Treatment and Recovery Part 2: Things to Remember

Above all, remember, you are not alone. Many people have feelings or experiences like these at some time in their lives. When such symptoms of mental illness become severe, some people reach out for help and treatment from health care providers. Others try to get through it on their own. Some people don't tell anyone what they are experiencing because they are afraid people will treat them badly. Other people share what they are experiencing with friends, family members, or co-workers.

Sometimes these symptoms are so severe that friends and people around you know you are having them even though you have not told them. No matter what your situation is, these feelings are very hard to live with. They may keep you from doing what you want to do with your life, what you have to do for yourself and others, and what you find rewarding and enjoyable.

As you begin to work on helping yourself feel better, there are some important things to keep in mind. 

• You will feel better. You will feel happy again. The disturbing experiences and feelings you've had or are having are temporary. This may be hard to believe, but it's true. No one knows how long these symptoms will last. However, there are lots of things you can do to relieve them. You will want help from others, including health care providers, family members and friends, in relieving your symptoms and for ongoing help in staying well. 
• The best time to address these symptoms is now, before they get any worse. 
• These symptoms are not your fault.
• You are just as valuable and important as anyone else.
• When you have these kinds of symptoms, it is hard to think clearly and make good decisions. If possible, don't make any major decisions-make expensive purchases, change jobs, move, or leave a partner or friend-until you feel better. If you have to make some major decisions, especially about getting treatment, ask your loved ones and health care providers for help. 
• Spend time with people you know, and work on developing friendships with people who are positive, caring, and who like you just the way you are. Sometimes people who have these kinds of symptoms are treated poorly by people who don't understand. Try to stay away from these types of people. 
• Listen to the concerns of and feedback from your health care providers, friends, and family members who are trying to help you, and work with them to find solutions that feel right to everyone involved. 
• These symptoms do not take away your basic personal rights. You have the right to
• ask for what you want, say yes or no, and change your mind.
• make mistakes.
• follow your own values, standards, and spiritual beliefs.
• express all of your feelings, both positive and negative, in a responsible manner.
• be afraid and uncertain.
• determine what is important to you and to make your own decisions based on what you want and need.
• have the friends and interests of your choice.
• be unique and allow yourself to change and grow.
• have your own personal space and time.
• be safe.
• be playful and frivolous when appropriate.
• be treated with dignity, compassion, and respect at all times.
• know the side effects of recommended medications and treatments.
• refuse medication and treatments that are unacceptable to you. 

• If you are told that the following things are not normal, don't believe it! They are normal. These kind of things happen to everyone and are part of being human:
• Getting angry when you are provoked
• Safely expressing emotions when you are happy, sad, or excited
• Forgetting things
• Feeling tired and discouraged sometimes
• Wanting to make your own decisions about your treatment and life

• It's up to you to take responsibility for your behavior and for getting better. You have the right to as much help as you need, but is crucial that you take charge.

Treatment and Recovery Part 1: Taking a Look at Yourself

Have you been told that you have a psychiatric or mental illness like depression, bipolar disorder (manic depression), schizophrenia, borderline personality disorder, obsessive-compulsive disorder, dissociative disorder, post-traumatic stress disorder, an eating disorder, or an anxiety disorder? Perhaps you have never been diagnosed but you know that something just isn't feeling right within yourself. It is time to take a good look at the situation. It may be helpful to have your spouse or someone else close to you speak candidly with you about what they have witnessed from your behavior. This is not the time for arguments or criticism. Respect everyone's point of view.

Do you experience any of the following, and do these experiences get in the way of doing the things you want to do most or all of the time?

• feeling like your life is hopeless and you are worthless
• wanting to end your life
• thinking you are so great that you are world famous, or that you can do supernatural things
• feeling anxious
• being afraid of common things like going outdoors or indoors, or of being seen in certain places
• feeling like something bad is going to happen and being afraid of everything
• being very "shaky", nervous, continually upset and irritable
• having a hard time controlling your behavior
• being unable to sit still
• doing things over and over again-finding it very hard to stop doing things like washing your hands, counting everything or collecting things you don't need
• doing strange or risky things-like wearing winter clothes in the summer and summer clothes in the winter, or driving too fast
• believing unusual things-like that the television or radio are talking to you, or that the smoke alarms or digital clocks in public buildings are taking pictures of you
• saying things over and over that don't make any sense
• hearing voices in your head
• seeing things you know aren't really there
• feeling as if everyone is against you or out to get you
• feeling out of touch with the world
• having periods of time go by when you don't know what has happened or how the time has passed-you don't remember being there but others say you were
• feeling unconnected to your body
• having an unusually hard time keeping your mind on what you are doing
• a sudden or gradual decrease or increase in your ability to think, focus, make decisions and understand things
• feeling like you want to cut yourself or hurt yourself in another physical way

If you answered "yes" to the first question or checked any of these experiences, this series is for you.  It is my hope that you will find helpful information that applies to your life and suggestions for things you can do to feel better. Above all, take this list and discuss it with your doctor. Don't be embarrassed or feel "crazy" or ashamed to talk to him about what you are going through. That is the first step toward recovery from a mental illness, and it is a very hard step to take! Trust me, I've been there! A little comfort may come from knowing that there is nothing you can say to your doctor that he has not heard before. You are not the only one dealing with things like what are mentioned in the list above. Many are going through the same thing! So be honest with yourself, and with your healthcare provider, and decide right now that you are worth fighting for. You deserve to live up to your full potential. Don't allow mental illness to rob you of your gifts.

