Sleep, sleep, and more sleep

Not sure how or why this is happening, but I do know it's happening. Going from hardly sleeping to sleeping, sleeping, and more sleeping. It's been so cold outside. To cold to go to my favorite park with my favorite girl, LiddyRae, and walk, absorb nature, and play. Yesterday, I napped for around two hours, so peacefully. Then again last night, for quite  a few hours, I slept- and actually rested. Today, the temps were up and the snow melted all away. I slept. This morning we had an earthquake  I found out about tonight. I slept. There were great things happening in the world today. I slept.
My sweet little girl woke me up for her dinner time at seven. Been awake since, barely. Ready for more sleep. There's so much I need to do. I think I'll sleep.

Small Victories......Getting There

Today there was a battle. There was a choice. I felt those horrid gears changing and grinding. It's been right at three (3) weeks since I've followed through with self-inflicting any pain. Today, as I allowed myself to really cry out the bunch of tears I've been holding inside, letting only some escape here and there, the feeling of weakness rolled over me and I felt an overwhelming desire to make it stop. As I cried, I lay there involuntarily drawing up into a small ball. My stomache was "cramping/aching" so strong just like my hands, with desire to go "pay for this weakness," and for all that my mind consist of, was so overtaking. Did I go do it? I wanted to, but I lay there. With the phone prayers of a beautiful friend, I finally relaxed into God's arms and am thankful to have made it past that time of what I dare to refer to as withdrawal. No different than stopping smoking, a person can become addicted to self-inflicting pain and after long periods of doing it (in my experience-years), to stop is mind-blowing when one (in my experience for sure) realizes in these times that their hands are cramping with desperation as the best is given to resist the wrongful act of hurting the body, God's temple.

With those last two words being said, let it be known that while I did a good job of succeeding that battle, I didn't and could NEVER have done that alone. I am thankful for my friends and family who are willing to pray with and for me and not give up on believing in me as I work to improve and grow stronger in belief in my own self; but the BIG glory goes to GOD- someone bigger than you and I. If it weren't for God, no way could I make it from day to day. I believe many people relate to this; maybe even more than care to admit. In the end, I am most grateful to God for his undying and unconditional love and for his strong arms that hold and carry us when we truly are not able to walk on our own feet; who picks us up and holds us when we've even fallen from our knees to flat on our face. Thank you God for this victory.

In Peace

Awake Again

Here we are. Don't worry; "we" is referring to my little dog and me ;) Last night, wide awake until plenty after daylight. Slept for a few hours and was awake again. Facing the beautiful winter day. You know what? I went out to run some errands and I believe everyone and their out-of-state relatives were out, as well. Hustling and bustling to get last minute Christmas commercializing taken care of. O'kay- so they were last minute shopping. There. That prolly made someone happy. I don't know who you are, but you know who you are :) Hmmm. Anyways, I noticed that the people I passed who were walking into and/or out from the stores were actually very friendly for this time of year. You know, here anyways, seems like most everyone is in such a hurry and/or on a "do or die" mission and they will run you over going into the stores, seem to want to play bumper cars or hit-and-run with their buggies (grocery carts) inside the stores (reminds of this one time on a trip, in Boston, inside Marshall's(or was it T.J. Max?) when I was culture shock-initiated to the NE. I was standing in front of, and right at, a long stand of hanging clothes and was looking at these items and a lady squeezed her way right in front of me to ge a look at the clothes on the hanging stand, herself. OK. I reeeeeally do mean ever bit of "squeezed her way in." I couldn't believe it. I'm sure I commented something like, "How rude." Who knows? Maybe it wasn't really that nice. I might've tried to match her actions with my words. Honestly, I don't remember.The sad thing was when I left the stores of friendly people greeting each other amazingly, like "deep southerners", as soon as I re-enterred (the word re-enterred doesn't look right) my truck and into traffic, even in parking lot traffic, (was it the same sweet-greeting people I'd just interacted with?), people were driving like they were out for blood. No joke. It was so sad to see. There were a few wrecks that I saw. Why? Why even that many in that small radius? Why do people feel they have to be so aggressive in driving? Mean? That's what I'm talking about- plain mean. You know, it's my belief that the best place ever to practice patience is in serious traffic. Try it. Go ahead. It won't hurt or kill you to let someone or two or even three someones pull out into the road in front of you. WARNING: DO NOT, I repeat- DO NOT look in the rear-view mirror until you "semi-master" being patient. If you do look in the mirror, you may see things from the driver(s) behind you that trigger your temper and then it's too easy to forget you have a choice of your attitude and outlook. So, just try it. Let someone over in your lane and wave them over with a warm wave. If you do practice Road-Reason (rationalism?.) everytime you you drive, you'll start to come in check with having patience instead of Road-Rage. Well, it's 5 o'clock somewhere. Actually, it is here. OK. I have something very serious to talk about. I just recognized that perhaps I have detoured my own thoughts so that I would be too tired to make this  matter known to everyone just yet. Hmm. Am I having a Real moment of uncovering some things that may be true? That would be great. And, what is the truth is that I really am tired now. For this blog-round, I am done. This is tiring and draining work. I WILL succeed and I WILL overcome, with the help of God, if it is his will. Goodnight world. Have a great holiday.

