Psychiatric disturbances and corticosteroids

There doesn’t seem to be all that much in the literature about psychiatric disturbances caused by corticosteroids, but here is a good overview I found:
http://williams.medicine.wisc.edu/steroid_psych_effects.pdf
In the following, I will make some short quotes from the article and respond to them based on my personal experience.

The most frequently identified symptoms include agitation, anxiety, distractibility, fear, hypomania, indifference, insomnia, irritability, lethargy, labile mood, pressured speech, restlessness, and tearfulness.

I’ve probably had all of those at some point. I’ve been on corticosteroids for about 10 years now. I tend to divide that 10 year period into two distinct portions: the first 9 years, where I was severely depressed, often unable to leave my room (causing me to drop out of college), severely indifferent, anhedonia, tearfulness (there were times I cried about things like pizza toppings), insomnia. Then a few years when by in which I was so apathetic I couldn’t cry about anything.

The second portion began in August 2015 with what seemed to be a rather severe psychotic manic episode. The first thing I did was stop seeing my therapist. This episode wound down after about a week and a half, but continues to this day. It would probably fall under the category of a “mixed episode” now, with symptoms of mania and depression at the same time. Overall though, I am much more energetic, I have trouble sleeping, I have a disturbing and constant desire for drugs and alcohol, suicidal ideations, irritability, I cry all the time, I spend too much money (spending money makes me feel good for 10 minutes or so). The major differences are the energy and the ability to enjoy things, though. I am now more or less able to enjoy some things some of the time.

The most commonly reported corticosteroid-induced psychiatric disturbances are affective, including mania, depression, or mixed states.
Most often, patients receiving short-term corticosteroid therapy present with euphoria or hypomania, whereas longterm therapy tends to engender depressive symptoms.

This fits with my experience.

An overly stimulating environment can exacerbate a patient’s condition.

This is why I am largely avoiding Facebook. It’s a constant, overstimulating, unpredictable stream of unrelated nonsense. There is too much going on. Everyone uses it for a different reason. It’s complete chaos. On a related note, this is probably why I can’t stand going to bars anymore. Too noisy, too many people, chaotic.

Among patients with corticosteroid-induced psychosis, as many as 33% experience suicidal ideation.

I am not surprised, and I fall within that 33%, without a doubt. I have spent many, many hours thinking about killing myself. There was only one time I think that I really intended to do it right at that moment, but certainly I’ve done a lot of things that could have killed me, also, and spent a lot of time thinking about how much I want to die. On wikipedia’s page on suicidal ideation, there is also mention of role-playing: I actually purchased an air gun that looks reasonably similar to a real gun, and I keep it in my desk so I can take it out periodically, point it at my head, and pull the trigger. It’s never been loaded with anything and only takes plastic BBs anyway, but that’s not the point; the point is that I like to point a fake gun at my head and pull the trigger. It’s worth mentioning that, before being on steroids, I never had a suicidal thought in my entire life.

While the article says that some people respond to antipsychotics and antidepressants, it also notes that treatment success can be unpredictable. I have not had any success with various mood stabilizers and antidepressants. Due to adrenal insufficiency, my steroids cannot be stopped. At this point, I am not seeing any options other than learning to deal with it on my own, since drugs and therapy haven’t helped, and I can’t afford to just keep throwing hundreds of dollars at the problem anymore.

Why I made this blog

Over the years, I have read a lot of bipolar disorder (and other mental illness) related websites and blogs. I related to bits and pieces of them. What struck me was that a lot of them talked so much about health and wellness and living in harmony with their mental illnesses. That’s all well and good and I am not disrespecting them, but where were the ones who were not well, who were not living in harmony with anything at all? My guess is that they weren’t blogging much.

I have discussed this before, but I have been in and out of therapy for the past 25 years. I have tried dozens of medications. Nothing helped. Everything cost a lot of money. At great length I decided if I can’t find medications that make me feel better, and if therapy has not helped, then I will have to find a way to live with not feeling good, and in some sense, embrace the idea of not being well.

That’s why I am here, I think. I largely left Facebook because I couldn’t relate to anything on Facebook, not even in the mental illness-related groups. A lot of them seemed very anti-psychiatry, and I am not. I choose not to be on meds anymore, and I choose not to see therapists for the time being, but I am not against any of those things and I think people should try things that might help them. The rest of Facebook seems filled with positive-thinking memes and I’ve also discussed why I dislike those. Happiness is not a choice, and may not be attainable for everyone. Additionally, I think/hope there are things in life other than happiness to strive for.

