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Carrie Fisher, known for the role of Princess Leia, has been fighting bipolar disorder all her life - she was not helped by medication, only by electroshock. She is my favorite bipolar, and therefore illustrates this article

This is the second part of the transcript of the broadcast about life and work in IT with bipolar disorder, the first and zero part about my story, how I learned from my mistakes, can be found in announcement and first part of decryption.

In this part of the decoding, all practical questions about mental disorders that readers of Habr asked during the broadcast: how to find a doctor, how to help a loved one with a disease, and whether you can be hospitalized and registered in modern Russia.

How do I find psychiatrist norms? Should I go along the standard path through budgetary institutions?

Judging by the reviews, they can only do worse in my region

I'll tell you how I found a psychiatrist. I had one good-known female psychotherapist, and through her acquaintances she directed me to my doctor. He was a man in his 40s with great experience, and he was distinguished from others by the fact that he was not stuck in the knowledge that had been invested in him 25 years ago at the university. He goes to conferences all the time, reads about new medicines, talks with other doctors, reads studies in English, speaks himself - that is, he is actively involved in his work. And he specializes in bipolar: look for the doctor who has a specialization in which he understands. The head and brain are very difficult.

As for neuropsychiatric dispensaries, which you can go to for free: I know that in St. Petersburg there is a good PND in the Petrograd district. Unfortunately, my girlfriend, who went there, was not cured - I don’t know what it was connected with. I read bad reviews, but I think that it all depends on the particular doctor you will see. Of course, the easy way is to look for a private doctor and go to him for money, and not have problems.

Were there any problems at work due to bipolar?

Yes they were. I was fired from my first IT job because I sat for two months, looked at the monitor and could do nothing. It just prompted me to go to a psychiatrist and get a diagnosis. Conflicts were only due to the fact that I behaved badly. Everything will be fine.

How to distinguish depression from bipolar?

With BAR of the first and second type, there is mania or hypomania. That is, if the mood graph is in the form of a saw, and emotionality is twisted towards a good mood beyond what people feel for no reason, then this is probably a bipolar. The psychiatrist will accurately determine.

Do lithium preparations help?

Yes, they help a lot. It has been helping for two thousand years, by the way - even the ancient Greeks noticed that people with increased emotionality, when they go to springs with mineral waters, where there is a lot of lithium, get better. Now lithium is prescribed first thing, I also took it, but it did not help, so I do not accept it anymore.

Interestingly, can the condition worsen or improve with age? How does the disease develop due to aging?

It gets worse with age, the disease progresses. I have mania and depression gradually getting deeper.

I would like to know how many episodes take place on average and to the maximum?

Phases last from a few weeks to two years.The bright intervals are intermissions when there is neither mania nor depression are quite short, and they may not be at all.

Can a maternal instinct and feelings for relatives be lost due to the disorder? How to fix this?

Yes maybe. During depression, sometimes a state occurs when there are no emotions at all. I had it, I broke up the relationship. Then the world is like through cotton wool. How to fix it - just be treated, engage in psychotherapy, take prescribed drugs.

Can a back and trigger points hurt amid bipolar disorder?

Yes, absolutely everything can hurt, especially during depression. It can make you sick, the temperature can rise - anything.

How did you get out of the syndrome of obsessive states, patterns of behavior? Type of overeating, loss of interest in appearance, excessive cleanliness

I just lived with it; and when I started to heal, it all went away.

Please illuminate the second type of BAR?

In short, there are two types of BAR. The bipolar species of the first type have full, pronounced mania - they blow down not only during depression, but also during mania. I have already said that in such cases speech is accelerated, sleep time is reduced, psychotic symptoms appear. Bipolar species of the second type have hypomania, with an increased mood and working capacity, which does not develop into a full-fledged mania. Type 2 BAR is often confused with recurrent depression.

How to interest a person to come back to life again?

No way. Interest in life will return if he can recover.

