As a teenager, I made everything tougher than it needed to be.

I argued when I was asked to do chores. I was miserable just to prove a point. I wouldn’t listen to good advice.

I was also a teenager with mental illness.

This changes the dynamic between parent and child in a big way—besides the normal parent-child arguments, now you fight about medications, psychiatrist visits, and counseling sessions.

Parents of children that have mental illness may also deal with problems like substance abuse, promiscuous sex, erratic and dangerous behavior, and even suicidal behavior.

Even the most supportive parent wonders where to turn for help.

Sometimes, there aren’t enough local resources available, or parents don’t even know where to begin to go and get them.

Many parents that I’ve talked to say that at least when their child is troubled, they still live under their roof. They feel, at least, like they have some sort of control over the situation.

But when your child grows up and moves out, how do you deal with the fear, anxiety, frustration, and other emotions that come with that lack of control?

I read a great article by Victoria Maxwell, a writer that lives with bipolar disorder. One day, she decided to discuss being an adult child with mental illness with her father.

Some of their wisdom includes the following:

• Parents: Having a child with mental illness is undoubtedly a long, difficult journey, and it is best to be realistic about this up front. Not to be negative, but it’s a good idea to be prepared for the ups and downs that come with having a child with a mental disorder.
• Just because it is taking a long time, doesn’t mean recovery won’t happen.
• Victoria’s dad’s advice to parents is to stay in contact with your child no matter what. Yes, even if they don’t want to be in contact with you. Victoria and her dad attest to the fact that even when she didn’t want to return her parents’ calls, she still was appreciative of them caring about her.
• Yes, sometimes the more you offer help, the more your child will push you away. But, your care and support will keep your child safe or at least will let them know that you are a safe haven as well.
• Even when Victoria’s interactions were negative with her parents, what was important was that there was contact.
• Victoria’s parents were open and accepting of her diagnosis and she has always been very appreciative of that. This provided ground for her self-acceptance.
• If you as a parent are feeling overwhelmed, frightened, exhausted, this is completely natural. This is an incredibly difficult experience.
• You should get support from other parents going through the same ordeal. Contact your local mental health group. Knowing that you are not alone can be extremely helpful and provide invaluable resources.

Here are some educational and support resources for parents with children with mental illness:

National Alliance on Mental Illness—grassroots organization with branches across the US

Canadian Mental Health Association—national mental health organization with branches across Canada

Depression & Bipolar Support Alliance—a great interactive organization with a great website. Branches across the US.

Mental Health America—find a support group

Mood Disorders Society of Canada—mental health mood disorder organization

Centre for Addiction and Mental Health—Canada

The Balanced Mind Foundation—for parents of children with mood disorders

Other organizations that might be helpful for support:

Alcoholics Anonymous

American Foundation for Suicide Prevention

1-800-273-TALK (Suicide Prevention and Support Hotline)

The Jed Foundation

Please comment on your experience either as a parent of a child with mental illness or as an adult child with mental illness. How was your relationship with your parent or child? What do you wish you could have done differently? How do you feel now that your child has moved out?

References:

Maxwell, V. (2012, February 28). Families falling apart: when adult children with mental illness don’t want help. Psychology Today, Retrieved from http://www.psychologytoday.com/blog/crazy-life/201202/families-falling-apart-when-adult-children-mental-illness-dont-want-help

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I have read into it, not enough to make me an expert, but enough that an English BA graduate would be able to understand what’s going on.

Truth be told, it’s not as easy as a quick textbook read.

According to Barlas (2013), by next year, patients will have purchased new individual and small-group health plans on the state exchanges mandated by the Affordable Care Act.

This is where the book doesn’t close. Mental health benefits will differ from state to state, and it’s hard to know whether they will meet the requirements of the Mental Health Parity and Addiction Equity Act of 2008.

To make it even more confusing, important issues such as network adequacy (or psychiatrist coverage) are still up in the air, along with physician payment rates.

The issue? Regardless of the illness we have,

60 to 70 million people in the US could be impacted by the new health care law, and most of us still don’t know what that means.

