Initially entered as a draft (12-7-13), updated and opened to public view.
After knowledge received in recent classes, I consider this more of a rough draft. As I do not plan on making changes, the official status is Final Draft.
This is a researched essay tied in with personal experience.
I was diagnosed with unipolar
depression at the age of ten. Unipolar depression is the type of depression
that most people are familiar with. Unipolar depression is a deep pit filled
with sticky, tar-like dysphoria that feels impossible to escape from. I went
through several different antidepressants, some with ill-effects, before I
ended up in the hospital at age sixteen. I had been on a specific
antidepressant for about a year. I felt that it had been working well for me
until I began having hypomanic and psychotic episodes. I would wake up in the
morning feeling sublime and go through my day brimming with energy. An endless stream of words would spill forth
from my mouth as I jiggled in my seat during class discussions. Sometime during
the evening something in my mind would shatter, though. Everything was wrong, the
world was against me, or there were demons trying to claw their way out of my
head. There was so much energy built up inside of me that I would just scream
until the electric whirlwind of emotion swirling inside me abated. My mom witnessed one of these episodes and
decided I needed to be hospitalized. My first stay in the adolescent
psychiatric ward truly unsettled me.
I weave my way through the
brightly lit corridor, squinting my eyes against the abrasive light given off
by humming fluorescent bulbs. Every time my heart beats, a stabbing pain shoots
through my temples in response. I do not want to be awake. I certainly do
not enjoy having been forced from my temporary room. I recall the murky
events of the previous day as I pad into the common area for breakfast.
The click of the door opening had
pulled me from slumber. My doctor seated himself on the bed opposite my own. My
back was to him, but I couldn't get my body to respond well enough to roll
over. I mumbled a nearly incoherent response when asked if I was awake.
"You can't leave until you
begin attending therapy sessions. You have to get out of bed." These words
swam around my barely conscious mind. My body felt so heavy. I finally
forced myself to roll over and face the doctor, though. I waded through
my thick-as-molasses brain to access an appropriate response to the doctor.
"I'm tired. I can't move. I
think it's too much."
Though it was a vague response, I
believe the psychiatrist understood what I meant by "too much." The
next set of pills delivered to me was slightly different. By dinner that
evening, I felt that my brain had reconnected with my body well enough to peel
myself away from the bed. Directly after dinner, staff members began setting up
the television for "movie night." I was called to the counter for my
evening medication several minutes after the G-rated movie began to cast its
flickering light over the audience. I recognized the pill that rattled around
in the little plastic cup I was handed.
"I don't want a sleeping
pill. I just woke up."
"You have to take it. Doctor
says you have to take it. No discussion. No arguing." I understood the
nurse saw me as just another troubled teenager looking for a fight. There was
no way I could express my fears to her. No way would she understand that after
being pseudo-comatose for nearly two days, I did not want to take anything that
would exacerbate the foggy drowsiness that still enveloped my mind.
I swallowed the pill with a gulp
and trudged back to my seat. The colorful flickering soon began to blur. My
eyes watered profusely as I attempted to regain my focus. The images on the
screen came in and out of focus several times before I gave in. I stood up
shakily and meandered through the small crowd with my arms stretched out for
balance. While slowly making my way back to my room, I noticed my head felt
incredibly light. I thought I would float away like a helium balloon if
not for my leaden body. Darkness swallowed me the moment I collapsed on the
bed.
"Sidney!"
I
pull myself from yesterday's memories and gaze about. A disgruntled
nurse peers at me from behind the nurses' station desk. I scramble over as
quickly as my leaden body will allow. Disgruntled Nurse greets me by thrusting
a pill cup in my direction while using her free hand to snag my wrist and
check my identification bracelet. Though I am still hung over from the sleeping
pill, I am more aware than I have been in two days. This is the first time I've
taken a moment to look at these specific pills. I know immediately what one of
them is. It's the antidepressant I've been taking for the past year. The other
is not familiar to me at all.
"What am I taking?" I
ask the nurse in my most polite voice.
"Pristiq and Geodon,"
Disgruntled Nurse hastily replies before calling the next name on her chart.
I vaguely recall the doctor
giving me an overview of the new medication and the reasons for which it was
prescribed. I believe he stated that he was prescribing me an antipsychotic
because I was showing signs of early bipolar disorder. My antidepressant,
working alone, was beginning to hinder rather than help.
The next two days I spend in the
adolescent psychiatric ward are identical to each other. I wake up in a fog and
lumber to the common area for breakfast. I take my morning medications, and
then head back to my room to shower and attempt to shed my remaining daze. I
get three hour-long reprieves throughout the day; the first one is after
breakfast, the second is after lunch, and the final one occurs right before
lights out. The rest of my days are filled with various styles of therapy.
