I, Too, Have Lost My Voice

In a seemingly ironic twist of fate, not only is my mother without words, without speech due to her stroke, but now I have fallen prey to an upper respiratory infection (cold or what have you) and cannot speak – well at least doing so hurts my throat.

So, I lay in bed bored wishing I felt well enough to do Christmas shopping which I have put off. I’m a terrible holiday shopper. I started to shop online. While that works for much stuff, I know that I can find cheaper clothes for my son and other family members at the local Target, Walmart or TJ Maxx. So, I hope that I feel better in the next day or two to do my shopping before Christmas sneaks up on us.

Meanwhile, I feel guilty that my mother is psychiatrically hospitalized. I have not visited, for two reasons. The last time I visited her at stroke rehab she became quite agitated and refused to get out of my car. Even if seeing me didn’t upset her, I am sick and her immune system has been compromised not just by age but by three decades of fighting lymphoma. An upper respiratory infection could literally kill her.

I should nap, but find it difficult to do so. Worry that I won’t be able to fall asleep at night if I nap. But I am sick (and tired), so I should rest.

Do NOT Smoke!

American Lung Association | Freedom From SmokingFirst of all I hope and pray that I am able to emotionally support my husband as he experiences grief, having lost his oldest brother last week to lung cancer. Grief, anxiety, and the fear of loss is what prompted me to begin writing this blog back in September 2013.

American Cancer SocietyMy husband benefitted from visiting his brother before he died. He was able to spend time with him and to come to terms with his imminent death.

DO NOT SMOKE. Please take care of your lungs.

Grief, Compassion, and Love

Grief can be the garden of compassion. If you keep your heart open through everything, your pain can become your greatest ally in your life's search for love and wisdom. -Rumi

Today my husband flew up to visit his brother who is at home receiving hospice care for advanced lung cancer which has aggressively metastasized. This post serves as a prayer for my husband, his brother, and the rest of their family. I’m at a loss for words.

This is also my second Writer’s Quote Wednesday 2015 post. Thank you Colleen Chesebro at SilverThreading.com for organizing Writer’s Quote Wednesday 2015.

Writer's Quote Wednesday 2015

Bipolar Disorder and Seasonal Affective Disorder

Spring has Sprung and the Birds are really Busy

Outside a cacophony of birds outside loudly pronounce that they have important work to do, nests to build, eggs to lay, offspring to bring into the world. Spring has sprung. The sun is bright. The season of rebirth is here. Hypomania is officially here, as well, folks. Yes, I have concurrent bipolar disorder and seasonal affective disorder. In spring, I ramp. Ramp I do indeed. Perhaps it’s a good time to visit my psychiatrist. Perhaps I do not need to take an antidepressant on top of my mood stabilizer now.

Near midnight, I resort to taking clonazepam to fall asleep. In fact, just one dose won’t do it at times like this. I lie in bed, then take a second pill, the bottle of which I keep bedside for just this purpose. I even chew the pills so that I don’t have to wait for my stomach to digest them. I want sleep. I need sleep. I beg the mucus membranes in my mouth to quickly absorb the medication into my bloodstream. Then, I lie in bed some more, mind hyper-alert, body fatigued, and finally go to the medicine cabinet to add melatonin and antihistamines to the mix, hoping that now I can somehow turn off that brain and rest. Past midnight, my mind is wide awake thirsting to get back online and work, which does not help, not at all.

To top things off, tomorrow – Tuesday morning – I have a Social Security Disability Mental Status Exam. Oh, joy.  Yes, I am anxious. Crap. Very anxious.

Worst of all and perhaps what I should have led with, one of my brother-in-laws is fighting for his life and perhaps losing the battle against lung cancer. He is still in his 50s. He is one of my husband’s two older fraternal twin brothers, both once Marines. My husband has always looked up to his older brothers and turned to them for advice on how to fix things. They looked out for him when he was a kid.  My heart goes out to my husband who is in great pain. Someone he loves dearly is dying, will be entering hospice care soon, and he can do nothing to fix it, to make his brother’s pain and cancer go away. I can do nothing to fix it. All we can do is love, pray, and reach out to share that love and those prayers.

