely break out in acts of senseless violence.  The most infamous example of Sonny’s violent side was when Sonny, during one of his “manic” moods, shot his wife Carly in the skull while she was in the process of giving birth to his son.

That episode sounds like it might have pissed me off instead. But Benard seemed okay with it.

“Two years ago the head writer came up to me about doing a breakdown story. I said as long as it’s done to educate people and to make it right.  And we did it.  It was fantastic,” the General Hospital actor added.

I wonder what people learned from the overall storyline.

Gone but I don't know where

You have been drifting for so long / I know you don’t want to come down / Somewhere below you, there’s people who love you / And they’re ready for you to come home / Please come home
~ Sarah McLachlan, “Drifting”

I have an appointment with my psychiatrist on Tuesday morning. I’m not quite sure what to do.

My “symptoms” are back. Now that I know what to look for as someone with bipolar disorder, I am aware of them. I’m having mania moments. I don’t want to sleep. I have no desire to. My husband sometimes MAKES me go to sleep. I’d rather be up doing the laundry, washing the dishes, blogging, reading other blogs, making to-do lists, and organizing the apartment–all at the same time–at 2 or 3 am. (This doesn’t mean all of this stuff gets finished.)

My husband and I have had physical fights in the past where he has had to restrain me because I wouldn’t go to bed and I wouldn’t sleep. It would be 4 in the morning and I refused to sleep and I’d fight him tooth and nail. I don’t know why. I have no problem wanting to sleep at 2 pm. Make it 2 am and there’s too much to do suddenly. I have the superhuman ability to get things accomplished between midnight and 5 am more than I can during the hours of 9 am to 11 pm. Right.

So now it’s almost 1 in the morning and I have nursery duty at church later in the morning. Then I have a hair appointment in the afternoon. Then I’m paranoid about what my hair stylist thinks of me.

She says she’s my friend but I wonder if she’s just pretending to like me because she feels sorry for me. I’m really lame you know. People at work acted nice to my face and then dissed me behind my back. She does the same thing to others, why wouldn’t she do the same to me? She just keeps me around and kisses up to me because I tip well.

Thinking like that scares me. It reminds me of the way my father used to think. Paranoid. (You can stop reading here. At this point on, it’s just a manic ramble that’s basically full of nothing but stream-of-consciousness just because i can.)

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Loose Screws Mental Health News

If the state gets its way, hundreds of children could be put in foster homes, in what could be a wrenching cultural adjustment that may require intensive counseling.

Wow. That's all I can say. How do you place 400 different children in foster homes and ensure they'll get proper care? You can't.

Loose Screws Mental Health News

I recently wrote about the MOTHERS Act and the unnecessary scare tactics surrounding it. A Dallas-Fort Worth TV station picked up on the story and provided a short one-sided view of the issue, continuing to purport that the bill is solely about drugging new moms. I don’t discount Ms. Philo’s terrible experience with her medication. In fact, I’d be against the act if its sole purpose was to force treatment on pregnant women – medicated or not. Again, I’d like to reiterate that the bill’s purpose is to educate moms about postpartum depression and postpartum psychosis – not to shove unnecessary pills down women’s throats.

If you have sleep apnea, your CPAP (Continuous Positive Airway Pressure) machine may alleviate depression symptoms. My husband has sleep apnea and hasn’t been able to use the CPAP machine because of sinus problems. When he doesn’t use it (he hasn’t for a while), he’s noticeably moodier and prone to depressive symptoms. But then again, anyone who doesn’t get good sleep for several days is pretty moody.

Seroquel XRAstraZeneca (AZ) is going after Teva Pharmaceutical Industries and Novartis AG’s Sandoz unit after the two companies applied to make cheaper version of Seroquel available. AZ’s patent on Seroquel expires in 2011. The trial date for patent litigation is August 11. In the meantime, according to the Bloomberg report, the FDA is considering approval of Seroquel XR for bipolar depression and bipolar mania.

What is it about the U.K. that they seem to take pharma’s power more seriously than the U.S.? The UK Medicines and Healthcare products Regulatory Agency (MHRA) charged GlaxoSmithKline (GSK), the maker of Seroxat (Paxil in the U.S.), with not fully disclosing their clinical trial data that downplayed serious side effects such as increasing suicidal tendencies among those 18 years and younger. The MHRA also asserts that Seroxat didn’t alleviate depression as much as GSK’s initial data showed. GSK, of course, denied manipulating the data to show favorable results:

GSK denies withholding data, claiming the risks did not come to light until the results of nine studies were pooled.

The UK minister of public health, Dawn Primarilo, promised to address the issue of Big Pharma hiding negative clinical trial data.

“Notwithstanding the limitations that may exist in the law, pharmaceutical companies should disclose any information they have that would have a bearing on the protection of health,” she says.

In other news, I shouldn’t be a successful writer or novelist. The correlation between creative writers and suicide is ridiculously high. More than 70 well-known writers and poets have successfully committed suicide. How much more “unknown” writers and poets have as well?