There is a one-on-one session, group talk-therapy sessions, art therapy, group
anger management courses, and a visit from a therapy dog. Though my
body still feels slightly leaden and I'm feeling dizzy occasionally, I
make it through both days fully conscious. My doctor releases me partway
through my fifth day in the adolescent psychiatric ward. I feel as though I
have been handed a hardly legible map and two gallons of water, set upon a raft
of questionable durability, and released upon the open ocean.
Once released, I spend a quiet
evening at home. I have school, along with stacks of make-up homework to
pick up, the next day. I try to get as much relaxation in as possible. After dinner,
I shower then read for several hours before heading to bed a little later than
I should. Life is supposed to return to normal tomorrow.
I awake to the grating sound of my
phone ringing. It is my father calling to tell me he is leaving to pick me up
in ten minutes. My heart races as I try to piece my scattered mind together. I
clumsily gather clothes for the day and head to the bathroom to clean up. After
spending a few minutes brushing my teeth, washing my face, and putting my
clothes on, I turn to head to the living room. I am barely across the bathroom
threshold when the edges of my vision darkens and I feel my body slacken. The
next thing I am aware of is a wave of nausea hitting me as the room swirls back
into view. I can hear my phone ringing, but I cannot yet comprehend what I am
supposed to do with that knowledge. I curl up on the floor in tears feeling as
if I’m right back where I was the night I was admitted into the hospital. My
raft has developed a gaping hole and I have no idea how to plug it.
My
doctor explains to me the next day that it was most likely the new medication
affecting my blood pressure, causing me to pass out. Only seven days after I
have begun my new medication, it is already being changed. Instead of an
antipsychotic, I am going to be taking a mood stabilizer. The hole has
essentially been patched up for me, and I will be at sea again in no time.
This
experience left me anxious about taking psychiatric medications. Not only was I
terrified after blacking out, dealing with some of the lesser side effects was
frustrating. I was left out of decisions pertaining to my health care because I
was a minor. No one explained to me in detail the reasons I was being medicated,
nor how I was supposed to cope with what little information I was given. Most
of the therapy sessions I had attended were aimed toward adolescents with
anger, alcohol, and drug problems. I felt as if I had been grouped together
with a gaggle of misbehaving delinquents and did not receive the proper kind of
attention. My recollections of this event prompted me to research alternative
treatments for bipolar spectrum disorders. I wanted to find out if there is a
better way of treating bipolar disorder than mere medications and ill-aimed
therapy.
Bipolar
disorder is a complex mental illness. Even as a person living with a bipolar
spectrum disorder, there is a lot I do not understand about it. I have just one
of several different types of bipolar disorder. I was initially diagnosed with
cyclothymia, and later “upgraded” to bipolar disorder type II. The bipolar
spectrum includes BD I, BD II, cyclothymia, and some less severe mood
dysregulation disorders. Each of these bipolar spectrum mood disorders consist
of alternating periods of extreme euphoria (mania or hypomania), depression, euthymia
(balanced mood state), and mixed states. The most common treatment for bipolar
spectrum disorders is pharmacotherapy (Leahy 419-422). Pharmacotherapy is the
treatment of a medical, or in this case psychiatric, ailment with medication. I
was first prescribed an antidepressant and an antianxiety medication, then had
an antipsychotic added on later. As the antipsychotic did not work well for me,
it was replaced by the more commonly prescribed mood stabilizer. Usually, the
first medication prescribed is an antidepressant. Bipolar disorder is commonly
misdiagnosed as unipolar depression because patients overlook manic and
hypomanic symptoms (Swartz, Levenson, and Frank 146). Antidepressants are known
to trigger mania and/or exacerbate mood cycling (Leahy 420). Once it is understood that a patient has
bipolar disorder, a mood stabilizer is usually prescribed. Mood stabilizers
calm activity in the brain, relieving much of the mood dysregulation. In more
severe cases, an antipsychotic will be prescribed. Antipsychotics treat
psychosis and agitation. Oftentimes, a sedative is prescribed for insomnia. Common
side effects of these medications include tremors, weight gain, thyroid
dysfunction, and elevated liver enzymes (Sarris, Lake, and Hoenders 883). According
to Robert L. Leahy, “Pharmacological treatment is typically essential for
bipolar disorder.” He also states that, “For many years in mental health, there
was an accepted “wisdom” that bipolar disorder was a biological illness that
simply required lithium (a common mood stabilizer). This all-or-nothing view
has since been eclipsed by the development of effective psychological
treatments used in conjunction with biological treatments (418-419).” This
means that though medication is highly recommended for patients with bipolar
disorder, there are other treatments available.
