Explainer Link Copied 02.21.24

A Nice Lil Intro to Antipsychotics

These meds might sound scary, but they’re really helpful. BySam Brodsky

For years, Esmé Weijun Wang, author of The Collected Schizophrenias, heard things that weren’t there and believed things that weren’t based in reality. Eventually she was diagnosed with schizoaffective disorder. While these hallucinations and delusions—symptoms of psychosis—aren’t totally gone now, she doesn’t have them as much anymore thanks to antipsychotic medications, she tells Wondermind. “For the most part, medication has helped me a lot,” she says. “I’m really grateful.”  

For people like Wang who’ve had hallucinations or delusions, it may be hard to sort out what’s real from what’s not. But antipsychotic meds can help them do life without those things getting in the way. If you’re hearing voices or truly believing that someone’s trying to hurt you when they aren’t, it’s going to be super difficult to go about your day, says psychiatrist Kamleh Shaban, MD. Antipsychotics “turn down this ‘noise,’” she explains. (It’s in the name after all: antipsychotics.) 

But these meds don’t only make psychosis better. For example, antipsychotics can also help people who don’t have psychosis deal with mood symptoms that are really messing with them, according to experts. (More on that in a bit.) 

So, if you’re just curious about antipsychotic medications, think you might need them, or have an important person in your life who’s about to start them, we’re here to talk about the basics. Here’s how they work, side effects to look out for, and how long you can expect to be on them. Your doctor will ultimately help you suss out what makes the most sense for the symptoms you’re having, but this is a good place to start.  

What are antipsychotics?

Like we said, these meds treat outside-of-reality symptoms like hallucinations and delusions. This means they help people with conditions that can come with psychosis, like schizophrenia, bipolar disorder, and even severe depression, according to the National Institute of Mental Health (NIMH).

But you don’t actually need to experience psychosis to be on antipsychotics. These meds can also help stabilize the high highs and low lows of people with mood disorders, says Dr. Shaban. They’re prescribed to treat dementia and Tourette syndrome too, says psychiatrist Efraim Keisari, MD. And some are even FDA-approved to help with irritability in autism spectrum disorder. So don’t be shocked if you aren’t seeing or hearing weird things and your doctor brings up antipsychotics.

And, just so you know, there are two main classes of antipsychotics: older ones (called first-generation or typical antipsychotics), like haloperidol and chlorpromazine, and newer ones (called second-generation or atypical antipsychotics), like aripiprazole and risperidone. These newer ones can treat more kinds of symptoms compared to the older drugs, according to the NIMH.

So how do antipsychotics work? 

The specifics are still sort of murky, to be honest. That said, experts think that these meds prevent an overproduction of dopamine in certain parts of the brain that causes psychotic symptoms, Dr. Shaban explains. They do this by blocking some of the brain’s dopamine receptors, sorta like putting in earplugs, says Dr. Keisari.

The same dopamine-blocking powers can potentially help stabilize your mood if you’re manic—or at least that’s the theory, says Dr. Shaban. At the same time, atypical antipsychotics can be a green light for dopamine in certain parts of the brain, letting it be released instead of blocked, which might contribute to improved mood, she explains. Sometimes taking one of those atypical antipsychotics can also help your depression in a way your antidepressant can’t by affecting a few different types of receptors in your brain, Dr. Keisari says.

What are the side effects of antipsychotics?

It’s possible you won’t have too many side effects when starting antipsychotics, depending on what dose and medication you’re on, says Dr. Keisari. But there are  ones to know about.

Muscle jerks or cramps you can’t control are more likely to happen with first-gen antipsychotics, says Dr. Shaban. (FYI, this is one reason why a lot of psychiatrists prefer to prescribe second-gens now, Dr. Keisari notes.) But you’re more likely to experience higher cholesterol and weight gain (aka metabolic side effects) from certain second-gen antipsychotics rather than the older meds, says Dr. Shaban. Plus, you can have a dry mouth, constipation, blurry vision, and trouble peeing because of some first- and  second-gen antipsychotics, says Dr. Keisari. 

Because of potential side effects, psychiatrists may send you for bloodwork. For example, they’ll usually have you get blood sugar and cholesterol labs done every three to six months if you’re on antipsychotics that can mess with that, Dr. Shaban says. And doctors will need to monitor your white blood cell count super closely if you’re taking the atypical antipsychotic clozapine, since it can lower a specific type of infection-fighting white blood cell, says Dr. Keisari.  

You’ll also want to talk to your doctor about the risks versus benefits of being on antipsychotics if you’re planning on getting pregnant, says Dr. Shaban. Using antipsychotic meds while pregnant may increase the baby’s risk for birth defects, research suggests. That said, “untreated mental health in a mother can have really lasting effects,” Dr. Shaban says, so only you and your doctor can decide what’s best for you. (Just so you know, she’s personally had pregnant patients who stayed on antipsychotics, so it’s not unheard of.)

How long can you take antipsychotics?

It really depends on what you’re being treated for. Someone with schizophrenia or schizoaffective disorder, for example, will probably need to stay on antipsychotic meds to manage their psychosis, says Dr. Shaban. But someone who’s using an antipsychotic in addition to other medication for depression or manic episodes might wean off that antipsychotic when they’re feeling stable, she adds. 

Remember that everyone’s different, so it might take some trial and error to find an antipsychotic that manages your symptoms and doesn’t give you bad side effects, Dr. Shaban says. Once you do, your symptoms may start to get better in a few days, though it could take a number of weeks to get the full effects, Dr. Keisari says.

Bottom line: Antipsychotic medications are usually prescribed for treating psychosis in disorders like schizophrenia, but they’re also used for other mental health conditions. Regardless of what you’re taking antipsychotics for, be open with your doctor about side effects and any questions you have, says Dr. Shaban. They can help you find what works for you.

The post A Nice Lil Intro to Antipsychotics appeared first on Wondermind.

Explainer Link Copied 09.29.23

Here’s What It Really Means to Be Delusional

TikTok isn’t wrong, but also… BySam Brodsky

According to TikTok, everyone’s a little “delulu” (internet-speak for delusional). Thinking you could get with an A-list celebrity if given the opportunity: probably a little delulu. Saying yes to a vacation next summer that your current bank account would cry at: also delulu. It’s social media’s latest buzzword for positive thinking that borders on the ridiculous (a slightly more unhinged version of main character energy or lucky girl syndrome, if you will).

