Bipolarism and Suicide

February 2, 2008

If you are reading this page it is perhaps because you are having thoughts of ending your life.  Perhaps you have been thinking about it for a while, and your plans are made, or perhaps you have not made any plans, but the thought is there.  Or maybe you have made a plan and deep down are hoping that someone will hear your cry for help and intervene.  Or maybe you are just tired and see no way of going on…the very act of living has become too difficult and painful…and you want it to end. 

You are Not Alone. 

Six years ago I was sitting in your chair.  I have bipolar disorder.  After two years of rapid cycling … long, severe depressions and far too short hypomanic periods,  I had reached the end of my endurance.  I decided I had had enough and made a conscious decision to end my life.  I made my plans carefully…it’s not important the method I chose.  When the time came I put my plan in motion.  My mindset was one of total isolation … frozen in time … positive that this was the only way. My reasoning was that it hurt too much to live, and I was a burden to family and friends (didn’t bother to ask them if that were true)

Since I am here telling you about it, it is obvious my attempt failed…but not before it caused severe anguish to my family, and considerable physical damage to me.  Somehow when we contemplate suicide we never entertain the thought that it might not be successful…and that it might leave residual damage.  Today I need to use oxygen as a result of my failed attempt.  But you know what?  I thank God every day that I’m alive.  It took a long while, but I got well, and I have gone on to help other people with this illness know that they can also be well and live up to their potential.  We cannot give up. 

“Suicide is a permanent solution to a temporary problem.”  Trust me…this is true.

I learned a few things from my experience that I would like to share with you – if you will take just a few minutes to listen – I’m sure you can afford a few minutes …

First of all, this is not something you can handle on your own.  You need to talk!  Talk to your doctor.  Talk to your counselor.  Talk to your family, and talk to your friends.  They need to know how badly you are feeling before they can help.  Vocalize your cry for help instead of internalizing it.  If that doesn’t work you can always go back to Plan A right?

If you are in imminent danger of harming yourself RUN, don’t walk…to the closest emergency room and tell them how you are feeling.  Call your doctor, call 911, call an ambulance or the local police.  Get Yourself to a place of safety and protect yourself. 

If you need to have someone with you, don’t be afraid to say so … and why.

Give up your “weapon of choice” be it drugs or whatever.  Give it to someone else for disposal or safekeeping.

i know you aren’t going to want to do this – one of the things we do when suicidal is to do all we can to keep our options open.  Giving these up is a first step to living.

 Journalize.  A simple record of the people in your life and why they are important can remind you why your own life is worth continuing,

Avoid drugs and alcohol because they may make it harder for you to resist destructive urges.  

Make a plan for LIFE!   The National Depressive and Manic Depressive Assn can help.

Go N
ow to:

Find others with the same illness who understand and have been through the same things you are going through.  You may find them at your local mental health association or here on the internet.   Bipolar World  has many areas of support, as do many other web sites on the net.

Browse through the pages at

View the information at SAVE

PREVENT SUICIDE NOW.COM — Suicide Prevention, Awareness, and Support — Prevent Suicide — Suicide Prevention, Awareness, and Support

Just as we can make a choice to die – we CAN make a choice to live.



Asperger’s and OCD Q&A

February 2, 2008

Asperger’s and OCD Q. My 16-year-old son has been diagnosed with Asperger’s and Obsessive-Compulsive Disorder (OCD). He is not currently on any medications, because he said that the Imipramine was not doing anything. His psychiatrist just moved but I want him to be on something.

My main concern is that he has delusions of thought control and deletion that seem to be episodic. He realizes they are not rational when we discuss them. Is this type of problem allowable in the category of OCD or are we now getting into schizoid territory?

What have you had success with in this type of case? He was on Risperdol, but the motor retardation and weight gain were worse than the original symptoms. I am a doctor and familiar with the nature of these diseases and the drugs used, but would like your input.

