Questions about bipolar
January 25, 2023 7:00 AM Subscribe
After 18 years of depression, I was tentatively diagnosed this week with some form of bipolar. I've started a small dose of Lamictal and am working on getting some medical leave from work to address burnout and give myself some slack during the med onramp time. I have questions for people who have lived with bipolar and people who have taken medical leave to address their mental health.
1. I don't feel bipolar (though it fits with the pattern of lows and highs I've had for the past ten years or so.) My life is mostly fine - I've almost always held down a job, I have a great support system, hobbies, a house, etc. Right now I'm up, which for me is just high functioning - I don't tend to get mania or engage in risky behaviors, but I'm speaking faster, getting things done, and sleeping less. When I'm down, which is most of the time, my brain tells me it's because I'm lazy, unlovable, and have made every bad choice I could have possibly made. I'm hope that meds will even it out, but in the meanwhile, how can I help myself get rid of this imposter syndrome? I know part of this is internalized bipolar stigma; have you read or watched anything that helped you feel better about going from a common diagnosis to a more serious one?
2. What can I expect from Lamictal? I'm also on a 30 mg dose of Cymbalta, which helps the depression a bit, but only in the sense of I keep myself fed and show up to work. If you started Lamictal, how long did it take for you to notice an effect? Do you have any recommendations for someone just starting it?
3. What about side effects? I don't have any other notable health conditions, am at a normal weight, exercise regularly, don't drink or smoke. I'm keeping a journal of my mood, side effects, exercise, and other helpful info - what else can I do to mitigate and track the side effects?
4. I'll probably go on leave next month, which is cold and dreary where I am (Pittsburgh.) I plan to attend some support meetings (for both bipolar and AA) and attend daytime classes of my sport-of-choice. Otherwise I plan to relax and let my brain feel better, but I feel like I need to plan this time so that I don't waste it or let it trigger a depressive episode. If you took leave from work to address burnout and mental health issues, what was helpful? What wasn't? Is there anything you wish you would have done?
I'm meeting weekly with my wonderful therapist and fortnightly with my psychiatrist.
1. I don't feel bipolar (though it fits with the pattern of lows and highs I've had for the past ten years or so.) My life is mostly fine - I've almost always held down a job, I have a great support system, hobbies, a house, etc. Right now I'm up, which for me is just high functioning - I don't tend to get mania or engage in risky behaviors, but I'm speaking faster, getting things done, and sleeping less. When I'm down, which is most of the time, my brain tells me it's because I'm lazy, unlovable, and have made every bad choice I could have possibly made. I'm hope that meds will even it out, but in the meanwhile, how can I help myself get rid of this imposter syndrome? I know part of this is internalized bipolar stigma; have you read or watched anything that helped you feel better about going from a common diagnosis to a more serious one?
2. What can I expect from Lamictal? I'm also on a 30 mg dose of Cymbalta, which helps the depression a bit, but only in the sense of I keep myself fed and show up to work. If you started Lamictal, how long did it take for you to notice an effect? Do you have any recommendations for someone just starting it?
3. What about side effects? I don't have any other notable health conditions, am at a normal weight, exercise regularly, don't drink or smoke. I'm keeping a journal of my mood, side effects, exercise, and other helpful info - what else can I do to mitigate and track the side effects?
4. I'll probably go on leave next month, which is cold and dreary where I am (Pittsburgh.) I plan to attend some support meetings (for both bipolar and AA) and attend daytime classes of my sport-of-choice. Otherwise I plan to relax and let my brain feel better, but I feel like I need to plan this time so that I don't waste it or let it trigger a depressive episode. If you took leave from work to address burnout and mental health issues, what was helpful? What wasn't? Is there anything you wish you would have done?
I'm meeting weekly with my wonderful therapist and fortnightly with my psychiatrist.
Best answer: Hi! I'm the long-term partner of a bipolar person who also lives in Pittsburgh. I don't want to speak over folks with bipolar about the actual lived-experience stuff so I'll skip over that, but did want to offer to put you in touch with him if it would be helpful to have someone local to talk to. (We're still quite covid-cautious so it might be email or Skype talking, unless you're down for an outdoor hangout somewhere when warmer weather strikes.) Neither of us will be able to speak to AA, but if you're potentially interested in other non-12-step sobriety supports, he has a fair amount of information about SMART Recovery and is always happy to talk with people about that. Our local support group experiences are a bit out of date but if useful, happy to share about that too.
