Bipolar, BPD and pregnant

Last time I wrote a post I was getting over RH and I’m happy to say I’m over him. I’m engaged to GC and realised from actually having proper sex with GC that what RH and I did that I called sex wasn’t actually sex… He couldn’t get it in because he didn’t turn me on and back then it was harder to do due to PTSD trauma.

I stopped writing on this blog because I was happier and busier and life just seemed to be going too fast for even my mind to catch up, let alone write it all down. But I’m pregnant now (approx 10 weeks) and have been pretty tired, ill and run down recently so I’ve had time to sit and think and after God knows how long I feel ready to write again.

I got engaged in July last year, probably the last time I was truly happy. Which sounds kind of horrible to say but honestly it’s true. Since September I’ve been stressed and even worse pretty ill. July was a fun month tbh. I probably got engaged a little too prematurely and rash. I went to a club with GC Sister in law for her 30th birthday and got pretty drunk which was awesome. Lithium was holding me. 

August actually wasn’t too bad either, JS had her birthday at a club and again I got pretty drunk but unfortunately threw up… Not the prettiest of scenes but it was fun. Unfortunately I didn’t really hear from her after that and I don’t know whether she considers me to have ruined her birthday or what but I haven’t heard much from her since.

I also got diagnosed with borderline personality disorder in August (at least according to my medical records) so I was glad to finally know if I did or did not have that.

I dropped out of both colleges in September. The childcare course because I realised I didn’t want to do and the counselling course because I had no feasible way of making it there – but that’s just a long-ish logistical story.

I got admitted to hospital in October due to lithium toxicity and body jerking which still hasn’t fully gone. But reduced when I was taken off lithium which was good because in November I found out I was 4-5 weeks pregnant. 

It’s been kinda crazy these past few months. How has everyone else been?

Break Ups

I don’t want to reread my last blog post so I may or may not be filling in the gaps. I’m pretty sure I told you about how I was dating RH or at least that we had done stuff. We dated for about a month and I had sex with him twice (he wasn’t great) before we had another messy split and I do mean full on messy. After the break up… He didn’t care. I got drunk a lot. It was bad. Luckily I had GC to pick up the pieces, not that I could tell him why I was so down without explaining the overlap of RH and GC dating. But as far as I can tell both myself and RH have moved onto other people and I deleted him on everything but snapchat and then he deleted me on that. We won’t be contacting each other again I don’t think.

I won’t go through why he and I broke up because I’m honestly trying to put that behind me because it was so hard trying to get over him and I can’t say I’m fully there yet but I’m in a better place with it. I’m not getting drunk and crying at least. So there is that. But I will say that after a large deliberation, there was fault on both sides before the break up and he was a fucking awful prick afterwards. He hurt me without directly talking to me and ignoring me but again, it isn’t really fair of me to say without explaining it but I think that’s the best I can say. One day I may fully explain what happened but I really just want to put RH behind me.

GC is someone new. I got with him after RH broke up with me the first time and then when RH and I broke up again a week or so later I had him there for me. But due to overlap I couldn’t tell him about RH.

GC is 26 years old so there is a reasonably big age gap which at first kinda caused issues because he fell head over heels for me whilst I was, for most of our relationship, trying to get over RH so I didn’t fall as fast as he did. So his ‘I love you’ (which I have returned), his talking of moving in together, marriage, kids… all seemed a bit premature for me. An 18 year old who just found the world again.

I did actually warm up to the idea of moving in together especially what with me and my dad at odds all the time but when I had warmed up to that, the marriage/engagement thing got more serious so that whilst what I thought was a joking (though uncomfortable) discussion between him and his niece when we were in town about weddings became a little less of a joke when he took me to get my ring finger measure in a ring shop. I didn’t react straight away because of the borderline personality disorder (yep another diagnosis btw), I don’t trust myself to react so I gave myself some time to digest what happened. I talked to my friends. JS (who I knew from college and got back into contact with again actually due to RH), EC and FM and they all thought “what the fuck” like I did.

