Category Archives: Mania

Swapping Big Moves for Little Moves

Let’s face it, living with bipolar disorder has had a huge influence on the way I make decisions. It hasn’t been all bad, I admit the impulsivity I tend to feel has left a trail of both exciting fun memories in my wake as well as some cringe-worthy ones, but I’ve spent a lot of time considering impulsivity and the ways it has both helped and harmed me.

Instead, today I want to specifically discuss making big moves.

For a long time I believed that I only made impulsive big, life altering decisions when I found myself experiencing hypomania and mania. This was evident when I dropped out of college, for example, at age 19. The idea of living aimlessly in the Colorado sprawl seemed like a wonderful idea, and it was great… for a while.

Likewise mixed episodes have lent themselves to impulsive big moves as well. Spur of the moment breakups would be an example, running away from home. Usually these kinds of big decisions have been fueled by the need to escape something (rather than make a positive change in my life) and the results have tended to be regrettable when I returned to rationality.

Recently I’ve been thinking a lot more about how that overwhelming impulsive urge influences depression, because for most of my life I would say I didn’t think it did. I mean, is sitting down and watching a full season of Ru Paul’s Drag Race because I’m too tired and depressed to do anything else a big impulsive move? Yeah… I didn’t think so.

Lately I’ve been seeing it a bit different. Maybe it is the nature of the depression I face, maybe it is a little mixed and coming with a small paper cup full of mania to act as a dipping sauce. Whatever the reason I’ve been able to hone in on this feeling, this urge to make a big move, and somewhere inside of me there is this spark that says,

If you make a big, sudden change in your life this depression with disappear.

To be fair, I’ve been doing this all along. In my younger years I found myself in some kind of Job-Hopping Phenomenon loop that I tried my best to grasp but couldn’t understand.

I would start a new job, be doing fine, and then start sinking into deep depression. The answer always seemed to involve quitting and starting a new job, where my hypomania would take over and I would feel great for a while until… you guessed it… wash, rinse, repeat.

For the most part I always chalked this job-switching thing to be coming from a place of reason though, not emotion. I told myself, “well, maybe this isn’t the right job for me,” and I’d launch myself out into the world feeling a sense of purpose every time I tried to find a new one. It kind of acted as a really inefficient, W2 swamping sort of band aid.

I didn’t connect the dots between these actions and that general bipolar big move urge until this month. I’ve been declining into depression for almost two months now, swiftly and severely enough for my psychiatrist to be on red alert (more on that next time). Honestly I think what I am experiencing may be a depression-heavy mixed episode because I’ve found myself in several swirling pools of psychosis where I seem to find myself in another place.

While I’m there everything is turned on its head, the only consistent element is that I feel overwhelmingly compelled to make a big move!

Sometimes the urge is to run away and start a new life, or get a job, or demolish my relationships with people… but every time the haze wears off I’ve been thankful to find I haven’t done any of those things.

With my manic and mixed episodes I feel like I have had the opportunity to practice not making those big moves I find myself gravitating toward. I’ve tried to remind myself of how horribly wrong they tend to go sometimes, and how what I am experiencing at the time is typically in the minority of how I feel otherwise.

The last few years my treatment resistant symptoms have left me experiencing severe depression without much alleviation, so much so that the only thing I could do was binge watch Ru Paul’s Drag Race. I feel like that might be what is causing me to hesitate when I fall into those whirlpools that try to bully me into mixing things up, because now I know that even when I do nothing at all I can make it out the other side.

In the grand scheme of things, I often picture bipolar disorder as a set of scales. I used to chuck whatever blocks I could find at them knowing that if one landed, they would flip my emotional state into the opposite direction and I could slide from depression into mania almost immediately. This crude method was effective short-term, but didn’t set up any kind of system for long-term stability.

