Chronic Pain

In June of 2002, I left work in order to have wrist surgery. The doctor, who was highly recommended, indicated that the recovery would only be about two weeks and I would be able to return to work without further complications. Unfortunately, it didn't work out that way. It was actually the beginning of a long and difficult journey through chronic pain.

The human hand is composed of 27 bones. One of the three primary wrist bones, the lunate, in my hand disintegrated due to lack of oxygen. The condition, known as Kienbock's Disease, is rare and is not clearly understood.

The things I learned from this experience are:

1. Importance of relationship with doctor. Bedside manners make a huge difference. This was true when dealing with my issues with my hand. It is even more critical when dealing with the ups and downs of bipolar disorder.
2. Importance of others who have gone through the same experience. One of the most memorable experiences I had while recovering from the pain and lack of mobility in my hand was talking to someone else who had gone through a similar experience. Doctors and therapists could share all kinds of knowledge and played a vital role in the healing/coping process but they could not fully empathize as they had never been there themselves. Talking to someone who had validated the experience for me and helped me cope a little better.
3. Time has a way of making things better. It has been over seven years since I had the operation that fused my wrist. Over the course of that time, the pain in my hand has subsided. It's not totally gone but I'm no longer writhing in pain at the slightest bump. I don't expect it to ever go entirely away, and at some point it may even get worse but for now I'm able to deal with it.
4. My time schedule is not the same as God's. Corollary to number 3 is the fact that I had no idea what the time schedule was for going through the ordeal of having my wrist fused. In fact, I had no idea that it was going to be an ordeal.
5. I had to learn to be flexible. Part of the process for me was not having use at all of my right, dominant hand for a period of six months or so. As a result, I had to learn how to do much with my left hand that I was used to doing with my right hand. Today, I am still much more ambidextrous than I would have been otherwise, i.e. I learned skills that I wouldn't otherwise have.

Although I realize that the similarities between the chronic pain in my hand/wrist and the chronic illness of bipolar disorder only go so far, I am expecting that there will be similar lessons learned from dealing with this challenging disorder.

Reasons to Live

When we are depressed, it can be difficult to remember the reasons we have to live. The following are some of the reasons that I keep in mind when I have those uncomfortable thoughts creeping into my head. It's a bit of a taboo subject but with some 30,000 cases of suicides annually in the United States, we cannot afford to keep this hidden. (That doesn't take into account the fact that there are 30 to 50 times as many attempted suicides as there are actual suicides.)

1. I have a responsibility and commitment to my family.
2. I believe I can learn to adjust to, or cope with, my problems.
3. I want to watch my children as they grow.
4. No matter how bad I feel, I know that it will not last.
5. I am afraid of death.
6. I love and enjoy my family and could not leave them.
7. It would not be fair to leave the children for others to take care of.
8. The effect on my children could be harmful.
9. It would hurt my family too much and I would not want them to suffer.
10. I am afraid that the method of killing myself would fail.
11. I consider it morally wrong.
12. I would not want my family to feel guilty afterward.

Source: Linehan, et al(PDF)

Clinical Depression Myths

In a recent post Therese Borchard outlined "10 Common Myths About Clinical Depression". As I read the post, I found myself nodding in agreement that the myths are prevalent in society. It wasn't until later in the evening as I was struggling to come to grips with my own depression—yep, it's back :(— that I began to realize that a lot of those myths are things I believe myself. I found that I was trying to control my depression as if it were just something I could shake off. I was getting frustrated with myself that I was unable to do so.

I've always considered myself a person of strong character. Besides the mental health issues I've encountered there have always been other significant challenges. (Isn't that true for us all?) But I've always been able to push my way through.

I'm finding that I'm not so easily able to push through this challenge. And I'm going back to meet with my psychiatrist tomorrow to discuss the possibility of my going back to work at least on a part-time basis as early as next week. I've got to say, I don't feel ready for that. Especially in light of the fear and struggles with depression and suicidal tendencies I've encountered in the last few days.

I find the image of an adult male cowering in a corner in fetal position disconcerting but I feel that way myself too often. It is not where I want to be!

Perhaps, it's good to be able to write this out and get this on the screen. On the surface I think I find myself putting on a good show. Something about the writing process allows me the freedom to get my feelings out.

Mood and Diet Connection

With the holiday season upon us, many of us are enjoying the feasts without putting on too much weight. For those of us with depression issues, we can experience the double whammy of not only adding pounds but also dipping into a blue funk.

