Hope for Recovery and Repair?
June 30, 2012 12:26 PM   Subscribe

Recovery from severe depression + sleep deprivation + personality change possible?

You are not my doctor, but I'm looking for thoughts or encouragement from anyone who's undergone a similar experience. I'm holding out for hope that this is reversible.

A few months ago, I had a manic episode. Scary, but dealable. Afterwards, I spend 6 weeks recovering at my parents' house, got on lithium, and felt good. I thought: this is manageable; I'm out of the woods. Then a month later, back at my home, I started getting depressed. I know this is a normal part of the bipolar cycle, but I thought I could "handle" it. I did some therapy, and rooted around for a psychiatrist, but didn't nip it in the bud. I also started waking up at 4 or 5. Then 2 or 3. I felt worse and worse (increasing depression and increasing sleep deprivation). I stopped feeling connected to the people around me. I saw a doc and tried a few medications for sleep (trazodone and doxepin). Trazodone (plus the lithium I'm on) made me feel ill, and doxepin (plus lith) made me feel screamingly anxious the first time I took it, then ill the second time. I vowed not to take it again, but got so desperate for sleep that I did, and woke up feeling confusion and disorientation.

Over the next six weeks, my mental health and ability to sleep deteriorated such that I ended up back at my folks' house, and will be seeing a doctor and therapist here next week.

I realize I managed this really badly. There's a lot I should have done differently, but here I am. And I'm terrified that I'm stuck with this new "self." I'm currently experiencing: no emotion; little sleep; loss of my personality from outgoing, intellectual, and joy-filled to flat, emotionless, and stupid; inability to form complex thoughts or conversation; inability to think about anything but this problem. No memory. Disorientation.

I also feel like my "inner life" is gone. I used to have a running commentary inside, and now there's nothing. I don't have preferences or emotion or taste. This is the scariest thing: my inner thoughts, and inner life, are gone. And I don't have an emotional connection to the world: I don't *feel* what I used to feel about friends, family, birds, trees. I can't think clearly or deeply. I feel aimless from the moment I wake up to when I go to sleep, with nothing pulling me in a direction. I don't have a sense of rootedness. I feel like I'm floating and my old self is gone. I don't have a sense of direction in my day, or in each hour, or minute. It feels like the frontal lobe of my brain got damaged somehow. I feel like I'm looking at the world through a sheet of glass, unable to connect with it.

Frankly, I don't recognize myself-- I feel like I've become a different person, who I don't like. My life feels like it happened to someone else. I had coffee with a friend yesterday, and I couldn't feel anything. She was so full of life, and I could only talk in short sentences. And I didn't even feel pain about it-- just blankness.

I know people recover from depression (I have in the past), but this somehow feels like more than depression, because there's no inner rumination and there's a complete loss of personality/identity. I'm afraid I've hurt my brain with the severe sleep deprivation/depression and maybe with the combination of medications (the waking confusion was alarming to me). I'm scared my brain has shifted into some other homeostasis and this zombie-self is permanent.

I know the brain is plastic, but this feels permanent. Do people recover from things like this? Can I get back to myself?
posted by anonymous to Health & Fitness (8 answers total) 11 users marked this as a favorite
you would be amazed how profound an effect sleep deprivation can have. and yes, it's reversible. you need to find a great psychiatrist that you feel you can trust and stick with him/her. it's not going to work out if the psych you're working with is the kind who sees people once ever six months, or is somebody you're not going to listen to. put some serious, serious effort into researching, interviewing, and selecting the best psychiatrist you can conceivably afford.
posted by facetious at 12:31 PM on June 30, 2012

A family member went through this recently. It has taken two different doctors and several different trials of medication to really make a difference. She was at first diagnosed with depression about four years ago but once the diagnosis was changed to bipolar disorder and medication adjusted accordingly, she feels like "she has her own brain back." It is not an easy road to travel, but much harder if you're not receiving proper medical intervention. SSRIs did little to help her, something that it took over four years to figure out. Therapy has made a big difference also. Ambien made the mania worse, seroquel has worked better but YMMV. There absolutely is another side.
posted by tamitang at 12:44 PM on June 30, 2012 [2 favorites]

Do not assume this is forever - very few meds can do that, especially at the normal therapeutic doses. I thought Geodon had messed me up for good (I was so, so weird on it) - the only thing that seems to be permanent is the blood sugar stuff. It's possible that this is just how you are on Lithium (being "flattened" or "empty" is something a lot of people complain about on Lithium) and you need to try a different mood stabilizer. There can be a lot of stuff causing this - your meds should be reevaluated, in my opinion, by an actual psychiatrist.

But change is the nature of bipolar disorder - the one thing we can all basically promise you is that you will feel dramatically different from how you feel now, at some point in the future (probably pretty soon.) You can and almost certainly (like, 95% or better odds) will feel healthy again.

