Saturday, June 4, 2011

Abilify my life


Psychiatrist clearly has no faith in your standard anti-depressants for me. With the Lamictal and now with the Abilify it seems to be as if he’s treating my BPD almost like Bipolar. Lamictal is used for Bipolar-II depression. Abilify is used both to treat Bipolar and for people without bipolar as a supplement to a currently utilized anti-depressant. As I have no anti-depressant and we’re going to be ramping up my dose to a therapeutic level... idk, that’s just what it seems like to me. If he is doing that it does make a certain amount of sense to me considering both are marked by extreme mood fluxuations. Borderline Personality Disorder and Bipolar Disorder share a lot of features actually. Maybe I’ll post about that sometime soonish.

I figured it might be beneficial to give periodic updates about how my meds are reacting with me. So far I’ve been on Abilify for all of 5 days at 2mg/day. On Monday I go up to 5 mg/day. Then back to see Psychiatrist to make sure I’m actually taking them properly and am not displaying unacceptable side effects. I have a feeling he is going to watch me very closely. 2 weeks between visits is a very short leash ::frown::. The first day I was clearly rage-tastic, but after that first day I've actually felt Okay. On a scale of Severely Depressed to Manic, my average is mildly depressed but wild fluctuation throughout the day. This week I've been relatively steady and up which is very unusual so I can only attribute it to the meds (or the nice weather and dating an amazing woman). I even feel pretty today for my date. Like a little gothic princess. Too cute to function.  But anyways, here’s a list of side effects! I mean seriously. Is it any wonder I have hesitations when it comes to psych meds?


In these studies, the most common Abilify side effects included:

· Headaches -- in up to 27 percent of people
· A sedated feeling -- up to 23 percent  (little bit)
· Agitation -- up to 19 percent <~~~ cuz I need more of this
· Insomnia -- up to 18 percent <~~~~ and this
· Fatigue -- up to 17 percent <~~~~ I get this with the Insomnia
· Anxiety -- up to 17 percent <~~~~ Have you met me?
· Drowsiness -- up to 16 percent
· Nausea -- up to 15 percent
· Vomiting -- up to 14 percent <~~~~ The non-bulimic kind
· Restlessness -- up to 12 percent
· Constipation -- up to 11 percent. <~~~~ Ew.
  
Some other common side effects (occurring in 2 percent to 10 percent of people) included:

· Dizziness
· Indigestion or heartburn
· Shakiness (tremors)
· Weight gain <~~~~ I will be so freaking pissed off.
· Restlessness
· Fatigue
· Dry mouth <~~~~ I propose weed as an alternative
· Joint pain <~~~~ The non weed alternative
· Throat pain
· Blurred vision
· Abdominal pain (stomach pain)
· Pain
· Cough
· Nasal congestion
· Increased salivation
· Swelling or water retention in the arms, legs, or feet.

Serious side effects include but are not limited to:

· Signs of diabetes, such as:

o    High blood sugar
o    Increased thirst
o    Frequent urination
o    Extreme hunger (see Abilify and Diabetes)

· Large or rapid weight gain <~~~~ I will be even doubly more freaking pissed off.
· Suicidal thoughts <~~~~ Sweet. In all fairness, it IS tough to be depressed when you’re dead. Just sayin’.
· High blood pressure (hypertension)
· Dizziness or fainting when going from a sitting or lying-down position to standing <~~~~ Wheeeeeee!
· Feelings of internal restlessness or jitteriness
· Any abnormal muscle movements (these movements can become permanent if Abilify is not stopped quickly)
· A painful erection of the penis that does not go away (priapism) <~~~~ This probably won’t happen.
· Signs or symptoms of neuroleptic malignant syndrome, which can include:

o    A high fever
o    Stiff muscles
o    Confusion
o    Irregular pulse or blood pressure
o    An increased heart rate (tachycardia)
o    Sweating
o    Irregular heart rhythms (arrhythmias)

· Signs of an allergic reaction, including:

o    Unexplained rash
o    Hives
o    Itching
o    Unexplained swelling
o    Wheezing
o    Difficulty breathing or swallowing.


