Onika L. Dainty

Bipolar I disorder is a mood disorder characterized by extreme highs (hypomanic, manic and psychotic episodes) and extreme lows (depressive episodes). When living with Bipolar I disorder it is necessary to take some form of medication to manage these drastic pendulums of moods otherwise you would be in constant flux between severe illness and short periods of stability. 

My medication journey started over 20 years ago and I have had both ups and downs when trying to find a medication cocktail that works best with my Bipolar disorder. Before I get into more details I would like to add that using medication to manage your Bipolar symptoms is a personal choice. Not everyone agrees with Western medicine and the methods it uses, however for me I have found that currently Bipolar disorder medications speak to my experience with this illness and I take medication daily for my mental health and sustained wellbeing.

There are four classes of medications used to address the various symptoms related to Bipolar disorder:

• Antidepressants: a class of medications used to treat depression and other mental health conditions. They work by increasing the activity of neurotransmitters in the brain. Side effects include-vomiting, diarrhea, weight gain, dry mouth, headaches, anxiety, sedation, tremors, constipation and in some cases thoughts of suicide.  

• Anticonvulsant: also known as anti-seizure medication is a class of medications that prevents or treats seizures and convulsions. They work by controlling abnormal electrical activity in the brain. Side effects include-drowsiness, fatigue, headaches, dizziness, nausea, blurred vision, stomach upset, weight gain or loss; rare but serious side effects include Stevens-Johnson's syndrome, liver failure, psychosis and lupus.

• Mood Stabilizers: a class of medications used to treat mood disturbances, such as Mania and Depression, and to help prevent manic and depressive episodes. They can also help reduce symptoms of Mania, such as rapid mood changes, sleep difficulties, racing thoughts, and risky behaviors. Lithium is the most widely used mood stabilizing drug.Side effects include-itchy skin or rashes, increased thirst, frequent urination, nausea, vomiting, slurred speech, blackouts, changes in vision, seizures, loss of coordination, weight gain, fatigue, headaches, drowsiness, dizziness, impaired memory, difficulty concentrating, hair loss, changes in menstrual cycle.

• Antipsychotics: a class of medication used to treat symptoms of psychosis, such as hallucinations, delusions and disorganized thinking. They work by altering brain chemistry to reduce psychotic symptoms and prevent them from returning. Side effects include-drowsiness, dizziness, dry mouth, blurred vision, tiredness, nausea, constipation, weight gain, trouble sleeping, tremors, stiffness, agitation, fluid retention, sexual problems, headaches, loss of menstrual periods in women, breast tenderness, muscle or nervous system problems. 

My Medication Journey

My medication journey had a rocky start in 2006, after my first manic-psychotic episode. I was given a cocktail of mood stabilizers, anticonvulsants and antipsychotics to stabilize me during what can only be called an extreme first episode. There are what I now call standard side effects like tiredness, drowsiness, tremors, increased appetite and dry mouth, that for me have come with the territory of taking this medication combination. 

However, three weeks after taking an anticonvulsant and mood stabilizer called Epival (Divalproex) I developed a rare and severe side effect called Stevens-Johnson syndrome, a flesh-eating skin disease that affects less than 1% of patients that take it. Once my medical team realized what was happening I was taken off this medication and put on Lithium which remains the main mood stabilizer I take daily. 

My Journey with Weight Gain and Medication

After extensive research and a lot of trial and error I have discovered that there are no Bipolar medications currently available where possible weight gain is not a side effect. For myself, it's the combination of mood stabilizers and antipsychotics that lead to increased appetite and weight gain. Both classes of medications have a weight gain component so when you put them together the likelihood of increased weight is inevitable for me. I have tried almost every combination of medication for my Bipolar and the one side effect that remains constant is gaining weight either an extreme amount (50lbs-80lbs) or a manageable amount (10lbs-15lbs). The only method I’ve found to combat this problematic side effect is being mindful about my diet and incorporating exercise into my daily routine. 

