I know this seems like an odd question, but I was considering it this morning (in my shower). It is a common problem for people with a mental illness. I have a tendency to avoid showering (really) and I know of others with a mental illness have gone weeks without showering. So, if all we’re talking about is standing in some warm water, why don’t we want to shower?

People throw around the word “depression” as if that word means only one thing. This is far from the case, therapeutically speaking. I would suggest there are mild, moderate or severe, relapsing/remitting or chronic depressions. Doing the basic math, that’s six types right there and we haven’t even taken into account treatment-resistant depression, or the depression subtypes noted in the DSM. Depression is not a disease; it’s a cluster of diseases.

I’m not known for my cheery everything’s-going-to-be-OK-puppies-rainbows-lollipops perspective. In fact, I’m against such perspectives. I find them disingenuous, phony, or seriously ill-informed. Save the rose-colored glasses for Sir Elton John, thank-you. I find smiling, being positive and telling people how great everything is to be just another chore on my list of things to do today when I’m already busy just trying to keep breathing and possibly pay rent.

Women are classic “I’m sorry” – ers. We’re taught to say “I’m sorry” from the time we can utter the words. We are the peacekeepers, claiming fault so no one else has to. We have to apologize for emotions because we’re “overemotional.” We have to apologize for our needs because we’re “clingy.” We’re sorry for our behavior, our significant other’s behavior and our children’s behavior. We are simply, sorry. And most women in 2011 realize this habit is one borne of the past and is no longer relevant in our everyday world. We realize we are not “sorry” at the drop of a hat or a glass of wine spilled by a drunken significant other. We realize there is a time to be sorry and there are times not to be. Unfortunately for me, I feel like I have to be sorry all the time, for every tear, for every thought, because if I’m not, people will leave.

Due to my frequent flirtations with treatment-resistance over the years, I have discussed ECT with a variety of doctors. To the first doctor, and the one after, I said simply, “I would rather die than do that”. Well, as it turns out when faced with death, you’ll do a lot of things you didn’t think you would.

Last week was my birthday. I didn't do anything or mark it in any way. That is mostly because, on my birthday, I look back and see bipolar behind me and I look forward and see bipolar in front of me.

I think I’m pretty great as a general rule. I’m kind, caring, intelligent, creative, talented, sexy, witty and a bunch of other stuff. Not particularly greater than anyone else, just the normal amount of great. Except for when I’m not, of course. Except for when I'm darkness sliced from evil. Except for when my slithering existence requires extinguishing. Then, I’m not so great.

Sometimes people don’t believe I’m particularly sick. They meet me, I look fine, I interact, I charm, I wit and all seems, if not normal, at least something reasonably normal adjacent. And that’s fine. It’s by design. Being a high-functioning mentally ill person, I can’t really afford to run around with my hair on fire. But faking normalcy, happiness and pleasure is a tricky and very expensive bit of business.

As I mentioned last time, many doctors feel that antidepressants actually make bipolar disorder worse. Some specialists, in fact, will routinely take people with bipolar disorder off of antidepressants when the bipolar is doing well. Like I said, it’s a matter of perspective. And I get asked all the time about getting off of antidepressants and other medication. So, exactly how should you get off an antidepressant and what should you worry about when doing so?

While many people with bipolar disorder have and continue to be treated with antidepressants along with many other medications, there is a controversy in the medical community as to whether this is an appropriate approach. In bipolar disorder there is some risk of antidepressants inducing mania or perhaps worsening rapid-cycling. But is this true? What evidence is there that antidepressants work in bipolar disorder? What evidence is there that they will make bipolar disorder worse? What do you do if you can’t take an antidepressant?