I’ve Been Quiet Lately

Quietly Taking Care. Writing & Doing Less.

I’ve been quiet lately. Out of commission. Taking it easy.

This holiday season brings tough firsts. First Thanksgiving since my father died in April. First Christmas coming up. My sister and I plan to remember him and observe our family Christmas traditions. We need each other. We miss our dad.

Seasonal affective disorder hit hard, too. As the days got shorter, I cocooned, became seasonally and situationally depressed. Seasonal depression, bipolar disorder and now my grief overwhelm me at times.

Taking care of myself….mostly. Seeing my psychiatrist and psychologist. Going to a grief support group at Jewish Federation & Family Services. Reaching out and asking for help, for support, when I need it.

SO IMPORTANT that you ask for and accept help. My insight into my need for help, reaching out for it and accepting it, has KEPT ME ALIVE.

When I was 18 years old and suicidal, realizing I needed help, asking for it and accepting it made all the difference.

Grieving

Grieving -- KittOMalley.com
Geometry art created with iOrnament app.

Grieving, not depressed. No bipolar depression. No depressive thought process. Just grief. Just a deep overwhelming feeling of loss. 

I miss my father. Miss him deeply and dearly.

Going to individual therapy and taking my medications for bipolar disorder, but now may be time for additional support, time for a grief support group, preferrably one led by an excellent licensed mental health professional.

As a licensed clinician, I have a bias. I need a group leader with advanced clinical knowledge of serious mental illness like bipolar disorder, as well as grief. As someone with bipolar disorder and a history of depression, I’m at risk of complicated grief.

Not only did my father recently die, my mother is a stroke survivor living with vascular dementia. She lives in memory care, but wants me to visit more often than I can afford to emotionally.

Squeezed between generations, I cheer my newly adult son as he takes steps to overcome social anxiety and manage his migraines. Until he gets his driver’s license, I chauffeur him to and from specialists appointments.

Rather than spend all my time and energy caring for the needs of others, I must care for myself. My personal boundaries are poor. Groups overwhelm me. I take care of others, not myself. Find myself overstimulated and become mildly hypomanic. Perform, rather than sit, listen and accept help from others.

Always a been performer, love being onstage, enjoy public speaking. Now’s not the time to be the center of attention, to be right, to be smart, to solve problems, to be the hero.

My brain isn’t functioning at its best. Grief-related brain fog. Can’t concentrate. Can’t remember. Simply overwhelmed emotionally. Often, I can’t even come up with a simple word to answer a question my husband asks. Cannot make a yes or no decision.

Today I deleted emails of great content I would usually share as a mental health advocate. I leave that to others for now.

Now, I grieve. Now I cocoon. Now I draw mandalas and patterns using iOrnament. Now I do jigsaw puzzles on my iPad. Now I watch TV.

Now, I cry softly, sometimes gently sob, for the father I love and miss.

Michael Pipich Guest Post: Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Are You Just Depressed or Is It the Onset of Bipolar Disorder_

This guest post hits close to home. For twenty-one years, from ages eighteen to thirty-nine, I was diagnosed with chronic depression (dysthymia). I’d tell doctors that I was at least cyclothymic, for I my over-productive workaholism led to cyclical depressive crashes. Finally, at thirty-nine years old, I was diagnosed bipolar II. — Kitt

Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Michael G. Pipich, MS, LMFT

About two-thirds of people with bipolar disorder are misdiagnosed with other mental health problems before bipolar is discovered.[1] Among those individuals, a significant majority are given a diagnosis of major depression. Most people with a major depressive disorder that is unrelated to bipolar disorder (typically known as non-bipolar depression or unipolar depression) can be treated safely and effectively with a combination of antidepressant medications and psychotherapy. But when people with undetected bipolar are treated this way, a host of mental health problems can occur, making the underlying bipolar condition much worse.

It’s understandable that someone may not immediately be given the bipolar diagnosis if their first mood swing begins in a depression mood zone. This seems particularly true of people who have bipolar II disorder. And sometimes, there may be more than one depressive episode before a manic or hypomanic episode happens in a person with bipolar.

If you’re wondering about whether you may have depression or the beginning of bipolar, there are some keys to keep in mind when seeking treatment.

First of all, when assessing if your depression is a part of bipolar, know that bipolar disorder has distinct genetic foundations. In other words, it runs in families and is passed through family genes. So if you suspect that any family members may have had bipolar disorder, it’s important to inform your doctor or therapist when entering treatment. If the information is available, a thorough family mental health history can really support a proper bipolar diagnosis. Unfortunately, such information isn’t always asked for, so be prepared to volunteer all that you know during an evaluation or treatment session.