Recovery begins NOW!




information adapted from www.samhsa.gov "Recovering Your Mental Health"

Exhausted? The Reason May Surprise you

It's the million dollar question: "Why am I so tired?" Like many women, you probably have a full plate, and then some! Kids, housework, career, errands, and all kinds of other obligations and stressful events take their toll on our energy levels. Mix in the symptoms of bipolar disorder, and your pep meter isn't even on the radar anymore! Eating well balanced meals, getting enough sleep, and getting regular exercise should make a real difference, but what if it doesn't?

There are endless potential explanations for your extreme fatigue. Thyroid problems, diabetes, anemia, sleep disorders, dehydration, viral infections...the list goes on and on (and on and on). Perhaps your doctor has tested you for some of these and the results came back as normal. Those results can come as a relief; no one's happy to have diabetes! But at the same time, all those normal test results can make you feel like you're going crazy. If everything is okay, then why do you feel so...not okay?

Last week I watched an episode of The Dr. Oz Show and the program brought to my attention something I had never considered as a cause of fatigue: Magnesium deficiency.

First off, what exactly does magnesium do for our bodies? With a little research I found that this mineral is rather crucial to our overall health. Besides having a cool name, magnesium:

• Helps form and maintain the bones and teeth. 
• Metabolizes carbohydrates and amino acids
• Aids in the metabolism of calcium, vitamin C, phosphorus, sodium and potassium
• Assists in converting blood sugar into energy
• Transmits messages between nerves in the body
•  Increases brain function while relieving stress and anxiety; aids in detox of cortisol
• Can reduce the occurrence of migraines
• Helps maintain healthy weight

That seems like a lot of hard work for one little mineral! Factor in that strength training, alcohol consumption, medications, chronic illnesses, and other influences described  here can deplete the body of magnesium, and it is easy to see why this is a common, albeit overlooked, deficiency to achieve.

Among the many potential Symptoms of Magnesium Deficiency here are a few that are commonly a sign of magnesium deficiency:

• Fatigue or lethargy
• Stomach discomfort, such as constipation, nausea/vomiting, or abdominal cramps
• Muscle cramps or spasms, often experienced in the legs
• Stiffness, numbness, or tingling in the extremities; often affects neck and jaw (pain and stiffness)
• Headaches, including migraines
• Irritability, confusion, anxiety, depression, and other behavioral disturbances
• Trouble staying or falling asleep
• Heart rate abnormalities, such as palpitations, chest pain, and lack of stamina with physical exertion
• Deficiencies in calcium and/or potassium
• cravings for salt or carbohydrates
• severe menstrual cramps and breast tenderness
• in some cases, even seizures

Unfortunately, testing for magnesium deficiency is not always a simple task. The results from a blood test can often come back normal since the mineral is found primarily in the cells, rather than in the bloodstream.Your doctor may wish to perform a magnesium loading test. You will be asked to collect your urine over a 24-hour period, and the doctor will test it for the total amount of magnesium found. You will then be given an injection of magnesium and be asked to collect another 24-hour urine sample. The level of magnesium will again be measured. If your body is retaining more than a certain amount of magnesium then it will be concluded that you are deficient since the body is holding on to the magnesium that was injected. Some doctors will only look to symptoms exhibited in the patient and prescribe a magnesium supplement to see if the condition improves. Other physicians may perform the sublingual epithelial test, which involves scraping cells from under your tongue to obtain an accurate magnesium reading.

According to the Institute of Medicine of the National Academy of Sciences, adults can take 350 mg per day of magnesium supplements without negative health effects. The recommended dosage for adult females is 310-320mg. For pregnant women that amount increases to 360-400mg, and for breastfeeding women the desired dosage is 320-360mg. Note that not all multivitamins contain magnesium. I recently added a supplement to my vitamin regimen that contains a high potency of calcium, magnesium and zinc. Shop around and ask your doctor what may work best for you.

