A New Cherry for the Drug Cocktail: Thyroid Medication

Forget that researchers don't exactly know why Lithium and other mood stabilizers work, except that it has something to do with seratonin levels. Now there's a new study out that suggests that users with treatment resistant bipolar I and II may benefit from the addition of a thyroid hormone called T3,

This study published in the Journal of Affective Disorders was a chart review of patients treated in a private clinic between 2002 and 2006. Patients in the study had been unsuccessfully treated with an average of 14 other medications before starting T3. The results were quite encouraging: improvement was experienced by 84%, and 33% experienced full remission. None of the patients experienced a switch into hypomania, and only 16 discontinued due to side effects.

So, if you're on a drug hunt, you might point your perscribing doctor to this study and see if this addition to the chemical stew might make the difference.

Nahmaah asks a good question. Why do I put lying on the list of truths about Manics? In part, she says:

"I can see that as being a part of the mania end of the spectrum, but I'm type II and if I lie about my illness I am not aware of it at all. I lie about things sometimes, but this behavior is certainly not limited to my kind of people and I don't think it's caused by my being bipolar."

I'll try to muster all the words I have as well as stories of Mr. Manic to talk about lies and lying. A couple of caveats first: I don't think this will be the last time this comes up; and I'm pretty sure a lot of people will take issue with my general observations.

So, to start, I will stipulate that while I'm not the first to notice that lying is a prominent feature in bipolar behavior, even to being listed as a criteria for bipolar diagnosis in children, what the medpros really focus on is low serotonin levels and impulse control, especially in manic states.



The studies out there that attempt to figure out how to get people to take their medicine seem to skirt the issue. As do the ones which look into various treatment modalities for treating bipolar and alcoholism or bipolar and cocaine addiction. Though in this case, it's about the bipolar patient lying to themselves about the impact alcohol or cocaine use has on their manic brain.

So, if you ask a specialist if lying is a key component of manic depression in adults, I'm not sure they would answer yes. Ask me, and I'll tell you it's woven deeply into the fabric of the disease in many ways.

On the way up...

• Manics lie because the fear of getting caught generates endorphins.


• Manics lie because "getting away with something" does, too.


• Manics lie because the first thing that goes when the wonky brain chemistry does the mental equivalent of a bridge collapse in high winds is judgement.


• Manics lie because the allure of mania is strong. Who wouldn't want to feel capable of creating a theory that linked poetry to physics, as Mr. Manic did in the summer of 1992.

On the way down...

• Manics lie because in the same way they monkey with their brain chemistry on the way up, they monkey with it on the way down. Too much alcohol affects the efficacy of mood stabilizers. The researchers say they don't know why, but there it is.
• Manics lie because the first thing that goes when the wonky brain chemistry does the mental equivalent of hibernating like a bear is judgement. The mind slows, confusion reigns. A gaping blackness reigns, as seductive as it is frightening. Used to managing their own storms, the beginning of depression is as likely a time for promiscuous sexual behavior, 100 mile per hour drives on country roads and other games of literal or figurative Russian roulette as they attempt to reboot with adrenaline. And then there is cocaine.

Manics lie to themselves as much as others. Knowing that sleep hygiene is imperative to good mental health for a manic, they resist the discipline of a regular bed time. Understanding that long term outcomes for substance abusers is worse than for those who abstain from alcohol, they continue to drink. Provided with study resuls that suggest exercise can be as effective as Zoloft for depression, and can actually help reverse the shrinkage of areas of the brain, manics, like the rest of the population too often cling to their sedentary lives. Manics lie to themselves when, in times of mania they start a thousand projects, and in times of great depression believe it is too much effort to bathe.

Lieing is a social necessity, a convenience and sometimes a symptom for all of us. But for a Manic, lieing can be devastating. If you are partner to a Manic, you have to be tuned into the pattern of their lies, small and large. Only then, can you reflect back reality, like a guide dog restraining his master at a crosswalk.

