Hell in Paradise – Part Two – Seeking The Real Aloha

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Our family in front of the Kona Inn Restaurant in Kailua-Kona at sunset, November 2013

To read the revised version of Part One please visit here

December, 2013

I know it sounds ridiculous to complain about being in Hawaii, but anyone who has experienced bipolar depression can empathize with this seemingly narcissistic attitude. No matter where you are, it doesn’t matter – being in such despair is a malady of the spirit that turns heaven into hell.

There were moments when I was able to acknowledge and appreciate my family’s joy during their various activities, but I was leaden and ashamed that I couldn’t be like them. 

We arrived at a gorgeous beach in Kua Bay that was perfect for boogie boarding. My girls and husband Craig made a beeline for the gentle aquamarine waves. I used to love to go boogie boarding when I was a teenager in the (much) colder waves in Santa Monica, California. In Hawaii I watched my family play in the waves from afar, unable to join them.  

I baked on the sand and people-watched instead, envious of the beach-goers glued to their books under umbrellas. I was so apathetic that I hadn’t even bothered to bring a good book with me. This was the complete opposite of how I behaved when I wasn’t depressed. Normally I’d never travel more than a couple feet without clutching a riveting book or my Kindle Fire.

Each day in Hawaii I desperately hoped for my unrelenting depression to lift so I would feel the Aloha spirit I heard so much about.  While the word “Aloha” is often used to mean “goodbye”, “hello” and “I love you”, there is a deeper meaning to the word.  The website http://www.huna.org explains:

Aloha is being a part of all, and all being a part of me. I will not willfully harm anyone or anything. The earth, the sky, the sea are mine to care for, to cherish and to protect. This is Hawaiian – this is Aloha!

I was full of anti-Aloha sentiment. That attitude felt all wrong in such a glorious setting.  In an attempt to feel better, I self-medicated with food and beverages.  On a humid, seventy-five degree day I inhaled a bag of “Donkey Balls”.  Yes, they were called Donkey Balls consisting of macadamia nuts covered with multiple layers of chocolate. The balls were a temporary sugar fix and they left me feeling nauseated and plumped up.

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My psychiatrist discouraged me from drinking caffeine due to the contraindications associated with the MAOI (monoamine oxidase inhibitor, a class) medication I recently starting taking with lithium. The  MAOI, called Parnate or tranylcypromine, was known to help treatment-resistant bipolar depression and like lithium, was old-school. MAOI’s were the first type of antidepressant developed, but Dr. D. didn’t think the Parnate would send me into mania as long as I took the mood stabilizer lithium.

My meds didn’t stop me from sucking down the famous Kona coffee of the region.  

High-quality Kona coffee often sells for at least $30.00 a pound.  Once I sipped some of it I understood why java addicts with cash to burn paid such an astronomical price for these beans. When we arrived at Al’s Kona Coffee Farm rental, Al left us a bag of his Kona blend.  I made a pot of it every day on his farm, and all that tasty coffee left me jittery and contributed to my insomnia.

Parnate’s dietary restrictions also prevented me from binging on certain comfort foods which I previously enjoyed such as aged cheeses and cured meats. MAOI’s require that patients relinquish eating anything high in the amino acid tyrine. I made up for that restriction by gobbling a large bowl of granola each night – it was a temporary sugar high.  Not to mention gross. Of course the sugary cereal also worsened my sleeplessness.

I was desperate to feel better, but since I felt so hopeless, I didn’t have much self-restraint.

To complicate matters, I obsessed about mortality.  We had brought my mother-in-law’s ashes and planned to scatter them in a spectacular location.  This type of ceremony was a fitting way to memorialize her because she loved the region. I knew she would have appreciated it.  But I was sickened by the macabre fact that her ashes were hidden a mere room away from where I slept every night.

We found the perfect place to disperse her ashes. It was a reef just off the Puuhonua o Honaunau National Park.  Also known as the Place of Refuge, this park was once the home of royal grounds and a place of refuge for ancient Hawaiian lawbreakers.  Kapu, or sacred laws, were tantamount to Hawaiian culture.  (If you’re thinking of that Brady Bunch Goes to Hawaii episode you’re not the only one!)

Seriously, the breaking of kapu could mean death. A kapu-breaker’s only chance for survival was to evade his pursuers and make it to a puuhonua, or a sacred place of refuge. Once there, a ceremony of absolution would take place and the law-breaker would be able to return to society.

On the surface, this park was a gorgeous, peaceful spot. As I learned a bit about its intense historical background, that distracted me a little bit from my depression   

Near the visitor center I walked by a huge plumeria bush and I surreptitiously picked a handful of the lovely, fragrant blooms.  Upon my return to the beach once again I was a passive observer rather than a participant.  I gave a few white and yellow plumeria blossoms to my husband and daughters and then I plopped down on my towel.  They walked out onto the reef together and tossed the plumerias into the ocean in remembrance of my mother-in-law.  (Craig decided to scatter her ashes alone.)

Less than ten days after we returned home, once again my bipolar depression lifted.  How did that happen?

A few days after our return my insomnia grew even worse and I experienced two completely sleepless nights.  Even one sleepless night could trigger mania and I could end up in the hospital, so I called Dr. D.  He prescribed Seroquel (generic name: quetiapine), a heavy-duty atypical antipsychotic.  It nipped my insomnia in the bud. As controversial as Seroquel is, I’ll always be deeply grateful to this medication for helping me in a crisis.

I noticed that my depression subsided a few days after I started taking the quetiapine.  It seemed to me that there could be a connection between my depression vanishing and starting the quetiapine, so I remained on it  despite the side effects  I had of daytime grogginess and some weight gain/nighttime hunger.