Although vitamins are a great way to supplement your diet, they should not be your only source of magnesium. Make an effort to add magnesium rich foods to your meals each day. The following table gives you an idea of what foods contain a good source of magnesium:

Foods High in Magnesium	Serving Size	Magnesium (mg)
Beans, black	1 cup	120
Broccoli, raw	1 cup	22
Halibut	1/2 fillet	170
Nuts, peanuts	1 oz	64
Okra, frozen	1 cup	94
Oysters	3 oz	49
Plantain, raw	1 medium	66
Rockfish	1 fillet	51
Scallop	6 large	55
Seeds, pumpkin and squash	1 oz (142 seeds)	151
Soy milk	1 cup	47
Spinach, cooked	1 cup	157
Tofu	1/4 block	37
Whole grain cereal, ready-to-eat	3/4 cup	24
Whole grain cereal, cooked	1 cup	56
Whole wheat bread	1 slice	24

USDA Nutrient Database for Standard References, Release 15 for Magnesium, Mg (mg) 

The Benefits of Therapy

It's a funny thing about therapy. I can convince myself that it is pointless, stop going, and be quite alright for a while. But eventually, gradually, the weight of the world becomes more than I can handle. All the bottled up thoughts start breaking me down inside, until I can't see, can't breathe, can't function. It is about this time I realize there is something powerful and necessary in having that outside person to talk to, to tell every thought and admit every feeling to, without fear of rebuttal or judgment. This is my lifeline to maintaining sanity.I need to stop severing ties every few months. 

 The American Psychoanalytical Association reports that "even when psychiatric care is free, only 4.3% of the population uses outpatient psychotherapy, and the average length of treatment is 11 sessions." 

Some people are completely against therapy. They are convinced a shrink would do nothing for them, or perhaps would even make their problems worse. Others have had a bad experience (or perhaps several) and that has put them off from further attempts at psychotherapy.  

While I am fortunate to have found a facility that caters to low income patients so that it is affordable for me, many do not have that option. Some do not have insurance, and many insurance plans don't cover therapy or other mental health costs. 

In a nutshell, there are many reasons why therapy does not work out for people. But there are many benefits to it. A therapist can help you, through a series of questions, insights, and exercises to do the following:

• figure out your worth and purpose
• set personal goals and follow through
• improve relationships
• overcome issues such as anxiety, phobias, depression, anger, etc.  
• gain a fresh perspective from an outside source that will not be swayed to "take sides" in your situation
• alleviate stress and bottled up emotions by talking it out with someone who listens and cares
• find healing from traumatic events 

Stuff like this can scarcely be "fixed" in just a few sessions. Rather, therapy is an ongoing part of your life; for months, years, perhaps for the rest of your life. It's not a sign of weakness to need counseling. It's a matter of finding the take-charge attitude that says "yes, I have some things I need to work on, and I am going to do what it takes to improve myself in order to reach my full potential."

Of course, not everyone likes reliving painful experiences or talking in general. When I first began therapy six years ago I was very apprehensive about the prospect of being made to talk for 45 minutes straight! But it ended up being not so bad, and I felt at peace when I left each week. There were more than a few occasions when I was so distraught over something I just cried the whole time, and other sessions were filled with a lot of silence because depression had my tongue. My therapist had to talk me through a major panic attack during some sessions because I would be so stressed from the waiting room (the joys of social anxiety). Not everyone is blessed with a great first therapist like I was, and I grieved deeply when she moved away. I really don't think I will ever have a therapist I connect with and enjoy talking to as much as I did her. But each new one has brought something new to the table. They have each offered up fresh perspectives, and I have grown stronger and more capable because of my time in therapy. So when I start missing appointments, it shows. I start backtracking and losing my way. Sure, I could walk the road alone; so many do. But it is so much easier having a guide to help me through the rough patches, and to cheer me on the entire way.

We never truly stop growing, but there are definitely circumstances and emotions that halt our progress from time to time. Therapy is a great way to refocus and learn to spread your wings and fly. When you find inner peace and tap into your vitality, the sky is the limit.

-Amy Purdy

Remastering Your Mind: Part One

The mind is a powerful device.It can remember details, solve problems, recalculate objectives; it can make decisions, learn a new hobby, and ace a math test. Okay, some minds can do all of that. Not mine. Especially the math part.

Of all the many symptoms that can be attributed to Bipolar Disorder, the tricks it plays with memory and focus are at the top of many people's complaint list. With mania comes the speeding thoughts, the far fetched ideas, the inability to zero in on any one thought in order to make any sense out of the madness. The average brain produces approximately 70,000 thoughts per day, but during a manic episode, it can often feel as if that amount is occurring by the minute! During depression, quite the opposite happens. Suddenly, tying your shoes makes for confusion. Remembering your niece's birthday? Forget it. That kid's going to get a belated card, if anything. The brain feels like it's having to churn through molasses just to figure out what to wear that day.

Weighing less than 5lb, our brains take on an excessive job of keeping our entire body functioning. It keeps the heart pumping, the lungs breathing, and regulates body temperature and blood pressure. It controls your ability to walk, talk, and sense the world around you through sight, smell, taste, sound, and touch. It gives you the means to think critically, make decisions, and feel emotions. There's not a single element of your body that the brain is not the head master of.

So, when there's a malfunction in the brain, it makes life a lot harder, eh?

