Bipolar Disease featuring client guest appearance – Podcast
Dwight Thompson (00:00):
Hi, welcome to Reset Your Mindset by LifeStance Health, myself Dwight Thompson and my co-host Nicholette Leanza, we’ll bring you conversations with leading LifeStance Health professionals who will help guide you on your journey to positive mental health and wellbeing. At LifeStance, we believe in the three pillars of mental health, mental flexibility, mindfulness, and resilience. Welcome everyone we’re really excited to be back with you for another episode and set by LifeStance Health. As always, we are joined by Nicholette Leanza my co-host, myself Dwight Thompson and today we’re very fortunate to have first time guest, one of our providers here in Columbus, Ohio, Holly Schweitzer, Holly, welcome and thank you for joining us.
Holly Schweitzer (00:56):
Thank you Dwight. It’s good to be here.
Dwight Thompson (00:58):
So we brought you on to talk about some of your specialties and we really like to give some of our listeners sort of a peek behind the curtain and some insight into different mental health concerns. And I can’t really think of many better people to talk about what we’re going to be talking about today which is bipolar disorder, which is something I know that you treat a lot. So let’s dive right into it. Holly, can you tell us simply what is bipolar disorder?
Holly Schweitzer (01:26):
Certainly, well, first I will start by saying that I am a psychiatric nurse practitioner and I’ve been with PsychBC since I guess 2016. And in my outpatient practice I treat a lot of bipolar disorder. So what is bipolar disorder? It is a mood disorder which is often characterized by symptoms of both depression and symptoms of mania. The actual technical definition of bipolar disorder though is that if one [inaudible 00:01:58] the person has to have at least one manic episode in their lifetime and that is what gives them the diagnosis of bipolar disorder. So in the true definition of bipolar so you don’t even actually have to have a depressive episode, you just have to have at least one manic episode in your lifetime. I think it’s important to note though there are different types of bipolar disorder so that is descriptive of bipolar 1 disorder.
Holly Schweitzer (02:23):
So there is also bipolar 2 disorder, which does require that you have at least one major depressive episode and one hypomanic episode. So that’s how you would meet criteria for bipolar 2 disorder. And characteristically we think of bipolar 2 disorder as people having more depression than mania typically over their lifetime. And when they have mania it is what we call hypomania in the sense that the mania it’s still as severe, it just doesn’t last as long. So it’s for shorter periods of time. And then kind of beyond that, there are sort of subsets of bipolar disorder or different types meaning there’s bipolar disorder with psychotic features. And then beyond that, there’s also schizoaffective disorder bipolar type. And so those two additional are used to describe people that not only suffer from bipolar disorder but also suffer from breaks in reality where they have psychotic symptoms as well.
Dwight Thompson (03:24):
Thank you. So a couple of the terms that you mentioned in layman’s terms can you explain what is mania? What is a manic episode?
Holly Schweitzer (03:33):
Well, I often tell patients mania is kind of feeling like Superman. So that’s kind of our traditional way that sometimes even patients will describe it. It’s a feeling of you don’t need to sleep and you just have a lot of energy. You kind of feel elevated or on top of the world, you want to just go and do like start a bunch of projects. Often it feels like your mind is racing, there’s just ideas flying everywhere and you can’t focus, you can’t read or you can’t really focus at your job you feel very distracted. And sometimes mania can move into some dangerous behavior. Right. Because if you’re feeling really good or sort of invincible, you might get some ideas in your head like I can drive my car a hundred miles per hour or there might be sexual indiscretions or spending sprees. So that’s kind of where sometimes mania gets people into some negative consequences.
Nicholette Leanza (04:38):
One of the things I’m thinking about right now is some media depictions of people in manic disorder or a manic episode, I should say. And I’m trying to think of examples to better kind of put across there an example of what it might look like that we know with Hollywood and the media sometimes it’s not exactly accurate. But off the top of my head, if anyone’s familiar with the show Shameless, one of the characters on that show, they do a fairly okay-ish job depicting his struggles with bipolar disorder and showing him making can some really faulty or having some very faulty decision making in manic episodes and stuff like that. Anyone else, Holly or Kendra, which we’ll be definitely bringing Kendra into this conversation, no other examples in movies or in the media that might show examples of a manic episode.
