My Bipolar Story: The Crack in the Wall

A personal story about life with bipolar disorder. Well, not only about bipolar disorder, but the twists and turns life can take.

This is a story I never thought that I would write; now I might be the only one that ever reads this, but if I'm not, then I hope that all those who read the story, will read it with an open mind. I hope that this story will finally ease the hurt, torment and despair that I have ever felt. This is not a story of malice, nor is it meant to hurt anybody; it's purely a reflection of my life the way that I've lived it, my innermost thoughts and feelings. I hope that through this story, I and everyone else will be able to understand ME better. My wish is that any resentment that anyone feels towards me, because of the things I have done, will be eased once this story is read.

This is written by me, about me, and for me. For the first time in my life, I'm going to be selfish, and yes maybe a bit ruthless. I have to be because if I don't do this now I never will, and it will be an additional regret in my life. I have omitted to use any surnames, as there are certain individuals who would not like to be known to others.

When I wrote this, I believed that I was writing the story just for myself, as a kind of self-healing, but I have since come to realize that although I accomplished the self-healing, I also hurt some members of my family. I am normally a very honest person and when I wrote my story the first time, I was writing it with so much anger inside of me. It has taken a lot of soul-searching to realize that one year ago I was really looking for retribution of some sort. I was still in the process of feeling very sorry for myself. It fed my EGO when people said, "how on earth did you get through all that," or "you are quite remarkable for all that you've been through." I understand now that the emotional pain I experienced was not unique in any way, and I'm sure that many people have gone through similar experiences. It has taken thirty-five years for me to be able to say that I can recall my memories without feeling as though my heart was being wrenched from my body. I have used the obstacles in my life as stepping-stones on my path to inner peace. As Shakespeare said, "There is nothing either good or bad, but thinking it makes it so."

PART ONE

I hope that this bipolar story will finally ease the hurt, torment and despair that I have ever felt. The story of a bipolar person.I was born on 24 September 1958. I never knew my birth father, as I believe that he was a very abusive man, so my mother had no choice but to leave him. When I was about three years old, my mother Nita married Barry who later adopted me. My sister Louise, who is eight years older than I am, came to live with us. We were the average middle-class family. These three people where everything to me. I loved each and every one of them with all my heart. I couldn't bear it when there was any kind of disharmony in our home; I always thought that one of them would leave me and never return. This type of insecurity stayed with me for many, many years.

I used to feel physically ill if there were any sort of disagreements in our family. I was a terribly shy, unconfident child. When I was 7 years old, I was sent to ballet and modern dance lessons. My mother thought that this would help me to gain more confidence in myself. Fortunately, I had a natural talent for dancing so I excelled at it. I became a very good dancer. It was silently understood that I would make dancing my career. I know that my mom and dad hoped that I would go and join The Royal Ballet Co. in London. Had I been 'smart' that is exactly what I should have done. I was very strong-willed and I always thought that I knew better than anyone else did. That was to be my downfall. Although, through my years of experience I realize that life seems to be made up of 'I should have' or 'if only' and really, at the time that I made my choices I probably 'would have' done exactly the same things.

From a very young girl, my sister was my confidant and I her's. We would tell each other everything. So, I guess in a way, I was quite mature in the way that I thought about life. My parents were strict on me, but as long as I was with Louise when we went out, then everything was okay. Our family was very close and we had a lot of good times together. In some ways, I was spoiled by my parents, my sister, grandparents, and other relatives. I was Marléne the dancer with a bright future ahead of me. I was the one person in the family that was going to 'become someone'. I know that my mother wanted me to have everything she didn't have. She wanted me to have a career. She was being a normal parent. She went without so much just so that I could go to dancing. She made all of my dancing costumes, and they were always the most beautiful costumes. She would sew day and night, often having to unpick and sew again. I never realized how much effort she put into my costumes and she was self-taught.

My teenage years fell in the midst of the Hippie era, 'peace brother' and all that nonsense. Most of my friends smoked pot and took other drugs, but I could see what it was doing to them and I decided for myself that the drug scene was definitely not for me. It must have been a very challenging time for parents in that period. My parents became very strict with me at that time. I wasn't allowed to go to discos or anything like that. I know they were trying to protect me, but when you are thirteen or fourteen it means a great deal to be able to do whatever your friends are doing. I so wanted to be able to go to the places that my friends went to, but my parents felt that I would succumb to the wicked deeds that were going on all around us. I never felt the need to take drugs or smoke cigarettes so I couldn't understand why they wouldn't trust me. At the same time, their other worry was that I would become pregnant, so I was repeatedly lectured about sex. I was told, 'never let a boy have his way with you' because then I would be labeled as 'cheap' or 'easy' and then I would never find a good husband. I suppose it didn't help matters that I was quite pretty and had a good figure. Well, we all managed to survive that period of our lives and I think that my parents were very grateful that I remained drug free with my virginity still intact.

Towards the middle of 1973, my family started to fall apart. I don't know what went wrong between my mom and dad. They started having lots of arguments and there was always tension in the air. I spent a lot of time crying and worrying that they were going to get divorced. I also spent a great deal of time at my sister's home. Louise and her husband lived just around the corner from us. When the tension got too bad at home, I would go there for some peace and a good talk. One evening, my parents had a terrible argument and I was called into their bedroom and told that my father wasn't actually my father and that he had adopted me when I was three years old. I was devastated. I couldn't believe what I was hearing. I remember I just ran out of the flat and went to my friend's place. I felt as though my whole life had been a lie. Everyone knew that Barry adopted me, and I never knew it. It had never crossed my mind. I thought of Barry as my 'real' dad. No one had ever given me any reason to think otherwise. What on earth was I supposed to do with this knowledge? I mean did he just stop being my dad. Then when they decided to be friends, would he be my dad again? This was extremely traumatic for me. I didn't know what to think. However, life goes on, my parents seemed to resolve their differences and everything went back to 'normal'. The subject of me being adopted never came up again. I felt that maybe I had dreamed up the whole thing.

In 1973, I did particularly well in my dancing and it reinforced my parents' belief that I should take my dancing to a further level. My dancing career was discussed at length and my parents decided that when I finished school at the end of 1974, I would be allowed to go and join one of the dance companies in London. This would've have been a wonderful opportunity for me. I had so much to look forward too. Every one would be proud of me and I would've fulfilled every ones' dreams. However, life doesn't always go the way we plan it to go.

I turned 15 in September 1973, my sister was expecting her first baby, and I had found out that I was adopted. Wow! What a year! Now turning 15 might not seem like much of a milestone, but it was for me, because that's the year my whole life changed. Oh boy! Did it change?


PART TWO

My nephew Zane was born on the 16th October 1973 and about a week later, I met David.

It was a Sunday. I had been to the beach with friends. When I got home, my parents were out, so I put on some music. I then went and gazed out of the window. Something caught my eye. I looked up and there was this guy staring at me from a flat across the road. After awhile of staring at each other, it became clear to me that he was enjoying the music I was playing. The music was rather loud! He asked if he could come over to visit me and I said no I would rather meet him downstairs. [My parents would've freaked out if they had come home and there was a strange guy in the flat] We spent the next hour or so talking to each other. When my parents came home, we told them that we had met each other at the beach and guess what? He just happens to live across the road. What a coincidence [the lies young people tell]! Anyway, my parents were fine about the whole thing and David was allowed to visit.

I couldn't believe it when David told me that, for a few weeks, he had been watching me but he didn't know how to approach me because I seemed so unapproachable. I thought to myself 'what on earth is this guy talking about.' I mean hell! This was me, plain little me. This guy could've had anyone he wanted. What on earth did he see in me? It was like a dream come true for me when, two days later, he asked me to be his girlfriend. It was hard for me to grasp that someone could feel so strongly about me in such a short time. I can remember the night after we met, we were walking to my front door and he was rubbing his hands together, so I asked him if he was cold or something and he said 'no, I'm just so happy to be with you.'

David was my first boyfriend and from the word go I loved him. Besides being a good-looking guy he was also a very kind and gentle natured person. He treated me as though I was the most important person in the world. I had never had this kind of treatment from any other person before, so as you can imagine it developed into a very intense, passionate affair, and when the girl is 15 and the boy is 19 there are definitely raging hormones. David and I would talk for hours and then there other times we would just be quiet and listen to music. Just as long as we were together, we were happy. I know that we cannot ever turn the clock back in time, but yes, I do wish I had been a bit more sensible. I wish that I could've believed that what we had was good and could have lasted. David was prepared to wait for me to finish school before we became physically involved, but I was such an insecure young girl and I thought that by taking things into my own hands I could make everything right. How wrong I was!

I desperately wanted to become pregnant. I wanted to live my whole life with David and I was prepared to go to any lengths to achieve that. I believed that if I was pregnant then no one could keep us apart. My parents would have to agree to us getting married. I firmly believed that I had everything sorted out. Well my wish was granted. I'm reminded of the saying; be careful what you wish for, it just might come true!

At the end of January 1974, we found out that I was pregnant. David had just turned twenty and I was still fifteen! As you can imagine, all hell broke loose. All my parents' dreams that they had for me, had in an instant been shattered. This was something that happened to other families, not ours. Even in 1974, this was any families' worst nightmare.

Once all the name calling and death threats had been handed out, our parents decided that they would give their consent for us to get married. Although my parents signed the papers, they would have absolutely nothing to do with David. They wouldn't allow him to visit me at home. I had to meet him downstairs. It was terrible. We spent a lot of time sitting in the park or visiting my sister. We were due to get married on Saturday 6th March 1974. About two weeks before we were due to get married, we rented a flat so that we would have somewhere to stay after the wedding. We used to go and sit in that empty flat and talk. We both hoped that my family, especially, would settle down and accept us.

On the Sunday before we were supposed to have been married, David took me home. When we got home, my father asked David to come inside. Well! David and I looked at each other as if to say 'at last they must be coming around'. What a shock awaited us. They never invited David in to be nice. They invited him in to tell him that he must get out of my life. He was never to come within a hundred yards of me. They didn't want him to try and contact me in anyway; if he did they would have him arrested. They had laid a charge of 'statutory rape' against him. David had to pay me money each month for what they called 'damages'. I felt as though my heart had been ripped out of my chest. The next day my parents decided to add salt to the wound. My father made me get out all the photos, records and anything else that David had given me. While my dad sat there, I had to tear up all my photos, and then he broke all the records, then I had to go and throw all of it into the rubbish bins downstairs. I wasn't allowed to throw anything away in our bin, just in case I tried to salvage something. I'm sure my parents thought that if I got rid of all the things that reminded me of David, then I would be fine. I would just get over it. Out of sight, out of mind was the motto of the day.

They tried to get me to go and have an abortion, but I flatly refused. Then they went to the welfare to find out how to go about having their daughters' baby adopted. They were told that the only person who could sign the papers would be me. But! [don't get excited], because in the very next breath they went on to tell me all the things that would happen to me if I didn't consent and sign those papers. I would be thrown out on the street with nothing; they would disown me, all sorts of wonderful threats like that. They obviously said all that to frighten me. They succeeded. I reluctantly agreed to all that they wanted. When the time came I would sign those papers. After all, at that stage in my life, I didn't have too many options open to me.

Even with all this going on, I still believed in my heart that David and I could find a way to be together and to keep our baby. Whew! I was badly mistaken. The Gods', the universe, in fact the whole damn lot were all against me at that time of my life. I knew that what we had done was wrong, but what I couldn't understand was that, to me, it wasn't the worst thing on earth to be done. Even at fifteen, I knew the enormity of the situation. I knew that it wasn't socially acceptable. I also knew that this was 'big stuff'- getting married and having a baby. I might have done a stupid thing, but I wasn't stupid. I didn't think like the usual fifteen-year-old. I knew exactly what I wanted and that was David and the baby.