Though I still find it difficult to lose weight I am able to maintain the number I see on the scale. A large part of medication management is self-love, self-acceptance and self-awareness. It was important for me to learn to love the skin I’m  in and not focus on the weight. It's about realizing that in my experiences  the positive effects of taking medication outweigh the negative side effects like weight gain and I have to give myself grace regardless of where the numbers land. Yes, my body isn’t always the size I desire but where would my mind be without the medication? If you are not there yet it’s also important to advocate for yourself with your medical team to find a combination of medications that suit your needs both mentally and physically. I’ve been on this medication journey for a very long time and I’ve realized certain side effects for me come with the territory and I am still learning to accept that. 

My Journey with Medication Non-Compliance

There have been many times on my medication journey where the side effects became so overwhelming I stopped taking my meds all together. Other times I was actually doing well on my medication and I stopped for that very reason–I was doing well and convinced myself I was better and didn’t need them. In either scenario, I had some hard lessons to learn from medication non-compliance. My current reality is I have a severe mood disorder called Bipolar I which means my brain chemistry is imbalanced causing extreme mood swings that go from Hypomania or Mania (high-highs) to Manic-psychosis (losing touch with reality) to Depression (low-lows). 

Without a medication regimen that keeps me balanced my brain is in constant flux between these extreme emotional states. When I take my medication as prescribed and I don’t use other outside substances I can maintain a baseline (stable mood) that allows me to live a full and enriching life. When I am non-compliant with my medication I enter chaos where I can do irreparable damage to my life and the lives of those around me.

Another aspect of medication non-compliance that is rarely discussed is there is no guarantee the medication cocktail that originally stabilized you will work after you have another Bipolar episode due to stopping your meds. Every episode is like a fingerprint, unique in that the physiological and psychological damage that is done is different in every episode and must be treated differently. For example, For seven years my therapeutic Lithium levels created a mood baseline. When I stopped taking my medication I had several manic-psychotic episodes due to a dangerously low Lithium level.  After hospitalization when Lithium was reintroduced to my system doctors had to give me the highest level of the medication for a longer period of time to stabilize me. Essentially, this process changed my Bipolar I disorder mood baseline.

Final Thoughts

 I used to take a handful of prescribed pills a day to manage my illness, swallowing them all was excruciating. I would look at them and say to myself “Only for now, not forever.” What I wasn’t able to see or accept until now was that medication will probably always be a part of my mental health journey but through  self-advocacy and determination I have worked with my medical team to cut my daily medication intake down by more than half which is much easier to swallow. By practicing self-compassion, self-love and self-acceptance I’m learning that side effects like weight gain are simply a trade off for stability not a character deficit or personal failure.

Like almost all things in life, taking medication to manage your mental illness is a choice. I have chosen to incorporate medication management on my journey to wellness. There are people in my life that are grateful for me staying compliant with my medication regimen and others who are always ready to offer alternative treatments to my Bipolar I disorder. Only you can decide what's right for you. I have experienced life both on and off medication and I prefer to use medication as a tool to enhance my mental health and manage my illness. I am well researched on new and emerging medication options for Bipolar disorder and I speak with my pharmacist and psychiatrist regularly about how to continue to have positive experiences through medication and mitigate the negative side effects that cause problems on my journey to better health.

Everyone’s medication journey will look and feel different. The side effects that are a challenge for me may not be a part of your story. That’s why it’s important to have these honest conversations that take us beyond the stigma of taking mental health medications by sharing our trials about the adverse effects these medications have on our mind and body. If you want to share any part of your medication journey  I would love to hear from you, please comment below.  

If you or someone you know is on a mental health medication journey speak with your pharmacist to discover what’s new in the mental health medication world that can help you find a cocktail that suits your unique needs.Remember, you are not alone, so let’s continue the conversation in hopes of fostering hope, change and understanding on our path to wellness.  

Life Lesson #4

Seventy-one and a half miles. 

190,725 steps. 

18 days.