These less common Abilify side effects include but are not limited to:

· Anemia
· Vertigo (a spinning sensation) <~~~~ Double wheeee!
· Tinnitus (ringing in the ears) <~~~~ So irritating
· Low thyroid (hypothyroidism) or high thyroid (hyperthyroidism)
· Gas <~~~~ Gross
· Gastroesophageal reflux disease(GERD)
· Hemorrhoids
· Irritable bowel syndrome (IBS)
· Canker sores
· Gallstones
· Yeast infections
· Arthritis
· Carpal tunnel syndrome
· Kidney stones
· Impotence, also known as erectile dysfunction or ED <~~~~ Doubtful
· An increased or decreased sex drive <~~~~ Either way I’d probably be ok with this.
· Acne
· Eczema
· Hair loss <~~~~ Not cool
· Varicose veins.

Friday, June 3, 2011

Rules Regarding Spending and Gender: None


Oh it’s Friday. What should I talk about today? I absolutely cannot focus so I’m just going to start typing and we’ll see where I go with this.
-         No meds induced rage yesterday. In fact I felt well rested and was very Okay all day.

-         Went on date #3 with my new Lady Friend. For date #2 I took her on a picnic to a romantically secluded beach outcropping. We snuggled, had wine and watched the sunset. Note: I will be as romantic as you let me.  She’s writes me poetry.

-         I made an amazing Turkish inspired 4 course meal last weekend: Almond Soup (Badem Çorbası), Potato Cigarette Borek (Patatesli Sigara Boregi), Turkish-Style Sirloin Steak in a Garlic-Fig Wine Reduction, and Honey and Nuts Snow White (Balli Cevizli Karbeyaz). Apparently I make an awe inspiring steak. This weekend I’m hoping to do Greek.

-         I spend money unchecked….
Seriously. I don’t even realize I do this. I see something, and I get it. I don’t think it’s impulsive at the time. Half the time I believe it’s absolutely justified. Like I had a nervous breakdown on Monday for fear that I couldn’t do my job well enough so I looked up training courses and dropped $600 for advanced training. It’s an investment for my future with the lab, right? It took me all of 10 minutes to make this decision.
I’m tribalizing my Sith Costume b/c my character specializes in Sith alchemy and sorcery so I went to the craft store. Instead of picking out a few key pieces I just get everything I think will fit and could possibly need for my adornment construction. I go in with one or two things in mind, but I don’t stop there. And I don’t think twice about how much it will be.
Is this really a problem if I can actually afford it? I could survive on what I have in the bank, easily, for 6 months with no adjustment to my lifestyle. I have bills that are paid but otherwise no monetary obligations. I could save more I suppose. But for what? What's the point of having money if not to spend it?
The weather is changing so I need new clothes for work. I want to fit in better at work too. I want to masculinize. I do not like the idea of appearing feminine at work. The women around my office wear skirts, and frilly office appropriate tops… I can’t fathom this. On some level I don’t respect it. I think if I were to do this I would not be taken seriously. As feminine as I get is to wear a sweater over dress slacks. I take my fashion cues from the men in my office. I want to blend in with them. Currently I dress too nice for my office, but this I also believe is acceptable. Dress slacks, button down shirts, nice sweaters. The men in my office typically wear jeans, polos, or even just plain t-shirts. With the changing weather I did just “invest” (read: drop a bunch of cash) in some new short sleeved polo shirts; black, white, and navy, which are more casual than the button down short sleeved shirts I own.