The last few years I have been learning to scale down those moves when the urges hit. Instead of running away, maybe I’ll take a shower. Instead of getting a job, I assign myself to take out the garbage every Monday and see if I can consistently do it. Instead of destroying my relationships I turn on the Xbox and funnel my aggression into some kind of PvP deathmatch.

Instead of chucking those big blocks at the scales it is more like I am adding single grains of rice. While there is a kind of tension that comes from refusing the big move beast the satisfaction of an impulsive remix, I’m finally understanding that I can come closer to making those scales balanced by making little moves than I ever did with the big ones.

 

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Providing an Outlet

Even since childhood I have often equated pain (emotional or otherwise) to be like electricity. Failing to provide an outlet for that force once it has entered my system generally results in short circuiting; an explosion of force down an unintended pathway as it tries to escape.

This morning I leaned in to kiss my partner goodbye as he left for work and stubbed my toe. You know the feeling you get when you know something gruesome has occurred to part of your body (in this case: a toenail) without looking -you can just feel it? Well, as pain started shooting through my foot I knew I wasn’t ready to look down and look at the damage quite yet. Even so, my first impression was to scream out in pain… but with my boyfriend standing less than 12 inches from my face (and it being 7 am in a crowded apartment building) I decided to hold it in.

Big mistake.

That energy that should have been released out my mouth shot down my throat to the next available thing; my arm. I immediately punched the wall (twice, apparently the first time wasn’t quite enough to allow all of that energy to escape) and winced as he left, attempting to walk off the pain in my foot.

While my big toenail is split (right in time for sandal weather, drats!) it wasn’t until my hand started to swell up from punching the wall that I realized that maybe I should have just screamed. Denying myself a natural outlet for letting that energy out certainly backfired, and my attempt to help my boyfriend and neighbors by keeping my seemingly inevitable screaming at bay ultimately hurt me in the end.

In my experience, the turmoil experienced in mental health isn’t much different. Providing myself with an outlet while depressed usually means verbalizing or writing through what is bothering me, while my manic outlets tend to be more physical; cleaning/exercising/and creative based projects. It took me many years to realize that, like punching the wall because of my big toe, failing to give myself an outlet for that energy trapped inside has often led me to explosive behavior, and outlets that have been seriously more damaging than what might have occurred if I had just followed my natural instinct.

I’ve done several training workshops about how to mitigate suicidality in crisis situations for other people, and I was shocked when each technique boiled down one core idea; confront the person about feeling suicidal, and then talk about why they feel that way with them.

Certainly I was expecting black hawk helicopters and swat teams and maybe a little magic to be involved, but ultimately providing an outlet for the person to express those feelings verbally in a nonjudgmental atmosphere proved that allowing some of that energy to escape was usually enough to disarm the threat of imminent suicide and get the person to some kind of treatment.

I would say that usually in my most dire moments I find myself at a loss for how to get that energy out. The fog associated with depression or mania might make it seem impossible, or unnecessary, and I might feel trapped in the moment, unsure of where to focus that energy without hurting myself or other people.

And obviously… I’m not perfect at it. After 15 years of considering this idea I still find myself punching walls occasionally or throwing my phone or rushing to my therapist feeling like a ticking time bomb because I’ve become certain that any words or actions on my part will destroy whoever I’m around (not true, as it turns out, but it still feels that way sometimes).

One thing I’ve done to help myself along though is to make a list for each of my intense mood states of good, useful, positive, harmless outlets that can help me get whatever energy I’m feeling out in a safe and satisfying way. Any time I think of something new, I add it, and that way when I am in the throes of a depressive fog, or so revved up on manic sunshine, or so irritable and agitated I don’t want to leave my room I have a little something to jog my memory.

Otherwise I might wind up punching the wall all the time and I’d never get my deposit back.

The Many Faces of Psychosis

My attempts at writing lately have not been particularly fruitful, but I have finally gotten some sleep. Unfortunately, the sleep was also accompanied by several intense conversations with my health care team pointing to ongoing psychosis the past few weeks (at least).

