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Obsessing over physical deterioration.


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I hope this makes sense. I can't think too well right now and I'm having trouble coming to the words.

Right now I'm in a deep depression (just crashed off of a psychotic mixed episode) and I'm also dealing with anxiety and other crazy stuff. Anyways, I'm terrified that as long as I'm in this state that I am losing brain cells and deteriorating further. Every second that I am like this provokes intense anxiety and obsessive, intrusive thoughts that it's only getting worse and that I'm getting dumber and dumber. I'm also terrified that the medications that they will surely give me at the recovery clinic will also cause further brain damage or adverse effects that might be permanent.

I'm not sure how rational all of this is. It makes sense to me but.. I don't know. I know that deterioration can occur with mood disorders but.. it just, I can't get this shit out of my head.

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I've had crappy obsessive thoughts in the past. Sounds like this is just one of yours. I hope, as it has been with me, that eventually the bad thought wears off. Once I spend a couple days obsessing it goes away.

I will tell you a scientific fact that might help at least a little. It is true that over time mental illnesses themselves do cause brain damage. This is due to the chemical imbalances. However, medication is believed to slow and possibly stop this damage that occurs. So I am hoping that you will consider this as incentive to take your medication. I was lucky enough to find paxil, which has almost stopped all of my OCD symptoms. I went from spending hours a day doing compulsions and spending much of my time miserable from horrible images and thoughts to it being barely an issue. I hope you are able to experience the same relief. Good luck.

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I've had crappy obsessive thoughts in the past. Sounds like this is just one of yours. I hope, as it has been with me, that eventually the bad thought wears off. Once I spend a couple days obsessing it goes away.

I will tell you a scientific fact that might help at least a little. It is true that over time mental illnesses themselves do cause brain damage. This is due to the chemical imbalances. However, medication is believed to slow and possibly stop this damage that occurs. So I am hoping that you will consider this as incentive to take your medication. I was lucky enough to find paxil, which has almost stopped all of my OCD symptoms. I went from spending hours a day doing compulsions and spending much of my time miserable from horrible images and thoughts to it being barely an issue. I hope you are able to experience the same relief. Good luck.

It's been like this for months. I always have this image in my head of my brain getting smaller. Everytime my head hurts (almost always) I conclude that it's my brain burning. There is also a feeling that even if I do get better and stop the progression of the damage, that it's too late and I won't have enough left in me to make life worth while (sort of an all or nothing kind of thing).

Screw it. I need to be put on a cocktail. I have to stop being scared.

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Cappa, bipolar is a progressive illness. Each episode further deteriorates cognitive functions. There are many studies that back this, and anyone like me who has lived long enough with this illness can tell you, it does effect cognition.

Here are a couple studies. You can find more at the weblinks by searching at the site. It is PubMed, the National Institute of Health's library of peer reviewed literature.

Progressive gray matter loss in patients with bipolar disorder.

http://www.ncbi.nlm.nih.gov/pubmed/1761738...Pubmed_RVDocSum

RESULTS: Patients with BPD showed a larger decline in hippocampal, fusiform, and cerebellar gray matter density over 4 years than control subjects. No significant changes in white matter density were found. Reductions in temporal lobe gray matter correlated with decline in intellectual function and with the number of intervening mood episodes over the follow-up period. CONCLUSIONS: Patients with BPD lose hippocampal, fusiform and cerebellar gray matter at an accelerated rate compared with healthy control subjects. This tissue loss is associated with deterioration in cognitive function and illness course.

Cognition in bipolar disorder

http://www.ncbi.nlm.nih.gov/pubmed/1582674...ogdbfrom=pubmed

BPD is often associated with cognitive deficits that tend to be present regardless of mood state. Greater impairments tend to be seen in BPD patients who are older, have an early onset of the disease, and suffer a more severe course of illness. The literature also suggests that cognitive deficits are present early in patients with BPD and may be cumulative, showing an association with the number of affective (particularly depressed) episodes over time.

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I'm terrified that as long as I'm in this state that I am losing brain cells and deteriorating further.

Well, like Stacia said, there's evidence that there is loss of cognitive functioning over time. But you're not thinking in a rational manner about this. Obsessing is going to make it seem worse. You're going to start to feel like you're going crazier when you're not as crazy as what you feel. It's kind of like memory with older people, I think. The more an older person seems to worry that their memory is going, so their memory goes. When they stop worrying so much about it, their memory improves. You do need to try to convince yourself that you're not thinking rationally. Easier said than done...

That said, positive thinking doesn't alleviate all symptoms. I know you're not a fan of psychiatric medication, and I am thinking that your thought process regarding your decision to forsake psychiatric medication is irrational.

My grandmother has been on some sort of psych medication since the late sixties, and she's still sharp as a tack. She's had some issues because she hasn't always been assertive in her treatment - if a medication wasn't working, she wouldn't really speak up. But her brain functioning isn't damaged from the medication. My mother has been on medication for about twenty years now, and more or less the same thing. Her cognitive functioning is fine. I'm not sure if that's any consolation, but I felt the need to add it.

I think you mentioned that you were in therapy...If you are, what does your therapist have to say about this?

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I'm terrified that as long as I'm in this state that I am losing brain cells and deteriorating further.

