Rethinking Mental Health

By Courtney Rundell

We’ve been together for a little over 6 years – the best years of my life. He’s intelligent, kind and compassionate. He’s a great listener. He knows me, my past, my dreams, my strengths, my weaknesses. He’s always there for me.

No, he’s not my boyfriend. He’s my psychiatrist.

Our relationship is one of the most important in my life. He’s saved my life countless times – I actually don’t think I’d be on this planet if it weren’t for him.

Finding the Prince Charming of psychiatrists wasn’t an easy task. It took 6 years, three frogs and two misdiagnoses, but I finally was lucky enough to stumble upon him.

Once upon a time…

Frog #1 diagnosed me with panic disorder and prescribed Celexa. After 6 weeks, my already intolerable anxiety was worse. So, he directed me to stop taking Celexa and to start taking tranquilizers every day, knowing full well I’d been sober over 2 years.

He didn’t offer another antidepressant, therapy or any other solution beside tranquilizers.

I left his office convinced that they were all the same. They’d all just want me to shut up and take whatever they threw my way. They were the boss, not me. I had no say in our relationship – it was patriarchal. I was just another girl.

Frog #2 diagnosed me with panic disorder and prescribed Lexipro which made my mouth taste like metal, so she switched me to Paxil which wrecked me, so she switched me to Zoloft which worked.

I saw her for 2 years. She was extremely cold, rarely spoke and took copious notes. The only phone number I was given was the appointment line, so we only spoke in sessions.

I left that relationship thinking that was as good as it gets – icy, clinical, lacking any new insights into my internal life. I would never feel warmth or compassion. I would never be understood.

The One Who Got Away was the staff psychiatrist at Northern Nevada Adult Mental Health Services. I was visiting my mother in Reno – 500 miles from home – when I was hospitalized.

He diagnosed me with bipolar 2 disorder and PTSD. Ends up, contrary to the beliefs of Frogs 1 and 2, I never even had panic disorder.

After a long talk, he handed me two prescriptions – one for Lithium and Zoloft and the second for “therapy and 12-step meetings once I got back to LA.” He wrote the second as a prescription to emphasize the importance of not only medication, but treatment as well.

I finally met the perfect match and I couldn’t have him. He was already taken and long distance relationships never worked. What a cruel trick the universe played on me!

Frog #3 did his own scheduling. He didn’t have a waiting room so I sat in the hallway outside his office. When he managed to remember our appointments, I was in his office no more than five minutes – just to get my refills. I spent more time outside his office than I did inside.

The second time he stood me up, I was done. I’d met a prince before, so I had a little spark of faith that he was out there, but it was most certainly not this one. I had enough self-respect to know that we both needed to show up for the relationship.

… and then I found my Prince.

He’s never been late or canceled an appointment. He has a waiting area and an assistant who does his scheduling. He changed my diagnosis from bipolar 1 to 2 after learning more about my cycles and affirmed that PTSD was causing my panic attacks. We did therapy for the first few years. I graduated to med checks, but I’m still in his office at least 20 minutes.

We have conversations. I never feel like I’m being observed. He takes notes after our session is over.

He’s always up on new research and treatment options. He never overmedicates and respects my sobriety. He’s open minded, experienced and human.

He’s walked me through a miscarriage, a pregnancy, suicidal depressions, postpartum OCD and mania and everywhere in between.

…and we lived happily ever after. The End.

The moral of my story can be best expressed with clichés:

1.      If at first you don’t succeed, try and try again.

2.      You have to kiss a lot of frogs before you find your prince.

3.      Rome wasn’t built in a day.

Courtney Rundell is a freelance blogger for the International Bipolar Foundation and the North Hollywood Patch. She speaks all over California about thriving with alcoholism, bipolar, and PTSD. When Courtney was diagnosed bipolar in 2006, a life she never knew was possible began. She’s devoted to inspiring and sparking hope in others now that she’s finally a free woman. Her personal blog can be found at www.BeePea.com.

