Insurance and Psychiatry, an Epic Struggle of Phone Calls

I’m currently looking for a new psychiatrist. For the past year, I’ve been under the university’s health care system that provides free psychiatric care to students in need. And they’ve been wonderful. My psychologist has been very helpful and my psychiatrist is incredibly aggressive in trying out medications. If it didn’t work quickly, he didn’t want to put me through any more unnecessary time in hoping that it would work. He would just see me in a month and try something new. It was summer, so I had some time to spare, and that’s all I’ve done this summer, trying medications (sounds like a relaxing vacation, doesn’t it?).

Unfortunately, this is only a stop-gap procedure. I’m running into the time where I need to find more permanent care for the next two years before graduate school. The problem is insurance. They just don’t cover anyone. Well, more precisely, they don’t cover anyone who either exists or is taking in patients right now.

Half of their list is from one place, which is very good, but is not accepting anyone right now. The other half of the list is for locations that the people no longer work at. Half a dozen phone calls later, and I find out that some of them have even moved on to other places. It’s easily one of the most frustrating things I’ve encountered in my life. The constant rejection and lack of relevant information is almost too much. So now I’ve even expanded my range to my parents, who live about 100 miles from me.

It reflects a sad state of our health care system. That I have to look 100 miles away to find care just so I can keep my prescriptions filled. But, I’ll find one in time. I have 3 month supplies and can get some refills from my current psych. Still, it’s an infuriating road bump to have to deal with all the hoops to jump through just to remain stable. It’s really a test of just how far I’ll go to keep functioning properly.

Coffee and a Cat, a Healthy Way to Keep Moods Stable

Every morning I have a routine. I wake up at around 8, fix some coffee, and plop down on the couch. There I think about the day, maybe what to blog, or even my research (though it’s usually too early for that). I often watch a little tv to wake up to, for now it’s Star Trek. But I also have a cat, who is an aggressively cuddly cat. My cat, Lucie (nicknamed lucifer for her evil catness) usually cuddles me, demands attention, and then food. And, she also helps keep me stable.

I’ve been thinking about this for some time, why is it that she helps me so much? There is research supporting pets helping with depression, usually along the lines of them cuddling, requiring attention, and subduing lonliness. I can definitely speak to this, she’s very helpful at keeping me sane when it comes to feeling lonely. But she also does a lot more from me, she demands care.

It sounds like it might be odd to think that demanding care is helpful when depressed or manic, but it does. The reason that I find is that she requires a rhythm. She needs to be fed, pet, brushed, cared for, etc… All of these require certain times, with some latitude. In short, she demands (she does demand them…) and requires certain behaviors regardless of the mood that I’m in. Thinking along the lines of behavioral activation, she provides a reinforcement for all of my behaviors. When I feed her, it’s an easy task, but she rewards me by cuddling and cozying up to me later. Brushing her, she meows and loves the attention. In fact, all of the behaviors directed at maintaining her health are rewarded very quickly. In terms of behavioral activation, she asserts her list of requirements and provides small rewards for completion.

And these little tasks add up, they take only a few minutes every day, but accomplishing small tasks has an enormous benefit to my psychological wellbeing. They give some degree of satisfaction, and in doing so, energy. And this small boost of energy is like getting a small shot of coffee into my system. I feel like I can do things, even when I’m depressed. And when I’m manic, it gives me something to focus on. I can’t ignore it either. I’m pestered constantly by my cat to do these things. So there’s no way that my memory has time to fail. In keeping me focused on a regular task, I’ve found greatly increased stability. Little patterns of behavior keep me focused, which helps with activating me while depressed, and calmer when manic.

Small regular behaviors also provide some early warning signs. Not accomplishing them shows that I’m drifting in my moods. Behaviors, for me at least, almost always manifest before a change in internal mood. So having external cues is very important.

Strangely, having a cup of coffee in the morning and a cat are two of the things that I not only look forward to, but also keep me in check in ways that I have not found in the literature surrounding pets.