So my original plan was for me to tell him last Sunday I wanted a break. No sleeping with other people or anything but just some time to feel less smoothered. But when I was coming home from a youth council meeting, he could tell something was off. I had apparently not returned his ‘I love you’ 3 times that day (one of those times I did realise I did because I wasn’t supposed to be on my phone so kept it short and sweet) and whilst I kept saying everything was okay, he asked if he could call. We ended up talking it out and he got really upset and I didn’t ask for a break because I didn’t want to be alone this weekend. So we made up and he’s slowed down a little bit. Which is good.

We do however have plans to move in together this summer which I don’t know whether I want to go through with or not. Not so much because I don’t love him or want to be with him but I’m starting school again so I don’t know if it’ll work practically. See, I signed up for school just before RH and I met up and I signed up for counselling course. Which costs about £465 (I think) and I had to put a £50 deposit down. After RH and I broke up but I had been around his nieces and GC nieces and nephew, I realised I was good with kids and wanted instead to do a childcare course so I signed up for that one. Now these two colleges are about 30 miles apart. If I live with GC, I live closer to town so I can get the bus and train to these places (the childcare college is close to town about a 20 minute walk from the centre and also means it’s easier to get to the train station to the counselling one as well) but it also would make it a lot more expensive and my dad wouldn’t be able to take me if i didn’t live with him… Also I feel he wouldn’t speak to me again if I did move out because of money.

But all of this sounds like I’m beginning to put my life together and I am a little bit. I didn’t think I’d see this day. But the thing is that the bipolar is mostly okay now and stable but the borderline is very obvious not the bipolar has gone and has very detrimental affects. Please read this to know more about the disorder. My abandonment issues vary from clinging to a person or pushing them away so I don’t get hurt (which is what I did with RH but trying not to do with GC). I am very self critical and insecure but luckily GC is just as insecure as I am.

I still take lithium and have regular appointments with my psychiatric nurse which I’m glad of because I very desperately need people to talk to. Recently, I have found and it might be related to the bpd that I can’t be on my own. I get very depressed if I don’t have someone to be around. Even if it’s a skype mic chat in my room or a phone call with someone. I need that because I can’t deal with myself and my thoughts. I spend just about every weekend now with GC and try and fill my week with my friends.

This week is half term so I didn’t have girls group and voice group. So I spent bank holiday Monday with Guy until about midday and then I went to see JS but that wasn’t as great as the other times because she brought her sister along so we couldn’t talk about personal stuff. I saw EC and her new house on Tuesday and slept over until Wednesday when I then had to get the bus back to the city and buy some stuff for people and today my brother and I went to the cinema and we saw Unfriended. Tomorrow I have my psych nurse and the doctor whom I am seeing about issues with my foot turning in. Saturday I am seeing my older brother which I kinda feel forced into doing because I missed seeing him last time because I was spending time with RH. So I missing my weekend with GC to see him and then seeing GC on the Sunday and possibly Monday too. Though seeing him on Monday could raise some issues as I need to be home in the mornings to take my brother to school so I can’t sleep over Sunday. I’m willing to spend all day with him but I need to help my brother with his anxiety so I’ll have to work that out.

Overall, when I’m good, I’m really good and when I’m feeling bad I’m really bad. Once I’m fully over RH, I think the emotional depression when alone will lift and be easier but for now it’s what I’m stuck with.

Heart issues and hypothyroidism

Before I started lithium I had a blood test and ECG. Blood test was fine and ECG came back saying I had a short PR interval. I had another ECG after I started lithium and my PR interval had lengthened and I was told the lithium could do that. I had another ECG but the results got lost and then another one and I heard nothing about it until I get a letter saying that I needed to wait for a letter for a 24 hour ECG. Why??? Is what I wondered. My dad spoke to my psychiatrist and she said that the cardiologist had recommended it. When I had an appointment over a week ago I asked her what the problem actually is and do you know what she said to me? “Unspecific heart issue” WHAT?? So that’s a thing I have to wait for. She also later changed the opinion of the lithium causing this issue saying that it didn’t cause it but I don’t understand how my heart was okay off the lithium but now I have an issue…

This is kind of up in the air as I’ve been told that this 24 hour ECG is mainly so they get a clear picture of my heart in a day to see if these “hiccups” are normal. I don’t know.