Well, like Stacia said, there's evidence that there is loss of cognitive functioning over time. But you're not thinking in a rational manner about this. Obsessing is going to make it seem worse. You're going to start to feel like you're going crazier when you're not as crazy as what you feel. It's kind of like memory with older people, I think. The more an older person seems to worry that their memory is going, so their memory goes. When they stop worrying so much about it, their memory improves. You do need to try to convince yourself that you're not thinking rationally. Easier said than done...

That said, positive thinking doesn't alleviate all symptoms. I know you're not a fan of psychiatric medication, and I am thinking that your thought process regarding your decision to forsake psychiatric medication is irrational.

My grandmother has been on some sort of psych medication since the late sixties, and she's still sharp as a tack. She's had some issues because she hasn't always been assertive in her treatment - if a medication wasn't working, she wouldn't really speak up. But her brain functioning isn't damaged from the medication. My mother has been on medication for about twenty years now, and more or less the same thing. Her cognitive functioning is fine. I'm not sure if that's any consolation, but I felt the need to add it.

I think you mentioned that you were in therapy...If you are, what does your therapist have to say about this?

I'm back and forth with the meds. I'm terrified of the adverse reactions (sometimes permanent) but I'm also terrified of deteriorating further. I'll keep an open mind when I'm in the recovery clinic, but I prefer to avoid SSRIs/SNRIs (seems like I have permanent PSSD since I was taking the stuff from age 15) and maybe even antipsychotics. I'm probably open to taking a mood stabilizer like lamictal, and with its broad indications it seems wholly appropriate, but I'm sure they're going to want to try an SSRI with an antipsychotic and benzos for bed... maybe not. I guess we'll see.

Right now I just lay in bed, tossing and turning and visualizing my brain burning. I can't help it. I wish I could just stop the thought when it rears its ugly head.

Do you think it's worth trying to get on some meds before the clinic? I just don't want to start on something and have it mess up everything once I get there. I do have some zyprexa in a drawer.. it should slow things down. What do you think?

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I'm back and forth with the meds. I'm terrified of the adverse reactions (sometimes permanent) but I'm also terrified of deteriorating further. I'll keep an open mind when I'm in the recovery clinic, but I prefer to avoid SSRIs/SNRIs (seems like I have permanent PSSD since I was taking the stuff from age 15) and maybe even antipsychotics. I'm probably open to taking a mood stabilizer like lamictal, and with its broad indications it seems wholly appropriate, but I'm sure they're going to want to try an SSRI with an antipsychotic and benzos for bed... maybe not. I guess we'll see.

Right now I just lay in bed, tossing and turning and visualizing my brain burning. I can't help it. I wish I could just stop the thought when it rears its ugly head.

Do you think it's worth trying to get on some meds before the clinic? I just don't want to start on something and have it mess up everything once I get there. I do have some zyprexa in a drawer.. it should slow things down. What do you think?

Not all prescribers are fond of AD's for the Bipolar crowd...mine won't prescribe them to persons with a Bipolar dx (besides a low dose of trazodone or Elavil for sleep) unless anticonvulsants/lithium/antipsychotics fail to work for depression. There's a chance you won't be given one.

A lot of prescribers also seem to prefer trazodone or a non-benzodiazepine medication for sleep. Or sometimes an antihistamine. Or Remeron. Or Seroquel. People tend to build up a tolerance for benzos quickly, and then they're not super useful for sleep. Unless your sleeping issues include persistent nightmares and night terrors like what I've had, in which case benzos are helpful. But they still don't actually help you get to sleep after a certain point. Plus some people abuse benzos as you know, and thus some prescribers just don't want to plain mess with them if possible. So again, there's a chance that you won't be given a prescription for one. Also, if you are prescribed something that is sedating for you for another symptom, they may nix sleeping meds altogether.

Mood stabilizers are good. They'll probably want to add an antipsychotic since you have psychotic symptoms. Plus antipsychotics often help with obsessive thoughts. They're worth a shot. But I can understand needing to warm up to the idea of taking certain types of medication. Plus there's the tardive dyskinesia thing. But that seems to be more of an issue with the old school AP's...even then, some people just don't get it. (Mom's been on Haldol for about ten years now - no issues)

Even if they write you prescriptions, you're going voluntarily. You don't have to take medication you don't want to take. I think it might help, if possible, to see if the clinic will work with you as you slowly take on meds one at a time. That will give you some time to wrap your head around the idea of taking medication and figure out what works for you.

As for starting meds now...tough to say. I definitely wouldn't use anything you have leftover without talking to a psyMD/psyNP/psyPA. It's easy enough to get on a cancellation list and get in quickly - people cancel on my doc all of the time. There's a chance that the doctor at the clinic will want to prescribe different medication than what you come in with. Or maybe not. I do think that they'll be less likely to tinker with it if a) it seems to be working and b) it's a current prescription.

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I could bitch about my own condition here, but it'd be irrelevant to the post. (But yes, I feel your pain on obsessing over physical deterioration, regardless of the cause.)

In any event, it's best to not be a hypochondriac and well, I know a lot of older individuals with mood spectrum disorders who are still feisty and sharp. In fact, I have a hard time believing the above research that bipolar disorder can "rot" the brain like that, but nonetheless you can probably avoid it by proper meds and therapy (that's just my guess there, but yeah). I personally think that your obsession over physical deterioration will be alleviated as the physical deterioration itself is calmed with meds and therapy.

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