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Mental Health (Expert Forum)
I have suffered from bi-polar disorder for 60 years, am now 62, what is the likely scenario for me.
Answered by
Roger Gould, M.D. - Mental Health, Wellness
Questions posted in the Mental Health forum are being answered by Dr. Roger L. Gould, author of the Mastering Stress and Depression program and affiliated with the UCLA. Department of Psychiatry. Topics covered include anger, attention deficit disorder (ADD), bipolar disorder, dementia, electroconvulsive therapy (ECT), learning disabilities, memory, obsessive compulsive disorder (OCD), panic, personality disorders, phobias, post-traumatic stress disorder (PTSD), schizophrenia, stress, transitions, and work problems.
I have suffered from bi-polar disorder for 60 years, am now 62, what is the likely scenario for me.
by RonPrice, Apr 25, 2007 12:00AM
My experience both long and short term with manic-depression, or bi-polar illness as it has come to be called in recent years, and with other maladies; as well as my personal circumstances at home in relation to my wife’s illness in recent years should provide mental health consumers, as they are often called these days, with an adequate information base to evaluate to some extent my situation at the age of 62 and predict the likely scenario in the decades ahead should I live a long life.
After half a dozen episodes, varying in length from several days to several months, and many experiences on the fringe of normality, the fringe of manic-depressive symptoms, and the heart of manic-depression between 1946 and 1980, I was treated with lithium carbonate in Launceston by a psychiatrist and officially diagnosed as manic-depressive. My history to that point had been far from smooth and linear, but periodically bisected, polarized and traumatized.
Fluvoxamine since 2001 has enabled me to work after 11 pm and into 2 to 3 am without the black moods. If I wake up at 4, 5 or 6, say, a degree of emotional blackness/worry is present but the transition to sodium valproate this month seems smooth. Such is a brief summary of my longitudinal and short term experience. I am happy to add more, but this is sufficient.
After half a dozen episodes, varying in length from several days to several months, and many experiences on the fringe of normality, the fringe of manic-depressive symptoms, and the heart of manic-depression between 1946 and 1980, I was treated with lithium carbonate in Launceston by a psychiatrist and officially diagnosed as manic-depressive. My history to that point had been far from smooth and linear, but periodically bisected, polarized and traumatized.
Fluvoxamine since 2001 has enabled me to work after 11 pm and into 2 to 3 am without the black moods. If I wake up at 4, 5 or 6, say, a degree of emotional blackness/worry is present but the transition to sodium valproate this month seems smooth. Such is a brief summary of my longitudinal and short term experience. I am happy to add more, but this is sufficient.
Doctor's Answer
by Roger Gould, M.D., Apr 26, 2007 12:00AM
, Apr 26, 2007 12:00AM
It's impossible to make the prediction you are asking for, because new medications are coming out all the time, and with age there is a natural smoothing out as you become wiser, and your response system is less reactive. Things could be much better, so don't despair, but live each day as best you can, since that's all you can do.
I take celexa/zyprexa and I see a therapist on a regular basis.This has been a life saver for me.Also my family is very supportive of me
Bi polar can be conquered with the right meds and therapy.
I still have emotions but not with the extrems I used to get before my meds.I
still get happy ,sad, and mad but they are normal reactions not the devasting ones I used to get.
Do you see a therapist as well as take meds?I highly encourage it especially since you are a care giver to your wife.
Let me know how you are and post here if you need to talk. this forum is great for that.
Love Venora
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MY BI-POLAR DISORDER--A 60 YEAR STORY IN CONTEXT: 1947-2007
--In 4 Parts: 5000 words
My experience both long and short term with manic-depression, or bi-polar illness as it has come to be called in recent years, and with other maladies; as well as my personal circumstances at home in relation to my wife’s illness in recent years should provide mental health consumers, as they are often called these days, with an adequate information base to evaluate to some extent their own situation, make relevant comparisons and contrasts to their own predicament whatever it may be and thereby gain some helpful knowledge or understandings which may be of use to them in personal terms. There are still many who do not feel comfortable seeking medical support and this account may help such people obtain appropriate treatment and, as a result, dramatically improve their quality of life. I think, too, that this essay is part of my own small part in reducing the damaging stigma associated with bi-polar disorder.