In England, we have this thing called the lithium registry and what I was told was supposed to happen is they are supposed to send you a letter and a bag (to put your bloods in to get sent to the lithium registry lab) usually every 3 months but if your dose is upped you have it 5 days afterwards. So I had a blood test for 600mg and I got my labs sent to me. My level was 0.65 which isn’t high enough actually for ‘acute’ treatment but is in a range a psychiatrist wants it to be. Now my thyroid levels to explain in case you don’t know.

You have a pitutary gland in your brain which sends TSH (Thyroid Stimulating Hormone) to your thyroid to make your thyroid produce T3 and T4 hormones and T4 is the one that was measured in my blood test now TSH is usually higher when your T4 level is lower because your thyroid isn’t working well so the hormone is sent to try and get it working more and that is hypothyroidism. The opposite is true of hyperthyroidism – T4 high and TSH low.

So getting these results back in paper form with very little explanation. So I looked it up and I find out about hypothyroidism so I go to symptoms and the symptoms I had brushed off as being part of winter or a lithium side effect are actually hypothyroidism. For example, one of the first symptoms I got was sensitivity to cold. I was freezing all the time. Joint pain which also worsened my hand pain I’d gotten from other things but it worsened it. I’m pretty sure it’s also slowed my healing down. I hurt my toe a month ago by dropping a stool on it. I bruised the bone and cut the skin. It has been a literal month and the cut on my toe hasn’t even healed yet.

Now if you go on ANY website and look at the causes of hypothyroidism lithium is one of them. Lithium actually the number one example of a medication that causes hypothyroidism. So I asked my psychiatrist what we are going to do and she said basically that it happened too fast to be caused by the lithium but we’ll see what the level is next time.

Now here’s where I’m fucked around:

Heart: The psychiatrist sent my dad a letter saying that if we took this letter down the ECG department at the hospital they would fit the 24 hr ECG there and then. We went today and you can’t do that for 24 hr ECG so that was a waste of time and really frustrating because we could have booked the appointment over the phone last week. Now I have to wait until April.

Thyroid: The psychiatrist told us 5 days after a dose is upped we will get a letter from the lithium registry asking for another blood test. We didn’t get one so when we saw the psychiatric nurse she called the lithium registry who told us we weren’t going to have one until May (3 months) and so now I have to wait even longer for the psychiatrist to write a letter asking for a thyroid test which shouldn’t take long but she for some reason is taking very long with it.

If that test comes back with saying my hypothyroidism is the same or worse then I have to go to my GP and ask them what they think I should do.

So at the moment, my mental health is still kinda depressed with swings into irritability now and again but otherwise I just am really tired with no energy. Thanks lithium.

Lithium

It feels longer than 14 days since my last post. So to keep you up to date:

Crisis Team

That went poorly. I met the crisis team people at my GP surgery and to save a lot of time, they didn’t like that. I don’t know what their obsession with home treatment is but they do not like being denied access to your house. During the times of seeing them I was very depressed and they asked the same questions in the 3 appointments we’ve had. Now I was supposed to see them everyday but I didn”t have to see them on the days I saw my psych nurse and I didn’t see them at the weekend so overall it added up to about 3, maybe 4 appointments. In those, let’s say 4 appointments, they decided that what would treat me is looking up “positive thinking” on youtube (yes, youtube) and going out more. Now the positive thinking on youtube thing is bull shit and I’ll tell you why: if a professional starts some sort of positive thinking regime (not that I could imagine how that would go) and said look up this on youtube as a supplement it might work but asking someone to look that up as an alternate to actual treatment is bad. They had a tendency to ring and arrange an appointment an hour before you’re supposed to be at the doctors surgery. It was just bad. Also after those 4 appointments, they have decided to discharge me. Yeah, they’re great.

My psych nurse is on holiday and won’t be back until next week. Which is also great.

Lithium

I am currently on 600mg. Side effects so now aren’t too bad. Nausea and stomach pain are the ones that are sticking around. Also, on my ECG before I started the lithium I had a short PR interval, next ECG on 400mg normal PR interval and now on 600mg, PR interval hitting the long side so I have to be monitored and have a lot of ECG which means I have to strip off in front of strangers a lot.

Mood

I find myself on the low side, not really much effect. I’ve been getting more irritable lately though I don’t know if that’s the lithium or just a mood thing but I have been. Plus my self esteem has been pretty low in regards to my appearance. Though I did just dye my hair burgundy.