In case you were wondering though, there are actually two definitions of delusional. One is “having false or unrealistic beliefs or opinions,” so basically all of the examples mentioned above (thanks, dictionary.com!). Then there’s the other delusional, meaning the mental health symptom.

Ahead, we explain what those kinds of delusions are, why they happen, and how they’re treated. 

What are delusions?

When we’re talking about being delusional in the mental health sense, we’re talking about having delusions, which impacts about 1.3% of the general population. That kind of delusion is “an often highly personal idea or belief system, not endorsed by one’s culture or subculture, that is maintained with conviction in spite of irrationality or evidence to the contrary,” according to the American Psychological Association. 

Yeah, there’s a lot to unpack there. But, basically, delusions are when someone believes an idea that’s not based in reality. Usually, that idea is about them or someone they know, and they have no evidence of it being true, says licensed clinical psychologist and Vanderbilt University Medical Center assistant professor Julia Sheffield, PhD, who researches delusions and works with people experiencing them. 

Some delusions might seem kind of plausible like someone believing a neighbor’s out to get them or an S.O. is cheating. Others objectively don’t make sense and aren’t possible, like a person convinced that they’re dead or that an outside force is controlling their thoughts or actions. 

Sure, those plausible delusions sort of sound like a TikTok video, but the thing that makes a delusional idea an actual mental health concern is that nothing can persuade the person not  to believe it, explains Dr. Sheffield. They’re not just ~manifesting~ or thinking positively—they’re truly convinced (and, most likely, concerned).

Delusions also tend to mess with how someone goes about their day. They can’t stop thinking or talking about those beliefs, says Dr. Sheffield. Say someone falsely believes people are after them. Some days it might not really bother them, but other days it could be all they think about and it keeps them from leaving their house or otherwise living their life, she explains.

Delusions like this can last for years, and some people may have a bunch of different delusions at once, says Dr. Sheffield.

What causes delusions? 

Although you don’t need a mental health condition to experience delusions, they’re often a symptom of psychotic disorders like delusional disorder, schizophrenia, or schizoaffective disorder, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). They can be a symptom of mood disorders such as major depressive disorder and bipolar disorder too, says Dr. Sheffield.

Delusions are also a key symptom of psychosis—or when someone has “unusual thoughts or experiences that other people don’t typically have,” Eve Lewandowski, PhD, director of clinical programming for McLean OnTrack, previously told Wondermind. People in psychosis can experience these unfounded beliefs along with things like hearing or seeing stuff that isn’t there (hallucinations).

While it’s still pretty unclear why delusions happen to some people, genes and other factors like early life stress and trauma are associated with a higher risk of developing conditions that can lead to delusional thinking, says psychiatrist and clinical assistant professor at Stanford University School of Medicine Khalid Salaheldin, MD. 

Plus, health issues like traumatic brain injuries, seizures, tumors, or dementia; drugs like stimulants and steroids; and substance withdrawal can also trigger delusions, says Dr. Salaheldin. 

How are delusions treated? 

The way mental health pros treat delusions depends mostly on what’s causing them, explains Dr. Salaheldin. For people whose delusions are a symptom of things like Alzheimer’s, seizures, or other medical issues, treatment focuses on the condition causing them, he says. 

But if a mental health condition is the root of the problem, therapy is often a solid starting point. With cognitive behavioral therapy for psychosis (CBTp), a therapist can help somebody experiencing one or more delusions make lifestyle changes that challenge those beliefs, Dr. Sheffield explains. So, if someone was staying at home worrying about people hurting them, the mental health pro could encourage that person to leave the house more. Then, the therapist might point out that no one actually messed with them when they went to the store, she notes. “If you’re helping the person engage in their daily life in a healthy, meaningful way, the delusion is going to just sort of quiet down. They’re going to feel less convinced of it,” Dr. Sheffield says. 

Meds like antipsychotics can help lessen someone’s delusions too, says Dr. Salaheldin. And if someone has depression or bipolar disorder that features delusions, SSRIs or mood stabilizers could be the right move, he adds. 

It also might be worth looking into programs called coordinated specialty care, where clinicians come together to treat someone’s early psychosis symptoms, like delusions, with medication management, therapy, family support, and more, according to the National Institute of Mental Health. JFYI, outpatient programs that take this group-effort approach are listed on the Early Psychosis Intervention Network website. While these are focused on the early stages of psychosis, some of the programs still accept people who’ve been dealing with it for a while, says Dr. Salaheldin, who works at one of these clinics at Stanford.

Of course, some people can really benefit from inpatient treatment if they can’t keep themselves or other people safe, says Dr. Salaheldin. So that’s always an option too.

Whether or not delusions fully go away, the right treatment can help people experiencing them live their lives and feel heard, validated, and supported, he says.  

So, if your version of delulu is more of a practice in very  ambitious goal setting, you do you. But keep in mind that serious mental health delusions exist too, and they can be really scary and confusing for the people experiencing them, notes Dr. Sheffield. Fortunately, there are mental health professionals who will listen to what’s going on and help people manage their symptoms—just like somebody having a panic attack or depressive episode, she notes.

The post Here’s What It Really Means to Be Delusional appeared first on Wondermind.

Stories Link Copied 05.26.23

11 Things People With Bipolar Disorder Want You to Know

No, meds won’t make you a “boring potato.” BySam Brodsky

Heads up: This article mentions the topic of suicide and self-harm if you want to skip it. 

Amber, 27, notices that some people shy away from getting to know her when they find out she has bipolar disorder. Some have even called her “crazy” when she’s reached out for help, she says. And she’s not the only one noticing the stigma. Three in five people with a mood disorder like bipolar said they get treated differently once others hear about their diagnosis, according to a National Alliance on Mental Illness (NAMI) survey from 2021.

Despite the progress society has made in raising awareness of mental health issues, there’s still a lot of shame attached to bipolar disorder. Amber sees this stigma when the media mainly paints people like her as being erratic 24/7 and only really features them in “crisis mode,” she says. Brandon, 30, sees it when he posts videos about his bipolar disorder and people leave massive generalizations in the comment sections. And Tara, 41, saw it when a former boss told her never to disclose her diagnosis in the office. Ever. This just shows that the less you understand the condition, the easier it is for you to make assumptions about how a person with bipolar thinks, feels, or acts. 