Reading, Writing, and...Forget Math

I'm reading a really good book titled "Peaks and Valleys" (it's authored by Spencer Johnson, M.D.) It's written in story form and reminds me of Dan Millman's style of writing when he has written in story form. Anyone can benefit from this book. It relates to work-life and everyday-Life-life. The challenge is; will you check it out at the library or find a copy of it somewhere and read it? I "double-dog dare" you :) Enough for now.

Love Is Peace,
His Princess, Peaceful Warrior

Stupid Rabbits!! Maybe They're Not O'kay; Or Maybe It's Me Who's Not O'kay

Do I feel angry? The truth is yes. I do. This posting is perhaps not "written" quite so gentle. It feels as though this learning and overcoming process will take so, so long. Am I in it for the long haul? YES!!!!!!!!!!!!! I'm NOT a quitter. Do I feel like quitting on myself? YES!!!!!!!!!!!!! And I refuse to give up!!! Am I working to convince my own self? It's obvious; YES!! Right now, in this moment I am angry about the rabbits and other animals.

What am I talking about? It's generally when I'm tired physically and sometimes just when tired emotionally. First, it's probably good to discipline myself by getting up and stretching, doing some deep breathing exercises, read over some positive affirmations and biblical promises, and/or whatever else will help to calm down so that I can express and in a way that gives a more clear as possible understanding to you, the reader. Could I delete all of what I just typed? Yes, but what help would that be if I am opening up to give an inside view of what this looks and feels like? No, I won't. Now for that break.