How to make a person interested in fighting for themselves and for their happiness? Self-pity leads to inaction and resentment in the past

By the age of 26, I realized that resentment and getting stuck in the past is childish and it is better to throw it away like unnecessary garbage. It’s not related to psychiatry; it is related to growing up.

How to understand that the problem is not a disease, but a behavior pattern? How not to lose a job and at the same time get out of procrastination?

If your relationship with people does not consistently fit in, and this is not due to the fact that you break down or shout at them, but just do not communicate, then most likely you do not know how to listen to other people or do not respect their decisions.

That was exactly what I had, and it was very difficult for me to communicate with bosses and colleagues. It was not associated with the disease. Relationship problems remained after I went into remission. I just started learning how to behave differently.

What if I constantly feel insulted - it’s not clear what?

This sensation exists regardless of my desire, with the presence of a coma in the throat. I can rejoice, but resentment remains. There is high spirits, and then again cruel gloom. Sometimes I pull myself out because I don’t want to stay in this state

Perhaps you are reflecting this condition incorrectly as an insult. Maybe this is a state of mental pain; if it stays stable even when you are happy, it means it is depression. You need to go to a psychiatrist and talk with him. This does not mean that you will definitely become a regular customer: it is possible that you have something to do with it that can be cured forever and not return to medication. Be sure to go.

What should I do if a person becomes lethargic with drugs prescribed by a psychotherapist, doesn’t want anything, constantly lies and is inactive and has constant side effects?

During the selection period, different things happen. They really have a lot of side effects. When I just started taking medication, I was depressed - I slept for 14 hours a day; I read a kilometer list of side effects and there was drowsiness. I thought: now there will be 20 hours, or what? I fell asleep at a meeting, during a conversation on Skype, once - during a personal conversation. In general, as long as the medicines are selected, there will be many side effects, and they will be heavy. It's hard to get through, but necessary.

I have endogenous depression, do I have to drink medicine all my life now? I started treatment recently

This will tell you a psychiatrist.Depends on the cause of depression.

Problem: I feel bad when leaving home. Difficult to breathe, dizziness, imbalance, sometimes high blood pressure and heartbeat

If I'm going somewhere, it's a nightmare. I constantly think about how bad it will be for me if I go out; this is what is happening. At first it was gradual, now it is already unbearable.
It is impossible to live a normal life. Who to contact?

See a psychiatrist. It sounds like a strong panic attack. Sometimes psychiatry - with pills, all of these, is needed only to give you a resource in order to understand psychotherapy. While you are deeply depressed, you don’t have the strength to go to a therapist and disassemble something, change your life, so sometimes pharmacy is needed as a supportive thing. When you figure it out, it can be removed, and everything will be fine. Most likely, your path is a supporting farm - > psychotherapy - > solution to the problem.

Is it possible to visit a psychiatrist and psychotherapist in state institutions, take prescribed medications - but without writing to the honey. book and database?

To which will the security service of future employers have access? Or should you visit private clinics to maintain anonymity? Depression with suicidal thoughts 2 years long, with periods of incomplete remission and deterioration, without mania.

If you have depression with suicidal thoughts - you definitely need to see a doctor. This is a nasty thing, why live with her? It must be thrown in the trash, and for this you need a doctor. Officially, in Russia there has long been no such thing as accounting; All your data is protected by medical confidentiality. Of course, the strictness of the laws is compensated by the non-enforcement, and I can’t guarantee that this won’t come anywhere, so if you are worried about anonymity, it’s better to go to private doctors. When I went to my doctor, I didn’t show any documents - you can even go under a false name.

Please give advice. The son is 9 years old, he was assigned OCD because obsessive thoughts appeared, previously there was ADHD

The doctor has prescribed antidepressants, although there is no depression, he is active. We began to drink medicines, now always drink them? While there is a weak effect. How will life be diagnosed with OCD in the future, will he be able to get rights, work?

He can have it all, everything will be fine. I can’t give advice about pharmacy - what to take, only a doctor can see who sees your child, takes tests from him, monitors the dynamics and knows the history of the disease. All I can say is hold on.