September 2013, I started writing this blog when my father in law was hospitalized for sepsis. We almost lost him, but he is still with us today, thank God. Crisis, my inability to do anything to help with the crisis – aside from loving my husband and praying – triggered my hypomania then.

Now, a little technical know-how on the seasonal triggers of mood cycling:

Is seasonal affective disorder a bipolar variant?

Curr Psychiatr. Author manuscript; available in PMC 2010 May 21.
Published in final edited form as: Curr Psychiatr. 2010 Feb; 9(2): 42–54.

Seasonal affective disorder (SAD) is an umbrella term for mood disorders that follow a seasonal pattern of recurrence. Bipolar I disorder (BD I) or bipolar II disorder (BD II) with seasonal pattern (BD SP) is the DSM-IV-TR diagnosis for persons with depressive episodes in the fall or winter and mania (BD I) or hypomania (BD II) in spring or summer.1

Table 1: DSM-IV-TR criteria for seasonal pattern specifier*

Table 1: DSM-IV-TR criteriia for seasonal pattern specifier: A - A regular pattern of major depressive episodes (MDEs) at a particular time of year (such as fall and/or winter). B - Full remission or change to mania or hypomania at a particular time of year (such as spring or summer). C - 2 seasonal MDEs that followed the pattern described in (A) and (B) occurred in the past 2 years (and no nonseasonal MDEs). D - Seasonal MDEs substantially outnumber nonseasonal MDEs across the lifespan.

Table 2: Physiopathologic findings and clinical management for SAD vs BD

Table 2: Physiopathological findings and clinical management for SAD (seasonal affective disorder)  vs BD (bipolar disorder). Differences: SAD - May be unipolar or bipolar. Defined by seasonality. Light therapy and antidepressants indicated. BD - Increased risk of psychosis and psychiatric hospitalization. Most BD is not seasonal. Mood stabilizers indicated. Risk of switching states with light therapy and antidepressants. Similarities: Atypical depressive symtpom presentation. Highly recurrent. Predictable season of recurrence allows proactive treatment. Assess for mania and hypomania in both disorders. Light therapy requires clinical supervision. Psychotherapy may be beneficial.

Proposed mechanisms for seasonal affective disorder

Etiologic hypotheses of seasonal affective disorder (SAD) include:

  • photoperiodic hypothesis (shorter winter days cause SAD,a perhaps mediated by a summer vs winter difference in duration of nightly melatonin release)b
  • phase shift hypothesis (less available light in winter may lead to an inability to synchronize circadian rhythms with sleep/wake rhythms).c

Some case studies of rapid-cycling bipolar disorder (BD) suggest that mood is correlated with daily hours of sunshine and light therapy is antidepressant. Rapid-cycling patients may be hypersensitive to day-to-day changes in photoperiod, analogous to mood changes in response to changes in photoperiod across the seasons in SAD.d

Circadian phase delays–in which internal rhythms lag behind the sleep cycle–are correlated with symptom severity in BDe and are implicated in the core pathology of BD.f Phase delays also are present in some individuals with SAD and are associated with severity and treatment response.Preliminary evidence suggests that variation in circadian clock genes is related to both BDf,h and SAD.i

Source: For reference citations, see this article at CurrentPsychiatry.com

Etiologic hypotheses for both BD and SAD propose that an external event (life stress in BD; decreased photoperiod in SAD) leads to circadian dysregulation and, in turn, mood episodes. Circadian-related hypotheses for SAD and BD are supported by evidence showing efficacy of treatments that manipulate behavioral and circadian rhythms.

Source:  Curr Psychiatr. Author manuscript; available in PMC 2010 May 21.
Published in final edited form as: Curr Psychiatr. 2010 Feb; 9(2): 42–54.
PMCID: PMC2874241