The days, nights and months that followed were sheer torture. Even when we moved to another flat in a different area, it didn't help. No change of any sort can erase memories. They stay with you forever. I remember when I had to go for check-ups at Addington Hospital, on the way home I would go into the baby shops and wonder what it would feel like if I could buy baby things for my baby. Oh boy! I wanted that baby so much.

During my pregnancy, more traumas awaited us. The first thing that happened was that my sister and her husband divorced. When I was about eight months pregnant my father left us. I don't know what went wrong between my mom and dad. All I know is that my mother, sister and I were a very miserable threesome. The only bright light in our lives was my little nephew. It was an extremely stressful situation for the three of us. We were all locked into this intense sadness, none of us knowing how we were going to get out of it. It was as though the powers that be said 'here are these three people that deserve a lesson in life, lets dump the whole lot into their laps , yes let's do it, cabooshhhhhh.' I mean, at that time, we couldn't have even tried to comfort each other, as each of us were going through so much of our own trauma. I'm not sure what lesson was supposed to have been learnt by all that sorrow and unhappiness.


At about 12.30am on the morning of the 30th September 1974, I woke up with pains everywhere, and I thought to myself that maybe the baby was on its way. I got out of bed and went through to the kitchen. I made tea, in fact over the next couple of hours I had plenty of tea. I tried to time the pains. They were irregular and extremely painful. I would get the time on the clock but then the pain would become so intense that I would forget where I had started. I never woke anyone up to help me; I did it on my own. I thought to myself 'my mistake, my pain.' Well as you can imagine it was a very long night. Eventually at about 5am I managed to get some kind of order going and I figured out that the pains were about 5 minutes apart. I want you to imagine this. A young girl six days after her sixteenth birthday knowing that within a few hours it would all be over. The baby would be taken away and she would never see it, hold it or be allowed to love it. Not only was I going through physical pain, I was going through such emotional pain that I didn't know which felt worse.

At 6am I woke up my mom and my sister. My sister went to fetch the guy that was taking us to the hospital [supposedly a family friend]. The whole way to the hospital I had to listen to this guy preaching about how young girls shouldn't get themselves into the situation that I was in, and if they did then they should either abort the baby or give it up for adoption. This idiot had no idea what he was talking about. My sister eventually told him to shut up. In stony silence we arrived at the hospital. My sister stayed with me the whole way through the 'labour,' she rubbed my back for me and spoke to me quietly, trying to reassure me that everything would be okay. The doctor sedated me quite heavily, but even through that drug induced state I knew exactly what was going on. Their reason for sedating me was that since I was a very young girl, giving birth to a baby that I wasn't going to keep, they didn't want me getting all hysterical [for goodness sake, I've never been hysterical in my whole life, oh no! not me, I just hold it all in]. They wanted me nice, calm, and accepting

Amongst all the pain and the drugs I still kept thinking that there would be a way to keep this baby. It didn't seem right that I had gone through so much with no reward. I thought to myself that if God was out there surely he would step in and help me. No good luck was coming my way, not that day anyhow. I remember thinking to myself that if I could just look out of the window, be very strong, and not look at my baby then I would give her up for adoption. I was strong. It was pouring with rain that day. I remember thinking that because I couldn't cry God was doing it for me. In fact he was doing a good job; he was crying buckets full of tears for the misery that was in that room, that particular day. It would have been nice if he could have stopped it all. I gave birth to my baby at 11.15am on that cold, rainy Monday morning. I heard her cry and that was the end of it. They whipped her out of that room so quickly. Louise, my sister, was standing outside the delivery room and she saw the baby. That I only found out many years later. I don't remember too much after that, the drugs, the trauma was just too much for me. It was very difficult in hospital as the ward that I was in was fairly close to the babies. I would wonder if it was my baby that was crying. They never gave me anything to dry up my milk; they made me experience that as well. I really paid the price for my mistake.

Three days after I arrived home the lady from the welfare office took me to register my baby and to sign the adoption papers. I registered her in David's and my name; I couldn't bring myself to register her with a father 'unknown'. I did know the father and I was still very much in love with him. So I went against what everyone told me and I put him down as the father. After registering her I was taken directly to the court to sign the adoption papers. I would like to erase that day from my mind. I was told repeatedly that I was doing the right thing for my baby. Now I ask you. Whom was I doing the right thing for? Not for my baby, she had a mother who loved her. Even if I was young I would've looked after her very well. Not for my family, they just saw all the hardships that awaited us, instead of seeing what it was doing to me. I was torn to pieces inside and I didn't know how I was going to get through the rest of my life. At the court they tell you that you are signing these adoption papers of your own free will. In my mind I was certainly not signing those papers of my own free will. I signed because there was absolutely nothing else that I could do. I was sixteen years old, no great education to speak of, and no husband. There was no way that I could have supported her. There was too much against me. All I got out of the situation was many years of grief. When I got home I told my mom that I had been to sign the 'papers' and all she said was 'well at least now we can all get on with our lives.'

Six months after the baby was born, I met David at the beach. We decided to meet the next day to discuss how we still felt about each other. We wanted to get back together, but my mom and sister saw David and me together. When I got home I was told again in no uncertain terms that if I wanted to go out with David again I would have to leave my family. Now there are confusing statements about this. My mother swears that she didn't say anything of the sort. In fact she reckons she said the exact opposite. Well if that's the case why did I decide not to meet David? Why then did I decide that there wouldn't be any kind of happiness for David and me? Why did I try and commit suicide a few days after meeting David? Would that be the actions of someone who has been given full consent to do something that they had wanted for so long? I don't think so.

After the attempted suicide, the doctors wanted to keep me in hospital for counseling, which I refused. What did happen was that I started to bury all the hurt. It was the only way that I could survive.

PART THREE

In January 1977, I met Gary. Later that year we married. My son Ryan was born on the 7th February 1978. It was wonderful to be able to hold him and feed him. He was and still is very precious to me. My daughter was born on the 19th December 1979. This was another great occasion for me. I now had two beautiful babies to love and take care of. Unfortunately, Gary was not the ideal husband. We argued a great deal and he became very abusive towards me. When my daughter was 2months old, I had to go back to work. Things between Gary and I were not good. He became very jealous of the attention that I gave to the kids. He would pick a fight with me all the time. I felt as though I was being pulled in all directions. My children need me, they were only little. Gary wouldn't help me with anything. I became mentally and physically drained. I lost far too much weight, my hair was falling out, and I had a continuous headache. I was working at a pharmacy at that time. One day the pharmacist called me into his office and asked me what my problem was. I told him that I didn't have any problems that I was aware of; He gave me stronger tablets for my headaches and advised that I se a doctor as soon as possible. A few weeks later, my mom came up to Newcastle to see us. She was shocked when she saw me. I weighed 35kg. I looked terrible. She asked if I would go and see a doctor while she was with us. I agreed.

The doctor sent me to St. Anne's Hospital in Pietermaritzburg. The psychiatrist that I saw was a wonderful man. The first day that I was there, he listened to me for hours. When I had finished my tale of woe, he sat there and looked at me for a very long time. Then he said to me, 'Marléne, you are the same age as my granddaughter, [I was 21] and in all my years as a psychiatrist, I have never seen anyone as young as you, go through so much trauma. I was in hospital for two and a half weeks. In that time, I was given a course of six electro-convulsive treatment [shock treatment], drips everyday and loads of anti-depressant tablets. In addition to all of that, he counseled me everyday.


Gary and I eventually moved back to Durban. Things between us progressively became worse and worse. The physical abuse had now extended to my children as well. Gary and I divorced in April 1983 I was 24 yrs old.

On the 3rd of May 1983, I met Bruce. Bruce was and is a wonderful person. We married on the 2nd September 1983. He adopted Ryan and Carmen. Our son Myles was born the following year on the 16th June 1984.

When I was pregnant with Myles, I went into depression. I couldn't understand why. I had a wonderful husband who loved me, my children had a loving father and we had a nice home. As I was pregnant, I couldn't take any tablets so I went to see a psychologist. His theory was that I was depressed because I was pregnant. This might sound stupid, but it isn't. You see, every time that I became pregnant; my subconscious mind would revert back to all the stress and trauma that I had experienced with my first pregnancy. Bruce was very understanding and supportive and once I understood everything the rest of the pregnancy went off well. We were advised not to have any more children.

In 1987, we moved to Colenso, so that our children could grow up in a small town environment. We all thoroughly enjoyed Colenso. The kids had so much freedom. I became the local dance teacher. I staged two variety shows to raise money for various charities. It was a very good time of our lives.

In June 1991, we bought a house in Ladysmith. It was not a very good move. Buying the house put us into a lot of financial difficulty. In March 1991, we agreed to look after two Taiwanese children, they were little girls, one was five years old and the other was a one-month-old baby. We agreed, as we desperately needed the money. They lived with us from Monday - Friday and they went home on weekends. My niece Carly also came to live with us. We now had six children in the house, three teenagers and three little ones. As you can imagine it was rather hectic. In March and April 1992, my mother and Bruce's mom and dad came to live with us as well; this took our household up to eleven!! Five adults and six children. I did everything for everyone. I did the washing, ironing, cleaning, cooking and looking after the baby and the bigger ones as well. I think I would drop dead if I had to do all of that now. We got through it all and everyone seemed happy enough. The only down side was that I started getting chronic headaches and I was battling to sleep. Maybe I should have looked at those symptoms more closely, but I didn't, I was too busy looking after everyone else to worry about my problems.

PART FOUR

My rollercoaster ride began in May 1992. I went from being a self-sufficient, contented, happy person to an emotional wreck. I was utterly miserable and I couldn't make out why. Bruce's theory was that I was doing too much and that there were too many people in the house. He was probably right, but when our parents left, nothing changed. I just seemed to get worse. The headaches got worse. I was only sleeping for about 2 hours a night and all I wanted to do was cry and cry and cry some more. I remember thinking to myself that I must 'pull myself together' but the more I tried the worse it got. I really thought that I had put depression behind me. I know my family meant well but they couldn't understand why I should be so depressed. I had everything that I had ever wanted. I needed to know how to rise above the depression. I needed to know how to feel good about myself again. No-one could give me the answers I so desperately needed.

Eventually, I went to hospital in Ladysmith. My doctor tried everything. He gave me five sleeping tablets every night, still no sleep. I just could not sleep. After two weeks of all this, armed with Prozac and sleeping tablets I went home. The Prozac had an adverse effect on me and my family suffered. I wasn't sleeping and neither was any one else. I was vacuuming and washing carpets at two in the morning, cooking the next days' dinner, you name it, I did it. Poor Bruce, sitting in the lounge just being there for me, telling me that he wasn't tired; meanwhile he must have been exhausted. THANK YOU is not a big enough word for the gratitude I feel for the support that he gave me.

Obviously it couldn't continue. The whole family would have been on Prozac. I was referred to a psychiatrist in Durban. I knew that I had to go but I didn't want to go as my youngest son Myles would be celebrating his eighth in the time that I would be away. I felt very awful about leaving Myles; we had never been apart from each other. When I had been in the Ladysmith hospital, I had seen my whole family twice sometimes three times a day. It was too far for them to come and see me in Durban. I felt as though my whole world was coming to and end. Bruce eventually called our family doctor in and between him, Bruce and the kids; they managed to convince me that two weeks wasn't forever.

By the evening of the first day, I was ready to go home. I didn't feel so bad. I had already phoned Bruce and told him that he must come and fetch me the next day. He must have thought to himself 'please God, keep her there, the kids and I need to get some sleep.' The doctor arrived later and once again, I went through my life story. He never said too much, psychiatrists never do. However, he did say that I was having a massive nervous breakdown. He explained to me that a girl of fifteen does not have the emotional maturity to cope with the kind of trauma that I had experienced. After having the baby when I was so young I had not received any sort of counseling. But, as we all know in that day and age, young girls were not counseled. They were expected to forget the whole miserable experience completely and get on with their lives. Many years later, I found out that Dr. L had not been too optimistic about my recovery. In fact, he said to Bruce that if I made ten more years it would be a lot.