Why Mrs. Manic? Why Embrace the Label?

I've been asked why I choose the blog moniker "Mrs. Manic." Frankly, like most things I do, it was the first thing that popped into my head. But I've been thinking about this blog for a long time. And generally, when I let things stew for long enough my subconscious (we'll call it Fred) works these things out all neatly for me.

I never took Mr. Manic's name when we married. It never occurred to me. In fact the only time I ever did an online search for how I could legally change my born name was when work slapped my legal name and not my name of preference on my email, confusing both colleagues and customers. That was last week. I've been married for the better part of a decade.

The Mr. Manic Fred calls forth to my mind's eye is a very specific image of my spouse from a poem he wrote that goes a little something like this:

A graceful ghost
plays stumble bum
pianissimo
and shuffles
off the buffalo
his astaire frayed and threadbare.

He lurches
with the snap
into a minor key.
The melody wanders like a lost soul
dancing on the ceiling.

Caterwauled and vaulted
into stone
heaven,
his echo re-echoes
fanfare and flourish,
percussive steel
toes play taps
in remorse code,
a bit of the old soft shoe.

Marleyed Boo Jangles
taxidancing with Madame X
for spare
prophecy.

This is the melody I unchained in life...

And that leaves me, in Internet parlance anyway, to be styled Mrs. Manic. In this blog, this space, not taking that name seems to distance me from my beloved. Not acknowledging that at the core of himself he has embraced the labels bipolar, manic depressive or merely crazy would be to dismiss the ways a label can be used as a battering ram, a whacking stick, a cave to hide in, a warm blanket and finally simply a jaunty flower for one's lapel.

Mr. Manic liked to shock the rubes with his madness in the protohistory of our life together. He would announce it at parties. I would grind my teeth. He would tell my friends before he had committed their names to memory. I would glare daggers. It's not his madness that rattled me, I like to think, as much as his rudeness.

But such behavior has its consequences. He did not have a drivers license. I heard endlessly of the years he did not have a car, did not drive and the depths to which he was uninterested in obtaining a license. I was unrepentant. You will get a drivers license, I insisted. It came up in counseling. "He will not get a drivers license," I would hiss at my end of the couch, the sane and defensive end. Our counselor would nod and Mr. Manic would astound her with yet another technicolor dream, dancing gracefully and distracting all comers with the shine of his charm and the glittering refractions of his madness.

Finally, Fred suggests, the badgering and foot stomping wore him down and Mr. Manic managed his way to be tested. The important question was asked (and here I imagine Billy Burke in her plastic crown and princess gown), "are you a good witch or a bad witch?"

To which witch, Mr. Manic giggles (remember this is my story) and answers that he is indeed, very, very bad. A check is made by the civil servant, whose pink sparkles have now vanished, on a form which will cause Mr. Manic and his Psych Doc to swear or affirm that he is not a menace to the driving public on a regular six monthly basis into eternity.

Mr. Manic was relatively new to his diagnosis when we crossed paths. I believe his struggle was to own it and not let it overwhelm or alter him. It is both at the core of what he is and incidental. We are now much more casual about both the label and the labeling. I use the term manic and manic depressive most usually, falling back on bipolar as a more clinical explanation if I share his status with co-workers. Our friends have long ago learned of his madness and sometimes gently ask if he's feeling a bit manic (or depressed).

Words get a good worn feel if you use them long enough like tools that come to fit themselves to your hand. Manic is not all that he is, but in this context, on this blog, he is wearing his tails, top hat and spats, taking his rented hands out for a spin, and I am playing Ginger Rogers, trying to follow his moves backwards and in high heels. He is Mr. Manic, and I am along for the ride.

The Bipolar Brain, The Manic Mind

A year ago, researchers from Harvard, MIT and the University of Cardiff released their findings after studying the brains of 10,000+ people, 4,387 with bipolar disorder.

