• Juan-Fernando Duque-Osorio

Advices for other Bipolars: I'm not a Completely Asymptomatic Patient as I’ve Stated Before

Updated: Aug 7

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Summary: In this therapeutic writing, which I started out feeling a little discouraged, I speak about my story as a bipolar emphasizing that now I am a cyclothymic which is the mildest form of the bipolar affective gradient. Supported with bibliography, I talk about the medications I take and how I manage them to keep myself relatively stable, being clear that only the treating doctor can prescribe a patient and, on the other hand, recognizing that, although I am relatively well now, I will never be a asymptomatic bipolar as this condition never gets completely cured. I speak of the three main pillars for the treatment of a mental patient; I make the recommendation to do sleep hygiene and practice therapeutic writing, topic about which I promise to do a separate post and I finish this writing more animated than when I started it.


Key Words: #YouCannotBeATotallyAsymptomaticBipolar #Cyclothymia #MedicationsForBipolarity #MedicalSupervision #Psychoeducation #SleepHygiene #ThreePillarsForTheTreatmentOfAMentalPatient #TherapeuticWriting.



Generally, when I make spontaneous posts I do them when I am very animated so that they turn out to be very crazy and cool. But let's see what comes out today that I'm not such a good mood. And I'm going to do something else that I don't usually do and that is to talk about specific medications that I take. Please do not take them on your own without your doctor's consent. I am not responsible for the misuse that can be given to the medicines that are named in this post.


I have given to several previous posts, titles like “I am already an asymptomatic bipolar” [1, 2] and such. Well this is not entirely true. My bipolarity has improved a lot, but not to the degree of being completely asymptomatic since this condition never gets totally cured. After being diagnosed when I was 14 (I was born on 11-Jul-1974) as a full bipolar, the situation, with ups and downs, has improved to the point that I am now a cyclothymic, which is the mildest type of bipolarity.


Today is a holiday Monday 20-Jul-2020, when one of the two independence days in Colombia is celebrated. I never take Monday holidays to rest. But today I have don´t the drive to turn on my big computer to work seriously. Like yesterday, I have done nothing but lazily lying down. Today Monday I am better than yesterday, but I am still a little low.


The symptoms that I was in the lows began last Saturday and finally on Sunday I realized that I was getting depressed. I still do not understand why, after dealing with my bipolar condition for more than 30 years, it takes me so long to realize that I am altered, especially getting depressed. It is as if one were programmed to think that one is always right and that if something is wrong it is the fault of the environment, but not due to endogenous (internal) causes. As soon as I realized that, towards the end of yesterday, I increased the dose of Amitriptyline by 25 mg that I usually take every night (50 mg). Amitriptyline is a tricyclic antidepressant that inhibits the reuptake of serotonin and norepinephrine allowing these neurotransmitters to stay longer in the synaptic cleft, performing their antidepressant function. [3, 4].


Yesterday Sunday I did not get up and did nothing different than sleep, but I took three 25-mg tablets of Amitriptyline three times throughout the day. At night I was a little better and today, although I'm not quite well, I'm better than yesterday. Amitriptyline is an excellent antidepressant because it acts fast and improves sleep. If you are bipolar and depressed, ask your doctor if you can take Amitriptyline. I recommend it.


The other mistake I was making and it is not the first time, is that I was taking Oxcarbazepine every day [5]. This is an anticonvulsant medication that in us, bipolar patients, helps to control mood increases, whether they are hypomanias or complete manias. It helps to fall asleep and stabilizes the mood, but downward. And most mood stabilizers work like this. Downward. If you are bipolar and are frequently depressed, ask your doctor if you are taking an anticonvulsant such as Oxcarbazepine, Valproate (= Valproic Acid) or Carbamazepine as these medicines tend to lower your mood. Maybe you need to decrease the dose or replace your mood stabilizer with Lamotrigine [6, 7] which is the only anticonvulsant that stabilizes the mood with an upward trend.


The reason anticonvulsants work in bipolar disorder is that in epileptic seizures, hypomanias and manias there is abnormal hyper-excitation of neurons. I explain it with the following simile: let's imagine a stadium in which each spectator is a neuron. When the viewer stands up, the neuron is hyper-excited. In the case of seizures, spectators get up from their seats in a chaotic way, so the patient enters a kind of "short circuit" that is the seizure. In the case of a hypomanias or manias, the spectators of the stadium rise in an orderly and concerted manner, forming the wave. So, there is still neural hyper-excitation but there is no "short circuit", to put it in some way.


