Friday, November 18, 2011

Trading your brain for your kidney and other medication conundrums

This is a blog about cutting edge science and bipolar disorder.

And here's the problem with cutting edge science and bipolar disorder: we get the treatments that could kill us or make us feel awful in a different way.

Of all the things I hate about being mentally ill (and there are many), it is the trading off my brain function for liver function, or one kind of brain function for another. Tweak one med and it means more frequent blood tests to make sure that my sanity doesn't kill the rest of me.

If you're like most people with a mental illness, this is the major reason people do not take their medications: side effects. Sometimes it doesn't even  make sense to read the list of likely side effects, never mind the unlikely ones, because not taking psych meds can result in other ugly things happening. So you trade one bad thing for one good thing and hope it all works out in the end.

Lucky for me, I have a combination that works. Very well. But there are times they need an upgrade because the brain is not static. And the pill count gets higher or more complicated and if you have something else wrong with you it eliminates most of the drugs that could help with that problem.

For example, taking lithium means that lots of hypertensive drugs are off the table. If you take olanzapine, you may end up with diabetes (hmmmmm...... sanity or diabetes??). Benzodiazepenes which are used for sleep could make you an addict.

The reason people with mental illness are so bad with their medication compliance is not just that we feel better from taking them (which in any illness this is true) but because the side effects can be so irritating and health threatening. Anyone who takes lithium knows how annoying dry mouth is and the volumes of liquid consumed means that there are many trips to the toilet. And every 3 months you hope the blood tests don't show signs of liver damage or kidney trouble or perhaps one day you wake up and your thyroid no longer works.

Well, there dont seem to be very good answers right now. Perhaps one day science will find a way to target the parts  of our brain causing us trouble and zap.... we're done. Until then, science has brought us some compromises that require us to make tough choices about our lives. So we take them as instructed and keep track of our side effects and if they get too bad, we try something else until if we're lucky we find something that works.

What choice do we have???

Tuesday, November 15, 2011

Getting through exams when you have bipolar disorder

It's that time of year again for the high school or college student.... midterms. And soon it will be finals. If you are a student with bipolar disorder, you must take extra care to make sure the stress does not cause you to have symptoms or a full-blown manic or depressive episode. So how do you stay healthy amid all the demands on your time? The short list of strategies (I don't want to add to your to-do list:). 

1. Make a monthly assignment calendar on which you put all due dates. Place it on your refrigerator, your door or your mirror: some place where you will see it everyday. This prevents surprises.
2. Go see your professors for a check-in about how you are doing and what you can do better and on what areas you should focus. If you have not registered as a student with a disability then you may want to reconsider so that you can have extra time if you need it.

3. Go to student support workshops re:stress, exams, studying strategies etc offered by your university campus.Your tuition pays for all these great resources on campus; don't waste those dollars.

4. Go to a library orientation. This will probably be one of the best spent 30-60 minutes of your entire college career. Understanding databases, references & citations, where to find what, and how to access library help, is essential to getting an A on that paper.

5. Form a study group. Accountability to others is a great motivator for us to do what we often do not like to do. You will learn from each other and you will put some structure into your study life while adding a little bit of social to the solitary study routine.

6. Set a study schedule. Now that you know when things are due, when your study group(s) will meet, and what the professor wants you to do, and how you are going to maximize the library, it's time to set a specific time and place to do your studying. Sometimes you may want to be in the library and other times at home or in a coffee shop. Change up the routine to keep you focused but do what works for you. Tip: If you get your weekend studying out of the way on Saturday and Sunday morning then you are guilt-free to enjoy your weekend night.