Yay! I’m Part of Health Blogger Network!

I just got the email today. I’m now a top blogger at Health Blogger Network. I’m quite excited to hear this news and can’t help but feel a little pride for my little blog that I’ve been running here. But I would also like to thank all the people who read and comment on my blog, especially the commenters. Your interest keeps me going when I think that no one reads this.

To all the readers now at Health Blogger Network, I post regularly. In fact, I’ve done it every day. And I hope to continue it every day as part of Bwoz’s Daily Bipolar Project. Sometimes it won’t be health related, but that’s because being bipolar doesn’t mean that I only think about being bipolar. I’ll post things that I’ve read in books, philosophy stuff that I’ve come across, and maybe some of the ideas that I have for research. Some of it will be technical, other times it’ll be trivial day to day things in my life that’s probably uninteresting to you. But part of blogging everyday is just that, sometimes I just don’t have any ideas left. But I’ll try my hardest to make lemonade out of it.

So again, thank you to all the readers, and welcome all you new ones.

Frustration, Destabilization, and Behavioral Activation

My car broke down yesterday. It was a traumatic experience because I was getting on the highway and it suddenly started lurching and died as I pulled off the highway. That was enough to send me into a mild panic attack. Thankfully, I had cigarettes to calm me down instantly (I don’t recommend smoking to stave them off since it can make panic attacks worse, but it’s all I had since I forgot my xanax). Still, that wasn’t enough. I was hypomanic and frustrated.

For the past few days, my mood has been elevated, but trending back to normal. Yet, this frustration really got the better of me. It’s normal to be a little down as a result of having additional problems and being trapped in a small town for yet another night, but this triggered a mood swing. Today, I was agitated and depressed. I couldn’t sit still, yet I just laid in bed watching star trek, not wanting to do anything except for crawling away to a small corner.

But there were two things that I did yesterday and today that helped enormously. First of which was focusing on rationalization and alternative plans. My girlfriend was there for me to bounce ideas off of, but what really helped was me going over every possible contingency and planning accordingly. Focusing while using a small meditative technique and exploring alternative possibilities helped alleviate the frustration by showing it to be the only rational choice. Even if it wasn’t, I convinced myself that it was, which is enough to defy some of the frustration.

Secondly, I tried some of my behavioral activation therapy this morning. I listed off things that I could get done and ranked their difficulty. The easy stuff I rewarded myself with just a little tv. Calling the mechanic, getting out of bed, getting in contact with people to arrange plans, etc… Now I’m rewarding myself again by reading some blogs and browsing the internet. What’s amazing is that it’s working very effectively. I still have some big stuff to do, and I’m not sure if I can do them, but it’s raised my bare functionality considerably by getting the small things out of the way.

And now lastly, I’m drinking some coffee to get caffeine’s antidepressant effects out of it. The effects seem to be working. I’m getting bare stuff done, maybe will eat soon, and I’m feeling less depressed. Not great, but by getting some of the little things done, I feel an enormous weight off of my shoulders and a small sense of accomplishment. Which is not that bad considering that I was able to rouse myself in just about 2 hours with the above technique.

Obtaining My New Mind-When Drugs Finally Work

I’ve been highly fortunate. I’ve found a cocktail of drugs that has had rapid success in stabilizing my moods without brain fog. It is the primary concern of mine to be able to stabilize my moods without sacrificing any of my mental capabilities. Unless it’s a severe depression, my mind works fairly well regardless of the mood that I am in. Coupled with being in academics, I’m forced to focus on maintaining my cognition as my primary target. And I’ve found it on abilify and lamictal.

I’m not ruling out the possibility of needing to change my dosing here and there, maybe a little more abilify, or a little less of the lamictal, but the buckshot has definitely hit the target and has stabilized me to a considerable degree. My manias no longer fly out of control, and my depressions are mild. Above all else, I’ve also gained a new reprieve from anxiety and paranoia. They are still there, but not in the same way that was crippling my ability to even call people. It’s really one of the greatest successes I’ve had in my life.