Groups

Groups are going well. I’ve taken a more active role with the girls group and with the voice group as well. For example this weekend I am going on a residential for team building and work shopping – not entirely sure that is though and so hopefully that goes well.

I’m still depressed and lithium is nasty but I’ve been worse so I guess that’s something.

First few days on lithium

I’m trying to get better with naming my blog posts and even writing them. I write them in my head, sometimes in their entirety but when it comes to writing it down, I seem to falter a little and it just never seems to fully convey the message I want to convey.

I started lithium on Tuesday and I haven’t noticed much. I experience chest pain after taking it and jitteriness in the few hours before I take it (but my guess is it’s coming out of my system, waiting to be rebuilt in the next hour). I’m on 400mg (daily) so I don’t expect anything to happen yet and in terms of medication I’m not giving up hope yet.

As for my overall mood, I’ve been… well, depressed. I mean that is literally the only way I could describe it. There was a slight change in my mood on Friday night with me becoming irritable and quite aggressive. I didn’t cross so much over into rage but I was just irritable and I thought maybe I was becoming hypomanic but rather than the happy side, the irritable side but that went back to depression pretty quickly.

I wish I could say, also that I’ve been feeling less suicidal but honestly I haven’t not really. Sometimes the urge and the ache is less but overall it’s there and I think what’s worse is that; now if I were to do anything it would be less impulsive and more well reasoned. People, whenever I say I feel suicidal, say I have a lot to live for but the honest truth is – aside from people in my life – I have none of my own reasons to carry this charade on. Even if I somehow get my moods under control I will always be teetering on the edge of a break down, I get very bored of things and will most likely not be able to stick to a job, I am very distrusting of people and find it immensely hard to form meaningful relationships. I honestly have a hard time believing this is all just depression talking or isolation and maybe it is and maybe I can recover from this but a lot of the time I honestly question whether I want to.

My psychiatric nurse once said I find the world a threatening place and maybe that’s why I’m closing myself off more but it’s weird. I find that my confidence in talking to strangers is better than it has been in a long time, my body confidence is probably better (though it has it’s moments) and so I don’t understand why I find everything threatening and why I have been withdrawing from all my friends and some of them are understanding of that and some are not but I just find it’s more a chore to talk to anyone than it is something I look forward to and it’s a shame because I’ve made some new friends recently and it was fun talking to them for 2 days and then I just got bored again. I’ve been getting bored a lot or just lacking interest. I guess that’s all kinda sad.

I’m not saying I will kill myself, of course I have thought about it but to say whether I would or wouldn’t do it could end up being a lie and wrong and I don’t want to lie on this blog, I don’t. I don’t want there to be inaccuracies in this account of my life because when people wonder why someone is the way they are, I want this blog to answer that and right now I can’t say for definite I won’t kill myself. I don’t even think I could promise that I wouldn’t try this month. But I can promise that I’m going to try to not try. I mean, really NOT doing something is kinda my wheel house so I should be good at it.

I’ve had more frequent appointments with my psych nurse and we’ve discussed the possibility of going into inpatient and meeting with the crisis team and I’ve been kind of holding off but I am honestly concerned that one day soon I will do something I can’t take back and I am. So on Monday it is time for a serious talk about what we are going to do because I can’t go on like this any more.

I’m so sick of me.

I saw the psychiatrist on Friday and I should have wrote a post Friday night or Saturday but I haven’t the energy or the head space to. I haven’t now either so excuse all the probable problems with grammar and syntax and all other grammatical things that will probably make this post slightly illegible.

I kinda reached my point where I know WHAT my problems are but I don’t know how to solve them and that somewhat makes it worse as it’s not one of those problems you can easily fix. For example when I realised my nail biting, as a child, was an issue I painted my nails everyday to stop myself from biting them and eventually the habit died and I have long but ugly nails. In more recent examples I knew my problem was procrastinating and I made active steps to stop that when it came to school work but that was about 8 months ago. I can’t fix these problems. I cannot fix the fact that I take people’s neutrality as hostile. I can’t fix the fact that I trust very few people. And I can’t fix pretty much everything currently wrong.

