Generalized Anxiety Disorder: The Merry-Go-Round from Hell

I know I’ve written about living with anxiety on a few occasions since this blog’s inception. I’ve talked about how the Fall often brings panic attacks and paranoia that makes leaving the house almost impossible. I’ve talked about what it’s like battling depression and anxiety. So while you may be tired of hearing about anxiety, I’m not done writing about it yet. Especially after having all the feels while watching this incredible video.

You may be thinking, but Marisa, you have bipolar disorder how is it possible that you also suffer from anxiety? Are you really that unlucky? Well, yes, yes I am. But it’s not just me.

People who have bipolar disorder often have comorbid conditions or what is often referred to as comorbidity. In the National Comorbidity Survey, 95% of the respondents with bipolar disorder met criteria for 3 or more lifetime psychiatric disorders. But what does this mean? Comorbidity is just a fancy way of saying that a person has a secondary or tertiary diagnosis that exists in tandem with the primary diagnosis.

In my case, the secondary diagnosis is Generalized Anxiety Disorder (GAD). However, a person with bipolar disorder could have any number of other diagnoses like, issues with addiction, ADD/ADHD, or a personality disorder.

The thing about having an anxiety disorder is that they also don’t come in a one sized fits all diagnosis either. Anxiety disorders run the gamut from phobias to panic disorders to social anxiety. Until the recent reorganization of disorders in the 5th iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), even obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) were categorized under the anxiety disorder banner.

The issue with having Generalized Anxiety Disorder (GAD) is that unlike a phobia or social anxiety, there is no physical manifestation of a threat. For example, if you have a phobia of snakes and you see a snake you know you’re going to be running for the hills. If you have social anxiety and you’re afraid of crowds, you know that a party where you know no one will set off your anxiety.

GAD is a little bit more slippery.  The Canadian Mental Health Association explains that GAD “is excessive worry around a number of everyday problems…” There’s no specific threat that activates this “excessive worry[ing].” It could be anything that sets your brain spinning into what I call, the spiral of doom. Your thoughts jump from one catastrophic conclusion to the next and this spiral makes you agitated, irritated, and often, depressed. Once it starts, it’s like a merry-go-round from hell. Once you get on you’ll never get off (insert evil laugh here).

And the thing is, unlike having bipolar disorder, I’ve been this way my ENTIRE FUCKING LIFE. When I was a kid, maybe around 7 or 8, I learned in science class that one day the Sun would simply burn out and die. The teacher went on to explain that this would mean that life on Earth would also be over. I’m sure she clearly stated that it wouldn’t happen in my lifetime or my children’s children’s lifetime. But it didn’t matter.

I was freaked the fuck out. I remember staring up at my ceiling at night, trying to fall asleep, and being terrified that tonight would be the night that Sun would just shrivel up and die.

My brain would cycle through all the catastrophic scenarios of what might happen once the Sun was dead. Would I die instantly or would there be some kind of wait? Like, would I know that I was dying because that seemed infinitely worse. Would there be some kind of explosion? Would gravity suddenly not exist and our bodies would all float up into space and I’d choke to death because, lack of oxygen people!

And this wasn’t the only irrational fear that I had as a child. I was also terrified of falling asleep because I was convinced that I wouldn’t wake up. Now, I don’t know if being obsessed with death as a child is a normal thing (I don’t have kids, I don’t know these things). But, thinking back on it, it seems pretty fucking dark to me. I’d try as hard as I could to imagine not existing and as soon as I felt on the cusp of knowing what that would feel like, it would slip through my fingers like water. What would it be like to be dead? Could I watch over my parents as they mourned my dead body? Or was it just like, one day I’m here and the next I’m not? This would roll into the inevitable question of: what if my parents died before I did?