That evening I was given an injection to put me to sleep. It didn't work. The nurses could not believe that I was still awake. Eventually at about 2am the nurse decided to phone Dr. L to find out if there was something else, they could give me. He could not believe that I was still awake. The nurse told him I was very much awake in fact, I was standing opposite her drinking a cup of tea. I was given another injection and when Dr. L arrived at 6am, I was still wide-awake. Years later when we spoke about that night, he told me that he could not believe it when he got that call, because one of those injections would put a six-foot, one hundred and eighty pound man to sleep very quickly.

It was established that I was suffering from Bipolar Disorder; this is when the Lithium levels in the body go out of sync. The Lithium Level in the body either becomes excessively high, which causes a person to become unusually energetic requiring little or no sleep whatsoever, or they drop too low which then causes severe depression. Lithium is a type of salt that all human beings have in their bodies. In the person who suffers from Bipolar Disorder, their body makes either too much or not enough. When someone who suffers from Bipolar goes into severe depression, the person cannot physically and mentally 'snap out of it.' Once that person hits the bottom unless treatment is administered they will more than likely commit suicide. It is like any other disease in the body. For example; if a person suffers from Diabetes, they need Insulin to regulate their sugar levels and if they do not receive the Insulin, they will go into Diabetic Shock, then a Coma and they can die. It is the same with any chronic illness. The difference between Bipolar and other chronic diseases is that Bipolar deals with the emotions. When I tell people that I suffer from Bipolar, they look at me as though I come from outer space. As intelligent as people claim to be these days you would think that they would understand a bit better. It is still a socially unacceptable disease to have, even now.


Over the next two weeks, I was given another six 'shock-treatments,' these treatments are very effective as they accelerate the recovery of the patient. My medication consisted of Lithium, anti-depressants and tranquilizers. I joined the chronic medication syndrome. I was told that I would have to remain on the tablets for the remainder of my natural life. By the end of June 1992, I was declared well enough to return home. I should have been as good as new. However, I was not happy. I fought the treatment. I did not want to have to take tablets for the rest of my life. I did not like Dr. L. It was too far to schlep all the way to Durban every time there was a problem. I put on so much weight. I went from 52kg - 74kg in a matter of four months. I had never been a fat person, but now I wasn't only fat I was obese.

I tried very hard to appear happy. My family had been through far too much with my illness and me. I felt that I could not keep doing this to them. Gee whiz! I was on every tablet imaginable, I had all the support that anyone could ask for and yet I still felt absolutely awful. If I didn't understand any of it, then how on earth could anyone else understand? I will try to explain, imagine your saddest moment of your life............ now multiply that by 100............. now multiply that by 1000............... [Hope you are still with me] now multiply that by 10000..............and keep going until you cannot multiply any more. Maybe you can understand a little bit, of what I was feeling. This is what is called the depths of despair; this is the mind of a person contemplating suicide. What would YOU do if your mind were in that state of hopelessness? I bet you would think about it.

On Good Friday 1993, I tried to commit suicide. I never did it to hurt anyone, in my very disturbed way of thinking that day; I firmly believed that I was doing the right thing. [This is the rationale of a suicidal person] I thought that I would be doing everyone a favor. I believed that Bruce and the kids would be better off without me. I would not have to feel despair, sadness, loneliness and emptiness any more. It engulfed me. I could feel it in every pore of my body. It overwhelmed me and was totally unbearable.

I swallowed 30 Leponex tablets; they are a powerful tranquilizer/sedative. My normal dose was one per night. You can imagine what 30 of them were going to do. I had washed my hair, bathed and in my pajamas by 3.30 in the afternoon. I had also phoned my sister-in-law Jennifer and thanked her for all her support while I had been ill. Jennifer thought that it had been a very strange call and a few minutes later she phoned back, but by then Bruce had found the empty pill bottle. I was rushed to hospital. My stomach was pumped, and I was given a coal-like liquid to drink. After all that they still couldn't get all the tablets out. The doctor tried to insert a drip but all my veins had collapsed. I eventually lost consciousness. Our doctor told Bruce that I had a 50/50 chance of survival. He said that I might die during the night, or I could become a 'vegetable' or I could make it and live. Well, I made it; my will to live is obviously far greater than my will to die. Thank God for that. I would have missed out on some wonderful things that have happened since then. There were repercussions. My daughter resented me; she could not understand that I would want to leave her like that. My eldest son was away at a friend's house when it happened and we didn't tell him until he got home on the Easter Monday. He said that he was glad that he wasn't there at the time. He also said that it did not seem real to him, as when he left home I was 'ok' and when he returned I was still 'ok'. My youngest son was only eight at the time. He says that he will never forgive. H e thinks that I planned the suicide over a period of time.

If I could turn back the clock to that awful day, with those dreadful feelings and change the way I felt. My God! I would. It took an instant to decide to end my life and that instant did so much damage. I looked at those tablets in my hand, and I thought to myself that they could end all my sadness, such terrible sadness. I wouldn't have to feel EMPTY anymore, and for the time that it took to think those thoughts was the one and only time in my 33yrs of life that I never thought of my children first. I know that words cannot erase the damage that was done, but I wrote a poem to my children, trying to explain how I felt. It's called:

I DID WRONG BY YOU

I thought my heart
Would break right in two,
That terrifying day
I did wrong by you.
I know that these words
Don't make amends
For what happened that day
But I recommend
You hear what I say.
Leaving you was not my intention,
I never knew
How to change direction.
I never gave a thought
To all I'd leave behind,
I was so distraught
I never meant to be unkind.
I saw myself losing hold
Of my resistance.
Daily thinking was
Bringing me down,
Twisting my mind
Beneath the ground.
Mistakes are wrong choices
Made by us all,
There are no rejoices
Only an open fall.
So hear me please
When I say this to you,
I'm sure you will agree
I did wrong by you.


Somehow I managed to get myself back on track. In 1994, we moved back to Colenso. We were always much happier in Colenso. I started teaching Ballroom and Latin American Dancing in Colenso, Ladysmith and Estcourt. The whole family joined in and we had lots of fun. Myles showed a lot of potential. He and his dance partner ended up becoming Junior Champs for the Kwa Zulu Natal region. I even managed to reduce my weight from 74kg - 58kg. Generally, we had 'picked up the pieces' and moved on.

My rollercoaster ride was not finished yet. August 1995 found me back in hospital, having another six shock treatments. I've often wondered to that 'powers that be' WHY, OH WHY? When everything was going so well in my life did this sadness, emptiness and utter despair return time and again to torment me. I often used to wonder what I had done that was so wrong. You have to understand that when I went into these depressions I was never hysterical in any way. It was more of a regression from the world. I did not sleep and I became very quiet and withdrawn. Once again, I came out of hospital, brushed myself off and started all over again.

May 1996, I bought a dog grooming business. Carmen and I ran it and we thoroughly enjoyed the work. We sold the business in November 1998 as Bruce was given a promotion in Pietermaritzburg.

PART SIX

In January 1997, I decided that I would go to the adoption agency and find out if I could eventually meet my daughter. As she was over 21yrs of age, they didn't foresee a problem, provided that she wanted to make contact. This was a dream that I had cherished since the day that I had given birth to her. I knew that someday, somehow I would meet her. Firstly, the agency had to get in touch with her adoptive parents and if they agreed then they would hand everything over to their daughter. In August 1997, on the Friday before Princess Diana died, Adrey contacted me. We agreed to set up a meeting at Durban beachfront for the Sunday. On the Friday night when she phoned me, I couldn't believe that I was actually speaking to this child that I had longed for, for so long. We spoke for an hour and a half. I was ecstatic. The next two nights were the longest nights of my life. When I first laid eyes on her, I couldn't believe how much she looked like David, except she has red hair. When David was young his hair was blonde and my hair is dark brown, hence the red hair.

We both aren't very emotional people but we did have tears in our eyes when we first saw each other. I couldn't grasp the fact that we were actually hugging each other. It was mind-blowing. I can't find the words to describe the feeling I felt. We saw each other fairly regularly over the next year and I even saw her on her birthday! She made it very clear that she loved her parents very much. I was happy that she had found a wonderful home with parents that adored her. It would have been nice if we could have been friends, but I think that was asking too much of the situation. Except for the first meeting, she hadn't told her parents that she was in communication with me, and that we saw each other quite often. Adrey and her boyfriend Wayne even came and spent a weekend with us in Colenso.

Towards the end of 1998, Adrey phoned me to confirm my postal address. I had hoped that I would be invited to the wedding. That was wishful thinking. A few days later, I received a letter in the post from Adrey. She asked me to stop contacting her because it was upsetting her mother. She also asked me to respect her wishes and give her up just as I had done before. As you can imagine I was terribly hurt, but there was nothing I could do about it. I had to let her go, again.

My rollercoaster ride with depression still wasn't finished as I had another big 'breakdown' in August 1998. I received another six shock treatments. I was getting so tired of this up and down all the time. I was tired of feeling miserable and depressed, I'm sure every one else was as well. After another two weeks in hospital and I went home feeling just as miserable as when I went in. I counted all my various tablets and they amounted to 600 in total. It was a Sunday and I planned my suicide for the Tuesday, because Bruce would be at work and the kids would have gone back to school. I intended to take all the tablets. I wouldn't be found alive this time. BUT...........The strangest things happen when you really let go.....................

Later that day, I was lying on my bed. I happened to glance over at the bedside table. There where some little books there that my mother had given me earlier to read. I had taken them just to please her; personally, I had no intention to read them. [The books are called: The Path of Truth] Anyway, the most amazing thing happened: I was particularly drawn to a little book with a yellow flower on it. [Yellow is my favorite color] I picked up the book and just opened it at random. This is the message that was sent to me: 'Are you sad, lonely or afraid? If you are then the one course open to you is to seek out GOD in your soul, for your depression grows only in YOUR acceptance of separation between yourself and HIM.'

The transformation in me was instantaneous. I felt complete calmness in my mind and my body. I believe this is called synchronicity. It changed my whole perspective on life. For the first time in many years, I felt wonderful. The hopelessness that I had been feeling literally vanished. There are miracles, they do take place. We just have to look in the right places. That day was the turning point of my life and I do THANK GOD. God is never too late; he's always right on-time. He certainly proved it that day. He gave me my miracle; he gave me back my life!

After that experience, I read every book that I could find on positive thinking. It changed the way that I thought about life and the Bipolar. It helped me to see that by fighting it I was only making it worse. I learned to accept it and manage it. I know when the signs are setting in and before it can take a great hold of me, I go and see Dr. L, he adjusts my tablets, and everything goes back to normal. I read a passage in one of Dr. Reg Barrett's books. I try and live my life by this rule, well most days anyhow. It goes like this: Imagine if you had a bank account that credited your account each morning with R86, 400.00 that carried over no balance from day to day, allowed you to keep no cash in your account and every evening cancelled whatever part of the amount you had failed to use during the day....What would you do? You would draw out every cent and use it. Well here is a little secret: You do have such a bank account and its' name is TIME; every morning you are credited with 86,400 seconds. Every night it cancels whatever you haven't used to good purpose, it carries over no balances, allows no overdrafts. Each day it opens a new account with you and each night it burns the records of the day. If you failed to use the day's deposit, the loss is yours. There is no going back, no drawing against "Tomorrow'. So draw on this precious fund of seconds and use it wisely in order to get the utmost in health, happiness and success.