A. Your son’s symptoms may, indeed, fall into the hazy borderland between OCD, Asperger’s syndrome, and perhaps one of the schizophreniform/schizotypal disorders. Although I do think it’s worth trying to pin down the diagnosis, sometimes this is very tricky, even with the best diagnostic evaluation. In such cases, assuming gross neurological disease has been ruled out, I find it most helpful to develop a list of target symptoms rather than focusing too much on the DSM diagnosis.

That said–since your son’s psychiatrist has left, this may be the time to get a fresh diagnostic and treatment perspective from a psychiatrist with special expertise in OCD and pervasive developmental disorders, if one is available in your area. (A medical school department of psychiatry is a good place to get referrals).

Now, to answer your question about delusions–in the strict understanding of OCD, actual delusions are not considered a part of the disorder. However, if the individual is able to “reality test” his/her belief–that is, appreciate the irrational or unrealistic nature of the idea–then, technically, the idea is not a bona fide delusion, but an overvalued idea or an obsession. But patients can vary in the degree to which they have insight, and sometimes their reality testing is very shaky. In such cases, a psychotic process may be present.

Similarly, obsessive-compulsive symptoms may be seen in Asperger’s and related disorders, but not amount to classical OCD. While neuropsychological testing may sometimes be helpful in clarifying these issues, an empirical approach is often the more feasible avenue, in my experience. Fortunately, the selective serotonin reuptake inhibitors (SSRIs) are both the treatment of choice in OCD, and a somewhat useful approach to autism spectrum disorders, such as Asperger’s (though SSRIs are not FDA-approved for Asperger’s Syndrome–nor, for that matter, is any medication).

For refractory OCD–or OCD that has psychotic-like features–the addition of an atypical antipsychotic to an SSRI seems to be the most promising approach; however, one could also argue in favor of sequential SSRI trials (at least two or three), since all the SSRIs (fluoxetine, sertraline, citalopram, paroxetine, fluvoxamine) are slightly different.

As your son has experienced, the atypical antipsychotics may have significant side effects. None is FDA-approved for the treatment of OCD, though risperidone has been the most widely used. There are also occasional reports of worsening OCD symptoms in response to atypical antipsychotics–but this is usually seen in patients with schizophrenia. Thus, if sequential SSRI trials were not helpful in your son’s case, consideration could be given to adjunctive use of one of the newer atypical antipsychotics, such as ziprasidone or aripiprazole, neither of which is likely to promote weight gain.

Each, of course, has risks and benefits including but not limited to pharmacokinetic interactions–that you would need to discuss carefully with the psychiatrist. Depending on the specific target symptoms, other medications could be considered as augmenters, such as clonazepam or buspirone. (The combination of an SSRI with clomipramine may also be considered in refractory OCD, though the side effects may be troublesome).

Finally, if your son is not involved in some form of cognitive-behavioral therapy, I would strongly recommend discussing this with his new psychiatrist, as CBT can be quite helpful in both OCD and autistic spectrum disorders. Good luck with getting your son feeling better.


February 2, 2008

What Are the Symptoms of Bipolar Disorder?

Bipolar disorder causes dramatic mood swings—from overly “high” and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include:

  • Increased energy, activity, and restlessness
  • Excessively “high,” overly good, euphoric mood
  • Extreme irritability
  • Racing thoughts and talking very fast, jumping from one idea to another
  • Distractibility, can’t concentrate well
  • Little sleep needed
  • Unrealistic beliefs in one’s abilities and powers
  • Poor judgment
  • Spending sprees
  • A lasting period of behavior that is different from usual
  • Increased sexual drive
  • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  • Provocative, intrusive, or aggressive behavior
  • Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include:

  • Lasting sad, anxious, or empty mood
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in activities once enjoyed, including sex
  • Decreased energy, a feeling of fatigue or of being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Restlessness or irritability
  • Sleeping too much, or can’t sleep
  • Change in appetite and/or unintended weight loss or gain
  • Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury
  • Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person’s usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.

It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call “the blues” when it is short-lived but is termed “dysthymia” when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

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February 2, 2008

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