Researchers have identified the mechanism by which valproic acid controls epileptic seizures, and by doing so, also revealed an underlying factor of seizures.
The drug protects the flow of potassium between neurons which is called the m current. During a seizure, the m current is inhibited, which allow the neurons to become too excitable. A seizure is the result.
Many people with bipolar disorder (including myself) also take valproic acid (divalproex/Depakote). The new mechanism explains how the drug helps with manic episodes, when neurons are hyperexcitable. But what about depression?
If manic episodes result from too little m current, perhaps depressive episodes occur due to too much m current. In that case, Depakote would work by limiting the m current.
This may sound contradictory, but if it is true, it is just one more example of homeostasis in the human body. Most conditions of the body — sleep, temperature, heart rate, growth of new cells, availability of nutrients such as protein — are best kept within a range of values that is generally the same for all people. One can have too much vitamin A or too little. Body temperature can be too low or too high.
Bipolar disorder results when the underlying factors (such as the m current) are not kept in balance, but swing wildly from one extreme to another. Drugs that adjust those underlying factors are potential treatments for bipolar.
WARNING: MAY CONTAIN TRIGGERS
I don’t know if I was ever completely serious about taking my own life. I know I wanted to hurt myself, though. And some of the things I did to hurt myself could have killed me, whether I intended that or not.
I felt so miserable at those times. No matter which way I looked I felt pain — unending, mind-crushing pain. There seemed to be no way out. I believed that I was a bad person, a complete failure, and that I had no business being on this planet making other people unhappy.
Bipolar disorder is a strong risk factor for suicide. The rate of suicide for the general public is about 1%. For those with bipolar, it is 15-17%. Suicide is the leading cause of premature death for bipolar patients. It is more likely if the person is undiagnosed or untreated. By “untreated” I mean “not taking medication.” The person may have the medication but refuse to take it. This is a very common problem for bipolar individuals — because they feel so good when they become hypomanic or even the early stages of mania, they don’t want to take a drug which will prevent both downswings and upswings.
I wonder how many people with bipolar take their meds as prescribed? Do you take them properly, or do you go with the temptation to skip them sometimes?
… or at least a part of me has taken up acting like a puffer fish. They are those poisonous little fish that can go from little to big in a matter of seconds, by taking in water and sometimes air. It’s amazing how different they look!
Some puffer fish have smooth skin, while others have spikes, like this one:
When a “porcupine” puffer feels threatened, she inflates to look as large as possible and to push out her spikes. There might be times when something unfamiliar approaches and she puffs just to be cautious. Or if she sees something that is the same shape as a predator, out come those spikes. It may not actually be a predator –and that is the crux of the problem.
My “predators” — I call them triggers — make me puff too. They can be anything that causes me shame. I cooked the chicken too long and it dried out. I wasted too much time doing puzzles. I binged on Goldfish crackers. I did something in the past that destroyed relationships with other people (I’m a certified bridge-burner). I forgot to do something. Anything
All of these cause me shame, but I pretend I don’t feel it until it gets brought to my attention by someone around me. Immediately I inflate and jab the person with my spikes — irritability, sarcasm, rage, and other unpleasantries.
I don’t enjoy being this way. Puffing my spikes takes a lot of emotional energy, and oh yeah, it can ruin relationships, too. My next task is to find a way to short-circuit the puffer fish part of me and use that energy to actually solve the problem.
Using Altoids tins to make a variety of items has become very popular. I have seen everything from emergency preparedness and first aid kits to electronics such as a flashlight or a solar powered iPhone charger to pocket chess and kids’ toys. So it was inevitable that I would decide to make a mini-crisis kit out of a tin. It’s handy when I don’t want to take a purse or other bag, because it fits in my pocket. Here’s what I put in:
I first heard about survival or crisis kits while in the hospital trauma unit, and I made my first one 7 or 8 years ago. The only problem with that one was that I never used it. I fell so quickly and thoroughly into feelings of rage or despair or terror that I completely forgot about the kit. If I had remembered, perhaps I would have been able to rise out of the overwhelming emotions much faster.