And the thing is, these types of irrational worries have never left me. Like, take my phone ringing as an example. This is literally the most terrifying thing in the world, especially if it shows up as “Unknown Caller.” Often I just let it go to voicemail and procrastinate picking up my messages until I can psych myself up. Once I pick up the message, I probably spend another hour or so formulating a script in my head for when I call you back. Why can’t people just communicate over e-mails and texts? Texts are great, well until those damn ellipses appear when the other person is typing…

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But this excessive worrying takes a toll on my health. As a kid I would continually complain about stomach aches that I still have to this day. If I even say to my mom, my stomach hurts, she instantly asks: “What are you worrying about?” My whole body feels like it’s constantly tight as a spring ready to explode out of my chest. I am probably the jumpiest person you’ll ever meet. My airways almost always feel tight, like I can never quite catch my breath. A woman I used to share an office with asked why I sighed all the time, it’s because I literally forget to fucking breathe people! I wring my hands like an old lady. I turn my wedding band over and over and over again until I leave a red mark underneath. My knees bounce and I don’t even know that I’m doing it until someone tells me to stop.

And by the end of the day, I’m so exhausted by this constant worrying about EVERY LITTLE DAMN THING that I’m too exhausted to do anything but collapse into bed. Every day of my life is like this. Some days are worse, some are better, but it never goes away. And I’m not sure it ever will.

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New Year’s Resolutions, Meds, and Weight Loss

Okay my mad lovelies, I’ve been gone for a while and for that I’m truly sorry. I really had to recuperate after the holidays, which passed in a blur of travel, food, and family. It was fun and all, but really fucking stressful. Every year I resolve to do Christmas differently, and every year I sort of repeat the same mistakes over and over again.

Regardless, I’m back and this post is a little late but as they say: better late than never. I’m talking about New Year’s resolutions this week.

I know, I know, we’re not supposed to make these pesky things anymore. And we’re especially not supposed to make ones about weight loss. It’s cliched. It’s overdone. It’s plain dumb. Right?

Well fuck that.

I made a New Year’s resolution to lose weight.

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Me in 2006 and 30 pounds ago.

I’ve sort of talked about my weight in an off hand way, but I’m going to get to real talk now. Since I began taking Seroquel over 8 years ago, I have gained about 30 pounds. That’s almost 4 pounds a year. Now, unlike some meds that cause the extra pounds to literally show up over night (I’m looking at you Zyprexa) my weight gain sort of creeped up slowly, year after year. But it’s not just about weight. I was officially diagnosed with an under active thyroid this year because of Seroquel (add another medication to the list). The drug is also to blame for my bad cholesterol levels rising (another side effect).

The first ten pounds happened after my first hospitalization and when I started taking 150 mg of Seroquel. Ten pounds go by practically unnoticed. Sure my jeans were a little snug, but I was generally the same shape as I always had been.

The next ten pounds came on after my Seroquel was increased to 300 mg, post another two week hospitalization, and a three month in-patient treatment program.

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Me in 2010 on my wedding day and 30 pounds heavier.

Somewhere between finishing my MA, deciding not to do my PhD, getting married, and working in the restaurant industry I gained another ten pounds. I have now stayed at this weight, more or less, for the past 6 years. But I can guarantee you if my Seroquel was increased again I would gain at least another ten pounds. (And as an FYI: I’m not calling myself fat. I’m not. I’m just heavier than I used to be).

I know as a feminist I should be saying I love myself, including my cellulite, because body positivity. I should be shouting riots, not diets in the street. I should be telling the diet industry that they can go fuck themselves (and they can).

But the reality is, I’m uncomfortable in my skin.

My brand of feminism believes that you should be comfortable in your skin and if you’re not, make a change. And I’m not just talking about your body. If you don’t like your job, your partner, your friends, make a fucking change. Don’t sit around crying about it. That’s not productive. Life is too short to feel stuck.

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Um, that doesn’t look gluten free or organic Gisele. 

I’m not losing weight because I want to look like Gisele Bundchen (her diet is scary folks!) because it’s her job to look like that. I’m not doing it because a relative mistakenly thought I was pregnant (they were old, they get a pass). I’m not doing it because Oprah is selling me my “best body” this year (because, fuck the diet industry).

