I've migrated over to a Wordpress blog because I wanted full blogging features. And I wasn't getting much done this afternoon anyway.

You can now find the new and exciting (or not-so-exciting) stuff over here: http://disorderlychickadee.wordpress.com

Posterous, by the way, didn't make that easy. I ended up using someone's nifty online XML extractor, and then hand-pasting each post into Wordpress. On the plus side, it only took about an hour, since there were only 25 posts.

I'm putting this up as my forwarding address, and I'll also update the one and only place that I know of that has this blog on the roll (another thing Posterous doesn't do: decent stats!)

Oh yeah, for anyone looking at your own Posterous stats, they're WRONG. They include your own pageviews, and add something like 3 page views every time you adjust a theme. Not exactly what you expect them to represent. Silly, no?

I've been pretty quiet on the blogging front recently for a very good reason. I'm writing my dissertation. This is not to be confused with "oh yeah, I'm sort of working on writing..." because it's actual productive this-is-the-real-thing writing.

This is a not-so-minor triumph of modern chemistry. At this time last year, I was stuck in a depression, combined with a hectic travel schedule, which meant I didn't get any real work done for about 4 months. It was extremely stressful to be unable to produce much of anything. It was one of the reasons I kept trying to get help even though I was feeling fine in the summer and fall. I just couldn't afford another cognitive shut-down like that if I was to graduate this year.

But now the meds seem to be really working and I've been pretty stable since the last round of changes more than a week ago. Even before that, I was starting to ramp up the writing activity. I'm breathing a huge sigh of relief. I have exactly two months to finish my dissertation manuscript. I still have three chapters to revise and three to write from scratch, but the fact that I've gotten two cases written up is making me optimistic about being able to meet my deadlines. I literally wrote a 35-page paper last week.

This productivity definitely isn't hypomania, which I wouldn't mind except that it increases my distractability so that I feel like I didn't take my ADD meds. There's no euphoria, and I'm not overly emotional in either direction. I'm not twitchy or somnolent. It's all pretty good, if less intense than I'm used to.

Spending 10-12 hours a day writing is extremely draining. I'm absolutely exhausted most of the time and even though my sleep habits haven't changed a bit, I'm much more tired. After that kind of intellectual work, I just want to veg out every evening. So that's what I'm doing - just watching TV with my hubby, knitting a little, and still staying sober.

It's not very dramatic, exciting, or glamorous, but it's a really nice change of pace for me. Here's hoping it sticks!

I decided to move this blog over to Wordpress because the features are better for supporting blogging rather than occasional "throw stuff up on the web" postings. However, the Posterous importer for Wordpress is currently broken, so I'm waiting on them fixing their importer. It's a good thing I have a lot of work to do right now, or else I'd move it manually out of impatience, and that would be a silly thing to do.

Anyway, when that happens, I'll post something to let folks know where the action is at.

In the meantime, I've increased both mood stabilizers and antidepressants. I just wasn't doing very well on the lower dose of antidepressants. Since then, things have been going pretty well! I've been mostly functional, despite the headaches that come with dosage changes - Wellbutrin in particular seems to give me headaches for a long time when upping the dose. But it'll go away eventually.

Of course, I have no faith at all that this is going to last. It never has before, after all. If this round of med changes follows the prior pattern, then I'll be down in the dumps in another week, crying for no reason, and struggling to work. If that doesn't happen, then I'll be thrilled!

I have an appointment with the PA at the psych's office tomorrow, and I suspect I know what the outcome will be - no immediate changes, but permission to up the Lamictal to 200mg if needed in another week. And maybe a small increase in the Adderall dose. I can tell it's wearing off a little earlier than I'd like, but this XR formulation is about a million times better than the immediate-release version in terms of managing inattention throughout the day. I'm also betting that they'll have me do a urine test, since I was already given an extension on that. I've only been completely clean for two weeks, so it'd come back positive, so hopefully they're looking for improvement over baseline rather than a negative result...

Another little improvement that I haven't wanted to mention lest I jinx something is that the meds changes are altering my appetite, for the better. I'm no longer hungry all the time, and I'm not binge eating; combined with quitting pot, I've cut my intake way, way down. Not to unhealthy levels or anything, but actually much closer to normal! The net result so far is that I've lost a few pounds while being more sedentary than I've been in months. I'm not constantly eating too much because I'm not hungry all the time. Hurrah!

I'm trying to take full advantage of this period of relative stability and cognitive functionality by working my little brains out. I have big ugly deadlines looming, so this is making a huge difference in both getting stuff done, and feeling like it's actually possible to finish in time to meet the hard deadlines. Here's hoping, anyway.