In February 2013, the US Department of Health and Human Services issued a final rule that outlines the essential health benefits (EHBs) that all qualified health plans (QHPs) must cover. The EHBs fall into 10 categories, with two being of prime importance to mental health patients:

• Mental Health and Substance Use Disorder Services, Including Behavioral Health Treatment
• Prescription Drugs

Almost all 50 states and the District of Columbia have chosen “benchmark plans.” These are very general with regard to the mental health category.

Barlas says that the small-group plan, which is the benchmark plan in most states, still typically has less generous mental health benefits than employer plans.

Stakeholders in California, for example, are worried about what is set to be minimal mental health benefits in their benchmark small-group plan.

All states have the option of supplementing mental health services in addition to the benchmark health plans in place.

The problem? They will not get any federal assistance to do so.

States’ approaches to the new way of thinking about health care in America are diverse.

Some proponents of better mental health care in the US are concerned about the way the new laws are laid out for the States’ taking.

Bottom line: The flexibility could affect mental health consumers’ ability to make fair comparisons among plans. It could also give us the problem we currently have—the ability for states to design plans that allow them to essentially cherry-pick healthier enrollees.

If you really break it down, is there really all this need for the uproar about socialism and these new laws killing the American way?

I do not have health insurance—the small company I work for currently does not offer it and my husband’s insurance at work is so expensive we cannot afford it. It’s almost as expensive as our rent.

In addition, I cannot get private health insurance because of bipolar disorder. So around I go, hoping I don’t get sick, using Patient Assistance plans and relying on the good graces of my psychiatrist.

Let’s not all get too excited nor too incensed when we hear the words “Affordable Care Act”.

I am still worried about my future as a mental health consumer, regardless of what legislation has been passed.

What do you know about the new health care law? What do you think about it? Do you currently have sufficient access to health care? Do you think the Affordable Care Act will change your current situation? 

References:

Barlas, S. (2013, 05 08). Update on mental health benefits and substance use disorder services under the Affordable Care Act. Retrieved from http://www.psychiatrictimes.com/display/article/10168/2141641

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If you have the illness, you know that you suffer emotionally, mentally, socially, and physically.

Medically, the diagnosis is associated with impaired functioning.

For instance, if a woman develops bipolar disorder at the age of 25, she could lose up to 9 years of her life because of cardiovascular and other medical problems.

She may also lose up to 14 years of productivity, and 12 years of good health.

A study by Greg Murray, PhD and Erin E. Michalak, PhD (2007), examined quality of life in patients with bipolar disorder. I take a look at this study in this article, also gleaning information from experience and facts I have received along the way.

The lifetime suicide rates of patients with bipolar disorder (treated or not) is as high as 15%.

Increasingly, studies are trying to access more details about quality of life impairment experienced by people with bipolar disorder.

Quality of life in populations with bipolar disorder appears to fall far below that observed in general population samples.

The medical outcome survey, or SF-36, is the most widely used quality of life measure in the bipolar population to date. Most quality of life studies have been done on populations such as those with unipolar depression.

The SF-36 contains 8 subscales. They assess physical functioning, social functioning, physical role limitations, emotional role limitations, pain, mental health, general health, and vitality.

Results indicate that quality of life in patients with bipolar disorder tends to be significantly compromised in all areas except for physical, compared with the general population.

As noted in the 2007 article, a study from the Netherlands compared SF-36 scores in people with bipolar disorder with scores found in people with a variety of other psychiatric disorders (anxiety disorders, substance abuse issues, depression, and no psychiatric disorder).

The participants with bipolar disorder were significantly more impaired in most SF-36 domains compared to the other participants.

Scores in general health, social functioning, physical roles, and emotional roles were consistently lower in the group with bipolar disorder than the group with unipolar depression; however, those with unipolar disorder showed more impairment in the bodily pain domain.

Hypomanic symptoms are currently used to distinguish bipolar disorder from unipolar depression in the current DSM.

However, much of the morbidity and mortality in bipolar disorder appears to be in the depressive phase, rather than the defining manic or hypomanic phases.

Among a sample of 129 patients, those who experienced an acute depressive episode or mixed episode were at significantly higher risk for suicide, panic disorder, and psychosis than patients experiencing purely manic episodes.

