Tag Archives: mood tracking

Big Picture Mood Charting

I’m sure those of you that have been reading a while know that I am a big mood-charting enthusiast and for those of you who haven’t, well, I get a real thrill from any kind of chart or graph in general. Don’t even get me started on those that can convey something as mysterious as the inner workings of living with bipolar disorder… that’s my jam.

I’ve spent a lot of time messing around with different charts and graphs as a result and ultimately I’ve found that there is one type of mood chart in particular that has been very helpful in providing a big-picture look at how my symptoms operate. I call it the “color band mood chart” and it is a way to visualize what types of episodes I have and when they have taken place over a period of time.

I’ve spent some time sharing about this type of charting before (here) but I wanted to revisit the topic because with nearly five years of data now on my chart it becomes very easy to see the comings and goings of my episodes. I live with mood swings that can occur over a long period of time (months) but also swings that can happen several times in a day so this method of charting is really useful for seeing my episode length and severity of symptoms in a single glance.

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This type of charting is done on graph paper and the key above denotes how the element of time is displayed in the chart. I have opted to leave out any mood swings taking up less than 3 hours in a day (even though they are often present) to chart the moods that encompass the longest period of time each day. I also limit the mood swings represented in a single block to 3, any more than that and I typically just consider it a “mixed episode” day.

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The key above shows what each colored box represents. Green areas are periods of stability. Blue represents depression, but darker blue signifies more severe depression (generally with some symptoms of suicidality). Yellow denotes hypomania with red representing full mania. Brown represents mixed symptoms and black represents more severe mixed symptoms (usually with psychosis or suicidality).

The chart below begins in 2011 and I’ve been compiling data every day (with the exception of a short period in June, 2011) since. Looking back and looking at the chart below I can certainly say that 2011 and 2014 were both pretty hard years for me and both required psychiatric hospitalizations. There have been other times I may have benefitted from hospitalization that I only really recognize by looking back at the chart as well.

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Sarah’s Color-Band Mood Chart showing bipolar episode length and severity  from 2011-2016

 

If you have been reading the past few months you might remember I had a pretty severe mixed episode in June and part of July and if you look here at the bottom of the chart you can see the dark shapes that represent that period as I fluttered between depressive, mixed, and elevated symptoms.

The information on these two pieces of graph paper have been huge in helping me convey my symptoms to my doctor and also to avoid undergoing treatment that isn’t potentially helpful to my own personal brand of bipolar disorder (as not all types of treatment are useful for all types of bipolar symptoms). I began the chart because I really wanted to find the patterns in how my episodes work, but as you can see there is really much more to my illness than experiencing symptoms at a specific time of year or alternating back and forth between depression and mania specifically. The chart has also been great for seeing how the medications I have tried have effected me and since my symptoms are treatment resistant it has been really important to have this tool to convey the way many medications have triggered (or worsened) episodes for me (like during the past few months) instead of quelled them.

It has been encouraging too to see episodes that were initially big chunks of depression or hypomania become smaller fractured chunks. Even without a medication to stabilize me everything I’ve learned about how to cope with the mood swings themselves has helped me bounce back out of them at times instead of staying locked in. Even though there are times I find there is little I can do to shake my way out of an episode, the smaller daily mood swings are something I’ve learned to cope with somewhat more effectively.

Just something fun to share and maybe some inspiration for those of you living with mood swings (bipolar or unipolar too). Being able to quantify the periods I am having problems has made living with my illness much easier to accept and try to treat.

For more information on mood charting (including other charting methods and tips) you can read “why chart?” as well as a number of other posts from Chart Week like “Personalizing Mood Chart Rating Scales or  “What else can I chart?”

 

Word of the Week: Apathy

The word of the week is apathy!

Apathy – indifference, lack of interest, enthusiasm, or concern

I’ve had a lot of names for apathy over the years (pointlessness, uncaring, disinterest, etc.) but this week apathy seemed like the perfect word to sink my teeth into.

For me, apathy has generally been a red flag for depression… but sometimes I have used the sort of “indifferent” element of my attitude to appear accommodating or like I am doing better (I’m totally casual guys!) than I actually am. On a positive note, apathy has also allowed me to move through an emotionally difficult situation with minor reaction (on my end) from time to time, which has felt like a relief every once in a while (since I am much more prone to over-thinking and over-feeling).

Though it can be helpful on occasion, apathy is much more likely to cause problems for me. My boyfriend doesn’t like when I don’t have an opinion on anything or when I don’t particularly feel like doing anything (neither do I for that matter). Most of my projects or activities fall to the wayside and I feel kind of stuck, like there is an invisible wall keeping me from wanting to proceed. When people ask me to pick between (A) or (B) I find myself waiting for any kind of emotion or indication of which one I want, which one is better… but it never comes.