7. Take care of yourself. All-nighters are a college staple; minimize them by taking the steps above. Below are some ways to make sure your body is ready for the studying and testing ahead.
  • Take your medications as prescribed. This is not the time to be playing around with your medications without the supervision of your doctor.
  • Exercise regularly - daily if possible; even if its a walk to run all your errands. Get your heart rate up and stress slowly melts away and sleep comes much easier at night.
  • Eat. Fresh fruits, vegetables and protein. Many people snack when they study so pop grapes or munch on carrots to stop that freshman 15 turning into a senior 30. Add in some Vitamin D and Omega 3 supplements and get at least half hour of sun everyday if you can. Best if you get it while going for a walk. Clears the head and calms the mood.
  • Sleep. Six to 8 hours of sleep maximizes memory function and brain function overall and keeps you alert in class. It may be best to skip that last hour of studying and go to bed so you can remember what you have already studied instead of forgetting everything. Maintain a sleep routine where you go to bed and wake up at the same time each night. See my post on sleep for more on how to keep your sleep and mood regular.
  • No drugs. Avoid all non-prescribed mood-altering drugs such as alcohol and caffeine. They impair your sleep and have a negative impact on the regulation of your moods. DO NOT TAKE ANY UNPRESCRIBED MEDICATIONS especially medications that are prescribed to your friends. These could have dangerous interactions with the medications you  may be taking for bipolar disorder.
  • Relax. However it is you do that: yoga, meditation etc. If your mind is clear you will find that there is more room for all the knowledge you're paying for.
  • See your doctor if you are not feeling well or think you may need some support to get through this stressful time. Prevention is much better than cure. 
No more points for you to learn here. You may do all this and not be able to prevent having symptoms or a full-blown episode but you will reduce the risk and improve your ability to cope.

This professor is wishing you happy studying and great grades. Now for me to come up with tips on how professors can get through the grading without pulling their hair out. 

Saturday, November 12, 2011

Seasons, climate and bipolar disorder. Revisited.

I don't know much about blog protocol but I do know that in the traditional world of publishing, there are times when popular articles get republished. So as we head into the dark days of winter I thought I would re-post an entry from September 2010 with the addition of a study from Finland which came out in 2010.

This study tested people diagnosed with bipolar disorder and their first-degree (immediate family) relatives and found that variations in mood and behavior tended to run in families and influenced performance on a neuropsychological tests that tested working memory, verbal fluency, executive functioning, auditory attention among others.
Rajajarvi et al (2010). The effects of seasons and seasonal variation on neuropsychological test performance in patients with bipolar 1 disorder and their first-degree relatives. Journal of Affective Disorders, 127(1-3), 58-65.

The original post is below.

As fall approaches many people living with bipolar disorder find that the changes in light/dark influence their mood. So I reviewed the literature for a sample of studies on the topic. Not much has been written lately on the topic but there seems to be inconclusive evidence about the influence of seasons and climate on the moods of people living with bipolar disorder. For a small sample of the research in this area, see below:

Using observations were provided by patients from different geographic locations in North and South America, Europe and Australia a recent study conducted by numerous researchers around the world found no relationship between moods in people living with bipolar disorder and seasons, latitude or climate.
Bauer et al (2009). Relationship among latitude, climate, season and self-reported mood in bipolar disorder. Journal of Affective Disorders, Vol 116(1-2), pp. 152-157.

In a large study of lithium serum levels measured between January 1995 and July 2004 in 3 large teaching hospitals in the Netherlands, there was a significant difference found in average lithium serum levels across seasons, with summer being the highest and winter being the lowest. However, these differences were too small to impact the therapeutic impact of lithium. Temperature variations followed the same pattern.
Wilting et al. (2007). The impact of environmental temperature on lithium serum levels. Bipolar Disorders, Vol 9(6), pp. 603-608.

As part of the ongoing STEP-BD (Systematic Treatment Enhancement Program for Bipolar Disorder), there was a study of seasonal and regional effects on people living with Bipolar Disorder I and II. Results showed that study participants who lived in northern areas were more likely to be depressed. Bipolar II patients were more ill year-round than were patients with Bipolar I and had greater monthly fluctuations in illness rates that patients with Bipolar I.
Friedman et al. (2006). Seasonal changes in clinical status in bipolar disorder: A prospective study in 1000 STEP-BD patients. Acta Psychiatrica Scandinavica, Vol 113(6), pp. 510-517.