I’m doing it because I want to do it and if you don’t want to do it, that’s cool.

Just don’t judge me.

Now let’s come back to the New Year’s resolution bit. It’s not like I had some epiphany on January 1st. I’ve been looking at myself for a while now wondering how I got here. Maybe it was the whole turning thirty thing. I don’t know. Making a New Year’s resolution to eat better and work out more just made sense.

It also made sense because as of January 1st I officially started coming off of Seroquel. I was complaining about the weight gain and my thyroid issue to my psychiatrist and she said: “Well, clearly you don’t tolerate Seroquel well. Why are you still on it? It’s not helping your mood.”

Because no one ever gave me a fucking choice.

It was Seroquel or bust. Deal with the weight gain because it moderately helps your mood. She didn’t buy into that logic.

Instead she said: “If you’re uncomfortable with your weight, that’s not good for your mood. It’s not about vanity, but about your mental health.”

(Side bar: I’m not condoning coming off of Seroquel because you feel like you ate too many cookies over Christmas. I had already begun a new regimen of medication — Saphris and Lamictal — before even considering stopping my medication. And even after agreeing with my psychiatrist to stop Seroquel, we are SLOWLY weening me off of it and btw the side effects are BRUTAL but that’s another post).

And so now, it’s the second week of January and I’m down 3 pounds. And yeah, I know that coming off of Seroquel won’t be the magic cure all to my weight problems. Like I said, I’m watching what I eat and hitting the gym, but I can do that. I can control those things. What I can’t control is how my body reacts to medication and it took a good doctor to point that out to me.

Finding balance with Bipolar Disorder

Embracing balance, I think, is a difficult task for most people. We’re bombarded by messages about living a healthy and balanced lifestyle. We need to eat well, sleep well, and exercise often. We need to find a work-life balance. However, for those of us with a mental illness, particularly bipolar disorder, finding balance can take a herculean effort.

The highs and lows of our illness naturally destabilize us. The highs are glorious, colourful, exciting, and adventurous while the lows are debilitating, painful, sad, and disastrous. We want the highs to go on forever and the lows to never show up. So asking us to embrace a balanced lifestyle is akin to asking us to forfeit the natural pull of our biology. Except, it’s something we, as bipolar sufferers, must learn to accept – even if it’s begrudgingly – if we ever intend on being well for an extended period of time.

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I don’t know if it’s the bipolar disorder, my brain, personality, or a combination of the three but I need to learn things the hard way. I’m stubborn as hell and I hate having to recognize my own weakness. I know that I have a disease that makes me tip one way or the other, but when it comes time to confront my own limitations it suddenly becomes a tug of war between my ego and doing what’s healthy.

Last week was an excellent example of this. I had a busy week. Or, for the non-working me, what constitutes a busy week. I had two therapy groups to attend, a private therapy session, an interview to prepare for, taping the interview, and I was hosting dinner guests. On top of this was the usual pre-Christmas stress. You may say to yourself:

“Marisa, this isn’t busy. This is an average week for most people. And you don’t even have a 40-hour work-week in there.”

And I know this.

Therein lies my struggle.

thatdbegreatIt isn’t particularly busy. It isn’t particularly stressful. But it still sent bipolar me spinning almost catastrophically into a hypomanic phase. For most of the week my brain was working at warp speed. My body was filled with excess anxious energy. I tried to write lists to divide each day into a manageable to-do list, but this didn’t stop the racing thoughts that had me thinking that I had to be everywhere and do everything all at once. And it wasn’t until Wednesday, when I arrived in my bipolar group completely worked up, that I told myself that I had to change.

I had to change the way I was behaving or hypomania would be my end result.

Normally, I would keep pushing myself until I sent myself into a full-on tail spin. I would fight my ego and that voice in my head saying: “You’re not even that busy. Normal people can handle this therefore, you can handle this.”