What it all comes down to is that bipolar disorder is often an “invisible disability, and people don’t understand what they can’t see,” says Brandon. This is why Christina, 34, who spent years advocating for herself before she got a diagnosis, says more awareness is crucial. Setting the record straight about what bipolar disorder is (and isn’t) and calling out harmful stereotypes can get people to be a bit more empathetic and understanding when they find out somebody has the disorder, Christina notes. 

So, some bipolar 101 to start: Bipolar disorder means someone has significant shifts in energy and mood that can interfere with their everyday life. To break it down even further, there are three main types. In bipolar I, someone experiences episodes of uber elevated, energetic, and/or irritable mood (aka mania), plus the lows of depression and sometimes milder elevated mood episodes (aka hypomania). In bipolar II, they have depressive episodes and hypomania. With cyclothymia, a person deals with less intense and shorter hypomania and depression symptoms that don’t quite fit a bipolar II diagnosis, and it lasts for at least two years, per the American Psychological Association.

People with bipolar disorder can also have mixed episodes where they have a combo of both manic and depressive symptoms, like feeling hopeless and sad but also very energized, according to the National Institute of Mental Health (NIMH).

Even if you do  know all this info, you might still consciously or subconsciously have some preconceived notions about people with bipolar disorder. To help chip away at the stigma, we spoke to people with a range of experiences living with the condition. Here’s what they want those not  living with it—or those who were just diagnosed and have a million and one questions—to remember.

1. Bipolar disorder is not the same thing as having mood swings. 

“It’s normal for everybody to feel sad, to feel anxious, to feel hyper, to feel happy, to feel elated,”  says therapist Amanda Eldabh, LCSW, who also happens to have bipolar II. It’s only when those changes in mood last for days, weeks, or more and impact how you function in daily life that they could fall into bipolar disorder territory, she clarifies. 

“I know guys whose ex-girlfriends had extreme reactions, tempers, or were unreasonable, and they labeled them as bipolar,” recalls Tara, who has bipolar I. “While we do experience extreme moods, it’s not typically a sudden change. We experience moods that can be extremely high or low … [and] may last days or weeks. It’s very different from someone getting angry or reacting in an extreme [way].”

Amber, who also has bipolar I, wants to clear up this misconception too. “These episodes are more than just a feeling. They impact behaviors and thought-processing. In manic episodes, I become rageful and convince myself that other people are conspiring against me,” she shares. “It seems like people are talking to me in a foreign language, my speech becomes illogical and rapid, and I have trouble sleeping.”

When Amber is depressed, she says she feels like she can’t breathe. “I convince myself that everyone would be better off without me, especially when dealing with the repercussions of my manic episodes,” she adds.

2. Bipolar disorder is treatable. 

Thinking that bipolar disorder can’t be treated just adds to the stigma that it’s this dreadful “life sentence,” says Eldabh. It can be treated with a combo of meds and psychotherapy, plus lifestyle changes (like a consistent routine and fam/friend support), per the NIMH. 

That said, treatment will look different for each person. For Eldabh, it’s a mood stabilizer and an antidepressant (that she says are lifesaving), along with regular meditation and mindfulness. For Brandon, who has bipolar I, mood stabilizers help him not  wake up with this “impending sense of doom.” Also, the antipsychotic he’s on helps with the paranoia that everyone was judging him, which makes doing things outside of his apartment so much easier, he says.

For Cat, 31, who was told by psychiatrists that she either has cyclothymia or bipolar II, treatment looks like therapy and a mood stabilizer. Exercise and journaling help her overall mental health, and she goes to support groups to hear from people with similar symptoms as a reminder she’s not alone. 

3. No two people will experience bipolar disorder in the exact same way. 

Maybe you’re generalizing what you think you know about bipolar disorder based on one interaction you’ve had with a cousin, friend, or co-worker. To avoid stereotyping, it’s good to know different people experience bipolar disorder differently, says Christina.

For example, Eldabh and Christina both have bipolar II. When Eldabh is hypomanic, she says she’ll get impulsive. Sometimes that means spending too much money, being hypersexual, or going on a random road trip without much thought. Christina says she’ll have a bunch of flowing ideas (she’ll write a full essay or tons of jokes for a new stand-up routine), she’ll have extra energy, and she’ll call or text people more than usual.

4. Mania isn’t necessarily a fun experience. 

Amber says people always assume that mania is euphoric, and while it can be for some who have bipolar disorder, it’s not fun or a good time, in her opinion. When she’s in manic episodes, “it feels as if I’m screaming on the inside but can’t control my actions and what I say on the outside,” she says. These episodes are exhausting for her—but she can’t sleep—and they can sometimes lead to self-harm. She also can experience delusions (a sign of psychosis) where she’ll speak super illogically and think people are targeting her.

Similarly, Brandon says that, for him, there’s really no positive aspect to mania even if the extreme confidence he felt was a nice change. In his first manic episode—which happened during the Covid pandemic—he had this elaborate delusion that people wanted to hurt him because he was figuring out his family members were criminals. So mania was really scary, and he ended up in the hospital for mental health treatment.

5. And hypomania isn’t just being in a good mood. 

Christina was first diagnosed with depression when she was 14, and it wasn’t until her mid-20s that she had periods of high energy and euphoria that she later realized were hypomania from bipolar II. But even when she told psychiatrists about her symptoms, it took years for a doctor to listen her and confirm the diagnosis she’d already suspected. One psychiatrist even said he thought she was just in a good mood because life was good (WTF!). 

Equating hypomania to a “just a good mood” (whether you’re a mental health professional or not) is simplifying a symptom that, for some people, can mess with a normal sleep schedule and cause impulsive behavior. Brandon says his bouts of hypomania—which happen a couple times a year and don’t include delusions—feel similar to mania in that he’s much more impulsive than usual (even if he does  feel more in control of those impulses when he’s hypomanic as opposed to manic).

6. Bipolar disorder doesn’t make people dangerous.

Sometimes Brandon will see comments on his videos about bipolar disorder from people who say their loved ones have verbally lashed out at them, and they’ll continue on to claim that every person with the disorder is like this. “It’s sad because they obviously went through something really traumatic with someone with bipolar disorder, but the issue, obviously, is that it’s such a blanket statement,” Brandon notes.