I'm not really mad (am I?), I'm just using provocative blog post titles because it entertains me. This is a long one, but the back story here provides some context for the rest of my musings on this blog.

Once upon a time, when I was 13, I was diagnosed with clinical depression. I self-harmed from age 12 to somewhere around age 22, mostly cutting but eventually also burning, which involved less mess and more pain that lasted longer. That's what landed me in the psych's office: my mom got suspicious and read my diary, which I resented for years but realize was a perfectly appropriate thing for her to do under the circumstances. I never kept another diary after that.

I went to therapy for awhile, which did little good because I was resentful and pretended my way out of it. I was on antidepressants for awhile as well - ye olde fluoxetine, since Prozac was the hot new thing at the time - but I can't recall anymore exactly how long that lasted. The depression never left. Despite the treatment, I kept on hurting myself worse and worse, and have some pretty ugly scars to this day.

I eventually made a couple of suicide attempts that I managed to hide well enough to stay out of the mental hospital, of which I was terrified. I never told anyone that I had tried to kill myself until many years later. Although I was scared of my worsening self-destructiveness, I was even more afraid of what would happen if I admitted to it. I also got arrested as a 9th grader, which retrospectively suggests that I was already having bipolar symptoms in high school, as the kind of trouble I got into was entirely against my usual nature, and is textbook typical of bipolar disorder. But it was so occasional that no one took note.

Manic symptoms really started to emerge when I began my undergraduate studies, but I had no idea just how abnormal my moods and behavior were because I hadn't felt "normal" since I was about 11. I thought I was just being an average college student, with weeks of all-nighters (no speed involved) and wild partying. Just like everyone else, right?

The periodic suicidal moods were clearly not normal, of course, so I went back on antidepressants. After an antidepressant triggered psychotic symptoms when I was 19 (when completely sober, and before ever trying illegal drugs) I went running for help - hearing voices when no one is there is scary! The professionals were utterly dismissive of my best guesses as to what was wrong, and told me there was no way I had either Bipolar Disorder or ADHD. They literally said that even if I did have ADHD, I had figured out how to compensate by now, and didn't need treatment. Despite the fact that my academic performance was suffering mightily and I was extremely distressed and unable to keep up with classes. Nincompoops! They also ruled out schizophrenia (apparently I tested positive but my responses invalidated the results), and simply scratched their heads when they couldn't really figure out what was wrong, so I just kept changing antidepressants to little effect.

I didn't know any better at the time, so I believed them, and things just kept getting worse throughout college. I couldn't articulate my symptoms very well because I had lived with them long enough that I didn't realize most of them actually were abnormal. I was manic a lot of the time. Despite being a genuinely good kid who would never normally do these things, I was very promiscuous and screwed literally anyone who would let me in his or her pants, racking up an embarrassingly long list of sex partners. I was binge drinking up to a fifth of hard liquor a night on weekends - until I discovered pot, that is, and started trying hallucinogens. I held up to three jobs at a time to try to keep up with my senseless and excessive spending (which took years to pay off), had wildly inconsistent academic performance, and got arrested again, but this time was charged as an adult.

I was completely out of control when I met my husband, but by some miracle, I still recognized that he was The One. An even bigger miracle was that he didn't think I was too crazy to tolerate! I managed to finish my BA (just barely), moved in with the boy, and life settled down almost immediately. I strongly believe that this was a literal lifesaver - I was on the fast-track to annihilation, but adapting to my husband's very normal lifestyle really helped my symptoms subdside. The relief was also due in part to a switch in medications to Welllbutrin, which doesn't turn me into a raving nutball like the other antidepressants did.

Shortly after that, however, I found myself unable to handle a normal work environment, and was diagnosed with ADHD (vindicated!) The meds made such a huge difference in my life that I can't begin to describe it. Just pop a couple of pills and normalcy ensues, or at least that's how it seemed. With newfound confidence after the trainwreck of undergrad, I enrolled in graduate school, zipped through my MS program with flying colors, and got early admission to the PhD program of my choice. Everything was going so beautifully. I was hypomanic.

We moved from our home state to New York, and suddenly, everything was not OK. The stress of the move, buying a house, starting a new (higher pressure) degree program, and losing my entire in-person social support network was really hard to handle. I started having panic attacks that I wouldn't admit were panic attacks. I started describing my condition to the prescribing doctors as depression and anxiety, despite a lack of diagnosis for the latter, because the anxiety had gotten so severe.

