Anxiety + Bipolar = ?; Mental Illness ÷ Access to Care = Bullshit.

As you might recall, my most recent post was about my anxiety symptoms. While my depressive symptoms have improved significantly since I started taking mood stabilizers, and my hypomania remains an enigma, my anxiety is pretty much as awful as it has ever been. True, I haven’t had a full-blown panic attack since stopping cymbalta, which is an indescribable relief. But, I still spend a good part of every day feeling like I an irrationally agitated, frightened, impatient and jittery worrywart.

Funnily enough, it only recently occurred to me that anxiety is not a typical symptom of bipolar disorder. The two poles in bipolar are (1) hypomania and (2) depression. As far as I can tell from Dr. Goggle, anxiety is most often present as a symptom in a person with a bipolar disorder in one of two ways. First, a person can have what is called an anxiety-based “mixed state” as part of their bipolar disorder, meaning they have either anxious hypomania or anxious depression or both. Second, a person can have a separate, co-occuring anxiety disorder.

There are many different types of anxiety disorders, like panic disorder, social anxiety disorder and obsessive compulsive disorder. From what I have read about the different anxiety disorders, it seems most likely I would be diagnosed with Generalized Anxiety Disorder or GAD. This disorder includes symptoms like:

  • Persistent worrying or obsession about small or large concerns that is out of proportion to the impact of the event;
  • Inability to set aside or let go of a worry;
  • Inability to relax, restlessness, and feeling keyed up or on edge;
  • Difficulty concentrating, or the feeling that your mind “goes blank;”
  • Worrying about excessively worrying (this one is my favorite and totally me);
  • Distress about making decisions for fear of making the wrong decision;
  • Carrying every option in a situation all the way out to its possible negative conclusion; and
  • Difficulty handling uncertainty or indecisiveness.
For anyone who knows me personally, I think we can agree that the above list describes me to a T. I do all of the things described above and while, at times, that has made me a very good attorney, it has not made me a very good partner or mother. In addition to the psychological symptoms listed above, the physical signs and symptoms of GAD may include:
  • Fatigue;
  • Irritability;
  • Muscle tension or muscle aches;
  • Trembling, feeling twitchy;
  • Being easily startled;
  • Trouble sleeping;
  • Sweating;
  • Nausea, diarrhea or irritable bowel syndrome; and
  • Headaches.

Again, this is pretty much my life (except the headaches part). So, it seems to me, in my vast expertise as a non-psychiatrist, non-psychologist former lawyer who gets much of her medical information from online articles, that I might have GAD in addition to BPII. If true, this is problematic.

The first line medications for GAD are antidepressants, except those don’t work for me anymore and, more importantly, could exacerbate my BPII symptoms. The second line medications for GAD are antipsychotics, many of which I tried last year and none of which helped with my anxiety, although they were great at knocking out my insomnia. Another category of drugs used for anxiety is benzos (e.g., Xanax, Ativan, etc.). I already take one of these meds, Klonopin (also known as clonazepam), every night for sleep and anxiety-related purposes. While it does help with sleep, I have felt little to no relief in terms of my daytime anxiety symptoms. Plus long-term use of benzos is generally frowned upon because they can be highly addictive and have nasty withdrawal effects (although not all psychiatrists agree that long-term use is bad).

So it seems I am in a bit of pinch. Whether my anxiety is related to my BPII or is a separate illness, I am not sure how it could be treated effectively without  risk, either in exacerbating my BPII or resulting in addiction. Luckily, I am not the one who has to make this decision; someone far more qualified and knowledgable about BPII and anxiety will do an evaluation and determine where my anxiety is coming from and how my meds should be adjusted. Unfortunately, I can’t seem to find a person, or a clinic of persons, with the expertise I need that doesn’t cost at least $400-500 for an initial evaluation and $200-300 for subsequent treatment sessions. No insurance accepted. Typically, therapy and med management occur once a week or once every two weeks; best case scenario then is $1000 for just my first month.

Of all the things that suck about having a mental illness, the lack of affordable care is right up there with not getting to drink alcohol and feeling like the world’s worst parent multiples times every single day. I realize that insurance companies are largely to blame for the deluge of mental healthcare providers fleeing the insurance system, but that doesn’t make it any less frustrating. If I need physical therapy, no problem, just pay my $25 copay and I’m good. If I need psychological therapy, not a single provider in my area who is accepting new patients is “in network.” Sure I can submit claims each month based on my out-of-pocket expenses, but until I hit my very high deductible, I don’t get shit back, despite all the money we pay each month in premiums. It’s a scam and, more importantly, it keeps many people with mental illness from accessing proper care. I am lucky to have the financial support of my family, which makes my care possible (although it may not be enough to support accessing the particular expertise that would be most helpful to my condition). Many more people with an illness just like mine, or much worse, simply don’t have and can’t get the necessary financial support for proper care.

Lack of access to healthcare due to insurance company policies, and consequent financial barriers, is not only personally devastating to many people and their families. It is also another example of the stigma against mental illness. Physical illnesses are covered and “in network” providers abound. Mental illnesses receive very little coverage and “in network” providers are practically non-existent. This is bullshit and everyone who knows anyone with a mental illness, or has had their life touched by mental illness in any way, should be furious. And if you don’t think mental illness has played a part in your life yet, just wait: What happens when your parent, your sibling, your friend or your child is diagnosed with a mental illness? What will you do then?

Everyone needs to pay attention now; fight the stigma and fight for affordable mental health care now. If we don’t speak up, if we don’t take action, this problem is bound to get worse (supposing that’s even possible).

I am not sure exactly what we should do. I’ve started by writing this blog in hopes of convincing other people that mental illness is not some aberration or character flaw. It is not a failure of personal effort or lack of positive thinking. It is an illness, just like cancer, diabetes or arthritis. And it can affect anyone, any time, for reasons you would never suspect, like having a baby (or two). But I don’t think speaking (or writing) is enough. I’m sure there are organizations out their working for change, like NAMI. Maybe we can help them. Or, maybe you can just tell the person in your life that has a mental illness that, although you don’t understand what they are going through, you recognize that they are struggling and that they are brave. I think that would be a good place to start.





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