Be aware, though, that your sense of "normal" may have been messed up by being hypomanic (or by cycling) for a long time. I wrestle a lot with how good I'm really "supposed" to feel, for instance (part of that is because I almost always satisfy the clinical criteria for either depression or hypomania.) Most people with bipolar disorder have whacked out expectations of themselves, their moods, their capabilities, and what feeling good really means. We are not exactly like unipolar depression patients - our brains are wired to expect to feel way too good about everything, and so we end up feeling a little disappointed (sometimes a LOT disappointed) when things aren't magical and they aren't magical and they STILL AREN'T MAGICAL WHAT IS THE FREAKING DEAL ALREADY. It can take a lot of work, while on the right meds, to sort that stuff out for yourself.

Consider some real, serious CBT/ISRT kinds of stuff. It is REALLY hard to teach yourself how to stay within the lines of normal life when you have a chronic mood disorder; these kinds of treatments were designed to help you do that. The STEP-BD study found they were very helpful. I also swear by supportive, traditional talk therapy, personally. Every week or two for life, in all likelihood. Which blows, but is better than the alternative. I don't personally recommend DBT because I hated it so very much, but it also helps some folks, so. I do appreciate support groups, though, because they remind me I'm not alone. Plus sometimes you can go to one and find out about which hospitals in your area have the best partial hospitalization treatments, from people who've quite literally been there.

Feel free, as always, to MeMail. Also read some biographies of bipolar types - this is where I whip out the link to Kay Redfield Jamison's An Unquiet Mind, of course - because they really do help you realize that the one true rule of bipolar disorder is change.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 1:17 PM on June 30, 2012 [5 favorites]

You can't permanently injure your brain by staying up late at night. You can't permanently injure your brain by thinking sad thoughts, or by thinking manic thoughts either. You have not broken anything.

It could be you got the correct diagnosis but need to adjust your meds. It could be you were misdiagnosed and that's why the meds aren't helping. Either way, the solution is to go to a psychiatrist (NOT JUST YOUR FAMILY DOCTOR) and keep following their advice. You may have to try more different medications before you feel better, but each one you try will give your psychiatrist more information and help them get closer to finding the solution.
posted by nebulawindphone at 1:31 PM on June 30, 2012 [4 favorites]

Seroquel is pretty great. I'm bipolar II. It helps me sleep; it also helps my moods. It's been a bit of a miracle drug for me. Other people have different reactions. It sounds like you just need to try a new combination of meds.
posted by hotelechozulu at 4:52 PM on June 30, 2012 [1 favorite]

I understand how you feel; you describe it very well- the sense of disconnection. When it gets that bad for me, sometimes vigorous excercise helps a little. Like, walking up to a run, if you are able to force yourself into that.

Do you have a routine? Something to anchor you into the world?

Umm, something my therapist has reccommended for me is to get very rooted in the physical world. Comfort food or food that you used to find comforting. Alternatively food with a variety of textures. Strong smells, both pleasant (like pure cinnamon) and unpleasant (a whiff of vinegar)

Hot or cool baths. Use a thermometer to check the temp. If you don't trust yourself.

Massages. If you haven't got much money, massage schools do them cheap.

Please try not to sit and stare for too long. Its so easy to get lost.

Guided meditation.

Doing sensory experiments, like touching something and writing down everything you feel. Pick a flower and write down everything you can notice about the flower. That kind of thing.

Stream-of-consciousness writing.

Shine your shoes or polish silver- I don't know why that's comforting, but for me it is.

Realise that your brain's chemistry isn't functioning in a way to allow you to take pleasure from normally pleasurable things at this time, so things need to be extra pleasureable for you to get the same out of them. At this time.

Gentle relaxation or classical music.


Cute pictures of animals.

Outrageous news stories that would normally get you worked up- can you provoke a reaction from yourself?

See if you can take a trip somewhere close to the sea. Low altitudes+large body of water=extra oxygen. Especially if you go through high altitudes first. Extra oxygen helps.

So: stuff that will provoke a reaction can help. Just make sure it's safe reaction-provoking stuff.

You might want to keep a person around or checking in on you while you go through this. And, of course, keep in touch with your doc/therapist/psych and make sure they know how you feel. If you can't articulate, maybe just show them the post.

None of these will help a lot. But some of them may help enough, to tide you over while you get through this to a better place.

I am wishing you all the best to get through this difficult time. It will get better. Lots of hugs.
posted by windykites at 6:30 PM on June 30, 2012 [2 favorites]

Oh yeah! Ask your doc how s/he feels about you using melatonin supplements for sleep. They work wonders for me!
posted by windykites at 6:32 PM on June 30, 2012

And I'm terrified that I'm stuck with this new "self." I'm currently experiencing: no emotion; little sleep; loss of my personality from outgoing, intellectual, and joy-filled to flat, emotionless, and stupid; inability to form complex thoughts or conversation; inability to think about anything but this problem. No memory. Disorientation.

This sounds like, well, depression. I'm not bipolar, but I've been depressed like this quite a lot, and one thing someone told me that I'll always remember is that when you're depressed, it's impossible to imagine your life any other way. You think you'll be stuck like that forever.

My point is you won't..
posted by lhude sing cuccu at 7:01 PM on June 30, 2012 [5 favorites]

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