Do you post to your Facebook, MySpace, Twitter, etc. about having bipolar disorder and the impact it has on your life? LadyJesse, a member of the forums, doesn't think it is a good idea. In her forum post Keep BP off FB she comments, "I mean why make your whole life about bipolar disorder (bp) and subject people to it all the time? My page is bp free because there is more to me than this illness. I wish other people could also develop other things to talk about."

What's your take on this? ~Kimberly

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Antidepressants are a key component in the treatment of those with bipolar disorder. We all know they are used to treat depression including depression associated with bipolar as well as anxiety. And I think most of us probably have a grasp on the idea that antidepressant can be the culprits in triggering mania for some people. But here something we didn't know.

A new published study has found that antidepressants may actually cause a change in your personality. The research team found evidence that these medications decrease neuroticism and increase extraversion. These changes are independent of the improvements in depression though they do seem to predict how well and how long remission of symptoms may occur.

Anne Harding, in an article titled Antidepressants Change Personality, Study Suggests, quotes the lead author, Dr. Tony Tang, "Medication can definitely change people's personalities, and change them quite substantially. Those changes are very important."

She also makes an important note, "Although the new study sheds some light on the relationship between SSRIs and personality, there is much that remains unknown about these drugs." ~Kimberly

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Life with bipolar disorder is a 400 meter, long hurdle race. Nowhere is this more telling than the workplace. For those with severe mental illnesses such as bipolar disorder, there are obstacles just getting out of bed and to the office. Tackling the barriers of stigma, misinformation and insensitivity seems insurmountable sometimes. These effects carry over to the loved-ones of those with these disorders.

We know this, but our supervisors and employers don't always have the same firsthand experience we have. Stewart D. Friedman, a Professor of Management at the University of Pennsylvania, talks about this in The Hidden Business Cost of Mental Illness published in Harvard Business Publishing. Yes, you read that correctly ... a business professional writing to business professionals offering salient advice that benefits both the business and the employee.

"There are real costs associated with employees having to carry this heavy weight of worry and responsibility, especially if they feel they must do so without the understanding and support of their organization. There is stress, unwanted social isolation in the workplace, and the feeling that they must find clandestine ways of responding to urgent demands for their attention. All of this undermines productivity by causing burn-out, unplanned absences, distractions from focused effort on tasks, and poor confidence in being able to contribute to the team. As a leader in your organization, you can reduce these costs and inspire greater performance from valued employees."

I've bookmarked this article and plan to use it when I'm doing training with members of my staff. Dr. Friedman presents a few solid suggestions for reducing stigma and these aren't just for managers. They are for anyone. ~Kimberly

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One of our forum members, Bwaisley, posted about the difficulty of discontinuing Ativan, which is a benzodiazepine anti-anxiety medication:

"I have been trying for months to get off Ativan. The best I can do is where I am right now on 0.5 mg a night. Whenever I try to reduce by a little bit, I spin into an anxiety attack. I've been on it for months. I even tried titrating off when my pdoc started titrating me onto Depakote ER. That didn't work. To top it off, every Sunday night I have to take 1 mg of Ativan because of the anxiety of starting a new work week. What the hell do I do now? I only want it for emergencies, but it won't let me. I feel trapped with no way out. Yuck!!!! Any suggestions?"

I feel for Bwaisley. I went through benzodiazepine withdrawal myself, when I had to go off all my medications in order to take part in a clinical trial. Discontinuing the other drugs wasn't bad - stopping Ativan was absolute misery.

Have you been through this, with Ativan or any of the other benzos? Please offer any suggestions you have to Bwaisley, or leave a comment below.
~Marcia

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Over the years Kimberly and I have written about ourselves - for example, Kimberly wrote about her son, and for a long time I shared my story in my I'm Bipolar Journal, which started on the day I was diagnosed with bipolar disorder. If you've followed the journal, you probably know me well by now, but we know far less about you. So today I'm asking: Who are you? Why do you visit this site? What here has helped you the most? Leave your answers at the bottom of this message. We'll be listening!
~Marcia

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Lists abound of suggestions and gift ideas based on any number of criteria including bipolar disorder. You can find books, t-shirts, totes, coffee mugs, zany clocks and even art by those with bipolar disorder. Aside from a whole library of books, my favorite to date is a t-shirt asking, "What makes you think your brain chemicals are normal?"

