My Experience with Geodon

Ziprasidone (the generic form of the antipsychotic drug Geodon) was prescribed to me in the spring of this year because I was experiencing a long-lasting bout of moderate to severe bipolar depression with episodes of rapid cycling bipolar and intrusive suicidal thoughts. Ziprasidone is used to treat acute manic or mixed episodes associated with bipolar disorder and to treat symptoms of schizophrenia. It is also used as a maintenance treatment of bipolar disorder when added to lithium or valproate (Depakote). I took the medication as prescribed (1 20mg capsule by mouth at bedtime with food) along with my other meds (depakote extended release, trazodone, metformin) for four days before I had to stop. Geodon caused me to wake up in the middle of the night every night and have strange thoughts. More specifically, I wanted to go outside and run as fast as I could through the woods behind our house. My sleep was disturbed despite taking trazodone at night for sleep. Complete prescribing information can be found here. FDA (U.S. Food & Drug Administration) can be found here.

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Mental Health Month 2017

Did you know that May is Mental Health Awareness Month? I forget every year but according to Wikipedia, it has been observed in the United States since 1949. I decided to post a fact about mental health once per day on one of my social media accounts and I thought I’d share all of them here in case anyone is inspired to do the same. All of these facts are quoted either from the National Alliance on Mental Illness or the World Health Organization. With regards to mental health in America:

  1. 1 in 5 Americans live with a mental health condition.
  2. Nearly 1 in 25 adults (10 million) in America live with a serious mental illness.
  3. A mental illness is a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day.
  4. 20% of youth ages 13-18 live a with mental health condition. Of these, 8% have an anxiety disorder, 10% have a behavior or conduct disorder, and 11% have a mood disorder.
  5. Even though most people can be successfully treated, less than half of the adults in the U.S. who need services and treatment get the help they need.
  6. Half of all chronic mental illness begins by age 14; three-quarters by age 24. Despite effective treatment, there are long delays—sometimes decades—between the first appearance of symptoms and when people get help.
  7. The average delay between the onset of symptoms and intervention is 8-10 years.
  8. Mental and substance use disorders are the leading cause of disability worldwide.
  9. Serious mental illness costs America $193.2 billion in lost earnings per year.
  10. Approximately 26% of homeless adults staying in shelters live with serious mental illness.
  11. Approximately 24% of state prisoners have “a recent history of a mental health condition.
  12. 70% of youth in state and local juvenile justice systems have a mental illness.
  13. Individuals living with serious mental illness face an increased risk of having chronic medical conditions. Adults in the U.S. living with serious mental illness die on average 25 years earlier than others, largely due to treatable medical conditions.
  14. Over one-third of students with a mental health condition age 14­–21 and older who are served by special education drop out—the highest dropout rate of any disability group.
  15. Mood disorders, including major depression, dysthymic disorder and bipolar disorder, are the third most common cause of hospitalization in the U.S. for both youth and adults aged 18–44.
  16. Suicide is the 10th leading cause of death in the U.S., the 3rd leading cause of death for people aged 10–24 and the 2nd leading cause of death for people aged 15–24.
  17. 1.1% of adults in the U.S. (1 in 100) live with schizophrenia.
  18. 2.6% of adults in the U.S. live with bipolar disorder.
  19. 6.9% of adults in the U.S. had at least one major depressive episode in the past year.
  20. 18.1% of adults in the U.S. experienced an anxiety disorder such as posttraumatic stress disorder, obsessive-compulsive disorder and specific phobias.
  21. Of the 20.2 million adults living with addiction disorders, just over half have co-occuring mental health disorders as well.
  22. African Americans and Hispanic Americans used mental health services at about one-half the rate of Caucasian Americans in the past year and Asian Americans at about one-third the rate.
  23. More than 90% of children who die by suicide have a mental health condition.
  24. Lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth are 2 to 3 times more likely to attempt suicide than straight youth.
  25. Each day an estimated 18-22 veterans die by suicide.
  26. The prevalence of mental illness (diagnosed American adults) by race: 13.9% Asian, 16.3% Hispanic, 18.6% Black, 19.3% White, 28.3% American Indian/Alaskan Native.
  27. LGBTQ individuals are 2 or more times more likely as straight individuals to have a mental health condition.
  28. Some critical issues faced by minority communities include decreased access to treatment, language barriers, higher levels of stigma, culturally insensitive health care system,  lower rates of health insurance, poorer quality of care, and racism, bias, homophobia or discrimination in treatment settings.
  29. War and disasters have a large impact on mental health and psychosocial well-being. Rates of mental disorder tend to double after emergencies.
  30. Human rights violations of people with mental and psychosocial disability are routinely reported in most countries. These include physical restraint, seclusion and denial of basic needs and privacy. Few countries have a legal framework that adequately protects the rights of people with mental disorders.
  31. Globally, there is huge inequity in the distribution of skilled human resources for mental health. Shortages of psychiatrists, psychiatric nurses, psychologists and social workers are among the main barriers to providing treatment and care in low- and middle-income countries. Low-income countries have 0.05 psychiatrists and 0.42 nurses per 100 000 people. The rate of psychiatrists in high income countries is 170 times greater and for nurses is 70 times greater.

