How does genetics fit in?

Genetics is the study of inheritance; it’s finding out what traits are handed down from lineage and what is environmental. Everyone is affected by genetics because we all have parents, who we got our genetic traits from.

Many factions of scientists track genetics through the generations. Most use a “genogram”for a reference for their research in one line or for one person. A genogram is like a family tree in that you put all of your ancestors, siblings, and relatives into the chart. Then, you track who had the trait in question and who may have had the trait but was unconfirmed. The creator may use interviews with family, birth & death records, as well as criminal records and past diaries to fill in the blanks. This is usually a good way to find out if a trait is environmentally induced or if it is genetic.

Talking about and noticing these types of traits gets me jazzed. I have my Bachelors of Science in Chemistry with an emphasis in DNA analysis & Criminalistics. Genetics was my favorite college course because the connections are so interesting. When you know a lot about a subject, it becomes more interesting. Plus, genetics is kind of a puzzle with clues as far as I’m concerned; it’s like a mystery novel.

It got even more interesting for me when Jeremy and I started talking about mental illness. He and I are both strong believers that mental illness can be both genetic and environmental. How this is described in the scientific world is usually comparison of expressivity and penetrance. In layman’s terms, expressivity is how much an individual displays a given gene trait and penetrance is how many individuals in a genetic pool are likely to have the gene for that trait.

This is where most average people hit a wall right now. There hasn’t been a phenomenal wealth of research done on the genetics of most mental illnesses. There are also a lot of barriers to proper diagnosis of mental illnesses because of the lack of research.

The National Institute of Mental Health, a division of the National Institute of Health (NIH) is trying to remedy that. They have greatly increased their research basis in the fields of mental health in the last 10 years. As a result, new medicines, treatments, and diagnosis protocols are being created every day.

Now, we are hoping to be a part of some of the research. The NIMH is currently running a research study called “Investigating the Genetics of Bipolar Disorder in those affected and their family members”. Finding this study has really opened our eyes to how our family members, primarily Jeremy’s family of origin, may be affected by Bipolar disorder. We’re hoping they will also partner with us to help with this study.

To really understand why we’re interested in it so highly, we need to talk some about Jeremy’s illness. He was diagnosed at 28 years old after years of struggle. He was divorced, had two children, worked the same job for 8 years, and had recently lost another relationship. When first treated, he was treated only for depression. He was given Effexor. As was common with this medication, when Jeremy still didn’t feel “well”, they increased his dosage. The more they increased it, the more his symptoms grew. He started having days and weeks of mania, very high anxiety and agitation, and delusional thoughts. One day he couldn’t take it anymore and he was taken to the hospital.

He ended up in an inpatient psychiatric treatment program. This is what you’d do for anyone with a severe illness; for severe pneumonia, they’d go to the PICU; for an infection they’d stay in the ICU. Think of inpatient treatment as the Intensive care unit for psychiatric cases. While there, he participated in many tests and many group sessions, as well as individual counseling. The psychiatrist determined that his response to Effexor was because he wasn’t depressed; he has bipolar disorder or cycling manic-depression.

Finding the right diagnosis makes it a lot easier to get the right treatment, but it is still not easy. Many of you have read my entry here about the mental illness in our life and the treatments we are currently seeking for it. There are hundreds more treatment options that we haven’t had to seek out yet. There are also a lot that we have tried that have not helped a lick. While in the hospital, the doctors tried many different medicines with Jeremy. Since going back on medication in 2012, there have been a few more added to the list. For some, they never find the “right” medicine for them. We are grateful that Jeremy’s found one that helped him.

Now, bring in the fact that his children struggle with illness too. The youngest is currently in residential treatment. Over the last month, the doctors there have reached out to see parallels between Jeremy’s evolution with mental illness and his son’s. In turn, they tried the medicine that’s been helping Jeremy. Lo and behold, his son has started to see some progress with impulse control and mood stabilization. That got me thinking of genetics.

When I started searching information on genetics and bipolar disorder, I found the study on the NIH site. Jeremy and I have discussed a little how his illness may be genetic. We have looked at his kids dealing with what the do, but we’ve also taken information from his family about some of Jeremy’s relatives and possible mental health issues.

Mental health is just becoming something that is viewed as a health issue instead of a stigmatized character flaw or weakness. In generations past, people were billed as “crazy”, “unstable”, or “psycho”. They were pushed out of society because of their odd behaviors or ideas. People with mental illness were avoided instead of being understood. There may well have been quite a few people who had some high functioning form of mental illness that were just outcast because of their odd life. Even in more recent generations, such as our parents, people with mental illness often didn’t seek diagnosis and treatment because of the stigma attached to it.