Tread carefully with gifts like these because one person's sense of humor is far from another's. I was appalled when I found a t-shirt depicting a stick-figure monkey running with a knife titled "Skippy, The Bi-Polar Monkey."

Also keep in mind that something you think is wonderful or helpful just might offend. I'm personally not fond of self-help books as gifts. To me, it smacks of pretension or judgment. A reader commented that she was put-off by a pill organizer as a gift. She felt she was being told her memory wasn't sufficient.

Don't forget to make sure your gift is appropriate i.e., alcohol is generally not a good idea. Many folks with bipolar disorder struggle with addictions.

What should be added to this list? What is something you think is a terrible gift idea for those with this disorder? ~Kimberly

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Anthony Michael Hall has snagged headlines a number of times here in November, but not for his acting or producing skills. Rather he has been accused of domestic violence from a row with his girlfriend (now ex), Diana Falzone, who has filed a restraining order against him.

As I often remind my kids, if we lose our temper or control, we are responsible for our actions regardless of our intentions. A fact I am sure no one needs to tell Michael. Since the story first hit the news, it has taken on the life of Star Gate replicators with every conceivable news venue and blog cranking out almost identical articles of the alleged details or lack thereof.

There are literally hundreds of these reports and every one of them reference that Michael has bipolar disorder. But does he? Perhaps it exists in an archive somewhere on the net, but I was unable to find an interview or a quote from Michael in which he discusses having bipolar disorder.

All of the comments about his bipolar disorder seem to stem from reports that the insurance company covering the production of The Dead Zone sued him in 2003 because of a shutdown of production in 2001 due to his hospitalization for "bipolar affective disorder depression with psychotic features." According to Josh Grossberg writing for E!, the suit claimed his hospitalization occurred after he stopped taking his medications. I could not find the outcome of the suit so I'm not sure this is the smoking gun to tag Michael with a diagnosis. I would rather hear it directly from him. ~Kimberly

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There is quite a lot of research to support the idea that a family history of mental illness increases the risk of a mental illness also developing in a child. As I previously noted in Could My Child Have Bipolar Disorder?, as many as 10% of those with a parent or sibling who has bipolar disorder will also develop bipolar disorder. Studies have also demonstrated that family members with both schizophrenia and unipolar depression are commonly found in the same family tree as those with bipolar disorder.

Recent research studies are finding the same evidence. In Offspring of Parents with Bipolar Disorder, Dr. Karen Wager shares some of the latest numbers:

• 10.6 percent of 388 kids who had at least one parent with one of the bipolar disorders also had one form of bipolar disorder or another compared to only .8 percent of 251 kids whose parents did not have the disorder.
• 29 percent of the 388 kids of those kids with both parents diagnosed also had the disorder.
• 52 percent of these children were diagnosed with some form of serious mental illness compared to only 29 percent of those whose parents did not have bipolar disorder.

These figures may seem scary even daunting if you have kids or you are considering pregnancy. However, "While your risk of having a child who develops a mental disorder is higher than if you or the child's other parent didn't have bipolar disorder, it isn't a guarantee that this will happen. And of course, nothing says that having a child with a mental disorder -- whether it appears in childhood or later in life -- won't still be a wonderful, fulfilling experience." (see Will My Child Inherit My Bipolar Disorder?) ~Kimberly

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I've had two of my cats since 2005, and this year I adopted a kitten from the same shelter who is about 7 1/2 months old now. I never worried about them getting into my meds. I keep medication bottles closed tight at all times, and the only time pills are out is right before I take them, when I get them all out morning and night and put them all on a little tray before taking them. The only time I'd be concerned was if I dropped one - then I always made sure I found it.