::wink::

I want to purchase jeans. But not women’s jeans that tend to be form fitting. I’m going to buy men’s jeans. I don’t want to accentuate my sexual differences.
I do not want to convey a sexualized image at all. I want as androgynous as possible in my dress.
I don’t know if it’s a fear of not being taken seriously professionally.  I don’t think so because I have no qualms about pulling my hair back to display the 17 piercings (I do remove my lip ring) I have in my head. Or maybe I just appreciate the irony.
On many levels I resent being female. I resent that I have hips that curve so I can’t have a streamlined profile in my slacks. I resent that I am the minority in my field. I resent that my friendships and relationships are colored depending on the gender of the person opposing me. May it’s not being female that I resent. Maybe it’s gender in general. Or more specifically the cultural connotations that accompany gender.
How do you really know what gender you are? I’m not male. I don’t feel female. What does female feel like? It’s not something I can put on, take off, and try something else on for a comparison. Either this is it, or it’s not. There are some days I do feel very feminine and appreciate all aspects of what femininity I have. There are more days I feel very masculine. Gender and sexuality is not a categorical designation for me. It’s fluid. I identify gender neutral but really I’m gender fluid as I easily transition depending on my mood.
When I’m out with Lady Friend I’m happy to be a woman though I slip into the ‘masculine’ role. I hold doors, I pay for meals… I hate that this is considered masculine, especially considering most of the men I know =P. So fuck that. I’m reclaiming this as being the role of How I Display Appreciation For Your Company. Someone make that a better acronym or something. My brain is puffy today.
Accentuate the standards, diminish the differences. If I blend in with the dress code they won’t notice how truly different I am. I hate that I think this way. I’ve been judged, ridiculed, and debased for being who I am though. Outside in the real world I could give a fuck less what people think. Everyone can suck it up and deal. Professional environments require more finesse in order to accomplish tasks optimally. It requires playing a part in a bigger game. There’s really no point in making a fuss or standing out besides. Ultimately no one cares. What really matters is what gets done at the end of the day, not the type of pants I put on. I simply choose which face to put forward to best meet my goals for the moment. How much of any of it truly matters? Not much. Yet, we still continue to play the game.

Thursday, June 2, 2011

The Blame Game

Everything feels like a provocation. Something always creates a reaction. Or does it?  I recently talked about Blaming, but I want to get further into it with some other stuff I’ve found that I think provides a deeper understanding of where blame comes from for someone with Borderline Personality Disorder.

The Blame Game
Dr. A.J. Mahari says that those with Borderline Personality Disorder tend to blame others for their problems and how they feel. Borderlines as a means of protecting themselves from the unrecognized and/or unconscious pain of the core wound of abandonment project their thoughts and feelings onto others. This makes everything seem to the borderline as if what is coming from or being done by him or her is actually coming from or being said or done by the loved one - the non-borderline. It can be confusing for those with BPD and crazy-making for loved ones of those with BPD. It leads to a relational dynamic that I refer to as the blame game - a game that nobody actually has a chance of winning. A game that hurts all involved in the dynamic of borderline relating that manifests in this borderline blame.

It is very typical for someone with BPD to honestly believe, while in the throes of a cognitively distorted thought process that everything they feel is someone else’s fault. So often, a person with BPD will take out their confusion and pain on those who try to care for them; on those who try to get close and try to stay close to them. What happens when someone tries to care or to be close for many with BPD is that once a certain line is crossed in closeness or familiarity the other person ceases to be who they are in the reality of the world of the borderline.

Borderline narcissism takes over. What is then experienced from the inside (usually unbeknownst to the borderline) is a very deep and intense transference. What the borderline feels deep inside (often this is a very large amount of pain) is projected out on to the close person (or caring person) who often then becomes a “parent figure” as a transference takes place – the closest loved one.

What this means is that instead of being in the here and now with someone who is trying to care about you and know you, if you have BPD, you somewhat dissociate from the here and now and re-play out an old relationship causing you to lose sight of both who the “other” is and who “you” are. This happens because many with BPD cannot meet their own needs and tend to look for others to do this for them. Needs and wants are often confused and left up to others. Borderlines are easily triggered when needs or wants aren’t met by people in their lives that have come to represent “object other”.