There are many sources for depression at this time of year--from painful reminders of who's no longer around to seeing all the festivities are involved in but somehow we're left out. Those can be difficult to bear.

Another reason we may be experiencing the doldrums though may be all the extra food that is available at this time of year. From the extra helpings of turkey, stuffing and mashed potatoes at Thanksgiving to the extra cookies and candies that are shared at Christmas parties. It's a festive time of year and all the great food adds to the experience.

Dr. Barry Sears in an article on the Christian Broadcasting Network site provides some great neurology background into how the brain works and how it is affected by diet. He suggests that we reduce the amount of sugar we intake and supplement with a high-quality fish oil.

I don't know if it is from following this type of advice the last couple weeks but since watching more closely what I eat and supplementing with fish oil my mood has definitely lifted--thankfully!

Therese Borchard, in her Beyond the Blues blog posts, also gives some great tips to eating healthily during the holidays:

• 5 Tips for Eating Healthy Through the Holidays
• 7 Ways to Manage Your Diabetic (or Sugar Sensitive) Waistline During the Holidays

Bipolar, ADHD and Depression

Both people with bipolar disorder and those with ADHD often experience depression. This depression may be primary–i.e. due to biochemical reasons the individual becomes depressed without apparent reason–or secondary–i.e. due to external forces such as relationship or work issues. Both primary and secondary forces can work together to exacerbate the depression as has been my case with my latest major depressive episode.

Lately, there has been a lot of advertising on electronic and print media touting anti-depressants. I, personally, don't have experience with taking anti-depressants, but when I'm battling deep depression I sometimes wish I could take something more that would help me out of it. Unfortunately for those with bipolar disorder, anti-depressants can have serious negative side effects: They can bring on hypomanic, manic, and mixed affective states and can cause rapid cycling. (The Bipolar Disorder Survivor Guide, David J. Miklowitz Ph.D., 2002)

To make matters worse, even after negating the side-affects of anti-depressants, there are some clinical studies that show that they are not the panacea the ads purport. (I'd love to hear from those who have taken anti-depressants with good affect.)

For more information on antidepressants, see this informative article on depression medication.

As always, consult your medical professional before making any change to your medication regimen.

ADHD and Bipolar Disorder

I've always struggled to maintain a daily routine. There are definitely routines to my life but they often do not follow a day-to-day pattern. Instead it's more hit and miss. This has been frustrating at times as the routines support my goals but in order for them to work they have to be followed in a non-linear fashion.

As I've come to grips with the idea that there might be biological reasons behind this, I've been in the habit of associating this with ADHD symptoms. It seems, however, that ADHD and bipolar disorder have a lot of similarities and a similar root. That is "Twin and family studies of ADHD show a substantial genetic heritability with little or no family environmental effect. Linkage and association studies have conclusively implicated the dopamine transporter gene (DAT1). DAT1 has also been confirmed as being associated with bipolar disorder." (Source: PubMed.gov article)

In layperson's terms I believe this is saying that in studies of twins and families excluding factors of nurture rather than nature the neurotransmitter dopamine transporter gene (DAT1) is implicated in both ADHD and bipolar disorder.

In a not as scientific article, ADHDNews.com outlines the similarities and differences between ADHD and bipolar disorder.

The similarities include:
• impulsivity
• inattention
• hyperactivity
• physical energy
• behavioral and emotional lability (behavior and emotions change frequently)
• frequent coexistence of conduct disorder and oppositional-defiant disorder
• and learning problems

For more information on determining the difference between ADHD and bipolar disorder, see this short article by Dr. William Dodson in ADDitude magazine.

Gratitude Day 3

Today, my wife and I headed south to Columbia, SC. We were able to visit some dear relatives of my wife. I am grateful for my family--both immediate and extended.

Gratitude Day 2

Today, I got in an accident when a car pulled in front of me and stopped along a busy road. It happened so quickly there was little I could do other than hit the brakes as quickly as I could. Too late.

The air bags deployed and there was glass and plastic all over the road. Two of the side windows shattered in the impact.

Thankfully, nobody was hurt. I am grateful for air bags and seat belts.

Bipolar Connections - Serendipity

Today, I read my Weekly Challenge from Manage Your Muse. As the title suggests, this is a weekly challenge distributed by Lynn Cutts of Manage Your Muse. Lynn specializes in life coaching for right-brained individuals. I find the weekly challenge a great way to reassess how I look at life.