How did you exit the manic phase for the first time and how do you exit now?

Now, if my manic phase begins, I call the doctor. It increases the dose. This is the only way and do not deceive yourself that this can be controlled. If you are a bipolar, you have to sit on a farm.

What can you advise a relative of a person with this diagnosis?

As I said: take care, help, support, incline to go to the doctor.

My relative is now in the manic phase. He believes that everything is fine with him, does not want to do anything about it. Persuasion and belief that it will be bad in depression later does not help. She doesn’t want to take medicine.

I already answered this question: unfortunately, all you can do is to ensure that he does not kill himself and doesn’t drive into someone by car.

My psychotherapist is my psychiatrist. Long sought a qualified person

Super. I also have a psychiatrist-psychotherapist. If this is not the same person, it would be nice to arrange for them to work together in order to exchange data about you and adjust treatment.

The psychologist is not a therapist. At least by education: the therapist (in Russia) is a doctor, and a psychologist’s diploma can be obtained after the course or even self-name
Yes. The word "psychologist" does not say anything, do not go to psychologists. If you want to learn (how to behave, react, track emotional outbursts) - go to psychotherapists, if you need help, treatment - to psychiatrists.

All these concepts cannot be confused.If there are serious problems: depression, insomnia, suicidal thoughts - you must immediately go to a psychiatrist. If less serious problems (I’m offended by my mother) - you can go to the therapist.

Is BAR caused by a genetically determined deficiency of lithium ions?

This is a lie; lithium does not help all bipolar people. No one knows where the BAR comes from. There is some evidence regarding genetic prerequisites, but, for example, not all identical twins develop BAD. Rather, there are many different factors: genetics, condition, environment, stress, but no one knows for sure.

Which specialist is best to start with? Reply please

It all depends on the symptoms. If you have psychotic symptoms, contact a psychiatrist right away (that is, hallucinations, delusions, obsessive states - the desire to kill yourself, harm yourself, etc.).

Do you drink pills all your life?

In my case, yes. I have a chemical imbalance, due to which the states of happiness and deep grief turn on by themselves, and in order to regulate the reuptake of serotonin and other things, I have to drink medicine all my life. But this is not for everyone.

Most depressive disorders are invisible on MRI?

Yes, it is true.

Can there be psychosomatic headaches, numbness, compression of the head in the case of BAR? Especially during emotional outbursts and fatigue. There is nothing on MRI.

Yes they can. I had a similar one.

There is no way to cure a persecution close to mania, he believes that doctors are conspiring with "them". Maybe there is some advice?

I dont know. A very difficult situation. Probably, I would try - I don’t know how legal it is at all - to ask a psychiatrist if it is possible to somehow add medicine, because here pharmacy is obviously necessary. Do not take this as advice, I do not know the answer to your question.

There are similar ups and downs, but they are weakly expressed, there were no hallucinations, is it worth worrying?

You may have cyclothymia - a weaker version of bipolar without extreme symptoms and psychotic manifestations. If this bothers you, see your doctor, check it out.

What examinations and tests did you take to confirm the diagnosis?

BAR is not detected by any analysis.

Luck doesn't exist, hug your friends tightly


Is it possible to drive a car with this diagnosis while in therapy?

Better not. Many medications cause drowsiness and reduce attention, depression also reduces attention, and many things can be overlooked in mania. In other countries, bipolar people are forbidden to drive a car and have weapons, but with us - remember about the strictness of laws and the non-enforcement? My psychiatrist answered the question about driving: "as you know, someone normally drives normally after three tablets of haloperidol." I... was a little surprised. In general, cross the road carefully. I think driving with a BAR is irresponsible. If you have these symptoms or are under pills, it’s best not to drive.

How to trigger phase inversion?

No way, this is uncontrollable.

Briefly about my ex: a couple of years ago, a manic phase gradually arises, which ends in the hospital - at that stage when the devils are climbing everywhere. There is no depressive phase.