That’s what a genogram looks at. Jeremy and I both believe that doing this kind of exercise could be very telling for our family. We are hoping that this NIH study will accept him as part of the study; we are also hoping that some of his family members will join him in participating if they can. It would be telling to find out if there are genetic markers for bipolar disorder. To have a definitive way to diagnose this horrible disease would be one step in the right direction for a viable treatment.

Until then, we’ll keep doing what we can find that helps; we’ll be working on running the race that God has put in front of us. Stay safe out there, my friends. We’ll see you on the road.

There are lots of those weeks

I’ve always been pretty high functioning and this addition of coping skills and recovery strategies hid my depression even more. From that point forward when depression hit, I could usually get it to start to go away in a few weeks. I’d give up drinking, plan some outings to “catch up” with friends (that were really just counseling sessions for me), change my eating habits and my exercise habits. I also forced myself to maintain my routine, even if I didn’t feel like  it. I studied at certain times; I went out with friends on certain days; I went to all work that I was scheduled for; I made a few dates with my boyfriend and eventually husband. Eventually I would always snap out of it somehow after 2-4 weeks.

3 years ago, I couldn’t handle how my environment was affecting my depression. It was happening more and more often, for longer and longer periods of time. Being part of a blended family contributed; having a family with multiple people with mental illness contributed; being in the beginning stages of starting a business contributed; being unable to care for my dogs contributed. I sat down with my husband and had a ultimatum. Something had to give and it had to be our mental health. We had to focus on treating ourselves with more respect and preventing others from treating us without respect.

First, we started with counseling. He and I did couples counseling at least monthly at the time. I did individual counseling once a month; he did individual counseling every other week. So, there was one week a month that we didn’t have counseling. He also saw a psychiatrist about his bipolar disorder and got some pharmaceutical help. After 6 months, they found a med that worked for him. I got my boyfriend back and the boys got a father who was really able to parent. My depression was under control and out of mind for a good 2 years.

With no apparent new/unique stimulus, a mild bout of depression started for me in the beginning of June 2016. I followed the same procedure that I had before: the routine, the scheduling, the eating habits, the exercise. A month came and went, then 6 weeks, then 2 months. At 2 months, I told our counselor that I thought I should see a doctor. The depression was deepening. I was having a hard time getting up, I wasn’t exercising the way I should, I was having a really hard time eating well, and I really wanted to drink but it made things worse.

Realize that finding a psychiatrist and getting antidepressants isn’t as easy for us as some. We do not currently have any health insurance. We are in the strange situation of making too much money for state Medicaid, but all of the plans are way out of our price range even with a subsidy. I can’t go to my insurance website to see “who’s covered”.

I started with the county Behavioral Health clinic. They have a sliding scale that currently has us at $0 for all services each month. What’s the problem? Well, the waiting list is 187 people long; I was informed that it would take at least a year to get through that long of a list. Plus, they had just lost one of their doctors, so it would be even longer until the end more than likely.

Next option, the free health clinic. St. Croix & Pierce counties join forces for a free clinic. It is specifically for people in our situation. For whatever reason, you can’t get Badgercare (Medicaid) but you don’t have insurance or can’t afford your deductible/co-pays. It’s held on Tuesday nights on a triage basis. Meaning, if what you have is not severe enough, you might not be seen. But, you fill out paperwork then you wait for your number to be called. The earlier you get there, the more likely you are to be seen.

I was pretty lucky. The only other people there when we went were a family full of sick kids and a few return customers just trying to get their prescriptions filled. (By the way, anything prescribed at the clinic can be picked up there for free as well.) I saw a doctor after waiting only 35 minutes. We talked about my history of depression, what I had been on before, and what side effects had happened before. He decided that a different SSRI might be the ticket. Prozac (fluoxetine) became my only pharmaceutical daily.

I can tell you that it helped within a week. I feel like myself, although I still do have one or two very mild side effects that are easily controlled with diet and exercise. I’ve been on it now for almost 2 months. I still have not had a call from the Behavioral Health psychiatrist, but I think I’ll be able to tell them that a GP doctor was more than capable of treating my simple mild depression.

I take my medicine and a bunch of supplements every day first thing in the morning. I try to continue my routines, but end up sleeping a little too much if I drink even small numbers of alcoholic drinks, as I did one day this week. We continue to do counseling regularly; right now, we see our counselor every other week for couples and the other weeks for individual.