(Image from Monthly Prescribing Reference)

Lamictal is hot shit

“In its own way, the best patient group for Lamictal therapy is the bipolar II patient, a person with mild manias and severe depressions.” The side effects are also more tolerable than those of any bipolar drugs: little weight gain, lethargy, or nausea. “It’s the most interesting drug to come along since lithium,” says Ivan Goldberg. “Lamictal is hot shit.”

I found this on soulful sepulcher and have to admit – Lamictal has killed my manias. Since going up to 200 mg in January, I haven’t had a real manic episode – well, it’s really a mixed episode, but whatever. This makes me wonder if the Lamictal IS working; if I’ve tricked myself with a placebo; or if God is just being merciful to me. I try to convince myself with the last two. (Well, I find the latter to be absolutely true.)

Despite my pharma rantings, I have to agree: "Lamictal is hot shit."

Bipolar I

"You’re manic, manic / There is a chemical in your brain / It’s pouring sunshine and rage / You can never know what to expect / You’re manic, manic" ~ Plumb: Manic

I spoke to someone online in November who asked me if I was bipolar I or II. I was reading the mood-tracking chart that my doctor gave me  (courtesy of GSK via Lamictal) and noticed it mentioned bipolar I.

But I am still left with many questions regarding bipolar disorder:

  • How will it affect me personally?
  • When I have an "episode," what is my husband supposed to do?

The bp diagnosis has explained a lot of things, but prompts so many more questions, which need answers…

Fun with ICD-9 codes

I came across a situation recently in which a woman was described having mania in bipolar disorder, but was “diagnosed” with 296.2. And the recommended treatment? Venlafaxine (Effexor).

I swear, sometimes doctors themselves don’t even know what to prescribe.

UPDATE:
Okay, maybe I was wrong?

2007 ICD-9-CM Diagnosis 296.2
    Major depressive disorder single episode
        * 296.2 is a non-specific code that cannot be used to specify a diagnosis
        * 296.2 contains 72 index entries
        * View the ICD-9-CM Volume 1 296.* hierarchy

    Alternate Terminology
        * Depressive psychosis, single episode or unspecified
        * Endogenous depression, single episode or unspecified
        * Involutional melancholia, single episode or unspecified
        * Manic-depressive psychosis or reaction, depressed type, single episode or unspecified
        * Monopolar depression, single episode or unspecified
        * Psychotic depression, single episode or unspecified

So it’s totally possible to have a bipolar episode and be depressed? WTF? Am I depressed with bipolar symptoms or am I bipolar with depressive episodes? Ugh, none of this diagnosis stuff makes sense. Glad I’m not a doctor now.

Loose Screws Mental Health News

Starting off with some crazy (npi) mental health news, psychotherapists are now beginning to diagnose depression and anxiety in infants. Yes, infants. Before you know it, newborns will begin suffering from post-traumatic stress disorder after enduring complications during delivery. Fetuses will suffer from depression due to lack of exposure to light.

I’m all for diagnosing mental illness in children, but infant depression? Unless it’s mistreated, the concept is ridiculous.

“He says he doesn’t put babies on the couch. Instead, he observed Jayda through a one way mirror. He was looking for clues on why she wouldn’t bond with her mother, Kari Garza.”

What?

“Psychologist Douglas Goldsmith says ‘even by the first birthday, some of the research is saying we should be able to start to see signs of more serious social disorders.’

There are some warning signs to look out for, such as a lack interest in sights and sounds. Others include of lack of desire to interact; listlessness; or excessive crying.”

I can’t help but think it’s rooted in a physical rather than a mental problem. I excessively cried for six months as an infant; no knew that I’d developed eczema and the itching was unbearable because I wasn’t able scratch.

“Figuring out what’s depression versus normal behavior is hard, according Pediatrician Linda Nelson of the Franciscan Children’s Hospital, because ‘the crankiness and all of that, teasing that out from true depression, it’s very difficult.'”

Josh of “We Worrywrites:

“I may be way off the mark on this one, but if I’m not mistaken, an infant’s cognitive abilities are incredibly limited and, for the most part, are dictated entirely by instinctual behaviors. It seems that it would be impossible to determine if an infant had depression or anxiety because it’s impossible to ask them.”

Nope, not off the mark at all.


Want to know what dealing with a bipolar is like? The following is dead on:

“Bipolar is a hell of a disease, and I wonder if patients [at my community health center job] knew how devastating it is, whether they’d choose to label themselves that way.

Bipolar used to be called manic-depression. People with bipolar disorder are constantly on a roller coast ride between severe depression and mania. On the depressed end, this can include feelings of worthlessness, excessive guilt, changes in eating (over- or under-), changes in sleep patterns (can’t go to sleep or can’t wake up), and recurrent thoughts of death.

On the manic end, bipolar people experience feelings of grandiosity, believing they’re capable of things nobody can do. At this end of the spectrum they often sleep very little, their thoughts race, and they can’t stop talking. They tend to get involved in risky activities, such as unrestrained buying sprees, sexual indiscretions, or foolish business investments. Some feel more angry than expansive in their manic phase, or when they’re on their way up or down.”