Alright. Sleeping is an issue. It really became a big problem about three or four months ago, or so. After realizing I was alive for real good reason, after having been within less than a half-hour of my own death, I became extremely "alive-wired." Sleeping suddenly became an issue. I work night shift, which works great for being in school, if  you're a "normal" healthy minded person who can adjust without the help of a lot of caffiene. Trying to keep a night shift schedule on my days off was a problem anyways; but, now it became a very large problem (trying to stick to a regular sleep routine). I didn't want to sleep. Why would I? There's constantly something happening and if I sleep, especially in the daytime, I'm bound to Miss Something! And you and I know there is No getting time back. It kind of reminds me of when I was a really little girl, when we'd have company who was visiting past nine o'clock (that was, for years, my natural internal "go-to-sleep-time"). I would bring my pillow from the bed to the middle of the living room floor and lay and go to sleep there, as I listened to the conversations at hand. Why? I knew why; even way back then - just like I know now; there was something going on and I didn't want to miss out. If I was in there, I "wouldn't miss out on anything."  I had to get out and keep pushing; go to the park and hike, bike; go to the pond and fish; take nature pictures; do whatever- outside of these walls- just don't sleep and do keep moving. "I can sleep another time." "Another time" was getting further and further apart. It turned into "sleep binging." But, then I became exhausted of being exhausted. Did I want to keep pushing? Not at that point. I just wanted/want to feel "normal" and to know what normal really is and to experience the term "balance", now more than ever before.
It's come to the point where I am so tired of fighting my ever constant busy mind. I might find that I can benefit by changing my view on this, but, right now I view this sleep situation as "if my body is so tired it can over-power my mind and relax to go to sleep, my body wins and I sleep. If my mind is so busy (and I don't know about you but I can't sleep when my mind is busy with tons of thoughts all running together at one time) that I can't comfortably relax and sleep, then my mind wins and I don't sleep again until my body wins the on-going battle. Sometimes awake for days. Other times asleep when I really do need to be awake. I've always been a heavy sleeper when I sleep. I've missed classes because I slept through class times and I've missed work because I slept right through time for work. I do take Trazadone which was a help for a little while because it's prescribed to help me sleep. I take it in the mornings at 9a.m. along with Klonopin, Celexa, and Melatonin. Yes, I do take it faithfully. At around 10p.m., I take klonopin again and then again at 3a.m. It seems as though, now, none of it is working. Yes, I have an appoinment with my psychiatrist and counselor(psychologist) on Jan. 12th and am trying to get in sooner.
I reeeally need to because, the most recent issue has been "seeing things." I notice it happens when I am really tired physically and/or emotionally. I can be in a bad or even a good mood; it doesn't seem to matter the mood, it just happens. And there they are. Or would it be more correct to say,"There they go?" There are rabbits hopping around and other little animals that I can never seem to make out exactly what they are. At first, I didn't tell anyone because even I know there are no rabbits or animals hopping around inside home or work or wal-mart or inside anywhere, except maybe the zoo. I noticed they are always hopping in different directions away from me, but never towards me. Sometimes I see them just zipping across in front of me. Everytime, I take a second look and they are gone. Then, the more it happened, I started to get worried. So, I told my best friend. It was embarressing to tell, even though she is my best friend, because, hello, it sounds totally crazy to me, so I can only imagine what it will sound like to her, let alone you, the reader. It bothered me so much that I used humor in discussing it to feel able to deal with it. I joked about how I wondered if I should get out my BB Pistol and start shooting at them, etc. As soon as I realized what I was doing (hiding my worry about it and using humor as my crutch), I stopped joking about it. It was not and is not funny to me. And, I figured as long as they don't start hopping toward me, especially those animals I cen't seem to figure out what they are, they not hurting me, so they're ok there.
My angel of a sister gave me some really good input: talk to my counselor ASAP Before they have a chance to "hop toward me" and turn scary. So, I made and will keep making phone calls until I can get in to see what we can do about those animals, now.
I don't understand it, but I'm going rabbit hunting and I will put these rabbitts, and other rodents, away for good, with the help of God and my counselor and Dr.

Love,
His Princess, Peaceful Warrior

Moving Forward

This has been and still is an over-used  and, in my opinion, an under-rated corprate statement: "Moving forward..." That's not the point I want to make, just saying.

Forward is a word of direction. Right? In The New International Webster's Vest Pocket Thesaurus "forward" is listed as an adjective, not an adverb (which is still blowing my mind because I thought forward was an adverb, and ONLY an adverb).  Listed with the word forward are the following words: bold, presumptuous, impertinent, fresh. From this list of synonyms, I choose to use the word bold.

Bold- adj. daring; forceful; impudent -bold'ly adv.  -bold'ness n. (The New Internaional Webster's Vest Pocket Dictionary) In the above listed thesaurus, one of the words are daring, courageous, and fearless.

It's interesting to me that in my case daring and courageous are characteristics which I possess and yet fearless is contradictory, in my case, to these words/characteristics. Fearless; on the contrary, I am experiencing increased anxiety and fear, along with a turning, churning gut, with the knowing that I am about to take the largest step I've ever taken in my life- exposing my mostly secret life; the obstacles which bring me great distress and turbulent turmoil.

I want to turn back around, run and scream, "No! I can't and I won't do this! I will not allow the ugliness to emerge it's ugly heads publicly! NO!!"

With strong conscientiousness and an extrreme desire to be well and free from the disorders I live with, I am determined to keep "walking"; boldly and daringly moving forward. I want to be free and to help others inspire and aspire to be free, too.