The wider context of my experience which I outline here is intended to place my bi-polar disorder in context and should provide others with what I hope is a helpful perspective on their own condition and situation. This essay of more than 5000 words and more than six A-4 pages is primarily written for internet sites on mental health, especially as manifested in depression and the bi-polar disorder. I also write this essay, this reflection, for my own satisfaction, to put into words something that has influenced my life for over half a century. Originally written in 2003, this piece of writing has been revised many times after my own introspections and the feedback from various internet respondents
1. Manic-Depression: Preamble
After half a dozen episodes, varying in length from several days to several months, and many experiences on the fringe of normality, the fringe of manic-depressive symptoms, and the heart of manic-depression between 1946 and 1980, I was treated with lithium carbonate in Launceston by a psychiatrist and officially diagnosed as manic-depressive. My history to that point had been far from smooth and linear, but periodically bisected, polarized and traumatized.
In some ways the inclusion of the names of those doctors who treated me over the years would personalize this account, but names are not that important and to include them here in this narrative causes confidentiality problems to some readers and at some websites--and so I leave names out. Those whose names I could mention would not be troubled by their inclusion here. I certainly appreciate the clinical work of several of the psychiatrists as well as several of the individuals I have known personally over the years. Their professional work and personal assistance has been invaluable and I want readers to recognize the primacy I give to the work of these specialized doctors and friends for their help and assistance, their saving me from what in any previous age and time period would have been a horrific, virtually end-of-normal-life experience.
I sojourned in a public and private world, from time to time, no less strange to me than if I had been among an exotic jungle tribe in Africa. It is the duty of all anthropologists to report on their exotic travels and field trips, whether to the Earth’s antipodes or to equally remote recesses of human experience, this is my accounting. I came, insensibly over several decades, to associate the extremes of my bi-polar disorder with the role of shamans among tribal, third world, animistic communities, people who relate their myths and their meanings my means of emotionally laden ecstatic visions. On the personal level, I discovered in myself unexpected patience, humility and hope. I learned to treat life as the most precious of gifts, infinitely vulnerable and precarious, to be infinitely prized and cherished. I had not become a saint, though; I still suffered; I was still impatient; I did not always appreciate life; I still got depressed. I had journeyed with my soul into an underworld and come back. It was a spiritual drama—on a psycho-neurological, a psycho-pharmacological, a schizo-affective level. I could narrate this drama in religious terms and describe it as a purgatorial dark night.
Stories in life are chaotic in the absence of narrative order. And so I tell my story here as briefly as possible to help establish, for me, a sense of order. I tell of these events, as a storyteller, my experience of life, to some extent without sequence or discernible causality. Life has an element of mystery no matter how much knowledge and understanding we bring to the problem. I claim that chaos narratives are incompatible with writing or with telling. Those who are truly living a chaos cannot tell of it in words except in the most bizarre fashion. The chaos that I describe in the distant past is told here in a story-form. I now reflect on that experience retrospectively. Lived chaos makes reflection, and consequently story-telling, impossible when one is in the midst of the experience. Telling, and even more so writing, it seems, is a way of taking control, creating order, thus keeping that once experienced chaos at bay.