PART SEVEN

In 1983, I enrolled in a Reiki Course. Part of the training was that we had to carry out 'self-healing' this entailed; 1) Affirmations - these are sayings that help clear the blocked energies in the body, it helps to raise all sorts of suppressed emotions and issues, which once dealt with certainly make you feel a lot better. The sayings are said twenty one times a day for twenty-one days. It has been scientifically proven that our subconscious mind takes twenty-one days to change its' thought pattern. 2) Self- healing; this is a hands-on healing done on yourself also for twenty-one days. Reiki has helped me tremendously in accepting and understanding certain events in my life. I now have a better understanding as to why I had to give Adrey up for adoption. Because of what I learned in Reiki, I delved deeply into cosmic cycles affect our lives and the choices that we make. I am finally able to accept and understand why Adrey was never allowed to belong to me. I wrote a poem about my reflections on the matter, this is how it goes:

SPIRITS IN THE CRADLE

SPIRITS IN THE COSMIC CRADLE
WAITING IN THE WINGS FOR BIRTH,
WILL THEY EVER BE ABLE
TO FIND THEIR WAY TO EARTH.
I WONDERED ABOUT THESE SPIRITS
UP IN THE COSMIC PLANE,
I WONDERED HOW THEY CAME TO EARTH
I THOUGHT, AND SOUGHT IN VAIN.
I WONDERED ABOUT THIS THING CALLED LIFE.
WHEN AND HOW DID IT BEGIN?
WAS IT AT BIRTH, OR AT CONCEPTION BESIDE THE HEARTH?
WHEN, I ASK, DID IT SET IN?
I'VE LISTENED AND READ,
I'VE THOUGHT ABOUT IT TOO.
THE ANSWERS I'VE COME UP WITH
IS WHAT I FEEL TO BE TRUE.
THERE ARE THESE ENERGIES THAT ARE FREE
FLOATING UP IN THE SKIES BEYOND,
WAITING FOR PARENTS YOU SEE,
WAITING, IN READINESS TO RESPOND.
THEY LOOK AROUND AND WHAT DO THEY SEE?
THEY SEE A MALE AND FEMALE ENERGY
JUST WAITING IN THE COSMIC TREE,
THIS IS DEFINITELY NO FALSE STRATEGY.
IT'S A PERFECT PLAN THAT'S WOVEN
UP IN THAT COSMIC PLANE,
FOR WE HAVE ALREADY CHOSEN
LIFE'S SPIRITUAL CHAIN.
WE HAVE HELP FROM A DIVINE PLANNER,
WHO HAS PLANNED ALL THIS BEFORE.
HE NEVER MAKES A MISTAKE
HE JUST GIVES US AN OPEN DOOR.
SOMETIMES THIS CHOICE OF PARENTS
GOES BACK A FEW YEARS OR MORE.
SOUL SITS IN THE WINGS PATIENTLY,
RESTING, UNTIL IT'S TIME TO EXPLORE.
THERE ARE TIMESWHEN WE ARE BORN,
WE ARE MEANT FOR ANOTHER IT WOULD SEEM,
THAT'S WHEN A LIFE GETS TORN
AND GOD ACTS AS A GO-BETWEEN.
IN LIFE WE ARE GIVEN CHOICES
STARTING BEFORE OUR BIRTH,
IT MIGHT NOT CALL FOR MANY REJOICES
FOR THOSE LIVING ON THIS EARTH.
THERE MIGHT BE A MOTHER OF A BABE,
SHE WANTS TO KEEP IT SO,
BUT IT IS MEANT FOR ANOTHER
SHE HAS TO LET IT GO.
IT GOES OUT FOR ADOPTION OR FOSTER-PARENTING TOO,
THIS IS SOULS PLAN FOR SOME OF US,
WE KNOW THIS TO BE TRUE.
OUR SOUL CHOOSES THIS LIFE
WITH ALL ITS HIGHS AND LOWS,
IT CHOOSES TO HAVE SOME STRIFE,
SO THAT THE SPIRIT GROWS.
NOW REMEMBER ALL THIS IS CHOSEN
UP IN THE COSMIC PLANE,
SOUL INSISTS OUR SCHOOL OF LIFE
BE ONE OF SPIRITUAL GAIN.
SO WHEN NEXT YOU'RE WONDERING
WHO YOU ARE, OR WHO YOU WERE MEANT TO BE,
KNOW THAT IN GODS' PLANNING
YOU ARE PART OF THE SPIRITUAL TREE.


After writing this poem, my way of thinking about Adrey changed. I was finally able to let her go. At last, I felt at peace within myself. I wish her well. I know that she has had a good life and will continue to do so. I look at myself as the vessel that had to bring her into this world. Her parents were unable to have children, but Adrey had obviously chosen them as her parents and the only way for her to get to them would have been through me, or someone like me. This might seem a little strange, but to me it's a logical explanation.

There are still some days when I feel sorry for myself, but then I think of a little speech that my youngest son Myles gave to me. He is a very perceptive young man and he told me that in order to be a 'whole' person, with no hang-ups, I'd have to mend the DAMN WALL. You see, he explained, 'if the railing at the top of the DAMN WALL is broken, you will fix it, because if you don't someone could fall off and drown. If it breaks again then you will fix it again. Then you might notice that the walk way is splitting. You will need to fix that too. Then he said, 'if you are smart, you will send divers down to the bottom of the wall to see exactly what is going on. And you know what Mom? They will come back up and tell you that there is a big CRACK in the dam wall and it needs to be fixed, because if it isn't then it doesn't matter how much work you do on the top, if the base of the wall is cracked everything will just keep breaking.' Then he said to me, 'Mom, you have to fix your 'DAM WALL' because if you don't, one day it might just collapse and it just might kill you.' I thank Myles for his intuitiveness. I thank him for making it all so clear to me. This is why I've written this story.

PART EIGHT

2007 - What a year that turned out to be. I connected with people I never thought I would see again, well not in this life anyway.

Bruce, my daughter Carmen, my granddaughter Jasmine and I went to visit my father in Philipolis. I had not seen my father for 33 years. We had a very nice visit with him and we still keep in contact with each other.

The second event was that I managed to contact David. The last time that I saw him was also 33 years ago. David and his wife Diane came to visit us. David, naturally, was very interested to find out all about Adrey. I gave him one of the photos of Adrey. I was pleased that he has had a successful life. Diane said that it came as no surprise to her that David and I would see each other again. She said that David had been through a tough time as well concerning Adrey and I. I have to say a very big THANK YOU to both Diane and Bruce for allowing David and I to meet again. Without their support, the meeting could never have taken place. This next poem was dedicated to all the young people of the 1970s' especially the ones that thought they knew it all.

MEMORIES

Life was so sweet in that period of time,
Rodrigues, Pink Floyd letting out a chime.
That was when she met him; I'm telling you it's true.
At first, it was magical, wonderful; they felt it was their due
Holding hands, sitting in the park, riding motor bikes too.
Feeling all excited when he knocked on the door,
She thought her heart would fall through the floor.
Oh! To be fifteen, no cares to be seen,
What a life, it was so happy it would seem.
Then the passion started, that's where the fault did lie,
They never thought ahead, this was no butterfly.
Their love was not enough for what lay ahead.
This was the most unspeakable thing that anyone could do.
It was the 70's after all, when youth was misconstrued.
What happened was really sad, these two had disobeyed.
So torn apart they were, by moms and dads a plenty,
This, they said will never do, they said it none to gently.
The boy was sent away to places unbeknown,
Do not return they said or your life won't be your own.
The girl was harder hi than he,
For she had lots of suffering and traumas, he did not see.
Now you might think this tale is filled with untruths,
But everything is true as truthful as can be.
Today she's a woman of forty-nine and fifty-three is he.
So many years have gone, so many things they've done.
The child they created is alive and well,
They each have great partners, this I think is swell.
After thirty-three years they met again, I know this to be so,
Oh! The wonderment of families makes a happy soul.
She's glad to have met him, and seen how he is now,
The tears that were once shed are replaced with a smile.
She's very glad to have shared this tale with all of you,
And remember when a butterfly lands on your shoulder, she's thinking of you.

There was one last meeting that took place. I managed to contact Adrey. She was sorry for the way that she had treated me before. Since we have been living in Pietermaritzburg, we have had an unlisted telephone no. She said that she had tried to find me but she wasn't successful. I told her about David and she was very keen to meet him. David was also very keen to meet Adrey. We set up a meeting. David and Diane could not believe how like David she was. Adrey has a little girl of her own now and we all met her as well. Unfortunately, that was the last time that I saw Adrey. I don't know if our paths will ever cross again. I still wish that some day she will find a place in her life for me. If it doesn't happen, I will be alright because I know that she has loving parents and a loving husband and child.

Bruce and I recently celebrated our 25th wedding anniversary, and in a few days, I will be celebrating my fiftieth birthday. I never thought that I would see these milestones in my life. I realize now that life is not about choosing the easy road; it's about choosing the road that is the most beneficial to you. For me, it's been a road where I learned to be compassionate, kind and considerate to everyone, including myself. If I had not experienced all the good and the bad, I wouldn't be the person I am today. I've had many obstacles in my way and many big mountains to climb, but climb them I did. In fact, I'm still climbing them, but they seem to be a bit easier now. I know I could never have done it all on my own. God knew it too, he knew that I had chosen a very rough road and he knew that I would need help, so he gave me the most wonderful family that any one could wish for. Bruce, Ryan, Carmen, Myles, my mother, sister and a whole host of other people have been my lifeline. They have stood beside me through all the depressive years, the 29 shock treatments, attempted suicides, back operations, you name it, these incredible people have been there and they still are.

Whenever I find myself being a bit righteous or I think that my views on life are the only ones that there are, I humble myself and remember this saying:

'WOULD YOU RATHER BE RIGHT/' OR 'WOULD YOU RATHER BE HAPPY/'

Ed. Note: Marlene is a member of HealthyPlace and shared her story after the HealthyPlace TV show on the Devastation Caused By Untreated Bipolar Disorder.

next: The Day I Was Diagnosed as Bipolar
~ bipolar disorder library
~ all bipolar disorder articles

APA Reference
Staff, H. (2009, March 17). My Bipolar Story: The Crack in the Wall, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/bipolar-disorder/articles/the-crack-in-the-wall

Last Updated: April 3, 2017

Soldiers and PTSD: HealthyPlace Newsletter

Here's what's happening on the HealthyPlace site this week:

Parenting is a Tough Job...

Especially when you have challenging children.   Dr. Steven Richfield, known as the "Parenting Coach" offers some helpful advice in the following articles:

  1. Coaching Social Responsibility To Techno-Savvy Teens
  2. Coaching The Child Who Struggles With Social Awkwardness
  3. Preparing The Aspergers Young Adult For The Social Challenges Of College
  4. Restraining The Judge Within: Tips For The Judgmental Parent

PTSD On HealthyPlace TV

Do you ever wonder what happens to our military vets when they return home? For many, life is very difficult.

Tonight (Tuesday), we're going to be focusing on "Soldiers and the Hidden Battle: Post-Traumatic Stress Disorder." Our guest is a vet who will be sharing his experiences with PTSD and what he's doing to recover. We'll also have the executive producer of "In Their Boots," a series of web documentaries featuring soldiers and their battle with PTSD. Plus HealthyPlace Medical Director and Board-Certified Psychiatrist, Dr. Harry Croft, will be discussing the latest research on PTSD and the most effective methods of treatment. Over the past 8 years, Dr. Croft has evaluated over 4,000 vets for PTSD.

As always, you'll be able to ask our guests your questions too. The show starts at 5:30p PT, 7:30 CT, 8:30 ET and airs live on our website.


continue story below

In the second half of the show, you get to ask Dr. Harry Croft, your personal mental health questions.