But I’m not normal. And I don’t necessarily mean that in a pejorative sense. I simply mean that I have this disease that makes me different than those without it. My ability to cope with stress is less than someone who doesn’t have bipolar disorder. End of story.

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So, I could have let myself spiral into hypomania. I mean, it would have been easy. That week would been filled with anxiety, productivity, and racing thoughts. I might have even enjoyed a rush of exhilaration. But the reality is, I’m also enjoying feeling well. I’m enjoying re-entering into my life. If I let my hypomania come to visit, I would inevitably have to deal with hypomania’s annoying and messy roommate, depression, who always overstays his welcome.

Instead I fought every fibre of my being and decided that I would stop everything on Wednesday. I took an extra 50 mgs of Seroquel (my calm-the-fuck down pills), laid on the sofa, and watched TV. Now, this didn’t stop the voice in my head from telling me that I needed to keep moving, but forcing myself to stop for a few hours allowed me time to recalibrate. It allowed me to tape my interview on Thursday without my words tumbling out in an incomprehensible torrent. It allowed me to take perspective on which tasks actually needed to be accomplished, which I could put off, and which I needed help with. And just like that, my hypomania turned around and went home.

Catching myself early and recognizing what I needed (and actually doing it) was a great triumph. It made me realize how much control I can have over this seemingly uncontrollable illness. And suddenly balance doesn’t seem like such a bad word. Maybe balance can be a good thing.

When mental illness turns physical

When fighting a mental illness, sometimes it’s not all just in your head but it turns physical as well. This is especially true when dealing with medication changes.

My mood has been stable for about two weeks (yay!) and I have started taking Lamictal, an anti-epileptic drug used to treat bipolar disorder. Starting Lamictal is a slow process due to the risk of a life threatening rash. It’s extremely rare, but still psychiatrists start the drug slowly. Increasing it every two weeks until optimal levels are reached.

One does not simplyHowever, while still getting used to the Lamictal in my system I am also starting to reduce the Zoloft and Seroquel that I’m taking. I hadn’t realized the dependence I had on these drugs until I started reducing them. Drugs that alter the chemical composition of your brain are also highly addictive. And because of this, the slightest reduction in dosage cause extreme physical side effects.

In an attempt to quicken the pace of my medication changes, I agreed to lowering Zoloft and Seroquel at the same time. I’m hoping to return to work at some point in the New Year, but before I can do that, I need to have my medication squared away.

After lowering the dose of both medications, I anticipated a temporary mood change. I anticipated anxiety. I anticipated not being able to sleep well. However, what I didn’t anticipate was the physical toll reducing the medication would have on me.

3105644On Friday, I could barely move because my joints were throbbing and my whole body felt achy. It was all I could do to find a comfortable spot on the couch. My entire body felt like it was being tortured. Yesterday the vertigo started. Every time I stood up, I had to steady myself as the world started to spin. Couple that with extreme fatigue and finding the motivation to do anything was difficult. Even writing this post is hard. My cognitive abilities are diminished. I have to coax out my words from hiding and try to string them together in some coherent sentence.

The positive side of this is that my mood has remained fairly stable throughout this process. And ultimately, that’s what I’m aiming for: stability. Since these past few weeks have been good for me, I have started entertaining the thought of returning to work. It no longer seems like a terrifying prospect. Instead, it’s a goal I’m actively working towards. I want to get my life back to normal and part of that normal is working. When you start to feel well, those really bad weeks or months seem so far away that you start to wonder if they were even real. Was I simply just blowing everything out of proportion? Who was that person who was so depressed? Why am I off of work if I’m doing well?

And then, you do something as small as making medication changes and you suddenly realize why you’re not working. I would not have been able to work with all of these physical side effects happening. I would have been useless to my employer.

It’s not easy fighting a mental illness, but I’m getting there.

You can read more about reducing Zoloft here and Seroquel here.