2. Enter: Lithium
Lithium is, arguably, the central pivot in this whole story. I have been on lithium now for twenty-seven years, about half of the total time I have experienced this significantly/partially genetic disorder. My mood swings, now in 2007, take place, for the most part, late in the evening and after midnight with the death wish still part of the experience, but none of the intensity that my mood swings had for many years, at least until 2001 when fluvoxamine was added to my medication package. The symptoms that affect my daily working capacity are fatigue and psychological weariness, sometimes after a night of light sleeping, tossing and turning and/or sometimes late at night after many hours of intellectual activity. Dryness of the mouth and short term memory loss also seem to affect my daily life as a result of (a) lithium treatment and (b), in the case of memory loss, perhaps due to the eight ECT treatments I had as far back as the late 1960s. My current psychiatrist who specializes in treating people with bi-polar disorder, has been providing his professional advice for the last five years, after a series of psychiatrists I have had going back to 1968.3
It seemed appropriate to outline this detailed statement for several purposes since the issue of the nature of my problem and what I have called manic-depression/bi-polar disorder is a complex one, varies from person to person and has been of concern over the sixty years that I have had to deal with its symptoms in my personal and working life-as have others involved with me. It is difficult to characterize my condition and it is for this reason that I have written what some may find to be a somewhat long statement for both my satisfaction and use by others. I hope the account below, in both long and short term contexts, will explain adequately my reasons for not wanting to work in any employment position or participate in any demanding social context. This account may also provide those interested with some useful information for dealing with their particular problems.
3. Manic-Depression: Long-term 1947-2001
There seems to be a process, one of immense variability, that I have experienced on a daily basis for some 60 years. The details, the symptoms, the behaviour, varies from year to year, with the decades, with the days. I cross from some normal behavioural constellation to an abnormal, intense one. The abnormal extreme position varies, as I say, from year to year in content, texture, tone and intensity. In 1946 it was characterized by uncontrollable early childhood behaviour. My mother had to deal with these aberrations. I think the diagnosis of bi-polarism at that early stage of my life is a remote possibility given a statistical average of 1% of manic-depressives having the disorder in childhood. Looking back to my childhood I did have some behavioural abnormalities, but their association with bi-polarism is, I think, unlikely in retrospect.
At the moment my bi-polarism is characterized by a mild tedium vitae attitude and behaviour as I have come to call it--late at night. Due to the above "process" over the last sixty years, due to the part of the process which occurs in varying degrees in various accentuated forms, it has often been difficult to define just where I was at any one time along that 'normal-abnormal' continuum. This was true at both the depressive end and the hypomanic end of the spectrum. It is difficult, therefore, to actually name the number of times when I have had major manic-depressive episodes, perhaps as many as eight, certainly as few as four, in my whole life, from the first episode--which was probably not an episode--in 1946 to the last brief episode in 1990 when I went off my lithium for between one and three months. Defining an episode is not easy for me to do; indeed, the concept of episode is only useful in some respects. In other ways it over-simplifies a complex set of behaviours and has value when trying to describe the experience in writing.
Since 1990 I have generally had little difficulty knowing where I was in this process, this swing of mood and feelings. The great intensities had gone by 1990. Total acceptance of the necessity of taking lithium was a critical variable in this process and it took a decade to achieve(1980-1990). At the hypomanic end of the continuum over the years there were experiences like the following: violent emotional instability and oscillation, abrupt changes and a sudden change in a large number of intellectual assumptions, elation, high energy. Mental balance, a psychological coherence between intellect and emotion and a rational reaction to the outside world all seemed to blow away, over a few hours to a few days, as I was plunged in a sea of what could be variously described as: emotional heat, intense awareness, sensitivity, sleeplessness, voluble talking, racing mental activity, fear, excessive and clearly irrational paranoia--and in 1968 virtually total incoherence at times--at one end of the spectrum; or intense depression, melancholia, an inner sense of despair and a desire to commit suicide4 at the other end. The latter I experienced from 1963 to 1965, off and on; the former from 1964 to 1990, on several occasions.
The longest depression I had was in 1963 and 1964 with perhaps two six month periods from June to November and July to December, respectively. The longest episode of hypomania was from June to November 1968. This episode was also given the name of schizo-affective disorder with the adjective mild placed at the front of the term. The episodes of hypomania in 1978, 1979, 1980 and 1990 were treated quickly with medication, although the 1978 episode, beginning in January, seemed to last for at least three or four months and had a mostly depressive component. It was treated with stelazine and the side effects were horrific. I wanted to get under the bedclothes every night after getting home from work due to paranoia and depressive symptoms. Only the 1980 episode required hospitalization in this case for one month.