And if you ever miss a show, like the one on self-injury last week, click here for a list of previous HealthyPlace Mental Health TV Shows.

Alternative Mental Health Treatments

Over the last two weeks, we've noticed a pickup in traffic to our Alternative Mental Health Community. As you might expect, people are interested in natural treatments for depression and anxiety as well as other mental health conditions. But they've also been visiting "Still My Mind," a special section written by Adrian Newington. The site offers inspiration to others who are seeking change within. Check it out and let us know what you think.

back to: HealthyPlace.com Newsletter Index

APA Reference
Staff, H. (2009, March 17). Soldiers and PTSD: HealthyPlace Newsletter, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/other-info/mental-health-newsletter/soldiers-and-ptsd

Last Updated: September 5, 2014

infected burns

The indications of a third degree buurn are as follows... no pain, black or white appearrence...

The indications of an infected burn... pain.

 

On a good day I cut, on a bad day I burn. Sunday morning I burned myself, it took 3 burns in the same place to make the pattern I wanted. 2 second degree burns and a 3rd. I'm hoping for a scar that will last, something that can be seen. A mark that says yes, your pre-suppositions are correct.

 

I want to show my pastor because he has  a psych degree and thinks he can figure me out. I want to show him the scars I have and tell him about the voices and why I don't like to drive. I want to disturb him that he'll either take action or just go away.

 

My friend said he'd bring be ice cream and beer and we'd watch movies. He's too sweet.

APA Reference
(2009, March 17). infected burns, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/support-blogs/myblog/infected-burns

Last Updated: January 14, 2014

Humalog for Treatment of Diabetes - Humalog Full Prescribing Information

Brand Names: Humalog Cartridge, Humalog KwikPen, Humalog Pen
Generic Name: Insulin Lispro

Dosage Form: Injection

Description
Pharmacology
Indications and Usage
Contraindications
Warnings
Precautions
Drug Interactions
Adverse Reactions
Overdose
Dosage
Supplied

Humalog Pen, Humalog Cartridge, KwikPen, insulin lispro patient information (in plain English)

Description

Humalog® Mix75/25™ [75% insulin lispro protamine suspension and 25% insulin lispro injection, (rDNA origin)] is a mixture of insulin lispro solution, a rapid-acting blood glucose-lowering agent and insulin lispro protamine suspension, an intermediate-acting blood glucose-lowering agent. Chemically, insulin lispro is Lys(B28), Pro(B29) human insulin analog, created when the amino acids at positions 28 and 29 on the insulin B-chain are reversed. Insulin lispro is synthesized in a special non-pathogenic laboratory strain of Escherichia coli bacteria that has been genetically altered to produce insulin lispro. Insulin lispro protamine suspension (NPL component) is a suspension of crystals produced from combining insulin lispro and protamine sulfate under appropriate conditions for crystal formation.

Insulin lispro has the following primary structure:

Insulin lispro primary structure

Insulin lispro has the empirical formula C257H383N65O77S6 and a molecular weight of 5808, both identical to that of human insulin.

Humalog Mix75/25 vials and Pens contain a sterile suspension of insulin lispro protamine suspension mixed with soluble insulin lispro for use as an injection.

Each milliliter of Humalog Mix75/25 injection contains insulin lispro 100 units, 0.28 mg protamine sulfate, 16 mg glycerin, 3.78 mg dibasic sodium phosphate, 1.76 mg Metacresol, zinc oxide content adjusted to provide 0.025 mg zinc ion, 0.715 mg phenol, and Water for Injection. Humalog Mix75/25 has a pH of 7.0 to 7.8. Hydrochloric acid 10% and/or sodium hydroxide 10% may have been added to adjust pH.


 


top

Clinical Pharmacology

Antidiabetic Activity

The primary activity of insulin, including Humalog Mix75/25, is the regulation of glucose metabolism. In addition, all insulins have several anabolic and anti-catabolic actions on many tissues in the body. In muscle and other tissues (except the brain), insulin causes rapid transport of glucose and amino acids intracellularly, promotes anabolism, and inhibits protein catabolism. In the liver, insulin promotes the uptake and storage of glucose in the form of glycogen, inhibits gluconeogenesis, and promotes the conversion of excess glucose into fat.

Insulin lispro, the rapid-acting component of Humalog Mix75/25, has been shown to be equipotent to Regular human insulin on a molar basis. One unit of Humalog® has the same glucose-lowering effect as one unit of Regular human insulin, but its effect is more rapid and of shorter duration. Humalog Mix75/25 has a similar glucose-lowering effect as compared with Humulin® 70/30 on a unit for unit basis.

Pharmacokinetics

Absorption

Studies in nondiabetic subjects and patients with type 1 (insulin-dependent) diabetes demonstrated that Humalog, the rapid-acting component of Humalog Mix75/25, is absorbed faster than Regular human insulin (U-100). In nondiabetic subjects given subcutaneous doses of Humalog ranging from 0.1 to 0.4 U/kg, peak serum concentrations were observed 30 to 90 minutes after dosing. When nondiabetic subjects received equivalent doses of Regular human insulin, peak insulin concentrations occurred between 50 to 120 minutes after dosing. Similar results were seen in patients with type 1 diabetes.

Serum Immunoreactive Insulin (IRI) Concentrations

Figure 1: Serum Immunoreactive Insulin (IRI) Concentrations, After Subcutaneous Injection of Humalog Mix75/25 or Humulin 70/30 in Healthy Nondiabetic Subjects.

Humalog Mix75/25 has two phases of absorption. The early phase represents insulin lispro and its distinct characteristics of rapid onset. The late phase represents the prolonged action of insulin lispro protamine suspension. In 30 healthy nondiabetic subjects given subcutaneous doses (0.3 U/kg) of Humalog Mix75/25, peak serum concentrations were observed 30 to 240 minutes (median, 60 minutes) after dosing (see Figure 1). Identical results were found in patients with type 1 diabetes. The rapid absorption characteristics of Humalog are maintained with Humalog Mix75/25 (see Figure 1).

Figure 1 represents serum insulin concentration versus time curves of Humalog Mix75/25 and Humulin 70/30. Humalog Mix75/25 has a more rapid absorption than Humulin 70/30, which has been confirmed in patients with type 1 diabetes.

Distribution

Radiolabeled distribution studies of Humalog Mix75/25 have not been conducted. However, the volume of distribution following injection of Humalog is identical to that of Regular human insulin, with a range of 0.26 to 0.36 L/kg.

Metabolism

Human metabolism studies of Humalog Mix75/25 have not been conducted. Studies in animals indicate that the metabolism of Humalog, the rapid-acting component of Humalog Mix75/25, is identical to that of Regular human insulin.

Elimination

Humalog Mix75/25 has two absorption phases, a rapid and a prolonged phase, representative of the insulin lispro and insulin lispro protamine suspension components of the mixture. As with other intermediate-acting insulins, a meaningful terminal phase half-life cannot be calculated after administration of Humalog Mix75/25 because of the prolonged insulin lispro protamine suspension absorption.

Pharmacodynamics

Studies in nondiabetic subjects and patients with diabetes demonstrated that Humalog has a more rapid onset of glucose-lowering activity, an earlier peak for glucose-lowering, and a shorter duration of glucose-lowering activity than Regular human insulin. The early onset of activity of Humalog Mix75/25 is directly related to the rapid absorption of Humalog. The time course of action of insulin and insulin analogs, such as Humalog (and hence Humalog Mix75/25), may vary considerably in different individuals or within the same individual. The parameters of Humalog Mix75/25 activity (time of onset, peak time, and duration) as presented in Figures 2 and 3 should be considered only as general guidelines. The rate of insulin absorption and consequently the onset of activity is known to be affected by the site of injection, exercise, and other variables (see General under PRECAUTIONS).

In a glucose clamp study performed in 30 nondiabetic subjects, the onset of action and glucose-lowering activity of Humalog, Humalog® Mix50/50™, Humalog Mix75/25, and insulin lispro protamine suspension (NPL component) were compared (see Figure 2). Graphs of mean glucose infusion rate versus time showed a distinct insulin activity profile for each formulation. The rapid onset of glucose-lowering activity characteristic of Humalog was maintained in Humalog Mix75/25.

In separate glucose clamp studies performed in nondiabetic subjects, pharmacodynamics of Humalog Mix75/25 and Humulin 70/30 were assessed and are presented in Figure 3. Humalog Mix75/25 has a duration of activity similar to that of Humulin 70/30.

Insulin Activity After Injection of Humalog

Figure 2: Insulin Activity After Injection of Humalog, Humalog Mix50/50, Humalog Mix75/25, or Insulin Lispro Protamine Suspension (NPL Component) in 30 Nondiabetic Subjects.

Insulin Activity After Injection of Humalog

Figure 3: Insulin Activity After Injection of Humalog Mix75/25 and Humulin 70/30 in Nondiabetic Subjects.

Figures 2 and 3 represent insulin activity profiles as measured by glucose clamp studies in healthy nondiabetic subjects.

Figure 2 shows the time activity profiles of Humalog, Humalog Mix50/50, Humalog Mix75/25, and insulin lispro protamine suspension (NPL component).

Figure 3 is a comparison of the time activity profiles of Humalog Mix75/25 (see Figure 3a) and of Humulin 70/30 (see Figure 3b) from two different studies.

Special Populations

Age and Gender

Information on the effect of age on the pharmacokinetics of Humalog Mix75/25 is unavailable. Pharmacokinetic and pharmacodynamic comparisons between men and women administered Humalog Mix75/25 showed no gender differences. In large Humalog clinical trials, sub-group analysis based on age and gender demonstrated that differences between Humalog and Regular human insulin in postprandial glucose parameters are maintained across sub-groups.

Smoking

The effect of smoking on the pharmacokinetics and pharmacodynamics of Humalog Mix75/25 has not been studied.

Pregnancy

The effect of pregnancy on the pharmacokinetics and pharmacodynamics of Humalog Mix75/25 has not been studied.

Obesity

The effect of obesity and/or subcutaneous fat thickness on the pharmacokinetics and pharmacodynamics of Humalog Mix75/25 has not been studied. In large clinical trials, which included patients with Body Mass Index up to and including 35 kg/m2, no consistent differences were observed between Humalog and Humulin® R with respect to postprandial glucose parameters.

Renal Impairment

The effect of renal impairment on the pharmacokinetics and pharmacodynamics of Humalog Mix75/25 has not been studied. In a study of 25 patients with type 2 diabetes and a wide range of renal function, the pharmacokinetic differences between Humalog and Regular human insulin were generally maintained. However, the sensitivity of the patients to insulin did change, with an increased response to insulin as the renal function declined. Careful glucose monitoring and dose reductions of insulin, including Humalog Mix75/25, may be necessary in patients with renal dysfunction.

Hepatic Impairment

Some studies with human insulin have shown increased circulating levels of insulin in patients with hepatic failure. The effect of hepatic impairment on the pharmacokinetics and pharmacodynamics of Humalog Mix75/25 has not been studied. However, in a study of 22 patients with type 2 diabetes, impaired hepatic function did not affect the subcutaneous absorption or general disposition of Humalog when compared with patients with no history of hepatic dysfunction. In that study, Humalog maintained its more rapid absorption and elimination when compared with Regular human insulin. Careful glucose monitoring and dose adjustments of insulin, including Humalog Mix75/25, may be necessary in patients with hepatic dysfunction.

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Indications and Usage

Humalog Mix75/25, a mixture of 75% insulin lispro protamine suspension and 25% insulin lispro injection, (rDNA origin), is indicated in the treatment of patients with diabetes mellitus for the control of hyperglycemia. Humalog Mix75/25 has a more rapid onset of glucose-lowering activity compared with Humulin 70/30 while having a similar duration of action. This profile is achieved by combining the rapid onset of Humalog with the intermediate action of insulin lispro protamine suspension.