So, now, I will share with you some of how these disorders effect my life. It makes no sense to me why I feel the compelling need to count like objects. For example; couting the sqaures of carpet in certain areas of my workplace, counting tiles that are of equal measurement; counting how many literal carpet-square steps away from a sensored operated door a person has to be before the door opens- I already know these particular places, how many there are and how many square steps are there. Somehow, the driving feeling of need arises and I begin to count and recount to make sure I really counted them right the last time. Setting the alarm clock. I HATE SETTING TE ALARM CLOCK and I can't stand the idea of trusting someone else to set it. Sure, you can set it AND I "have" to get up to the alarm buttons off and check and recheck and check again and again until I feel it's safe that it will go off on time. For me to set it involves whatever seems proper body posture at each particular time of setting it and holding my breath and pulling in my abs as I set it to the time it is to be set for. Once there, I feel the need to check the volume on the alarm clock with the sleep button (it can't be ALL the way up because it might burst the speaker and then it's no good anymore. It can't be less than a smidgen away from all the way up though because if it's too low I don't trust that I will hear it at all.). Then, I set the alarm 1 and 2 buttons to on and then look at the face of the clock to make sure they are really showing as on. That is not enough. I turn alarms 1 and 2 back off and press the sleep button and immediately press snooze. "ok. I will hear that. Good." Before I turn alarms 1 and 2 back to on, I press the alarm 1 and 2 time-setting buttons to make sure they are set correctly for p.m. or a.m., depending on when I will need to wake up. "ok. It's correct. Now, NO WAIT! I have to make sure I saw it right. It could be wrong." So, I hold my breath and check again. Now I see that it really is correct so I turn the alarm buttons 1 and 2 back on. "WAIT! I've got to be sure. Sometimes our eyes play tricks on us. This could be that time. ok. Check." So, I turn off the alarms 1 and 2 and re-check the time set for and sometimes squinch my eyes and Always get a "good stare" in at the times just to "be sure." Now, I'm ready. Wait, wait! First check alarm 1 and then check alarm 2 again. ok. Good. Damnit!! Now I've pressed all these buttons and the volume may be off from where I had it!" I press sleep. Sounds the same, I press snooze. "Ok. It's good to go." I turn alarms 1 and 2 back on, V-E-R-Y carefully, so as not to disturb all the work I just put into making sure it's going to work right. Now that they are back on, I give the clock face one more careful stare and sometimes I am finished and can lay down and sleep. Other times, depending on my anxiety level and/or mood(s), I start the whole process back over from the beginning and repeat until I am convinced this alarm clock will function like it is supposed to. Sometimes, when I lay down, I think I am satisfied with the clock and then suddenly feel the overwhelming need to get back up and check "just one more time." When I have tried to set the alarm clock and do it only once and walk away, all i can say is it is agonizing, stomache turning, turmoil until I went and completed the whole "routine."

I like food; however I view it as fuel not neccesarily as something I need to over-induldge in. The problem with food is that if there is no napkin of some sort available anxiety starts building. Why? Because, while i don't mind dirt, vehicle grease, etc. on my hands, food on my hands stirs up a whirlwind of emotions and a whole lot of anxiety. I don't get it. It just happens that way.

This is enough for now. There are more things to share that relate to these already shared. I am growing anxious as I continue to write, so I choose to use this as an opportunity to say, "Rachel, you have control over you. It's ok to step away now and relax."

And so, I will;

With love

Introduction and Basic Education

  It is with a humble spirit that I create and manage this blog.

  First and foremost, I am a child of God. Second, my name is Rachel. Last, I am a human being just like you who just happens to have Obsessive-Complusive Disorder (OCD), Borderline Personality Disorder (BPD), and Hypo-manic Depression (Bipolar Disorder).
  It is my intent to journal in this blog as an emotional outlet, to educate those who want to be educated on these disorders, and to reach out to those who also suffer the same disorder(s) as me. There may be times when my blogs contain graphic or adult material not suited for children. So as not to offend or expose anyone to them who chooses not to take the deep look in, I will be sure to tag them with some type of adult warning, as a matter of respect.