When it comes to psychosis I find myself in something of a pickle. I have not been able to tolerate taking an antipsychotic on a daily basis (because of intense side effects like ultra-rapid weight gain and feeling so fatigued and exhausted I can barely move) so my psychiatrist allows me to take it only in times I am experiencing psychosis. It definitely isn’t the sort of thing I would generally expect is a good idea, however my rapid cycling paired with my inability to tolerate the drugs for more than a few days at a time make it more useful than, say, nothing at all. Many times it seems like one or two days are enough to kick the legs out from under the psychosis before my mood cycles away from it.

The biggest hurdle in this method for me has been being able to identify when the psychosis is present on my own. With a good team looking out for me (my boyfriend included) it becomes easier… but even after meeting this “character” (psychosis) on and off for at least the last 50% of my life I have a hard time picking it out of a crowd.

Meeting psychosis when physically ill or on various medications has left memories that were already too fuzzy around the edges to be able to account for an accurate depiction.

Meeting psychosis when manic has been like stumbling upon a huge party where the music and lights are easily drowning out the words and the intentions of the faces I see around me.

Meeting psychosis when in a mixed episode has been like crawling into a crime novel where I don’t know who I can trust, and psychosis might look just as innocent or guilty as anyone else I stumble upon… leaving me with no distinguishing features.

Finally, meeting psychosis when I feel (or think I feel) stable has been the most confusing thing of all. The encounter is totally unexpected, and I find myself quickly trying to write the ensuing conversations and situations off as simple irrational fear or rapid mood swings happening too fast for me to put a defining stamp on them.

The best indicator I have of psychosis is when pieces of my life, pieces of stories don’t line up the way they ought to. When the memories I have don’t correspond with the half dozen other people who were there at the time. When my boyfriend seems to have me caught in a “lie” but as far as I know, I’ve only spoken the truth.

At any rate, I expect to spend the rest of the day on the couch due to the exhaustion I feel from the rispiridone today, but if that is what is necessary to aid in alleviating the confusion, I am ready to do it.

the mania/insomnia symbiosis

I am no stranger to insomnia. I’ve experienced the overactive brain induced insomnia, the straight up fear and adrenaline based kind (airplanes are notorious for producing that for me), even insomnia formed by a series of horrible nightmares and my body and mind developing a fear of sleeping.

Typically, though, the type of insomnia that tends to really sneak up on me (and especially in the summer) is the kind where I’ve missed my sleep window and can’t reclaim it.

My energy level is very rarely a straight line, it is more often a series of peaks and valleys, and their intensity seems to be associated with my mood swings, diet, and anxiety or excitement, among other things. I have found that for my situation, going to sleep in the evening at the first sign of tiredness has typically been the only way for me to ensure I get to sleep. The problem is that this energy trough might occur at 6 pm (right after I’ve eaten dinner) and the best case scenario would put me in a position to wake up the next morning at 6 am. Once that energy lull passes, I can find myself wide awake again -thus unable to sleep.

I’ve always needed a lot of sleep. More than most people. 12 hours tends to leave me in the best emotional position the next morning, but 10 hours can be manageable.

Missing my sleep window because of anxiety or outside forces (loud neighbors, hot apartment, unfavorable reactions to medications, etc.) might mean I only get 7 hours, sometimes less. That might be sustainable for a day or two, but the longer I go without sleep, the more symptoms of mania I begin to acquire. The more symptoms of mania (even hypomania) I acquire, the less likely I am to be able to sleep the next night.

This fuel might be racing thoughts, or a huge spike in energy, or euphoria (where feeling good seems to counteract the idea of sleeping) among others. Regardless, these traits begin to mix with an increasing fog that sets in from insomnia. My actions start to feel like they matter less, since the fog distorts any of the negative consequences that might be on the horizon… leading to impulsive and relatively irrational decision making. That poor decision making might include missing my next sleep window, when one (rarely, with hypo/mania) occurs.

