Lamitcal + Abilify = You Really Need Sunblock

Lamictal, as we all know, can really mess with your skin.  In rare cases, it can mess with your skin so badly that it can kill you.  But those are rare cases.  Most of us just notice that our skin is more easily irritated than before.

The warnings on Abilify caution you to avoid direct sunlight.  Seriously.

So what happens when you fail to take your meds into account and spend an afternoon in the sun without sunblock, which would be a bad idea anyway because you inherited the pasty skin of your Irish ancestors? What happens is that you wind up with a sunburn that flakes for weeks afterwards.

Strangely enough, my sunburn wasn't bad enough to hurt.  My skin just stayed really red for almost a week.  Three weeks later, my skin is still flaking slightly.  In pre-lamictal/abilify days, this whole process would have taken about a week.

So, kids, if you're on either of these meds, and all the more so on both, wear that sunblock.

Witnessing Violence

I suspect the scene will haunt me for some time to come.  A young man, defibrillation leads attached uselessly to his chest, gunshot wounds in his torso, dead in a pool of his own blood.

I, of course, caught the least of it.

Mine was not the life that was ended so suddenly.  I wasn't the one who got up on Friday morning, fully expecting to go to bed on Friday night, only to be shot down in the street.  I'm not the grieving father, wailing over his son's body.  I'm not the cousin desperately juggling her two small children while trying to find out what happened to her relative.  I'm not even the woman who was led away from the scene, crying and traumatized, having witnessed the shooting itself.

I'm just a neighbor who witnessed the aftermath.  I'm just one of the people who had to leave the streetcar because its route was blocked by the crime scene, and therefore had to walk past it to get home.  I'm even less affected than the dozens of people staring in horror at what happened right in front of their homes.

I'm left wondering who could do such a thing.  I know that murders happen every day, that there are places in the world where violence happens on a worse scale than a single murder (and that this violence is often perpetrated at the hands of my own government).  But who could do such a thing?  Who could end someone else's life like that?

Oddly, I find myself asking myself -- over and over again --  how the killers could fail to consider the number of people whose lives would be changed irrevocably by their action.  I ask myself this, even though the kind of people who could shoot another human being are obviously not the kind of people who give a damn about the aftermath.  They don't care any more for the young man's family, for the people who witnessed the crime, or for the neighbors who are shaken to the core, than they cared for the life they took.  Obviously.  They're the kind of people who can and did kill someone in cold blood.

I don't feel like this shooting makes me less safe in my neighborhood.  When violence goes down in my here, it's inevitably a young black man who dies, and always at close range.  The death is blamed on gang activity, though the victim is not always a gang member.  Sometimes the shooters mistake their victim's identity.  Oops.

But it seems to me that blaming the crime on "gang activity" is a way of washing our hands of it.  Those gangs; what are you going to do?  I'm doubtful that the police investigate these shootings with the care they'd take if the victims were a different color, if there weren't that label of "gang violence" associated with them.  After all, I suspect that this is one reason why these shootings happen at close range.  The killers know that accidentally shooting someone like me would have repercussions.  This makes me angry.

Since witnessing that crime scene, I find I'm less tolerant of our culture's practice of portraying violence in the name of entertainment.  How many of the people who make that choice have ever seen what I saw?  How many of them have known someone who was murdered?  How many of them have lost a family member to violence?  Not many, I suspect.  Those people probably live in better neighborhoods, neighborhoods that are far removed from tragedies like the one I witnessed.

Something needs to change.  As a society, we need to stop glorifying violence.  We need to give our young men something to do, a way they can contribute to their communities.  We need to take the murders of young black men as seriously as we would anyone else.  We need a justice system that heals, restores, and rehabilitates, rather than one that turns people into harder, more violent people than they were to begin with.

Thus endeth the preaching.  Now I need to go figure out how to heal from what I saw.

Grieving the Relapse of Chronic Illness

I've been struggling a lot lately with the issue of how to live with a chronic illness.  As i've said before, I'm having a hard time caring for myself -- I was doing a damn good job of taking care of myself when I had my psychotic episode.  I was eating right, exercising, getting enough sleep, taking my meds, avoiding caffeine and sugar and alcohol, and I had the worst mental health crash of my life.

A few days ago, I found a post about grieving the relapse of a chronic illness by Dr Aletta of Explore What's Next.  Like it or not (and I don't like it, believe me) mental illness is a chronic condition.  We will do well for awhile.  Maybe we'll decide that we can handle a bit more stress in our lives.  We'll stop saying "no" to things we really should.  And then we'll relapse.  It sucks.

Dr. Aletta's post did three things for me.  First, it made me realize that there was something I wasn't doing to take care of myself -- I wasn't managing my stress levels.  Of course, I'd been under worse stress in my life, so I thought I could handle it.  Still, I was under a lot of stress.  Between that and my lack of sunlight, it seems I doomed myself.

Second, she writes candidly about hating to take the meds required for her condition.  She did what she advises her patients never, ever to do -- she altered her dosage so she took less of the medication.  I've never done this myself, but the temptation is always there.  I felt a lot better just knowing that a psychologist can make the same mistakes a lot of us do as we try to live with the side effects of our meds.

Finally, reading this post made me realize that my recent frustration and depression is normal for someone having a relapse.  When we have a relapse it's natural to grieve.  It's normal to be in denial, to get angry, to get depressed -- though that last one is bitterly ironic for someone with a mood disorder.  I've spent a lot of time lately feeling very angry and resentful.  It's not fair that I have to live with this chronic condition, that I have to put so much energy into caring for myself, when others can just go about their lives.

This is just a synopsis of Dr. Aletta's article.  I highly recommend reading the original.