I got called into the appointment but TD (psych nurse) wasn’t down  yet so I sat down with the psychiatrist and told her that I just wanted to say what I had to say without interruptions because I would probably get confused or lost if I got interrupted. I began by saying how in the last appointment I felt like I wasn’t listened to and how I know she said about the hallucinations being dissociative ones but I said I felt like all hallucinations are warrant for concern and how I didn’t feel the fact I was still depressed on medication was taken seriously enough. Which is about the time TD came in and I then said how I had stopped the medication and how I tried to commit suicide which brought out the notepads and they began to ask me questions about how the hospital dealt with it and I told them I didn’t tell them but they were still pushing and I don’t really understand why because I lied to them saying the overdose was an accident so they aren’t expected to maintain a standard of care relating to a suicide attempt.

They then went on to assure me they didn’t take it seriously and they were concerned and we discussed how unlike previous times this was more impulsive and that unlike previous times I wasn’t relieved I failed this time, I was pissed I failed. I learned that impulsivity in bipolar can happen in all mood states whereas I thought it was just a manic end of the spectrum thing. They were concerned about my that.

Something interesting I was asked was: did I feel I needed to be in hospital the days leading up to the suicide attempt. I said I did because I did. I mean I guess maybe the more recent suicide episodes are different to the ones before in that I just really want to die. There is no light at the end of the tunnel for me. I’m just really sick of living. She asked how I felt now (as in at that moment) and at that moment I didn’t feel too bad; they thought i was angry. I wasn’t really angry more than I was frustrated.

The outcome was that I am being put on lithium and there is apparently a lithium registry? Which I don’t even know…  Which means before that I need an ECG and a blood test. Bring on blood tests every 3 months *sighs*

How I’m feeling right now? Just bad. Like I can’t even describe it but good things happened and I think I will probably focus on that.

Science Blog: Bipolar Brain

Now as we know there are different types of bipolar:

  • Bipolar I= Categorized by at least one manic episode
  • Bipolar II= Never experiences full blown mania, experiences hypomania
  • Cyclothymia= Mildest form, less severe mood swings between hypomania and mild depression

But how does that relate to the population?

  • Bipolar affects about 2.6% of the U.S population.
  • Bipolar disorder results in 9.2 years reduction in expected life span (scary, right?!)
  • About 1 in 5 patients with bipolar disorder commits suicide.
  • Almost 70% of bipolar patients are misdiagnosed 3 or more times before receiving their correct diagnosis.

Now there is a spectrum for bipolar and here it is:

spectrumAnd we know the symptoms of the spectrum, right?

 Manic Symptoms:

  • Easily distracted
  • Little need for sleep
  • Poor judgment
  • Poor temper control
  • Reckless behavior and lack of self control
  • Elevated mood
  • Easily agitated or irritable
  • Increased energy
  • Racing thoughts
  • Very high self-esteem
  • Talking a lot/quickly
  • Spending sprees
  • Increased promiscuity
  • Poor Judgment
  • Binge eating, drinking, drug use

 Depression Symptoms:

  • Low mood or sadness
  • Trouble concentrating, making decisions, decreased memory
  • Eating problems-weight loss or gain
  • Fatigue
  • Feeling guilty, worthless or hopeless
  • Decreased self-esteem
  • Thoughts of suicide
  • Decreased pleasure in activities once enjoyed
  • Trouble sleeping
  • Isolation from friends and family

Mixed State: When two phases of depression and mania overlap or quickly cycle after another.

But what’s the neurobiology of it all?
ee2These are pictures of bipolar brains. So what does it tell us, well it tells us that:

  • Although the abnormalities in the brain due to bipolar disorder are still unknown, the structural abnormalities believed to be linked to bipolar disorder are amygdala, basal ganglia, and the prefrontal cortex. Research is currently being conducted to find more definite information on the definite causes and changes in the brain of bipolar disorder.
  • Recently using MRI, hyperintense (bright white) spots have been found in bipolar patients. Hyperintensities have previously been associated with a change in water content in the brain tissue, but the causes of these are not known.
  • Amygdala volumes have been shown to be reduced in unmedicated patients and increased in medicated patients. This is seen in the chart below.
    1-s2.0-S1053811909012099-gr2So what does it actually look like, you know, hormonally?
    bipolar-brainAt the top is ‘normal’ brains, in the middle hypomanic and at the bottom depressed brains.