And, odds of experiencing significant impairment of role functioning with patients with depressive symptoms were 3 to 6 times greater than for those who were not depressed.

Growing evidence for the marked association between depressive episodes and lowered quality of life in patients with bipolar disorder is clinically significant.

This is especially important in that depressive symptoms predominate over manic symptoms in patients with bipolar disorder I and particularly bipolar disorder II .

A large portion of the quality of life challenge therefore evidently stems from the depressive side of bipolar disorder.

One criticism that experts have is that certain elements of bipolar disorder such as financial indiscretion and hypersexuality when hypomanic demand specific instruments not already accounted for.

For this reason, clinicians are now trying to develop disorder-specific scales for bipolar disorder.

These two PhDs who wrote the article developed a scale that measured a variety of factors, including adverse affects of medications, occupation, level of education, environment, and sexuality.

Even though many of the patients were functioning very well despite their diagnosis, they all mentioned several years of hardship and adjustment before getting “back on track”.

The emerging body of research suggests that the factor of quality of life in patients with bipolar disorder should be carefully evaluated and brought into the holistic picture of treatment.

Experts encourage therapists and psychiatrists to continuously evaluate quality of life in patients with bipolar disorder to enrich understanding of patient progress.

With this as a tool, clinicians can tailor treatment regimens, considering the important aspects of a person’s life.

People with bipolar disorder deserve to know more about how to make all facets of their lives better, along with what medicines to take and how to change their thought patterns.

We need guidance on why we aren’t doing well and how to stay well. This would go a long way in prolonging and enriching the lives of those with bipolar disorder.

What is the biggest obstacle you struggle with in the 8 subscales of the SF-36? What do you think your clinicians can do to help you increase your quality of life? What can you do for yourself?

References:

Murray, G., & Michalak, E. E. (2007). Quality of life in patients with bipolar disorder: Defining and measuring goals. Psychiatric Times, Retrieved from http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/54001?pageNumber=1

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At this time last year, I was coming off of severe episodes of depression and mania after having to leave my Master’s program (more on that in a future article).

I was just starting a new job, and I was unsure of myself and what the future would hold.

A year later, I’m proud that I am writing furiously, I am working furiously, and I am meeting so many people that are making an impact on my life.

The mental health community has meant more to me in the last five years than I can describe.

From face-to-face support groups to mental health non-profits to great friends I have made on Twitter and PsychCentral.com, I am so proud of how well the bipolar community and the mental health community as a whole props one another up in times of darkness and celebrates each other in times of joy.

I have been anticipating Mental Health Awareness Month for a couple of months now. Yesterday, my article started being featured on FamilyGuiding.com, and I was also hoping to write this article to commemorate the month of May.

Many times in my life, I have idealized events, later being unhappy because they didn’t fit my expectations.

But the supporters of mental health never let me down.

When I woke up yesterday, I was delighted to see organizations like NAMI and HealthyPlace posting banners and graphics to inspire and support people affected by mental illness.

I have seen tweets and Facebook posts educating the public with facts on what mental illness is really like.

I have seen people congratulating each other for months of personal success. I have seen the determination, already, of people who want to end stigma.

And we have almost a whole month left.

You have no idea how much you all inspire me. There are so many talented, thoughtful, courageous people with bipolar disorder and other mental illnesses out there who are determined to make a change in the world.

They are determined to bring an understanding to their illnesses, no matter how many times they have to fall down and get back up again.

What good is a life if you don’t make a difference? I have the belief that one’s mental illness can either destroy them or be a great gift.

Every single person with a mental disorder is beautiful. Why do I say this? Because it takes a special person to live with bipolar disorder, schizophrenia, borderline personality disorder–any illness of the mind.

You have to be creative, relentless, strong, hopeful, and extremely tough to live this way.

If you care about the future of society’s view on mental health as well as the future of the care that our mentally ill community receives, I encourage you to do at least one thing to commemorate Mental Health Awareness Month.