When I think about where and when I first heard this quote I draw a blank. It’s as if I was born with this philosophy in my bones and in my heart so the first time it appeared before me I already knew it. It's the story of my life, reminding me that no matter what my goals are, what challenges I face, what adversity I need to overcome to reach my final destination I must take the most important first step without fear of the outcome or even knowing where the journey will take me. Even when the walk feels impossible and never-ending, every journey is an adventure with no guarantees that it will help you or hurt your current circumstance. By taking the first step the only certainty is that you will have to continue to walk down an unknown path to gain knowledge and understanding of your purpose, to learn the lessons that every journey teaches you. 

I remember the fear I felt at 5 years old taking that first step onto an airplane at the Cheddi Jagan International Airport in my home Guyana where my mother and I would fly to Canada, to our new lives and it feels like I’ve been taking first steps ever since. 

The first step into a Canadian elementary school where I would experience racism and bullying. 

The first step into my new house in Pickering, ON where I felt love and happiness, where I wrote my first award-winning poem, where my family was whole. 

My first step into the hallways of my high school where I experienced gender-based violence, fear and constant anxiety. 

The first step onto my university campus where I found escape from my past, where I smoked my first joint while experiencing extreme depression, where I graduated with my first Honours degree in History

My first step inside the observation room of a Psychiatric Intensive Care Unit (PICU) where I would be diagnosed with Bipolar I disorder  and the course of my life would be forever changed.

When I was discharged from my first psychiatric hold I had no idea that on my journey to wellness I would have copious admissions, struggle with substance use issues, go to rehab, have a dual-diagnosis, have a co-occurring disorder, be non-compliant with my medication, be restrained to multiple hospital beds, be fired from numerous jobs, lose friendships, lose family, face my trauma, face the death of loved ones, experience homelessness, successfully complete two other higher-education credentials, become a national ambassador for mental health, start a podcast, be an advocate and public speaker for mental illness, write a book, re-write a book start a blog, be reunited with my family, enjoy cooking, live in a beautiful house or end-up going to the gym everyday.   

Seventy-one and a half miles. 

190,725 steps. 

18 days.

The above stats are the amount of miles I’ve walked on the treadmill and the amount of steps I’ve taken in the 18 days I’ve been going to the gym. It might not seem relevant in the face of everything else I’ve said but for me it represents what Lao Tzu is trying to say. The journey of a thousand miles begins with a single step. It's about making a decision to change your circumstances, to be resilient in the face of adversity, being fearless and doing something you’ve never done before in an attempt to change the direction of your life. I have had a lot of tragedy on my journey but I’ve had a lot of triumphs as well. I choose to learn from the tragedy and celebrate the triumphs by filling my journey with things, people and experiences that bring me joy. I choose to fearlessly walk my thousand miles in happiness and hope instead of fear and despair. Thank you Lao Tzu for teaching me how important it is to take the first step.

The Challenges of Dating: Women’s Experiences with Bipolar Disorder

Love, Relationships and Bipolar Disorder Series - Part 5

When entering into a dating dynamic it's easy to neglect the principles of mental health and wellness that are important to managing your Bipolar disorder. Dating comes with new and unknown elements that can have either positive or challenging outcomes for the already established regime that women create for managing their mental illness. In this article I will explore why it's important to maintain structure, routine and habits while dating, how to balance self-care and relationship commitments and tools and resources that can be helpful for having a positive dating experience. 

Maintaining Stability: Structure, Routine and Habits While Dating

Establishing structure, routine and good habits are crucial when managing Bipolar disorder. Important practices like having an organized living space, good sleep and personal hygiene can be important to how you function in your mental health and in your new dating dynamic. Bipolar disorder and the mood shifts that come with the illness may be affected in a negative way if you are unable to maintain and manage the norms you establish for yourself prior to introducing a potential partner into your world. 

Dating can be filled with experiences and emotions that you are required to navigate. So it's key that you maintain your equilibrium by continuing to create structure, routine and habits that allow you to manage the often unknown challenges that can come with dating a potential partner. Women who have Bipolar disorder can feel a gambit of strong emotions while going through the dating experience similar to women who do not deal with mental illness. It's important to establish a self-care tool kit for dating before your emotional wellness is tested. 