It’s highly strange though to now look back on my previous mind. I no longer identify with myself in a manic or a depressed state. Usually, I have the distance to say that what I do in those states is really not myself acting, but now it’s far different. I have a hard time even associating myself with those emotional states. I understand them and remember them, but it’s harder to hold in my mind what they feel like. It’s almost as if someone very close to me had them, but I did not have the episodes myself.

The outcome of this is a minor identity crisis. I have this new mind that seems to work better than it did before. There are mood swings, which I’m very used to, but there is a new element of clarity and expanded limits. I can no longer tell whether I’ll burn out or react negatively to a situation. I became a recluse to hide my behaviors and prevent any social interaction from worsening them, but now I seem to be able to tolerate more. But this leaves me uncertain as to how far my limits are.

I’ve red lined in the past, where I reached my limits and broke. But now those limits have changed, and I don’t know where they went. I don’t know if all of them are better, or if some have shrunk while others have grown. I really don’t know where I am and am in uncharted waters.

This is different as well from the changes in limitations that happen when I go on a new drug. New side effects are really not that new, and I adapt to them quickly because it’s clear how much they are impairing me. Traditionally, the side effects do not shift my social interaction or even stamina all that much. But now, all those goal posts have been moved, and I’m lost without knowing how far I can go.

As a result, I’m actually taking a small vacation due to the drug working. I’m taking only a single class this fall and sitting in on some others. I’m unsure of how far or how long I can withstand the pressures of academics, and I don’t want to be caught in another trap of taking on too much. It may seem strange to think that after getting better I need time off, but that’s exactly what I need because I do not know how much better I am. I don’t know how long I can withstand daily stress from reading, writing, arguing, and being judged on my work. So, as counter intuitive as it might seem, now that I’m better, I’m taking time off. Hopefully, at the end of it, I’ll know where I sit again and can feel comfortable in my own skin, knowing how far I can truly go.

Adventures in Abilify – Day 31 – Management of Mania

A few days ago I managed to trigger a hypomania with coffee and a hangover from a beer. It was a good test case for abilify’s mania management. And it worked. It didn’t blow open into a full blown mania. Rather, it’s kept me mildly hypomanic so that I feel good, but not in a delusional way or with massive thoughts of grandeur. It’s kept me mellow and happy instead. A major advantage that I’ve found is that it’s kept my sleep cycle in check. Often, when I’m manic, like most people, I sleep a lot less. This is a wonderful feeling, but it’s still sleep deprivation and my mind starts to wane with only a few hours of sleep each night. Lack of sleep also worsens my mania by undermining my impulse control a few days into sleep deprivation. It’s kept my sharp, active, and combined with the behavioral activation practices that I employed yesterday, highly productive without stopping for anything in between.

Over all, abilify has just chilled me out. It’s rounded off the time in which I swing, so that I’m not flip flopping moods in a matter of an hour or two, so I have more time to prepare and analyze where I’m headed. By keeping my moods in check, I also have massively increased focus and productivity. I still seem to be distracted easily, and I love stories, but I find that any story will do. Right now I’m addicted to Star Trek Voyager (reliving my childhood in the process). But in the times off from watching it, I get a lot done. I’ve been able to right and research a 10 page paper in a single 5 hour sitting. I’m still not happy with it, but it’s good enough in my opinion. It’s condensed, quick, and to the point, which is good enough (though I could go on for page after page if I really could get into it).

An odd thing is cropping up in my mood journal though. I’m generally more self sufficient and do not need to interact with people. I withdraw more into my mind and am very happy there. I like not having to interact with people and spending days at home doing things that I want to do without other people is incredibly satisfying. I don’t fear talking to other people, I’d just rather not and instead do it on my own. Though, agitation and anxiety are at an all time low, so that’s a good sign.

In the end, after 1 month, I’ve been restored to moderate to high functionality considering the rapid cycling and extremes of my moods. I’m still not functional in the way that normal people are, but I’ll take my eccentricities any day over normality.