Dwight Thompson (05:31):
I can’t really think of necessarily any examples it just, I mean, Holly, I think you’re shedding light on how hard it is. I mean, it can sort of manifest in so many different fashions. And so we appreciate you explaining it a little bit and sort of breaking it down for those folks that might not be privy to what exactly bipolar disorder is or maybe even people that are maybe navigating it themselves, which you help people do a lot. So with that being said we’re really fortunate to have you joining us Holly, but this is a really special episode for us because we actually have the pleasure of bringing on a client of yours to speak to her story, her amazing story and some of her experiences navigating her mental health. So with that being said, Kendra, welcome to the show.
Hi, thanks for having me.
Dwight Thompson (06:21):
Absolutely. Kendra, tell us a little bit about yourself. I know it’s an open ended statement but we love to just learn a little bit more about you.
Yeah. So I am a nurse during the day. I actually just got a new job working with pediatrics.
Dwight Thompson (06:39):
Yeah. Thank you. And I was diagnosed with bipolar disorder shortly before meeting Holly actually. And I had depressive episode before that and then had my first manic episode in 2017. So it’s been a journey.
Dwight Thompson (07:02):
Yeah. Well I’m sure you’re happy that you found Holly. I know she does incredible work. So when were you diagnosed with bipolar disorder?
I think I was diagnosed with bipolar disorder in March of 2012 after my first hospitalization.
Dwight Thompson (07:18):
Okay. I sort of saw you nodding along when Holly was giving some of the examples of the way it manifests. Were you able to relate to any of those?
Yes. Just especially with the manic episodes you’re literally watching yourself do these things that go against all of your moral values and you can’t stop yourself. I know for me, I was drinking excessively and that’s not something that I usually do, increased in sexual behaviors, spending money on ridiculous things. I think one of the funniest purchases that came out of my first manic episode was an actual working Ivy poll that I bought off the internet because we were learning Ivies in school and I thought I needed to practice and it’s still in the box at my parents’ house. So I can definitely relate to all those things but definitely with the manic episodes what they look like in your life.
Dwight Thompson (08:18):
Let me ask you this and this is for both Holly and Kendra. What is the specific treatment methods for navigating bipolar disorder? Holly.
Holly Schweitzer (08:29):
Yeah, [inaudible 00:08:30] first I mean I think what I need to say first is that a lot of patients don’t seek treatment for mania. And that is why it is actually so hard to treat. Most patients when they’re feeling that way they feel good, they feel like there’s nothing necessarily wrong. And sometimes they’re just getting a lot of stuff done and they kind of like to have that energy, that manic energy. And I’m not always saying that mania is pleasant because it’s not there’s also mania that is characterized by extreme agitation and irritability. And it feels very uncomfortable almost like a buzzing sort of an anxious feeling. So that’s a very unpleasant type of mania and that’s often just thought to be anxiety sometimes with patients. So again it’s almost hard to treat because patients don’t necessarily come in for treatment of mania.
Holly Schweitzer (09:26):
And so you kind of have to be very thorough when you’re asking questions and getting a history and trying to figure out what is the manic history. And occasionally you’ll get somebody though right out of the hospital or in the hospital because the mania has taken them that far where they need inpatient care. So traditionally the treatment for mania is mood stabilizers. And there’s different types of mood stabilizers but what we believe is that within the neurons, which neurons are what transfers information in a brain. Right. So within the neurons, there are ion channels. And those channels we believe are just opening and shutting so fast with mania and that’s what causes these extreme changes in mood. And so what the mood stabilizers do is it slows down the ion flow in the channels to help regulate the neuron and stabilize the neuron. And so those medications include things like Depakote, Lithium, Lamictal, I’m going to forget some I’m sure Tegretol. So, and they all work a little bit differently that’s just kind of a broad way to describe how the mood stabilizers work.
Dwight Thompson (10:40):
Yeah. Thank you for explaining that. Just like with so many other mental health concern this is very multifaceted and incredibly difficult I’m sure at times to navigate. Kendra, how have you found yourself sort of navigating life with bipolar disorder?
It’s definitely a team approach. I can’t do it by myself. I’ve got Holly as my nurse practitioner and then I’ve got an amazing therapist that’s also through PsychBC. So really having that open communication with them throughout everything. Also, having my family and friends that I’m closest with knowing what’s going on at most times.
Dwight Thompson (11:21):
And being open and starting conversations with them. It just makes it a lot easier to live with it because I’m not spending as much time explaining this is what bipolar disorder is because they’ve already taken time to know it. So I can just kind of be like, Hey, I’m feeling like I’m a little hypomanic right now. What can we do? So.
