On Bipolar Affective Disorder (No Qualifier)

A NOTE TO START – This post has footnotes. They are indicated by * and located at the bottom of the page.

What’s the only consistent thing in life? Change. You’ve heard that before, right? It’s one of those bumper sticker platitudes people sling at you when your life moves in an unexpected direction.

What’s the only consistent thing in Bipolar Affective Disorder? I’ll give you three guesses but you’re only going to need one. If you guessed “change,” congratulations! You’re right!

But it’s not the “oh man, life is progressing and now it’s time for a new [school/job/apartment/house/relationship – insert your adjustment stressor here]” kind of change. No, it’s jumping from one extreme to the other. It’s being on the very end row of one of those big swinging viking boats you see at the county fair. Sometimes, it’s really fun and you’re enjoying the rush; sometimes, you’re trying to run the length of it with each sway, desperately hoping that you’ll end up in the middle and the nausea and whiplash will decrease. What you don’t fully realize is that you’re just running from end to end on a broken ride that will never stop swinging. And the whole time the ride attendant is just standing there throwing handfuls of pills at you and screaming promises that the medicine will make it better. It won’t fix the ride or get you off the boat, but it will make the stomach lurching and head spinning more tolerable. And it sounds like complete and utter bullshit.*

My BPAD diagnosis is very recent. No one is quite sure what type of Bipolar I am yet, but everyone agrees the description of my life experience lies somewhere in the lines of the DSM-V diagnostic criteria.

For most of my adult life, I have enjoyed (and I do mean enjoyed) periods of little-to-no sleep, insights into philosophy, the deep knowledge that, “at my core I’m creative and beautiful and that picture on the wall is crooked but that’s ok because I can fix it and I should fix it – actually I should just change up the whole wall decor because that’s old and boring now and I wonder if god ever just decides to switch things up because they’re stagnant and boring or maybe that’s why the universe is in constant motion and everything is changing, so god doesn’t get bored? My god the universe is a beautiful thing, though, and I’m made of stardust which means I’m infinite and everything is connected so beautifully I could cry for joy and everything is going to be ok because everything is already ok and everything has always been ok and I’m going to go write some amazing poetry or play some guitar or take awesome photographs right after I fix that damn picture on the wall!” – actual to-scale model of my brain-train when I’m hypomanic. I understand if you’ve never been hypomanic, that may sound overwhelming. But it’s really not. It’s fun. It’s being “high on life.” It’s seeing more vividly and appreciating everything around you at a level so deep it seems to resonate throughout your body and out into the world and attract positivity and good vibes to you. Hypomania is being “up,” but still able to function. It’s not psychotic, it’s not detached from reality, it’s not a hindrance to your daily life. It’s just a state of being that feels really good. 

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Hypomanic/Manic – colorful, beautiful, vivid, surreal

As the laws of physics dictate, though, what goes up, must come down. And my crashes from hypomania were brutal. “Nothing is ok. Nothing has ever been ok. Nothing will ever be ok. What’s the point? Everyone hates me. Fuck it.” As is common with many non-diagnosed people on the Bipolar spectrum, it was during depressive episodes that I sought help. Therapy for my thoughts, SSRI antidepressants for my brain chemicals, etc. Until very recently, my manic phases were decidedly in the hypomanic range, so I saw no issue even worth reporting to doctors. The closest I ever came to mentioning it was to say, “Yeah, you know, I have about 3 or 4 bouts of insomnia a year, but I’m pretty good at functioning through them so it’s not really an issue.”

The professionals accepted this at face value, and for 8 years, so progressed my life. Periods of creativity and intense interest in learning new topics (I once spent $200 on books about how to play the piano only to decide two days later that I did not, in fact, want to play the piano, for example.) My sporadic interest in a wide variety of hobbies has been referred to as “flighty” or “quirky.” Friends learned long ago to reply to my enthusiasm about new endeavors with as slightly disconnected and non-committal, “Oh yeah? I hope you enjoy it.” But, when I’m feeling that excitement, their responses never bother me. When I’m feeling the depression, though, every conversation replays in my head and I think “My God, I’m such a fucking loser. I can’t stick with anything. My friends aren’t invested in my interests anymore because I’m such a flake. My friends don’t even like me, they just tolerate me.” and so on.