The borderline demands from the “object other”, who is being experienced as someone from their past. This other person, not knowing what is unfolding has no chance to be able to find the right response, or enough of any response that will please the borderline for long. The person with BPD then does the push-pull, in an effort to gain or maintain control. They feel out of control because they are re-experiencing painful feelings from their pasts. So unmet needs continue to escalate and the borderline gets angry – often to the point of rage, whether that rage is acted in or acted out – and demands more from the other person.
The other person, no doubt is confused, feeling attacked and like they can’t do anything “right” enough begins to pull away, in one form or another. This is the classic repeat of the borderline nightmare of abandonment.

But if you have BPD, and you haven’t worked through this you may not realize that you, yourself are causing your own re-abandonment. The abandonment is perceived abandonment. In reality they are not abandoning you they are taking care of themselves, which every human being has both the right and responsibility to do. 

The Blame Game: Person A feels blamed by the borderline. The borderline feels blamed and shamed and let down and abandoned by person A. Person A then feels attacked by the borderline. Person A may attack back. The borderline then feels like a helpless victim which will then precipitate either their further acting out or acting in. Acting out often means rage, punishment, and verbal abuse aimed at the loved one. Acting in by the person with BPD often means an inner-rage often not consciously connected to and punishing the loved one in the form of the silent treatment.

Person A then feels like they’re in a no-win situation. The borderline keeps upping the ante, demanding what he/she needs and wants in often less than direct and highly manipulative ways. At this point the borderline has regressed to a child-like state wherein, for them, they are the center of the universe (this is where the BPD narcissism comes in). This is their reality. The other person, person A, has no idea now what is going on. Loved ones need to learn how break free from what keeps them from living with healthier boundaries and find their own healing and recovery.

The blame game begins right here. The borderline blames the person A for (essentially whatever those close in childhood did to him/her) everything. Usually the borderline cannot see their role in this. (Not until a certain amount of healing has taken place.) Person A blames the borderline. Then both blame the borderline’s past. Others in their lives, jobs, therapists….etc may also be blamed. No one knows how to take responsibility here and usually at this point enmeshment is deep and intense. When any two people get enmeshed everything can seem foggy and unclear. From this clouded haze each party, like a blind bird flying in the wind seeks control in an effort to protect themselves and to try to regain some balance.

For person A in this scenario you cannot “win”. You are going to be blamed because often the borderline has lost total sight of you. (Or will for periods of time) You have become someone from their past that they could not trust.

The key to understanding what becomes the “blame game” is for the person with BPD to want to get better. To want to get better means be ready to face the pain. It is only when you face the pain that you will begin to gain a healthy perspective from which you can then think in less frequently-distorted ways to the point where you will be able to recognize when you are so triggered as to blur your past with someone in your present. The process of recovery from BPD requires that each person with BPD find ways to gain more awareness of what must be learned and accepted in order to take personal responsibility for in his or her life and for the regulation of his or her own triggered dysregulated emotions.

Personal responsibility is key here as well. You must take responsibility for your needs, your wants, your pain, your actions and you must learn that there is no excuse for abuse. Blaming anyone else, even someone who abused or hurt you in childhood is not going to help you heal now. It will not help you meet your needs. It will not help you learn how to maintain relationships. It will not help you to find yourself. It will only continue to support your staying stuck in borderline suffering due to what amounts to continuing to choose to abandon your pain.
Blame is a defense mechanism. The pain is real. The pain feels immediate. It can also feel very overwhelming. If you have BPD and you do not learn to catch the triggers and see the patterns and take responsibility you will continue to drive people who care about you away and do great emotional damage to yourself and to others in the process. Blaming others will only keep you stuck in the active throes of BPD and the suffering that means in your life.

Taking responsibility for yourself and your emotions now is the only way to end the blame game and get on and stay on the road to recovery. To unwind the clues that are no doubt there in your thinking before you get into this pattern over and over again it is important to discuss with your therapist what you feel and think just before you have “blow-ups” with others, or just before you lose your temper, or just before you begin to push and pull or manipulate, control or get physically intimidating and or abusive.

