I' m Just So Tired

I' m  Just  So  Tired

 I' m  not  physically  tired  but  tired.  You  see  I  have  Bipolar  I  with  psychosis,  PTSD, and  General  Anxiety  Disorder.  “Wow  you're  nuts!”  you  are  thinking.  I  probably am!  Of  the  three  the  bipolar  is  the  worse  and  longest  running.  My  depression episodes  run  so  long  and  are  so  severe  I  was  originally  misdiagnosed  with  Major Depressive  Disorder  for  nearly  thirty  years!  “Why  are  you  sad?  Whatcha  got  to be  sad  about?  Just  think  positive,”  you  are  probably  wanting  to  tell  me.  Let  me stop  you  right  there.  You  may  use  the  words  “sad”  and  “depressed” interchangeably  but  sadness  doesn't  even  come  CLOSE  to  what  depression  feels like.  People  thinking  sadness  equals  depression  and  thus  discounting  what  we  go through  on  a  daily  basis  is  where  a  large  part  of  the  stigma  surrounding depression  comes  from.  Both  major  depressive  disorder  and  bipolar  depression (you  guessed  it  that's  what  bipolar's  depression  episodes  are  called)  are  severe, tend  to  be  long  lasting,  and  is  often  debilitating  without  proper  medical  care which  includes  pharmacology.

Here,  let  me  give  you  some  simplified  science  to  educate  you  on  what  causes depression  in  both  conditions.  In  Major  Depressive  Disorder,  Bipolar  Disorder, and  many  other  mental  illnesses  the  #1  underlying  cause  is  a  genetic  chemical imbalance  in  the  brain.  Our  brains  LITERALLY  don't  create  enough  or  don't absorb  enough  of  certain  brain  chemical(s)  (aka  neurotransmitters).  These neurotransmitters  are  responsible  for  a  host  of  things  including  mood  stability and  sending  or  receiving  messages  between  the  neurons.    Dopamine,  Serotonin, norepinephrine  (also  know  n  as  noradrenaline)  are  the  keys  to  mental  wellness and  mental  illness.

In  a  depressive  episode  the  neurotransmitter  (remember  those  are  what  we  call in  layman  terms  “brain  chemicals”)  serotonin  isn't  being  produced  enough creating  an  imbalance  between  what  the  neuroreceptors  (the  parts  of  the  neuron t hat  receives  the  chemicals  enabling  them  to  receive  messages)  need  to  keep  the brain  working  correctly,  including  maintain  a  balanced  healthy  normal  mood.  If the  serotonin  dips  low  enough  and  the  outside  stressors  are  great  enough  it  can lead  a  clinically  depressed  person  to  contemplate  or  attempt  suicide.  When serotonin  levels  are  restored  to  a  healthy  level,  almost  always  by pharmacological  assistance,  their  depression  doesn't  magically  go  away  but rather  it  goes  into  remission.  As  long  as  the  healthy  level  of  serotonin  is maintained  the  individual  remains  in  remission.  That  is  why  it's  so  so  so important  to  stay  ON  your  medication  even  when  you  feel  better.  You  need  your psych  meds  just  as  much  as  a  type  one  diabetic  needs  his  or  her  insulin.

Now  you  may  be  saying  “Well  SSRI's  don't  work  for  me.  My  doctor  had  me  try each  one  of  the  ones  out  there  as  well  as  St.  John's  Wort  for  six  months  or  more and  I  felt  the  same!  What  gives??”  Did  you  know  a  small  percentage  of  people are  actually  lacking  norepinephrine,  often  as  well  as  serotonin?  No?  That's  okay  I honestly  didn't  know  that  either  until  doing  research  for  this  post.  It's  even possible  that  those  of  us  who  have  experienced  multiple  depressive  episodes actually  have  less  norepinephinergic  neurons  (1)  then  people  who  have  no history  of  depression  (those  lucky  bastards).  That's  just  peachy  huh?  Research also  shows  that  low  levels  of  serotonin  can  trigger  a  drop  in  norepinephrine levels  that  can  trigger  a  depression  episode  or  (joy  joy  *  sarcasm  *)  make  a depression  episode  worse.  Research  also  suggests  that  those  of  us  with  chronic (long  term)  depression  have  a  nerepinephrinergic  system  that  can't  handle  stress well  (1).  Which  from  my  thirty  plus  years  of  experience  with  severe  depressive episodes  and  my  yearly  decrease  in  ability  to  handle  stress  well  makes  perfect sense.  So  it's  possible  that  SSRIs  are  ineffective  for  some  individuals  or  not effective  without  a  partner  drug  to  restore  the  level  of  norephinephrine  such  as Cymbalta  or  Effexor  XR  which  are  classified  as  SNRIs  (another  class  of antidepressants).  Effexor  is  the  only  one  of  these  I  have  heard  of  being prescribed  without  being  paired  with  a  SSRI  such  as  Prozac,  Zoloft,  Celexa,  and my  personal  favorite  Lexapro.  More  on  my  experiences  with  various  psych medications  in  a  later  post.