What goes in a survival kit? Like a kit designed for survival in a hurricane or a snowstorm, an emotional survival kit provides for emergencies. Basically, it contains items that appeal to the 5 senses and create a sense of well-being. Sensory input is a great way to self-soothe. By looking at a pleasant picture, using fragrant lotion, or tasting something I love, I am distracted from the overwhelming feelings so that their power over me is broken. A survival kit should include at least one thing for each of the 5 senses: sight, hearing, taste, smell, and touch. It is also good to include something that will distract the mind itself.
Here’s the contents of the kit I made recently:
~ pictures of my children and their cats (sight)
~ a rosary (touch, also spiritual)
~ lip gloss (smell, taste, touch)
~ sugar-free candy (taste)
~ a book that makes me laugh (Non Campus Mentis)
~ mp3 player (hearing)
This list is not particularly different from the kit I made years ago, but this time I’m actually using it! When I feel myself growing distraught, irritable, or nervous, I use one or more of the things in my kit to help me return to equilibrium. To be honest, I am surprised at how effective it is!
The single most useful item is the lip gloss, probably because it is multi-sensory. It smells like strawberries, absolutely delicious! Putting it on immediately calms me; one requirement, however, is that I must use the lip gloss only when I need it for self-soothing — the rest of the time I use regular lip balm.
From now on, I have no excuse for not making use of a survival or crisis kit. I know that it works. It’s a resource I can use on a daily basis to self-soothe and modulate my emotions.
Next post: How to make a mini-crisis kit from an Altoids tin
This is a documentary about what happens when mental illness and police intersect. This is the “weapon” we need, to fight ignorance by means of information and education.
My personal psychiatrist spends most of his time in prison. He is a prison psychiatrist. He tells me that roughly 50% of the prison population have a pre-existing psychiatric diagnosis–and he gives me a sardonic smile as he says, “And the rest are undiagnosed.”
Whether or not you agree with that, I’m sure you will agree that beating, shooting, tasering, and incarcerating people who may simply be disoriented, delusional, hallucinating, or displaying side effects of anti-psychotic medicines such as stiff gait and slurred speech, is not only inappropriate and inhumane, but criminal.
If you agree with the message of this film, I urge you to go to the authors’ website and see how you can…
I have a lot of trouble relaxing sometimes. It’s much easier to say “relax” than to actually do it! I’ve practiced a variety of techniques since I was a teenager, because beginning in childhood I had extreme anxiety and trouble falling asleep. I’m not sure how I learned about ways to relax, but I think I read it in a self-help book.
Some of the relaxation techniques that I have used focus directly on the muscles that are tense. I prefer to lie on my back but you could sit in a comfortable chair. I start with my feet. I tense the muscles of my feet as tightly as I can and hold for 3-5 seconds, then relax, imagining all the tension flowing out. I repeat this for my feet, then move to my ankles and calves. I try to feel the heaviness of each area as I move up. For example, when I finish my legs, I tell myself that my legs are as heavy as concrete. I continue with my arms, torso, neck and head. When I’m finished, I search through my body for any remaining tension, and if I find any I repeat the tense-release procedure.This is also called progressive relaxation.
Sometimes I imagine all my muscles becoming as heavy as lead and being pulled downward by gravity. Other times I use conscious breathing, one of the simplest methods. I often do it lying down before I fall asleep because it helps me clear my mind of worry and racing thoughts. I have practiced it enough that, except in the most worrisome times, all I need to do is to slow down and even out my breathing rhythm. I pay attention to my breath and in a few seconds my muscles begin to relax. I drop my jaw a bit (I carry a lot of anxiety in my jaw) to release the tension there and take some breaths through my mouth. Sometimes I have to call my attention back to my breath several times, but if I persist (and don’t get frustrated with myself!) I usually achieve my goal.