I was able to laugh again – not fake laughs, but the real deal. I had fun with my girls and Craig, and I felt hope trickle back into my brain. To my utter relief, I could write again. I stopped waking up every day wishing I could escape back into an agitated sleep. I knew that life would continue to be difficult, but I hoped with every cell in my being that I wouldn’t return to the hell of bipolar depression ever again.

10/9/15 Meds Update: I’ve been taking 900 mg of lithium/night, 30 mg of tranylcypromine/Parante a day ever since Hawaii. I slowly tapered off Seroquel, but I resumed taking it last August when I became hypomanic at the Catamaran Writers Conference. Today marks the second week I’ve been off Seroquel. So far, so good, but if I find myself becoming hypomanic I’ll take it again in a heartbeat! 

Dyane is completing her memoir Birth of a New Brain – Healing from Postpartum Bipolar Disorder with a foreword by Dr. Walker Karraa (author of the acclaimed book Transformed by Postpartum Depression: Women’s Stories of Trauma and Growth).

Wherever You Go, There You Are

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Lately I’ve been thinking about Hawaii an awful lot.

Last November, our family scrimped and saved for months to take a sentimental trip to Kailua-Kona on the Big Island.  My mother-in-law died last spring, and we brought her ashes with us, for she loved living in Hawaii for many years.  My husband Craig knew she would have approved of his scattering her ashes in such a meaningful location.  We also thought our two little girls would benefit from an informal family ceremony in their grandmother’s honor.

So yes, this trip was a big deal for us to take –  we definitely knew how lucky we were to visit such an exotic place.  We stayed at Al’s Kona Coffee  Farm, a rental unit with a kitchen so we could make the majority of our meals and save money.  My husband knew the Kona area well from visiting his Mom when she lived there, and he planned our activities to be mostly free or low-cost.

We had scheduled the trip twice before, but Craig had to reschedule due to my hospitalizations for bipolar depression relapses.  Al was very understanding of my medical situation, and not only was he flexible in our rescheduling; he gave us a good deal.

Look at how spectacular Al’s Kona Coffee Farm is!

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A month before our trip, my bipolar depression had finally lifted due to my trying an “old-school” medication.  I started taking the MAOI (monoamine oxidase inhibitor) named  tranylcypromine or Parnate.  My pdoc added it to the lithium I was already taking, and within two days – kaboom.  My evil, hated, soul-sucking depression was gone.

I located two studies online conducted in the 1970’s that found MAOI’s combined with lithium had a greater effect together to lift bipolar depression than when used separately.  I also read a document that described MAOI’s as the “last-resort” medication for bipolar depression.  When I spotted that, I said “WTF?”   Why no psychiatrist had ever suggested the MAOI class to me before, since I was super-medication-resistant, remains a mystery to me.  There are food and beverage restrictions with MAOI’s, but they aren’t the end of the world, and the restrictions are totally worth it if the depression goes away.

Anyway, three days before we took off on our flight, my depression returned.  Words cannot express the level of disappointment and fear that descended upon me.  I’ll cut to the chase right now and let you know that three weeks later, after we returned from Hawaii, my doctor added Seroquel to the lithium and Parnate.  The depression went away and it has stayed away ever since.

But the entire time I was in Hawaii, my depression was unrelenting.  I contacted my psychiatrist and we upped my Parnate dosage, but it made me feel too wired and didn’t alleviate the depression, so I returned to the prior dosage.  While I was able to appreciate my little girls’ joy as they boogie boarded, and I took in the natural beauty of the Big Island as much as I could, I still felt like a zombie.

I’m attempting to fake being happy in the picture posted above.  Underneath the smile is utter hopelessness.  Despite the beaches with warm aquamarine water, the incredibly tasty Kona coffee, the fresh poke fish, the chocolate-covered macadamia nuts, the dolphins, and the sunsets, I felt beyond horrible.

The lesson I learned was that it didn’t matter if I was in Paradise if I didn’t have the right meds.  Some of you know that’s way easier said than done!

We could have cancelled our trip yet a third time, but  since we were so close to our departure date I didn’t have the heart to cancel.  Plus I was praying for a miracle to happen.  At least Craig and the girls had a great time.  He didn’t hold it against me that I was a less-than-ideal travel companion, and I am very grateful for that.

Someday I hope we get a “do-over”.

When Craig took his mother’s ashes out to a stunning reef on the bay by the Puʻuhonua o Hōnaunau National Historical Park, I was unable to join him.  I sat in the sand, motionless for the most part, unable to even read a book.  I am hoping that some day we’ll have the good fortune to return to that area and I can pay my respects properly.

While there I’d pick a few plumeria flowers, which are flowers that my mother-in-law adored.  I’d walk out on the reef and toss the blossoms in the water in honor of the woman who gave me the best husband I could ask for.   Then I’d walk down to the beach and swim a little, because when we went to Hawaii last year I was so down, I couldn’t even swim in the ocean.

I know that many people in our world could never afford a trip like the one I describe.  Recently I watched the documentary “Happy” that profiles different cultures with authentically happy people.  None of the “stars” of this film were wealthy, most of them lived on small incomes and some were what our society would consider extremely poor.  All of these people truly appreciated their day-to-day lives.  We could all learn from these individuals.  I may never get a chance to return to Hawaii, so I want to appreciate my “here & now” better.  (I don’t know about you, but it’s much easier for me to do this in the spring when it’s warm instead of freezing!)

I wish each of you the trip of a lifetime, wherever your dream place may be.  And I wish even more that your love and appreciation for your here and now grows significantly over time.  It would be awesome if each of us, especially those of us suffering with mood disorders, could not only appreciate the present, but experience some simple happiness every day.

I am sooo not there yet, but I’ll let you know when I’m making some headway.

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