Sundown..... Symptoms increase around sunset...

I (almost) always feel strange between 4pm-8pm.....

Right now it is 6:30 and the strangeness has set in.  It's not too bad today.

Mostly this strangeness is an increase in my symptoms.  Often it is a depressed feeling, but today it seems to be a glowiness.  Sometimes it presents itself as anxiety.  It's not always the same feeling, but it's always a wrong feeling.  Many of the days, recently, I have a sadness during this time period, that's not here during the rest of the day/night.

Once the sun has set, I usually go back to feeling fine.. I haven't figured out what the reason is behind this.  I thought it might be the change in light, but even on overcast days I seem to have a peak in symptoms during this time.  I thought it might be blood sugar changes, but even when I eat early, I still get the symptoms.

So mostly I just write this incase this experience is more common that I've found online (my searching hasn't found anything much).

Mostly I treat this evening mood disturbance how I try to treat any other mood change.  If I can, I keep doing what I normally do, and just tell myself that I'm experiencing bipolar symptoms.  If I need to, I do one of the things that tends to calm me - take a nap, listen to music, take a walk, etc.   If I can sleep, that's just about the best solution, but I'm not always tired - just symptomatic!

Thinking back on my life, I've had changes associated with this time of day for a long time.  Perhaps many people do experience a change during the early evening time, and all that I'm experiencing is an exaggeration of the change that everyone else gets. Of course, being tired in the early evening is normal.  Coffee with dinner is popular.  Energy drinks are just about made for this time of day.  (Not for me, though. I can't tolerate too much caffeine.)

P.S.  I am familiar with the term sundowning. It refers to symptoms in people with Alzheimer's disease or dementia.  They often have an increase in confusion and other Alzheimer's symptoms. I haven't heard of it associated with any other form of mental illness.

Virus HERV-W could be the cause of Schizophrenia, Bipolar Disorder, and MS...

I just finished reading an article entitled The Insanity Virus by Douglas Fox (Discover Magazine, June 2010) about the connection between a virus and mental illness.  The virus HERV-W is a retrovirus that could trigger diseases like schizophrenia, bipolar disorder, and MS.  The virus lives in a person's DNA and the proposal is that if a person has a weakened immune system shortly after birth, this virus isn't contained well.  Subsequent infections later in life cause the HERV-W to unleash itself and do damage....

Apparently, it is thought that infection by toxoplasmosis or influenza, can wake up the HERV-W virus.  Moreso, basically anything that causes inflammation - like an infection, cigarette smoke, pollutants in drinking water - can cause retroviruses to be awakened...

Beyond the science of the article (which is quite intriguing!), I'm interested in the practical implications of what this could mean, and one statement from this article about schizophrenia says: "It explains why the disease waxes and wanes like a chronic infection.  And it could explain why some schizophrenics suffer their first psychosis after a mysterious, monolike illness."

Current reasoning for the waxing and waning of mental illness has to do with things like: changes in levels of stress, changes in medication, ability to cope, lifelong progression of the illness, etc.  What if it also has to do with the immune system?

I, personally, often feel that my mood is effected by physical sickness. I started taking zinc to treat a cold and then found that it helps my depression.

If a person is under more stress, they are more likely to get physically sick, as well as have increased psychiatric symptoms.

Should treating our immune system be part of treating bipolar disorder?  The article has this solution:  Faith Dickerson at Sheppard Pratt Health System, "is running a clinical trial to examine whether adding an anti-infective agent called artemisinin to the drugs that patients are already taking can lessen the symptoms of schizophrenia. The drug would hit HERV-W indirectly by tamping down the infections that awaken it."

Lithium Flatness (loss of creativity, not liking lithium)

A lot of people seem to not like being on lithium (or some other mood stabilizer).  They say that it ruins their creativity, makes them feel flat or emotionless.