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Contraindications

Humalog Mix75/25 is contraindicated during episodes of hypoglycemia and in patients sensitive to insulin lispro or any of the excipients contained in the formulation.

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Warnings

Humalog differs from Regular human insulin by its rapid onset of action as well as a shorter duration of activity. Therefore, the dose of Humalog Mix75/25 should be given within 15 minutes before a meal.

Hypoglycemia is the most common adverse effect associated with the use of insulins, including Humalog Mix75/25. As with all insulins, the timing of hypoglycemia may differ among various insulin formulations. Glucose monitoring is recommended for all patients with diabetes.

Any change of insulin should be made cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type (e.g., Regular, NPH, analog), species, or method of manufacture may result in the need for a change in dosage.


 


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Precautions

General

Hypoglycemia and hypokalemia are among the potential clinical adverse effects associated with the use of all insulins. Because of differences in the action of Humalog Mix75/25 and other insulins, care should be taken in patients in whom such potential side effects might be clinically relevant (e.g., patients who are fasting, have autonomic neuropathy, or are using potassium-lowering drugs or patients taking drugs sensitive to serum potassium level). Lipodystrophy and hypersensitivity are among other potential clinical adverse effects associated with the use of all insulins.

As with all insulin preparations, the time course of Humalog Mix75/25 action may vary in different individuals or at different times in the same individual and is dependent on site of injection, blood supply, temperature, and physical activity.

Adjustment of dosage of any insulin may be necessary if patients change their physical activity or their usual meal plan. Insulin requirements may be altered during illness, emotional disturbances, or other stress.

Hypoglycemia — As with all insulin preparations, hypoglycemic reactions may be associated with the administration of Humalog Mix75/25. Rapid changes in serum glucose concentrations may induce symptoms of hypoglycemia in persons with diabetes, regardless of the glucose value. Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions, such as long duration of diabetes, diabetic nerve disease, use of medications such as beta-blockers, or intensified diabetes control.

Renal Impairment — As with other insulins, the requirements for Humalog Mix75/25 may be reduced in patients with renal impairment.

Hepatic Impairment — Although impaired hepatic function does not affect the absorption or disposition of Humalog, careful glucose monitoring and dose adjustments of insulin, including Humalog Mix75/25, may be necessary.

Allergy — Local Allergy — As with any insulin therapy, patients may experience redness, swelling, or itching at the site of injection. These minor reactions usually resolve in a few days to a few weeks. In some instances, these reactions may be related to factors other than insulin, such as irritants in the skin cleansing agent or poor injection technique.

Systemic Allergy — Less common, but potentially more serious, is generalized allergy to insulin, which may cause rash (including pruritus) over the whole body, shortness of breath, wheezing, reduction in blood pressure, rapid pulse, or sweating. Severe cases of generalized allergy, including anaphylactic reaction, may be life threatening. Localized reactions and generalized myalgias have been reported with the use of cresol as an injectable excipient.

Antibody Production — In clinical trials, antibodies that cross-react with human insulin and insulin lispro were observed in both human insulin mixtures and insulin lispro mixtures treatment groups.

Information for Patients

Patients should be informed of the potential risks and advantages of Humalog Mix75/25 and alternative therapies. Patients should not mix Humalog Mix75/25 with any other insulin. They should also be informed about the importance of proper insulin storage, injection technique, timing of dosage, adherence to meal planning, regular physical activity, regular blood glucose monitoring, periodic hemoglobin A1c testing, recognition and management of hypo- and hyperglycemia, and periodic assessment for diabetes complications.

Patients should be advised to inform their physician if they are pregnant or intend to become pregnant.

Refer patients to the Patient Information leaflet for information on normal appearance, timing of dosing (within 15 minutes before a meal), storing, and common adverse effects.

For Patients Using Insulin Pen Delivery Devices: Before starting therapy, patients should read the Patient Information leaflet that accompanies the drug product and the User Manual that accompanies the delivery device and re-read them each time the prescription is renewed. Patients should be instructed on how to properly use the delivery device, prime the Pen to a stream of insulin, and properly dispose of needles. Patients should be advised not to share their Pens with others.

Laboratory Tests

As with all insulins, the therapeutic response to Humalog Mix75/25 should be monitored by periodic blood glucose tests. Periodic measurement of hemoglobin A1c is recommended for the monitoring of long-term glycemic control.

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Drug Interactions

Insulin requirements may be increased by medications with hyperglycemic activity such as corticosteroids, isoniazid, certain lipid-lowering drugs (e.g., niacin), estrogens, oral contraceptives, phenothiazines, and thyroid replacement therapy.

Insulin requirements may be decreased in the presence of drugs that increase insulin sensitivity or have hypoglycemic activity, such as oral antidiabetic agents, salicylates, sulfa antibiotics, certain antidepressants (monoamine oxidase inhibitors), angiotensin-converting-enzyme inhibitors, angiotensin II receptor blocking agents, beta-adrenergic blockers, inhibitors of pancreatic function (e.g., octreotide), and alcohol. Beta-adrenergic blockers may mask the symptoms of hypoglycemia in some patients.

Carcinogenesis, Mutagenesis, Impairment of Fertility

Long-term studies in animals have not been performed to evaluate the carcinogenic potential of Humalog, Humalog Mix75/25, or Humalog Mix50/50. Insulin lispro was not mutagenic in a battery of in vitro and in vivo genetic toxicity assays (bacterial mutation tests, unscheduled DNA synthesis, mouse lymphoma assay, chromosomal aberration tests, and a micronucleus test). There is no evidence from animal studies of impairment of fertility induced by insulin lispro.

Pregnancy

Teratogenic Effects — Pregnancy Category B

Reproduction studies with insulin lispro have been performed in pregnant rats and rabbits at parenteral doses up to 4 and 0.3 times, respectively, the average human dose (40 units/day) based on body surface area. The results have revealed no evidence of impaired fertility or harm to the fetus due to insulin lispro. There are, however, no adequate and well-controlled studies with Humalog, Humalog Mix75/25, or Humalog Mix50/50 in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed.

Nursing Mothers

It is unknown whether insulin lispro is excreted in significant amounts in human milk. Many drugs, including human insulin, are excreted in human milk. For this reason, caution should be exercised when Humalog Mix75/25 is administered to a nursing woman. Patients with diabetes who are lactating may require adjustments in Humalog Mix75/25 dose, meal plan, or both.

Pediatric Use

Safety and effectiveness of Humalog Mix75/25 in patients less than 18 years of age have not been established.

Geriatric Use

Clinical studies of Humalog Mix75/25 did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently than younger patients. In general, dose selection for an elderly patient should take into consideration the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy in this population.

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Adverse Reactions

Clinical studies comparing Humalog Mix75/25 with human insulin mixtures did not demonstrate a difference in frequency of adverse events between the two treatments.

Adverse events commonly associated with human insulin therapy include the following:

Body as a Whole — allergic reactions (see PRECAUTIONS).

Skin and Appendages — injection site reaction, lipodystrophy, pruritus, rash.

Other — hypoglycemia (see WARNINGS and PRECAUTIONS).

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Overdose

Hypoglycemia may occur as a result of an excess of insulin relative to food intake, energy expenditure, or both. Mild episodes of hypoglycemia usually can be treated with oral glucose. Adjustments in drug dosage, meal patterns, or exercise, may be needed. More severe episodes with coma, seizure, or neurologic impairment may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose. Sustained carbohydrate intake and observation may be necessary because hypoglycemia may recur after apparent clinical recovery

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Dosage and Administration

Table 1*: Summary of Pharmacodynamic Properties of Insulin Products (Pooled Cross-Study Comparison)

The information supplied in Table 1 indicates when peak insulin activity can be expected and the percent of the total insulin activity occurring during the first 4 hours. The information was derived from 3 separate glucose clamp studies in nondiabetic subjects. Values represent means, with ranges provided in parentheses.

Insulin Products

Dose, U/kg

Time of Peak Activity, Hours After Dosing

Percent of Total Activity Occurring in the First 4 Hours

Humalog

0.3

2.4
(0.8 - 4.3)

70%
(49 - 89%)

Humulin R

0.32
(0.26 - 0.37)

4.4
(4.0 - 5.5)

54%
(38 - 65%)

Humalog Mix75/25

0.3

2.6
(1.0 - 6.5)

35%
(21 - 56%)

Humulin 70/30

0.3

4.4
(1.5 - 16)

32%
(14 - 60%)

Humalog Mix50/50

0.3

2.3
(0.8 - 4.8)

45%
(27 - 69%)

Humulin 50/50

0.3

3.3
(2.0 - 5.5)

44%
(21 - 60%)

NPH

0.32
(0.27 - 0.40)

5.5
(3.5 - 9.5)

14%
(3.0 - 48%)

NPL component

0.3

5.8
(1.3 - 18.3)

22%
(6.3 - 40%)

Humalog Mix75/25 is intended only for subcutaneous administration. Humalog Mix75/25 should not be administered intravenously. Dosage regimens of Humalog Mix75/25 will vary among patients and should be determined by the healthcare provider familiar with the patient's metabolic needs, eating habits, and other lifestyle variables. Humalog has been shown to be equipotent to Regular human insulin on a molar basis. One unit of Humalog has the same glucose-lowering effect as one unit of Regular human insulin, but its effect is more rapid and of shorter duration. Humalog Mix75/25 has a similar glucose-lowering effect as compared with Humulin 70/30 on a unit for unit basis. The quicker glucose-lowering effect of Humalog is related to the more rapid absorption rate of insulin lispro from subcutaneous tissue.

Humalog Mix75/25 starts lowering blood glucose more quickly than Regular human insulin, allowing for convenient dosing immediately before a meal (within 15 minutes). In contrast, mixtures containing Regular human insulin should be given 30 to 60 minutes before a meal.

The rate of insulin absorption and consequently the onset of activity are known to be affected by the site of injection, exercise, and other variables. As with all insulin preparations, the time course of action of Humalog Mix75/25 may vary considerably in different individuals or within the same individual. Patients must be educated to use proper injection techniques.

Humalog Mix75/25 should be inspected visually before use. Humalog Mix75/25 should be used only if it appears uniformly cloudy after mixing. Humalog Mix75/25 should not be used after its expiration date.

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How Supplied

Humalog Mix75/25 [75% insulin lispro protamine suspension and 25% insulin lispro injection, (rDNA origin)] is available in the following package sizes: each presentation containing 100 units insulin lispro per mL (U-100).

10 mL vials

NDC 0002-7511-01 (VL-7511)

5 x 3 mL prefilled insulin delivery devices (Pen)

NDC 0002-8794-59 (HP-8794)

5 x 3 mL prefilled insulin delivery devices (KwikPen™)

NDC 0002-8797-59 (HP-8797)

Storage — Humalog Mix75/25 should be stored in a refrigerator [2° to 8°C (36° to 46°F)], but not in the freezer. Do not use Humalog Mix75/25 if it has been frozen. Unrefrigerated [below 30°C (86°F)] vials must be used within 28 days or be discarded, even if they still contain Humalog Mix75/25. Unrefrigerated [below 30°C (86°F)] Pens, and KwikPens must be used within 10 days or be discarded, even if they still contain Humalog Mix75/25. Protect from direct heat and light. See table below:

Not In-Use (Unopened) Room Temperature [Below 30°C (86°F)]

Not In-Use (Unopened) Refrigerated

In-Use (Opened) Room Temperature [Below 30°C (86°F)]

10 mL Vial

28 days

Until expiration date

28 days, refrigerated/room temperature.

3 mL Pen and KwikPen (prefilled)

10 days

Until expiration date

10 days. Do not refrigerate.