If you’re looking for citations, they are here, here, here, here, and here. Happy Mental Health Awareness Month!!!

Mental Health First Aid

Thanks to Kalamazoo County Community Mental Health & Substance Abuse Services (KCMHSAS) for providing me with a full scholarship to attend this training, I went to an 8-hour Adult Mental Health First Aid course yesterday afternoon. According to their website, this course “teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders. The training gives you the skills you need to reach out and provide initial help and support to someone who may be developing a mental health or substance use problem or experiencing a crisis.”

The program was initially developed in Australia and has since been adapted for use in over 20 countries, including the United States. The main goal is to equip people with the tools they need to start a dialogue about mental health so that individuals who are in crisis can get the help that they need.

“Most of us would know how to help if we saw someone having a heart attack—we’d start CPR, or at the very least, call 9-1-1. But too few of us would know how to respond if we saw someone having a panic attack or if we were concerned that a friend or co-worker might be showing signs of alcoholism.

Mental Health First Aid takes the fear and hesitation out of starting conversations about mental health and substance use problems by improving understanding and providing an action plan that teaches people to safely and responsibly identify and address a potential mental illness or substance use disorder.” The Mental Health Action Plan utilizes the following acronym: ALGEE (pronounced like the word, “algae”)

  • Action A: Assess for risk of suicide or harm
  • Action L: Listen nonjudgmentally
  • Action G: Give reassurance and information
  • Action E: Encourage appropriate professional help
  • Action E: Encourage self-help and other support strategies

In the course, we learned the signs and symptoms of depression, anxiety disorders, suicidal behavior, non-suicidal self-harm, psychosis, and substance use disorders. We did a lot of group work, where we were given hypothetical situations and asked to use the Mental Health Action Plan to determine how to help the individuals in our case studies. We learned that the action plan is non-linear, meaning that you don’t necessarily complete all of the steps in order and you don’t have to complete all of the steps in each situation.

There were a dozen individuals in the class with me and the majority of them are social workers, but there were a few people who work outside of the mental health/substance abuse field, including business professionals, a college student and so on. I think that everyone found the course to be helpful. Much of the material seemed like common sense to me, but that may be because I have lived a lot of it. I found it interesting listening to people talk about the signs and symptoms. For example, we did an activity related to hearing voices (psychosis) in which we broke into groups of three and two people had a conversation with each other while the third person whispered into one of the other people’s ears. Everyone was shocked at how distracting this is but I have experienced auditory hallucinations, so I was not very surprised. I’m glad that it helped them to better understand what an individual that is hearing voices might be experiencing.

