Where I am One Month Post Breakdown

In order to discuss where I am today, we have to back track a bit to my psychiatric evaluation.

Psychiatric Evaluation

I met with my psychiatrist 1 week after my breakdown, on June 19th.

She reviewed the notes from my time in the ER and follow up psychotherapy appointment, then asked specific symptom based questions like how quickly my moods would cycle, what type of risks or impulses I struggled to control, what my relationships were like, etc.

From our discussion, we were able to determine which symptoms I experience on a daily basis, which seem to occur in phases (multiple days or weeks), and which happen only on occasion.

She then asked about any head injuries I’ve sustained (a concussion in 2001 and a skull fracture in 2012; there is a well documented connection between head injuries and mental illness,) and checked my recent lab work (my potassium levels were low, and I was advised to eat potassium dense foods and drink Gatorade; low potassium levels contributed to my skull fracture six years ago, so this was crucial information.)

Finally when she finished assessing my symptoms, she told me I would be a difficult case to diagnose; she had the notes from the ER and my psychologist suggesting I was Bipolar, and she also agreed that I appeared to meet the criteria.

However, she suggested my symptoms actually line up more closely with Borderline Personality Disorder (BPD).

Borderline Personality Disorder vs. Bipolar Disorder

Borderline Personality Disorder is a personality disorder, and Bipolar Disorder is a mood disorder, but they are very similar, and often misdiagnosed for each other. They can also be diagnosed together; the brain is complicated that way.

In my interpretation, these are the reasons my psychiatrist believes I have BPD:

I experience consistent, intense, and rapid mood swings, and my thinking is extremely “black and white.” I also have a history of volatile relationships, episodes of rage, a low sense of self-worth, impulse control issues, a history of self harm, and an intense fear of abandonment; all textbook symptoms of BPD.

But I did also display potential manic symptoms, (notably the phases of little sleep or need for it, and corresponding escalated risk taking behavior,) so Bipolar Disorder couldn’t be ruled out.

It was possible I had both (in addition to my pre-existing conditions), and would need further evaluation before an official diagnosis could be made.

Treatment Plan

For Bipolar Disorder, mood stabilizers are often prescribed, but since I don’t have an official diagnosis for Bipolar Disorder, and mood stabilizers can be very hard on your organs, my psychiatrist held off on prescribing these.

For Borderline Personality Disorder, however, medication is not the best treatment option. Instead, the most success is often found through a specific type of therapy called Dialectical Behavior Therapy (DBT for short; Psychology loves acronyms.)

Then my psychiatrist explained that Xanax was no longer the best medication for me.

She suggested a benzodiazepine would still be beneficial, but instead of Xanax, (which is only effective for an average of 2-4 hours) I would benefit more from Klonopin, which is effective for 8-10 hours, with the idea being longer lasting medication = fewer pills needed to achieve anxiety relief.

Lastly, we talked about options for appetite stimulation.

During the evaluation, we discussed my issues with eating, and I had mentioned how Remeron was successful for appetite stimulation before, but I had gained too much weight, too fast (for my personal health and comfort anyway).

She told me that’s not uncommon at the dosage I was on, but Remeron can be tweaked by a psychiatrist to act on different neurotransmitters when the dosage is increased, in theory avoiding the excessive weight gain while still treating my anxiety.

Where I am Today

So now that it’s been just over a month since my breakdown and I’m getting closer to an official diagnosis, I’m happy to say I’ve made at least a little progress.

(Okay, maybe more than a little, but I’m still working on giving myself more credit.)

Through my health insurance, Dialectical Behavior Therapy is offered in a group setting. I enrolled as soon as possible, and started attending weekly DBT sessions at the end of June.

DBT is a skills-based therapy, broken down into four modules: Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. The point of DBT group therapy is to learn the skills, and share personal experiences, support, and advice with members of the group.

My DBT sessions take place every Thursday for an hour and a half, and will continue for 10-12 weeks, at which point I will graduate on to a more advanced DBT group that is less about learning the skills, and more about enforcing them.

I’ve been in DBT for 3 weeks now, and so far I’ve found it incredibly helpful. Not only is the material taught in DBT extremely useful, but learning it in a group setting allows me to feel less alone, to share my struggles and experiences, and get feedback and advice I might not have thought about before.

Everything discussed in group therapy is confidential, and I will never share what we talk about in group. However, after I complete more sessions, I do plan to share as much as I can about the skills I’ve learned, and how they help me personally.

But for now, I’m still learning.

In terms of medication, I no longer take Xanax (as recommended) and have switched to Klonopin instead. I’ve noticed a significant difference in the length of time I feel anxiety relief, and have had to take far fewer pills as a result.

I also started taking Remeron again at the end of June, and am happy to report my appetite has returned with a vengeance, and I’ve already gained 5 pounds. (I still struggle with nausea, but that’s also improving.)

*If you’re someone that struggles to gain weight due to anxiety (or any reason really),  I highly recommend adding Boost or Ensure to your daily diet; they are life savers for me (I suggest the chocolate flavor, but you do you).

My next medication evaluation will be at the end of July, where my psychiatrist will increase my Remeron dosage to help curb the excessive appetite and hopefully avoid too much weight gain. At this point we will also revisit the Bipolar discussion and consider adding mood stabilizers if need be.

Lastly, I continue to see my therapist on a bi-weekly schedule, and do a lot of research-based reading on my own. If you’d like to know what books I’m reading to help learn about mental health and how to improve it, you can see my recent Instagram post or email me for the list.

Overall, I still have mood swings and feel anxious every day, but I can reel myself back in much faster now, and my life feels more manageable by the day.

I’m slowly learning how to change the way I think and master my emotions, and truly believe that through consistent Dialectical Behavior Therapy, continued Psychotherapy, proper medication, and my own personal research, I will finally have emotional stability and mental peace of mind.