Well, that was fine with the two older cats, but the other night the youngster, Buzz, got up on my desk and started licking the pills in the tray, which I'd set out but not taken yet. ACK! I grabbed him right away and tossed him off the desk, then took the pills immediately (yes, the ones he'd licked - they're just too expensive to throw away).

So now I know I have to take my meds as soon as I get them out. Fortunately, I was right here when he did that, so there wasn't time for him to hurt himself with them. But I knew I had to share this story, which proves that no matter what pets have done in the past, a new pet may behave differently - and is a reminder that even existing pets may do something they haven't done before.

This made me wonder whether you, our readers, have stories to tell about your pets and your meds. Leave yours in a comment!
~Marcia

Photo of Buzz at 9 weeks old by Marcia Purse. All Rights Reserved.

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Medications for the treatment of bipolar disorder can be prohibitively expensive. However, there are programs offering medications free of charge or at reduced prices. Many pharmaceutical companies offer programs to reduce or even provide needed meds for those who qualify. Lady MacBeth has graciously compiled a list of phone numbers to the assistance programs for specific drugs. She writes, "These are the phone numbers for assistant drug programs. Sometimes I call them myself and other times I have to get my psychiatrist's office to call them."

If your prescription is not available through one of these programs or if you don't qualify, there are some other options you can use to help reduce the cost of your prescriptions. Michael Bihari, the About.com Guide to Health Insurance, offers Ten Ways to Save Money on Your Medications. He shares, "Your prescription medications can be very expensive and may strain your budget, especially if you have a chronic illness. Whether or not you have health insurance with drug coverage, there are many ways to save money on your medications."

Do you have any other suggestions? Please share! ~Kimberly

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A few days ago, I asked for your strategies for getting through the holidays. We have a few excellent points made by readers.

As a Certified Professional Coach for supporters in the bipolar community and the wife of a man with bipolar disorder the most important thing I do and recommend others to do is be prepared and learn from the past. If you know that certain situations or people spark the triggers of the illness than make the conscious choice to stay away. If they don't understand then they're not the kind of people you want to be around. You must love yourself and your partner above all others and keep "family guilt" out of the equation when deciding what to do and where to go for the holidays. from Kathleen

Share what you are doing to ameliorate holiday stress.

And happy Thanksgiving to those celebrating this U.S. holiday today. On this day of thanks, let me say thank you to each of you for giving of yourself in this community even in the midst of your own difficulties. Each of you make a difference in other people's lives every day. ~Kimberly

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It is perfectly normal to have days where you feel low and days when you are on top of the world. The emotional rise and fall of life is part of the human condition. So how can you tell when your experiences are normal and when they've pushed into the extremes of depression or mania associated with bipolar disorder? Should you consider scheduling an appointment to be evaluated by a psychiatrist? Consider three basic rules of thumb. ~Kimberly

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The holiday season is usually a stressful time for most people; it is even worse for those with mental illnesses such as bipolar disorder. However, there are ways to alleviate some of the anxiety surrounding the many events associated with the holidays. How do you manage the stressful festivities? What are your tips for surviving the holidays? ~Kimberly

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That's what the family of Michael J. Gibson is saying after a San Francisco Bay Area Rapid Transit (BART) officer shoved him into a window of a train station, breaking the glass and injuring both. According to The Raw Story, Gibson has been charge with "felony battery of a police officer, obstructing and resisting an officer, disorderly conduct and public intoxication." Gibson's sister, however, says the officer was way out of line, and that her brother suffers from "bipolar disorder and schizophrenia."

The incident was caught by a passenger with a cell phone and the video posted on YouTube, where it gained widespread attention. (Warning: there is a lot of foul language in the video.)