OCD

"OCD  is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting,checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing theseso-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety.
People with obsessive-compulsive disorder (OCD) have persistent, upsetting thoughts (obsessions) and use rituals (compulsions) to control the anxiety these thoughts produce. Most of the time, the rituals end up controlling them.
For example, if people are obsessed with germs or dirt, they may develop a compulsion to wash their hands over and over again. If they develop an obsession with intruders, they may lock and relock their doors many times before going to bed. Being afraid of social embarrassment may prompt people with OCD to comb their hair compulsively in front of a mirror-sometimes they get “caught” in the mirror and can’t move away from it. Performing such rituals is not pleasurable. At best, it produces temporary relief from the anxiety created by obsessive thoughts.
Other common rituals are a need to repeatedly check things, touch things (especially in a particular sequence), or count things. Some common obsessions include having frequent thoughts of violence and harming loved ones, persistently thinking about performing sexual acts the person dislikes, or having thoughts that are prohibited by religious beliefs. People with OCD may also be preoccupied with order and symmetry, have difficulty throwing things out (so they accumulate), or hoard unneeded items.
Healthy people also have rituals, such as checking to see if the stove is off several times before leaving the house. The difference is that people with OCD perform their rituals even though doing so interferes with daily life and they find the repetition distressing. Although most adults with OCD recognize that what they are doing is senseless, some adults and most children may not realize that their behavior is out of the ordinary.
OCD affects about 2.2 million American adults,¹ and the problem can be accompanied by eating disorders,⁶ other anxiety disorders, or depression.^2,4 It strikes men and women in roughly equal numbers and usually appears in childhood, adolescence, or early adulthood.² One-third of adults with OCD develop symptoms as children, and research indicates that OCD might run in families.³
The course of the disease is quite varied. Symptoms may come and go, ease over time, or get worse. If OCD becomes severe, it can keep a person from working or carrying out normal responsibilities at home. People with OCD may try to help themselves by avoiding situations that trigger their obsessions, or they may use alcohol or drugs to calm themselves.^4,5
OCD usually responds well to treatment with certain medications and/or exposure-based psychotherapy, in which people face situations that cause fear or anxiety and become less sensitive (desensitized) to them. NIMH is supporting research into new treatment approaches for people whose OCD does not respond well to the usual therapies. These approaches include combination and augmentation (add-on) treatments, as well as modern techniques such as deep brain stimulation.


BPD

"BPD is serious mental illness characterized by pervasive instability of moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of identity. Originally thought to be at the "borderline" of of psychosis, people with BPD suffer from a disorder of emotional regulation.While less known than schizophrenia or bipolar disorder (manic-depressive illness), BPD is more common, affecting 2 percent of adults, mostly young women. There is a high rateof self-injury without suicide intent, as well as a significant rate of suicide attempts and completed suicide in severe cases. Patients often need extensive mental health services, and account for 20 percent of psychiatric hospitalizations. Yet, with help, many improve over time and are eventually able to lead productive lives.

Symptoms

While a person with depression or bipolar disorder typically endures the same mood for weeks, a person with BPD may experience intense bouts of anger, depression, and anxiety that may last only hours, or at most a day.⁵ These may be associated with episodes of impulsive aggression, self-injury, and drug or alcohol abuse. Distortions in cognition and sense of self can lead to frequent changes in long-term goals, career plans, jobs, friendships, gender identity, and values. Sometimes people with BPD view themselves as fundamentally bad, or unworthy. They may feel unfairly misunderstood or mistreated, bored, empty, and have little idea who they are. Such symptoms are most acute when people with BPD feel isolated and lacking in social support, and may result in frantic efforts to avoid being alone.
People with BPD often have highly unstable patterns of social relationships. While they can develop intense but stormy attachments, their attitudes towards family, friends, and loved ones may suddenly shift from idealization (great admiration and love) to devaluation (intense anger and dislike). Thus, they may form an immediate attachment and idealize the other person, but when a slight separation or conflict occurs, they switch unexpectedly to the other extreme and angrily accuse the other person of not caring for them at all. Even with family members, individuals with BPD are highly sensitive to rejection, reacting with anger and distress to such mild separations as a vacation, a business trip, or a sudden change in plans. These fears of abandonment seem to be related to difficulties feeling emotionally connected to important persons when they are physically absent, leaving the individual with BPD feeling lost and perhaps worthless. Suicide threats and attempts may occur along with anger at perceived abandonment and disappointments.
People with BPD exhibit other impulsive behaviors, such as excessive spending, binge eating and risky sex. BPD often occurs together with other psychiatric problems, particularly bipolar disorder, depression, anxiety disorders, substance abuse, and other personality disorders.

Treatment

Treatments for BPD have improved in recent years. Group and individual psychotherapy are at least partially effective for many patients. Within the past 15 years, a new psychosocial treatment termed dialectical behavior therapy (DBT) was developed specifically to treat BPD, and this technique has looked promising in treatment studies.⁶ Pharmacological treatments are often prescribed based on specific target symptoms shown by the individual patient. Antidepressant drugs and mood stabilizers may be helpful for depressed and/or labile mood. Antipsychotic drugs may also be used when there are distortions in thinking.⁷