Apart from the additional struggle that mental disorder can place on the mind and body, an average adult between the ages 20-60 will lose around 0.04 to 0.11oz. of brain tissue per year. After the age of 60, this amount increases to 0.14oz. per year.  To understand a little more about how the brain works, allow me to share an excerpt from The Odd Brain by Dr. Stephen Juan:

"As clean, trim, strong, and fit as any athlete, the brain maintains its continuous high level of top performance by 'washing' itself. It keeps itself immaculately free of the slightest contaminating impurity, that is, of anything that could rob it of efficiency.

Our brain is at its largest in early adulthood, when it has approximately 100 billion neurons (brain cells). Most scientists agree that we lose between 10,000 and 100,000 neurons per day. When neurons die through old age, disease, or injury, they are rapidly consumed and digested by special glial cells attached to neurons. You might say they are the brain's wonderful little housekeepers. In addition to being cleaners, these glial cells also serve as nurses by providing sustenance to healthy neurons. 

 This washing process helps the brain store, along with its more than 100 billion neurons, more than 100 billion items of information. This is five hundred time the amount of information in a set of encyclopedias. And the glial cells may help account for the fact that the brain is still able to send out electrical impulses thirty-seven hours after death."

If that makes you feel like the deceased may have more wits about them than you, then you are not alone. And it's understandable to feel that way, as the brain often gets neglected. Like our stomachs crave food, our minds crave intellectual stimulation.  To build a muscle, you must work the muscle. You must also give it the loving care that it deserves. Proper nutrition and physical exercise go a long way in keeping the mind at optimum function. Likewise, challenging the brain and learning how to manage stress and other neuron-depleting emotions will aid in a healthier brain, and a happier you.

My goal for this series on remastering your mind is to shed light on many of the reasons why our ability to think and reason are affected by our lifestyles, and the role mental illness plays on the issue. I will also address some fundamental ways to regain control over your brain's functioning powers. In the next segment of this series, we will look at a few of the most common brain funks we fall captive to.

-Amy Purdy

Progress...or Something Like It

Oftentimes I can't tell whether I am moving forward or backward. Progress is a tricky thing. I'm getting older, but am I getting wiser? Some days I am really cynical. Other days I fake attempts of optimism (this is always a short lived play; I am a realist, after all). Other days depression vows to defeat me. Tonight I happen to be very happy and hopeful and more apt to take things at face value, rather than muddling things up with over-analytical thinking.

I have been on a bit of a roller coaster lately, not only with my moods, but with my life goals.  I have spent a fair share of time on getting my hopes up, having them fall abruptly, being crushed by imaginary setbacks, and being uplifted by the smallest advancements to my goals that bystanders would just overlook or take for granted.  I hold certain intentions dear to me, and when I care about something my whole being revolves around it whether it is healthy to do so or not. I have to keep reminding myself that it's okay that the best things in life take time, and that awful dreaded word PATIENCE.  I also have to clutch in my hands a thing called reality because not everything turns out the way we want it to.  We may yearn for a certain outcome more than anything in the world but never attain it, because our fate holds something better.  As faithless as I can be at times I do still believe certain aspects of our lives are meant to be.  I also believe that there are a lot of treasures along the way to finding our destiny but it is very easy to miss out on them if we focus too hard on the future.  Today is here for a reason.  We can choose to enjoy it, or we can choose to underestimate it, and perhaps lose the best part of our lives along with it.  

Bipolar From the Other Side

Our guest blogger for this week wishes to remain anonymous for protection of her identity, as she reveals an intimate firsthand account of what it is like to grow up with a parent with untreated Bipolar Disorder. 
 

My battle with Bipolar Disease began in January 1977. The day I was born! How, you might ask? Well, it's a long story! My mom has it. But in the 70's it wasn't a known illness. Those were the days of generalized mental illness and not much was known about it. Most doctors classified everyone with mental illness into one of two groups, depressed or other. Most mental illness was treated with heavy drugs and hospitalization for a short period of "rest". They put the person in the hospital and drugged them up, and after a brief stay they released them with a notebook full of drugs and a bill of clean health. Not much follow up was done. Like my mom, those plans were not followed after release and most of them either didn't take the medications or abused them. 

My mom was released with her pills and a  nice dose of drug addiction to go with it. Like other individuals with bipolar she was misdiagnosed as only depressed. No one goes to the doctor when they are happy and full of energy. Mom learned pretty quickly that the medicines she was given caused her to have "lots of energy and fun" or in other words they triggered her manic states. From her side she had all the energy in the world to do everything. She could clean house and still have energy to go party with her friends! From my side it meant a lot of 2 a.m. house scrubbing! I remember one time she woke my brother and I up at 3 a.m. to disinfect the house with bleach and ammonia. I was 8, and after a quick rescue by my aunt we were once again placed in the "comforts" of my grandmother's home. My grandmother was a hoarder but at least there we were allowed to be children! My mom went on another "vacation to get more rest"! I loved living with my grandmother, because being there I was allowed to play and it was always the same house. With my mom we moved a lot, sometimes not having our own home but instead bouncing from one of her "friends" to the next. Many times I had to hide in my closet or under the bed with my little brother while my mom's current boyfriend thundered through our ghetto apartment on a drunken rage. There were many abusive boyfriends that came and went in her life, some not even staying longer than the night. Sometimes we would be woken up late at night with her throwing what little possessions we had into a car and flying off because "someone was after us"! She took her medication and then added to them as she saw fit. Most of the time those medicines were washed down with a healthy drink of alcohol! 