I also started traveling a lot, and with that, began noticing this bizarre pattern: for no reason I could fathom, I would hardly sleep during the entire trip but felt beyond fantastic even though my eyes were burning for lack of rest. I would drink like a fish in the desert (far in excess of my normal tolerance), became the life of the party and was suddenly full of sparkling wit. I had truly brilliant insights into my research and amazing mental clarity.

When I got home, I'd immediately crash into a depressive period, but I easily rationalized away all these strange symptoms. It was just the excitement of travel, the stimulus of social interaction and heady intellectual dialogue. Eventually I started to notice that anyone keeping similar hours was suffering mightily from the lack of sleep - but not I. Still, no alarm bells were ringing. Clearly I just didn't need as much sleep as they did, and could operate at a substantial deficit for a week at a time without much trouble. It was so much fun!

During a visit to our home state over Thanksgiving in 2010, a close friend disclosed her recent diagnosis of Bipolar II and the resulting changes to her life. The symptoms she described made my neck prickle and hair stand on end. She could have been describing me, save for some specifics. I was suddenly terrified, like all the self-diagnosing hypochondriacs out there, but after doing a little research of my own and thinking back over the insanity of my college days (yeah, that really wasn't normal) I decided it was best to rule this out as a cause of the problems I was experiencing. Back to the mental health professionals...

It was a messy, long, difficult, confusing process that took almost a year and involved no less than 5 separate psych evaluations, but eventually I started to believe them when they kept telling me I was bipolar. For the record, it's officially bipolar II. In some ways, the diagnosis was a huge relief; there was a real, valid reason I was feeling so awful and strange, and why the depression wouldn't go away even at the maximum dose of the only antidepressant that had ever worked. Suddenly my entire life made so much more sense and I realized that I wasn't to blame for a lot of my intermittent "bad behavior" because I was simply off my rocker at the time and had no comprehension of the fact that I was doing really stupid things.

In November of 2011, at age 33, they finally convinced me that I needed to accept the diagnosis and make some significant changes. I started mood stabilizers, started therapy, and was re-diagnosed with ADHD via the CPT II test. So far, the meds are helping - going back on ADHD meds makes a huge difference yet again; I had only stopped taking them to rule them out as a cause of mania, which was clearly not the case when I continued having ever more severe mood swings. The Lamictal also seems to be doing something good for me, as symptoms that I (yet again) didn't realize were symptoms have improved dramatically already. I'm not yet stabilized, but getting there.

Although I still question my diagnosis at times - this is still pretty new for me, despite spending a year trying to disprove the hypothesis - I just look back at the last year of mood charts I kept. I'm a scientist and data geek at heart; I would never fake data, and looking at those charts, running correlations and F-tests, makes it impossible to deny. As I learn more about bipolar disorder and the meds start addressing symptoms that I had believed were just the way things are, I realize that there is no error this time. It took more than 15 years from my first manic symptoms to a proper diagnosis, but I finally have hope for a more stable, saner future.

Bipolar people tend to have problems with substance abuse, with much greater frequency than other mood disorders. The usual statistics bandied about suggest that around 50% of us end up with alcohol or substance addictions, often due to self-medication to alleviate symptoms (usually prior to starting treatment). Count me in.

I've smoked pot for over 10 years, and after starting grad school for my MS in 2005, I started drinking again. Previously, I drank in undergrad for a few years but gave it up entirely in favor of pot. I didn't want to admit it to myself or anyone else, but the alcohol was really becoming a problem in the last year or so. And the pot is/was definitely an addiction, even if not a dependency, because although I know that it's not good for me, I'd keep doing it and never wanted to stop. It contributed to binge eating (already a problem with my bipolar depression) and it's technically a depressant, so you know, that's obviously not so smart, is it? But it was one of the only things that let me relax and would reduce anxiety enough to keep going

Note that I just said "was." My psychiatrist is requiring that I give it up if I want the ADHD meds and will be enforcing it with urine tests. I'll skip the extended rant about how extremely pissed off I am about being coerced by the threat of withholding meds that I really, really need. Honestly, I need the ADHD meds even more than the pot. And logically, it's a really good idea to get myself stable on meds without the interference of other psychoactive substances before screwing around with the mix.

So. As of December 27, I stopped smoking pot. It's a matter of self-control; I've done it before, and I can do it again. It's not actually that hard for me (some addiction, eh?) but it has been more of a struggle this time on the emotional level, because it's an indefinite but probably extended abstinence from something I really enjoy and it's not something I decided that I want to do for myself. I'm not "ready" to quit, but I don't have a choice.

