Chris and Annalaura both grew up in the Midwest — he in the "middle of nowhere" Indiana and she in Michigan. They met, married, and headed out west to Utah in 2009 to attend Brigham Young University (BYU). He studied photography as an art major and loves writing. She graduated with an English undergraduate degree, then got a master's degree in public administration.
In 2012, life was pretty normal for them as a young couple. Then Annalaura's mom unexpectedly died. A month later Chris had his first bipolar swing, although, they didn't know that's what it was at the time. Prior to that, he had never experienced any significant mental health issues, but the death of Annalaura's mom was a trigger.
"It's not uncommon for a stressful life event, like the birth of a child or the death of a parent, to trigger the first manifestations of bipolar disorder," said Annalaura. At first, she wasn't quite sure what was going on with Chris, she just knew her husband wasn't acting like himself.
"Bipolar disorder is a mood disorder, and sometimes it can be quite severe. In bipolar disorder, people have not only depressive episodes, but they also have times where their mood elevates and they have manic episodes," said Matthew Pierson, MD, Assistant Professor of Psychiatry at Huntsman Mental Health Institute (HMHI) at University of Utah Health. He also works in the Treatment Resistant Mood Disorders (TRMD) Clinic.
Most people are familiar with signs of depression, says Dr. Pierson, but not always as familiar with mania. It's the reverse of depression, where a person becomes overly excited or euphoric. They may have grandiose levels of self-confidence, and thoughts running quickly and constantly through their head. They may also engage in risky or pleasurable behaviors, like driving really fast, racking up credit card debt, or having an affair.
Chris' mania led to intense focus on a project, which might lead to him neglecting work or personal responsibilities. He also used narcotics and had an affair. During depressive swings, Chris would have common feelings of depression, like sadness and fatigue. Sometimes the depression would overwhelm him, and he would seriously consider or attempt suicide.
Chris' bipolar illness also includes mixed episodes — symptoms of mania and depression at the same time, which can be particularly dangerous. The depression causes intense feelings of sadness, while mania keeps him hyper-focused on thoughts of suicide.
"Sometimes I feel like my loved ones would be better off without me. I'm tired, like tired of trying to stay alive," said Chris. "It takes so much work to fight against those feelings and suicidal ideations."
Bipolar disorder can be very difficult to diagnose or recognize because everyone experiences it differently. In fact, mania episodes sometimes seem like a good thing after someone experiences depression. Loved ones and friends might think the person is getting better. But for Chris, the positive feelings of having more energy and being in a better mood would often give way to something frightening.
"It goes from 'this is good' to 'this is scary,' and you are not in control of yourself anymore," said Chris. "It's like being in a car with the pedal to the medal but you can't take your foot off the gas. It's too fast and too much."
The mental health professionals he saw were treating him for specific behaviors — substance abuse, depression, suicidal ideation — but failing to put them all together and look at a bigger picture. Finally, a new therapist suggested a psychiatric evaluation.
The following day they met with a psychiatric nurse practitioner who listened carefully to all the information about Chris' behaviors over the last several years, and immediately knew it was bipolar. That offered some relief for Chris and Annalaura because now they at least had the words to describe what he was going through. But there was still a long way to go before he would find the treatment he needed.
There are multiple options for bipolar treatment. It's a trial-and-error process as doctors figure out exactly which medications, or combination of medications and lifestyle changes, will work best.
"What makes bipolar so challenging — at least for us — is that the stakes are so high. When someone else has a bad day, they're grumpy and they eat junk food and watch TV until they feel better. When I have a bad day, I try to kill myself," said Chris.
The medications and lifestyle changes were stabilizing Chris, but his "stable level" was so close to rock bottom that even a small dip could be disastrous. Every year at the same time, like clockwork, Chris would experience the same symptoms and would eventually check into a crisis care facility. In five years he made six serious suicide attempts.
"I was in a hopeless place. We were starting to get more answers, but there were still no solutions," said Chris.