As I got older I realized something was wrong with my mom other than just depression. I tried to understand what was wrong with her but came to an understanding that many of the problems she had came from improper treatments. Most of the doctors she saw just gave her pills to take and that was it. Those pills lead to drug addiction and her taking other illegal drugs on top of them. Not having proper treatment also allowed other smaller mental illnesses to become bigger ones. Her obsessive compulsive disorder became an obsession with germs and cleanliness. Instead of baths we were bleached to kill the germs we brought home from school. The manic states triggered by the misdiagnoses and treatment for depression led to her being very promiscuous and erratic behaviors. Many times there would be guys in and out of the house all day long. She became abusive when the drugs ran out or when her ever shifting moods changed. I was entered into pageants as a way for her to get easy money. She became obsessed with my weight and appearance refusing to let me eat for days sometimes because I had lost, saying it was because I was fat. I would be forced to exercise after eating to be sure I kept a slim appearance. When there was any new illness out my mom would come down with it. Many times I remember being taken to a doctor when I felt fine and being told I needed to tell the doctor I was sick. My brother was too. She became convinced things inside her body needed to be removed. 

As time went by she developed a sort of obsessive paranoia. She thought the government had sold her drugs and were now controlling her like a puppet. She thought cars were following us because they were on the same road as us, people walking down the road were spies. We lived in downtown Atlanta mind you! We moved to the country to "hide from the spies" when I was 11. After that she still thought we were being followed when we would go get groceries. Our phones were bugged so they could listen to our phone conversations. When I rebelled against her paranoia I became "one of them". I was working with the government to try to kill her. She thinks everything I do has some secret motive planned out by the spies to be carried against her. 

Today after years of drug addiction and improper treatment for mental illness my mom has failing health due to the drug abuse, multiple unwarranted surgeries, and poor self care. She thinks that her phones are still bugged but now she has a new suspicion to add to it. She thinks that she was tricked into getting satellite television service and that the "spies" took advantage of the installation to install cameras in her house to watch her. She screams at the top of her lungs at it to stop watching her when she turns it on and the blue light comes on. She has her moments when it gets so bad I wish she would just hurry up and die; other times she's perfectly normal. Those times switch without warning, sometimes as fast as a matter of a few seconds. I know it's bad to say I wish my mother would die but during those times it's impossible to reach her or even get her help. She has mood swings where she'll go from having a good time laughing one minute to where she's crying the next and suicidal. She sometimes has mood swings so drastic she goes from happy and looking forward to having a family gathering to extreme rage because in her eyes we're "all trying to hurt her and we've all been turned against her" and she wants to kill us all. She becomes violent not only towards us but to herself as well. I sometimes look forward to putting her in a nursing home and forgetting her. I want someone else to have to deal with her. I feel like I am alone in her care because both my father and brother cater to her whims to keep her from turning on them or trying to hurt herself. The rest of the family treats her like a family joke, something to be made fun of or joked about. My efforts to try to help her are met with violence from her and sometimes resistance from my family because they don't want to deal with her. She goes to many different doctors to get pills or try to make them cut on her, sometimes causing injures or infections to get them. When a doctor catches on she stops going to them and says the spies got to them. She thinks that the spies have put things in her body to cause cancer, which she claims to have but has never been diagnosed with. She had all of her teeth pulled because she thought that there were spying devices in them. A lot of the doctors are just out to make money!

I live in fear that I will turn out like her. I question everything I do and even when I am sick I don't like going to the doctor because I worry that it's all in my head. I fear that I will also get mental illnesses as bad as she does. I know I have severe O.C.D. I have a bad fear of germs that I try to hide; I have to have things specific ways or I become anxious. I know these are caused from her telling me growing up that I would die from germs. My first relationships were with men who were abusive and treated me just like those I saw her date. Because of those abusive relationships I have developed P.T.S.D. which causes the O.C.D to become worse. I am extremely detail focused to the point of scrapping entire projects to start over again due to one tiny flaw. 

This is why I am a strong advocate for proper mental health care, correct diagnosis, and strong support. Without those the mental health and well being of the individual can deteriorate to a point where it can not be helped easily. When a person has a mental illness it not only affects the person but those around them as well, especially children they may have. Mental illness needs to be properly cared for not only by the individual but also by those around them because sometimes the person isn't aware of their own actions. It's not something to be hidden or treated like a family shame. It takes the entire family to support the person and assure they take care of their own health and take their medicine properly.