KwikPens manufactured by Eli Lilly and Company, Indianapolis, IN 46285, USA

Pens manufactured by Eli Lilly and Company, Indianapolis, IN 46285, USA or Lilly France, F-67640 Fegersheim, France

Vials manufactured byEli Lilly and Company, Indianapolis, IN 46285, USA or Lilly France, F-67640 Fegersheim, Francefor Eli Lilly and Company, Indianapolis, IN 46285, USA

www.Humalog.com

PV 5551 AMP

last updated 03/2009

Humalog Pen, Humalog Cartridge, KwikPen, insulin lispro patient information (in plain English)

Detailed Info on Signs, Symptoms, Causes, Treatments of Diabetes


The information in this monograph is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects. This information is generalized and is not intended as specific medical advice. If you have questions about the medicines you are taking or would like more information, check with your doctor, pharmacist, or nurse.

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APA Reference
Staff, H. (2009, March 16). Humalog for Treatment of Diabetes - Humalog Full Prescribing Information, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/diabetes/medications/insulin-injecting-diabetes-treatment

Last Updated: March 10, 2016

NIMH: Psychotherapy and Antidepressant Medications Work Best

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Treatment choice will depend on the outcome of the evaluation. There are a variety of antidepressant medications and psychotherapies that can be used to treat depressive disorders. Some people with milder forms may do well with psychotherapy alone. People with moderate to severe depression often benefit from antidepressants. Most do best with combined treatment: antidepressant medication to gain relatively quick symptom relief and psychotherapy to learn more effective ways to deal with life's problems, including depression. Depending on the patient's diagnosis and severity of symptoms, the therapist may prescribe antidepressant medication and/or one of the several forms of psychotherapy that have proven effective for depression.

More Info

Depression Treatments: Depression Medications and Therapeutic Treatments

Living Without Depression and Manic Depression: A Guide To Maintaining Mood Stability

Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You

Many forms of psychotherapy, including some short-term (10-20 weeks) therapies, can help depressed individuals. "Talking" therapies help patients gain insight into and resolve their problems through verbal "give-and-take" with the therapist. "Behavioral" therapies help patients learn how to obtain more satisfaction and rewards through their own actions and how to unlearn the behavioral patterns that contribute to or result from their depression.

Two of the short-term psychotherapies that research has shown helpful for some forms of depression are interpersonal and cognitive/behavioral therapies. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate (or increase) the depression. Cognitive-behavioral therapists help patients change the negative styles of thinking and behaving often associated with depression.

Psychodynamic therapies, which are sometimes used to treat depressed persons, focus on resolving the patient's internal conflicts. These therapies are often reserved until the depressive symptoms are significantly improved. In general, severe depressive illnesses, particularly those that are recurrent, will require medication (or ECT under special conditions) along with, or preceding, psychotherapy for the best outcome.

Source: National Institute of Mental Health

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APA Reference
Staff, H. (2009, March 15). NIMH: Psychotherapy and Antidepressant Medications Work Best, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/lexapro/patient-center/nimh-psychotherapy-and-antidepressant-medications-work-best

Last Updated: January 14, 2014

The Power of Social Support

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My definition of a man is this:
a being who can get used to anything."
Dostoyevsky

The title of my book is When Going Through Hell - Don't Stop! What do I mean by hell? I define it as "relentless physical or emotional pain that appears to have no end." This was my experience of living with chronic, unremitting anxiety and depression.

I found that the best way to cope with such intense discomfort was to live my life one day at a time. Whenever I contemplated the prospect of dealing with my pain over the long term, I became overwhelmed. But if I could reduce my life to a single 24-hour segment of time-that was something I could handle. If I could tread water (or, being in hell, tread fire) each day, then perhaps I could survive my ordeal.

Working together, my therapist and I created what I called "my daily survival plan for living in hell." The central idea was simple-to develop coping strategies that would get me through the day, hour by hour, minute by minute. Because I was fighting a war on two fronts, I had to devise and employ techniques that would deal with both the depression and the anxiety. I used my coping strategies to create four categories of support, which I have summarized on the following pages. These categories are: physical support, mental/emotional support, spiritual support, and most importantly, people support.

What follows is a brief outline of my daily survival plan. I have rewritten it in the second person so that you can adapt it to your individual needs. Remember, the goal is to identify coping strategies that will keep you safe and get you through each day until the pattern of the depression shifts.

A. People Support

Social support is a key ingredient in dealing with emotional pain. Find a way to structure your daily routine so that you will be around people much of the time. If there is a day treatment program in your area, some form of group therapy, or depression support groups at your local hospital, attend them. Don't be embarrassed about asking for help from family members or friends. You are suffering from an illness, not a personal weakness or defect in character.

My own sense of connection with people gave me a reason not to harm myself. I did not want to afflict my friends and family with the anguish that would result from my self-imposed departure. A lifeguard at the pool where I swam, agreed with my thinking. "Other people are a good reason to stay alive," she affirmed.

Support is critical in helping people to cope with all kinds of extreme circumstances. Survivor researcher, Julius Siegal, emphasizes that communication among prisoners of war provides a lifeline for their survival. And for those who are prisoners of their inner wars, support is equally crucial. In chronicling his own depressive episode, novelist Andrew Solomon wrote:

Recovery depends enormously on support. The depressives I've met who have done the best were cushioned with love. Nothing taught me more about the love of my father and my friends than my own depression.

B. Physical Support

The second aspect of your daily survival plan consists of finding ways to nurture your physical body. Here are some suggestions.

  • Exercise: Research has shown that regular exercise can improve mood in cases of mild to moderate depression. Exercise is one of the best ways to elevate and stabilize mood as well as improve overall physical health. Pick an activity that you might enjoy, even if it is as simple as walking around the block, and engage in it as often as you can (three to four times a week is ideal).

  • Diet and Nutrition: Eat a diet that is high in complex carbohydrates and protein, avoiding foods such as simple sugars that can cause emotional ups and downs. Try to stay away from foods that have chemical additives or preservatives that may create ups and downs for chemically sensitive individuals.

  • Sleep: Adopt a regular sleep schedule to get your body into a routine. If you have trouble getting to sleep or suffer from insomnia, there are behavioral techniques as well as medication that can help you to sleep. The book "No More Sleepless Nights" by Peter Hauri is a good resource.

  • Medication: Take your antidepressant medication as prescribed. Check with your health care professional before making any changes in dosage. Be patient and give the medicine enough time to work.

C. Mental/Emotional Support

Every thought and feeling produces a neurochemical change in your brain. Although you may not always be able to control the painful symptoms of depression and anxiety, you can influence the way you think and feel about those symptoms.

  • Monitoring self-talk. Monitoring one's self-talk is an integral strategy of cognitive-behavioral therapy, a talk therapy widely used in treating depression. You may wish to work with a therapist who specializes in cognitive therapy. He or she can help you to replace thoughts of catastrophe and doom with affirmations that encourage you to apply present-moment coping strategies. For example, the statement "My depression will never get better" can be replaced by the affirmation "Nothing stays the same forever" or "This, too, will pass." Switching from negative to positive self-talk is a process that may have to practiced once, twice, sometimes ten times a day. Since the depressed brain tends to see life through dark-colored glasses, monitoring one's inner dialogue provides a lifeline to healing.


  • Keep a mood diary.One of the survival techniques I used to stay alive in my hell was to keep track of my anxiety and depression on a day-to-day basis. To this end, I created a daily mood scale. Somehow, the simple act of observing and recording moods gave me a sense of control over them. I also used the mood diary to track my reactions to pharmaceutical drugs and to record daily thoughts and feelings. Here is the scale that I used. Feel free to adapt it to your own needs.

Daily Mood Scale

Score 1-10
Depression
Score 1-10
Anxiety
8 -10
despair, suicidal feelings,
8 - 10
out-of-control behavior, hitting, rhyming voices
6 - 7
at the edge, feeling really bad
6 - 7
strong agitation, pacing
5
definite malaise, insomnia
5
moderate worry, physical agitation
3 - 4
depression slightly stronger
3 - 4
mild fear and worry
1 - 2
minorly depressed mood
1 - 2
slight fear and worry
0
absence of symptoms
0
absence of symptoms

Clearly the goal is to be on the low end of the scale. The lower the number, the fewer the symptoms.

  • Be compassionate with yourself. As part of one's emotional self-care, it is important to release the toxic feelings of blame, guilt or shame that are so often felt by a person who is depressed. Try to remember that depression is an illness, like diabetes or heart disease. It is not caused by a personal weakness or a defect in character. It is not your fault that you have this disorder."

    Once again you can turn to the affirmation process. Whenever you start to judge yourself for being depressed you can repeat, "It's not my fault that I am unwell. I am actually a powerful person residing inside a very sick body. I am taking good care of myself and will continue to do so until I get well."

  • Focus on the little things. In the middle of my episode I asked my therapist, if all I am doing is trying to survive from day to day, how do I find any quality to my life?"

    "The quality is in the little things," she replied.

    Whether it is a kind word from a friend, a sunny day, a beautiful sunset, or an unexpected break from the pain, see if you can take in and appreciate these small moments of grace. Having such moments is akin to making deposits into an "emotional bank account." When the dark periods return, you can draw upon these stored memories and affirm that life can still be beautiful, if only for an instant.

    Above all, no matter how bad things seem, remember that nothing stays the same forever. Change is the only constant in the universe. One of the most powerful thoughts you can hold is the simple affirmation "This too, will pass."

D. Spiritual Support

If you believe in God, a Higher Power, or any benevolent spiritual presence, now is the time to make use of your faith. Attending a form of worship with other people can bring both spiritual and social support. If you have a spiritual advisor (rabbi, priest, minister, etc.), talk with that person as often as possible. Put your name on any prayer support list(s) you know of. Don't be bashful about asking others to pray for you. (A list of twenty-four hour telephone prayer ministries in provided for you in my section on prayer.) The universe longs to help you in your time of need.

Because of the disabling nature of depression, you may not be able to implement all of the strategies that I have presented. That is okay. Just do the best you can. Do not underestimate the power of intention. Your earnest desire to get well is a powerful force that can draw unexpected help and support to you-even when you are severely limited by a depressive illness.

Healing from Depression: 12 Weeks to a Better Mood: A Body, Mind, and Spirit Recovery ProgramThis page was adapted from the book, "Healing from Depression: 12 Weeks to a Better Mood: A Body, Mind, and Spirit Recovery Program", by Douglas Bloch, M.A.

Bloch is an author, teacher and counselor who writes and speaks on the topics of psychology, healing and spirituality. He earned his B.A. in Psychology from New York University and an M.A. in Counseling from the University of Oregon.

Bloch is the author of ten books, including the inspirational self-help trilogy Words That Heal: Affirmations and Meditations for Daily Living; Listening to Your Inner Voice; and I Am With You Always, as well as the parenting book, Positive Self-Talk for Children.

next: ~ back to: Depression Articles

APA Reference
Staff, H. (2009, March 15). The Power of Social Support, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/lexapro/patient-center/the-power-of-social-support

Last Updated: January 14, 2014

Too Many Quit Taking Antidepressants Too Soon

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Taking Antidepressant Drugs at Least 9 Months Prevents Depression Relapse

It's a big problem: Too many people don't take antidepressants long enough to get the full benefit.

"A few weeks into it, people think 'OK, I feel better, I don't need to keep taking it anymore," says study researcher Scott A. Bull, PharmD, a pharmacy research analyst at Kaiser Permanente in Oakland, Calif.

However, depression has a high rate of relapse -- which very often occurs in the first year, Bull says. "The goal of depression treatment is to prevent these relapses." It can take 9 months of treatment -- maybe up to a year -- to help prevent a depression relapse.

But why do patients quit taking antidepressants? Bull sheds some light on the problem in the Sept. 18, 2002 issue of The Journal of the American Medical Association.