When I am feeling a lot of apathy I have a hard time trusting my decisions because I lose most of the criteria I would normally use to make a decision. It becomes easy for me to eat a whole bag of candy, or drink a lot, or sleep all day because I don’t feel any potential consequence. I only feel… like I don’t care.

For now I will say that even though apathy lent itself to having pancakes for dinner this week, I’ll be happy when it moves on.

 

 

 

 

The Number You Have Dialed Has Been Disconnected

I don’t know if you have ever spoken and felt like nobody could hear you, but for me this feeling can potentially trump symptoms like delusions and hallucinations for the most maddening feeling I’ve ever experienced. Even when I am experiencing hallucinations or delusions (and maybe even don’t recognize it) I can talk to someone about it; but the times when my mouth and body do not convey what I want them to (or they do but in such a way that nobody can understand them) have left me (the innermost me) feeling like a phantom limb.

Last weekend, in a matter of days, I became engulfed by that feeling. Everything I was trying to say, the jokes I was making, the observations I attempted to casually convey, became hostile. It seemed no matter how I spoke or stood or gestured, people were genuinely afraid of me. Those desperate sorts of pleas hoping to convey my intense sorrow came out, instead, angry.

My manic episode from the week previous had turned dark, and as the depression I was experiencing became more and more intense, so did my apparent rage. The rage left me incapable of conveying the depression, and being unable to express myself left me feeling so isolated and alone that I could feel the depression feeding on it and growing exponentially.

When Monday rolled around I tried everything I could think of to crawl out of the disconnected, suicidal funk I was in. I emailed my psychiatrist only to find out he was on vacation. I called the intake coordinator for the new clinic I’m trying to access therapy through but she did not have time to talk. I called the crisis line (as I’ve been calling them a lot lately) but all the phones were busy! This, if nothing else, seemed like a sign, so I grabbed my purse and a book and went straight to the emergency room.

It can be very confusing to watch yourself begin to destroy your own life (your job, your relationships, maybe even yourself through impulsive drug or alcohol use) and feel like you are a passenger during the whole experience. Unfortunately, this is a feeling I am familiar with so I knew that the only real card I had left to play was hospitalization.

What I didn’t know was that I would be spending all day and all night in the emergency room before reaching that inpatient bed. I was awake for 36 hours and extremely alert and energetic (as I said, mixed episode) fueling those depressive and hostile waves that kept coming until I was (somehow now in an inpatient room) crying uncontrollably for hours, and periodically ripping up anything in my room I could find to rip up.

My goal was to outlast the episode until it switched into depression or stability (whichever came first), a fairly easy goal I figured, since my episodes cycle so rapidly and I was already 12 days into the mixed episode. Though it wasn’t fun (but hospitalizations never are) I seem to have outlasted the hostility and was expelled through the other end of the hospital Friday experiencing severe depression instead.

So I am home now, and though my decision-maker seems to be broken and I had a panic attack trying to go into the grocery store I am, seemingly, a free woman again.

My mind has still been trying to whisper all manner of horrible things to me, but I can eat food that wasn’t produced in a hospital now… so it makes all that a bit easier to live with.

Needless to say, my posts may be somewhat spotty for a bit. I’ve been very overwhelmed by a lot of the things that have happened this year, and several more big things are scheduled to go down this month.

In the meantime, take care of yourselves! I’ll be doing the same.

Long Game: Depression

There are times when my rapid cycling gives way to a long, drawn out affair. Though I sometimes experience other moods “popping in” during these episodes I can usually distinguish an episode up for the long-game because my symptoms begin like a snowball rolling down a hill. By the time it reaches the bottom it can easily knock me off my skis.

While I have experienced four solid weeks of depression now I wasn’t ready to call the “big episode” until I felt certain the depression wasn’t going anywhere.

This week it became clear the depression is here to stay for a while. That is, unless the dosage of bupropion (Wellbutrin) I doubled on monday begins to work some magic.

The signpost I passed during my current descent was clear enough, and I felt pretty proud of myself for noticing. My thought process seems to have become overwhelmed by depression now, and I found myself wondering why my boyfriend cared about me so much when I really didn’t deserve it.

Errr…

There is this realm of guilt and self-loathing that I only really experience during depression (though sometimes it can occur during my mixed episodes), and it is something that tends to take a firm hold on me when the depression lingers long enough to convince me these thoughts and feelings must be true.

At this point, I think I’ve played this game long enough to be able to see where this is going. When I have episodes like this they often last for months at a time and in the past have been known to result in hospitalization… that is, unless something can pop me out of it.

Right now it seems clear that my next course of action is to batten down the hatches, and frankly since I am already in the process of pursuing ECT (electroconvulsive therapy) there is a chance I could get lucky and I can line it up by the time (or even before) I truly hit rock bottom.

