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.

When you fall off the wagon

We’re talking a proverbial wagon. Don’t worry; we did not go farm this weekend or anything. Although that would have been a great workout, had we done it.

A year ago, Jeremy and I were both very very dedicated to our health. As a result, he was at the lightest he had been in 20 years and I was at my strongest. We planned our meals ahead of time; we planned our exercise and followed through; we took our medicines daily; we spent time regularly doing self-care. All aspects of our life were kept at our healthiest options.

In March 2016, our youngest had some mental health issues start to take over his life. For the next 6 months, our life was filled with massive stress, doctors, and cops. The stress was too overwhelming for both of us. We doubled our counseling sessions. Jeremy and his doctor agreed that he probably should increase his mood stabilizer medicine. As a result of increasing too quickly, Jeremy got a dangerous rash and had to go off of the medicine that had worked for 2 years. This medicine is mostly to treat his bipolar disorder by keeping his moods in a “normal” range and help him focus better.

The new medicine to replace it was Lithium. Jeremy was on Lithium while he trained for the Twin Cities Marathon and I was training for the Rails to Trails half-marathon. A med change when there is little stress is hard. Noticing side effects and getting through the mood swings can be overwhelming. It’s triple hard when you have something that is a goal or some kind of stress in your life.

He made it through the marathon. He even had a pretty good time, even though he hadn’t trained as hard as he had hoped. For those that don’t do long distance races, there’s important information that you probably don’t know: the after crash of a race. Think of it like another life event: a wedding. You plan for months, you spend hours every day thinking of this event and planning for it. You may work to lose weight, make decorations, and pick out the perfect dress/DJ/location/cake. The day comes and you have a major high. You love your event and it goes off without a hitch. Afterward, you’re faced with a slight depression. You spend hours thinking “what do I do now?” and “There’s no purpose to my time anymore.” You looked forward to this event for months and now it’s just over. The same  happens with athletes after a major race/game/event.

Jeremy had that happen. On top of the medicine changes, Jeremy went through a pretty extreme depression. We don’t know if it was a side effect from the Lithium, a outcome from the kid stress, a downswing from going off of Lamictal, or the after-race crash. All we know is that his thoughts started racing, his self-talk got dark, and he became despondent about life in general. There were days that I had to help him get out of bed for work.

Needless to say, he was not doing any kind of exercise at that time. I was also still untreated for my depression. Between the two of us, it was hard for us to do enough thinking just to make ourselves eat, shower, and work each day. Eating healthy was the last thing in our heads. We were lucky if we made frozen pizza or mac & cheese; we weren’t even going to attempt salads.

So, what happens when someone is unable to be physically healthy? In our experience, not only does their physical health deteriorate, but their mental, spiritual, and financial health all suffer as well. It stands to reason that it’s hard to get out of that spiral. We had to keep going to work and we knew it. Thankfully, we were able to push through in that area.

We’re both pretty grateful that we have found some treatment that helped. I was put on Fluoxetine (Prozac) in December. It made it lots easier for me to get out of bed, do the work I need to do, and help him with what he needs. He also went back on Lamictal in December. This needs to be a very gradual process. Even though he is still at a very low dosage of this mood stabilizer, getting off the Lithium seems to have brought him up out of the suicidal thoughts and deep depression. We are functioning again, that’s the important thing.

Something to realize though is that “functioning” is not the same as “thriving”. It was something we talked about when we walked out on the land we plan to park on this summer. Jeremy’s lamotrigine dosage is still low enough that he’s not 100% stable. Counseling helps and the low dosage does help; it’s just not ideal yet. We are both about 30 lbs heavier than we would like to be. Neither of us are exercising as much as we need to. We’re still not eating as well as we’d like. Now that we’re functioning, we can start to address these issues that keep us from thriving. We may soon get back on track to be healthy in all parts of our life.

We start a new eating plan today with Clean & Simple Nutrition. We are hoping that a change in nutrition will give us a bit of a boost toward motivation. Within the month, we will both start training for our next races. We hope that you take some motivation to keep going, to get started, and to get healthy from our story. Stay safe and 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.