I think that the most important activity of the day was breaking into groups of two for role playing, having a conversation with a friend that we think might be suicidal, and asking them directly, “Are you having thoughts of suicide?” or “Are you thinking about killing yourself?” This activity is required in the course because how can we help someone who is suicidal if we can’t even ask them if we are? I had never said those words out loud and it was hard but we all did it and now I know that I can. I guess I just assumed that I would be able to do it before. We learned not to ask vague questions such as, “Are you thinking about harming yourself?” or “You’re not planning on doing anything crazy, are you?” because the individual may not see suicide as harmful or crazy. We need to be very direct. If the person says “yes,” there are four follow-up questions to ask:

  1. Do you have a plan?
  2. Have you decided when you would do it?
  3. Have you collected the things you need to carry out your plan?
  4. Do you have another plan?

I’m going to share two crisis resources here.

  • The National Suicide Prevention Lifeline is 1-800-273-TALK (8255). It is “a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week.”
  • The Crisis Text Line is a 24/7 anonymous service for anyone experiencing any kind of crisis. Text 741741 or message them on Facebook and you will be connected to a trained counselor. If your cell phone plan is with AT&T, T-Mobile, Sprint, or Verizon, texts to 741741 are free of charge. If you have a plan with a different carrier, standard text message rates apply.

We covered a lot of material throughout the day, but we didn’t have to try to memorize everything because we were given a copy of the book, “Mental Health First Aid USA” to keep. It’s full of information about mental health conditions, plus statistics and vetted resources. KCMHSAS also provided us with a detailed resource list specific to our county.

If you’re able to attend a Mental Health First Aid training, I highly recommend it. Did you know that 19.6% of American adults (1 in 5) have a mental disorder in a given year? This is equivalent to 45.6 million people. These types of disorders can have a huge impact on their education, work, relationships, and health. Early intervention can greatly reduce the impact and first aiders can make a big difference by helping individuals that are in crisis to have their needs met. Can you imagine what the world would be like if we had as many people trained in Mental Health First Aid as we do in First Aid and CPR?

Writing Your Own Story

Last Saturday, I attended a workshop called “Narrative Medicine: Unpacking and Authoring Our Stories” at Kalamazoo College’s Arcus Center for Social Justice Leadership, facilitated by the Icarus Project. It was geared particularly towards individuals with mental illness. We discussed labels, who we get them from, how they are used, and how we can change the way that our personal stories are told in order to better represent us.

I have been rapid cycling between depression and mania for the past several months, something which I do not normally do. As a result, I have not taken the best care of myself and I have been isolating myself because I don’t want people to see me this way. I know that isolating is a terrible idea. Anyway, attending this workshop was a big step for me and I’m glad that I went. Although I didn’t brush my hair or shower, I did put on a nice outfit. I didn’t talk to many people because I’m experiencing confused speech and self-consciousness, but I did contribute to the group discussions.

First, we looked at the labels that we have been given during our lives. The facilitator asked us to raise our hands when we heard a label that we have either been given or that we personally identify with. Some of the labels: anxious, depressed, too sensitive, moody, difficult, dramatic, complicated, angry, irritable, aggressive, autistic, bipolar, troublemaker, irresponsible, flaky, lazy, borderline, paranoid, antisocial, immature, shy, broken, clingy, needy, and narcissist. Just about everyone in the room raised their hand for “anxious,” and the facilitator listed three different interpretations of anxiety. Her point was that there is more than one meaning for the word.

Next, she asked us to write a list of our personal labels and include where we got them from/who gave them to us. I would like to spend some more time on this, but I found the activity to be eye-opening. A lot of the labels associated with my mental illness were given to me by my family and peers when I was young. I was told that I was moody, too sensitive, bipolar, antisocial, and shy early in my life. Some labels were given to me in my adult life by medical professionals, significant others, co-workers, and peers: anxious, irritable, lazy, clingy, needy, flaky, depressed. Others are core beliefs that I attached to myself: broken, difficult, dramatic, complicated.