In their study, Bull and colleagues interviewed 99 doctors and 137 people with depression. People who had seen their doctors less than three times after starting their antidepressant were more likely to stop depression medication treatment because of side effects and because they did not clearly understand their treatment.

More patient-doctor visits are the answer, says Bull. "They provide an opportunity for these discussions to occur."

It's all very true, says Harold Koenig, MD, associate professor of psychiatry at Duke University School of Medicine.

"People who are depressed are not very motivated anyway," he says. "They need to be encouraged, to get past the negative thinking -- that this drug won't work, that it costs too much. Side effects can be upsetting. Plus, there's still a stigma about having to rely on a pill to feel normal."

"These antidepressant medications are very effective for treating depression. However, the body takes time to get used to them. They're changing your brain's biochemistry," says Koenig. Patients need to know that if one medication doesn't work, another one might.

Getting past initial side effects requires "toughing it out," Koenig says. "A lot of times people have to get over a hill -- side effects -- before they get to the valley. It can take a month to six weeks to get past that period. But that doesn't happen until you take the pills religiously -- every day -- because they have to build up in your system."

If this is the first depression -- and it's clearly linked with an event like divorce or job loss -- antidepressants may be necessary for no more than a year or so, Koenig says.

For people who have been depressed before, the drugs may be about the only way to get past depression. "Every episode actually creates permanent changes in the brain," he says. "Antidepressants are very effective in treating severe depression."

next: The Power of Social Support ~ back to: Depression Articles

APA Reference
Staff, H. (2009, March 15). Too Many Quit Taking Antidepressants Too Soon, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/lexapro/patient-center/too-many-quit-taking-antidepressants-too-soon

Last Updated: June 18, 2016

For Depression, the Family Doctor May Be the First Choice

see new important safety information

To treat severe or complicated depression, turn to a mental health specialist; a psychiatrist or psychologist. Here's why.

For most of his life, John Smythe of Glen Rock, N.J., struggled with a hot temper during day and insomnia at night. He thought of these problems as family traits; his parents had them, too. But two years ago his internist told him that they were signs of clinical depression.

John Greden
Dr. John Greden says, "Just as you wouldn't want a primary-care physician to do coronary bypass surgery, you wouldn't want one to treat severe or complicated depression."

"A chill went down my spine," recalled Mr. Smythe, 60, who runs a small business. "Depression to me was somebody walking around moping, sort of withdrawn. It never occurred to me that there could be other symptoms."

His internist, Dr. Rick Cohen of nearby Midland Park, prescribed an antidepressant. It did not take Mr. Smythe long to start feeling better. "I could stay rational without getting annoyed and slamming the phone down," he said. "It turned me around."

Mr. Smythe is in a lucky minority. Only about 40 percent of people in treatment for depression get adequate care, according to a survey of more than 9,000 Americans that was sponsored by the National Institute of Mental Health and released last week.

The study defined "adequate treatment for depression" as a course of at least 30 days on an antidepressant or a mood stabilizer, along with four visits to a doctor or at least eight 30-minute psychotherapy sessions with a mental health professional.

Dr. Ronald Kessler, a professor of health care policy at Harvard who was the lead author of the study, says a crucial problem is that general medical doctors tend to be the first line of defense against mental disorders as well as physical ones. Because they are not as well informed about depression as mental health specialists, he said, they are more likely to undertreat it — prescribing either too little medication or an inappropriate one, like an anti-anxiety drug.

These general practitioners, typically family doctors and internists, treat 70 percent of the people who seek help for depression, according to other research. And more of them are treating depression now than a decade ago, Dr. Kessler said, because the newer antidepressants - selective serotonin reuptake inhibitors - are safer and easier to prescribe than older drugs.

"The companies that make these drugs are providing more educational material to general medical doctors," he said.

Psychiatrists say the new findings should not be interpreted to mean that primary-care physicians are unqualified to treat depression.

"The notion that everybody with depression should be treated by a mental health professional is ridiculous," said Dr. John Greden, a psychiatrist who is director of the Depression Center at the University of Michigan.

Dr. Greden said many general practitioners could effectively treat people with mild to moderate depression. But he added that mental health professionals agreed that severe or intractable depression should be referred to a psychiatrist or a psychologist.


"Just as you wouldn't want a primary-care physician to do coronary bypass surgery, you wouldn't want one to treat severe or complicated depression," said Dr. Greden, who works with primary-care doctors in Michigan on ways to improve the diagnosis and treatment of depression.

But there are many obstacles to receiving adequate care from a general practitioner, even for mild or moderate depression, experts say. For one thing, Dr. Greden says, primary-care physicians do not receive enough training on how to recognize the condition.

"Most patients don't come in and say, `I feel sad or depressed,' " he said. "They emphasize complaints like fatigue or insomnia or other physical manifestations of depression."

So their doctors tend to treat the physical symptoms, Dr. Greden added, by prescribing sleeping pills for insomnia, for example, instead of looking for the underlying causes.

Another obstacle is that many general practitioners are uncomfortable talking about depression, said Dr. David Kupfer, chairman of psychiatry at the University of Pittsburgh Medical Center, who has studied trends in treating depression.

"If a patient talks about his sleep problems, the doctor won't ask about other possible depression symptoms," he said.

Yet another obstacle is time. Doctors in managed-care plans have a financial incentive to see as many patients as possible each day. Dr. Cohen, the internist, said the time pressure discouraged many of his colleagues from asking the necessary questions to find out whether patients are depressed.

"One colleague said to me, `I see so many patients a day, I don't want to open up a can of worms,' " he said.

When they do diagnose depression, primary-care doctors often fail to provide enough information on drugs' side effects, patients say. Yet unpleasant side effects from antidepressants llike anxiousness, weight gain and loss of sexual desire are among the main reasons that patients stop taking antidepressants.

Howard Smith

Howard Smith says the benefits of antidepressants can take a few weeks to show up.

"I've rarely heard any patient say, `My family doctor explained it all to me,' " said Howard Smith, director of operations for the Mood Disorders Support Group, an organization in New York City that operates support groups for people with depression and bipolar disorder.

Mr. Smith says the side effects can start within a day of two of beginning an antidepressant, but the benefits often take a few weeks to show up. "So patients call their doctors and complain that they feel sicker, and the doctors tell them to stop the medication or they prescribe something else," he said.

If doctors took the time to explain to their patients that the side effects were often temporary, he said, many more would continue treatment and have their depression effectively managed.

Dr. Cohen said most primary-care doctors did not know about the nuances of the many antidepressants — which ones are best for particular symptoms and what to do if the lowest dose does not work.

"Internists are grilled on how to use multiple medications for diabetes or hypertension and how to switch medications if the first one doesn't work," he said. "But there's not as much education geared to internists on dosing and switching antidepressants."


Further, research has shown that depression medication and psychotherapy together are more effective for treating depression than either approach alone.

If general practitioners lack the time and expertise to treat depression properly — and if they are not compensated enough for it under managed care — why do they provide most of the treatment for depression?

"Many of my patients want me to treat them because they trust me as their family doctor," said Dr. Jim Martin, a family physician in San Antonio. "Some of my patients don't want to see a specialist because of the stigma of depression."

But growing numbers of patients no longer have the choice, he added, because some managed-care plans have begun reducing or even eliminating coverage for general practitioners for treating depression.

Psychiatrists say it is unrealistic to think that mental health professionals can do the job themselves because there are not enough of them to treat the estimated 35 million Americans with depression, only about half of whom receive treatment now.

"Without primary-care physicians, we won't make a dent in treating more people with depression," Dr. Greden said.

His research shows that primary-care physicians improve their ability to diagnose and treat depression when they forge relationships with psychiatrists and psychologists, consulting with them about particular patients. Under this model, primary-care doctors do the medical treatment, but check with the specialists about drug choice and dosing and refer patients to them for talk therapy.

"If general practitioners don't have the wiggle room from managed care to spend more time with patients who are suffering from depression," Dr. Kupfer said, "society will pay a large price in suicides and in high levels of impairment."

Source: NY Times

You can find comprehensive information about depression and treatment for depression in the HealthyPlace.com Depression Center.

next: Too Many Quit Taking Antidepressants Too Soon ~ back to: Depression Articles

APA Reference
Staff, H. (2009, March 15). For Depression, the Family Doctor May Be the First Choice, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/lexapro/patient-center/for-depression-the-family-doctor-may-be-the-first-choice

Last Updated: January 14, 2014

Depression Articles and News Stories Table of Contents

APA Reference
Staff, H. (2009, March 15). Depression Articles and News Stories Table of Contents, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/lexapro/patient-center/depression-articles-and-news-stories-toc

Last Updated: January 14, 2014

How to Use Lexapro

Instructions for taking Lexapro, how to handle a missed dose of Lexapro, and Lexapro effectiveness.

Taking LEXAPRO

LEXAPRO tablets or oral solution should be taken once daily morning or evening, with or without food, and followed by a full glass of water. Take LEXAPRO exactly as directed by your doctor. If you do not understand these instructions, ask your pharmacist, nurse, or doctor to explain them to you.

If your physician has prescribed the oral solution of LEXAPRO, be sure to use a dose-measuring spoon, cup, or dropper, not a regular tablespoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

Do not stop taking LEXAPRO without first talking to your doctor. Remember that you must allow time to feel the full benefit of drug therapy for depression. It may take several weeks for you to start feeling better.

Store LEXAPRO at room temperature away from moisture and heat.

LEXAPRO Effectiveness

In clinical studies, many patients treated with LEXAPRO began to feel better within 1 or 2 weeks, although the full effect may take 4 to 6 weeks. You should follow up with your healthcare professional or doctor and report your progress.

Remember to take your medication as long as your healthcare professional advises, even if you start feeling better; otherwise your symptoms could return or worsen.

Missed a Dose of Lexapro

If you forget to take your prescribed dose of LEXAPRO, take the missed dose that same day as soon as you remember, then call your healthcare professional or doctor for more information. The next day, resume according to your regular dosing schedule. Doubling a daily dose to compensate for a missed dose is not recommended. If you have additional questions about dosing, please talk to your healthcare professional.

What to Avoid While Taking LEXAPRO

Because drugs of this type may impair judgment, thinking, or motor skills, they should be used with caution in patients operating hazardous machinery, including automobiles, until patients are reasonably certain that LEXAPRO does not affect their abilities to engage in such activities.

Use alcohol cautiously. Alcohol may increase drowsiness and dizziness while taking LEXAPRO or may affect your condition.

LEXAPRO should not be taken concurrently with citalopram (Celexa™).

See Drug Interactions.

Adults with Major Depressive Disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. Patients being treated with antidepressants should be observed closely for clinical worsening and suicidality, especially at the beginning of a course of drug therapy, or at the time of dose changes, either increases or decreases. Lexapro is contraindicated in patients taking monoamine oxidase inhibitors (MAOIs), pimozide (see DRUG INTERACTIONS - Pimozide and Celexa), or in patients with a hypersensitivity to escitalopram oxalate. As with other SSRIs, caution is indicated in the coadministration of tricyclic antidepressants (TCAs) with Lexapro. As with other psychotropic drugs that interfere with serotonin reuptake, patients should be cautioned regarding the risk of bleeding associated with the concomitant use of Lexapro with NSAIDs, aspirin, or other drugs that affect coagulation. The most common adverse events reported with Lexapro vs placebo (approximately 5% or greater and approximately 2x placebo) were nausea, insomnia, ejaculation disorder, somnolence, increased sweating, fatigue, decreased libido, and anorgasmia

next: LEXAPRO Side-Effects Profile

APA Reference
Staff, H. (2009, March 15). How to Use Lexapro, HealthyPlace. Retrieved on 2024, October 9 from https://www.healthyplace.com/lexapro/patient-center/use

Last Updated: January 14, 2014