What happened in your past needs to be unwound today. Blaming anyone for the choices that you’ve made as to how to cope with your past up until now is not a healthy choice. It is often a very lonely and isolating choice to make.

It is important to stop blaming anyone or anything else. Look to yourself. The way you relate to others and the ways that you experience others are generated from your own past patterns of relational experience. Experience that for those with BPD included shame of abandonment. When you open up to understanding these patterns and the ways and reasons they trigger so much emotion that is difficult to regulate or cope with you will actively be engaging the process of recovery. When you can understand the blame game you will no longer have to go there. The result will be happier and healthier patterns of relating.


These are things I think are SO important. Personal Responsibility. Take responsibility for your own actions. Stop blaming other people. I know it’s hard. I know it hurts. But what is done is done. All there is now, is to move forward. Look to solutions. The past cannot be changed, so blaming the past only furthers to keep us stuck in a black hole of hurt and hindered healing. We do have a choice in how we choose to walk into our future.

Wednesday, June 1, 2011

Day 1


On my new meds and so far….

I’ve been too tired to stay awake at work. I took a nap in my car at lunch.

Sitting up straight was exhausting.

Clearly I couldn’t go to the gym even though I didn’t go yesterday so now I have guilt on top of fat.

The sound of human voices makes me want to rip out peoples tongues and shove them straight into their lungs.

I want to break… everything. Everything. Throw things against the floor, put my fists through walls, and tear the shit out of everything that so much as comes within my peripheral.

HULK. SMASH. RAGE.

I swear by all things unholy that the next person that tries talking to me in IRL is going to experience first hand what my fist tastes like.

I want to tear the world down and watch it burn.

On top of everything else, I’ve quit drinking.

ARRRRGGHGHGHG GRRRRRRR!


Time for another round



Psychiatrist was NOT happy with me. I missed my psych appointment at the beginning of the month. I stopped taking my meds altogether. I’m pretty certain he was ready to send me on my way. He actually suggested I seek a second opinion from another psychiatrist… if I don’t believe him, maybe having multiple opinions will convince me that medication is necessary.  
Ultimately it’s my choice. He believes I need to be on medication. However, I am the one that really needs to believe I need to be on medication. Honestly, I’m still struggling with this. I know I should be, but I still do not want to be.
He was relatively gentle. Even so, I was starting to dissolve into anxiety. I felt like I’d fucked up so bad. He would drop me for sure. I’d have to start all over. He was so disappointed in me. I’d have to get a new pdoc. Maybe it’s not that BPD is med resistant so much as it’s the person with BPD that resists meds. I know I’m certainly falling towards this.
Part of me wants to not be on meds. He actually suggested I stay off meds. That I see how things go for me with the nicer weather and the new dating, see how I am affected or not, see if I am ok, if not, come back in a few months… and this thought panicked me too.  Not being able to come back, not knowing when I could come back, if I would come back, if he’d take me back.
I let him down. I let myself down. What’s the point in even continuing to try? I might as well just give up. On everything. These thoughts are not ok. They’re not going to take over my life. I’m not actually going to give up on everything, but I wanted to by the time I got home.  I felt like I’d failed. Failed him. Failed myself. Everything feels heavy and slow. I can’t do anything right. That failure wrapped around me like a wet blanket clinging to my skin, slowing me down with the additional dampness making the goal of any progress uncomfortable far away.
I don’t want to be on meds, but I don’t want to operate without a safety net either. Except psych meds aren’t like pain killers…. You can’t take one and expect it to kick in 45 minutes later. It takes time to build up in your system and then it takes time to find the right dose. It takes commitment. Something I have been lacking in the meds department.
I need to make the commitment.
In short. I need to grow up. Decide what I want. And stick with it.
Psychiatrist was contemplating Lithium, but as my commitment to medical treatment has been wavering Lithium is not the way to go since it requires blood level monitoring. Instead, I’m starting on Abilify. It’s yet another, atypical anti-psychotic. I need to accept the fact that regular anti-depressants aren’t going to be enough for me: get over this aversion to anti-psychotics.
So here goes. New drug. New commitment. And I will give this a proper chance to work for me.