Some Ideas:

• “Wear Lime” and tell people why you’re wearing it. Lime is popularly considered the color of mental health awareness.
• Write a blog or article about mental health.
• Educate someone with a fact about mental disorders.
• Create an art piece devoted to mental health awareness and ending stigma.
• Organize a fundraiser for your local mental health organization, or donate to mental health organizations in need
• Spend time with a friend or family member with mental illness
• Take time to go online and learn facts about a mental disorder (I suggest sites like National Institute of Mental Health)

The possibilities are endless. Just educate, support, love, and make it a point every year to do so.

I’m really excited about the way things are looking in 2013. I hope that we will be even more open, honest, and understanding next year.

Happy Mental Health Awareness Month! Please let me know how you are celebrating!

Follow @KatGalaxy

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I think that’s part of falling into a deep episode of depression—it’s almost more powerful than you are. You think you can handle a bad day and then you’re holding a cake knife in your mother’s kitchen, threatening to hurt yourself.

It’s like you don’t even realize how sick you are until it’s too late.

And that’s what I did, one February afternoon during an argument with my mother. In hindsight, it appears that I wasn’t feeling well at the time. The depression was building up, and I finally snapped.

It was the culmination of years of not getting along with my mom.

It was also a feeling of abandonment once again.

Feeling like my mother didn’t accept me.

I hadn’t wanted to die at all that day, until I got that familiar feeling of loss and pain as I argued with my mother.

It took me beyond the breaking point.

I couldn’t control it. I just grabbed the cake knife out of the drawer and started screaming at the top of my lungs.

I probably wouldn’t have done anything drastic, I want to think. Maybe I was just blowing off steam.

Should my mom have trusted that I wouldn’t have hurt myself or anyone else?

Was she just trying to get back at me for the years of tension?

She called the cops on me that day. I didn’t think she was going to really do it.

But she did. And within a minute or two, three police cars were outside my mother’s house.

It was so embarrassing. I imagined the neighbors across the street looking outside and seeing the mess I had created with my inability to control myself.

I was feeling pretty wired by the time the police got there, and I knew that something was about to go down.

This wasn’t good.

In a pseudo-fight-or-flight situation, I marched outside and met with the cop that seemed to be heading the investigation.

The first thing I said to him was that my mother and I were arguing and she didn’t need to call the police. It was all a misunderstanding.

He pretty much ignored me, and started to talk to my mom, who followed behind me. She was fairly calm, told the guy what I threatened to do.

I guess at one point I had put the freaking cake knife up to my throat. A cake knife.

He told me I had a red mark on my neck. That was the evidence he needed, and he told me to put my hands behind my back. We weren’t talking any further after that.

I was put in handcuffs, and without shoes, was placed into the back of the car.

Me, a college student, a kid who never got into trouble in any capacity, someone who was going somewhere.

I’m in the back of a cop car.

I watched him grab my ID from my mom. That was it. I was going. I started to panic and cry a bit.

I thought about all the people on Cops who tried to kick in the windows.

I thought about doing that.

Probably a bad idea.

The cop proceeded to lecture me about making bad decisions while I tried to hide in the back seat.

I asked him to think about turning around.

Wasn’t going to happen.

When we got to the hospital, we went around back where the helicopter sat.

He let me out, still in handcuffs, and at that point, I actually considered running.

After a daydream of running past the helicopter into the sun, I was able to decide against that and proceeded to get the “special treatment”, being admitted as fast as someone that comes in in an ambulance.

The cop stayed with me for a few minutes, talking to the nurses about his escapades in Las Vegas and appearing quite unprofessional, even for my standards at the time.

I wasn’t in a good mood. I was annoyed I was there—I wanted to go home and be with my fiancé. I wanted to see my cats.

I didn’t want to be cooped up in the hospital like last time, only a year ago.

I was “Baker Acted”.

Never in my wildest dreams did I ever think something like that was going to happen to me. It was worlds beyond what I had thought for myself.

It was a joke before, something that would never happen to me, even though I had mental illness. I just wasn’t going to be in that situation.

I was a bit embarrassed, and I was very mad at a lot of people—my mother, my father, the police.

I got out of the hospital in a matter of a day or two. They didn’t think I needed to be there. I put on a good show, acting like it was a fluke and that I could deal with my treatment at home—that I wasn’t as sick as I had threatened.