    • Abnormal intracellular function of the brain of bipolar patients, such as producing higher amounts of serotonin, dopamine and norepinephrine.
    • These abnormalities lead to “racing thoughts” or the patient feeling like they can’t “turn off” their brains.
    • In this figure, you can see the reduced activity in the depressed brain, by the presence of more dark blue and can see the overactivity in the manic brain by the presence of more green, yellow and red in the brain scan.

    DanaGuide_CH15C33_P437_spot

    • Studies done with mice have shown that mice with a mutation in the CLOCK gene will develop manic behavior. This behavior includes: hyperactivity, decreased sleep, reduced anxiety, and an increased response to cocaine. The researchers were able to get rid of the manic behavior by returning the expression of CLOCK to normal, specifically in the ventral tegmental area of the mouse brain.
    • The ventral tegmental area is very rich in dopamine receptors. Because of this, the researchers believe that the same issue that the efficacy of atypical antipsychotics in acute mania might be achieved by their ability to lower activity in neurons specifically within the ventral tegmental area.
    • Levels of expression of oligodendrocyte-myelin-related genes are decreased in brain tissue of individuals with bipolar disorder. Oligodendrocytes produce myelin membranes that insulates axons and allow nerve impulses to fire very rapidly, so a loss in myelin is theorized to interrupt the communication between neurons and lead to possible thought disturbances that are seen in bipolar disorder.

    br-800epi1

    -Although individuals with bipolar disorder do not demonstrate a size difference in hippocampus, bipolar patients have shown hippocampal dysfunction in:

    • a reduced volume in nonpyramidal cell layers
    • a reduced number of somatostati-positive and paravalbumin positive neurons
    • reduced somal volume of cornu ammonis sector 2/3
    • reduced mRNA levels for somatostatin, parvalbumin and glutamic acid decarboxylase 1
    • The hippocampal anatomy is displayed above to illustrate these problems.

    Some studies have also shown a loss in gray matter in bipolar patients, depicted in the graph below. Gray matter is made up of neuronal cell bodies and regulates muscle control and sensory perception, which include: seeing, hearing, memory, emotions, and speech.

1-s2.0-S0006322307002338-gr2 003_brain-white-matterOkay, so what CAUSES bipolar disorder?

The causes of bipolar disorder are vastly unknown, and much research is currently being done to determine the exact cause. However, it is believed to be a combination of genetic factors, environmental factors, and the individuals biochemical processes.

–First degree relatives of a person with bipolar disorder are 7 times more likely to develop bipolar disorder.

–80% concordance rate in identical twins and 16% in fraternal twins, which means that in the case of twin studies, an identical twin has an 80% chance of having bipolar if their identical twin has it, and only 16% chance if the twin is fraternal. This explains the high genetic factor seen with bipolar disorder. Because identical twins share 100% of their DNA, while fraternal twins are regular siblings that share only 50% of each other’s DNA.

–Several genes appear to be linked to bipolar disorder:

  • CACNA1C, on chromosome 12. This gene encodes the alpha 1C subunit of the L-type calcium ion channel in the brain
  • ANK3- an adaptor protein found at the axon initial segments and regulates the assembly of voltage-gated sodium channels.
  • Both ANK3 and CACNA1C genes are down-regulated in response to lithium.
  • Abnormal CLOCK gene function

And of course triggers:

  • Stressful life events
  • Certain medications
  • Major life changes
  • Drug or alcohol abuse
  • Seasonal changes
    But these only trigger episodes in predisposed individuals.

Well I’m on the treatment phase now, so what should I expect?

Mood Stabilizers are most often used because although bipolar patients experience depression, antidepressants are used to treat bipolar patients with caution, because antidepressants have been known to trigger manic episodes in individuals with bipolar disorder. If antidepressants are used, they are used in addition to mood stabilizing drugs.

  • Lithium
  • Valproate
  • Lamotrigine
  • Carbamazephine

ECT: Electroconvulsive therapy (ECT) may be used to treat the manic or depressive phase of bipolar. ECT uses an electrical current to cause brief seizure, while the individual is under anesthesia. This is considered the most effective non-drug treatment for bipolar disorder.

Transcranial magnetic stimulation (TMS) uses high-frequency magnetic pulses to target affected areas of the brain. This treatment if used more commonly than ECT.