Keeping my mood under control begins to feel less important, as my sudden frequent crying spells also begin to alternate with fits of hysterical laughter can’t contain… and though there is an audience at the grocery store as I have a laughing fit so severe I am crying and sitting on the floor, it just makes me laugh harder because their concerned faces look increasingly hilarious to me.

Insomnia makes me feel like I am doing a better job of managing my mood swings even though I have had several outside opinions that this idea is not true. While I definitely become more reactive and my swings can land in rapid succession (as they do normally for me, many in a day) my perspective on this situation varies largely from an outside opinion. An outsider might argue I am more difficult to manage (since my brain seems too tiered to bother with trying to negate my impulses triggered by mood swings… well, and the fact that I begin to express everything that crosses my mind, even to strangers) but the euphoria I experience makes me feel that I am doing a great job of taking care of myself, and the fog that has come from not sleeping makes every moment that isn’t the present seem long gone. Out of sight, out of mind.

Ultimately, I find that insomnia may not be the primary trigger of mania on all of the occasions that I experience it, but it does typically perpetuate manic and hypomanic symptoms for me in a symbiotic way.

The less I sleep, the more manic I become.

The more manic I become, the less I sleep.

 

Attempting Hormonal Therapy with Mixed Emotional Results

I know I have been somewhat MIA the last couple weeks, but here is a quick rundown of my current situation and how things have been faring.

It looks like some (if not all) of the GI problems I have been having since trying Seroquel (all of which are still present even after almost six months of stopping it) are potentially due to a hormonal problem triggered by the drug. After having an endoscopy (having a camera put down my throat to inspect my stomach) and a colonoscopy (same thing, only in reverse… and with significantly less dignity) the result was that the doctors could find no reasonable cause for the intense amount of pain and other odd symptoms I have been having.

After everyone scratched their heads for a while I did some of my own detective work and I went to see a gynecologist. She recommended hormones. I started taking them two weeks ago… and the result was pretty much exactly what I expected – the same sort of response I have had to pretty much every drug (even the flu shot) the last couple years.

A bad reaction.

You see, not only do I experience a treatment resistant, very sensitive, easily triggered version of bipolar disorder (type 1), most medications I have tried (even something as simple as a nasal spray) have triggered big problems for me either by making my emotional state completely deteriorate and triggering a big bipolar episode, or by triggering significant side effects (which generally just go on to trigger more bipolar episodes).

So on day 5 of hormone treatment when I began crying uncontrollably for an entire day I pretty much knew it was the end of that road, but I kept taking the drugs for two more days (just to be sure it wasn’t my own rapid cycling). Nope, by day seven I had become completely engulfed in suicidality and promptly called the gynecologist’s office to inform them and stop taking the new hormones.

Stopping the hormones suddenly was also a problem. Within two days I was no longer in the throes of depression, but instead I became manic and couldn’t sleep for three days.

I had another appointment with the gynecologist yesterday to try and figure out what to do next. She recommended another form of hormonal therapy (with significantly fewer hormones) which I started last night. Personally, I don’t expect this to end up any different than the last round, but I am willing to give this treatment option a shot because my only other option is surgery… which, frankly, scares the bajeezus out of me a little bit.

Like my continuously evolving trial of medications to potentially treat my bipolar symptoms, after hearing about my experiences the doctor concluded that I am very brave for being willing to try hormones again. It is my belief, however, that bravery and desperation can often look a lot alike from the outside looking in…

At any rate, that would be what I have currently been up to. I am sure the mania was also partially fueled by the fact that it has been summer-time weather (sunshine in the 60’s) in Seattle last week, the total opposite of what normally goes down here in January. It seems weather like this could make for an entirely different kind of winter than I am normally used to (30+ days of rain in a row potentially ending in a depressive hospitalization). Mania has its pitfalls, but honestly there are times (like the winter) where it just feels nice to have a little variety.