Sleep: the secret to even moods

According to the National Institutes of Health, chronic sleep loss or sleep disorders may impact up to 70 million Americans and cost up to $16billion in healthcare costs and $60billion in lost productivity. So sleep is a big deal, not only to people living with bipolar disorder, who often have sleep disorders related to the illness
but also to people in general.

GOOD SLEEP is as essential for health as is good nutrition and physical activity. Getting good sleep means going to bed when you are tired, falling asleep within 15-30 minutes, staying asleep for 6-8 hours, and waking up feeling rested.

Sleep has been the bane of my existence ever since I was a child and I have spent a lot of my life trying to sleep when my body has other ideas so I have spent a lot of time researching sleep and trying strategies that work and spent a chapter in my book, Bipolar 101, discussing sleep. Sleep behaviors are on the list of symptoms for both depressive and manic episodes. Lack of sleep triggers bipolar symptoms and makes existing symptoms worse so getting enough sleep is very important to the mental health of someone living with bipolar disorder.

For manic episodes sleep goes bye bye and the rush of being able to just go-go-go eventually puts us in the hospital if we don't get back on track. During a bout of depression many people would prefer not to get out of bed. Treatment for bipolar disord

er usually gets people back on track with their sleep but if sleeplessness continues then they are often treated with medications that induce sleep.

Sleep deprivation (sleep deficit) is also the leading cause of accidents (of all kinds) in the USA because the brain does not function well on lack of sleep. Too little sleep also weakens our immune system so that we are more susceptible to illness. So what I am saying in this post can apply to anyone, not just people living with mental illness.
The latest research suggests that a sleep routine that keeps our circadian rhythms (internal clock) on a regular schedule, also keeps the mind on an even keel.

How do we do this? By developing a sleep routine; and at a minimum your sleep routine should include the following:
  1. Going to bed at the same time each night and getting up at the same time each morning. Everyday. No changes on weekends. This sets your internal time clock and helps keep your moods on an even keel.
  2. Give yourself 30 - 60 minutes to prepare for bed and find a way of developing a habit in terms of the sequencing of your preparation. The point is to slow down the body so it is ready to go to bed. For example, you could start by taking your medications (in particular, medications that make you drowsy) so they have some time to take effect before getting into bed? Or if they are quick acting you may want to take them last. Make sure you have set your alarm or put a glass of water by the bed (this is especially for people suffering from the dry mouth side effects of many bipolar medications). Some people find a bath calming. Others find a shower either calming or stimulating so find the activities that work best for you.
  3. A calming down activity such as meditation or yoga or reading (a calm book:). Drinking a cup of warm milk (which has naturally occurring ingredients that make people sleepy) or chamomile tea is also helpful.
Research has also shown that we sleep better in cool temperatures so make sure to turn off/down the heating in your room. A dark room also encourages sleep and if you cannot create a really dark room then sleep with a blindfold on. TVs should be banned from the bedroom. So should laptop computers and your cellphone, if you are having a hard time with distractions.

One of the best ways to get better sleep is to be physically active on a regular basis. For those who have trouble sleeping it is better if you exercise in the morning, because the body takes some time to calm down when you exercise so if you do it too close to your bedtime, your body may be to revved up to fall asleep.

If you want to know more about sleep and mental well-being and find evidence-based strategies for improving sleep, then check out a new publication by the Mental Health Foundation in the UK, which has published a free downloadable book on sleep called, 'Sleep Matters: The Impact of Sleep on Health and Well-Being', click here.

The National Institutes of Health also publishes a sleep guide called, 'Your Guide to Healthy Sleep' is available free if you click here.

Friday, November 11, 2011

War and the mind

Today is Veteran's Day. And in honor of all those who have served I explore the impact of war on mental health on my Psychology Today blog with a post titled: Mental Health and the Culture of War.

Imagine what it would be like to have bipolar disorder and deal with the challenges of war and there seems to be no clear evidence that war can trigger bipolar disorder but who knows. If you know someone who is a veteran who may have mental health problems, please refer them to the Department of Veteran's Affairs (VA)