Okay if you're  still  following  me  you  are  probably  wondering  about  dopamine.  I'm getting  there  hold  up!  Low  dopamine  levels  are  linked  to  loss  of  pleasure  in actives  one  used  to  enjoy.  Got  an  activity  you  lost  interest  in  as  your  severe  / clinical  depression  came  back  with  a  vengence?  Don't  feel  bad  I've  got  piles  of half  finished  projects  and  a  few  started  and  abandoned  novels  thanks  to  this. Dopamine  accumulated  in  the  wrong  places  can  also  lead  to  a  psychotic  episodes (yippee  –  NOT!)  Lovely  huh?  I  know.  Dopamine's  big  role  in  our  brain  is  to  help the  various  parts  of  our  brain  “talk”  to  one  another  (wait...we  really  do  have voices  in  our  heads??  Man  those  psychiatrist  been  lying  to  us  saying  we  are crazy  cuz  we  hear  voices  in  our  head!  ;-)  *  joking  *  )  Low  levels  of  our  pal dopamine  causes  us  to  exhibit  symptoms  like:  depression,  difficulty  handling stress,  fatigue,  mood  swings,  inability  to  concentrate,  inability  to  complete  taks, etc.  (boy  does  THAT  list  look  familiar!)

MAO  inhibitors,  an  old  school  class  of antidepressants,  which  include  Zelapan,  Nardil,  Emsam,  and  others  can  be  used to  stabilize  dopamine  levels.  Another  old  school  one  that  helps  with  dopamine and  is  a  stimulant  (can  I  have  some?  I  am  dragging  ass  seriously!)  is  Wellbutrin. Wellbutrin  is  a  norepinephrine  AND  dopamine  reuptake  inhibitor  which  works  to increase  the  amount  of  both  in  ones  brain  (by  preventing  the  body  from absorbing  it  to  recycle  it).  SNRIs  are  a  class  of  drug  that  are  serotonic  and nonadrenaline  reuptake  inhibitors.  Remember  that  works  to  increase  the  levels of  these  in  ones  brain,  thats  a  good  thing.  Examples  of  SNRIs  are  Effexor, Hydrocloride,  Cymbalta,  Yentreve,  Meridia,  and  others.

So  I 'm  tried,  as  you  have  probably  figured  out  by  now,  because  the  chemicals  in my  brain  are  off  balance.  Because  I'm  uninsured  due  to  what  my  jobs  offer  and the  lack  of  expansion  of  medicaid  in  my  state  thanks  to  republicans  and  don't have  the  money  to  spare  to  go  to  the  doctor  (about  $500  at  least  for  the  office visit)  and  then  go  to  the  pharmacy  (a  minium  of  $20  with  discount  cards  per prescription)  I  have  run  out  of  meds  and  can't  get  more.  Don't  get  me  wrong  I  do like  my  state  well  enough  but  we  could  use  more  free  clinics  for  those  of  us without  insurance,  not  eligible  for  medicaid,  and  not  rolling  in  money  to  afford that  office  visit  etc.  We  need  these  free  or  very  very  low  cost  (like  $20  or  $50  an office  visit,  all  inclusive)  in  every  small  town  as  well  as  city  of  every  size.  Sadly  we have  few  of  these  and  they  are  only  in  mid-size  cities  or  bigger  which  does nothing  to  help  those  of  us  in  the  rural  areas  of  this  state.  So  y es  I'm  tired  and it's  all  in  my  head  –  but  not  the  way  people  who  don't  believe  mental  illness  is real mean.



 (1) www.mentalhelp.net/articles/biology-of-depression-neurotransmitters