Recent Research Findings

Although the cause of BPD is unknown, both environmental and genetic factors are thought to play a role in predisposing patients to BPD symptoms and traits. Studies show that many, but not all individuals with BPD report a history of abuse, neglect, or separation as young children.⁸ Forty to 71 percent of BPD patients report having been sexually abused, usually by a non-caregiver.⁹ Researchers believe that BPD results from a combination of individual vulnerability to environmental stress, neglect or abuse as young children, and a series of events that trigger the onset of the disorder as young adults. Adults with BPD are also considerably more likely to be the victim of violence, including rape and other crimes. This may result from both harmful environments as well as impulsivity and poor judgement in choosing partners and lifestyles.
NIMH-funded neuroscience research is revealing brain mechanisms underlying the impulsivity, mood instability, aggression, anger, and negative emotion seen in BPD. Studies suggest that people predisposed to impulsive aggression have impaired regulation of the neural circuits that modulate emotion.¹⁰ The amygdala, a small almond-shaped structure deep inside the brain, is an important component of the circuit that regulates negative emotion. In response to signals from other brain centers indicating a perceived threat, it marshals fear and arousal. This might be more pronounced under the influence of drugs like alcohol, or stress. Areas in the front of the brain (pre-frontal area) act to dampen the activity of this circuit. Recent brain imaging studies show that individual differences in the ability to activate regions of the prefrontal cerebral cortex thought to be involved in inhibitory activity predict the ability to suppress negative emotion.¹¹
Serotonin, norepinephrine and acetylcholine are among the chemical messengers in these circuits that play a role in the regulation of emotions, including sadness, anger, anxiety, and irritability. Drugs that enhance brain serotonin function may improve emotional symptoms in BPD. Likewise, mood-stabilizing drugs that are known to enhance the activity of GABA, the brain's major inhibitory neurotransmitter, may help people who experience BPD-like mood swings. Such brain-based vulnerabilities can be managed with help from behavioral interventions and medications, much like people manage susceptibility to diabetes or high blood pressure.⁷"

Hypo-manic Depression (Bipolar Disorder)

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.
Bipolar disorder often develops in a person's late teens or early adult years. At least half of all cases start before age 25.¹ Some people have their first symptoms during childhood, while others may develop symptoms late in life.
Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

What are the symptoms of bipolar disorder?

People with bipolar disorder experience unusually intense emotional states that occur in distinct periods called "mood episodes." An overly joyful or overexcited state is called a manic episode, and an extremely sad or hopeless state is called a depressive episode. Sometimes, a mood episode includes symptoms of both mania and depression. This is called a mixed state. People with bipolar disorder also may be explosive and irritable during a mood episode.
Extreme changes in energy, activity, sleep, and behavior go along with these changes in mood. It is possible for someone with bipolar disorder to experience a long-lasting period of unstable moods rather than discrete episodes of depression or mania.
A person may be having an episode of bipolar disorder if he or she has a number of manic or depressive symptoms for most of the day, nearly every day, for at least one or two weeks. Sometimes symptoms are so severe that the person cannot function normally at work, school, or home.
Symptoms of bipolar disorder are described below.

Symptoms of mania or a manic episode include:

Symptoms of depression or a depressive episode include:

Mood Changes A long period of feeling "high," or an overly happy or outgoing mood Extremely irritable mood, agitation, feeling "jumpy" or "wired." Behavioral Changes Talking very fast, jumping from one idea to another, having racing thoughts Being easily distracted Increasing goal-directed activities, such as taking on new projects Being restless Sleeping little Having an unrealistic belief in one's abilities Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as spending sprees, impulsive sex, and impulsive business investments.

Mood Changes A long period of feeling worried or empty Loss of interest in activities once enjoyed, including sex. Behavioral Changes Feeling tired or "slowed down" Having problems concentrating, remembering, and making decisions Being restless or irritable Changing eating, sleeping, or other habits Thinking of death or suicide, or attempting suicide.

In addition to mania and depression, bipolar disorder can cause a range of moods, as shown on the scale.