And here I am, 4 days sober from pot. I don't like it. I got over the withdrawal after a couple days of extreme irritability that makes me rant like crazy, but my moods drop substantially when I don't "abuse" pot and alcohol, even when I'm on meds (and yes, I'm 100% compliant.) I've only tried abstinence during winter months when my moods are already lower, however, so I can't claim causality since I haven't controlled for seasonal variability. The last time I gave up both pot and alcohol at the same time for a month was February of this year. It was horrible. I was on a jacked-up dose of antidepressants and no ADHD meds and no mood stabilizers, so that probably had as much to do with it as the sobriety (and I still resent that damn psychiatrist so much.)The biggest thing I've learned from all of this is that it's a really bad idea to make more than one or two major changes at a time, because it really screws me up.

Anyway, at the time I wrote a blog post called "Sobriety Sucks" but in a fit of insanity, deleted everything on this blog. I still think sobriety sucks. I still can't relax. My anti-anxiety meds are a joke; they're less effective than pot, and the side effects are a lot worse. The psychiatrist won't give me benzos, so I'm stuck with this and "hot baths" which I don't take because they don't work. Sorry, I've written off all the Internet's brilliant wisdom when it comes to suggestions of things to do to relieve anxiety other than drugs, because they don't work. The only reliable solution for me is backpacking, and that's really not going to happen in the middle of the winter when I'm trying to write a dissertation. But I've tolerated this crap for so long that, well, what's new? Other than immense, ever-increasing stress from swiftly arriving dissertation deadlines. <insert instant panic attack here>

I'm still trying to take it real easy on the alcohol, but that's a story for another day.

When I first started going to a psychiatrist to be evaluated for bipolar, my husband said he couldn't see it. He's always known about my depressive episodes - I've been on meds for that for over 20 years. I told him that of course he didn't see it, because the manic symptoms have always been at their worst and my behavior at its most abnormal when he's not around. The milder hypomanias don't seem all that unusual to an observer, either.

As I've started treatment and began being much more open with him about my emotional state, he's been incredibly supportive in his typically quiet way. But I have to give some serious props to my husband for a brief conversation last night, paraphrased:

Me: "Why do you put up with me?"

Hubby: "I'm not putting up with you. I love you."

Me: "But I'm so distractable and moody and I don't mean to be so difficult..."

Hubby: "So?"

Me, tears in my eyes: "Sorry I'm sad for no reason."

Hubby: "You're sad because your body is messed up. That's a reason and it's not your fault. I love you anyway."

That is what love, support, and acceptance looks like in my house. Pretty amazing, right?

I figured out the connection between womanly hormones and mood a long time before my bipolar diagnosis. About 4 days before my period, everything makes me cry. Good or bad, funny or sad, everything makes me feel on the verge of tears, and they'll spill over a few times - but no crying for no reason (there's always something that triggers the tears) and no crying jags. It's really not all that bad; one day a month during which I feel everything very intensely is pretty tolerable. It's a million times easier to handle than my bipolar mood swings, and I can definitely tell the difference.

I track my cycles so it's actually pretty darn predictable. But it still surprises me every time. I have yet to start marking my calendar with a note to expect a little mood disturbance, and maybe I should. The best way I've found to handle these particular moods is to just take it easy for the day. That's much easier to do than handling bipolar mood swings, because I have no idea how long they will last or how severe they will become.

PMS is (generally) tolerable, temporary, and caused by changes to estrogen and progesterone levels. Estrogen is one of the strongest mind-altering drugs out there. Estrogen affects mood-related neurotransmitter production and uptake, endorphin production, and acetylcholine, the neurotransmitter related to memory. Progesterone can cause anxiety, irritability, and depression when out of balance with estrogen. And some bodies are just more sensitive to the same hormones than others.

Bipolar disorder isn't nearly as well understood, but involves all the same symptoms and neurochemicals as the whole estrogen and progesterone thing. And then some. Of course, we don't really have much scientific knowledge about how female hormones play into the mix for bipolar brains. There is no equivalent of hormone replacement for bipolar disorder.

What I can report is that when I'm depressed, PMS makes it worse. When I'm hypomanic, PMS shifts my mood toward irritability, which is usually the downward spiral out of a hypomanic episode anyway. Today's an irritable day, but since I know PMS is playing into it, I have genuine hope for a better day tomorrow. I really can't afford much more lost time.

Everything has been going OK. Not awful, not great. Just OK. And I should be grateful for that, right?