Next, your personal history of mood swings should be explored. If you’ve had severe ups and downs during childhood or adolescence, these may be more than the common tumult of growing up. They may instead be early expressions of bipolar disorder. It’s especially important to review periods of hyperactivity, bouts of unexplained rage, self-harm, or suicidal thoughts or actions that could have occurred at any time in life. There certainly may be other explanations for these, such as early life trauma or severe loss and grief experienced during these formative years. But if explosive behaviors or deep depression occurred at different times, especially with little or no provocation, it can point to underlying bipolar disorder.

Usually, most people with bipolar who seek treatment on their own are currently or recently depressed, or are experiencing consequences of untreated bipolar disorder. Any history of mania or hypomania is less obvious, however. And often, bipolar patients will either not understand manic symptoms or will avoid discussion about them. If you have had at least one occurrence in your life of intense euphoria, excitability, unexplained energy and creativity, avoidance of sleep, or impulsive behaviors, inform your treatment professional. But also bear in mind that mania and hypomania may be marked by intense periods of irritability and agitation, know as dysphoria. This is in contrast to the euphoria that most people think about with bipolar mania. Often a dysphoric type of manic or hypomanic episode can be mistaken for the kind of agitation seen in major depression. This can mislead the course of treatment to focus only on depression, while missing the full bipolar condition.

This brings us to the most important part of knowing whether you have depression or bipolar onset. According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), if a patient is given an antidepressant medication, and it produces manic symptoms, the person is then diagnosed with bipolar disorder.[2] While this is a very clear indication of bipolar, how the mania surfaces in the individual may take different forms. For example, a person in a depression mood zone can improve early in the treatment, and as a result, may not show manic symptoms right away. Any slight improvement may provide a hopeful sign that treatment is working, but when the person starts to get worse because of emerging mania—especially if it’s dysphoric—the unwitting response may be to apply more antidepressant medication. Now we have some real problems.

So, if at some point in your treatment, an antidepressant medication makes you feel more agitated, more irritable, more aggressive, or you start to experience hyperactivity or greater impulsivity, tell your treatment professional right away. This could be the start of a manic episode that is revealing a previously undiagnosed bipolar disorder. Even more importantly, any increase in suicidal thoughts or possible psychotic symptoms, such as hallucinations, should be reported immediately, as these can be life-threatening. Any antidepressants will either likely be eliminated at this point, or possibly paired with a mood stabilizing or antipsychotic drug to keep a lid on mania.

With bipolar finally recognized, bipolar medications can be introduced to decrease manic-type symptoms, while keeping depression in check. Alongside medications, it’s important to have therapy focus on the unique challenges facing people with bipolar disorder. Major depression is frequently considered an acute condition because it often can resolve in time, so medications may be discontinued at some point, along with a shorter overall approach to therapy. But bipolar disorder is a lifelong condition. Even though its symptoms can come and go in episodes, the genetic nature of the condition means the bipolar patient will need continuing care through the lifespan.


[1] Hirschfeld R. M., Lewis, L., & Vornik, L. A. (2003). Perceptions and impact of bipolar disorder: How far have we really come? Results of the National Depressive and Manic-Depressive Association 200 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64(2), 161–174.

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author, 128-130.


Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder by Michael G. Pipich, MS, LMFT. Foreword by Joseph Shrand, MD.

Michael G. Pipich, MS, LMFT is a psychotherapist and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder, (Citadel Press, Sept 2018). He practices in Denver, Colorado, and can be reached at MichaelPipich.com.

Press Contact: Janet Appel Public Relations
205 West 54 Street, New York, New York 10019
212-258-2413

 

 

If the National Suicide Hotline puts you on hold, where else can you call?

Just updated my Mental Health Resources page, incorporating these crisis lines. Thank you, Hufsa Ahmad, for this excellent list of crisis hotlines.

National Suicide Prevention Lifeline 1-800-273-8255 www.suicidepreventionlifeline.org

Crisis Lines

Hufsa Ahmad

In light of Anthony Bourdain and Kate Spades’ suicides, both discussion of suicide and calls to suicide hotlines have peaked. I have heard some people share that when they call the National Suicide Hotline (800-273-8255), they  are put on hold. If you do not want to wait, there are alternate suicide hotline numbers that are local/state-wide or population-specific that can be more accessible since they are targeted to a smaller population.

For example, for people who are local to Southern California, an alternate suicide hotline number that is more accessible is Didi Hirsch’s Suicide Hotline: (877) 727-4747. It’s specifically to serve Los Angeles, Orange, Ventura, San Bernardino, Riverside and Imperial Counties, which is why it’s less in demand. Their counselors are very well trained and they spend a good amount of time with you. I have received training from Didi Hirsch and am very familiar with this organization so I…

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