For me it feels like the real bummer is that pretty much everything I own is still in boxes after moving, I’ve been extremely unmotivated (thanks depression!) and given this current situation, I’m not really sure when that might change.

Really, let’s be honest though. I have access to a tea kettle, some dvd’s, and a barrage of pillows, and I consider those all to be highly prized items when experiencing a depressive descent. I want to be prepared but, fingers crossed… maybe I wont reach that point.

Toadking – Free New Tracking & Charting App for Android Users

While psychiatric medications have not helped me manage my treatment resistant bipolar symptoms, there is one thing that has truly contributed to my understanding and daily management of both my emotional symptoms and those related to anxiety. I can easily say the most helpful tool I’ve come across is mood tracking.

Not only do I track the status of my moods, I also track things like anxiety level, sleep quality, and level of physical pain. Anything that might contribute to exacerbating my bipolar symptoms is something I want to keep tabs on, and this has helped me understand exactly what kinds of things trigger my episodes, gives me an easy way to relay information to my psychiatrist, and has given me a much wider understanding of the disorders I am dealing with.

These days, it can be hard to find time to jot down notes; it seems the easiest solution is to do so on the go. While there are a few mood charting apps out there, I am someone who really hates paying for something that might not work for me in the long-run.

That said, if you are someone who is already tracking different elements in your life or would like to start and have an android device, you’re in luck! There is a new, open-source app developed by a tracking-app user for android called toadking.

Toadking Charting App

Toadking Tracking & Charting App

The toadking app allows users to choose one or several elements to track (which could be anything from level of depression to sleep quality to stress level, there is no cap on the number of things you can track so the sky is the limit here!) and then designate a 1-10 value for those elements once each day. Don’t worry, if things change throughout the day you can always go back and change your value!

Once you have compiled some data, you can use the share tool to create printable graphs for each element, an excel file with your compiled data, or email that data to your doctors or therapist, creating an easy way for them to check up on your status.

Some of you readers might remember that I am a bit of a graph nut, and I was pleased to learn that the finished graphs can be bar graphs, line graphs, or a table. While viewing the graphs in “history” mode on the device, the graphs can be seen showing one month at a time, however when exporting graphs you can select from the current month, previous month, last three months, last six months, and even one year’s worth of graph data!

If you really want some perspective on how your mood or anxiety or sleep habits have changed over time, there is nothing quite like seeing a full year’s worth of data!

So if you, like me, prefer no-frills tools and abhor obnoxious adds popping up constantly on your “free” apps and you have an android device, I would definitely recommend giving this tracking app a try. After all, it is totally free… so what do you have to lose?

Here is a link to the toadking website where you can find more information, as well as access to the source code (I know I have some programmers out there reading so a little shout out to you!) and a support area if anyone has any questions regarding usage.

I also want to provide a link to the page at Google Play where the app can be downloaded, so you can get straight to the fun part if you’re interested in checking it out!

Finally, I want to make a quick note about the creator of this app, because this app is something he could have sold to someone (who would ultimately charge you and I to use it) and decided instead to share it for free with those that could really get good use out of it. In my book, that is really saying something, so I really want to encourage people to try this out and potentially pass it on to anyone you think might find it useful.

Find that you love this app? You can drop the creator a line or kick in a donation to his cause here

Feeling Worse Before Feeling Better

During my last two visits with my psychiatrist we concluded to move forward with the idea of pursuing electroconvulsive therapy (ECT) as the next treatment option for my treatment-resistant bipolar symptoms.

While saying, “let’s do it!” has set a series of actions in motion (mostly on his side), I have yet to see any of the fruits of that action. At this point he is trying to get me a consultation with the staff at one of the two hospitals in the area that perform ECT, but the situation is tricky. Of the two hospitals, the closest one severely gives me the creeps, and the other involves a commute through a busy area (and we don’t have a car). Naturally I’m assuming that after urging my brain into a state of convulsion, I probably shouldn’t be riding the bus, so figuring out a system to even get to the hospital for these treatments is another thing to work on.

Having said that, after some research it appears that there will probably be a significant wait time (no surprise there) to even see these leading doctors to have a consultation. I am not expecting any of this to happen any time soon, but I am a little thankful to have some time to allow my head to wrap itself around the idea of taking such a step in such a (scary?) direction. I know my fear probably isn’t overwhelmingly warranted, seeing as I was just as nervous about the idea of taking lithium and now, even after having overdosed on it, I find it no more terrifying (and possibly even less so) than any other drug I’ve tried thus far.