But mainly, this is a place where I can say whatever I want. If you are reading this, it means you are on my turf and I don’t have to apologize for saying anything disturbing. If you don’t like it, you don’t have to read it. I always felt that everything I posted on Facebook was probably considered distasteful by 90% of the people reading it and I find Facebook to be, on the whole, a very unwelcoming and ugly place.

Another big reason I dislike Facebook is I feel it encourages you to post and repost garbage rather than anything with any sort of content, and it encourages people to press “like” rather than participate in any kind of discussion. I’d rather be here talking to myself than promote that sort of thing.

On the other hand, I liked livejournal a lot when people still used it (which is to say, before Facebook became popular). It had the lj-cut option for longer posts, you could add images and links in the things you wrote, and so on. I think that’s because it encouraged people to think about what they wrote, rather than posting nonsense every five minutes. I’m not saying I’m not guilty of that, too, but leaving Facebook would largely solve that problem. If I’m going to post here, it’s going to be in complete sentences and paragraphs, in any case.

On discussing feelings and difficulty talking to therapists

When I was a kid, talking about feelings was damned near verboten. Or rather, if you brought such things up, you’d be told to “stop being stupid” and basically to shut up. And I think that’s why, now, when people say, “you can talk to me if you need someone to talk to,” my [internal] response is something along the lines of, “What the fuck? No.” (Likewise, I was also discouraged from playing make-believe because it was “lying” to pretend something was something else.)

I was always kind of shocked when, on television or in real life, I’d see families who not only discussed how they felt about things, but also hugged each other, said “I love you” to each other, parents told children they were proud of them, etc. That never happened to me while I was growing up. I eventually started being able to hug people at family functions and to hug friends I hadn’t seen in a while, but this is not an action I would initiate myself, and touching people still seems kind of weird to me.

I think this may also be why I was unable to really talk to any of my therapists over the years. There is a sort of major blockage that prevents me from verbalizing anything related to feelings (especially negative ones) out loud, ever, to anybody. So, over the years, I decided maybe I should stop seeing therapists. Not really through any fault of their own, as they all had different styles and tried different things, but because I was not able to talk to them (or anyone) about myself. When this goes on, on and on, for 25 years or so, you start to feel like everyone’s time (and a lot of money) is being wasted.

That, and, since childhood, I’ve always had a mental image of myself sort of like some kind of badass gunslinger in an old west movie. I just kind of go around with a pokerface, nothing apparently bothering me, sometimes getting drunk and telling funny stories. There is no room for feelings in my self-image. There was the idea that having feelings was a weakness. Not just expressing them (which is obviously worse than having them), but to have them at all was a shameful thing to never admit to anyone. I never managed to get over that. Sometimes I’ve gotten pretty good at repression, though.

Responding to a post discussing “bipolar myths”

In response to this post:

Myth #1: Mania is the “good part” of bipolar disorder.

I can see why that’s a myth, but sometimes it is. Last August I was fucking elated for about a week for no reason at all. But usually I feel pretty awful, yeah.

Myth #3: Everyone with bipolar is violent.

Word. I am probably the most nonviolent person I have ever met. Toward living things, anyway; I beat the fuck out of inanimate objects sometimes.

Myth #5: People with bipolar disorder cannot maintain healthy relationships.

Some can, some can’t. I think the evidence points toward me being one of the people who aren’t able to, though, but I understand why other people would dislike this idea.

Myth #9: People with bipolar disorder are just being dramatic.

I have been accused of this one pretty much since childhood.

Myth #11: When you start taking medication for bipolar disorder, you’re “cured.”

Hahahaha. No. Meds have never have any positive effect on me.

Myth #12: People with bipolar disorder can’t be successful.

I’m sure plenty of people can, but I am still struggling with attempting to have any sort of success in life, and I am not very hopeful about it.

Why I don’t use trigger warnings

Once upon a time, I was going to college for foreign languages and put in some applications to graduate schools for linguistic anthropology. Language is one of the things I love deeply, and I will defend it no matter how many people think it should be censored. A lot of people don’t seem to have any idea how language even works, how it changes over time, etc.