My mother was furious. She knew I had wormed my way out of the hospital. She made weird threats, telling me she was cutting me off my health insurance.

And the toxic relationship continued.

I think about this day all the time, for a lot of reasons. I think moments like that change you. It’s hard to be in the position where you are cornered and there’s nothing you can do about it.

Finally feeling the effects of the things that you’ve done.

What is the Florida Baker Act? Read Here.

I’ll talk more in the future about my hospital experiences. Please comment!

Follow @KatGalaxy

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I have created mixtapes and written songs devoted to bipolar disorder.

When I was at my highest and lowest moment in life, I was listening to music. 

Many individuals with bipolar are artistic, and maybe this is where my love of music comes from.

I also think it comes from my stepfather.

He had me listening to The Beatles and The Clash and The Doors from the time I was five years old.

I grew up listening to these bands and more—Bob Dylan, Bob Marley, The Violent Femmes, Tom Petty.

There was a soundtrack to everything, and I became dependent on music to explain what I couldn’t put into words.

I started using music as my translator, writing the lyrics of important songs on my social media profiles, and quoting lines to make a point.

When I was amidst another turbulent time in a romantic relationship, I would play a playlist I created especially for this moment—with songs like “Fake Plastic Trees” by Radiohead and “Self Esteem” by The Offspring.

The first time I experienced a manic episode, I wanted to listen to anything fast.

I was drinking beer, listening to Motorhead, head banging.

I remember I was really into “Mother” by Danzig, and at my most manic point, the profound bass of dubstep was what I craved.

Listening to music, singing, making playlists, and sharing lyrics are how I stay sane.

I have so much energy inside, whether it is manic—high-speed, fuzzy, and instinctual, or depressed—slow, foggy, almost too cerebral.

I feel the urge to get out what is bubbling inside of me, what is flying around inside my head—and I’m determined not to use that energy in a negative way.

Instead, I dance and sing and thrash and feel the comfort of knowing that there is someone out there that has felt the same way that I have—maybe they don’t have bipolar, but they have felt the pain of loss and feeling like a loser and not being able to relate to anyone.

Musicians have the ability to express these feelings beautifully—fluidly, one by one, no matter what the circumstance.

Music can be amazing therapy. I want to share with you some of the songs that I can relate to when I’m feeling like feeling…

Feel free to comment with songs of your own to share with the mental health community.

Kat’s Song List- April 2013

• “Ache With Me” –Against Me!, White Crosses
• “Born To Die” –Lana Del Rey, Born To Die
• “Oh My God” –Ida Maria, Fortress ‘Round My Heart
• “All That You Have Is Your Soul” –Tracy Chapman, Crossroads
• “Feel The Pain” –Dinosaur Jr., Without a Sound
• “Maybe Not” –Cat Power, You Are Free
• “The Cave” –Mumford & Sons, Sigh No More
• “Society” –Eddie Vedder, Into the Wild Soundtrack
• “You Know What I Mean” –Cults, Cults
• “Colorblind” –Counting Crows, This Desert Life
• “Goodbye” –Best Coast, Crazy For You
• “Youth” –Daughter, The Wild Youth
• “The Engine Driver” –The Decemberists, Picaresque
• “Shake It Out” –Florence and the Machine, Ceremonials

Hope you enjoy! –Kat 

Follow @KatGalaxy

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I was born in 1988. When I was in kindergarten, the computers we played on had black screens with green figures and symbols.

I know I’m not that old, but technology has really exploded since the late 80’s. I started with Oregon Trail and look where we are now. We’re excited about everything tech.

Today, we can’t imagine life without apps.

One of the greatest things that have happened since the advent of the app are apps that aid those with chronic illness.

Not only can you use your phone for directions, recipes, books, and video games, you can also use it to manage your bipolar disorder.

In this article, I take a look at a few apps that are used by people with bipolar.

I’m sure you’ll find at least one that you’ll want to add to your collection.

Optimism

Optimism used to be a little too expensive for me, that is, until one of Her Bipolar Life’s readers Carole Milner informed me that it is now free.

Go out and get it!