One side of the scale includes severe depression, moderate depression, and mild low mood. Moderate depression may cause less extreme symptoms, and mild low mood is called dysthymia when it is chronic or long-term. In the middle of the scale is normal or balanced mood.
At the other end of the scale are hypomania and severe mania. Some people with bipolar disorder experience hypomania. During hypomanic episodes, a person may have increased energy and activity levels that are not as severe as typical mania, or he or she may have episodes that last less than a week and do not require emergency care. A person having a hypomanic episode may feel very good, be highly productive, and function well. This person may not feel that anything is wrong even as family and friends recognize the mood swings as possible bipolar disorder. Without proper treatment, however, people with hypomania may develop severe mania or depression.
During a mixed state, symptoms often include agitation, trouble sleeping, major changes in appetite, and suicidal thinking. People in a mixed state may feel very sad or hopeless while feeling extremely energized.
Sometimes, a person with severe episodes of mania or depression has psychotic symptoms too, such as hallucinations or delusions. The psychotic symptoms tend to reflect the person's extreme mood. For example, psychotic symptoms for a person having a manic episode may include believing he or she is famous, has a lot of money, or has special powers. In the same way, a person having a depressive episode may believe he or she is ruined and penniless, or has committed a crime. As a result, people with bipolar disorder who have psychotic symptoms are sometimes wrongly diagnosed as having schizophrenia, another severe mental illness that is linked with hallucinations and delusions.
People with bipolar disorder may also have behavioral problems. They may abuse alcohol or substances, have relationship problems, or perform poorly in school or at work. At first, it's not easy to recognize these problems as signs of a major mental illness.

How is bipolar disorder treated?

To date, there is no cure for bipolar disorder. But proper treatment helps most people with bipolar disorder gain better control of their mood swings and related symptoms.^18-20 This is also true for people with the most severe forms of the illness.

Because bipolar disorder is a lifelong and recurrent illness, people with the disorder need long-term treatment to maintain control of bipolar symptoms. An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity.²¹

Medications

Bipolar disorder can be diagnosed and medications prescribed by people with an M.D. (doctor of medicine). Usually, bipolar medications are prescribed by a psychiatrist. In some states, clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. Check with your state's licensing agency to find out more.
Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.
Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person's symptoms change or if side effects become serious, the doctor may switch or add medications.
Some of the types of medications generally used to treat bipolar disorder are listed on the next page. Information on medications can change. For the most up to date information on use and side effects contact the U.S. Food and Drug Administration (FDA).

1. Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Except for lithium, many of these medications are anticonvulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:

• Lithium (sometimes known as Eskalith or Lithobid) was the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
• Valproic acid or divalproex sodium (Depakote), approved by the FDA in 1995 for treating mania, is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder.^{23, 24} Also see the section in this booklet, "Should young women take valproic acid?"
• More recently, the anticonvulsant lamotrigine (Lamictal) received FDA approval for maintenance treatment of bipolar disorder.
• Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No large studies have shown that these medications are more effective than mood stabilizers.

Valproic acid, lamotrigine, and other anticonvulsant medications have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.

Lithium and Thyroid Function
People with bipolar disorder often have thyroid gland problems. Lithium treatment may also cause low thyroid levels in some people.²² Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.
Because too much or too little thyroid hormone can lead to mood and energy changes, it is important to have a doctor check thyroid levels carefully. A person with bipolar disorder may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.

Should young women take valproic acid?
Valproic acid may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20.^{25, 26} PCOS causes a woman's eggs to develop into cysts, or fluid filled sacs that collect in the ovaries instead of being released by monthly periods. This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid.²⁷ Young girls and women taking valproic acid should be monitored carefully by a doctor.

2. Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications. Atypical antipsychotic medications are called "atypical" to set them apart from earlier medications, which are called "conventional" or "first-generation" antipsychotics.

• Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis.²⁸ Olanzapine is also available in an injectable form, which quickly treats agitation associated with a manic or mixed episode. Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms. However, some studies show that people taking olanzapine may gain weight and have other side effects that can increase their risk for diabetes and heart disease. These side effects are more likely in people taking olanzapine when compared with people prescribed other atypical antipsychotics.
• Aripiprazole (Abilify), like olanzapine, is approved for treatment of a manic or mixed episode. Aripiprazole is also used for maintenance treatment after a severe or sudden episode. As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.
• Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.
• Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.

3. Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person's risk of switching to mania or hypomania, or of developing rapid cycling symptoms.²⁹ To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.

Recently, a large-scale, NIMH-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.³⁰

• Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.

Some medications are better at treating one type of bipolar symptoms than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.
What are the side effects of these medications?
Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits.
The psychiatrist prescribing the medication or pharmacist can also answer questions about side effects. Over the last decade, treatments have improved, and some medications now have fewer or more tolerable side effects than earlier treatments. However, everyone responds differently to medications. In some cases, side effects may not appear until a person has taken a medication for some time.
If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to "rebound," or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

FDA Warning on Antidepressants
Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. The FDA warning says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. For the latest information visit the FDA website.