Here are some suggestions for what you may include in your Dating Self-Care Tool-Kit:

• Journaling: writing can help you process any mood swings or emotional irregularities that may arise when dating a potential partner. Journaling daily about your dating experiences and the feelings connected to them can help you decide if you want to continue the relationship or take a break to focus on your needs or personal goals.

• Meditation: listening to calming meditation music before or after a date or before bed can help calm and center your mind bringing back balance and focus on the things you want to achieve in your life and relationships.

• Music: Listening to your favorite music playlist can evoke feelings of joy and happiness allowing you to express your emotions in a healthy way. Singing-a-long or dancing to the beat of music acts as a release for pent up emotions and can bring you back to a more balanced state of mind. 

• Exercise: a daily exercise routine can release the feel-good chemicals your brain needs to maintain good mental health. Whether it’s yoga, walking or high-intensity cardio, taking the time to address your physical needs with exercise is a great way to refocus, reset and reframe your thoughts, feelings and emotions.  

• Nutrition: Eating a wholesome and balanced meal can give you the energy you need to face either positive or negative challenges in your dating experience. Sometimes indulging in comfort foods like mac and cheese or chocolate may be just what you need to feel good  but it’s important to remember not to overindulge as this could lead to unhealthy patterns and behaviours related to managing challenging feelings in your potential relationship. 

• Medication Management: It’s important to continue to manage your medication regime during the dating experience. Taking your medication as prescribed will ensure they continue to be a benefit to your mental health and mood stability.  Maintaining balance in your mental illness is essential to positive outcomes in both your daily life and your dating life.

• Therapy/Counselling: talking to your therapist or councillor can help you manage the difficult up and down emotions that can come with dating. Being open with your healthcare professionals as well as your support team can foster open communication with your potential partner. Being able to express yourself about the dating process with a professional can assist in navigating the more challenging emotions that come with dating.   

• Stay Grounded: practice grounding techniques like breathing exercises or walking in nature can help manage the strong emotions that can come up while dating. Another practice that has recently been suggested for staying grounded is walking or standing barefoot outside or inside your home. There is a school of thought that suggests connecting with the earth or “earthing” can reduce stress, improve sleep, ease anxiety and enhance mood. 

 Resources and Support in Your Community or Online

If you are considering starting to date and are concerned about the challenges you may face due to mental illness below are a few resources that may help:

Ontario Shores Centre for Mental Health Science: Cognitive Behavioral Therapy (CBT); Cognitive Processing Therapy (CPT)  Group Program- Outpatient referral and self-referral programs.  

Center for Addiction and Mental Health (CAMH)- Mental Health 101, Bipolar Disorder: Information Guide-Free tutorial 

Durham Mental Health Service (DMHS)-Community Support Programs; Peer Support Services. Outpatient referral and Self-referral. 

Apps That Support Dating with Mental Illness

NoLongerLonely: app focuses on connecting singles with mental issues, allowing people to openly disclose their issues. 

Hinge and OKCupid: these apps increasingly encourage people to discuss their mental health issues through profile prompts and features that facilitate these conversations. 

Final Thoughts

Like most things in life worth trying, dating will come with its own unique challenges. One of the key ways of dealing with challenges is being prepared for both positive or negative outcomes. Having a Dating Self-Care Tool-Kit is a great way to enter the world of potential relationships. Self-care is essential to maintaining good mental health therefore when embarking on the journey of dating it's important to have the tools you require to manage your Bipolar disorder. Maintaining structure, routine and habit during your dating life is also a great way to ensure your mood and emotions remain stable. Remember, you are not alone in your journey to love so lean on your support team, healthcare professionals and use the resources that are available to have the best dating experience possible. 

Remember, “the best dates are the ones that surprise us,” so I’m wishing all my readers lots of great surprises in your dating adventures. Happy Valentine’s Day.  

Love, Relationships and Bipolar Disorder Series - Part 4

One of the most difficult and emotional aspects of a relationship is when it ends. When you struggle with a mood condition like Bipolar disorder it can be even more challenging to find your balance after a break-up, whether you are the one to end the relationship or it's the other party's decision. Breakups fall under the category of trauma and can trigger mood swings and intensify emotions. It is important to use your mental health tool kit to manage the myriad of feelings such as sadness, shame, guilt, anger, regret or pain that may plague your mind during this difficult process. 