In November of this year, I had what I thought was just a particularly bad case of insomnia triggered by a major life change (more on that in a future post) and emerging PTSD symptoms from traumas sustained throughout the years. I couldn’t eat; I couldn’t sleep. For 10 days. I oscillated between energetic depression (feeling like staying in bed and sleeping all day but not being able to stay still or close my eyes) and this sense of wired energy with no focus. My friends noted I was talking a mile a minute, and my thoughts were coming at me even faster. I would start to rearrange a room in my house, then get distracted by doing laundry, then get distracted by video chatting a friend and telling her how terrible everything was, then insisting everything was fine and I didn’t need to see a doctor at all because I was good, and so on. On day 6 without sleep, and with the prompting of some friends, I went to Urgent Care. I knew I needed to sleep, though my mind was not the least bit tired. I physically could not sit or stand in one place for long at all. The Urgent Care nurse gave me a small amount of Lorazapam to “bring me down” and allow me to sleep. It did not work. It doped me up, and seemed to increase my depressive symptoms, but sleep was still impossible. NOTHING would allow me to sleep. I was just wired and felt completely overloaded. I saw three different doctors in three days, and they each attributed my symptoms to somethings different – PTSD, Generalized Anxiety Disorder, and “Adjustment Disorder with Anxiety.” Each doctor attempted to refer me to a psychiatrist. No psychiatrists ever got back to me. My primary care doctor started me on a low dose of Zoloft to help with the depression and anxiety I was experiencing.

Sleep never fully returned. I was tired now, though. And I would sleep for a few hours here and few hours there throughout the day and night and catch naps whenever and wherever I could. Despite still not having regular sleep, the energy was gone and the freight train of depression slammed into me head-on and splattered every single reason I possibly had to be happy or even to live across the tracks and gravel and grass. “Brutal” is an understatement. At first, it was painful – drinking and sobbing each night to try to not feel so much self loathing. Then, it became calm, numbed resolve. A firm knowledge that nothing would ever get better and nothing mattered. Nihilism incarnate. My job didn’t matter, my friends didn’t matter, school didn’t matter, my family didn’t matter, hell, my daughter didn’t even matter. And I couldn’t make them matter. It was the worst depression I’ve ever experienced.

depression
Depressed – black and white, trapped, no way out

So, I went to inpatient to get a handle on the depression and sleep issues (as well as the flashbacks. panic attacks, and nightmares I was having – but those are PTSD things and this post is about BPAD, so we’ll save those details for another time.) The doctors on the unit, though, attributed all my struggles to uni-polar depression and PTSD and, in addition to a few other meds, substantially increased my dosage of Zoloft, which is an SSRI antidepressant – you know, the type I’d taken sporadically over the years but never for longer than 4 months at a time (because, Hey! When you feel better, who needs meds? Am I right?**)

(Spoiler alert – The footer for that last sentence says “I am not right.”) I need to amend that statement slightly. The right meds are important. In case you didn’t know, SSRI’s can actually seriously exacerbate Bipolar symptoms. Who knew, right?  Well, doctors know that, but because everything was happening at once and no one (myself included) had any sort of inclination that I’d been hypomanic multiple times throughout the years, treating my depression like depression seemed reasonable. As it so happens, though, “mania” is not always painting your kitchen on a whim because you just know you’re the next HGTV star, spending your entire paycheck on new clothes to become a model, going out and doing drugs and having dangerous sex you later regret, or becoming so psychotic that you lose time or believe you understand the Illuminate are actually the good guys and everyone needs to understand that they are, in fact, running our society, but they are the benevolent overlords and we all need to spread their message.***  No, sometimes “mania” is what the professionals like to refer to as a “mixed state” (which is exactly what it sounds like and, coincidentally, exactly what I was experiencing.) Depression mixed with energy and the inability to sleep. Rapidly cycling from energized and feeling superhuman and above the need for help to agitated and wanting to give up and incapable of getting help in the span of a few hours, multiple times a day. In other words, hell on earth.

So, I’ve got this history of hypomania that I had no clue about (being able to work 108 hours in a week without sleep or impaired functioning all while spending the awake overnight shifts writing poetry that’s getting a ton of love on Tumblr is not a problem. Objectively, no one is going to say “something’s wrong with me, I’m being too productive, I better get help!”), I’ve got these pretty brutal bouts of depression, and every now and then I’ve got these periods of feeling neither depressed nor “amped up.” From the time I was 19, this was my normal. In reality, every time I ignored the hypomania, every time doctors tried to treat the depression with SSRIs, I was unknowingly inching closer and closer to a full blown manic episode.****

After discharge from the inpatient unit, I went to a Partial Hospitalization Program and finally met with a psychiatrist for a full, two hour eval. (The first true psych eval I’ve ever received.)