The following sections describe some common side effects of the different types of medications used to treat bipolar disorder.
1. Mood Stabilizers
In some cases, lithium can cause side effects such as:

• Restlessness
• Dry mouth
• Bloating or indigestion
• Acne
• Unusual discomfort to cold temperatures
• Joint or muscle pain
• Brittle nails or hair.³¹

Lithium also causes side effects not listed here. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible.
If a person with bipolar disorder is being treated with lithium, it is important to make regular visits to the treating doctor. The doctor needs to check the levels of lithium in the person's blood, as well as kidney and thyroid function.

These medications may also be linked with rare but serious side effects. Talk with the treating doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you're taking.

Common side effects of other mood stabilizing medications include:

• Drowsiness
• Dizziness
• Headache
• Diarrhea
• Constipation
• Heartburn
• Mood swings
• Stuffed or runny nose, or other cold-like symptoms.^32-37

2. Atypical Antipsychotics
Some people have side effects when they start taking atypical antipsychotics. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

• Drowsiness
• Dizziness when changing positions
• Blurred vision
• Rapid heartbeat
• Sensitivity to the sun
• Skin rashes
• Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol.³⁸ A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking these medications.
In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these moments. TD can range from mild to severe, and it cannot always be cured. Some people with TD recover partially or fully after they stop taking the drug.
3. Antidepressants
The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include:

• Headache, which usually goes away within a few days.
• Nausea (feeling sick to your stomach), which usually goes away within a few days.
• Sleep problems, such as sleeplessness or drowsiness. This may happen during the first few weeks but then go away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed.
• Agitation (feeling jittery).
• Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.

Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.
For the most up-to-date information on medications for treating bipolar disorder and their side effects, please see the online NIMH Medications booklet.

Should women who are pregnant or may become pregnant take medication for bipolar disorder?
Women with bipolar disorder who are pregnant or may become pregnant face special challenges. The mood stabilizing medications in use today can harm a developing fetus or nursing infant.³⁹ But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.⁴⁰
Scientists are not sure yet, but lithium is likely the preferred mood-stabilizing medication for pregnant women with bipolar disorder.^{40, 41} However, lithium can lead to heart problems in the fetus. Women need to know that most bipolar medications are passed on through breast milk.⁴¹ Pregnant women and nursing mothers should talk to their doctors about the benefits and risks of all available treatments.

Psychotherapy
In addition to medication, psychotherapy, or "talk" therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

1. Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
2. Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
3. Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
4. Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psychoeducation may also be helpful for family members and caregivers.

A licensed psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor's instructions for any psychotherapy will provide the greatest benefit.
For more information, see the Substance Abuse and Mental Health Services Administration web page on choosing a mental health therapist.
Recently, NIMH funded a clinical trial called the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). This was the largest treatment study ever conducted for bipolar disorder. In a study on psychotherapies, STEP-BD researchers compared people in two groups. The first group was treated with collaborative care (three sessions of psychoeducation over six weeks). The second group was treated with medication and intensive psychotherapy (30 sessions over nine months of CBT, interpersonal and social rhythm therapy, or family-focused therapy). Researchers found that the second group had fewer relapses, lower hospitalization rates, and were better able to stick with their treatment plans.⁴² They were also more likely to get well faster and stay well longer.
NIMH is supporting more research on which combinations of psychotherapy and medication work best. The goal is to help people with bipolar disorder live symptom-free for longer periods and to recover from episodes more quickly. Researchers also hope to determine whether psychotherapy helps delay the start of bipolar disorder in children at high risk for the illness.
Visit the NIMH Web site for more information on psychotherapy.

Other treatments

1. Electroconvulsive Therapy (ECT)—For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments. Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.⁴³
   Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.
   ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.⁴⁴
2. Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.

People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or dangerous effects.

Herbal Supplements
In general, there is not much research about herbal or natural supplements. Little is known about their effects on bipolar disorder. An herb called St. John's wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder.⁴⁵ St. John's wort can also make other medications less effective, including some antidepressant and anticonvulsant medications.⁴⁶ Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder.⁴⁷ Study results have been mixed.⁴⁸ It is important to talk with a doctor before taking any herbal or natural supplements because of the serious risk of interactions with other medications."

While this is a very lengthy blog, I hope and trust that someone benefits. All disorder information was taken from the National Institute of Mental Health (NIMH) official website. For more information on the NIMH, please visit http://www.nimh.nih.gov/ .