On today's challenge, there was a link to the 30 Days of Thanks. This is simply an opportunity to blog about what we are grateful for. That seemed fitting to me due to the season of the year here in the United States and also because I think remembering the things for which we are grateful helps us to feel better about our situation.

While I was on the 30 Days of Thanks site, I saw a banner ad for Free Rice which helps develop a stronger vocabulary while providing rice for the world's hungry. That is a combination I can support! The vocabulary is challenging, too.

So today, I'd like to say I'm thankful for the serendipitous experiences that can be found on the internet. (I'm also thankful that I'm feeling better than I have in days. Yeah!)

Comedies

Last night I was (am!) still in a depressed funk but I had the opportunity to spend some time with my wife. I try to keep going despite how I'm feeling. We ended up watching "Father of the Bride 2" with Steve Martin. It was a lot of fun and the laughing helped lift me, at least momentarily, out of my funk.

Daily accomplishments

Since starting my recovery from my latest depressive episode, I have begun to keep track of various things: my moods for the day, whether I've taken my medicine, any physiological concerns, and a short sentence or two on the major events of the day as they relate to having bipolar disorder.

In addition to these, one thing that helps me keep moving forward is making a mental note of what I accomplished during the day. Some days it may be something very simple: I did the dishes and picked up in the living room. Other days I may have gotten a lot done in the yard. Either way, I know that I accomplished something. I'm not terribly concerned about how much I've accomplished at this point just that I've moved the ball forward.

I long to accomplish a great and noble task, but it is my chief duty to accomplish small tasks as if they were great and noble. - Helen Keller

By the way, Julie Fast has a great article in today's blog about how to move forward when feeling down.

Keep On Keeping On

This week, for whatever reason, has been really difficult for me.  It started out on Sunday evening, which is definitely part of a pattern that is appearing over the last several weeks. I'm fine Sunday day, then as the evening approaches, my mood starts to slide down into depression. By Monday, I'm typically into a deep depression.  Tuesday the depression starts to lift and by the end of the week I'm on my way, at least, to stable.

This week, Tuesday was as bad as Sunday and Monday. I'm curious, does anyone else have a cycle of depression/moods that follow a pattern over the course of a week.

Some of the thoughts on why I'm experiencing this are two-fold. First, my major depressive period that I'm in recovery from started out in the same pattern: Sunday evening then deep into depression on Monday. Of course, it didn't start lifting until I started getting some help and working on getting better.  So every week on Sunday as the work week begins to edge closer, I'm heading into depression.

The second thing that may be causing my depressive cycle this week is that I suggested to a co-worker, who is filling in for me while I'm out, that we have lunch this week. In retrospect, that may not have been such a good idea. It's not him but rather the situation that is the problem. (Of course, he is constantly asking when I will be back to work which does drive me a little crazy.)

I'm afraid I have effectively canceled the lunch appointment this week by ignoring the suggestion I made last week. I hate to not honor my commitments (really, I do!), but recovering from my illness at this point takes precedence. I guess the honorable thing to do would be to tell him.


When I'm feeling down, like I have been, I often feel that I just want it to end. Not suicidal thoughts necessarily just that I want to get past this. Sometimes this illness seems interminable.

I found two articles on psychcentral.com that give ideas for how to combat the blues:

1. Six Ideas for Beating Winter Blahs
2. 12 Winter Depression Busters

These are definitely not comprehensive lists.  For me, I'm finding that at this time of year that I'm grateful that my yard has been covered with leaves.  The repetitive and mindless motion of raking leaves allows me the escape where I can just be without having to think or plan or talk to anyone. The task is defined and I can complete it at my pace.  Having my children helping can make it even better.

What do you do when you're feeling down to keep on keeping on?

Fellow Sufferers

This weekend, I had the opportunity to converse with some family members who also have bipolar disorder. I've got to say, it's comforting to be able to talk to people who know what I'm going through.

How about you? Do you have people in your life who can relate to what you're going through in fighting this disorder? You can find support groups.

Guilt

Recently, I have begun to notice how often I am feeling guilty in association with my illness and recovery. I have felt guilty about the things I haven't done. Namely, that I denied the presence of my disorder and consequently did nothing to gain more insight into it. 

Instead, I focused on my career and my family. I don't think that is a bad thing. It was a shifting of priorities. Perhaps guilt is just a way to acknowledge the possibility of a different path.