MeMail me if I or we can be of any help locally. Otherwise, just know someone nearby is rooting for you!
posted by Stacey at 8:53 AM on January 25, 2023 [3 favorites]
MeMail me if I or we can be of any help locally. Otherwise, just know someone nearby is rooting for you!
posted by Stacey at 8:53 AM on January 25, 2023 [3 favorites]
Best answer: After 10 years of trying to treat my depression I happened to mention to my psychiatrist that I had been working on a project all night, and it developed that most people take breaks and sleep when they do that. And thus a Bipolar 2 diagnosis was born.
From your description you are also Bipolar 2. Bipolar 1 includes actual mania, which is a dangerous condition and you would have noticed at some point before this. Bipolar 2 instead has hypomania, which is that wonderful feeling of being engaged and excited about everything. If you could bottle and sell it you’d make a fortune.
I used to refer to Bipolar 2 as “Bipolar Lite” due to the lack of mania, but that ignores the fact that the downswings are deeper and more prolonged than Bipolar 1. It’s a real condition and you (I) should take it seriously.
I take lamotrigine (Lamictal) along with Cymbalta and I find the side effects of the lamotrigine to be negligible. The effect of the lamotrigine for me is to make the boundaries a little tighter — the highs aren’t as high and the lows aren’t as low. Personally I wouldn’t mind it if the highs stayed as high as they were, but you get what you get.
The stigma is tough. Part of the reason I was calling it “Bipolar Lite” was to make myself feel a little better about having a Bipolar diagnosis. I don’t think I’ve ever seen Bipolar 2 mentioned in media, but honestly “person who suffers from depression but is occasionally really high functioning” is not very cinematic.
On the plus side if you are Bipolar 2 then that's what you are: someone who suffers from depression but is occasionally really high functioning. I find it relatively easy to live with that description.
I went on Lamictal many years ago but I don't remember it being an ordeal -- I'd be much more worried about being burned out and having a lot of free time on my hands in the middle of an Allegheny winter. I think normal advice applies there: keep yourself busy, don't neglect self-care, etc.
A note of hope: treating my depression was going very poorly until we realized I was bipolar. Figuring that out changed the whole approach and led directly to a successful treatment. I hope the same happens for you.
posted by Tell Me No Lies at 9:26 AM on January 25, 2023 [5 favorites]
From your description you are also Bipolar 2. Bipolar 1 includes actual mania, which is a dangerous condition and you would have noticed at some point before this. Bipolar 2 instead has hypomania, which is that wonderful feeling of being engaged and excited about everything. If you could bottle and sell it you’d make a fortune.
I used to refer to Bipolar 2 as “Bipolar Lite” due to the lack of mania, but that ignores the fact that the downswings are deeper and more prolonged than Bipolar 1. It’s a real condition and you (I) should take it seriously.
I take lamotrigine (Lamictal) along with Cymbalta and I find the side effects of the lamotrigine to be negligible. The effect of the lamotrigine for me is to make the boundaries a little tighter — the highs aren’t as high and the lows aren’t as low. Personally I wouldn’t mind it if the highs stayed as high as they were, but you get what you get.
The stigma is tough. Part of the reason I was calling it “Bipolar Lite” was to make myself feel a little better about having a Bipolar diagnosis. I don’t think I’ve ever seen Bipolar 2 mentioned in media, but honestly “person who suffers from depression but is occasionally really high functioning” is not very cinematic.
On the plus side if you are Bipolar 2 then that's what you are: someone who suffers from depression but is occasionally really high functioning. I find it relatively easy to live with that description.
I went on Lamictal many years ago but I don't remember it being an ordeal -- I'd be much more worried about being burned out and having a lot of free time on my hands in the middle of an Allegheny winter. I think normal advice applies there: keep yourself busy, don't neglect self-care, etc.
A note of hope: treating my depression was going very poorly until we realized I was bipolar. Figuring that out changed the whole approach and led directly to a successful treatment. I hope the same happens for you.
posted by Tell Me No Lies at 9:26 AM on January 25, 2023 [5 favorites]
Best answer: I was recently diagnosed with Bipolar 2, and my story is very similar to yours. I've had some moments of bad decision making when what I recognize in retrospect was hypomania was combined with youthful stupidity, but overall I've just gone about my life alternating between being very, very depressed, and having bouts of Having Energy And Getting Shit Done.
So, I dunno, if having another person as a data point in your fight against imposter syndrome is helpful, here I am.
I had to try a few medications before I found one that works. Lamictal was great, but I had the scary rash situation that sometimes happens, so I can't take it anymore. Zyprexa and Abilify were each a bust. I've landed on Latuda, and my psychiatrist had to double the dosage before it started working, but now I feel like a regular person who is not depressed. It's fantastic.