It was after the sixth attempt that his inpatient care doctors referred Chris to see Dr. Pierson in the TRMD Clinic. The TRMD Clinic specializes in working with patients who don't respond to other medication and lifestyle treatment options. Bipolar disorder is particularly difficult, because drugs that work for unipolar depression (depression without mania) usually don't work the same for someone with bipolar disorder.
Psychiatrists use algorithms to determine what medication protocols to try. Once a patient exhausts those options, they can meet with doctors in the TRMD Clinic. When he met with Chris, Dr. Pierson suggested they try electroconvulsive therapy (ECT).
"ECT is a highly effective treatment for bipolar disorder," said Dr. Pierson. "It's been widely available since the early 1940s, but its technique has changed over the years."
During treatment, doctors induce a short seizure in the brain through electrodes placed on the patient's forehead. The seizure lasts about one minute while they are comfortably and safely under anesthesia. The patient gets treatment about three times a week over the course of three to four weeks. Doctors don't fully understand how the treatment works in the brain, but the goal is to bring people out of their depressive or manic episode with repeated treatments. For Chris, this elevates his "stable level" so a few rough days doesn't send him into crisis care.
About 80 percent of patients report success in coming out of a manic or depressive state. ECT can also help the person remain stable over a longer period of time to avoid sliding back into mania or depression. For the 20 percent of patients who don't respond to ECT, the TRMD Clinic has other advanced treatment options available.
Decades of research and experience show that ECT is safe, with very low complication rates. For patients like Chris, the benefits far outweigh the risks.
"When Dr. Pierson brought it up, I was in the hospital for trying to kill myself. I had been on all sorts of medications, and I was averaging nearly a month in the hospital every year," said Chris. "It felt like I didn't have time to keep trying new things to see if they would work. I just said yes."
Dr. Pierson carefully explained the potential risks and side effects. The most common immediate side effects are headaches, nausea, and muscle soreness. Longer-term side effects can include both short- and long-term memory loss or forgetfulness, which take a few weeks or even months to resolve. It's definitely not the same as epilepsy, and it doesn't affect the patient's personality in any way. That was one concern for Chris and Annalaura.
"Your brain is where so much of your personality is. You feel physically terrible, and this treatment could heal your body, but we wondered, would he be the same as when he went in?" said Annalaura. Fortunately, the doctors at HMHI explained that they didn't need to worry about personality changes. He would still be the same Chris, just hopefully without the significant challenges of his bipolar disorder.
HMHI has a large team that supports ECT patients. That includes the doctor, nurses, social workers, psychotherapists, and support staff at the front desk or working with insurance companies to get treatment when it's covered. Additionally, they can offer ECT to adolescents and children — something that is not available in every state, but is in Utah — with plenty of data demonstrating its success in young patients.
Anyone going through treatment also needs a lot of support and trust from their family, spouse, or caregiver. The patient might not be in a mental place where they can determine that this is the best thing to do.
"Having family support is huge for someone going through ECT," said Dr. Pierson. "It's really the best way to help people get started, and keep coming back when they need the treatment."
"When we notice swings, we have to have a long conversation to examine every angle and figure out if it's time for a treatment," said Annalaura.
ECT is effective, but it isn't a cure. It can pull someone out of current mania or depression, but the person could backslide, which is why many patients benefit from maintenance treatments. In the meantime, doctors continue working with patients to find medications, therapy, and lifestyle changes to keep them steady as long as possible.
For Chris, that was one of the most beneficial parts. He is no longer hovering near rock bottom. He went from one or more hospital stays each year, to zero mental health-related hospitalizations since his first treatment in late 2019. He and Annalaura communicate constantly to stay ahead of manic or depressive swings. If he gets too far down either road, they contact his doctors to talk about getting another ECT treatment.
ECT gives Chris the freedom to be a productive member of his family. He no longer feels like a liability to the people around him. Instead he's an active, participating, engaged member of his community. He spent the last several years as a stay-at-home dad, homeschooling his 7-year-old son, and getting more involved in his community.
"I just want to be a dad, husband, friend, and brother. I want to play a role in the world around me, instead of having my disease be the role I play," said Chris. "ECT and the team at Huntsman Mental Health Institute give me that chance."