Saying that all people with bipolar disorder will lash out perpetuates the stereotype that those with the disorder—especially those with severe forms of mania—are violent. In reality, just because someone with bipolar disorder can be irritable during manic episodes, doesn’t mean they will become violent, says clinical social worker Kirsten Bolton, LICSW, who works with patients who have bipolar disorder or psychotic disorders in one of McLean Hospital’s residential treatment programs. Plus, someone with bipolar disorder is way more likely to be a victim of violence than a perpetrator of violence, she adds.

7. People with bipolar disorder aren’t always manic or depressed.

Christina was nervous colleagues would think she was “unstable” once they found out that she had bipolar II and that it might cloud their judgment about what she could bring to the table as an employee. “I was worried people would think, Oh my gosh, who knows what version we’re gonna get today at the office? ” she says.

But it’s not like Christina is either hypomanic or depressed all day, every day. Her mood is at a stable baseline the vast majority of the time thanks to the medication she’s on, she says. As Tara explains it: It’s not like a yo-yo. It’s more like a rollercoaster where she has extreme moods broken up by periods where she feels like herself. 

This baseline or stable mood is called euthymia, says Sarah Sperry, PhD, assistant professor of psychiatry at the University of Michigan and an associate director in the university’s Heinz C. Prechter Bipolar Research Program. Even without medication, people with bipolar disorder still experience a baseline mood and aren’t just constantly fluctuating between manic and depressive symptoms, she says. Plus, it’s important to note that not every big emotion experienced is due to someone’s bipolar disorder—everyone has big feelings and they aren’t necessarily a symptom just because you live with bipolar disorder.  

8. You can have bipolar disorder and be in healthy partnerships.

Cat felt like it would be impossible to keep up a healthy love life since she hadn’t seen any positive examples of that in the media. “I have seen our society sexualize bipolar disorder with phrases and memes, saying things like, ‘People with bipolar disorder are great for one night stands but not girlfriend/boyfriend/partner material ’cause they’re always gonna be crazy,’” Cat explains. 

As she learned about her own diagnosis and continued to live with her condition, she realized that wasn’t true. She reports that she’s been in a happy, monogamous relationship for two and a half years now, and she says it’s important to know that bipolar disorder does not disqualify you from having meaningful bonds. 

9. Bipolar II isn’t necessarily less severe than bipolar I. 

Eldabh says a lot of people think because she has bipolar II (and not bipolar I) and she’s successful as a mental health professional that she doesn’t struggle—and that’s not fair to assume. For her, bipolar II can be debilitating. For example, she attempted suicide during a hypomanic episode in the past.

Not to mention, depressive episodes in bipolar II can actually be longer and come on more often than depression in bipolar I, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). For Eldabh, her depressive episodes can be intense and sometimes manifest as intense guilt and regret for things she did during a hypomanic episode, which can lead to suicidal thoughts.

10. Bipolar disorder meds don’t turn you into a zombie.

At first, Cat fell into the trap of thinking she would be emotionless once she started mood stabilizers to level out her extreme highs and lows. “I thought medication would make me a boring potato because I thought creativity, bubbliness, and friendliness came hand in hand with what I now know can  be hypomania,” she says. But Cat found out that she can be joyful, bubbly, and excited even when she’s not hypomanic.

We’re happy to report that Cat is NOT a boring potato. Her periods of hypomania and depression aren’t as long or intense because of her meds, and she still taps into her creative side as an artist, she says. Facts: Cat painted a giant canvas of a whale while jamming out to Rihanna after the last Super Bowl, and she continues to do makeup gigs for film and photoshoots.  

Bottom line: It’s a major misconception that all mental health meds will flatten your emotions. Sure, that might be the case for some people depending on what they’re taking—Nick, 36, who has bipolar II, says he thinks his combo of meds was partially to blame for his “stifled” emotions—but that’s not something that’ll 100% happen.

11. And getting off medication isn’t really the goal for most people with bipolar disorder. 

Since there’s such a stigma around mental health meds in general, Brandon says people always assume he wants to stop taking them as soon as possible. But, turns out, he’s finally found stability after 20 years, so he’s for sure staying on them, he says. “I’m under the impression that I will be on medicine the rest of my life, and I’ve accepted that,” he adds.

It’s true that a lot of people with bipolar disorder take medication to help prevent future mood episodes and reduce symptoms in between episodes—so the majority of those living with the disorder will stay on meds, explains Dr. Sperry. But some people can decrease their meds or go off of them depending on their circumstances, she says.

Thanks to medication, help from mental health professionals, and social support, Amber says she’s living a fulfilling life. “Bipolar disorder may be an obstacle you have to live with, but it does not need to define where you will go and who you want to be,” she assures.

The post 11 Things People With Bipolar Disorder Want You to Know appeared first on Wondermind.

Stories Link Copied 05.16.23

7 People on What Psychosis Actually Feels Like

“Most of the time it feels like a glitch in the matrix.” BySam Brodsky

When psychosis comes up in conversation, it usually starts with something like, “Did you hear about that terrible thing in the news?” and is followed by, “Man, mental health is such a problem in this country.” While, yeah, the latter is sort of true, research shows that people with a psychosis-related disorder are actually more likely to be a victim of a crime than a perpetrator. The reality is that most people who experience psychosis symptoms won’t  be featured in dramatic headlines or national tragedies. 

That said, psychosis can be a very intense and sometimes scary experience. But it’s one that plenty of people recover from with the help of mental health pros and the right meds. Actually, Selena Gomez (Wondermind’s co-founder and Chief Impact Officer) talked about previously having a psychotic episode in the documentary My Mind & Me. 

But even though it’s more common than you’d think—as many as 100 people out of every 100,000 develop psychosis each year, according to the National Institute of Mental Health (NIMH)—the general public’s lack of knowledge about psychosis adds to the stigma, says licensed psychologist Eve Lewandowski, PhD, who works with patients who have psychotic disorders at McLean Hospital and Harvard Medical School. 

So, ICYMI, psychosis can be a symptom of mental health disorders like schizophrenia, schizoaffective disorder, bipolar disorder (in manic or depressive episodes), and even PTSD, explains Dr. Lewandowski. Also, psychosis can sometimes happen shortly after people give birth in what’s known as “postpartum psychosis,” according to the American Psychological Association. It can be a condition in itself or occur due to an underlying mental health condition that started before, during, or after pregnancy.