My dad died in 2007 and as part of my mourning for his death I had an insomnia crisis. With the medical doctor who was treating me, we couldn’t find any other solution than taking anticonvulsants in large quantities to make me sleep above all. This was a mistake because it made my grief worse. Unless you are in mania or hypomania (in high mood) do not make the same mistake that I made around 2010 in the sense of abusing anticonvulsants such as Oxcarbazepine (trileptal) or Pregabalin (lyrica) to sleep. They are going to make you sleep, but they will lower your mood. With your doctor, look for other sleeping options such as sleep-helping antidepressants such as Amitriptyline [3, 4] or Trazodone (this medication must be used with care because it can produce concerns about death). And although they are one of the few psychiatric medications that produce true addiction, benzodiazepines are a good option. One of these, Clonazepam [8, 9], which I have been taking since 2011, helped me a lot in overcoming the mourning for the death of my dad.


A medication that is very effective for insomnia, but is very dangerous, is Zopiclone. One person reported starting to take a tablet and in no time was taking 20 each day, became addicted and required treatment to get detoxified [10]. This medication should be controlled like benzodiazepines. The fact that, at least in Colombia, it is available over the counter, makes Zopiclone a medication with high addictive potential.


In 2017, I got another insomnia crisis, supposedly, because what really happened in that year was that because of my age, my sleeping hours began to diminish; I got scared and started doing something that should not be done and this is to experiment using new mediations for me without the supervision of a medical doctor. This exacerbated my crisis, which lasted until 2018.


In 2019 I started taking a medication that everyone should take, even if they don't have a mental condition because it has no side effects and improves sleep a lot. The only thing is that it is difficult to take. Is called:


Sleep hygiene.


Then I started to see the real progress. You have to implement a whole ritual, with fixed hours to be able to sleep on time. For example, I start my ritual at 6:30 p.m. when I start to stop working, have dinner and take my medications at 7:00 p.m. Then I relax with soft music, write in a private log, to finally fall asleep after 10:00 pm. At first it is difficult to do sleep hygiene because, I repeat, you must follow a strict schedule. But the moment comes that one does it automatically. It is highly recommended.


From 2019 to now I have improved a lot but, I repeat, I will never be completely free of symptoms. My sleep will continue to be disturbed from time to time and my mood will continue to have variations even if they are small. Sometimes I wake up at 3:00 or 4:00 in the morning with an irrepressible mood to work and with a hunger as if it were lunchtime. In these cases, it is convenient, on the following night, to reinforce a medicine such as Oxcarbazepine, since those early awakenings are symptoms that I am going into hypomania. On the contrary, there are days when I sleep until 9:00 or 10:00 am and wake up with no desire to work. That is a sign that I am getting depressed and I must increase the Amitriptyline which is the antidepressant that I use.


I have said several times in this writing that you should consult your doctor. I, because of the apology of having a master's degree in basic medical sciences within which I rotated through neurobiology, have sinned to the contrary. I think that patients should follow the instructions of their doctor, but they should also have some knowledge about their pathology and the medications they take for it, as there will be times of emergency in which they will not count with their doctor and will have to make decisions on their own. You should have a plan for when you can't sleep, prepared with the help of your doctor. At least one medication in your formula should be mobile to overcome these types of contingencies. Conversely, if you are getting a lot of sleep, and therefore your mood is getting lower, you should know which medication to reduce. I take four medicines of which half are fixed and the others I vary according to how I feel. Fortunately, the proportion of days with sleep and stable mood is higher every time. These medicines are:


· Clonazepam [8, 9] which is a benzodiazepine which is why it is addictive and should not be changed. I Always take the same amount.


· Levomepromazine [11, 12]. Strong hypnotic (sleeping medicine) on which I have already reached the optimal dose and I always take the same amount.


· Amitriptyline [3, 4]: Tricyclic antidepressant that I take a higher dose if I feel like I'm getting depressed and diminish its dose if I feel my mood is getting higher.


· Oxcarbazepine [5]: As I said, it is a medication that stabilizes the mood downwards and I lower its dose when I am getting depressed and do the contrary when I am going into hypomania.


Being bipolar is like being born as a big truck with the brakes and accelerators slightly damaged. We have a greater load volume (greater capacity for learning and data storage, that is, we tend to be intelligent) but once the speed gets out of control, we are very difficult to stop (manias or hypomanias) or when we stop (depressions) it is harder to get us going again.


The three pillars for living with a well-managed mental condition are:


· Pharmacotherapy


· Psychoeducation


· Psychotherapy


Pharmacotherapy are the medications that only your treating doctor can prescribe. Psychoeducation is learning more about your mental condition in order to better manage that "massive vehicle" that is a bipolar. Psychoeducation is having a facultative with whom unburden. Be it your psychologist or psychiatrist. Although I have never participated in one, support groups also help a lot. But you will soon discover that no one will understand you better than yourself. This is where the concept of therapeutic writing comes in [13-17] which I highly recommend and I will make another post about it. I get relieved writing in my private log in which sometimes I exaggerate because it is obvious that I suffer from hypergraphy or graphomania (compulsion to write [18, 19]). So much that I am now trying to invest that excess reflexive writing energy into blogging like I just did on this post.


