Thank you for the added information. It helps a lot. I believe I can now be of help with this issue.
I can imagine how overwhelming, distressing, and frustrating this situation must be for you. You are clearly having a hard time finding the right combination for stability and functionality for your son.
And this is actually the key to my answer to you that you need to consider and think about. He is exhibiting signs of schizophrenia more than Bipolar Disorder (BD) based on what you're telling me. And his reaction to meds seem more in terms of schizophrenia as well as the doctor's attempts at correcting the meds. I don't know if it makes a big difference at this point as the meds are very similar. ECEPT when you get to adverse reactions and lack of stability and you start having to mix and match the meds. That's when it gets to be a question of what the focus is going to be.
I want to share with you my honest impression: I think you need to get more professionals involved. I am not trying to cast doubts on his psychiatrist. But this is a very difficult and atypical case of BD. My sincere recommendation?
If this were my relative, and given that I believe in "team" work for complicated case and I do work on teams with schizophrenic cases that are complex, I would urge you to find who in your area is renowned as expert in working with BD and schizophrenia and contact them for an evaluation. This might be someone in a different city in a big university hospital. The key will be to present this to the psychiatrist. If he can get on board with the team approach, that you're looking for a consultation, then he might even be able to make the referral. Otherwise, you're going to have to be proactive in searching this expert out.
I would also look for the psychologist in the area who is considered most expert in working with BD. Which gets me to the behavioral part here. It is hard to think of behavioral interventions because the meds are so integral right now in trying to stabilize him and determining if they're part of the problem or not. But I am working right now with a schizophrenia patient who's having that problem as well. And the behavioral work we're doing is helping him a lot with his anxiety, attitude, and motivation. So let me put in my ideas on that for you here. Okay?
I'll address it to him because he may benefit. Here goes:
On the one hand Bipolar Disorder (BD) depends on managing your moods and being stable. You are having a hard time getting just the right combination of meds. Okay. We'll have to work within those parameters. Most people with BD rely on meds to manage their moods. We however need to use a more comprehensive management strategy because the meds aren't working smoothly yet for you. But you should know, the management strategy I'm going to talk about is one that I use in treatment not just when meds are inappropriate. Meds are not enough for many people with BD to keep stable. There has to be a manual management strategy in place. Also, at the end I'm going to paste in a technique for you to use to help you bring down the anxiety when it's present. It's not a cure, just a technique you can use throughout the day that is very helpful.
In my practice, I use the management resources with people with BD from Mary Ellen Copeland. I have found her work easy for people to use and easy to keep with him . The biggest problem is forgetting to keep to the plan when times are good and then something happens! Copeland also had BD and was hospitalized. She's a therapist and developed a BD treatment protocol called Wellness Recovery Action Plan (WRAP). First let me cite one of her books for you.
The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland. Amazon: http://www.amazon.com/Depression-Workbook-Guide-Living-Second/dp/157224268X/ref=sr_1_1?ie=UTF8&s=books&qid=1284317815&sr=8-1-catcorr
Now here's a YouTube search I've put together on the WRAP program. I want you to look at the videos and see what you think:
The video with Mary Ellen is a bit strong but worthwhile. Okay, so you see I hope my point here:
I believe from my experience that it is SO important for you to not just take the meds and expect them to do everything. YOU have to take charge of managing every and any aspect of your BD that you can. And having a strategy like the WRAP program is a coherent way to do this. So that you can regulate your moods as they cycle. Here's what I mean:
Most people are like cars with automatic transmission. They tool around the day going from a little sad and then they feel a little glad and if they get to too high a gear, the emotional transmission just automatically sends them back to a lower gear and if the low gets too low, the transmission clicks into a higher gear. Rarely are they thinking about it. They are usually within their normal range.
You with BD are like a car with a manual transmission. You start having a racing mood and unless you downshift manually, you're going to be out of control soon until you can't maintain that and you cycle down and then get too far down, etc. So you have to continually use the clutch and manually adjust the emotional gear.
That's what a program like the WRAP plan is about. It gives you the tools to notice what's going on and to make adjustments. So that is why I'm stressing it for you.
I wish you and your son the very best!
Now, I want to give you a tool to use for when the depression is overwhelming or there is anxiety. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.
I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.
So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?
- After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
- Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
- Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
- Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
- Continue down your body, repeating the procedure with the following muscle groups:
- entire right arm
- right forearm and hand (making a fist)
- right hand
- entire left arm
- left forearm and hand (again, making a fist)
- left hand
- entire right leg
- lower right leg and foot
- right foot
- entire left leg
- lower left leg and foot
- left foot
- for the shortened version, which includes just four main muscle groups:
- neck, shoulders and arms
- abdomen and chest
- buttocks, legs and feet
Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.
What You Need:
- A comfortable place.
- Some privacy.
- A few minutes.