Optimism is a mood tracking app that rivals all others. You can compile “Stay Well Strategies”, “Triggers”, and “Symptoms” for intel on yourself.

Even more awesome, the mood charts can be saved as a PDF and printed, which is perfect for showing to your doctor.

After all, most of us have had that psych appointment where we didn’t remember everything we should have about our moods.

You can get it for Mac, Windows, iPhone, and iPad, and it’s also available as a web browser.

Bipolar Diet Daily

If you’re like me and take Zyprexa, you know how great this app could be.

Obesity can be a factor for many with bipolar disorder. This app is free and provides tips and support for managing food, weight, and even mood.

From the creators of www.bipolar-lives.com

Bipolar Connect

This free app has been downloaded thousands of times, and is a social outlet to talk with peers about topics related to bipolar disorder.

You can start conversations and learn from others. It’s a great on-the-go support source.

eMoods Bipolar Mood Tracker

I have personally used this app before, and I like it. It’s specific to bipolar disorder, and is easy to use.

You can track your moods daily, keep note of your medications, and you can even print out a copy of your chart.

Note: This app does not log multiple moods and symptoms per day. So if you’re looking for a chart for daily extremes of moods and symptoms, this would be for you.

Moodlytics

This is my favorite app right now. It’s big, bright, and very user-friendly.

If you’re looking for an easy and insightful mood app, this is it.

You can use a very limited version of the Moodlytics app for free, but it’s worth it to buy the full version.

It’s very cheap, around a dollar.

Some of its features include application privacy (you will have to provide a code to get in), track unlimited moods, track past moods, save and tag photos for moods, add and define custom moods and categories, and set goals.

The best part about this app is the analytics, though. You can look at trends in moods by week, by person in your life, by area of your life, and even daily mood fluctuations.

One of the best mental health apps I’ve found.

I’ll be back for another round of app talk in a future post, but for now, check out these and other apps and tell me what you think. If you use an app that is not on here, let us know in the comments! We would all love to collect more useful bipolar apps.

Follow @KatGalaxy

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My grandparents lived in a busy neighborhood with lots of children.

There were kids my age next door on both sides, and we would all gather to play in the afternoons or on weekends.

One Saturday, we were playing hide and seek throughout the neighborhood and some of the girls were suggesting that I be “it”—the one to find the others.

I didn’t like being put on the spot, and I took it personal that I was being singled out. I told them I was quitting, and ran home.

This is a silly example, but it shows how early I had trouble with my peers.

From a young age I always assumed that I was being attacked and made fun of, and maybe some of that was true.

I never had a hard time making friends, but my moods always made it hard to deal with them long term.

In middle school, I would get irritable if I spent too much time with my friends.

A good day would turn into me kicking my friend out of my house when they didn’t behave like I expected.

My parents noticed my behavior and would scold me about it.

“You’ve got to be nicer. And more patient.”

I don’t know why I’ve had trouble with my peers since childhood. It’s not to say that I haven’t had best friends, boyfriends, or acquaintances—I’ve been successful, but I recognize I’ve messed up a lot.

I can make the friends, but can I make them stay?

Do I want them to stay?

It’s no secret that many individuals with bipolar disorder have a hard time maintaining friendships.

As I said, I don’t think those with bipolar have a hard time making them.

People with bipolar can easily appear alluring, fun, and the kind of friend someone wants to have.

The hard part is maintaining that persona.

There are loads of blogs and forum topics online about friendships and bipolar disorder.

The blog Bipolar Manifesto says, “the swings we experience are not only destructive to ourselves but to those we are closest to”. Preserving relationships depends on hard work, and it appears that the weaker relationships are often dissolved due to absence, irritability, and other symptoms.

When I was in high school, my relationships began to suffer incredibly. My middle school best friend and I quickly drifted apart after freshman year.

During high school, symptoms of my bipolar became very apparent, and it was quite easy for me to drop this friend in favor of wild nights with boys.

I think she thinks I betrayed her, and looking back, maybe I did.

But I didn’t realize it. And I felt that I couldn’t control my ways sometimes.

That is part of the problem.

I was able to keep some friendships going throughout that time, and the relationships that survived were mostly with male friends who didn’t require that much attention.