“Have you ever been manic?” she asks.

“No.” I answer, thinking of “mania” in the traditionally understood sense.

“How about hypomanic?”

“Uhhh… what’s that?”

She explains and it’s like a lightning bolt hits the top of my head and travels straight through to my feet. I feel my face get red. My mind starts to race. My dad’s Bipolar. I can’t be Bipolar. My therapist actually looked at me one time and said “the only two truly crazy conditions, and by crazy, I mean the brain is reacting in a way that makes no sense and can only be described as a malfunction, are Schizophrenia and Bipolar, and you’re neither of those.” Right! Exactly! I’m neither of those. If I’m Bipolar then I really am crazy and even my therapist will think so! So, I can’t be. I should lie. No. I should tell the truth. I’m here for help. They can’t help if I’m not honest. But Bipolar means meds for life and a whole bucket of “fuck off, no thank you.” I can’t do that.

My silence was long enough, I guess, for her to press more. Over the next few days working with her, my diagnosis changed from Bipolar II (hypomania only) to “Either Bipolar I or Bipolar II” (based on the 10 days with no sleep, which would technically constitute a full blown manic episode and therefore move me into a Bipolar I territory), to comments of “Well, you’ve just got this sort of rapid cycle thing going on, don’t you?” to “Well, whatever you are, you seem to be mixed.” So, for those interested, my “official diagnosis” right now is just Bipolar Affective Disorder with no qualifier, but we’re working on getting more specific.

Currently, I am on mood stabilizers for the first time in my life, which will, in theory, prevent both the manic/hypomanic episodes and the depressive episodes. I’m not up to a fully therapeutic dosage yet, so I’m still kind of all over the place. I’m tracking my moods daily on an app in an effort to gather more information so my psychiatrist and I can get a better understanding of my specific brand of BPAD. Regardless, though, I’ve certainly been learning a lot about the diagnosis and it’s implications. Sticking to a daily schedule, going to bed and waking up at the same time each day, and taking meds at breakfast, lunch, dinner, and at bedtime to get stabilized. Cutting way back on caffeine intake. Eating healthy food. Avoiding alcohol.  You know, stuff that sounds absolutely boring and obnoxious to insert into my life. My life that previously consisted of 2 am drives to look at the stars and a 4 am swim in a river with some friends of mine and nights of no sleep and writing and parties until 5 am and stints as a photographer and as a poet and as a guitarist, etc, etc.

But here’s the thing with managing Bipolar: if you want to be free of that whiplash and nausea, you can’t keep running from one end of the ride to the other –  you’ve got to find some way to sit closer to the middle of the boat and stay there.

Tonight, I’m missing my little brother’s music gig in town because I know I need to avoid over-stimulation too close to bed time and I’ve been all over the place mood-wise the past few days, so staying out of a bar is probably a good idea, too. Self-Care isn’t all spa treatments and vacations. Sometimes it sucks. Sometimes it’s skipping out on stuff you really want to do because you know that long term stability and health are more important than short term fun. I’m trying to get to the middle of the ride.

FOOTNOTES:

*Meds are not bullshit. They are important. I am in no way advocating you neglect the advice of medical professionals. The doctors, psychiatrists, and therapists are there to help and the meds will help you tolerate your condition and live a more comfortable and adjusted life. I’m simply acknowledging the frustration that can occur when you really just want off the fucking boat.

**I am not right. Again, I’m going to say it: medications are important. They are prescribed for a reason. Medical professionals are here to help you.

***All true stories of people I know personally with BPAD

****I still haven’t had a “traditional” manic episode, and I’m now on mood stabilizers so it’s possible I never will (See? MEDS ARE GOOD. Gonna keep driving that point home because I have days I struggle with the idea myself and if I say it enough, I’ll drill it into my own head – metaphorically, of course. No actual head drills. They don’t still do lobotomies, do they?*****)

***** Ok, my footnote has a footnote. I may need help. Seriously, though, sometimes my sense of humor is morbid. It’s self deprecating and it’s part of how I cope. I never mean to offend. If I do, tell me, please. I will sincerely own it and apologize. I’m trying to be a force for good here, so when I make a joke, I want to know if it’s in bad taste. If you’re reading this, I love you and I respect you.

**************All photos in this post taken by me. (c) Sheila Mercon (until I legally change my name back to my Maiden name of O’Donnell)

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