It is plain from the video that Gibson was out of line, and that the officer could not have determined the man was mentally ill. Regardless, it appears to me that there was absolutely no reason for the officer to slam Gibson into the glass. And would the officer have treated Gibson differently if he had known about the man's mental illness? What do you think?
~Marcia

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The antipsychotic Geodon (generic ziprasidone) has been formally approved by the US Food and Drug Administration for maintenance treatment of bipolar disorder, when used along with lithium or valproate (Depakote, etc.). In a controlled clinical trial, more patients went six months without a mood episode when Geodon was combined with either lithium or valproate than those who got a placebo instead of Geodon - 80.3% compared to 62.6%. In addition, more people taking the placebo dropped out of the study due to side effects than did those taking Geodon.

Geodon was previously approved in 2001 for schizophrenia and schizoaffective disorder, and in 2004 for treatment of acute manic or mixed episodes in bipolar I disorder. The additional approval for maintenance treatment gives doctors another long-term use drug to help stabilize moods.

Geodon Drug Profile
Geodon Side Effects

Sources:
Gever, John. Ziprasidoned Okayed for Bipolar Disorder. MedPage Today. 11-23-09.
Geodon Approved Label. Drugs@FDA. 11-19-09. 11-23-09.

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Does it seem like your prescriptions for bipolar disorder are getting more expensive every time you go to the pharmacy? You may be right. There is growing concern that drug manufacturers are raising prices to bolster their return on investment before health care legislation is enacted that might impact what they can charge.

Duff Wilson, in an article published Monday by the New York Times, reported that "the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation's drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992."

Apparently members of Congress have received enough evidence to call for an investigation. Wilson noted in another New York Times' article yesterday that Democrats in the House submitted a letter to the Government Accountability Office requesting the investigation. The letter is quoted as saying "Any price gouging is unacceptable, but anticipatory price gouging is especially offensive."

No kidding! Even with health insurance, the prescription bills for our household equate to more than a week's worth of groceries. Greed knows no bounds. ~Kimberly

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Relationships are hard. I often think of my marriage like a binary star system with each of us on our own ecliptic but orbiting each other in tandem. However, the reality is that the physics of gravity that keep stars in beautiful synchronicity don't work so well with people. Add a severe mental illness such as bipolar disorder to the equation of relationships and the potential for difficulties is exponential.

Lifevirtues, a member of our forums, eloquently shares her fear of relationships, "Damn the social experience. It is a deceitful dynamic; we are perpetually befriending our enemies, and we inevitably hurt the ones we love. Whatever dialectic ideal exists is simply that - an ideal. Actuality does not allow for balance.

"How can I say it is wrong when it is all there is? This is humanity. I can avert my eyes, I can try to brush past those who attempt to ignite the social flame, but I can't deny nature. Connections kindle and grow, and someone is always burned in the process.

"I am scared to get close to people. Terrified, actually. I don't care if I get hurt by someone. I don't care if someone mentally or verbally abuses me, I don't care if someone betrays me. What frightens me is my potential to hurt others."

I hear you, Lifevirtues. But bipolar disorder isn't the common denominator for our potential to hurt others. Each of us can and usually will hurt the ones we love at one time or another. This is the human condition as you noted. However, two other important components of the human psyche are the ability to learn and to forgive. What do you guys think? ~Kimberly

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ABC News and other organizations are reporting on a study that found people with bipolar who smoke appear to have a higher risk of suicidal behavior than those who don't. Prior studies have had similar results, but this time researchers think they have come up with one possible reason.

The study by Dr. Michael Ostacher and others at Massachusetts General Hospital looked at 31 smokers and 85 non-smokers. The researchers a standard questionnaire that measured suicidal thoughts and behaviors along with one that measures impulsiveness, as well as noting actual suicide attempts.

They found that smokers had a higher rate of impulsiveness than non-smokers and that the smokers generally scored higher on the test for suicidal thoughts and behaviors. They also found that the smokers in the study had a significantly higher number of suicide attempts within 9 months - 16.1% compared to 3.5% for the non-smokers.