-Anonymous

The Two Sides of Depression

 I was going to work on my current article tonight since I'm so behind on updating the site, but I can't focus on it because of all the emotions welled up inside of me. The last two days have been dreadfully hard, as severe depression has made me unable to cope with the world around me. I guess this deepest realm of depression leads to paranoia in my case, because I have felt largely criticized and verbally attacked by my closest loved ones. And that hurts. Whether I am overreacting or not, the pain is real, and I ache to be loved and accepted right now.

Why is it when we need comfort the most, it's so hard to come by? I have my suspicions of why.

What people who have never experienced severe depression don't realize, is that the pain we are feeling can't be easily vocalized. It is difficult to convey what we need; often we don't even know! Usually, I just want someone to hold me while I cry. But do you know how weak and needy that makes me feel? "I want you to hold me." Those words to my significant other can scarcely birth themselves from my lips before I begin to feel guilty and stupid and ashamed for even asking. And it's not that I don't get held in reward for these terribly difficult words, but always in the back of my mind I wonder if he has any inkling to how much I am hurting. Does he really want to hold me when I am like this, or is he just doing it out of duty? I feel guilty for even wondering that. I am grateful for the human contact, the sincerity I receive from him, but even so, I know nothing can really take the hurt away until this awful depression passes. He knows it too. The holding never lasts as long as the ache does. How can it; someone has to carry on, and it's always him who has to hold down the fort until I am well enough to do my share again.

Depression makes us vulnerable to criticism and anger from others. "Why can't you just..." "You're being lazy/selfish/immature."  "Why don't you get off the couch and go take a shower." "You're bringing me down with you."  And of course we aren't trying to make life harder for our loved ones. Most of us are not after attention or special treatment. We aren't making excuses for our lack of participation in daily living. We just really can't function. And that very fact makes us feel worse. Tack on the outside criticism, the impatience with our behavior, the frustration, the nagging, the yelling, the resignation to even care anymore...sometimes the ones who supposedly love us can be our worst enemies in the fight against mental illness.

I sometimes try to picture myself with my loved one's point of view: she hasn't showered in days. She's been wearing the same clothes and her hair is oily. She has no energy. She appears to have no will to do anything. She's behind on housework, barely interacts with the baby, and randomly bursts out crying for no reason. I would try to help her if I could but she seems to be pushing me away and sinking deeper and deeper into her own little world. I'm afraid if I get too close she will pull me down with her. I'm angry because I want to make her feel better and I can't. I'm powerless to stop what's going on with her. I wish she would just snap out of it and go back to being the woman that I love.

Now, I'm no mind reader, and I don't know what is really going through his mind when I get so bad off, but I imagine I'm not too far off in my assumptions. Chances are, your loved ones have a similar point-of-view. Bottom line, depression is a trial for all of us. Going through it, and watching someone we love go through it, both take a toll on one's mind and body. If your loved one will agree to go to therapy with you, or even to their own separate therapist, it could be very helpful in reconciling what each is feeling and how to work together for a successful recovery. Beyond anything, when I am depressed, I want to know I am cared for and that I am not alone. I don't want to be abandoned. In that most unbearable hell, stuffed with bad thoughts and insecurities, I want to know I have a hand to hold throughout, and that when I reach the other side again I will have people that welcome me back to the world of the living with open arms and no lingering disfavor.

*Pub YCN* Contrasting Features of Infant Feeding Methods: An Examination of Distinctions Between Breastfeeding and Formula Feeding

The topic of infant feeding is a prominent one among parents. Browse the baby aisles of any store and you will find a wide array of infant formula ranging in price, dietary needs, and brand. Each brand promises to provide excellent nutritional sustenance comparable to that found in breast milk. In today's busy world where mothers often rejoin the workforce weeks after the birth of their child, formula offers the convenience of not being tied down to baby or breast pump. On the other end of the spectrum, however, research consistently affirms the benefits of a mother's milk outweigh those found in even the most advance formula. Parents struggling to make the best choice for their baby must carefully evaluate many aspects of each option before making a decision. The preference to breastfeed or formula feed is largely influenced by contrasting the financial, social, and nutritional aspects of each option. 