You get people saying gay people can’t reclaim words like “queer” because of the history, but those same people seem oblivious to the fact that “gay” didn’t even mean “homosexual” until quite recently. Therefore, the meaning and connotation has changed. The same goes for any “reclaiming” of words.

However, the most irritating thing, for me, is when you tell people you’re against censorship and they automatically assume you’re in favor of bigotry and hate speech. That’s not what it means. Hate is what drives hate speech, the words are somewhat less important than the hate. And if you are not hateful, you can use those same words in non-hateful ways. I don’t think censorship is ever the way to go.

But on to trigger warnings. I don’t use them. This doesn’t mean I’m in favor of upsetting people, this means I consider other people to be in control of what they’re doing on the internet. You know what upsets me? The pope. Catholicism. Christianity in general. But I would never, ever, ever expect people to put “trigger warnings” every time they talk about Christianity. Mental illnesses or not (and I consider my overreaction to be mental illness-related), I don’t consider it their responsibility. I’ve also read that the more you avoid “triggers,” the more scary and debilitating they become for you. So I don’t avoid things that upset me greatly; in fact, I often seek them out on purpose. I don’t expect everyone to do that, but I imagine that most blog posts, etc. have titles that tell you what might be in the content, and you can avoid it if you want. I did actually add a paragraph to my sidebar here, simply stating that if you need trigger warnings for any reason, maybe it’s best that you don’t even look at my blog.

I also think the widespread use of trigger warnings minimizes the experiences of people who actually have PTSD (and, with the extent of trigger warnings on the internet, I doubt all of them have it. I think many of them may just not want to think about certain topics). And like I said, I completely lose my mind with rage when people talk about Christianity sometimes. But that reaction is my own, and no one is under any obligation to cater to me and censor their speech or writing about Christianity in front of me. If I expect to interact with people at all, I realize that I need to accept that other people have different beliefs and ideas that I do. Avoiding it just makes the reaction that much stronger. I recall that, after years of not really being around any type of religious people, how shocked I was when a distant relative started calling me “stupid” and “evil” just because I am not a Christian. I was not exposed to that sort of religious-based hatred for a long time, and likewise, I think she surrounds herself with people who think exactly like her and no one ever says anything that might upset another person, so it’s just a big echo chamber and they don’t know how to react to other kinds of people. (It wasn’t so much the name-calling for not being religious that made me rage about her, it was the homophobia and the protesting against gay rights.)

And likewise, I think people would find it fucking absurd if I asked them to use “trigger warnings” when they mention religion, but I’m pretty sure I get as upset at the mention of certain things about religion (esp. Christianity) as they do when people use certain words or discuss other “triggering” topics.

Also, I am unable to write much more than a sentence without including something that’s potentially triggering to somebody, so it’s much easier to just say “don’t ever look at my blog, don’t read anything I write” than to get into the particulars. I can understand the reasons other people do, but I wouldn’t remember when to do so, and would probably need so many I wouldn’t feel like doing it anyway.

All in the brain?

This article criticizes a TV program on mental illness hosted by Stephen Fry for making mental illness seem too physical, too brain-based, too much talk of “chemical imbalances.” It suggests, and rightly so, that many people are influenced by circumstances and trauma. Certainly, circumstances play a role or you wouldn’t have things like PTSD or situational depression.

What I found interesting here, though, was the idea that emphasizing the idea of a chemical imbalance somehow does a disservice to people with mental illnesses. I’m not sure I’ve heard that particular point of view before.

Additionally, I don’t see where he’s coming from by claiming that, just because people mention chemical imbalance, this somehow means conditions occur “out of the blue.” He then mentions genetic vulnerability, which seems likely since conditions often seem to run in families. But that still doesn’t mean they occur out of nowhere or have nothing to do with circumstances.

And again, I can’t comment on the television program because I haven’t seen it. If it shows up on YouTube or streaming services, I may try to watch it at some point in the future, though.

What I mostly found interesting was this fellow’s extreme emphasis on circumstances (“misfortunes,” as he puts it). While I don’t deny they can play a role, it goes against my own experience, I think. I feel like mental illnesses have largely caused my misfortunes in life, rather than misfortunes bringing on mental illnesses.

