Treatment Plan

There are many different ways to approach treating Bipolar Disorder depending on preference and effectiveness.  My own treatment plan has been working reasonably well, and I think long term is going to be very helpful in managing my own illness.   Not uncommon, I have a two pronged approach that addresses the full spectrum of this condition. 

 Chemical:  For me, it is crucial to use medications to help control the underlying causes and symptoms.  Initially I had good success with the med management.  At the time of my official diagnosis I was having a manic episode and my Dr. started me off on Lamictal, Seroquel, and Depakote.  Of course the Lamictal has to be increased slowly, but as soon as I reached therapeutic levels the mania had stabilized.  After a while I started having some pretty disruptive side effects from the Depakote (Blurred Vision) and had to discontinue.  By that time however I was fairly stable and it didn’t seem to have an impact.  Then my insurance changed, and Seroquel was no longer covered and I had to make a change.  I started taking   Perphenazine, and it seemed to work well to maintain my swings.  I had been unemployed for about eight months during this time, but finally found a job in February.  That’s when I realized that the Perphenazine was sedating and I was having a difficult time staying focused at my new job.  We went through a couple of different options in the same family of Perphenazine, but the sedation remained a problem.  About a month ago I switched to Risperidone.  I seem to be tolerating it well, but don’t believe I’ve reached therapeutic levels yet as the mania has returned. I’m confident however that with the right combination of meds this illness should be completely manageable

Therapy:  Just as important as the chemical approach is having a good therapist.   Of course my issues didn’t start with my diagnosis, and I have spent years in therapy with a number of different therapists.  There are many different types of therapy; from biogenic feedback to cognitive behavior therapy, Gestalt therapy and so forth.  The list goes on and on.  For me I’ve found that the analytical method works the best with my self awareness and experience.  My therapist now is awesome.    During our sessions she will mostly listen, only asking a few questions that help focus on a particular area or subject.  In many cases I come to my own realizations rather than relying on her insight.  Other times she will support our conversations and my own experiences with clinical reasoning.  For example, in a recent session I was telling her how I seemed to have difficulty tolerating all medications such as antibiotics.  I’ve been told all my life that I was highly allergic to penicillin based on a reaction I had when I had my tonsils removed at 18 months.  She had an ‘Ah Ha’ moment and explained that 18 months is the most critical time in personality development, and the separation from my mother, even though it was only a few days was a very tramatic event and has a lot to do with who I am today.   In the early school years I was also diagnosed as hyperactive (ADD hadn’t been defined yet) and spent years on Ritalin.  And apparently, according to her it’s very common that people with Bipolar Disorder are very frequently diagnosed as hyperactive.  It’s suspected that the diagnosis, usually made by a pediatrician, is not always accurate.  As most people suffering from Bipolar Disorder tend to be highly intelligent and creative, they tend to be very bored in the traditional classroom setting, and don’t perform well and are easily distracted.  I tend to agree with this as an adult I have no symptoms of ADD at all, instead have an almost laser like focus on whatever the task at hand.  Being treated as a child however impacts the developmental progress as it sets you apart as damaged and different.   

Other times I’m convinced that my therapist is clairvoyant.    Out of nowhere she reveals things that I didn’t even know about myself.  But once I have time to really consider it, she’s always been spot on.  It’s almost scary how good she is with this.  Like I said… she’s awesome, and a perfect fit for my particular circumstances and needs. 

Bipolar Disorder is incurable, and can be extremely difficult to control and maintain.  For me it takes a coordinated attack on both the physical and emotional causes and influences.  It is always a work in progress as circumstances change, life events happen, moods swing and even as the body ages. Needless to say, this approach isn’t always successful, and constantly needs monitoring and adjustments as things change.  And this plan won’t work for everyone.   We’re all different with needs and how we respond to the various treatments.  The main thing is, have a plan.  Be flexible and expect changes, but stick with it.  And remember, when it comes to health care providers, we are the consumers.  If the provider doesn’t fit you have the right and responsibility to change.  We all have a large degree of responsibility and diligence to ensure we can manage this to the best of our ability.

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