I don't have this problem.  And I propose that there are two reasons for this, which need to work together -

1. Take the lowest dose of lithium or other mood stabilizer that is effective.

2. Make lifestyle changes.

If you think of mania or hypomania as being similar to alcoholism, except that the addiction is to "excessive involvement in pleasurable activities that have a high potential for painful consequences," whether it be sex or shopping or drugs or whatever your activity of choice is - then you can see how taking a mood stabilizer alone isn't the whole solution.

You have to change your lifestyle.  That is, your activities. If you are an alcoholic and love going to the bar but then start taking a medicine that makes you not able to drink, then you're not going to like that medicine because when you go to the bar you won't experience the same enjoyment as you used to.  The key of course, is to stop going to the bar.

I propose that you can have creativity and lots of emotions and be taking a mood stabilizer, IF you refocus your life on activities that aren't excessive and that don't have painful consequences.

If you can successfully change your lifestyle, then you may even be able to reduce the mood stabilizer.  Ideally, you want to be taking the mood stabilizer at the lowest amount so that you can still feel a wide dynamic of emotions.

Changing your lifestyle is not easy, and could involve major changes like changing a romantic relationship, changing your friends, changing where you live, changing careers, etc.  This is all stressful stuff that by itself could cause your moods to become worse, which is why you might need to see a therapist and a psychiatrist regularly so you can keep your meds adjusted as you go through these changes.

Also, some of your experiences might be rooted in not just brain chemicals gone awry, but they might be the result of environmental problems like trauma, lack of self confidence, difficult relationships, etc. Things that need to be worked through over time, perhaps in therapy.

So the mood stabilizer is just one part of the equation.  It's a big part, but if you aren't committed to making changes, then the mood stabilizer alone might not work.  The good news is that usually a mood stabilizer changes your thoughts enough that it makes it easier for you to slow down and do some self-examining to see what you want your life to look like.  You just have to embrace the opportunity to ask yourself big questions.

I'll leave it to you to come up with the questions that need to be asked.

--

Footnotes:

1. I'm not a doctor, but from personal experience, I would suggest that you might need a higher dose of lithium or mood stabilizer at first, but that after you have made lifestyle changes and/or sought other treatment like therapy, then the mood stabilizer might be adjusted downward.  However, you have to always be watchful of a dangerous hypomania/mania episode coming on... Best to catch these episodes by watching your THOUGHTS and catching them before your actions take a turn for the worse.

2. Omitted from above, is this:

Going to the bar doesn't have painful consequences for everyone, but it does for alcoholics.

Similarly, whatever activity you became addicted to while hypomanic, you should try to avoid.

This statement might be a bit radical, but avoiding something at first might be a good idea. For example, don't go to the mall if you have trouble with spending too much money.

Hypomania and Jumping

My Dad built a deck onto my house, and for awhile, he had the steps all done, but not the railing.  One afternoon, after coming home from high school, I decided that a fun activity would be to see how far I could jump. I started on a lower step and worked my way to almost the very top of the deck.  I jumped until I got a little bit scared....

I was probably manic or hypomanic, as I suspect I was a lot during my teenage years. Looking back on it, mania explains a lot of my decisions...  Check out the following criteria for hypomania. I would say this jumping activity falls straight into #7.

Criteria for Hypomanic Episode  (from the DSM-IV TR)

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

   1. inflated self-esteem or grandiosity
   2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
   3. more talkative than usual or pressure to keep talking
   4. flight of ideas, or subjective experience that thoughts are racing
   5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
   6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
   7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Giving up too easily?

Most often, the difference between success and no success, seems to be persistence.  Sure, chance plays a part, as does a slew of other things that you don't have much control over, but persistence is something you actually do have control over.

While playing chess a couple of weeks ago, I realized that I often give up too early in the game.  When I do play the game out, a disadvantageous situation often turns around, and some of the time I still win.  But, when the going gets tough, I was giving up too easily.  The most often excuse I gave myself is that I felt tired. But was I really tired of playing, or, was I just doubting myself?  Why do I quit when the going gets tough?

Translating chess psychology and strategy into real life is something I like to do, and so I thought about what I've given up on in the past, and the reason why.