Anyone who has children can vouch for the fact that babies cost money! Economic factors make providing for the needs of infants quite a hardship, especially for lower income families. For this reason, many parents look for ways to save money during the infant stage.  Apart from disposable diapers, formula is one of the most expensive costs during the first year of life. Since many babies can only tolerate certain types of formula, generic forms may be out of the question. Furthermore, there are purchases to be made such as bottles and nipples. Breast milk is an ideal option for some families, as it provides a healthy, virtually free food for babies. Related expenses to be considered include nursing bras, nursing pads, topical cream and other products intended for the care of the nipple area, special nursing pillows, and lactation consultant services. In some cases, nipple shields are necessary to assist a child who has difficulty latching on. Despite the cheaper method of breastfeeding, this may be a harder choice for mothers who must return to work soon after their infant is born. Depending on their workplace, some mothers may be able to pump breast milk on their break and store it in the refrigerator until time to go home. This method requires a suitable breast pump and sanitary containers for storage. While new breast pumps may cost a few hundred dollars, hospitals and other health facilities usually offer rentals for little to no cost. Serving pumped breast milk will necessitate many of the items needed for formula feeding, such as bottles and nipples. If feeding costs exceed a family’s disposable income, the mother and child may be eligible to receive government assistance such as the Women, Infant and Children program (WIC).  It is relative to note that a large number of women receiving assistance from WIC opt to use formula rather than breast milk. “Scholars have suggested that the pharmaceutical company’s economic alliance with the taxpayer-funded WIC program may actually deter low-income women from breastfeeding because of the competing effects of the WIC program (which openly supports breastfeeding), and the pharmaceutical industry that prominently displays formula advertisements at local WIC centers, and routinely distributes free formula to low-income women”

(Chatterji & Brooks-Gunn, 2004; Stolzer & Zeece 2006). Whether a mother has reason to fret over the financial aspect of infant feeding plays a big role in how acutely her decision is swayed by cost factors. 

While costs are not a prime issue for every family, the social reaction to different methods of infant feeding impacts nearly all mothers in one way or another. The American Academy of Pediatrics  recommends breastfeeding as the healthiest choice for an infant’s first year of life. Some doctors and breastfeeding advocates use this information to urge mothers to choose breastfeeding despite the mother’s personal beliefs or feelings on the matter. Consequently, mothers may often harbor feelings of guilt regarding their choice to formula feed. On the other hand, mothers who do decide to breastfeed may be judged unreasonably for breastfeeding in public. Despite laws protecting the rights of breastfeeding mothers in many parts of the world, the public can create an uncomfortable atmosphere by staring, expressing loud, inappropriate comments, or even confronting the mother about moving to a private area to feed her child. Unfortunately, not every public place has a discrete area for mothers to feed their children. It is for this reason that many mothers will choose to pump milk at home to feed to the child on outings, or to formula feed. “Women are simultaneously encouraged and discouraged by societal expectations regarding breastfeeding. The message seems to be ‘The ideal mother breastfeeds, but not if we have to see it’. It sets up an impossible situation where women feel negative emotions about their feeding choice, regardless of what that choice is” (Guttman &  Zimmerman 2000).

Despite years of perfecting the components of formula, there are still differences between it and breast milk. Breast milk contains the perfect amount of nutrients for baby; specifically, each mother makes the perfect milk for her own baby. Her milk will change and adapt to accommodate the precise nutritional needs of her own child. “There are reported long-term benefits for the child such as immunity and a decreased risk of metabolic syndrome and obesity. There is also the suggestion that the cognitive development of breastfed babies is superior to artificially fed babies” (Savino & Lupica  2006). In addition, breast milk contains infection-fighting antibodies not found in any formula. Some babies have difficulty tolerating the synthetic nutritional components of formula, which can lead to gastric distress and, in more severe cases, malabsorption. Generally, the mother’s milk is more easily digested and absorbed by baby. Nutritional content of formula depends highly on the proper preparation and amount of formula given. The guidance of the child’s pediatrician can help ensure that baby is receiving the adequate type and amount of formula for exact age, weight, and individual needs. 

The choice to breastfeed or formula feed is rarely based on a single consideration. Rather, each aspect of infant feeding must be weighed carefully in effort to make a well-informed decision. Aside from all evidence related to determining the most beneficial choice in infant feeding, deciding whether to breastfeed or formula feed remains a personal right of the parent, and may be persuaded through examining the distinctions between each option in order to form an educated opinion on what is best for parent and child. Undoubtedly, the financial, social, and nutritional aspects of each option play a role in the decision. 

*Please note that several medications, psychiatric or otherwise, are unsafe to take while breastfeeding. Speak to your doctor about your options. Often, the same adjustments that were made to your medications to accommodate pregnancy will work while breastfeeding, but not necessarily. Lithium, for instance, may be assumed safe by your obstetrician during pregnancy, but not while breastfeeding. Do your research and ask your health provider what may work best for you. 

 -Amy Purdy

References

Guttman, N., and Zimmerman, D. R. (2000). Low-income mothers’ views on breastfeeding. Social Science and Medicine, 50, 1457–1473.

Savino F, Lupica MM (2006) Breast milk: Biological Constituents for Health and Well-being in Infancy. Recenti Prog Med. 97(10):519–27

Stolzer, J. M. (2010). Breastfeeding and WIC Participants: A Qualitative Analysis. Journal Of Poverty,  14(4), 423-442. doi:10.1080/10875549.2010.517081

Alcohol and Bipolar Disorder: A Cocktail For Disaster?