I expect I will know pretty soon if I will be able to tolerate this new drug, ironically enough it has the potential to alleviate my lactose-intolerance that started when taking Seroquel, however the pills themselves contain lactose so taking it so far has not been a fun ride. Really, just the fact that I have found a doctor who has found evidence of a diagnosable problem after six months of doctors being unable to give me any kind of answers has been encouraging, even if the treatment options do turn out to be somewhat torturous.

In my life, a little hope can go a long way.

One Good (Manic) Turn Deserves Another

The last thing my (ex) therapist said to me (jokingly) was,

“…and I never got to see you manic!”

In my depressed state I shrugged and replied,

“it is rare these days… euphoric mania, anyway. It hardly ever happens anymore, frankly I can’t even remember the last time it did.”

Little did I know, within a week I’d be hunkered over my chest of drawers urgently rearranging my shirts because, well, is it better for them to be grouped by print or by sleeve length?? And, no, no, no, the underwear needs to be arranged in descending order of favoritism and then by color!

As much as I would like to say I saw this swing coming, I would be lying to you. Generally I would say I have a tendency to become manic in October, however I find that when I say that ahead of time it never actually occurs.

This time around I think I would like to blame the aggressive head cold that has been going around for my lack of catching the warning signs. Normally euphoric mania comes on largely in a physical way for me first, but I can’t say I felt any kind of awesomeness, electric humming, or skin-crawliness that I normally experience until much later on. This time around (because of the cold) I felt sinus pressure, ringing ears, a sore throat that lingered on much longer than I anticipated, and initially much more lethargy than I normally would when mania strikes. By the time I started to realize things were getting out of control it was a bit too late to divert it.

Of course, in hindsight I can say, “ahhhhhh, ok,” to the series of odd and rather impulsive actions that led up to my frantic laundry situation and subsequent hours of laying in bed awake, chest pounding, having rapid conversations in my own head. One would think I might have had a clue when the series of somewhat depressing situations I’ve found myself in lately became increasingly hysterically funny to me, or when I stopped each of five consecutive movies I was trying to watch halfway through because I no longer felt interested (and then the only movie that did hold my attention was The Silence of the Lambs), or when I cut all of the instances of the number “2” out of a cosmo magazine to see which one was “the best,” or when I spontaneously maxed out my credit card buying tickets to see The Who. I was even having trouble writing, many of my sentences were coming out backwards.

Contrary to popular belief, these are not things I normally do. I’m the kind of girl that usually just likes to wad her shirts up in a ball and shove them in the drawer, or look at the prices and fluid ounces of every bottle of shampoo in the store to make sure I am getting the absolute best deal before buying one. I know I usually claim I don’t do the “spending” thing with mania, but apparently this was an exception. (Boy, I hope I’m not inadvertently picking that habit up!)

To be fair, I think normally these are things my boyfriend would probably notice, however he was out of town for work all last week.

The episode seems to have peaked Saturday night and then turned to the dark side, leaving me experiencing four swings of “crazy girlfriend” type, hostile-agitated-mixed chunks appearing between mildly euphoric moments throughout the day.

I’ve been having trouble getting my thoughts together long enough to complete anything I’ve been trying to write, but I have a few ideas that I hope to get down soon. Thankfully I have been lucky not to experience any psychosis in the last week (knock on wood), however the sort of hostile, “I hate you” mood swings I’ve been having haven’t exactly been a walk in the park either.

I have my intake appointment with my new psychiatric clinic on Friday (hooray!) and though they are usually somewhat grueling, I will be happy to have someone around to help me untangle the big ball of emotional spaghetti in my brain again.

Bipolar Disorder and Hygiene

While this isn’t a topic discussed very often, hygiene is one of the elements often noted by psychiatrists and therapists when diagnosing or tracking depression, bipolar disorder, schizoaffective disorder, and schizophrenia in patients. Poor hygiene can be a big indicator of depression, psychosis, or mania, and I thought today I would discuss my own experiences with this a little bit.