I think I gained about five pounds on Abilify. Most of these atypical antipsychotics have weight gain as a potential side effect. That's been the only notable side effect of any of the meds, other than a dampening of libido which I'm already used to with my SSRI (which I'm also still taking).
posted by missrachael at 12:40 PM on January 25, 2023
So, I dunno, if having another person as a data point in your fight against imposter syndrome is helpful, here I am.
I had to try a few medications before I found one that works. Lamictal was great, but I had the scary rash situation that sometimes happens, so I can't take it anymore. Zyprexa and Abilify were each a bust. I've landed on Latuda, and my psychiatrist had to double the dosage before it started working, but now I feel like a regular person who is not depressed. It's fantastic.
I think I gained about five pounds on Abilify. Most of these atypical antipsychotics have weight gain as a potential side effect. That's been the only notable side effect of any of the meds, other than a dampening of libido which I'm already used to with my SSRI (which I'm also still taking).
posted by missrachael at 12:40 PM on January 25, 2023
Best answer: I was taking various meds for depression for years. Lexapro, Prozac, Wellbutrin, maybe others. They were not good. I went to a different psychiatrist who diagnosed me with Bipolar 2 and ADHD. He prescribed Lamictal and adderal. This was back in 2011 and it was life changing. I didn't have a lot of side effects that I can recall. I was playing fast and loose with my meds at one point and not being consistent which I will never do again. The highs were too high and and the lows were getting low low low. I think I will be on it forever and am fine with that. I take it before bed.
The depression is always there. Sometimes further back, sometimes a little closer. I thought that having a better life, good relationship, stability, etc would mean no more depression but that is not the case for me. My life changed for the better in significant ways and it just didn't make sense to me. Brain gonna do what brain is gonna do. The lamictal gives me space and allows me to have perspective and clarity.
posted by mokeydraws at 1:41 PM on January 25, 2023
The depression is always there. Sometimes further back, sometimes a little closer. I thought that having a better life, good relationship, stability, etc would mean no more depression but that is not the case for me. My life changed for the better in significant ways and it just didn't make sense to me. Brain gonna do what brain is gonna do. The lamictal gives me space and allows me to have perspective and clarity.
posted by mokeydraws at 1:41 PM on January 25, 2023
Best answer: Howdy. Fellow Bipolar here. While this may sound weird, congratulations on your diagnosis. Sometimes it can be so relieving to have a name for what you live with. I say live with because I don't believe in saying "have" or "suffer from." I hear that a lot from others with our diagnosis. I am bipolar type 1. It's a unique creature in that I spend most of my life in mania, with small bursts of mixed or depressive episodes.
In my experience with Lamictal, it can be very useful for anxiety and depression. I don't find that it does much to quell my worst mania, but it does take the edge off. That said, I was prescribed a very high dose of it and only after finding new medication management did I find that out and have begun the slow process of weaning off. With that process of withdrawal, I have found that I'm experiencing the horrible rash that missrachael indicated.
Most medicine has advantages and disadvantages. It varies for each person based on brain and body chemistry. Be very honest with your prescriber and find a therapist who has experience dealing with bipolar. With proper medication and a mix of dialectal and cognitive behavior therapy, our condition is manageable.
Some things I would recommend?
-Be very kind and patient with yourself. There is no exact science for living with bipolar. It takes a lot of hard work to manage it, but you are SO capable of it.
-Add to the journal the medications you are on. What are the doses? When did you start? When did you stop? What were the experiences that you had? Was it effective? If any, what were the side effects. This is important. I've lost track of the meds I have been on, and get the question quite often about what I've tried. I never thought this would be important, but trust me when I say that it is crucial.
-Pay deliberate attention to self-care. Schedule times to take meds, and adhere to them. Ask your prescriber what time of day you should be taking your meds as some cause drowsiness or even hyperactivity. If you do experience mania, take sleep when you can get it.
-Start listening to your body. There are always telltale signs that a shift is coming. One of mine is a very painful joint ache when coming back to mania from a depressive state. When I feel this, I know that I'm days away from a bout. As you come to understand how BP works in your case, you'll learn the tells. Ask others in your life to alert you to shifts that they see. Be open to when they indicate that they see something.
-Guard your money from yourself. I literally have put credit cards into blocks of ice in my freezer and have removed all traces of card numbers from my computer. Amazon is the devil's tool and it's hard not to be tempted by its siren song.