I have also felt guilty that I have been away from work as long as I have. Not everyone is able to take off a couple months and spend time with family. It has been a real blessing to be able to do so and one that I can continue to do in some fashion.

Finally, I have felt guilty because I have spent so much time recovering from my illness while there are others I know of who are fighting for their lives as their bodies are physically ravaged with cancer. Their illnesses seem to be so much more serious and real. My illness has been all in my head (though yesterday's post shows that there are definite physiological effects as well.)

In fact, I struggle to legitimize my illness.  This is where guilt becomes particularly burdensome. I wonder if part of it has to do with the stigma that is associated with mental illness. Too often, the thinking is "If people would just take some responsibility for themselves, there would be fewer people living on the streets." Part of that may be true. But I can tell you, the need to fight tooth and nail over the past couple months for me has been very real. There were definitely times that all I wanted was to cease to exist and I was willing to do what was necessary to do so.

In trying to think of an example that would show this, I would point to the feelings that smokers have when they are craving a cigarette. It takes strength to overcome that temptation. Similarly, overcoming suicidal thoughts can also be extremely challenging. I am glad that I am beginning to get past those feelings because I have many wonderful reasons to be alive and most of them are my family. Then there are the things I care about: art, music, church service.

So, I am recognizing the guilt that I have been passing through. In doing so, I strive to embrace those things I haven't done that I would like to do and I acknowledge those that I have done that I can leave behind now.

What a powerful opportunity for growth!

What a Pain ;-)

Yesterday, I saw a short video on Bipolar TV on the WebMD site. Jane Pauley is interviewing David Miklowitz, Ph.D. regarding behavioral activation (the video is under Bipolar in Focus). From what I gathered, the purpose of behavioral activation is to enable the individual with bipolar disorder to work towards accomplishing goals, i.e. re-engaged with their environment.

As those who have experienced depression know, things that were once pleasurable are no longer. Behavioral activation seeks to remedy that scenario and has proven to be effective for some.

In the video, Dr Miklowitz used the example of a patient who is severely depressed and has just broken up with his wife.  There are two things in his life that remain important to him: his animals and his garden. Other than that he wants to stay in bed. The therapist may work with this individual to arise 15 minutes earlier and to take the dog for a walk.  The key is to gradually get the individual re-engaged with his environment.

I have been working on getting myself more engaged with my environment. While recovering from this depressive episode that I am, there are a few things that have kept me going: my family, my faith/church service, and music. After a period of time, I also began to write again which I had let slip out of my life as I concentrated on my career as an accountant.

At this point, I'm still not certain if I will go back to work as an accountant. It is also probably one of the areas of my life that I've been avoiding like none other.

In addition to watching the video on behavioral activation, I also watched a video on the "Benefits of Volunteering" (under Bipolar Tips for Life).  Putting the two together I thought this might be a good way to move towards getting back into the workforce. While I'm OK with living a non-conventional life, in fact my goal is to do so, for nearly the past twenty years I've worked for some form of corporation or another. At times, I've actually enjoyed it--enough said.

My present thinking, as well as my wife's and many others in my support structure, has been that I'll get back into working for somebody else. Which brought me to the volunteering way of getting back into work. Unfortunately, filling out the forms yesterday sent me into an unexpected physical onslaught. At the time, I had no idea how to even put it into words. Even now, as I write about it, I begin to feel some of the same physical challenges: racing pulse and pressure in my head. It also involves feeling constricted with tightness in my throat. My hand, which I had surgery on years ago, has also been acting up like it hasn't in years.

It's certainly an uncomfortable experience and one I don't really understand. I didn't know if I was having a panic attack or a heart attack. I saw on WebMD that anxiety and physical symptoms often come in tandem with depression. (Also check out the Depression Symptom Finder tool in the right-hand side-bar. You can also use this useful depression symptom diary, which is a pdf file.) I know that when I first met with my primary care physician and I was in crisis, my heart rate and blood pressure were significantly elevated. I knew I felt awful but I was unaware that this was translating into my physiology.

The body often tells us a lot if we are willing to listen. I like the idea of looking at a person's life as a whole and attempting to get everything to work holistically towards recovery.

Here's to your health!

Down

I'm feeling a little down today, and I don't know why. It may be due to the rain outside. It may be due to the change in the way I'm taking my medications--after dinner instead of right before bed. It may be due to me having a crazy sleep pattern last night. Or, it may be due to the biological chemicals in me are just acting up today.