I continued to hang out with mostly guys throughout college, as my impression of female friends was tainted.

Not only do we negatively affect our friends, we get negatively affected by the way that they pull away or don’t forgive us when we do something wrong.

We all lose sometimes, unfortunately.

My current friendship state is peculiar. I’m married, and my husband is my greatest friend. We’ve been friends for close to 10 years, and I’m lucky that I get to spend all my time with someone that is so much like me.

I am also very close with my little sister, but I am still struggling with real life friendships.

I have just joined a professional organization, so that might help. What I have to keep in mind, though, is that relationships take nurturing.

I have to pull myself out of my moods sometimes and spend time with people in order to keep relationships maintained.

They don’t do so themselves.

Like many with bipolar disorder, it is easier to keep friends online.

I think this helps us get support without having to deal with the pain and rejection of friends in real life.

My therapist says I need physical friendships, but after a lifetime of issues, sometimes that seems daunting.

How do you do in maintaining friendships? Are you like many with bipolar disorder, having trouble with personal relationships? What are your tips for others on how to maintain friendships?

Follow @KatGalaxy

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This is the second article in a series about bipolar women. As I discussed in the first article on hormones, pregnancy, and medication, this series will explore issues specific to females with bipolar.

The following information, taken from a National Institute of Health manuscript on women and  bipolar across the lifespan, was compiled to inform you about all of the things you might not have known.

Share this information with your friends. Being a woman with bipolar disorder is both unique and challenging. A part of understanding this illness is being armed with information.

Men vs. Women

In case you were wondering, bipolar I disorder affects men and women equally.  More women have bipolar II disorder than men.

Onset of Illness

Women also develop bipolar depression, mixed mania, and rapid cycling more commonly than men.

While the average onset for both sexes for bipolar disorder is 21 years of age, women are actually over-represented in later-onset illness (45-49 years).

Assessment

Because women often have co-morbid or co-occurring conditions (see section “Co-morbid Conditions”), a complete assessment includes medical, psychiatric, alcohol/substance use, and family histories as well as inquiry about stressors and screening for unusual beliefs and risk of harm to self or others.

Medications and Treatment

Women face delays in treatment, up to 11 years from onset, because of failure to diagnose. This is compared with seven years on average for men.

Also:

• If you’re considering lithium, renal, thyroid, and pregnancy status must be checked before starting.
• Medication choices differ between women and men. Fat-soluble medications have a greater volume of distribution and longer half-life in women that lead to higher drug serum levels and prolonged clinical and adverse effects. Women may benefit from a lower initial dose, then customized according to side-effect tolerance and therapeutic effect.
• Electroconvulsive therapy (ECT) remains an option for bipolar psychosis, treatment resistance, severe mixed episode, or pregnancy, to induce rapid mood stabilization.

Co-morbid Conditions

Women are at a greater risk of co-morbid conditions like alcohol abuse, thyroid disease, medication-induced obesity, and migraine headaches than men.

Pain disorders occur more in bipolar women, and hypothyroidism more in common with women than men in bipolar.

Also:

• Medical issues of bipolar women may related to co-morbid psychiatric or medical illnesses, medication toxicity, side effects, or lifestyle factors.

Symptoms

Reported atypical symptoms for women include: Weight gain, hypersomnia, and extremely low energy .

Extrapyramidal side effects (tremor, rigidity, akathesia, bradykinesia, tardive dyskinesia, dystonia) remain elevated in women and the elderly (I happen to have some tardive dyskinesia myself).

History of Abuse

A past history of sexual abuse is reported twice is often in women with bipolar as men.

Suicide

And despite what many may think, risk of suicide is unrelated to gender.

Pregnancy, Breastfeeding, and Postpartum

Pregnancy does come at a price when you have bipolar disorder.

Bipolar recurrences occur in 45% to 50% of pregnancies, but with lithium the recurrence rate falls to 21%.

Abrupt discontinuation of anti-manic agents and a past history of four or more episodes are significantly associated with increased risk of recurrence.

Ideally, women with bipolar will work with their health care providers when planning their families and develop a comfortable approach before conception.