-Here's some advice that I struggle with. Forgive yourself for your past. It seems from your post that upon reflection you see patterns of BP episodes there. Mistakes are forgivable. Don't take it personally. Move forward! Onward!
I hope this doesn't come off a scary or preachy. I want the best for you. You are a good person, no matter what depression or BP tells you.
Feel free to contact me here and I will answer any other questions you may have.
Stay strong. You can do this!
posted by Zooming Right Along at 8:32 PM on January 25, 2023 [3 favorites]
In my experience with Lamictal, it can be very useful for anxiety and depression. I don't find that it does much to quell my worst mania, but it does take the edge off. That said, I was prescribed a very high dose of it and only after finding new medication management did I find that out and have begun the slow process of weaning off. With that process of withdrawal, I have found that I'm experiencing the horrible rash that missrachael indicated.
Most medicine has advantages and disadvantages. It varies for each person based on brain and body chemistry. Be very honest with your prescriber and find a therapist who has experience dealing with bipolar. With proper medication and a mix of dialectal and cognitive behavior therapy, our condition is manageable.
Some things I would recommend?
-Be very kind and patient with yourself. There is no exact science for living with bipolar. It takes a lot of hard work to manage it, but you are SO capable of it.
-Add to the journal the medications you are on. What are the doses? When did you start? When did you stop? What were the experiences that you had? Was it effective? If any, what were the side effects. This is important. I've lost track of the meds I have been on, and get the question quite often about what I've tried. I never thought this would be important, but trust me when I say that it is crucial.
-Pay deliberate attention to self-care. Schedule times to take meds, and adhere to them. Ask your prescriber what time of day you should be taking your meds as some cause drowsiness or even hyperactivity. If you do experience mania, take sleep when you can get it.
-Start listening to your body. There are always telltale signs that a shift is coming. One of mine is a very painful joint ache when coming back to mania from a depressive state. When I feel this, I know that I'm days away from a bout. As you come to understand how BP works in your case, you'll learn the tells. Ask others in your life to alert you to shifts that they see. Be open to when they indicate that they see something.
-Guard your money from yourself. I literally have put credit cards into blocks of ice in my freezer and have removed all traces of card numbers from my computer. Amazon is the devil's tool and it's hard not to be tempted by its siren song.
-Here's some advice that I struggle with. Forgive yourself for your past. It seems from your post that upon reflection you see patterns of BP episodes there. Mistakes are forgivable. Don't take it personally. Move forward! Onward!
I hope this doesn't come off a scary or preachy. I want the best for you. You are a good person, no matter what depression or BP tells you.
Feel free to contact me here and I will answer any other questions you may have.
Stay strong. You can do this!
posted by Zooming Right Along at 8:32 PM on January 25, 2023 [3 favorites]
Response by poster: Wow. Thank each of you so much for your compassionate, helpful answers - I truly appreciate it. Overall I do feel relief that perhaps we're finally addressing the correct issue, and that, well, it's not just that I'm not cut out for a fulfilling life. I feel hopeful in a way that I haven't in a long time.
I'm taking all these responses to heart and know that I'll revisit this thread frequently. If someone is trawling through questions marked "bipolar" please feel free to message me. I'm starting to recognize that connection and support can make a vast difference in mental health challenges.
Thank you all.
posted by punchtothehead at 6:33 AM on January 27, 2023 [1 favorite]
I'm taking all these responses to heart and know that I'll revisit this thread frequently. If someone is trawling through questions marked "bipolar" please feel free to message me. I'm starting to recognize that connection and support can make a vast difference in mental health challenges.
Thank you all.
posted by punchtothehead at 6:33 AM on January 27, 2023 [1 favorite]
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I don't know what to say to your first question, except that I've given up on the idea that I can change my depressive thoughts in the short term. The only thing to quiet down those awful self-accusatory thoughts is medication, and the volume of those thoughts - when they get really loud - that's how I recognize I'm depressed and need my antidepressants raised, or changed.
Lamictal - It had a nice effect of reducing my anxiety. I don't find it to be a drug that you really feel the effects of - it's very subtle. But for me it has a side effect of extreme fatigue - which does go away after a couple of weeks. You might notice it every time you raise your dose. So yes, I'd think you would want to be off work while you adjust.
Being on leave - I know that when you have time off work, it feels like a really great opportunity to be productive and have big plans for the future and start projects, etc. But honestly, the best thing you can do is try to rest your brain. You don't want to be stimulating yourself too much. Be slow. Sleep. Read. Watch TV.
Best of luck.
posted by kitcat at 8:17 AM on January 25, 2023 [1 favorite]