Who knows? Some may throw in, who cares? I don't know. All I know is I'm down and I'd rather be up or at least stable.

That said. My wife and I went to see a new therapist yesterday. My wife has also been told she has bipolar disorder. That combined with the challenges of dealing with my recent episode(s) has gotten her feeling more out of sorts lately. I didn't realize how much until we were talking to the therapist.

It's funny but in the past I've always been a little uncomfortable talking to therapists. I don't like divulging my innermost thoughts to a stranger. (Does it strike anyone else as strange that now I'm blogging about it?) But I'm beginning to find that talk therapy helps open up some guided dialogue that helps.

We both liked the therapist we met with yesterday. Unfortunately, we discovered after we had met with her that she isn't covered by our insurance. Not sure what we'll do with that as I'd like to continue seeing her as our therapist.

It also helps that my wife and I are going together. We are so involved in each others lives that being together in therapy just makes sense. Plus it helps to work together. This is, after all, a family challenge.

Memories

I enjoy writing. It's a great creative outlet that enables me to get my thoughts on paper, but I'm always writing for an audience. Oft-told advice for novelists is that they should imagine the reader who they are and what their interests are. Unfortunately, I do that too well and find myself obsessing about who will be reading what I'm writing.

What will they think, for example, when I say that my brothers are largely incapacitated by mental illness? That I'm an uncaring brother with no hope for their potential? Or that mental illness is a death sentence that prevents everyone affected by it from having a full life?

The truth, as usual, is a little more complicated. My memories of my younger brother David often center around the time when he was a senior in high school. My parents had moved to Seattle for Dad's work, and David had returned to Springfield, Oregon to stay with friends from church and finish his senior year. He seemed to be at the top of his game. (In retrospect, part of it may have been the effects of bipolar disorder.)

He was working two part-time jobs, going to school, while still seeming to find time for friends, music and developing style. I was beginning to really admire my little brother. Instead of the constant shadow that I couldn't escape, he was really turning into someone special. (Not that he wasn't before, but I was actually beginning to see something there I hadn't seen before.)

Move forward several years. We had both moved to Seattle to live with our family. David was working as a janitor at Pike Place Market. We were both taking classes at community college.

Then things began to turn sour.

David would begin to disappear for weeks at a time. This wasn't entirely new. When he was a teenager he would often hang out with friends either fishing, playing Dungeons & Dragons, etc and we would have no idea where he was and when he would be coming back. This was different, though. He would always be back in the wee hours of the morning.

After him being gone for several days without word from him, we began to be really word. We made the rounds calling friends, hospitals, etc with no success. He would finally re-emerge at a friend's place. I'm fairly certain that, at times, he was sleeping under bridges (which gives me a whole new perspective on the homeless situation.)

As things progressed, we began to learn that this was more than a rebellious or independent streak in David. He began to tell us of hallucinations and paranoid episodes. Naturally, this was kind of freaky for us. He was still our brother and son. He began to get help but as I mentioned earlier this did not come easily and eventually meant that we had to turn responsibility for him over to the state.

I love the kind, warm-hearted brother I have now, but I miss the brother I admired for different reasons as we approached adulthood.

Why I'm writing this blog

I guess this is my attempt to come out of the proverbial "closet" so to speak.

Unfortunately, bipolar disorder has a lot of stigma associated with it which makes it even more difficult to recover from episodes, etc. In an effort to reduce some of that stigma and show that this is an illness similar to diabetes or cancer or... I am recording my experiences with the disorder.

Regarding the name, I called it Bipolar Family partly because mental illness has hit my family so hard. Both my brothers are largely incapacitated by mental illness. They are still great, wonderful, loving people but they are not going to amass a wonderful resume or head a large happy family. What they offer the world is very different from what we unfortunately call success.

The other reason I call the blog Bipolar Family is that in a way those of us who suffer in whatever way from the effects of mental illness are all in this together. I love what the actor Glenn Close and her sister Jesse are doing with their newly launched foundation, Bring Change 2 Mind.

Part of me wants to apologize for being open about having bipolar disorder. It isn't a pleasant subject. I read recently about Sandy Naiman, an award-winning journalist who suffers from schizoaffective disorder and has been successful in battling the stigma of mental illness in her environment. She indicated that fifty years ago cancer had a similar stigma. It was not something you talked about and was referred to as the "C-word." People with cancer feared that if employers found out about their illness they would lose their jobs or never work again. Those who suffer from mental illness face that same level of stigma. They worry about losing their jobs, their families and their friends.