Around the middle of development, she realizes what is happening, may ask to take her to the doctor, but toward the end she does not realize, "it's all you sick." Sleep disturbance, fussiness, energy is directed towards home economics. The question that worries me is the following: attitude towards the person with whom you live and, in the period of remission, sincerely love, can it be replaced by the stably opposite?

I think no. I know that during depression, there may be a feeling that there is emptiness inside you and there are no feelings. But there is no such thing as a diametrical change. We do not take episodic rage into account.

If you let the phase develop, to what extent your (I hope) your beloved husband in your perception can become a fiend of hell?

I didn’t have that. Even when I was very depressed, I realized that I love him. It was this love and desire to maintain a relationship that helped me to get out and take all the drugs with complex side effects.

How to separate long-term somatic disorders from mental disorders? Can somatic escalate into mental disorders?

I don't know.

All my conscious life I have been struggling with two states:

when I want to be successful and do something for this (it’s like mania, but it doesn’t exactly match the description) and the second - when there are no good thoughts in my head, only a sense of insignificance and a desire to stop everything, since nothing positive brain wants to perceive, and all people seem vile, including me. I sin that I am just by nature, because sometimes I can force myself to get out of a state of depression by watching a motivational video, etc. Still sometimes there are uncontrolled bouts of panic attacks. When something upsets or triggers me, I can break a cup or tear a T-shirt on myself, but this is rare. Maybe it's just poor stress tolerance, or is it still a disease?

Yes, this is very similar to depression. I'm not sure if you have mania. I know that there is a weak type of bipolar disorder - cyclothymia, then a person has a depressive and hypomanic phase. They are not so pronounced as to reach psychoses, but this feeling of “all shit and me too” will be, and the feeling of “oh I'm flying” will also be.

It is worth mentioning that mania does not immediately become a mania. There is hypomania - productive, cool, pleasant, which gradually develops into mania.

I am glad that it is possible to ask a question to a person with experience on the other side of psychiatry. I am sure that your efforts will help many people solve problems.

I have periods of reduced productivity, after which I begin to worry that I’m not working well enough, because of which productivity decreases more severely, depression begins, it becomes very difficult to get myself to work - and so along the chain. How to learn to avoid this? Is this a reason for going to the doctor? I won’t be upset if they diagnose me, I’m only afraid to upset my relatives with the diagnosis. Is this okay?

I think it's normal that you love your relatives and worry about them. It is worth going to the doctor to rule out the worst - the endogenous cause of depression (that is, when there are not enough screws in the head). Perhaps your problem is solved by psychotherapy with a good psychotherapist, but I can only advise, I'm not a doctor.

Does a large neuropsychic load provoke the development of BAD?

Probably yes. I heard yes. As I said, I had a hardcore life, and maybe it influenced.

I got hooked on drugs, without them I can’t. Did you have an addiction, if so, how did you get out of it? Or do you drink pills all the time?

As I said, I always drink pills, and I will always drink them.

Panic fear of escalators, I can’t ride at all. Is it a psychiatrist or a psychotherapist?

I recommend starting with a therapist. You do not say that you have hallucinations or something else terrible - therefore, go to a psychotherapist, talk to him about it.

What is more serious - bipolar or schiz?

These are the same disease severities.

did Claire Danes play well in the BAR in Homeland?
I started to look, but I was not very hooked. I can not answer.

I understand that something is wrong with me, but I'm afraid to see a psychiatrist. If everything turns out to be really bad, the last thing I want to do is spend a week or a couple of months in the ward. How to be Because of this fear, I have not been able to ask for help for about 5 years now.

There is only one option in which you will be locked in the ward: if you try to do yourself something bad. For example, cut veins. If not, no one will forcefully hospitalize you.I went to the psychiatrist because I was already so ill that there was nothing to lose, and I did not want to go on like that. If you also don’t want to go on like this, ask for help.

I am interested in the topic of depression, could you tell us more about this aspect: you seem to live and do something, but you don’t want to do anything; sometimes it’s high from work, sometimes not; there is absolutely no desire to do any housework, to clean, and so on.