It
seems that my psychiatrist was following a well-worn path. He prescribed to me the
usual medications to alleviate my mood dysregulation symptoms. He did not
continue with the recommended path, though. Contrary to the fact that
pharmacotherapy is the “first line of treatment” for bipolar disorder, the
overall success of treating bipolar disorder with only medication is “moderate.”(Parikh,
et al. 483) Nearly all of my research suggests that patients seek a form of
therapy designed for mood disorders. There are three styles of therapy geared
toward bipolar patients that are highly favored by mental health professionals.
These therapies include cognitive behavioral therapy (CBT), interpersonal and
social rhythm therapy (IPSRT), and family focused therapy (FFT). These are
often used after, or in conjunction with, psychoeducation (PE) (Leahy 420;
Parikh, et al. 483). Both CBT and IPSRT work towards a goal of being able to
manage symptoms of bipolar disorder. Both therapies are also constructed with
the assumption that the patient will be taking medication to relieve the more
severe symptoms of the disorder (Frank 465). I find it unusual that my
psychiatrist did not offer to refer me to a therapist specializing in any of
these styles of therapy. I feel that I would have benefitted from learning more
about my mental illness and developing coping skills.
Once I was released from the
structured environment of the hospital, I reverted back to the lifestyle I was
living before. My lifestyle motto was “go with the flow”, a far cry from any
sort of schedule. Ellen Frank states that, “Stabilizing social rhythms is a key
aspect of the management of mood symptoms (466).” Regardless of the patient’s
pharmacotherapy status, learning to cope with a life-long mood disorder is
pertinent. Frank emphasizes this by explaining the importance of circadian
rhythms. We were once ruled by the rising and setting of the sun. Because of
the many technological and societal changes the world has undergone, this is no
longer true for everyone. Work, recreational activities, and social obligations
are constantly altering our schedules. People with a predisposition to mood
disorders are affected by these small shifts far more than the general
population. It is more difficult for people with bipolar disorder to recover
from cogs in the system (464). CBT and IPSRT both provide tools for dealing
with such occurrences. I had no such tools and was already in a weakened mental
state from my abrupt rhythm alteration. Once I was faced with a strong negative
emotion, the fear and anxiety brought on from suddenly blacking out, my
tentative hold on my emotions was broken.
Being able to deal with strong
emotions is an important aspect of coping with bipolar disorder. I had
previously allowed myself to be mowed-over by any strong emotion. Cognitive
behavioral therapy focuses on thought processes and behaviors. Patients are
taught to recognize and monitor mood swings. They are then taught how to use
this knowledge and apply coping techniques. Patients learn how to gauge how
much stimulation they should have depending on whether they are entering a
manic or depressive state. Problem solving skills are taught along with methods
of viewing the problems in a less stressful way. Patients also learn how to
decipher when and why they need to seek professional help. The “cognitive
restructuring” aspect of CBT challenges dysfunctional beliefs (Parikh, et al.
486). Interpersonal and social rhythm therapy focuses more on forming routines
and improving satisfaction with social relationships. Though the focus is
forming healthy lifestyle habits, IPSRT does involve learning the same coping
skills that CBT teaches (Swartz, Levenson, and Frank 149). Both styles of
therapy aim to teach the patient how to cope with the mood fluctuations that
pharmacotherapy cannot completely abate. Patients who lack the skills and
knowledge of how to handle difficulties or stressors are more likely to end up
requiring hospitalization (Leahy 421). Without the knowledge and skills
provided by these therapies, I did end up requiring hospitalization about nine
months after I was released the first time.
Sometime after my diagnosis, I was
faced with the possibility that I would have to be medicated for bipolar
disorder for the remainder of my life. Not only did I feel slightly broken
because of this knowledge, I was greatly disappointed that I would have to deal
with the side effects for a lifetime as well. During my research, I also found
a few alternative methods patients use that are referred to as complementary
and alternative medicines (CAM). These are either used in conjunction with, or
instead of, medication prescribed by a doctor. Up to fifty percent of
psychiatric patients seek CAM therapies. These therapies include, but are not
limited to, acupuncture, naturopathy, and medicinal herbs. Research on
supplement therapies even found that certain regions with high fish consumption
had lower rates of bipolar disorder. They believe this is linked to the higher
consumption of fatty and amino acids (Sarris, Lake, and Hoenders 881-885). I’ve
theorized that patients are more comfortable with these more natural remedies
because they lack the same side effects that psychiatric medications commonly
produce. Taking a herbal supplement may
also seem less daunting than having to fill multiple prescriptions. According
to the National Comorbidity Survey Replication, sixty-one percent of patients
with bipolar disorder did not meet the minimum suggested treatment requirements
(Gruber, Jane, and Persons 17). Refusal to take psychiatric medication seems to
be a common issue among those affected by bipolar disorder. I became especially
disenchanted with pharmaceuticals after my hospitalization experiences. This is a good argument for pushing
alternative therapies.