Psychosis may also happen to people without mental health conditions who are sleep deprived, according to the NIMH. Same goes for some who take medications like stimulants or antidepressants and for those who misuse or withdraw from alcohol or certain substances, notes Dr. Lewandowski.

When psychosis happens, it’s common to see or hear stuff that isn’t there (hallucinations) and/or believe things that aren’t based in reality (delusions), Dr. Lewandowski says. For example, you might think people on TV are trying to warn you that everyone is out to get you. It’s important to take culture, religion, and personal experience into account too, says licensed clinical psychologist Jenny Wang, PhD. So, if you don’t normally hear God speak to you, and you suddenly do, something could be off. 

You could also talk in a way that’s hard to understand or jump from one topic to another, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). Plus, those who develop psychosis might isolate themselves, lose interest in things they’re usually game for, or act unusually, Dr. Lewandowski adds. 

Psychosis symptoms can last for days, weeks, or even up to a year, especially if they go untreated, says Dr. Lewandowski. But whether or not psychosis is a one-time thing or comes and goes, people can recover from it. With treatment like meds (antipsychotics, for instance), therapy, and outside support, they can “live rich, full lives,” says Dr. Lewandowski. 

“Though people like me have experienced really intense mental states, we’re just people too,” says Esmé Weijun Wang, author of The Collected Schizophrenias, who’s dealt with psychosis. “It’s not something to be afraid of. It’s not something to feel like is so alien that we’re beyond human or beyond saving,” she adds.

Here, we asked people who’ve been there to share their experiences with psychosis so you can feel less alone or just get a better idea of how they’ve learned to deal. 

1. I felt disconnected from the earth.

“Being in psychosis is very overwhelming for me. [As someone with schizoaffective disorder, bipolar type,] I think I’ve experienced it maybe three to four times within the last several years. And usually when I have an episode, it starts with bizarre thoughts and behaviors. I feel this intense state of fear and feelings of paranoia, like an existential threat or some kind of crisis. Sometimes I lose grip on reality and, most of the time, it feels like a glitch in the matrix, like a disturbance in my mind. So these thoughts make me feel disconnected with reality, ungrounded, and untethered from the earth.

It usually lasts a few days, and, in a worst-case scenario, I end up going to the hospital. But I’ve been grounded for a few years now.” —Sarah A., 34

2. I felt weird in my body.

“Over time, my psychosis [which is related to schizophrenia] has most definitely changed. It started with being extremely, extremely difficult. It literally felt like I was falling into a pit of despair all the time. I had a lot of fear, anxiety, all that kind of stuff. A lot of sleepless nights, paranoia, the feeling of wanting to jump out of my skin. I couldn’t stand being in my tangible body because of how bad it all felt and how much was going through my mind.

[When my psychosis was most extreme,] some of the feelings and thoughts were very, very religious. I believed that I was Jesus Christ and that we were trying to narrow down who the ‘true Jesus’ was. When I was really ill years ago, I had auditory hallucinations, visual hallucinations, and delusions. I couldn’t even focus on anything. There was no ability for me to be living a typical life. I’d just walk down the street, yelling at people, thinking that cars were alive and they were trying to kill me.

I’ve been taking my antipsychotic for six years and an antidepressant for a while too. I don’t feel that anxiety. I don’t feel the extreme paranoia that I used to, where I thought people were trying to kill me. I just have moderate thoughts that are kind of paranoid.

If I’m really stressed out, it’ll come back a little bit like that, but it won’t reach the point where I lose the ability to recognize: OK, this isn’t real. Nothing’s perfect, right? But you can get to a spot where you do feel like you’re living a life that’s fulfilling.” —Celia F., 35

3. It was like a bad dream.

“My first hallucinogenic episode happened after I relapsed from alcohol addiction in March 2017.  Up until that point, I’d been drinking for about seven years. In that time, I’d gone from drinking one to three glasses of wine per night to two to three bottles a night or sometimes more.

When I stopped drinking abruptly or cut back from what I was drinking too quickly, I would begin to get severe alcohol withdrawal symptoms known as delirium tremens (DTs). This began with the shakes, fever, and nausea usually between 24 and 36 hours after the last drink. After 48 hours, my withdrawals would progress, and I began to hallucinate. It was like I was dreaming while I was awake.

During these episodes, my senses were heightened and everything I saw, heard, and felt was distorted. Typically, I’d see wasps, bats, spiders, and crab-like creatures. They would be terrifying experiences, and I couldn’t control my body or easily snap out of these episodes.

I was eventually able to embrace my recovery in November 2019. It inspired me to write Smashed Not Wasted  about my experiences.” —Sam T., 37

4. It’s not always scary. 

“I feel like psychosis is almost just not believing anything or believing false things, like I can’t really trust what’s around me because I think everyone’s lying to me. I don’t believe anybody is telling the truth.

Getting diagnosed with schizophrenia was not a bad thing because then I could finally be treated for the correct illness. I’m on medication, which helps 95% of the time. I’m cool with that. Otherwise, this would happen all the time and I wouldn’t be able to leave my house.

I now know how to ignore the really bad voices. I know that they’re fake now, but they’ll still come in like, ‘Why did you just say that? What did you do? Why would you do that? That was stupid. That’s why those people don’t like you.’ It’s just like a big ball of self-hate smacking you in the face.

[People who haven’t experienced psychosis might] think, Oh, it’s a psychosis episode. It’s scary. It’s so frightening. No, it’s not frightening. It’s not scary. It’s not really dangerous for me. It can happen just while sitting on your futon, and you’re not going to hurt anybody.” —Michelle H., 35

5. I believed some bizarre things about my family.

“During the pandemic, in December of 2020 to April 2021, was my first major manic episode that turned into psychosis. That’s the first time, and only time, I went to a hospital, and that’s where I was first diagnosed [with bipolar I]. I didn’t have any visual hallucinations or audio hallucinations, but I was convinced my family had always been part of this international criminal organization, and all the evidence I was finding about that explained every detail of my life up to that point.

Nothing has ever felt more true than how that felt to me during that time. I thought I was finding all this evidence online of their criminal activities. I actually took screenshots of Reddit posts of people talking about situations they had been in, where people they knew were part of bad stuff, and, later, after my psychosis, I realized what they said was not what I was reading or seeing at all. 