By Marybeth Smith

Marybeth Smith was diagnosed with Bipolar II at age 26. Marybeth created the website www.askabipolar.com in hopes of helping others understand what it’s like to suffer from mental illnesses. Marybeth is the author of the Amazon Kindle Best Seller and ABNA quarter-finalist, Fall Girl, and is currently working on the sequel while pursuing a degree in Child Psychology. Additionally, Marybeth designs websites, writes for bpHope Magazine and The International Bipolar Foundation, and serves as a board member for NAMI MI.

There are people in this world who meet their best friend in Kindergarten and are friends forever. Others meet in high school. Some in college. They meet, they click, and the friendship grows, making the term ‘BFF’ an actual thing.

Best Friends Forever.

They exist.

Not so much in my life.

I met my best friend in Kindergarten. Then I switched schools. The same happened in first grade, and then I went best friendless until the seventh grade. We went to different high schools, and then she went to college. We stayed in touch, but grew apart.

And then … there were the high school BFF’s.

The symptoms of my illness really came to life in high school. Thus my friendships began to take a bit of a bipolar curve of their own. I’d get depressed and suddenly I was like a magnet with the opposite charge … everyone cleared the area and kept clear until I surfaced. Then I’d switch to a little hypomania and suddenly everyone was my friend. I was funny, I was entertaining, I was friendly, I was fun.

Until I’d fall again.

I’d crash.

I’d turn into an irritable, depressing monster.

Friends were lost, friends were made, and friends were lost again. Then new friends were made again. I was and am great at making friends … still, they pretty much all ended the same way. I’d get depressed and say or do stupid things and it’s goodbye friendship.

I’d like to say this changed as I got older. I’d like to say it became easier to maintain friendships after my diagnosis. Unfortunately, it actually got a bit worse. There were friends I would stop being friends with and then start being friends with again about a year later only to go through the entire ordeal again.

Now maybe these things happen to everyone. And then again, maybe it’s just a problem I have. But sometimes I wonder if it’s a problem that everyone who struggles with bipolar disorder experiences. Do you have a difficult time maintaining friendships? Do you think it has anything to do with your illness?

By Courtney Rundell

Courtney Rundell is a freelance blogger for the International Bipolar Foundation and the North Hollywood Patch. She speaks all over California about thriving with alcoholism, bipolar, and PTSD.

When Courtney was diagnosed bipolar in 2006, a life she never knew was possible began. She’s devoted to inspiring and sparking hope in others now that she’s finally a free woman.

Her personal blog can be found at www.BeePea.com.

Sinead O’Connor’s recent decision to cancel her upcoming tour “due to bipolar disorder” took courage few know. While putting one’s career on hold due to cancer or Parkinson’s evokes worldwide sympathy, doing so because of mental illness shines a light on how much stigma still surrounds mental health issues.

I know all too well the vulnerability it takes to admit defeat to mental illness. Six years ago, I was placed on a 72-hour hold in a locked down psychiatric unit and diagnosed with bipolar disorder.

I was committed because I was overcommitted.

Shortly after getting my Master’s Degree, I landed my first paying directing gig when I was in the darkest depression I’d ever experienced. I felt like my career was finally taking off so I took the job, banking on the hope that my old frenetic energy would return like Mighty Mouse and save the day.

Normally, I could summon the energy. When I was a stage actress, I used it to memorize lines. When I was a student, I employed it to stay up all night studying for an exam. After my tasks were achieved, I hibernated. I’d literally sleep around the clock until I was able to function again. That was simply how I operated, so it didn’t seem peculiar to me.

But this time was different – that energy was nowhere to be found. My depression grew darker and heavier until I was finally buried and crushed by my rapidly piling responsibilities. My only answer was suicide.

Then I was in an ambulance and the gig was up.

Being diagnosed bipolar was shocking, yet it made sense. I often felt like I had two different personalities – one manic, one depressive. My manic self would run around making promises that my depressive self couldn’t possibly fulfill. Then the shame of not coming through on the promises I’d made only pushed me deeper into depression, creating a vicious circle of darkness and disgrace.