Though medication is highly recommended
for bipolar patients, it seems that specific forms of therapy are of equal, if
not greater, importance. Therapy supplies patients with important knowledge and
skills. My aunt, Cathy Johnson, is a licensed mental health counselor. She was
aghast at the concept of coping with bipolar disorder without medication. She
claims that because bipolar disorder is believed to be a dysregulation of
certain chemicals in the brain, it requires a chemical assist to cope with.
Johnson clarified that the need for medication does not detract from the
importance of therapy, though. Education about the illness itself and ways to
handle it are important. Apparently therapy is also a convenient way to keep
track of a patient’s moods and get them help if they are not handling a
situation well. If I had known more about bipolar disorder and the possible
reactions to the drugs I was prescribed, I may not have been so put off by my
experience. I would have greatly benefited from therapy that pertained to my
specific issues. Being caught off guard in a stressful scenario right after
being discharged caused me to relapse. Perhaps if I had been taught coping
mechanisms, I would have been able to handle the situation better.
All of my resources tout
pharmacotherapy, but many of them also emphasize that medication is not a
cure-all. My coworker, Christy Kaczmarczyk, was originally diagnosed with BD I
twelve years ago. She claims that pharmacotherapy has been a God-send, but that
medication was not biggest aspect of her healing. She has attended many
different styles of therapy and gained a lot of insight about herself and her
illness from it. Though Christy dislikes the side effects from her medications
and her moods still fluctuate, she claims those things are worth dealing with. Bipolar
disorder is not simple or easy to manage. It requires a lot of work, a lot of
knowledge, and patience. These are all things one cannot gain through a pill.
Though the possible “faulty regulation” of adrenaline, serotonin, and dopamine
may be eased through medication, life does not stop being complex or
frustrating (Encyclopedia Britannica). Successful treatment of bipolar disorder
requires both pharmacotherapy and alternative therapies.
Works
Cited
Encyclopedia Britannica. “Bipolar Disorder.” Encyclopedia Britannica Online Academic Edition.
Encyclopedia Britannica Inc.,
2013. Web. 25 Nov. 2013.
Frank, Ellen. "Interpersonal And Social Rhythm
Therapy: A Means Of Improving Depression And
Preventing Relapse In Bipolar Disorder." Journal Of Clinical Psychology
63.5 (2007): 463-473. Academic
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Gruber, June, and Jacqueline B. Persons.
"Unquiet Treatment: Handling Treatment Refusal In Bipolar Disorder." Journal Of Cognitive Psychotherapy
24.1 (2010): 16-25. Academic
Search Premier. Web. 13 Nov. 2013.
Johnson, Cathy. Personal interview. 30 Nov. 2013.
Kaczmarczyk, Christy. Personal interview. 29 Nov.
2013.
Leahy, Robert L. "Bipolar Disorder: Causes,
Contexts, And Treatments." Journal Of Clinical Psychology 63.5
(2007): 417-424. Academic Search Premier. Web. 19 Nov. 2013.
Parikh, Sagar V., et al. "Psychosocial
Interventions For Bipolar Disorder And Coping Style Modification: Similar
Clinical Outcomes, Similar Mechanisms?." Canadian Journal Of Psychiatry 58.8 (2013): 482-486. Academic
Search Premier. Web. 13 Nov. 2013.
Sarris, Jerome, James Lake, and Rogier Hoenders.
"Bipolar Disorder And Complementary Medicine:
Current Evidence, Safety Issues, And Clinical Considerations." Journal
Of Alternative & Complementary Medicine 17.10
(2011): 881-890. Academic Search Premier.
Web. 14 Nov. 2013.
Swartz, Holly A., Jessica C. Levenson, and Ellen
Frank. "Psychotherapy For Bipolar II Disorder: The Role Of Interpersonal
And Social Rhythm Therapy." Professional Psychology: Research And Practice 43.2 (2012): 145-153. PsycARTICLES. Web. 11
Nov. 2013.
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