I also find it a bit baffling that someone would say that emphasizing the role that neurochemistry plays in mental illness would be doing a disservice to people with mental illnesses. I’ve used the diabetes comparison myself (namely, you wouldn’t tell a diabetic to just “be strong” and “deal with it;” you’d realize they have a problem with their pancreas producing insulin and require medication/insulin injections to remain healthy). Likewise, if a person is clinically depressed, it’s possible that no amount of “being strong” or “thinking positive thoughts” is going to fix it if it is a condition in their brain.

Patients’ dissatisfaction with an exclusively medical approach is well founded, because research has shown that this approach has been extraordinarily unsuccessful, despite what clinicians often assert.

I also can’t comment on the state of psychiatric care in Britain since I live in the US, but the quote above sounds like the way people (usually people with no history of mental illness) complain about psychiatric medications being over-prescribed. I’m sure that’s a legitimate problem in some cases, but people seem to extend this idea so far that they think no one is helped by medication, and that becomes a problem.

I saw something elsewhere today talking about how it’s “too easy” to get antidepressants. In the US, anyway, there are 2 problems with this: (1) when a person sees a doctor, they expect them to try to fix the problem, not send them to long-term therapy or to other specialists, except in extreme cases, and (2) some people can’t afford that long-term therapy or more specialists. That doctor appointment may be their only hope of doing anything about the problems they are having, at least in the immediate future. They want to feel like their doctors are doing something for them. It would be great if everyone had more time to spend with medical and mental health professionals for these discussions, but I don’t see it happening in the near future.

The more that ordinary people think of mental illness as a genetically-determined brain condition, and the less they recognise it to be a reaction to misfortune, the more they shun mental health patients.

I just find this bizarre. Why would something having a biological basis contribute to stigma? He even says earlier in the article that it’s a “predisposition,” which means the person isn’t “broken,” they are just predisposed to either having something go wrong with their mental health, or reacting badly to circumstances. But not all mental illness is a “reaction to misfortune,” that is just absurd. I may not be a professor of psychology like the author here, but from my own experience, I don’t feel like my mental illnesses are a “reaction to misfortune.” I feel like my mental illnesses, which I may well have been predisposed to genetically, have caused me misfortune.

It is nice to not look at Facebook much anymore

I still update some pages and the page I made for this blog, but it’s nice to not look at my newsfeed much. For a long time, I was unsure about giving up Facebook because I felt like it was my only window into the rest of humanity, since I don’t talk on telephones, text, or leave the house. It was the only way I communicated with people. But, as stated before, the communication on Facebook was so lacking I figured it didn’t matter much either way, and if Facebook upset me I’d be better off dispensing with human interaction entirely (to the extent that anyone considers using Facebook to be interacting with humans anyway).

It’s nice, though; it is a type of peace and quiet. I remember a cartoon that went around at some point. The first panel was a person saying they wished they could hear other people’s thoughts, and then the second panel was Facebook, and the person then changed their mind about hearing other people’s thoughts. For me, the most irritating part is that Facebook tries to be all things to all people, and then everyone ends up using it for a different purpose. One person blocks anyone who talks about religion and politics, another only uses FB to talk about religion and politics, etc.

Having a blog again is nice because it means that I, too, have to think about what I’m posting and make one or two posts in a day, rather than how things are on Facebook, where it’s fairly normal to post twenty things a day that no one sees or cares about. Better to post one or two things no one reads or cares about here, because at least this space belongs to me. I figure my ego may be too large to post things on Facebook where they’re just going to disappear and no one is going to read them.

This past several months, FB has been disturbing to the point of being nightmarish due to the mania. I feel better already, though. I also have more time to do productive things. The problem before is that, since I work from home, I needed something to do in the downtime so I would end up on Facebook. Now I realize there are probably better ways to spend my time.

Discussion of mental health problems

Regarding the content of this article: http://ideas.ted.com/how-should-we-talk-about-mental-health/:

I’ve been saying that about crime for a long time. While it’s true that some of the mass shootings have been done by people diagnosed with mental illness, the media seems to portray it as if any mentally ill person is going to shoot up the nearest school or theater if you give them enough time. Most people with mental illnesses are never going to go on a shooting rampage, but that doesn’t make a good headline so that is completely ignored. It’s no wonder people don’t want to talk about mental illness if people think that makes them dangerous and violent.