Without stopping, I just want to chat with friends and read books. It seems like apathy is called, but there is a nuance: due to hearing loss, I can’t fully accept the stream, will there be a text version?

Yes, there will be a transcript. I will say this: if you have the strength to communicate with friends and read books, most likely you do not have a deep depression. I think that cleaning, work and other things are possible when you are in a resource state; to get into it, you need to achieve at least some success. We are like rats that push a button, enjoy and push further. I want to go to work when it has some success, advancement, goals. When this is not, nothing happens. Maybe you have the opportunity to change the scope of activities to one that will inspire you, and in which the results will be better obtained?

Where does this come from? Is it an innate feature of the brain, or is it acquired? It seems to me that I have such a diagnosis - in my life I pursue an ideal image of myself, but it is unattainable, and, probably, it broke me terribly

As I said, no one knows exactly where it comes from. There are genetic prerequisites: for example, if you had relatives with depression and mental illness, then it is more likely that you can also start. The environment also strongly affects, stress can trigger the beginning. You can’t say for sure. I hope that you are going back - I saw that people can collect themselves back. Everything will be fine.

I have a second type BAR, I’ve been treated for about a year. Is it possible at all to go into remission, and then refuse medication? Is it possible to support oneself by natural means?

If you drop the pill, the disease is likely to return. Schizophrenia and BAR are severe mental illnesses that must be constantly monitored by the pharmacy.

Treating BAR with baths, massages and sports is the same as treating diabetes with hands on hand. If you are a diabetic, you need insulin. If you have an endogenous mental illness, you need to be supported with antipsychotics, antidepressants, and other pharmaceuticals. Moreover, if a person went into remission, abandoned the medicine, and again had mania or depression, the same dose of the same medicine may not help him. Therefore, do not throw drugs. If you are in remission, put a candle, and then take the pills further.

My son also works in IT, I sent him your article, I'm not sure that he will read it. I asked him to go to a psychiatrist many times, doesn’t want to hear, help, please,

Make sure that he does not kill himself - that’s all you can do. If you see that he is in a deep depression - come to him and watch him, this is very important. Maybe love, respect and support will gradually convince him to accept help.

It looks like I have uncontrollable mental problems

I constantly feel insult, negative, it affects all spheres of life. Despite the fact that I perfectly understand that I do not want this, I am constantly engaged in self-digging.
It seems to me that there is a key to the head that will solve all this. Could these problems be due to creative unrealization? As a child, I myself was drawn to creativity, I wanted to be a physicist, constantly inventing something. Then - school, work, there was no trace of the opportunity to create. I suffer from this, as if in a subconscious mind - a hole that I try to close, but have to earn money.

You know, I have the same problem. I would like to make a brilliant advertisement, but I need to earn money. I understand you. I think so, it may be due to creative unrealization, and it sounds like a question that is being solved with a therapist. Come to him, unearth everything to the end, instead of doing it alone. Perhaps it will help you - psychotherapy helps many well.

I have a diagnosis - organic damage to the central nervous system, depersonalization syndrome, derealization, depressive syndrome with anxiety

I'm 54, have been tormented for 20 years. We have already tried everything possible with a psychiatrist, there are almost no improvements. I have a leadership position, working hard. Would you recommend something?

I am very sorry for you. Maybe you should change your psychiatrist. I’m not saying that you have a bad specialist, I don’t know him and you, but maybe a fresh look at the problem will help. Maybe you are lucky - for example, a new medicine will be released, and a new doctor will offer an experimental treatment regimen. My doctor said that fitting into experiments wasn’t so bad: I was first scared when he suggested, but then he explained that there are good results.

Alcohol and BAR - is it possible?

It is impossible. But I drink.

What is your treatment regimen that brought about remission?

I never talk about my treatment regimen. I understand that there is a strong temptation to go and drink the same pills that helped another - but this way you can easily earn yourself psychosis, collect all the side effects and go crazy completely.


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