Knowing that I let down many people was beyond humiliating. A deep sense of vulnerability and rawness came with admitting that I was too sick to follow through with my commitments and my sickness only magnified the already negative situation.

My world fell apart, and while I felt like everyone was pointing and laughing at me, I was by no means in the public eye. I can’t begin to imagine what Sinead’s feeling right now.

Sinead O’Connor has lived a life that most people can’t imagine. She’s toured the world. She’s the first-ever priestess to be ordained. She’s given of herself and her celebrity to fight hunger and poverty. She’s a human rights advocate and has spoken out against AIDS/HIV stigma.

And she’s mother to four children. That in itself is a feat unimaginable to me.

Therefore, in lieu of judgment, might I suggest we applaud Sinead’s bravery? Applaud her immeasurable courage. Applaud her honesty. Applaud her humanness.

We are not our accomplishments. Tours can be rescheduled, life cannot.

Brava, Sinead. Brava.

By Sunny Aslam, MD

Sunny Aslam, MD, is assistant professor of psychiatry at SUNY Upstate Medical University and Director of Education and Training at Hutchings Psychiatric Center, a recovery-oriented psychiatric hospital in Syracuse, NY. When he is not playing with his young daughter, he can be found at the Carrier Dome cheering on the Syracuse Orange.

You may have heard recently that ketamine, an anesthetic medication, may be a promising treatment for depression. There have been no new drugs that treat depression in a unique way in decades, but ketamine works in a different way in the brain than traditional antidepressants.

Ketamine blocks a chemical called glutamate in the brain, which is different from the action of many antidepressants. Most antidepressants work on the neurotransmitters, of which serotonin is the most well known. Ketamine can help put a patient to sleep for surgery or relieve a patient who is in pain by placing them in a kind of trance called ‘dissociative anesthesia’. For this reason, the drug can also be abused, helping those who wish to leave reality; the drug can also cause hallucinations similar to PCP.

Small studies of 6-33 patients receiving low-dose ketamine have shown impressive results in reducing depression and suicidal thinking. One study showed improvements in depression within 40 minutes! Others showed improvement within hours to days, which is much shorter than the weeks to months traditional antidepressants or psychotherapy can take to have an effect. The effect lasted 7-10 days in some trials.

Studies in animals have shown increases in hormones and neurotransmitters that promote growth of brain cells. This is similar to how traditional antidepressants are thought to work, but it appears to happen much more quickly with ketamine. Ketamine may activate areas of the brain that are slowed in depression by increasing blood flow and consumption of blood sugar.

Larger, more rigorous studies are needed and are currently being conducted. One study hopes to compare ketamine with another anesthetic in 72 persons and should be completed later this year. Patients will be followed for up to 8 weeks.

Although the research is preliminary, and abuse concerns are real, ketamine appears to have a bright future.

By Thomas L. Schwartz, MD

Psychotherapy, talk therapy, and counseling are all terms used when treatment revolves around a patient talking to a therapist every week. This series of blogs aims to evaluate some common myths about getting therapy for one’s mental or emotional symptoms. The first post in this series addressed the purpose of psychotherapy.

Myth: Talking about your issues is a psychological-only treatment in that it does not affect biological brain functioning.

Reality: This may be partially true. Talking about things often calms one down and lets one see several points of view and options for corrective actions in the future.

But psychotherapy is also a brain process. Talking things through likely strengthens the front part of the brain, making it stronger and better able to control the parts of the brain involved in drives and impulses (such as anger and sadness).

Imagine a depression study in which half of the patients only get psychotherapy, and the other half only get an antidepressant medication. Both groups of patients would get their brains scanned. (Such a study was published in the Archives of General Psychiatry in 2001.) Guess what? Those whose depression got better had the same changes in brain functioning, regardless of whether they took the medication or just talked in therapy. So talking in psychotherapy does create biological changes, just like some medications do.

Why is this important?  Some patients think psychotherapy is just talking and they want a more “biological” treatment that is studied and scientific.  Psychotherapy is both of these.