Dwight Thompson (11:44):
Well, Kendra kudos to you for taking sort of, you’ve clearly have such a sense of urgency to sort of approach this and get your arms around it. So just that is incredible because I think like Holly mentioned a lot of folks don’t really take that first step to better take care of it so.
It took me a while to get to that point though. [crosstalk 00:12:05].
Holly Schweitzer (12:06):
Can we talk about getting to the point of acceptance.
So let’s just talk about that.
Holly Schweitzer (12:12):
It’s a huge challenge, right. Because Kendra is all of these things. Right. She’s intelligent and she’s funny and she’s a good nurse and she’s a good friend. And so to say, I have bipolar disorder, which I don’t like to use the word disorder I like to use the word illness that’s just my own personal I feel like the word disorder sometimes separates mental health from other types of illnesses in a unfair way. But to just to be accepting that she has to deal with this as part of her day to day life I think it’s just so natural or normal for patients to resist that, to say this isn’t really happening or I can somehow beat this or to minimize what’s happening.
Holly Schweitzer (12:53):
And patients will do that for years unfortunately before they might come to accept okay, this isn’t changing, I have to actually live with this day to day now how am I going to do that? And that is not an easy process. And that is why bi patients are in many ways like my heroes. I mean, they are the most inspiring people that I deal with day in and day out because they have to come to terms with all this and I’m just a part of that journey, I guess, kind of watching from a distance as they come to that place of acceptance. And definitely in the last two to three years, Kendra has not only come to that place of acceptance but she’s come forward and then so brave about trying to help others through the journey so.
Dwight Thompson (13:36):
Incredible. And Holly, Nicky’s going to kill me because this is going to go off on a tangent a little bit but you said something there that I’d like to talk about more when you said you prefer the verbiage illness, juxtaposed to disorder. Why do you think using illness sort of normalizes it more? Because if I understand correctly, I think that’s sort of what you were getting at.
Holly Schweitzer (13:57):
Right. I mean, disorder in itself to me has almost a negative connotation almost as if it’s the fault of the individual like this person has a disorder. I don’t know if it’s just me who has a negative feeling around that word but I do think a lot of people have that sort of connotation behind the name of that, versus thinking of this as an illness, right, just like other illnesses where there is a biological basis, a genetic basis, an environmental impact and then of course the impact of the individual. So I think when we think of disorder, we think only of the individual and we’re taking away the fact that it’s an illness just like all other illnesses.
Dwight Thompson (14:40):
Yeah. That makes total sense. And Kendra, it sounds like you’ve done a excellent job of having conversations that I’m sure are not easy when you’re talking to family members and friends but that’s what you’re trying to do is normalize it, right?
Yes, definitely. I feel like the more we talk about something less scared we’re going to be. I’m a big Harry Potter fan and there’s the quote where they’re like, the fear of the name only increases the fear of the thing itself. So I’m trying to be upfront about it and take away that stigma.
Nicholette Leanza (15:12):
And I think that’s part of the issue that there’s still a stigma out there with mental health issues in general, the bipolar disorder. So I think speaking up about it, talking about it definitely takes away that stigma a lot, a bit more. And it’s still a process of kind of, as a society us getting more comfortable and recognizing mental health is just as important as physical health too. So Kendra, you are definitely a trailblazer here.
Nicholette Leanza (15:46):
Can you expand a little bit more on maybe the psychotic symptoms that might come out of bipolar disorder and the treatment for those?
Holly Schweitzer (15:54):
Yeah. So psychotic symptoms are obviously some of the more problematic symptoms that can come with bipolar disorder as psychotic means that the patient literally had a break from reality. And they often present as either delusions or hallucinations. So a delusion is a false belief and that belief it’s based on usually something in reality but there’s a misperception about it. And there’s different types of delusions and that’s probably the easiest way for me to explain it. So for example, there’s the bizarre illusion where that might be the classic, someone believing that they’re having conversations with an alien in their backyard, right. So something that most people would think is physically impossible that would be a bizarre delusion. And then there’s persecutory delusions, which are pretty more common. And they’re very difficult for patients to deal with where they feel like they’re being conspired against or control or maybe even someone’s controlling their own thoughts or can hear their thoughts.