In the meantime my depression is significant. In the month of June I experienced eight days of “stability”, and in July I experienced three. Keep in mind, “stability” is simply a word here that means the majority of the day was spent feeling well, which can mean an entire day -but more often for me means something like experiencing 8 hours of feeling well and 5 hours of total chaos. Even when it doesn’t account for the entire day, a significant mood swing lasting even 1/4 of the day is enough to cause major issues with my plans and ability to get things done.

The most frustrating part of seeing these numbers is knowing that it is summer, and that this is the time of year I typically the best. That means even though I am feeling my “best”, I am still experiencing episodes lasting between 3/4 of the month to the entire month.

For that reason my psychiatrist has opted to allow me to try an antidepressant again while we wait for a word on the ECT situation. Wellbutrin/Bupropion has been the only medication that has ever (presumably) had a positive effect on me, however I took it over ten years ago and the psychiatrist I was seeing was definitely… sub-par. At this point I can’t say if it truly did anything for me, but it appears that in conjunction with whatever else I was taking, it didn’t cause psychotic mania (the way other antidepressants have for me).

In order to even allow me to try wellbutrin/bupropion again, my doctor is requiring me to go up to 50 mg of seroquel/quetiapine. I increased my dosage from 37.5 mg to 50 mg on Sunday night, and the last 52 hours I have been a mess. I’ve had hot flashes and profuse sweating, overwhelming nausea, constant upset stomach and stomach pain, lethargy, lack of appetite, etc. Not a fun time, but this morning I can already tell is a slight leg up after yesterday, so hopefully I can get over this hump soon to test out wellbutrin again.

So there’s an update, this is really the best I can muster in my given state. What I can say is that I am actively doing everything in my power to try to guide (or wrench, whatever works) myself into a better place… even if that means feeling significantly worse because of side effects before I can feel better.

Bypassing the Mood-Swing Middle Ground

This has been a particularly weird week for me, and I don’t know exactly what is to blame at this point. It could be the weather (overcast half the day, sunny the rest), it could be the time of year (things get rather busy in the summer, after all), it could even be the quetiapine (though that is something I intend to explore a little more next week).

In any case, I’ve been experiencing a distinct reduction in the amount of middle-ground I normally experience with my bipolar mood fluctuations. Let me explain.

Normally, for me, I can cycle extremely rapidly (more than one mood swing in a day, sometimes more than one kind of mood swing in a day) in addition to having the more typical drawn-out episodes that last days, weeks, or months. Usually in these situations, there is some kind of transition period… some kind of middle ground my mood passes on the way to the next mood.

For example, moving from:

Depression -> brief period of stability -> hypomania.

or

Depression -> brief period of stability -> depression.

Usually there is enough time (even if it is a matter of thirty minutes) for my mind to teeter through a point of stability, allowing me to poke my head out of whatever mood swing I’m having, look around, prepare myself for whatever is about to come next, and duck back down.

This is generally how I operate on a daily basis, and this small snippet of feeling “okay” is part of what allows me to mentally prepare myself to shift gears, or gain a moment of respite before ducking back into an ugly place. Something like coming up for a breath of air before diving back down to… wherever.

However… there are people out there who have mood swings that operate differently. This week I was one of those people.

I have been jumping back and forth directly from one extreme mood state to the next, which looks a little more like this:

Suicidal depression -> euphoric hypomania bordering on true mania -> suicidal depression

The gradual transition I am used to has been replaced by a sporadic jumping straight from extreme state to extreme state. These jumps are, admittedly, rather jarring, though I’m much less likely to put up a fuss going from feeling suicidal one moment to totally high and euphoric the next (as opposed to the other way around). As I said, I don’t know exactly what is causing this change, but I am going to keep my eye on it for another week (unless things get ugly) before talking to my psychiatrist.

Unfortunately, this sort of thing is fairly typical for me when trying new medications (which is a little funny, because they tend to have the opposite effect for me than they do with everyone else) but I am trying not to jump to any conclusions. Again, more time and attention is needed before I make any moves, and who knows? This could be a summer-time fluke that will straighten itself out again before too long.

In any case, I am finding the severe depression much more tolerable when paired with euphoric hypomania. The trouble there is that, as someone with zero income, I can’t really afford to spend too many more days like yesterday, frolicking in the sun buying two dresses, a new purse, a pair of shoes, and four dvds. Normally I don’t have a huge problem with the “spending money” aspect of hypomania, (and what I bought may not seem like much to someone who has had more than $7 in their bank account for the last 6 months) but yesterday’s hypomania was a bit of a doozy.

So happy Friday folks! We’ve made it through another week! Today I’m feeling a little curious; do you (bipolar diagnosees) typically experience a more gradual change in mood, a rapid switch from one mood to the next, or a combination of the two? If you feel like exploring this topic in the comments, I’d be interested to know. As a side note, lets skip any comments about the medication I’m trying because (as I mentioned) I’m planning on coming back to this more in-depth next week. Thanks!