Managing Your Mental Illness While Dealing with a Breakup: Coping Mechanisms

Managing your Bipolar disorder can be difficult on a good day. But how do you manage a mood disorder with a major element of emotional dysfunction when you are faced with the end of a romantic relationship that has the potential to send you spiraling into mood swings and emotional chaos? 

The following is a list of healthy coping mechanisms for dealing with a breakup:

• Allow Yourself to Feel Your Emotions: breakups are similar to the grieving process after a loved one passes. It's okay to feel your feelings whether they range from sadness to guilt or anger. It's also okay to let your emotions out in a healthy way like crying for a period of time. It's important to remember that whatever feelings you are experiencing are real and valid.  It's also important to process then let go of the difficult emotions and move forward into a more positive headspace.

• Talk to Someone: one of the most productive ways to get through a break-up is communicating your thoughts and feelings about the situation to a close friend, a loved one or in therapy or counseling. Use your support system when you are struggling with difficult emotions as they could have ideas on how to move forward, use empathic language to encourage you, share their own lived experience with break-ups or simply just be there to listen or be a sounding board. 

• Social Media Detox: One of the biggest challenges when dealing with a difficult break-up is the presence of the other party on your social media channels. It's been recommended to me in the past to do a 30-day social media cleanse where you limit access to all accounts that may be related to the other party (i.e. their friends or loved ones), limit access to any photographs or videos that may trigger difficult emotions.This may be hard at first but it allows you the time you need to process the break-up and ultimately heal and move forward.

• Set Boundaries: You may find yourself in a situation where there is still contact via phone or text between yourself and the other individual involved in the break-up. These unhealthy behaviours only serve to prolong the process of moving forward and can leave you stuck in the mindset that the break-up is temporary. It is important to communicate before the end of a relationship the reasons why you two are not suited.  

Once this communication has occurred, set boundaries expressing your need for emotional and physical space to heal and move forward. In other words, if you are in the midst of a break-up likely there is a reason and setting healthy boundaries will give you the opportunity to take care of your mental health and prepare yourself for future connections.     

• Self-Care: Practicing self-care is a great way to manage your feelings around a break-up. Having a daily routine around taking care of yourself is essential. Having good sleep hygiene and physical hygiene like daily showers and brushing your teeth can go a long way in helping you avoid depression or anxiety. Daily journaling where you write thoughts about the break-up can help you track your moods as well as process your feelings and can help with healing and moving forward. Exercise and nutrition can serve in physical wellness which promotes focus, motivation and energy. 

• Medication Management:  It's important to continue to manage your medication  taking your mood stabilizers/anti-psychotics as prescribed especially during a difficult and emotional period. Speak with your psychiatrist about changes in your mood and behaviour post-breakup. For example, it's natural to experience a low period after a challenging break-up that may cause issues with your sleep hygiene (sleeping too much or not enough). Your healthcare team may have solutions about how to manage your medication more effectively during this difficult time.   

Final Thoughts

There is a 1962 song by Neil Sedaka called “Breaking Up Is Hard to Do,” and when it comes to this subject truer words were never spoken. Breaking up becomes even more difficult when you factor in a mental illness like Bipolar disorder. When you have a mood disorder your emotions have a tendency to overtake you when dealing with a loss or trauma which is what a break-up can feel like. Depending on the circumstance you may experience the gambit of emotions from high highs (Mania) to low lows (Depression) and there simply is no way to tell how long these extremes will last. 

Therefore, it’s important not to hide inside your feelings, speak to someone about what you are dealing with, use the tools you have in your mental health toolkit, speak to your psychiatrist about the emotional difficulties you are facing and finally trust in yourself that this too shall pass. A break-up can signify the end but also the beginning. Facing your negative emotions around the circumstances of a break-up can be the best way to build resilience after a relationship ends. 

Remember, you are not alone, there is light at the end of the tunnel and there is always sunshine after the rain.