I was building and building this narrative for close to three weeks. I was convinced that people wanted to hurt me because I was figuring this out. And when my family actually came to help me, they asked me to come out to my apartment building’s garage. It’s probably 100 feet from the apartment door. I was too scared to do it, so I asked my brother to come get me. 

[Once I got to the hospital,] the antipsychotic kicked in, so I was starting to [come back to reality] within three days, but I was still very wary of certain people in my family for maybe another month. Although I didn’t believe the full story I had created.” —Brandon C., 30

6. I wasn’t myself.

“I had undiagnosed postpartum depression and anxiety. The week leading up to my actual postpartum psychosis event—which lasted for at least three weeks—I was very much on cloud nine, thinking I was untouchable. The day that I went completely outside of reality, I woke up feeling like the weight of the world was on my shoulders, thinking that God was telling me I needed the prayers of many to tell my story. At that time, I didn’t know what story that was. I also did things that morning that were not like myself, including quitting my job. 

I spent two or three nights in the psychiatric ER, and I ended up being transferred to an inpatient unit, where I stayed for two weeks. I remember being very scared. I would call my family at least 20 times a day. I do  try to find some humor in it [because] I thought that I was on the set of Grey’s Anatomy  and that other patients were LeBron James and Bradley Cooper.

When I was discharged, I couldn’t be by myself. I couldn’t be with my kids by myself. I couldn’t work and I couldn’t drive. That went on for several weeks and I ended up going to an intensive outpatient program. I spent a year [total] recovering. I got off antipsychotics after that year, and I’m still on an antidepressant. I quickly shared my story and started a nonprofit [to advocate for postpartum psychosis awareness].” —Kristina D., 38

7. I felt like I was on a tightrope.

“The first time I experienced a hallucination, it was a voice in my ear that said, ‘I hate you,’ when I was in the shower of my dorm in college. It was so realistic, it was so real, that I could hear it directly in my ear, and I started thinking, Is this something coming from the pipes? Is there something weird going on where a sound is coming through the drain from downstairs or upstairs? 

Delusion tends to be more of what I experience these days. One that I’ve experienced, that I wrote about in my book, The Collected Schizophrenias, was believing that I was dead. Another one that I experienced a lot in my younger years was a delusion where you believe that all of your loved ones are replaced by doubles or robots.

Around 2013 or 2014, when I was diagnosed with schizoaffective disorder, I became quite hopeless, and my doctor told me I had a drug-resistant form of psychosis and schizoaffective disorder, bipolar type. But I ended up [finding meds that have worked for me, which] I’ve been taking for a number of years. Now, it’s unlikely for me to have a psychotic episode unless I’m under a lot of stress.

I feel like there was a period of time where my mind was much more fragile and I had to be aware of whether or not I was on the verge of having an episode. Now, I’ll go through maybe a few weeks where the symptoms are kind of more present—where I have the physical sensation of walking on a tightrope or just standing on a very small square foot of flooring with a very deep and dark abyss around it. For me, there’s a sense of not feeling physically stable in addition to mentally stable. But, for the most part, medication has helped me a lot.” —Esmé W., 39

Quotes have been edited and condensed for length and clarity.

The post 7 People on What Psychosis Actually Feels Like appeared first on Wondermind.

Stories Link Copied 01.31.23

8 People Share What Really Helped Them With Peripartum Depression

"Just because you feel bad doesn't mean you are bad." BySam Brodsky

If you’re going through it, peripartum depression can seem like a thing no one really warned you about, but it’s actually pretty common. About 9% of women experience depression in pregnancy—and around 7% go through a depressive episode within the first 12 months after giving birth, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). (It’s worth noting here that people of different gender identities can give birth, but these stats from the DSM-5-TR  were gathered in a way that doesn’t seem to have taken that into consideration.)

For those unfamiliar with the term, peripartum depression refers to depression that happens during or after pregnancy. You may have also heard it called postpartum depression or perinatal depression, or, more generally, referred to as part of perinatal mood and anxiety disorders (PMADs). In the DSM-5-TR, it’s listed as “major depressive disorder with peripartum onset.” The phrasing may change a bit depending on who you’re talking to, but the overall gist is the same. 

Peripartum depression can feel like you’re “paddling as hard as you can to keep your head above water. You’re just waiting and waiting and waiting for someone to throw you a life preserver and pull you out on the shore and save you,” says licensed social worker Paige Bellenbaum, LMSW, founding director and chief external relations officer at The Motherhood Center of New York. 

The exact symptoms can vary from person to person, though you may feel sad, worthless, or fatigued, and your sleeping schedule and appetite might also be off. That might sound like it’s just par for the course of being a sleep-deprived new parent, but, in the case of peripartum depression, these symptoms are debilitating and long-lasting, going far beyond what most consider to be the “baby blues.” 

In a lot of cases, there’s also an added layer of guilt since you’re in charge of this brand new human at a time that’s “supposed” to be THE best (whatever that means), says perinatal psychologist Katayune Kaeni, PsyD, PMH-C. Remember this though: “What you’re going through [does not mean anything] about who you are. It’s about being under high stress during this major life transition. Just because you feel bad doesn’t mean you are bad,” Dr. Kaeni assures. 

Many people’s peripartum depression symptoms begin during pregnancy or within the first four weeks following delivery, according to the DSM-5-TR,  but they can start up anytime within the first year of giving birth, and, if left untreated, may last for years, says Dr. Kaeni. Other types of PMADs can happen alongside depression, whether that’s OCD, an anxiety disorder, or postpartum psychosis, Dr. Kaeni explains. (And just so you know, partners of people who’ve given birth can experience postpartum depression too, says Dr. Kaeni.)

The recovery process may be slow, but treatments like therapy and antidepressants, along with support from your loved ones and those who’ve been there, can help. “When you’re on the road to recovery, it’s never a straight line to the finish line. But there comes a time where you look back and say, ‘I’m past it,’” Bellenbaum says. She knows because she’s been through it—and so has Dr. Kaeni. Ahead, you’ll hear from both of these mental health pros and other parents about what helped them navigate this type of depression. 

Heads up: There’s some discussion around suicidal ideation below.

1. Therapy and meds.

“When my daughter was about 12 months, I started feeling it. There was so much excitement and new changes with her that I relished in. Then, there was a shift—whether gradual or overnight I couldn’t say—where I would look at her do something cute and know I should smile or photograph this and be excited, but I just couldn’t. Then guilt and shame would set in because all I wanted was to be a mom and now it seemed like I didn’t like it.  