Factors that need to be considered include risks to the patient, family, and fetus of an untreated illness; and the substantial risk for relapse with discontinuation of treatment.

Birth defects and intrauterine death should be considered in choosing medications. The lowest effective dose will likely be used to minimize any risk.

For women that take lithium, the risk of Ebstein’s anomaly is at a 10 to 20 times increased risk.

Lithium levels should be checked at each trimester and doses adjusted accordingly.

Vomiting, dehydration, and volume shifts during delivery can alter serum drug levels.

Because of risk of birth defects and complications, it is advisable to follow the pregnancy with level II/III ultrasounds in the second and third trimesters.

And actually, ECT appears to be an effective and safe alternative treatment for bipolar episodes in pregnancy.

Omega-3 fatty acids continue to be studied for their mood-stabilizing effects and may be a potential treatment option in pregnancy.

Postpartum Depression

Postpartum psychosis affects 1 to 2 women per thousand after delivery and seems more closely linked to bipolar.

It begins within two weeks of childbirth with symptoms of mood disturbance, confusion, delusional thinking, hallucinations, poor concentration, and impaired judgment/insight.

The failure to treat postpartum psychiatric conditions may result in worsening symptoms, more treatment-resistant illness, and impaired maternal function, with adverse consequences for the baby.

The situation requires complete screening for thoughts of harming self or others, and necessitates immediate treatment in a hospital setting with an anti-manic agent, antipsychotic agent or ECT.

Thank you for reading Volume 2 of  my series on women with bipolar. Did you know all of these facts above? If not, what surprised you or helped you the most? If you did, please share with us a fact of your own!

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Photo Credit: Ben Raynal via Compfight

Is there such thing as thinking about your mental illness too much?

In the throes of depression I have had multiple people, diagnosed and not, tell me that maybe I think excessively about having bipolar.

Maybe it’s affecting me.

I meet that with mixed emotions.

One part of me asks, how can you think that, especially when you’re bipolar yourself?

You take medicine every day, don’t you?

I happen to take 10 pills a day. I don’t think I could ever forget the reason why I was swallowing them.

Plus, my moods still rule me, even after being diagnosed for almost six years. When I’m depressed, I know it’s my bipolar talking.

When I’m angry, there it is.

This could happen my whole life.

It’s hard to feel normal when you are so unbalanced.

So I take some offense.

But another part of me understands what these people are saying.

When you spend a lot of your time thinking about how much of a plight you are in, you tend to get bogged down in it.

As the song “The Good That Won’t Come Out” by Rilo Kiley says, “you say I choose sadness, that it never once has chosen me.”

Maybe they’re right.

I think of the movie Field of Dreams, when the voice in the cornfield tells Ray Kinsella “If you build it, they will come.”

But this isn’t baseball.

If we think too much about bipolar, is it going to keep us from reaching a plateau of recovery?

Are we depressing ourselves by engaging in our illness too much?

I want to say that we are doing much more than hurting ourselves by being active with the bipolar community and by being cognizant of our illness.

We are advocating, we are finding people we finally identify with, we are getting all of the negative out of our head.

It can be therapeutic to write, speak, and engage in other healthy self-expression in order to cope with mental illness.

And this may include thinking about having bipolar disorder.

All in all, I think that there needs to be a healthy balance for people in thinking about and identifying with a chronic illness and having other interests and avenues such as healthy relationships, hobbies, and studies.

I think we all know there are people out there that allow their illness to envelop them.

The problem is, they aren’t being active about their recovery in expressing themselves.

Instead, they are in a hole and they want to pull people down with them.

I will always be a part of the bipolar, mental illness, and chronic illness community, and no one’s opinion is going to keep me from doing what I love best, helping others learn about bipolar disorder.

However, I think that if someone is indicating to me that I’m dwelling on my illness, or if I see in myself that maybe I am thinking about my depression too much, that it’s time to just go be me, meditate, swim, do something calming and relaxing.

Everything bipolar is involved with balance. Keep balance with your advocacy, expression, and non-mental illness adventures, and you should be fine.

What do you think about what people have said? Do you think that if you think about mental illness too much, that it is a form of self-sabotage?

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Photo Credit: Kristina Alexanderson via Compfight