The simplest place for me to begin is probably with depression. I often use a three-tiered rating scale for my depressive symptoms, where a 1 is considered mild and a 3 is quite severe.

My hygiene usually starts to slip in phase two. At that point I have been struggling to keep up with things like daily chores, social situations, and my motivation might be completely devoid or I have lack of caring for most of the things going on.

When I feel overwhelmed and like I can’t catch up with all of the things I am supposed to be doing, it usually means I start cutting corners. I’ll eat my eggs with a spoon so I don’t have to do the dishes. I’ll wear the same thing every day for a week so I don’t have to figure out a new outfit. Likewise, my time in the shower will start to slip from every other day to every three or four days.

Part of it is about not feeling like I have enough time to get everything done, but another part is simply about not wanting to. When I am forcing myself to attempt to get the dishes done, it takes a lot of time and energy to do so. Generally the more depressed I get, the less energy and motivation I have. Activities that may have happened on a daily basis become less and less frequent, and that includes everything from leaving the apartment to showering.

Another aspect of the hygiene problem for me comes from the shower itself. If I am on the couch I might be able to keep my mind somewhat occupied by the TV. If I am in bed I could try to read a book. When I’m in the shower though, I am left entirely with my own thoughts. If I am depressed and take a shower, I feel almost exclusively worse coming out than I did going in. So what do I normally do in regard to triggers? I avoid them.

When phase 3 of depression rears its ugly head it means I am grappling with severe suicidality. Every minute feels like a constant battle with myself, and I care less and less about the things around me. In this place it is far more than a lack of motivation that keeps me from taking care of myself, it is like being caught in a net in my own mind, and if I don’t spend every waking moment trying to free myself from that net I will be trapped there forever.

When that happens, good hygiene is not even remotely on my radar. Everything external became extraneous, and I can’t help but be convinced that shaving my legs wont have anything to do with making it through the episode alive.

As far as mania is concerned (as I can perform everything fairly well while hypomanic) the issue is similar to phase three of depression, except that attention that I have turned inward when suicidal is turned outward when I experience mania. The attention and focus I have on one small detail often consumes me, and my priorities around normal external things (like sleep, eating, bathing) evaporate. It isn’t about losing motivation, on the contrary -I find my motivation so consuming I can’t think to focus on anything else.

Similarly, there are times when I am manic where I feel sort of above the law, if you know what I mean. Something larger or more meaningful than the average person, and in those moments I can say that my slightly delusional mind finds basic hygiene below me.

The issues I have regarding hygiene and psychosis might only really make sense if you have experienced it. There have been times where I have felt so paranoid and fearful that standing behind a shower curtain (and not being able to see what is on the other side) is impossible. Other times I have feelings of violence and rage so intense I don’t feel comfortable leaving my room or the presence of another person… which puts bathing somewhat out of the question.

Honestly, I think the issues we face in regard to maintaining good hygiene is not something understood by most people. Those that have not experienced the entanglement of depression, the overwhelming focus of mania, or the abrupt fear of psychosis may fail to grasp how difficult it can be to focus on oneself and follow through when there are so many symptoms guiding me away from bathing or changing my socks or brushing my teeth.

I guess I just wanted to make a point of explaining that poor hygiene isn’t always a product of laziness or a brazen lack of adherence to social standards. There are times when a lack of energy or motivation can put the kibosh on taking care of our hygiene, as well as times when our symptoms are severe enough to engross us so fully that our goal is merely survival and nothing more.

In a society where a “bad” outfit or poor hygiene can make one the product of ridicule, I think it is important to remember that there may be factors in any given person’s situation that we may not know about. When people can be so quick to judge, sometimes I feel like the most support can come from the person who simply gives me a break.