Luckily, my general practitioner listened to me when I broke down in his office. He gave me a prescription for antidepressants and encouraged me to go back to counseling. The medication gave me a boost and the counseling helped change my perspective. I was doing a lot of circular thinking by comparing myself to other moms (including celebrities) and feeling like a failure. Counseling helped me practice gratitude for what I had, celebrate what I was doing, and not do the comparison thing. I could feel myself reconnecting with some of the simple moments. I found my rhythm and balance of life. I no longer felt like an outsider to our family.” —Amanda T., 45

2. Faking it till I made it.

“After my first pregnancy, I had suicidal thoughts and was going through severe anxiety and depression, but I didn’t realize what was going on. When I expected my second child, I prepared with regular therapy sessions. I thought I avoided postpartum depression until I hit rock bottom when my baby was 5 months old.

What has helped me is dialectical behavior therapy—specifically a skill I learned from it, called opposite action, where you do the opposite of what your emotions urge you to do. For example, I was terrified of traveling because it felt like a mountain of things could go wrong and hurt my kids. I checked the facts, made a safety plan with my husband, and traveled. At first I didn’t enjoy it. I was stressed, tired, and numb. But after a few trips, I started feeling joy again. 

The exposure is the key. If I fear something, I check the facts about it. If my fear is not justified, then I do the opposite. It’s like faking it until you make it.” —Anonymous

3. Doing things I liked.

“I experienced depression both during and after my pregnancy. During my pregnancy, feelings crept up on me. I would experience heavy thoughts one day, a normal day or so would pass, and then I would feel a desire for extreme isolation away from everyone. In mentioning these thoughts and feelings to my therapist and doctor, they advised that this was clinically diagnosable as depression. 

After birth, the depression hit me like a train. My sleep was impacted; my mood was impacted; and the ability to feel like a present mother, friend, sister, and employee all became a struggle. So did attending social events and simple tasks such as getting dressed or brushing my hair.

Aside from prescribed medication, fresh air, and alone time, participating in activities that I enjoyed before pregnancy, such as watching gymnastics and coaching when physically able, helped. I returned to coaching a few months after giving birth, and it did help my mood significantly. Being active and outside of the house made a world of difference when I had the strength, because it gave me an opportunity to do something I love and be around people.” —Indira, P., 27

4. Reaching out for help.

“My symptoms started during pregnancy, but it wasn’t until about six weeks postpartum where I really crashed. I became increasingly anxious and convinced that something terrible was going to happen to my son. At the apogee of that anxiety, I also became incredibly depressed. I stopped taking care of myself. I wasn’t able to sleep at all. I stopped eating. I felt hopeless. I felt helpless. I felt like I’d made a huge mistake. I felt like I didn’t like my baby and I didn’t want him. I wanted to run away somewhere and never come back. I had nothing to look forward to. I was convinced that this is what my life was going to look like forever.

The critical point for me was when I was pushing my son in a stroller one day. I hadn’t been outside in a long, long time. As I was approaching the corner, I just felt like I was surrounded by this gray, depressing fog. I saw this bus starting to pass in front of me, and every part of my body wanted to just end my life. I remember looking at the reflection of myself in the glass and not recognizing who I saw. That’s when I made the decision to get the help I needed.

I had been in therapy, but I found a therapist who specialized in perinatal mood and anxiety disorders. I had been on an antidepressant prior, and I went back on one. As with any medication, I started to feel better slowly. At one point, I went to a support group for women experiencing postpartum depression, which I thought to be incredibly empowering and validating and normalizing—to realize I wasn’t alone.” —Paige Bellenbaum, LMSW, 49

5. Leaning into self-compassion.

“The thing that was the scariest for me about experiencing postpartum depression with my first child was that it didn’t show up like ‘normal’ depression. I didn’t notice that the intrusive thoughts had taken a permanent residence in my brain. I thought crying all day and berating myself for not being a better mom was just a normal part of being a new parent. I think this was compounded by the messages I was receiving in American culture about how this should be the best time in my life.

The biggest lesson during my first round of PMAD was that I needed to be kinder to myself. Motherhood is an ancient practice that takes time and tenderness to learn. I expected to master sleep schedules and keep my career going while raising a baby full time. When those things didn’t happen as planned, it felt like my life and my identity in the world was crashing all around me. But, in reality, I was building a new life. I was learning new priorities, new routines, and how to live with a brand new person in the world. 

The second time, I had to learn to cope with anxiety and panic attacks as well as my depressive episodes. One practice that’s helped me is to talk to my anxiety and tell her that everything is OK and ‘I got this.’ Once I allow her the space to feel safe, I feel more grounded and able to move through the panic attack quickly or avoid it altogether.” —Erin B., 35

6. Getting support.

“I experienced depression and anxiety following the birth of both of my girls, and, as I look back, there’s an incredible amount I didn’t know. The most heartbreaking thing was that I didn’t think anything was wrong and I definitely didn’t feel comfortable speaking up about it. That truly almost cost me absolutely everything when I went through postpartum psychosis and spent two weeks in a psychiatric unit. I went completely outside of reality and, at times, didn’t recognize my husband. 

Essentially, being forced to get help enabled me to understand how important self-care, being honest, and asking for (and accepting) help was. Having a support system and people to help you is absolutely imperative. 

My husband had to work during my episode and immediately became the full-time caregiver to our two kids (age 2 and 5 months at the time) and to me. Our families would alternate weeks to come help, and I wouldn’t have made it without everyone’s support.” —Kristina D., 37

7. Approaching the day in bite-sized bits.

“I developed my postpartum depression nine months after I gave birth to my daughter. I chalked my symptoms up to life stressors. But once those events passed, I was left feeling so alone and sad.

Every morning was grueling. I knew I needed to get up to take care of my baby and myself, but my body was fighting my mind. It felt like every little task and chore was so overwhelming. It was exhausting knowing everything I needed to do to provide for my little one but feeling so sad and wanting to cry. It was also incredibly hard to ask for help—from anyone. I opened up to my husband a little bit, but he had his plate full too and he was already so incredible in helping me whenever he could. I felt guilty adding anything more. Secretly, I was screaming for help in my head and wishing anyone would offer any ounce of help at all.