Thank you very much for reading this short article.


References:

1. Duque-Osorio JF. Nueva Década, Nuevo Blog, Nueva Vida como Bipolar Asintomático. El Blog de JFDO; 2020. Available in: http://bit.ly/2tv0zec. Accessed on 11-Feb-2020.


2. Duque-Osorio JF. New Decade, New Blog, New Life as an Asymptomatic Bipolar. JFDO's Blog; 2020. Available in: http://bit.ly/36cSGHy. Accessed on 11-Feb-2020.


3. Amitriptilina. España-Argentina. IQB - Instituto Químico Biológico; 2014. Available in: https://bit.ly/AmitriptlinaVademecumIQB. Accessed on 05-Ago-2020.


4. Thour A, Marwaha R. Amitriptyline. Bethesda, Maryland-USA. NCBI (National Center for Biotechnology Information) - StatPearls Publishing; 2020. Available in: https://www.ncbi.nlm.nih.gov/books/NBK537225/. Accessed on 05-Ago-2020.


5. Preuss C, Randhawa G, Tom J, Saadabadi A. Oxcarbazepine. Bethesda, Maryland-USA. NCBI (National Center for Biotechnology Information) - StatPearls Publishing; 2020. Available in: https://www.ncbi.nlm.nih.gov/books/NBK482313/. Accessed on 05-Ago-2020.


6. Betchel NT, Fariba K, Saadabadi A. Lamotrigine. Bethesda, Maryland-USA. NCBI (National Center for Biotechnology Information) - StatPearls Publishing; 2020. Available in: https://www.ncbi.nlm.nih.gov/books/NBK470442/. Accessed on 05-Ago-2020.


7. Lamotrigina. España-Argentina. IQB - Instituto Químico Biológico; 2014. Available in: https://bit.ly/LamotriginaVademecumIQB. Accessed on 05-Ago-2020.


8. Clonazepam. IQB - Instituto Químico Biológico, España; 2011. Available in: https://bit.ly/ClonazepamVademecumIQB. Accessed on 05-Ago-2020.


9. Basit H, Kahwaji CI. Clonazpam. Bethesda, Maryland-USA. NCBI (National Center for Biotechnology Information) - StatPearls Publishing; 2020. Available in: https://www.ncbi.nlm.nih.gov/books/NBK556010/.


10. Arcila K. El somnífero de venta libre que puede ser tan adictivo como la heroína. Colombia. Las2Orillas; 2015. Available in: https://bit.ly/3gzyc1q. Accessed on 05-Ago-2020.


11. Levomepromazina. Con el aval de la sociedad española de neurología; 2019. Available in: https://www.hipocampo.org/levomepromazina.asp. Accessed on 17-Oct-2019.


12. Levomepromazine. Bethesda, Maryland-USA. NIH: Pubchem-NCBI (National Center for Biotechnology Information) - 2020. Available in: https://pubchem.ncbi.nlm.nih.gov/compound/Levomepromazine. Accessed on 05-Ago-2020.


13. Fernández E, Bacon F. Invitación a la Escritura Terapéutica: Ideas Para Generar Bienestar. International Journal of Collaborative Practice. 2013; 4(1): 27-47. Available in: https://psicopedia.org/wp-content/uploads/2016/03/Invitacion-a-la-escritura-terapeutica.pdf. Accessed on 17-Oct-2019.


14. Kohan SA. La escritura terapéutica. Alba Editorial; 2013.


15. Baikie KA, Geerligs L, Wilhelm K. Expressive writing and positive writing for participants with mood disorders: An online randomized controlled trial. Journal of affective disorders. 2012; 136(3): 310-319.


16. King R, Neilsen P, White E. Creative writing in recovery from severe mental illness. International Journal of Mental Health Nursing. 2013; 22(5): 444-452.


17. Wright J, Chung MC. Mastery or mystery? Therapeutic writing: a review of the literature. British Journal of Guidance & Counselling. 2001; 29(3): 277-291. Available in: https://bit.ly/TherapeuticWritingAReview. Accessed on 05-Ago-2020.


18. Can SS, Karakaş Uğurlu G, Cakmak S. Dandy walker variant and bipolar I disorder with graphomania. Psychiatry Investig. 2014; 11(3): 336-339. Available in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4124195/.


19. Gamero A. Hipergrafía: La Escritura como Enfermedad. La Piedra de Sísifo; 2013. Available in: https://bit.ly/37vuPFb. Accessed on 15-Jun-2020.

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© 2020 by Juan-Fernando Duque-Osorio. MSc. Ibagué-Colombia