Illuminating

Since Josh was diagnosed with Bipolar II, I have read countless books and websites on the subject.  I have poured through message boards and attended a Bipolar Support Group.  Along the way I've learned quite a bit, but I'm still learning.

I downloaded a book onto my Kindle yesterday, and while I'm only about 25% through the book, I have already learned something very important.

Josh probably isn't a good candidate for anti-depressants.  Somewhere, in all the reading I've done, I totally missed the concept of anti-depressants triggering mania in someone who is Bipolar.  Actually this is complete stupidity on my part because Josh's initial slide into mania was probably 'caused' by the use of Prestiq for his depression.

And that's the problem with this disorder.  There are SO many issues at play with it and yet, there is so much unknown.  As I've moved through all this, I've actually 'forgotten' some of the things I learned early on.

This is the book I am reading.    Dr. Phelps also maintains a website, which is FULL of great information.

On his website (and probably in his book, although I haven't got to that section of it yet) there is DETAILED information about the brain and how it 'might' be effected by Bipolar.  Dr. Phelps explains current research and possible explanations for what happens inside a Bipolar brain.  While it can all get pretty technical, even *I* could follow along and absorb the information.

In reading this book and website, I can 'see' Josh when Dr. Phelps talks about Mixed States.  While Josh doesn't exhibit full blown mania in conjunction with full blown depression, I still can see him when Dr. Phelps explains it like this: 

"This combination is one of the most severe and dangerous mood states known.  You feel overengergized to the point of agitation, and yet you are terribly depressed.  You may feel extremely irritable and extremely hopeless at  the same time, giving you an angry, "What's the point anyway?" attitude.  Your mind is usually racing with thoughts, nearly all of them very negative.  Perhaps worse of all is a reversed self confidence, where the grandiosity of mania is instead experienced as a profound lack of self-esteem, to the point where you feel worse than worthless: you are slime, you are a burden to others, and you cannot do anything correctly or of any value. 

While depression alone can lead to suicide, depression in this mixed-state condition often leads to intense suicidal thoughts that seem utterly appropriate.  People can really believe their loved ones will be better off without them."

I guess the best way to say it is that it makes sense that in the depressed state Josh is in, when he becomes even slightly manic, all those racing thoughts are negative and directed at himself.  I HEARD that in my kitchen the other night.

To put it very simply, Dr. Phelps believes in the concept of a "Mood Spectrum", where mania can be mild and laying beneath the surface, even in someone who 'lives' almost all the way to the left on the Spectrum.  He cautions that identifying someone with "Major Depression" and not looking for underlying 'soft' bipolar symptoms is dangerous.  If there are underlying 'soft' bipolar symptoms and an anti-depressant is used, the medication can trigger a manic phase.

It's quite possible that this is exactly what happened to Josh.  He exhibited many 'soft' bipolar symptoms, yet the original diagnosis was depression.  Of course, it's quite possible that the medication had nothing to do with the slide towards the other end of the spectrum, it might have naturally occurred, but it certainly makes you wonder.

I'm terrified that his current depression, when coupled with even a mild manic state, could lead him to suicide.  You listen to him and it's hard to miss how much he hates himself and life in general.  And if he's all up in his head, having racing thoughts, and all those thoughts are negative...well, it's easy to see how suicide might seem like the perfect solution to the problem.

And yet, he refuses treatment, refuses to accept that Bipolar may be at work in his life. 

I can understand the denial, and I imagine that there is a process Josh has to go through to get to acceptance, I just wish he'd GET THERE.  It terrifies me to think that he may be one of the many who never accepts the disorder and is handicapped by it forever.  More terrifying is thinking that he may kill himself, and in it all, I question how long I can financially hold this all together.

I spoke with Josh last night, and we're going to look at apartments this weekend.  He is still in training as a server at work but said he enjoys it and "it's a piece of cake".  He begins actually serving next week and I hope that it doesn't stress him.  I imagine a server in training isn't given a full section to work, so what looks easy now, may look very different to him next week. 

He sounded good though, and I always like to hear that.

And here's my final thought for the day.  Where do *I* find a Dr. Phelps?  MY therapist suggested a doctor to me, who she doesn't 'know', she only knows that he specializes in Bipolar.  When I researched him on the internet, the comments from his patients were HORRIBLE.  Let's face it, I've gotten Josh to agree to another assessment, I HAVE to get him in front of someone who is highly skilled in diagnosing but also skilled in guiding a patient towards acceptance.  I don't have the luxury of trial and error in finding the correct doctor for Josh.

Dr. Phelps seems like a dedicated, forward thinking practioner; a doctor who looks at the big picture and relates ALL he's learned through his work with patients to each patient.  I don't want to put Josh in front of someone who isn't the same.  The mental health field is full of horror stories and I don't want Josh to be one of them.  I feel intense pressure to 'get this right' because it may be my last chance to get him onboard anytime soon.

I've searched the internet locally seeking someone very gifted in Bipolar, but I've come up with nothing.  I think I'll call the therapist that Josh was seeing when he became depressed.  In his practice he has a couple of psychiatrists and maybe one of them would be our best choice?  

I don't know.  All I do know is that this Bipolar thing leaves me constantly feeling like a fish out of water.  Can you imagine how Josh must feel then?