Most patients think that they sign up for psychotherapy and they go in and talk in order to “vent” their feelings. Others think they are going it to see a counselor (like a lawyer or financial advisor) who will tell them what to do and how to behave.

Some of this is true. Venting your feelings or “getting it all out” in a safe environment may be helpful in cases of grief where a loved one has died, but I have also met patients who have had therapists where they have been venting every week for seven years… and they still aren’t better. So venting is part of the process in some cases. Some therapists will tell you what to do and how to behave, but this may not be a hallmark of a good therapist. Good therapists work with you in hopes that you see better ways to behave, interact, and function and act on those in your own way.

Below are some concepts that govern certain types of psychotherapy. Yes, just like there are several types of medications that work in several different ways, there are different types and styles of psychotherapy:

Analytical or psychodynamic therapy suggests that your past (your parents, your upbringing, your environment, your friends, and all of the good and bad things that ever happened to you) shapes who you are and dictates how you behave in the present. If you learn about yourself and your past then gain insight into your patterns and behaviors, you can learn to react differently in the future and your symptoms will gradually improve.

Cognitive-behavioral psychotherapy (CBT) suggests that patients have developed automatic negative and self-defeating thoughts. CBT does not care if problems came from your parents or elsewhere but cares that in the ‘here and now’ that you are suffering as your automatic thoughts (for example: I always fail, I am never any good, everyone always abandons me) trigger negative emotions (sadness, anger, despondency) which you get stuck in and become depressed or anxious. CBT therapists teach skills and resiliency in regards to fighting through and counteracting these negative, automatic thoughts.

There are likely 20 other forms of psychotherapy, each with their own underlying theory and process of reducing psychiatric symptoms.

Finally, biologically-minded therapists think that psychotherapy may activate certain brain areas and deactivate others, thus lowering symptoms. Yes – talking to a therapist actually changes brain patterns and activity. My future blogs will look at some of these more closely.

Psychotherapy, talk therapy, and counseling are all terms used when treatment revolves around a patient talking to a therapist every week. This series of blogs aims to evaluate some common myths about getting therapy for one’s mental or emotional symptoms.

Myth: The purpose of psychotherapy is to see your counselor and ‘vent,’ or describe all of your problems. (more…)

How does our brain chemistry affect our mental health? This series explains some of the science behind the medicine.

Take a guess, what is the molecule above?

Hints

1. Sometimes I come from eating turkey or chocolate.

 

2. In the brain, when plentiful I promote social affiliation, resiliency and the ability to adapt to situations.

 

3. If excessive, from something like the drug ecstasy, I may cause patients to become very outgoing, or even promiscuous.

 

4. If through genetics, stress, or trauma I become less available or depleted in the brain, I may cause symptoms of sadness, despair, guilt, worthlessness or suicidal thoughts.

 

5. A majority of FDA approved antidepressants cause the brain to increase my concentration and availability. After a few weeks of this, these depression symptoms may be reversed in some patients.

(more…)

One of the many traits of being bipolar is the ability to see the world in a different way. Many might say it is a curse, but it can also be a gift when looked at from a positive perspective. This change in perspective can literally help you to see with greater clarity.

From early childhood, we have been taking tests to assess our understanding of the world. These tests have had a profound impact on us in ways that we are often unaware. They have created a world view that places too much importance on passing the test and not enough on learning more about ourselves. In some ways, the tests themselves have gotten in the way of what the goal was in the first place. (more…)

On a recent Google search I found a reference to Dr. Marcia Angell’s article “The Epidemic of Mental Illness: Why?” in The New York Review of Books.  Dr. Angell gained popularity by becoming an editor-in-chief of the New England Journal of Medicine and has since written many articles about the negatives of the pharmaceutical industry.  She agrees with other authors in her review as follows:

1. Our understanding of categories of mental illness and their treatments has been influenced by drug companies, in that drug companies create mental illness categories or diagnoses so that their drugs will have places to be used when marketed.

2. Mental illness is not caused by chemical imbalances in the brain.

This view is actually too simplistic. (more…)