I really took some time at the start of the day to mentally prepare. That meant waking up an hour earlier than I normally would to allow myself to lay there, watch a show, and hype myself up. Another small thing I did was break down my day into 10-minute increments. I wouldn’t think about all the things I needed to do that day all at once. I would say to myself, ‘In the next 10 minutes, all you need to do is change her diaper.’ It helped in the long run.” —Joy K., 27

8. Challenging my thoughts.

“It took me about a year to realize what was going on because, as a therapist, there was this additional layer of pressure that I should have been able to figure this out. There’s also a little bit of denial. I did not want to be depressed. So, for me, the light bulb came on when I decided to just honestly sit down and fill out a depression screening myself so that I could objectively see: OK, yeah, you are actually dealing with something. Seeing that objectively on that piece of paper really made me see that I needed help.

So I went back to therapy. They were helpful, but it wasn’t a great fit, so I decided to use the skills that I know—and help people learn—to change my thought process. 

I had a colleague that used a catchphrase to describe this process: ‘Catch it, check it, change it.’ The first part is essentially building an awareness of your own thought process and trying to catch your negative self-judgmental thoughts. Checking it is: Is that really a true statement? Is it a true thought or feeling about something that’s happening? And then changing it is offering yourself an alternative. So let’s say I’m feeling like I’m a bad mom, and I catch myself saying that to myself. I check it: Am I really a bad mom? What are the things I’m doing to help my child?  Then, change it to something that’s either neutral or positive like, I’m doing my best right now. Or even a positive one would be, I am a good mom.” —Katayune Kaeni, PsyD, PMH-C, 44

These quotes have been edited and condensed for length and clarity.

The post 8 People Share What Really Helped Them With Peripartum Depression appeared first on Wondermind.

Explainer Link Copied 09.16.22

What’s the Difference Between Mania and Hypomania?

The same—but different! BySam Brodsky

Chances are you’ve heard of mania, a mood state that can make people feel next-level energized or pretty damn irritable. Whether you have bipolar disorder or randomly heard someone mention a “hypomanic episode” in passing, you might be curious about what that means exactly—and how it’s different from straight up mania.

But first, here’s what they have in common: Both mania and hypomania are episodes of elevated or irritable mood where people could have racing thoughts, be super talkative, avoid sleeping, feel restless, and have inflated self-esteem, according to the American Psychological Association (APA). They’re also both symptoms of bipolar disorder and other mental health conditions. 

People going through a manic or hypomanic episode may feel uber productive and do impulsive or overly ambitious things, like staying up all night to repaint their bedroom, says Kirsten Bolton, LICSW, a clinical social worker for McLean Hospital. Plus, they might take some serious risks, like randomly spending a ton of money they definitely can’t afford to.

All that said, there are some BIG differences between the two symptoms. Here’s what makes mania and hypomania different, who’s at risk for those symptoms, how they’re treated, and more.

How to tell the difference between hypomania and mania

TL;DR: Hypomania is usually milder than mania, according to the APA. That’s partly because untreated hypomanic episodes are typically shorter than untreated manic episodes, explains Po Wang, MD, Stanford University clinical professor of psychiatry and former director of the university’s Bipolar Disorders Clinic. A hypomanic episode lasts at least four days and a manic one lasts at least a week, per the Diagnostic And Statistical Manual Of Mental Disorders (DSM-5-TR). 

On top of that, a hypomanic episode isn’t severe enough to majorly interfere with a person’s social or work life or land them in the emergency room like a severe manic episode can, according to the DSM-5-TR.

Unlike hypomania, severe manic episodes can cause some people to experience psychosis, where they lose touch with reality in the form of hallucinations or delusions. The latter could manifest as grandiose delusions, Bolton explains, like thinking they can win the Grammys even though they can’t hold a tune (sorry). Outside of this, they might make strong connections between themself and the universe, like seeing a Vermont license plate and interpreting that as a message that they should drop everything and drive there ASAP. 

Who actually experiences hypomanic and manic episodes

There are three main types of bipolar disorder, and knowing whether you’ve experienced mania or hypomania (or both) can help experts point you to the right diagnosis. Mania is a key feature in a bipolar I disorder diagnosis (though you can still experience hypomanic episodes in bipolar I), whereas hypomania is a feature of bipolar II disorder. (FWIW, even though hypomania is a less severe form of mania, bipolar II is not a less severe form of bipolar disorder, according to the DSM-5-TR.) 

People with schizoaffective disorder can also experience a hypomanic or manic episode, explains Dr. Wang. It’s worth mentioning, too, that substances like cannabis, cocaine, steroids, and methamphetamines can sometimes trigger mania and hypomania in the general population as well as in those diagnosed with or predisposed to conditions like bipolar disorder, explains Dr. Wang.

What’s more, medical conditions that impact the part of the brain that regulates emotions and impulses may also cause hypomanic or manic symptoms, says director of Yale School of Medicine’s Mood Disorders Research Program Hilary Blumberg, MD, professor of psychiatry and psychiatric neuroscience. These can include multiple sclerosis, brain trauma, stroke, and more, according to the DSM-5-TR.

How hypomania and mania are treated

The best thing to do during a manic or hypomanic episode is to seek out support from a mental health professional. They can get to the root of the issue and prescribe the right treatment or medication, like mood stabilizers or antipsychotics. That said, if you or someone you’re looking out for has stopped eating or drinking or are getting into dangerous situations during a manic episode, it could be worth seeking help at a hospital or treatment center right away, says Bolton. 

Meds and therapy aside, Dr. Blumberg and her team at Yale are studying how regulating sleep and daily routines can help mitigate symptoms of bipolar disorder, like mania and hypomania. Dr. Blumberg says this can be an effective treatment option in addition to others like meds and psychotherapy. So, with that in mind, it could be helpful to encourage people dealing with this symptom to get more sleep and/or narrow down all the projects they want to take on, says Dr. Wang.

FYI, after mania plays out, people may have regrets about their behavior, and it’s common to have “varying degrees of lethargy and depressed mood,” says Bolton. That makes sense considering studies suggest 60% of manic episodes happen right before a major depressive one, according to the DSM-5-TR. Same goes for hypomania: Depression almost always follows a hypomanic episode, Dr. Wang says. But, by managing hypomanic or manic episodes with a solid support system and potentially some medication, it’s possible to minimize the impact of those low periods, says Dr. Wang.

The post What’s the Difference Between Mania and Hypomania? appeared first on Wondermind.