After taking some time to write these things down, we came together as a group to discuss our thoughts. I shared that the majority of my labels were given to me when I was young. The facilitator asked if I still identify with them (I do). This is something that I will ruminate over. Other thoughts from the group:

  • Many of us didn’t list any “positive” labels.
  • There’s power in labels. They control our behaviour. We eventually believe them even if they’re not true to us.
  • We may be quicker to internalize labels due to certain circumstances.
  • Can we escape labels? Who can do this? Some are easier to drop than others.
  • Powerful people label others despite their lack of personal understanding.
  • Being called “needy” by your significant other stifles your expression of love.

Next, we learned that nobody is capable of telling your story better than you. The facilitator read Mary’s story. The story described Mary’s physical, medical, financial, environmental, family, educational, mental, social, and employment situation. Here’s Mary’s full story: Mary’s family has lived in chronic poverty since the sources of employment in her rural town were closed down and most people in town lost their main source of income. Therefore, Mary has been poor all of her life. Despite the lack of wealth, Mary’s family is very loving and supporting. They make a point to get together at least twice a week and they share a meal, watch a movie, have conversations, or play board games. Mary’s town was deeply impacted by environmental trauma. For most of her life, Mary drank poisoned water that has given her a chronic illness. Because of lack of resources, Mary is not able to get the medical help she needs. She missed school so much that she dropped out of high school. This made Mary very lonely and depressed. Mary was embarrassed and started progressively isolating from her peers until she hardly had and friends left. Mary spends her days with her nieces, whom she enjoys very much, her next door neighbor, or her pets. Because of the unpredictable nature of her condition, she is not able to remain employed. Mary has been unemployed for the last decade. She is very angry about her lack of ability to hold down a job because of medical reasons and often lashed out at employers and co-workers. Mary eventually stopped leaving her house except for a few social outings every week. Mary has been receiving social benefits that allow her to meet basic food and housing needs.

Then, the facilitator read the town mayor’s version of Mary’s story. The mayor wants to make budget cuts to social services because he thinks that people are lazy and abusing the system. The mayor’s version of the story only included the facts that Mary has been poor all of her life, she dropped out of high school, has been unemployed for the last decade, previously lashed out at employers and co-workers, and has been receiving social benefits that allow her to meet basic food and housing needs. The mayor’s story doesn’t paint the full picture. Mary’s doctor has another version. After listening to the exact same story from Mary, they write down that she has been poor all of her life, has chronic illness, dropped out of high school (which made her lonely, depressed, embarrassed), isolated from her friends until she barely had any left, is unemployed and angry, lashed out at employers and co-workers, and has stopped leaving her house. Again, this is not the whole story. Finally, the facilitator read Mary’s rich uncle’s version of Mary’s story. Mary is struggling financially, but her uncle doesn’t want to help her because: Mary’s family is very loving and supporting. They get together at least twice a week to share a meal, watch a movie, have conversations, or play board games. Mary spends her days with her nieces, whom she enjoys very much. She also spends time with her next door neighbor and her pets. She goes on social outings every week and she has been receiving social benefits that allow her to meet her basic food and housing needs.

This last section really stuck with me because I have seen firsthand what happens when someone else tells my story. I am the only person that can tell my full story, and the first step to doing so is to examine which labels are attached to me and determine whether or not they serve me.

Finally, we discussed ways to reclaim our personal narratives. Here are a few things that we came up with:

  • “My existence is resistence.” Just living your life.
  • Being seen in public spaces.
  • Using our voices (refusing to be silenced).
  • Finding/Creating/Supporting safe spaces, where you have permission to be fully yourself unconditionally.
  • Allowing ourselves to be vulnerable (within a safe space) in order to be true to ourselves and inspire others to do the same.
  • Finding/building community and standing together.
  • Art expression (shared is especially powerful).