About twelve years ago, back in high school, I gave up programming. Before I gave it up, I really liked it. I had a book that I was following, and I just got to one point and I got stuck. I couldn't go further.  So instead of seeking out a solution, I quit.  Today I can think of many solutions. Get a different book. Find a teacher or mentor. Try a different programming language. It could have just been a mistake in the book, or a gap in my knowledge. 

So now I am back, programming.  A little bit. I find it enjoyable once again.  I'd love to make a million dollars from something I program some day, but for now, I'm just picking up the path where I left it... Except for now I have twelve more years of maturity, wisdom, and confidence under my belt. It might just make the difference.  Plus, perhaps even more important: my moods are controlled. I'm no longer living in a prolonged stretch of irrational hypomania in a stressed out environment.

What have you quit, and why?  Is it time to revisit?

Seagull Takeoff Near Cannon Beach, Oregon

Picture taken by me :)

My Experience with Face Recognition Disorder (Prosopagnosia or Face Blindness)

I have difficulty recognizing faces.  It's not something I realized I had difficulty with when I was a child, but looking back on my experiences, it seems that I've had this difficulty all of my life.

When I was a child, I thought I just had trouble remembering names.  This is something that many people say that they have trouble with.  I had never heard of prosopagnosia, so the closest description I could find to what I was experiencing was a problem with remembering names.

But, for me, it was not the names, but the faces.

Since I have trouble recognizing faces, I rely on other clues, like hair color/style and voice.

If people appear similar in other aspects, then it is hard for me to tell them apart.

One of my earliest memories regarding this problem is that in school sometimes teachers would have students pass back graded papers.  I dreaded doing this task, because I had trouble telling some of the students apart.

I tried working in a bagel shop, but that only lasted a couple of days.  I was so busy trying to fulfill the orders, that I forgot to look at the people to remember who ordered what.  This caused some frustrated customers (as well as a frustrated me!)  I'm sure I appeared dumb, but really I was just coping with a difficulty that I wasn't aware I had.

About 4 years ago, I came across information on prosopagnosia (thanks to the marvelous internet) and realized that described my condition accurately!  Since then I have been actively practicing to increase my ability to recognize people and faces.... I am getting better, although I'm not sure whether my ability to recognize faces is actually improving, or whether I'm just getting better at picking up other clues to remember people!

I watch TV shows and movies and try to recognize actors. This used to be an impossible task, but now I am able to do it some of the time.  I think I rely on the sound of their voice as much or more than their face. It's just easier for me.

I still sometimes get lost when watching a movie that has multiple people who look similar, and this can make the plot impossible to follow... A very frustrating thing!

I have been taking piracetam to try to improve some of my cognitive skills. It's an interesting drug (sold as a supplement in the USA).  It works on the brain by somehow increasing or improving neural pathways, or at least that's what it seems to be doing.  It's not a stimulant, but rather a nootropic (a smart drug).  Since it changes neural pathways, it can have some effects on mood (both positive and negative), but that's not the purpose I take it for.

It seems to help me with recognizing people, language skills, and word retrieval.  I had speech and hearing problems as a kid and so I still have some difficulty in that area, and it seems to me that piracetam helps.  If I take it before watching Jeopardy, I can usually get more answers right because it seems that I can think of the answers faster. That all too common "it's on the tip of my tongue" experience goes away.

For more details on face recognition disorder, check out Cecilia's description.

Mistaking Mania for Personality....

One of my high school teachers described me as "taking awhile to warm up."

That's because I started off being quiet and they came across as being outgoing later in the year.  Or so my teacher thought.

Looking back on it, I wonder, perhaps she had observed me in a depressed mood and then in a manic mood?

Mania isn't easily recognized.  I talked to someone who was manic once (her speech was rapid and she quickly switched from one thought to the next and it didn't make much sense), but there are other shades of mania that seem to present themselves as personality (hyper, outgoing) perhaps accompanied with risky behavior.  Since society often equates adolescence with risky behavior, people don't see it as mania.