But those with mental illness are more than their mental illness. The illness is something they have. It is not who they are.

I'm hoping that in our era of rapid change that it won't take decades to overcome the stigma of mental illness.

As Glenn Close's sister Jessie mentions in one of the videos, it's uncomfortable at times wearing the "bipolar" t-shirt. But I'm hoping that it will be worth it.

In the beginning

About two months ago, I started a head first dive into a deep depression. It was deep enough, and serious enough, that I made an appointment with the doctor. It began on the weekend. I had a tough time sleeping--which isn't unusual, in and of itself, but it was unusually bad as far as not being able to sleep hardly at all.

Sunday night I think I ended up going to sleep, finally, around 4am. I slept for about 5 hours and then called into work sick. I simply did not have it in me. My wife, of course, was quite alarmed and began to worry about whether my life was in danger. I have had suicidal thoughts since I was a teen. Lately, those thoughts and feelings have been a lot stronger and more difficult to break.

I made an appointment with my primary care physician and my wife made an appointment with a psychiatrist. Getting in to see my primary care physician was not difficult and I saw her the next day. She indicated that she thought I had bipolar disorder and prescribed Depakote for me. She also wrote a release from work for me that day.

Unfortunately, getting in to see a psychiatrist in Asheville is not so easy. The earliest I could get in to see the psychiatrist was at the end of the month.

When I did get in to see my psychiatrist, she seconded the opinion regarding the bipolar diagnosis (Type I) and the script. However, she felt the level of Depakote was too low and doubled that. She also prescribed Seroquel as a second tier drug. And thus begins my challenge of finding the right medication mix that will work in battling this illness.

To put it bluntly, the Seroquel was a miserable experience. From what I understand, the Seroquel was to help in leveling off the mania that comes with bipolar.

One of the biggest challenges I've had in fighting this episode(s) of illness is getting my sleep regulated. Prior to seeing my psychiatrist and actually since it was not uncommon for me to be unable to get to sleep before 3am or 4am. This was not due to my not trying to get to sleep prior to then. In fact, it is quite the opposite. There is nothing quite so aggravating knowing that my body should be exhausted but having sleep be so far away. I know that I will drive my wife crazy with my constant tossing and turning as I struggle with the frustration of being awake but wanting to be asleep, so I have been in the habit of getting up and vegging or doing some minor tasks around the house. Many a night I've gotten most of the laundry done or did the dishes. ;-)

Anyway, the Seroquel was to help me moderate my sleep. My psychiatrist recommended that I start off slowly and work myself up to full strength. Well, that first night I took the Seroquel I ended up sleeping--too well. I didn't wake up for 14 hours--around 1:30pm. This was even more aggravating than not being able to sleep. At least when I wasn't sleeping I was getting some things done!

The next night I took half a pill. (The prescribed amount that I was aiming for was to take 2 pills.) This time was better than the first but I still felt like a zombie the next day. Needless to say, I hope, this wasn't doing much for the severe depression that I was struggling to climb out of. Between my psychiatrist and psychotherapist that I was beginning to see I came to the conclusion that I would try to continue on the Depakote and let the Seroquel go. (I even went down to 1/4 pill with still experiencing the side effects of drowsiness.)

This is not to say that I wasn't still having difficulty moderating my sleeping schedule. I was still having a terrible time getting to sleep. But I also knew that getting the medication mix down can take time. I won't get to it in this post, but it took my younger brother David years to get a medication that helped him to stabilize. On that respect, at least, I was ready for the long haul.

I have now seen my psychiatrist three times and I think I've found a medication mix that works OK for me. I'm now taking Geodon which, so far, is not causing the drowsiness side effects.

I'm not out of the woods yet, but I'm beginning to see some hope. Depression still strikes from out of nowhere and knocks me on my backside. I would describe it as having the rug pulled out from me. I go from a standing position to on my backside desperately clawing to get back on my feet but it's from a deep hole with no walls to grasp. This can be triggered by the most innocuous thing--a bill, a phone call, a conversation.

I'm thinking one of the great challenges of recovering from this episode is learning the coping mechanisms I need in order to live a healthy life--not unlike learning to deal with the diabetes that I'm also having to contend with. In fact, having to come face-to-face with the diabetes has helped me in some ways to deal with the challenges of bipolar disorder.