I rarely watch television, but since I was feeling a little blue last night I flipped on the tube and settled on watching a couple of sitcoms for some comedic relief. In the course of one hour's viewing time I witnessed at least five beer commercials. I finally had to turn the TV off because it was making me crave a beer something fierce, and I was seriously considering breaking into the cooking wine, since there is currently no beer in the house.

As you may well be aware, substance abuse is fairly common with sufferers of mental illness. While I personally don't see anything dreadfully wrong with an occasional drink to let off some steam, great care must be taken in making sure it does not become a habit that you depend on. It is also important that you make sure alcohol does not interact dangerously with your medication. In addition, since alcohol is a depressant, it can often worsen your symptoms. Another risk is the loss of inhibitions, which can be especially detrimental in the already unbridled territory of mania.

Ranking only second to caffeine, alcohol is a wildly consumed psychoactive drug. While caffeine is often consumed for its get-up-and-go effects, people choose alcohol for many different reasons. It's the legal drug of choice at many celebrations. It is also a quick fix for the the ailments of stress, depression, and anxiety. If I have a social function to go to I often will drink a small amount of alcohol before I go because it loosens me up enough to reduce the chance of a socially induced panic attack, and allows me to actually enjoy the company of others. It is tricky business, mind you, to drink just enough to cope with the anxiety but not enough to appear like I have been drinking. I have been known to show up at a family Christmas get-together quite sloshed. I would not recommend doing it that way, as it is embarrassing for all involved!

The following illustrates the effects of alcohol more specifically:

Published on DrugsAlcohol.info (http://www.drugsalcohol.info)

Blood alcohol concentration (BAC) is usually recorded in milligrams of alcohol per 100 millilitres of blood. This can be shortened to milligrams percent, written as mg%.

One unit is equivalent to 15mg% for an average man and 20mg% for an average woman.¹

BAC	Effect
20mg%	More relaxed, pleasantly calm, a feeling of well being.
30mg%	More talkative, losing some inhibitions, risk of accidents starts to increase.
50mg%	Carefree, inhibitions going fast, judgement beginning to be affected, decision-making skills start to deteriorate.
80mg%	Hand-eye coordination markedly diminished, accident rate doubled.
100mg%	Obvious deterioration in physical and social control, clumsy and emotional.
160mg%	Swaying and slurring, obviously drunk.
200mg%	Some staggering, double vision and perhaps vomiting.
300mg%	Grossly intoxicated and semi-comatose.
400mg%	Unconscious and unable to arouse, breathing shallow, cough reflex lost, high risk of suffocating on inhaled vomit.
500mg%	Death likely from paralysis of breathing.

References

1. National Health and Medical Research Council. Australian Alcohol Guidelines: Health risks and benefits. Canberra: National Health and Medical Research Council, 2001.

And here's a nifty little calculator to determine what impact your drink of choice may have on you  BAC Calculator

While mild to moderate alcohol consumption can somewhat assist in uplifting mood, reducing stress, and facing social obligations, there is a thin line between a healthy amount of drinking and substance abuse. Not only is alcohol dependence harmful to physical health (say goodbye to your liver), but it can wreak havoc on your home life and job performance, and can also delay recovery and even worsen psychological disorders.

Generally, drinking is not the greatest activity for someone with Bipolar Disorder, as it can trigger depressive episodes and increase the severity of other symptoms associated with the illness.  Neurological effects of alcohol in a patient with Bipolar Disorder can make treatment more difficult, thereby delaying recovery from depressive or manic episodes. Moreover, alcohol use affects sleep patterns, preventing your body from reaching the deep REM sleep stage that accounts for the most beneficial duration of rest. Adequate sleep is essential for mood management in Bipolar Disorder. There are also serious dangers to mixing alcohol with psychiatric medications. Here you will find a list of common interactions associated with alcohol and certain prescription drugs: Alcohol-Medication Interactions  Speak to your doctor about whether drinking, of any amount, is safe with your medications.

Studies conclude that women with Bipolar Disorder are seven times more likely to become alcoholics than those without the illness, and men with Bipolar Disorder are three times more likely. According to researchers from the University of California at Los Angeles, "Men with bipolar, who are alcoholics, most often had a family history of alcoholism, bipolar disorder and drug abuse when compared with nonalcoholic bipolar men. Alcoholism among bipolar women, however, did not stem from family lineage. Their addiction had more to do with anxiety and depression". It is important to understand why you drink, and to prevent it from taking over your life. Like any addiction, the dependence on alcohol can be a gradual development that you are not aware of until it has become a problem.  To examine your drinking habits and determine whether you may need help, fill out this Alcohol Abuse Questionaire.

In closing, only you and your doctor can decide whether a little innocent bubbly will be a safe venue for enjoyment. If the doc gives you the okay, then remember to drink responsibly and DON'T DRINK AND DRIVE!

-Amy Purdy