However, I completely disagree with the avoiding words like “crazy” and “psycho.” As with any word, it depends on usage. I agree with the Ruby Wax quote in the article. What matters is the idea being conveyed, not so much the words you use to convey it. If you’re belittling a person for being mentally ill, it doesn’t matter if you use the phrase “mentally ill” or “crazy;” what matters is that you’re being an asshole.

I’ve encountered a lot of people who refuse any sort of help with mental illness because it’s regarded more as a personal failing than a medical issue, and people should just “suck it up” and deal with it. It is not considered the same at all. If you have high blood pressure, you’re not considered a weak person for taking HBP medication; you’re considered to be a person taking care of their health. Not so with mental illnesses; if you take medications you’re considered to be “running away from your problems” or thinking that “popping pills can fix everything.” If you’re less depressed on your anti-depressants, then your happiness is false and not valid, also.

When I was young, my parents never told anyone that I was seeing therapists, had been hospitalized for mental illness, or was taking psychiatric medication because of the stigma. My mom even shushed me once as an adult because I said I’d been to the therapist earlier that day before going out for dinner with relatives. Apparently seeing a therapist is something so shameful you don’t talk about it. You’re supposed to lie and say you were seeing the optometrist or something. It is regarded as a personal failure and not a “real” health problem.

And this is why I think people need to talk about it more. The more people are exposed to the idea that “crazy people” aren’t necessarily going to kill them, the less stigma there will be. Another thing I’ve encountered with bipolar disorder is that people seem to say it’s somehow wrong for me to show emotions because they are used to me being in a depressed state, where I am very stoic and Vulcan-like, and they seem to try to discourage me from talking at all because this apparently makes them uncomfortable or clashes with their idea of what kind of a person I am. But again, that’s why I turn to blogging: it’s a monologue. I am able to express myself as long as there isn’t anyone else around to act like I’m making them uncomfortable or like they just wish I would shut up. I am not good at talking to people face to face.

Medications and suicidal thoughts

My dermatologist has increased my mycophenolate, will need more bloodtests to make sure that isn’t killing me. They don’t want to change the prednisone yet because they don’t want me to end up in the hospital. That’s all well and good except being on this high a dose of prednisone makes me want to die about 8 hours a day. The rest of the hours I mostly stare into space. I have found myself in a sort of shitty situation where I will die without the medications, but the medications make me want to die.

The pope is at it again

pope
I’ve been through this shit before, but once again with the “no true Scotsman” fallacy: the PR Pope’s latest soundbyte is that Donald Trump isn’t a Christian. I disagree because I define “christian” as “follower of Christianity,” not “nice person” or “person I like that I want to be associated with.” Adolf Hitler was a Christian. So was Fred Phelps. So is Donald Trump, if he claims he is. Because if you don’t acknowledge that, then you’re saying you can void anyone’s religious affiliation just because you don’t like them as a person or you don’t like their actions/words. This is bullshit also because all religious people cherry pick their texts. You can’t do otherwise, because the texts contradict themselves. Otherwise the definition of “Christian” depends on the speaker. If it’s a Protestant, then it doesn’t include Catholics, and so on. As a non-Christian, I see no alternative to defining “Christian” as [self-identified] follower of Christianity, and I find it absurd that anyone could even disagree with that.
popecrush
At some point last fall, I had to unfollow several Facebook pages because they did nothing but post about the pope, and I had developed a massive psychotic hatred of both him and the Catholic Church. Not like a normal, rational hatred of the pope, but I mean I lost my fucking mind if I saw a photo of him on my newsfeed. I nearly left Facebook because I couldn’t avoid all the pope-fellating and it was bad for my blood pressure. This rarely happens, getting angry over something like this, but when it does happen, it’s always something to do with religion.

Edited to add that I just saw another meme, this time saying something about people “realizing that a socialist Jew is the most Christian candidate” running for president. There is so much wrong with this. For the last time, “Christian” doesn’t mean “good person;” it means “follower of Christianity.” Bernie Sanders is Jewish, and regardless of how religious he is or is not, he certainly is not a follower of Christianity or a member of the Christian religion. What a shitty thing to say, as if a Jewish person can’t be a good person unless someone erroneously calls them a Christian to elevate them from their Jewishness.