The scientists found an association between Bipolar Disorder and two genes which help make proteins that control the activity of nerve cells by managing the flow of sodium and calcium ions into and out of cells.

This research appears to walk hand in hand with another study of dead manic brains by the smart folks at The Imperial College London, Cambridge and the National Institutes of Mental Health in the US. They compared postmortem brain tissue samples of manics with normal brains. The samples came from the prefrontal cortex (the place where adult behavior springs from, but they call it higher cognitive functioning). "Surprise. Surprise Surprise..." as Gomer Pile used to say. Manic brains have different chemical concentrations than non manic brains.

Most of this research is aimed at finding new therapies, or explaining why old therapies like Lithium and valproic acid work.

But what you can take to heart from it is that the manic brain, well, it's manic. What studies like this also show up is that the medication does also make changes to the manic brain. We may not know why, but some of the stuff we do, helps.

What I believe you should take from this is an understanding that Manic Depression isn't just what happens the first time your Manic goes off the reservation with a full blown episode (DSM-IV diagnosis criteria for Bipolar I). Your Manic was born a manic and will always be a manic, but how they behave and what symptoms they may exhibit are as impacted by the environment as their genes and the "upset of the balance of different transmitters known as excitatory and inhibitory transmitters."

What it might also be useful to internalize is that there aren't any switches, there are just imbalances. Which might lead a rational person to suppose that Bipolar disorder actually results in a spectrum of behavior and impacts and that the neat little DSM-IV boxes are useful in coding insurance forms for reimbursement, but aren't necessarily guides to day to day navigation of a chronic, maddening and ultimately real disease of the brain.

Manic Depression: The Definition vs. The Reality

Definition

manic depression noun
a mental illness causing someone to change from being extremely happy and excited to being extremely sad: He suffers from manic depression.

manic depressive noun
a person who has manic depression
(from Cambridge Advanced Learner's Dictionary)

The Cambridge Learner's Dictionary definition of manic depression (or bipolar disorder for those who believe a different label helps) is a bit disconcerting. After all, almost all of us change from being extremely happy and excited to being extremely sad. But translating manic into happy and excited is like using the phrase "dust up" to describe an F5 (incredible) tornado. Equally as questionable is equating depression with being extremely sad.

Extremely sad doesn't cover not getting out of bed for a week except to go to the bathroom. It doesn't cover letting one job after another slip away because it's too much effort to call in sick. It doesn't describe the sad clown face produced by a flat affect. It doesn't begin to get at the truth of the depression part of Manic Depression. And you should know. You have been or are now contemplating living with it.

Here are some facts to prime the discussion:

• The primary symptoms of bipolar disorder are dramatic and unpredictable mood swings. If you look at the DSM-IV and the diagnostic criteria, it calls for one or more Manic episodes for a diagnosis of Bipolar I. To be Bipolar II you should have had at least one major depressive episode and one hypomanic episode.



• The median time to diagnosis from the time folks first get into the medical system is 22 months. A large study conducted from 2000-2002 found nearly a third of bipolar diagnoses did not occur for four years or more. It took 10 years for Mr. Manic to get his diagnosis.



• According to the NIH, Bipolar Disorder affects somewhere around 5.7 Million American Adults



• Somewhere between 10-15% of folks diagnosed as Bipolar I commit suicide. The only more fatal mental illness is Anorexia

So, to be diagnosed you have to fit a check list. Even trained mental health professionals, when faced with a real live person to evaluate against that list, generally miss the boat for months (if not years). How could they not when bipolar behavior masquerades as "willfully bad behavior," charming but irascible behavior, blowing off steam, a little touched. Millions of people have it, and hundreds of thousands are going to die as a result. Pretty scary, huh?

Take a deep breath. Really. Right now. Breathe.