Holly Schweitzer (16:59):
And so those are very terrifying symptoms. And that might be also sometimes why patients are scared to come forward because they don’t even know what’s real and not real. Like I said, they feel as though something’s outside of their control or controlling them. And then there’s also grandiose delusions you’re feeling like you have some sort of special power or some special ability and you so strongly believe that you are willing to kind of do maybe some irrational things. But those are delusions and then hallucinations are when you hear voices outside of your own. Maybe you’re in the shower and you hear something telling you to hurt yourself or maybe you’re out driving and you hear a voice telling you you’re being followed. So again, it’s usually a pretty scary experience. And then visual hallucinations can be as strong as seeing a physical person or just shapes or shadows or something like that. So usually with psychotic features, it does require additional medication including atypical anti-psychotics, which are often used for the bipolar disorder anyways to also help manage the mood symptoms. So I don’t know if that explained everything.
Nicholette Leanza (18:09):
Oh yeah. Perfect. That was very thorough thank you. So Kendra can you tell us a little bit more about your struggles with some of the maybe psychotic symptoms you endured?
Yeah. So after my first diagnosis of bipolar disorder, I had year after year of just the ups and downs of bipolar disorder. And I was kind of getting used to that and kind of my new normal. And then in October of 2018, I was really stressed out at work. And that led to my first psychotic episode where I heard I’m a huge Lady Gaga fan. And she had released a new song that came out with the movie sha… oh not shallow, but the movie A Star is Born and I downloaded the song and I listened to it and I liked it. So I started listening to it again and again and again for pretty much 48 hours straight.
And after listening to it so many times, I believe that Lady Gaga was telling me that I needed to kill myself and I believed it. So I started taking the actions needed to do what I thought that I needed to do. At the last minute, I reached out to a friend to tell her what was happening and they took me to one of the local hospitals where I stayed inpatient for 18 days. So I was in there for a long time. And that was when we added an anti-psychotic to my medication regimen. But that was a big deal for me because it took what was my normal and kind of flipped it on its head so.
Dwight Thompson (19:51):
Thank you for sharing that Kendra. That sounds incredibly difficult. And so that sort of happens and what are next steps after when you’re sort of looking at like aftercare and how you’re going to sort of navigate life now that you’re on this? What did life look like after that?
It still took us a while to find the right anti-psychotic that works for me. Luckily for me… So something that I’ve struggled with for years and I know Holly’s going to be like this is [inaudible 00:20:23] I really have a hard time staying on my meds. I will be doing good and then all of a sudden I will get this thought in my head of I don’t need them, I shouldn’t have to take them, I can get away without taking them and nobody will know. And that always comes back to haunt me because that’s when the mania or the depression or even the psychotic stuff comes back into play harder. So we did find a medication that’s a monthly injectable medication. So that helps with the compliance. That’s been a life changer for me.
Dwight Thompson (20:59):
Nicholette Leanza (21:00):
Well, Kendra let me ask you this, what advice would you give someone who is newly diagnosed with bipolar disorder or bipolar illness [inaudible 00:21:08] any specific advice you’d give someone who’s just newly diagnosed with it?
Yeah. Some advice for somebody that was newly diagnosed with bipolar disorder, I would say to really evaluate your support system, make sure that you have a good treatment team behind you. That’s all on the same page and also evaluating who in your life can be a support when it comes to bipolar disorder. Who can you go to, who can you trust and just kind of making sure that they know that that’s how you see them. And relying on those people and letting those people love you and take care of you on your bad days.
Dwight Thompson (21:48):
Yeah. Great answer.
Nicholette Leanza (21:50):
Holly, anything else you’d like to share with us as we wind down our time together? Any other things you think would be very important for people to understand about bipolar disorder?
Holly Schweitzer (22:01):
Well, I think Kendra just touched on it in terms of struggling with compliance. And we kind of talked about in the beginning with even acceptance of the illness. S and it’s not that the patients don’t want to be compliant, being compliant with these medications is difficult, not just taking medication daily but managing side effects and then also managing when you’re still having symptoms while you’re taking medication. So those are just frustrations that they have to manage and deal with in addition to the illness itself. So working with your treatment team closely and being as honest as you can about your compliance is just so important. Because these illnesses they do get worse if they’re not treated just like any other illness. And I try to remind patients that the more compliant you are, the better chances we have of success. But that obviously requires a lot of open dialogue and willingness to both of us be vulnerable to each other in many ways, because it’s a very entrusting relationship where they have to be willing to trust me and I have to be willing to trust them so.
Nicholette Leanza (23:03):
Good point, okay.
Dwight Thompson (23:06):
Well, Holly and Kendra, thank you both so much for joining us. Kendra, thank you so much for being so candid and Holly thank you for your insight. I think there’s going to be a lot of people with a lot of takeaways from this. This was very informative and very relatable as well. So thank you both.
Thank you both.
Holly Schweitzer (23:26):
Thank you guys.