Tuesday, May 31, 2011

Hidden suffering of the Psychopath...

I saw this article and was intrigued. Especially as the Conlcuding paragraph is this:

It is extremely important to recognize hidden suffering, loneliness and lack of self-esteem as risk factors for violent, criminal behavior in psychopaths. Studying the statements of violent criminal psychopaths sheds light on their striking and specific vulnerability and emotional pain. More experimental psychopharmacological, neurofeedback and combined psychotherapeutic research is needed to prevent and treat psychopathic behavior.

The current picture of the psychopath, which is reflected in the leading diagnostic criteria of psychopathy offered by Cleckley (1982) and Hare et al. (1990), is incomplete because emotional suffering and loneliness are ignored. When these aspects are considered, our conception of the psychopath goes beyond the heartless and becomes more human.



It's not an incredibly recent article but it does take a look at psychopathy from a perspective other than witch burning and untreatable. I wonder if clinicians generally ignore research like this on purpose or discount it automatically in favor of perpetuating the stigma.

ElectroShocking

Shocking news about Electroshock therapy. Then again, maybe it’s not so shocking afterall… Regardless, I’m rather fascinated so I thought I would share. Enjoy!


Hyperactive Nerve Cells May Contribute to Depression
Identification of cellular mechanism could lead to novel and effective treatments
Scientists at BNL, Cold Spring Harbor Laboratory, and the University of California, San Diego (USCD) School of Mediciine, have identified hyperactive cells in a tiny brain structure that may play an important role in depression. The study, conducted in rats and appearing in the February 24, 2011 issue of Nature, is helping to reveal a cellular mechanism for depressive disorders that could lead to new, effective treatments.
The research provides evidence that inhibition of this particular brain region – the lateral havenula – using implanted electrodes can reverse certain behaviors associated with depression, and also provides a mechanism to explain this effect. These findings lend support to the use of deep brain stimulation as a clinical treatment for people with long-standing, treatment-resistant depression.
This research was supported through Laboratory Directed Research and Development at BNL, and by the Simons Foundation, the Dana Foundation, the National Institute of Mental Health, and a Shiley-Marcos endowment at UCSD.
“This research identifies a new anatomical circuit in the brain that mediates depression, and shows how it interacts with the brain’s reward system to trigger a  constant disappointment signal – which certainly would be depressing,” said Fritz Henn, a neurobiologist and psychiatrist at BNL and Cold Spring Harbor laboratories and a co-investigator on the research. “But,” he added, “identifying this circuit and how it works may open new doors to reversing these effects.”
For example, said co-investigator Roberto Malinow, a professor of neurosciences at the USCD School of Medicine, “It’s possible that the genes specifically expressed in these neurons could be targeted genetically or pharmacologically in order to manipulate them and reduce depression.”
Scientists have known that cells in the lateral habenula are activated by negative or unpleasant events, including punishment and disappointment, such as when you don’t get an expected reward. It may seem intuitive that such negative stimuli can lead to depression, but not everyone who experiences disappointment collapses into a state of  helplessness. To explore this connection, the scientists took a closer look at the brain circuits.
Overall, the results showed that these lateral habenula nerve cells were hyperactive in the depressed animals but not in the control subjects. Furthermore, the degree of hyperactivity coincided with the degree of helplessness.
To explore whether electrical stimulation could potentially reverse this reward-dampening effect, the researchers placed a stimulating electrode in the lateral habenula and measured the effects on the brain cells leading to the reward center. They found that electrical stimulation of hyperactive habenula brain cells markedly decreased excitatory activity leading ot the reward center.
“The study provides a cellular mechanism that may explain the hyperactive of the lateral habenula nerve cells observed in depressed  humans and animal models of depression, as well as why ‘silenceing’ these circuits, whether surgically or pharmacologically, can reduce depression-like symptoms in animals,” Henn said.
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