Living with a bipolar spouse or significant other isn't easy, but few things in life are. Yes, it is a mental illness. Yes it means you will make choices in life you may not have anticipated. But, it is not a death sentence. It is not a reason to panic. It certainly isn't a reason to be embarrassed.

If it isn't the worst thing that ever happened to you (and even if it is), what exactly is it? Let's start with some of the things you're going to read on the Internet. You're going to stumble across lists like this, this or this. You're going to see a lot of discussion about the efficacy of lithium (making a comeback). You're going to hear about episodes, as though mania and depression float in on little clouds at odd moments and settle on those of the bipolar persuasion rather than being an amplification of the normal manic mind. You're going to see a lot of statistics about things like comorbidity, hallucinations and potentially violent behavior. Then if you dig deep enough you'll find folks like Stephen Fry who are wending the path, afraid medication will take their creativity away.

It's all very confusing, and not very helpful to figuring out how to live the manic life with the one you love. So I'm going to try to give you some guide posts to living with your manic. They boil down to the following;

• If they are bipolar, they aren't just bipolar when they have an "episode." They are bipolar. Period. There is no getting over the accident of birth that dealt them a manic brain.
• If they are bipolar, it isn't just highs and lows of mood, it's highs and lows of energy. That's were mixed states come from.
• If they are bipolar, the first thing that goes in an "episode" is judgement.
• If they are bipolar, they will self medicate.
• If they are bipolar, they will lie.
• If they are bipolar, support matters.
• If they are bipolar, drugs can be wonderful, but all they do is provide an opening to learn new behaviors.
• If they are bipolar, living a life where the highs and lows are tamped down, doesn't have to inhibit either art or creativity.
• If they are bipolar, sleep matters. It matters enormously...much more than you think.
• If they are bipolar, stress wins all arguments. But you can't count on what stresses you to stress them.
• MedPros have very limited expectations of their bipolar charges. You will often have to discount these expectations.
• When you do not take care of yourself your bipolar other will start to spiral.
• Coddling your manic will not help them navigate the world.
• If they are bipolar, they will have tells. You will get a masters degree in them, and it may help your poker game.
• If they are bipolar, they will have triggers. Some they will pull themselves.
• If they are bipolar, you will have to find your own peace with the burdens you will be asked to bear. After all, life isn't fair.

Hey, it's a start.

Living the Manic Life

In February, a dear friend lost her son to suicide. In April, another lost his son. Today, on one of the blogs I read, a frequent poster talked about the grief he felt at losing his nephew, who left behind a wife and baby.

I think a lot about bipolar disorder. It's part of the fabric of my life. My father was a manic-depressive who hung himself as his brother had before him. I never knew my uncle, but I did know my cousin who struggled mightily with the disease. She left a husband. My uncle left seven children. My father left six and two ex-wives.

My mother ultimately could not navigate my father's madness. He checked into the VA hospital for an extended stay and they were divorced when he left many months later.

Once she admitted to me that she wished she had been stronger, or known more.

I would like to start this conversation on bipolar disorder and manic depression to act as a guide for those who find themselves living the manic life, without the benefit of being bipolar themselves. I would like to dedicate this effort to my lost father, uncle, cousin and my very present husband. It is possible to live a joyful, satisfying life full of possibility as well as lithium, Abilify and Remeron. In fact it is more than merely possible.

We'll talk about lying. We'll talk about sleep hygiene. We'll talk about medication and self medication. We'll talk about addiction, heredity, Kay Redfield Jamison and the artistic side of Manic Depression. We'll talk about early warning signs, bad behavior and an appropriate team of advisors and medpros.

We'll talk about what the medical profession misses when it delights in watching the bear dance. And we'll talk about how you have to keep yourself steady and in good health to make the grand trip. We'll look at the latest research, argue about labels and discuss what happens when the diagnosis comes, as it always comes, far too late.

And sometimes, we'll just remember the ones we've loved who, like moths pulled to the flame, circled the dark too closely and were consumed.