I've had meds adjusted yet again. More Lamictal and different ADHD meds (back to Adderall, hurrah!) At this point, I'm really hoping the cocktail of drugs is getting to be somewhere in the neighborhood of "therapeutic levels" but we'll see. Just as with the last few Lamictal dosage increases, feeling good initially fades off into not-so-great after a few days, so I may still need to increase that dosage a bit further.

But I've been functional! This is very good news indeed. Thanks to the ADHD meds, I'm finally able to keep on task long enough to really get things done. Thanks to the mood stabilizers, my brain is not ricocheting between mood states so fast and hard that I can't think straight, and I'm finally able to get some real work done. It's a massive improvement and I'm relieved, grateful, and hopeful.

Admittedly, however, I'm not real thrilled with where everything is at just now. I'm feeling a bit emotionally flat, which is not enjoyable. Maybe this is normal - no extremes of mood, just floating somewhere in the middle. It's uncomfortable, unfamiliar, and I don't really like it. For a few days, the last Lamictal increase had me on the edge of hypomania; just a few symptoms popping up and making me crave that high so badly I could just about scream. It's a vicious tease to be within sight of hypomania but unable to get there.

Overall, it's an improvement. I'm not sure if this is how it's supposed to be, though, or if there's better to be had. I have always tended to settle too easily when it comes to meds. Once things are "good enough" - typically just barely better than whatever came before - then I leave well enough alone. Which is why I took antidepressants for years and was still depressed, for example. So I guess that will remain to be seen.

In the meantime, there was a holiday. It was much like any other weekend at my house, except that I took the whole day off for Christmas. But now I'd best get back to work.

I was doing so much better last week that I'm massively disappointed to feel so rotten all over again. Anxious, depressed, tearful - my therapist even said that I seemed "fragile" today and that usually I seem strong despite my mood. I did manage not to cry during the session, but it looks like I'll be crying on and off all day again. Damn, I hate this.

I agree with my therapist. I feel like I might break. Crying for no reason will do that. So the advice today is to get a little work done and then take it easy on myself. Easier said than done, on both counts. He said I really need to be firm with the doctor tomorrow about what I need, e.g. stronger stuff for both ADHD and anxiety.

My therapist also said that I need to emphasize that I'm under extreme work stress in addition to the mood swings and usual bipolar stuff. I'm afraid of seeming like I'm drug-seeking, but I'm going to try. Ironically enough, it hadn't even occurred to me that a dissertation is a huge cause of anxiety and that anyone would be stressed out by this!

I've chopped my work down into little tiny bits and I just want to get one small chunk done today. I'm not even going to try for two. I need to finish this chapter this week, and the fact that it's taken a month longer than expected is really, really freaking me out. I'm fast arriving to the point where I might not actually be able to finish "on time." But I can't even think about that right now, or I'll totally freak out and get nothing done at all!

The sun is shining this morning and I should feel good about that. I don't. I just feel worse because the sun is shining but I want to crawl back in bed and cry myself to sleep. So I keep telling myself it will get better, and trying to believe it.

I used to take three tabs of the same pill each morning (Wellbutrin XL). Just a little something to make sure everything works upstairs. Now I have three daily prescriptions (total of 5 tablets) and three supplements. It seems like a lot to swallow, and a big change.

From left to right as shown in the picture, I have an Omega 3-6-9 gelcap, because studies have shown that Omega-3's are good for bipolar brains. Then I have a B-complex with Folic Acid, because my meds tend to deplete that vitamin, and it helps with mood and brain function anyway. Next, Vitamin D-3, another one that supports mood in general, and offsets depletion from meds.

The rest are prescription drugs. The next pill in the picture, the short buffy colored one, is (generic, they're all generic) Concerta 18mg (methylphenidate). Not all that helpful for me in this small of a dose, sadly. Next, a Wellbutrin XL (bupropion, budeprion) 150mg - down from 450mg, which is the max dose. Finally, 3 tablets of 25mg Lamictal (lamotrigine), which is the one that I consider "magical" at this point - it's really making a positive difference. I swear it is. Just not quite enough to keep me stable as yet...

Bipolar people are well known for having problems with medication "compliance," e.g. going along with all the pills getting shoved down your throat. And it can be hard to accept that you need them forever. Much less that you need them at all, in those periods when you feel relatively normal. I've been getting rather curious how I'd feel without the meds. It's been so long -- at least 15 years -- since I was off psychoactive meds for more than a day or two at a time, and I don't know what I'm like without the drugs. So I guess I must be feeling relatively better, if I'm getting the idea that I don't really need the chemical enhancements (because let's face it, I do...)