When I first learned controlled breathing, it was a bit scary because I had a fear of suffocating and I didn’t like to think about my breathing at all (this was a long, long time ago). However, I persisted because I had bad insomnia, and over time I got better at it. I also had trouble, as most people do, with intrusive thoughts. I tried to actively push them away but that didn’t work because it still took my concentration away from my breath. I had to learn to let them go as if they were leaving anyway. I also find it helpful to use a mantra when I have severely intrusive thoughts, because when I think the mantra I’m automatically thinking other things less. A mantra can be a word or a phrase or a longer prayer.
Here’s how to get started with conscious breathing: First, make sure you are in a position (lying or sitting) where you can comfortably allow your chest and abdomen to expand as you breathe. Begin by noticing your breathing – not controlling it, just noticing. Awareness by itself may slow it down. Other thoughts will come to mind; let them float away. Gently draw your attention back to your breath. The goal is to maintain passive concentration. Next, try to breathe in through your nose for a count of 5, then out through your mouth for a count of 5. Don’t force it, just let it happen. Feel the air flowing into your nostrils then past your tongue. Let the breath travel to every part of your body, gathering negativity and stress, which you can then breathe out to be rid of it. The next inhalation will bring in peace and relaxation. Continue this practice for 20-30 minutes, or as long as you comfortably can. Don’t be discouraged if you are bombarded with unwanted thoughts! With practice, you will be able to let them automatically slide out as soon as they enter. At the end of the meditation you will feel calmer, relaxed, and refreshed (and possibly asleep!).
I’ve been away for quite awhile, and when I did post it usually had nothing to do with bipolar or other mental health issues. Now I am ready to get back into the groove. This will require an overhaul of the site, both content and appearance. Over the next few weeks I will remove some of the more personal and off-topic posts. My goal is to create a blog for people with bipolar and other mental health issues that is crammed with basic information, hacks, and research reports.
In particular, I want to rebuild my reader base by giving something useful with every post. I would like readers to be involved with the blog by commenting and writing guest posts.
To begin, I will introduce myself. My name is Anita Simpson and I live in Texas. I was diagnosed with bipolar disorder in 1997, borderline personality disorder in 2006, and dissociative identity disorder in 2007. Before that, I had episodes of major depression beginning when I was 13 years old. I also had anxiety issues — although they were not diagnosed as such — beginning in my childhood.
I’m now in my early 50s. At 30, I began to be aware of traumatic events that occurred when I was very young. Those memories started me on a path of gradual disintegration until I was unable to work anymore and my daily functioning was poor. I spent a great deal of time in mental hospitals until finally the path began to turn up again. For several years now, I’ve been improving, thanks to therapy, medication, hospitals, and most important, the people who love me. My spiritual life has been the underpinning of all those, and I wouldn’t be here if not for my faith.
I’ve learned a few lessons along the way, and I hope to share what I’ve learned through this blog.
Learn to forget? Seems to me I have to first learn how to remember! Those of us past a certain age know that feeling well. So do young mothers, workaholics and anyone else who is overly busy. We all know that sinking feeling when we’ve forgotten an appointment. How many of us search for a word in the middle of a sentence, only to have it pop into our heads hours later?
Then again, there are things I would like to forget. That scary movie I saw just before bedtime. The dirty house that I have no energy to clean. The accident I had last summer that now makes taking any left turn into traffic an ordeal.
It’s 3 a.m. and all is still. Even the traffic noises are muffled as I step outside and carefully, noiselessly close and lock the back door.
The air smells of burnt wood, watered grass and decaying leaves — the usual scents of autumn prevail.
Where am I going in this quiet time? Perhaps I don’t need a destination. It is enough just to be there, accepting the flow of the night breeze, not seeking but only being.
Quiet is an important part of my life. I am a loner who becomes agitated if I am around large groups of people for a very long time. The stillness allows my heart to beat without constraint, my mind to imagine without limits. I treasure my quiet moments with just myself and God.