I'm a smoker, and I've never attempted suicide. I also haven't experienced suicidal thoughts to any great degree. What about you? Do you smoke? Do you have problems with thoughts of or preparations for suicide, or have you made an attempt?
~Marcia

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Lexapro is one of the SSRI antidepressants and was created from Celexa (citalopram). The generic name of Lexapro is escitalopram, but Lexapro is not currently available in generic form.

There are several warnings about Lexapro, especially about mixing it with other drugs and over-the-counter supplements, and discontinuing Lexapro treatment too quickly can cause a variety of unpleasant side effects.

Our Lexapro Drug Profile will give you in-depth information about this antidepressant.

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Bipolar disorder is difficult to diagnose. There is currently no definitive medical test for this disorder. Furthermore, there are a number of physical conditions and quite a few psychiatric disorders which present symptoms that can be confused with those of bipolar disorder. And just to complicate things a bit more, a great many psychiatric disorders can occur in tandem.

Mark Zimmerman et al with Department of Psychiatry and Human Behavior at Brown University School of Medicine discuss this in an article, "Performance of the Mood Disorders Questionnaire in a Psychiatric Outpatient Setting," published in the November edition of Bipolar Disorders. "Bipolar disorder is a serious illness resulting in significant psychosocial morbidity and excess mortality. During the past few years a series of research reports, reviews, and commentaries have suggested that bipolar disorder is under recognized, and that many patients, particularly those with major depressive disorder (MDD), have, in fact, bipolar disorder. Even for those patients diagnosed with bipolar disorder, the lag between initial treatment seeking and the correct diagnosis is often more than 10 years."

To facilitate and improve the diagnosis of bipolar disorder, researchers and practitioners have developed a number of screening questionnaires and assessments. One of these is the Mood Disorder Questionnaire (MDQ) developed by a team of psychiatrists, researchers and consumer advocates led by Robert M.A. Hirschfeld with the University of Texas Medical Branch. The MDQ is one of the most commonly used of these assessment tools. You can view the full questionnaire on the Depression and Bipolar Support Alliance website.

Unfortunately there is growing evidence that the utility of the MDQ might not be as strong as is needed for accurately diagnosing bipolar disorder. In the most recent research report about the MDQ, Mark Zimmerman and his team found the results of this questionnaire to be more limited then initial research indicated. "A screening measure needs to have high sensitivity, and each of these three studies found that the sensitivity of the MDQ was less than 70% when the scale was scored according to the developers recommendations."

So what does this mean for us? It means that we shouldn't accept a diagnosis of bipolar disorder based on a brief questionnaire. If your doctor or a therapist uses the MDQ or another similar screening tool, you should simply consider this a starting point towards an accurate diagnosis. Your physician should proceed with a full clinical evaluation for bipolar disorder. How Is Bipolar Disorder Diagnosed? discusses what this process involves. ~Kimberly

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I read a comment this evening that really struck me. In response to Marcia's Addictive Personality blog, Sarah brought up the topic of avoidance - what she termed an escapist personality.

"I have an escapist personality, not an addiction. My escapist personality causes me to sabotage regular activities like going for coffee with a friend, turning off my phone and ignoring/avoiding life.

"I can get into a book and days will pass without a shower or a proper meal. I can watch 8 movies in a day. I can sleep for 18 hours at a time and feel absolutely guilty about all of the above. But that won't stop me from doing it again and again."

I think Sarah has expressed a common theme for those with bipolar disorder, with any severe mental illness really. Avoiding ... attempting to escape those situations or things that make us uncomfortable. Do you actively avoid normal life activities? Do think you think it is a viable coping strategy or more maladaptive behavior? I tend to lean towards maladaptive behavior.

There are certainly some specific situations that are in our best interest to avoid - drunk dialing your boss, streaking through the neighborhood park, spitting on a cop. However, facing something that makes us uncomfortable and expanding our comfort zone is a growth point. I know! Easier said than done.

Sarah shares, "I want to know if others out there feel like they sabotage their happiness and what I can do about it." Thoughts? ~Kimberly

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