I still have some pretty major hormonal swings thanks to my PCOS (my ovaries don’t quite work as effectively as my body needs them to). This week, I spent a day or so in a bit of a fog; I felt a bit like a zombie; Jeremy was genuinely concerned for my mental state; the counselor even noted a strangeness. As my hormones have moved to the next stage of the month, I have begun to feel better. This is the nature of mental illness and hormonal imbalance: everything affects it and you can never truly know just by the feeling if it’s caused by your surroundings/nutrition/habits or if it’s a flare that needs some pharmaceutical intervention until you’ve sat with it, dissected it, and tried changing some of those situations.

Now, I move back into my usual life and our wonderfully crazy life goes on. We make doctor appointments, work, and force ourselves to face every day. So, stay safe, readers. We will see you on the road.

It’s been one of those weeks

Today, I do not feel like writing in the blog. I did not feel like getting out of bed. I have felt like doing nothing all day long. This is not a unique day for me that I “just need to rest a little”. This is something that happens almost daily for me when my depression is in full swing. Thankfully, that’s not really what this was, but it was a small taste.

Depression has been a recurring part of my life for much of my life. It really got stuck in my brain during puberty. I was not a popular person; I was not unpopular either. I had friends, but they didn’t stick around a lot. I wasn’t invited to parties much. I did have one really dedicated friend until we found boys, then we stopped hanging out as much.

Boys were another beast altogether. Hormones raging, a teenage girl thinks that every by loves her if he looks her way. We hadn’t learned yet that boys are generally jerks until they are done with puberty. But, we blindly followed them into the abyss of teenage angst, first kisses, and riding in cars.

I would say that some of my depression taking hold harder was actually because of boys. My last high school boyfriend was fairly emotionally abusive. That put some wonderfully evil self-esteem breakers into my internal vocabulary. My first few dates in college were with a sex crazed jerk, which just reinforced the bad phrases cycling because of that bad boyfriend. Then, I had a few years of great guys that came and went. They weren’t ready to take on that emerging mental illness and what it entailed. I was engaged and it ended badly. I hit a downward slope. I dated some strange ones too. My depression got out of control.

At one point in college, I decided I needed some counseling and to see a psychiatrist. I had been cut from the ROTC, which was my only career plan. I was continually exploding at my then-boyfriend. I decided to quit rugby, which was my second love. I cried randomly; I hid in my room for days on end; I “forgot” to shower, brush my teeth, or eat. I recognized that this wasn’t normal activity, but I wasn’t sure what was wrong. So, I went to the school clinic and got on the list. The counselor was not great. I don’t even remember his name. I met with him twice. The doctor was just as subpar, I met with him twice as well 3 months apart. He prescribed Lexapro the first time, the second time he told me that I was probably past the worst of my disorder and that he didn’t recommend going off of the medication. I did anyway because I felt that I had a handle on my depression. I was mostly right.

You see, when someone is put onto an SSRI (Selective Serotonin Reuptake Inhibitor), it is recommended that they stay on it for at least a year to prevent relapse. Doctors are adamant in their recommendation of staying on the medication. I had felt that this depression was more connected to my situation than something long term. I thought all I needed was a quick jolt of happy and my life would go back to good. I was mostly right.

I dealt really well for another year. I changed schools, picked a different major, lost some weight, joined a church, got engaged, found an apartment, made some friends. Then, stress came and I did well. I thought I really had outwitted that doctor until a big tidal wave hit.

My fiance split up with me in April of that following year. I was devastated and shocked. So shocked that my sister (who was visiting that weekend) said that I didn’t seem like I even cared when I told her. I went through the motions until a month later when school was out for the summer; I moved back to my parents’ place; I grieved my future plans again. I spent most of that summer in a near fog. I worked as much as I could at the local group home company. Once late in the summer, one of my high school friends tried to set me up with his roommate and it was a horrible disaster. I was not sad, but I was not happy either. I was numb.

When I went back to the town of my school, I spent the first month being sad and lonely. I didn’t hang out with my friends; I didn’t have classes yet to distract me. I wallowed in my apartment eating pizza, drinking beer, and reading. Once school started, I was lucky enough that my friends didn’t let me wallow and I started to turn that corner again. I also had a great Bible study group that helped me learn some coping skills for my depression. The depression started to subside and I got back to my life.

 

 

If you check back in tomorrow, you can hear the rest of this story. See you on the road!