How to Lose Weight and Keep It Off: You Can Do It

Wilma Goodfellow over at The Prozac Monologues has been writing a series of posts about the prevalence of metabolic syndrome in general, and particularly in the mentally ill.  She herself recently decided to lose weight.  Last week's post was about how to "reprogram" yourself to do it.  I highly recommend it (and the rest of the series) to anyone who's trying to get healthy.  You will learn not just about how to lose weight, but the mechanisms that cause overeating and overweight in the first place.

In her first post in the series, she quotes from the CIA World Fact Book that the United States ranks 50th in the world in terms of life expectancy.  Now that's something to be proud of, right?  Right?

Among the severely mentally ill, the figures are far, far worse: we have an average life expectancy of someone in Sudan.  To refresh your memory about Sudan, the last decade has brought them civil war, genocide, and famine.

These numbers are due to several factors.  Many of the drugs we take cause us to gain weight, or cause us to crave food (lookin' at you, Lexapro!).  Many of us also face inadequate medical care; we don't have access to nutritionists, dietitians, or physical trainers that can help us lose weight.  Goodfellow's series shows us that weight loss is still possible.

As they say, weight loss isn't easy.  To sustain it, you need to change your lifestyle, and change it permanently.  Sound hard?  It is.  Three years ago I lost 60 lbs, because I was 33 years old and already developing back and knee problems.  It was a struggle, but it was worth it -- both in terms of my current quality of life, and the extra 15 years I may have because of it.

CBT for Depression: Mood and Thought Diary

Last week I started therapy for my depression and ADD.  If therapy for ADD sounds strange, allow me to say that it's always been a huge factor in my depression.  When you grow up with any sort of neurological difference, your self-esteem is systematically crushed into a pulp; you're told that you're not "really" trying, that you don't care enough to learn, that you could do so much better if you just "worked up to your full potential".

It's that last one that really got to me.  I was told repeatedly by my parents and teachers that I was "too smart" to be sucking in school as much as I was.  I didn't feel like I was smart at all.  If I was so damn smart, why was school so hard?  Why couldn't I remember a word the teacher said?  Why couldn't I finish my assignments?  Why wouldn't they all realize that I was just plain dumb and leave me alone?

Growing up like that plants a lot of negative thoughts in your head.  The thought and mood diary that my therapist assigned me to do last week has really brought that out into the light.  I learned that sometimes my thoughts precede my mood, and sometimes my mood precedes my thoughts, but that whatever the situation holy crap am I a negative person!

The Danger of Broadening the "Bipolar" Diagnosis in the DSM V

Bipolar Blog posted an opinion piece today from a research psychiatrist, Mark Zimmerman, MD, who sees danger in expanding the definition of bipolar disorder in the DSM V.  Some of you may already know that the DSM V is considering such diagnoses as "bipolar III" and "mood spectrum disorder" to describe those whose symptoms are "sub-threshold" for bipolar disorder, but are a little closer to bipolar than to unipolar depression.

This is a controversy in the psychiatric community, with some doctors, like Nassir Ghaemi, advocating for the expanded diagnosis.

I'm not sure what to think about this.  My own official diagnosis is "depression with psychotic features".  For whatever reason, my illness involves daily depressive mood swings that last from 3 pm until 7 pm.  My illness cycles in a way that typical depression doesn't.  While I don't have a bipolar diagnosis -- I've never had a hypomanic or manic episode -- I'm being treated in exactly the same way I would be if I were bipolar: I'm on a mood stabilizer instead of an antidepressant, with an antipsychotic thrown in for additional support.  In my case, it doesn't matter what my diagnosis is called; the important thing is that I'm getting the treatment I need.

But it would be pretty easy for a pdoc to look at my symptoms and keep trying me on SSRI's, no matter that they sedate me.  In that way I might be better off with some sort of expanded bipolar diagnosis.

On the other hand, as Zimmerman points out, there is a danger in expanding the definition of bipolar disorder to include people who've never had mania of any stripe but are considered "sub-threshold" in some way.  There's no evidence that mood stabilizers are a better treatment for these folks, and mood stabilizers often have more unwanted side effects than SSRI's.

There's a bigger danger in misdiagnosing and medicating someone for bipolar disorder: some of these meds can actually cause the symptoms they're meant to alleviate.  I've seen this first hand with my friend Anna.

Anna had been on SSRI's for years without really feeling an effect from them.  Her depression worsened, and she was diagnosed as bipolar II based solely on the fact that over the years, she hadn't responded to trials of at least three antidepressants.  So her pdoc tried a cocktail that involved a mood stabilizer, an SSRI, and an antipsychotic.  At that point, she had her first hypomanic episode.

That was a year and a half ago.  Since then her pdoc tried her on various combinations of meds in those categories.  She wound up in the hospital several times.  She had to deal with side effects like tremors, at which point her doctor put her on a beta blocker; then came the anxiety, for which her doctor put her on clonopin.  She was finally able to talk her pdoc into giving her much lower doses of her meds.

She's finally stable, and no longer has to take other meds to treat side effects of the first ones.  Needless to say, she resents losing a year of her life to the experimentations of her medical team.

In her case, it seems like the meds she's on actually induced her bipolar condition.  Keep in mind that she'd never showsn symptoms of hypomania before her bipolar II diagnosis.  In her case, it seems that an expanded definition of bipolar did not help to treat her illness.

I think the moral of the story is that whatever the DSM V committee decides to do with bipolar definitions, it would be nice if psychiatrists kept in mind that it's just a guideline.  People do not fit neatly into their categories.  When it comes to diagnosing a real, live, human being, the art, and not just the science, of medicine must come into play.