The Icarus Project

“The Icarus Project is a support network and education project by and for people who experience the world in ways that are often diagnosed as mental illness. We advance social justice by fostering mutual aid practices that reconnect healing and collective liberation. We transform ourselves through transforming the world around us.” (quoted from their website)

I was not familiar with the Icarus Project prior to this workshop, but I’m happy that I discovered them. The workshop gave me a lot of things to think about regarding my personal situation, and I like that they provide great resources such as publications and handouts on their website.

The Arcus Center for Social Justice Leadership 

“The ACSJL is an initiative of Kalamazoo College whose mission is to develop and sustain leaders in human rights and social justice through education and capacity-building.” (quoted from their website)

I have found the Arcus Center to be a safe space that offers enriching social justice leadership workshops. Besides this event, I attended a workshop on self-care for social justice leaders and a film screening/discussion related to human trafficking, both of which provided me with a wealth of knowledge and resources. (Delicious) meals are usually served at their (free) workshops, which are listed on their Facebook page and website. Please note that you must register in advance in order to eat. I subscribed to their mailing list so that I don’t miss any announcements.

Oops

Oops, it has been a minute since I posted. That’s the nature of bipolar. Sometimes I’m hyper-motivated and productive and other times I drop all projects and veg out for weeks or months at a time. Just wanted to pop in and say that I’m here. I’m dealing with rapid cycling, health issues, and employment changes so life is a struggle at the moment, but things will get better.

I rarely experience mania or rapid cycling, so it’s interesting when I do. One of the up sides of mania for me is increased sex drive. The down side to this is that I can be insatiable. So there’s that. Can’t get enough. I’m wearing my husband out.

I often feel more angry when I’m manic too. I keep going to sleep wondering if I could punch through the bedroom wall. I’m not sure why I’m angry at night, but I bet that I could punch through the wall. It’s plaster because our house is like 116 years old. I don’t want to have to fix the wall though, so I’m making responsible choices. Win.

Anyway, just wanted to check in and let you know what I’m up to. I’ll make an effort to post more regularly 😉

Shameless

I started watching Shameless on Netflix about a month ago and I am halfway through season 5 already. I like it for several reasons, one of which is the excellent portrayal of bipolar disorder in both Monica and Ian Gallagher. Spoiler alert: if you haven’t watched through season 5 episode 8, you may want to skip this post for now.

I didn’t “get” Monica until the Thanksgiving dinner episode, at which time I knew as soon as she stood up from the table that she was going to do something terrible. In terms of “highs” and “lows,” I spend most of my time depressed and I tend to get suicidal. Unfortunately, I also get impulsive. As Monica and Ian show us, depressed + suicidal + impulsive = danger.

When Ian was acting strange after going MIA from the army, I wasn’t sure if it was drugs or mania but when he wouldn’t get out of bed for days, I knew.

The one thing that I would say is that my experience in psych wards was slightly different from what Monica and Ian experienced. I have been in three different wards. Two things:

  1. Psych wards have nightly “checks,” in which hospital staff look into your room at night to make sure that you are in bed, okay, and that you’re not getting into trouble. So, Monica’s nighttime sexytime with the other patient is something that isn’t likely to happen.
  2. The guard at the hospital got rough with Ian. I have never experienced or witnessed unnecessary force in a psych ward. I’m sure that it happens, but I don’t think it is common.

I’m up to the point where Ian says that he flushed his meds because they make him feel awful. If you have never taken medicine for a mental illness, you can’t possibly understand what it’s like. And you can’t understand what it’s like to live with a mental illness if you don’t have one, but this show can help you to get a feeling for it. It’s refreshing to see bipolar accurately portrayed in a show. I tried watching Homeland, a series in which Claire Danes plays a CIA agent with bipolar disorder. I thought that show did okay, but Shameless does much better. Consider watching it.