I had some experience of this variously characterized illness in childhood as far back as about 1947 at the age of 2 and then onward through early, middle and late childhood into the puberty cusp of 12 or 13 I manifested symptoms which, in retrospect, seem to me examples of a lack of control of my emotions, a far too intense activity threshold and activity with what could be called mild bi-polar symptoms. It was not until much later in life, though, that I began to see these behavioural aberrations in childhood, at puberty and during adolescence as possibly having a link with my future mental illness. It was not until I was 19 in 1963 that any characteristics of this illness became quite clearly apparent in my day-to-day life. They did not receive the required medical attention and the diagnosis of schizo-affective disorder, bi-polarism and/or depression did not take place—medically. I was just given lots of advice from religious to common-sensical varying from diet to exercise. And after several months or several years the emotional aberrations disappeared, at least for a time.
My episodes over the years seemed to exhibit quite separate and distinct tendencies and patterns; hypomania was always characterized by elation and depression was always characterized by varying degrees of very low moods. In the 1978 episode, elation and depression followed each other alternatively within a two to three month period. Clearly, in the episodes in the late '70s, fear, paranoia and the extremes of depression seemed to be much less than those of the 1960s.
This account above has none of the fine detail that I could include like: (a) mental and mostly auditory hallucinations, (b) specific fears and paranoias, (c) electroconvulsive therapy, (d) psychiatric analysis and diagnosis, (e) the many years of dealing with suicidal thoughts and the death wish, (f) experiences in and out of half a dozen hospitals, unnumbered doctors’ clinics and the advice from more people than I care to think of, (g) adjusting to medications that varied from ones which put me to sleep to ones which made me high; (h) the affects of these swings on my employment, my relationships and my attitude to life; and (i) the periods in my life when the manifestations of the disorder were few and far between. Many of the situations, looking back, were humorous and the contexts absurd. And there was much else but, as I indicate, I hesitate to go into more detail. My aim here is to make a short, clinical statement, to put the facts on paper. Perhaps later I will go into the kind of detail some readers have already asked for. And so--I want to make this statement as short as possible but as detailed as I can to give a longitudinal perspective.
There are a variety of manic-depressive profiles, different typicalities, from person to person. It is bipolar because both ends of the spectrum, the moods, were experienced over the period 1947 to 2007, 60 years. Thanks to lithium most of the extremes were treated at the age of 35 in 1980. It took another ten years, until 1990 as I say above, for me to fully accept the lithium treatment. From time to time in the 1980s I tried to live without the lithium, to ‘go it alone’, as they say colloquially. Such, in as brief a way as possible, is the summary of my experience over the years. I have written more extensively of this in my autobiography which is readily available on the internet if anyone is interested. I would like, now, to focus on my more recent experience of the last decade and a half, 1991-2007, and especially the last half dozen years, 2001-2007. By 1991 I had no problems with lithium compliance, a problem I had in the first decade of lithium treatment.
4. Manic-Depression: Short-term 1991-2007
In the eight years 1991 to 1999 I finished my life of full-time employment, began my obsession with writing and experienced, at last after a decade a full-acceptance of my lithium treatment. In 2001, after two years of early retirement, my supervising psychiatrist in Tasmania suggested I go onto fluvoxamine in addition to the lithium treatment. Fluvoxamine is an anti-depressant. The fluvoxamine removed the blacknesses I had continued to experience at night, from late in the evening until early morning when I was awake or partially awake. The death-wish has always been associated with these blacknesses. With the fluvoxamine, gradually the blacknesses, the nightly depressions, disappeared or virtually so with only residues of a lower mood remained. The death wish remained as did sleeping problems, but in a much milder form. Like so many things in life, the death wish and mood swings have varying degrees of intensity and coping is the key question—and one not easily described and/or answered.
Frequent urination, periodic nausea and memory problems related, in part and perhaps, to the shock treatments I had back in the 1960s, were new problems by the year 2001. But t