Kindling

Taylor asked for a definition of this. I need something to do to start to settle from 13 hours of travel so I'll answer. Later I'll have more to say. I think.

Taylor, kindling is a theory that is tossed around for BPI patients (BPI and BPII have different courses; BPI tends to generally get worse, BPII is gender-related in how it progresses). According to the theory bipolar episodes affect the brain so that each episode or med can influence the course of the disease essentially by damaging new areas. If the disease is controlled then there is less damage from ongoing episodes, and if the number of episodes are limited then the risk of brain damage is lowered. It is an attempt to explain why I can do well on a cocktail for so long, have an episode and those meds won't work anymore. It also helps explain rapid cycling/mixed episodes as a result of that brain damage. The theory is based on a guess that BPI and seizures have some shared causes/triggers, although they don't know enough to know why. What I have read is pretty specific about this being a BPI thing; I'm not sure what the BPII story is.

My story of kindling, since they believe I am an excellent example, is this: I was diagnosed with depression, anxiety, PTSD, primary insomnia, etc. for quite a while because I lied to avoid diagnosis and because I don't act very typical for someone with my kind of bipolar. I think the idea danced through people's heads and then they'd decided if I was bipolar then I had to be BPI and I had to have this and this and there was NO WAY I'd be doing as well as I was in grad school and working and dealing with some extreme family stress and whatever else. That continued when I was a new professional with this great career; I just didn't seem like my life was falling apart enough. So I was treated for depression. I wasn't just treated, I was really treated. I just didn't respond well to the meds and kept getting worse, making it more desperate to fix me before I killed myself. I had a nice pattern with most meds (check out my meds blog for the specifics; it is sequential) of going on it, feeling better for a few days, getting worse, increasing the dose, feeling better, getting worse, etc. Eventually I'd max out, have to taper off and start something else. I never felt good on most of them and now know that they were making me hypomanic. I was incredible blessed that Remeron seemed to act as a mood stabilizer for me. It gave me several years of feeling good. Eventually though it wasn't enough.

Added to this mix was inconsistent medical treatment. In college I had a great psychologist and was treated for the depression by the campus doctor who didn't seem to know much. In grad school I had many attempts with therapists, none of which worked out. I had a psychiatrist who seemed pretty disinterested, and then he died suddenly. His replacement was the first person who said she thought I was bipolar, but she was far too aggressive and that suggestion was thrown away. I was treated by several family doctors for a while after school, then a really, really bad psychiatrist. Finally I started with a good therapist and then really good psychiatric care and that has continued.

Several months before I was actually diagnosed I was put on lithium to see if it would help me not want to kill myself since my antidepressant wasn't doing so well. Lithium had the interesting effect of making it extremely clear that I was cycling. Even I knew it without question.

The problem was that I had been on every antidepressant available, pretty much, in a very short time, and on many doses. I went from what would be more traditional rapid cycling, defined as 4 or more episodes per year, to what I call Superballing. I easily shift from very manic to very depressed 3-5 times per therapy session sometimes. I can't track my cycling very well because it is too fast, but during the hour someone else watches I know we've seen some intense changes. I am absolutely unable to do mood charting because my cycling is too fast. I was in a clinical trial and even they quit trying to make me do it because it was a losing battle. I also have very severe mixed episodes, where my thoughts are depressive and my energy is manic or vice versa or some other combination, and those also probably are related to the early treatment mistake.

Then, just to make me even more fun, I don't respond to meds normally. So in 5 years time the longest I've been remotely stable was 5 months and even then I had episodes on a mild scale. All that I've said about dose changes and med switches not being so good? I have had 2 months in 2 years without, and most months I have 2-3. I have not gone 4 weeks without email discussion with my doctor in so long I can't remember. 22 months? So every change just adds to my messed up brain soup.

In addition is the "Just Me" theory, which says that if your body has been through as much chemical onslaught as mine it will react strangely to anything introduced. I can count on needing more or less than recommended of any med and I will have at least one oddball side effect.

There's a long answer when I thought this would be short. Long, long day. Manic thoughts. Must shut up.