Congrats. You get the gold star. You’ve just learned something today (if you’re not bipolar).


I recently read Graham’s Blog and among a list of meds, I saw “Zispin.”

Whaa?

It’s trademarked as Remeron in the U.S. and Zispin in Great Britain. The generic name is mirtazapine. Sounds like a name for a German lady €“ Fraulein Mirtazapine.

According to the wonderful wikipedia, mirta treats “mild to severe” depression.” That’s a wide spectrum of patients to cover. Mirta is as effective for people with mild depression as it is for those who are dang near suicidal everyday? I’m not convinced.

Of course, since it’s a med, it’s used off-label for panic disorder, GAC, OCD, and PTSD among other health problems.

If you’re you suffer from bipolar and get a prescription for this stuff, get another doctor quick: mania is a side effect.

I won’t get into the fine details of how mirta works, but it appears that it enhances neurotransmitter actions rather than affect serotonin levels directly.

There’s my new medication lesson of the day.


I’m late on the bandwagon, here. I’m sure Furious Seasons, CL Psych, and other blogs have railed on the injustice of Judge Weinstein’s stupid yes, it is stupid decision to uphold his gag order (he imposed it so why would he change it?) that keeps blogs from “dissemination” Eli Lilly’s leaked documents. Basically, the judge wants to block wiki Zyprexa Kills from showing this info. Any other blog that has the documents, links to it, or publishes it is — well — subject to a gag order as well. *gag*

I have a personal opinion on the matter and since you’re reading this blog, you’ll be subjected to it.

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Venlafaxine withdrawal symptoms

Work has got me busy, folks, so posts may drop significantly in the next coming days/months. Possibly through April or May. (I’ll probably have one of those work days when I end up doing more blogging than working. It happens every now and then.) But don’t be surprised if Saturday quotes, Wednesday puppies, and Sunday stats are what pops up each week. I’ve got many of those backlogged through April. I’ll try to backlog some other posts on bipolar disorder and depression for the coming weeks and quickly blog on anything that’s timely.

electric shockIn the meantime, I had to take a sick day today. It’s my third day off of the Effexor and I’m having some weird side effects (see Case 1: Standard Dose under the link). Whenever I turn or move too quickly (consider your “natural” body turn), I “kind of” see stars and the whole world slightly spins beyond my field of vision for about 3 seconds before coming back into focus. After doing some light research on the side effects of venlafaxine (Effexor’s generic name), I’ve found out that side effects can incude vertigo, dizziness, light-headedness (associated with dizziness), and something called “brain shivers,” which are a form of electric shock sensations. You know that feeling when you get an electric shock from somebody? Yeah, imagine feeling that throughout your whole body. Precisely; not a good feeling. Nancy Schimelpfening, blogger for depression.about.com, found a newsgroup posting on the brain shiver effect, mainly associated with venlafaxine:

It happens to me if I turn my head quickly, or if I stop suddenly, or in general with sudden motion. They’re worse if I’m nervous.

i’ve seen them described as feeling as though your brain keeps going when you turn your head. that doesn’t seem quite adequate to me. it’s more like this:

you turn your head (or your whole body — this happens to me if i whirl around too quickly as i’m taking the stairs. what. doesn’t everyone whirl on the stairs…?), but your brain *stays put* for a micro second, then tries to catch up but only in a stuttering, stopstart motion, accompanied by a staccato ‘zzt zzt zzt’ with each stop. the ‘zzt’ you can feel in your head, an electric sort of vertigo, and it often reverberates in your hands and fingers. some folks feel it in their toes; i haven’t yet.

sometimes your brain overshoots and comes strobing back, then overshoots again.. this all unfolds in just a second or two.

these days i endeavor to go around corners all smooth slow and steadylike. helps to reduce the number of brain shivers per day

Yeah, that’s me. It’s hard to explain to someone who’s never felt it. I got this feeling after not taking Paxil for three days too. The effects eventually wore off, but it was such a weird feeling.

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Bipolar disorder

“Avalanche is sullen and too thin / She starves herself to rid herself of sin / And the kick is so divine when she sees bones beneath her skin / And she says /Hey baby can you bleed like me? / C’mon baby can you bleed like me” ~ Garbage, “Bleed Like Me”

Medication bottlesI went to the psychiatrist Wednesday and received the oddest diagnosis of my life: he told me that I’ve got bipolar disorder and that I’m on the wrong medication.

For most of my life, I’ve been convinced that I’ve had major depressive disorder and nothing else. When I was a teenager, I thought I might have been bipolar (age 15-19) but my manic side gradually faded with puberty and I became much more of a depressive.

This is the first doctor or psychiatrist in the history of my life to ever tell me that I’m bipolar. At first, I thought he got his diagnosis wrong. “I can’t be bipolar, I’m not really manic. I don’t spend a lot of cash – well, not recently anyway – I don’t experience euphoric states quite often and I don’t have feelings of grandiosity. And I don’t engage in risky behaviors, you know. I don’t drink or do drugs. I’m a good girl. I can’t be bipolar.”

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