Tag Archives: mood tracking

A Bittersweet Return to Psychiatry

As you may remember, the healthcare reform required that I find a new psychiatrist… only to have that one present itself as unreliable. After a few desperate phone calls and a miracle (the fact that my old psychiatrst is now taking my new insurance) I made an appointment with him a few weeks ago.

The appointment was yesterday, and though I’ve only been without a psychiatrist for three months it has felt like forever. While I waltzed into his office feeling quite chipper and very glad to see him, the appointment was rather bittersweet.

At this point it seems like my mood swings have developed something of a pattern, something that hasn’t happened in the three years I’ve been mood charting and tracking my symptoms. I could be jumping to conclusions here, after all the pattern might have been spurred by the pain and/or medication from when my ovarian cysts have been rupturing (now two for two, two months, two cysts). While I would be thrilled to be able to expect some level of predictability with what I’m dealing with, I’m not holding my breath for at least another month so I can see what happens next.

So far, the pattern looks a little something like this:

16 days hypomanic level euphoria dominant mixed episode
6 days with multiple depressive mood swings per day
5 days of stable mood
6 days with multiple depressive mood swings per day
17 days hypomanic-manic level dysphoria dominant mixed episode
6 days severe depression

I realize this is like… barely a pattern, but it is more like a pattern than anything I’ve experienced before.

Anyway, bittersweet. Great to see my old psychiatrist, but somewhat alarming to realize he has given me every medication (save the newest one, Saphris) that is available or reasonable for me to try. Three months ago I knew this, so why did it feel like such a shock to hear again yesterday?

It seems like I’ve exhausted nearly every possibility when it comes to psychiatric medications without any luck. I say nearly because, again, I can try Saphris (though I want to make sure I can get it for free before consenting to that, it currently has no generic and is terribly expensive) and I’ve agreed to try Seroquel. Again.

The thing is, I was first given Seroquel (quetiapine) while hospitalized, and they gave me a massive dosage first thing in the morning. Within an hour I couldn’t stand or walk because I was so dizzy, and because of that I told them I wouldn’t take it again. 

I think things might be different if I can take a little bit at a time at bedtime and get my body used to the effects (as long as they aren’t as horrible as they were taking a massive dose). You see, I have a very sensitive body chemistry and I tend to feel side effects somewhat exponentially, in conjunction with most medications having little positive effect for me (treatment resistant symptoms!). I’m more than willing to try this again, because frankly I have few (two?) options left in this realm of medicine.

By 2 pm yesterday I was feeling completely despondent and suicidal. I mean, nobody likes to hear that they feel like shit but there are no medications left to treat me. Talk about hopelessness!

That is, until I started thinking about the other options out there. I know there are still many other types of treatments I can try, it just gets my goat how often people (patients, doctors, pharmaceutical companies) promise guaranteed relief from pharmaceuticals when that hasn’t been my experience at all.

At this point, though I’ve tried acupuncture, there are other alternative treatments out there I can try. The trouble is that the ones my insurance covers are the ones I can afford at this point. I went into a terrible amount of credit card debt when I was trying acupuncture as a treatment method and unfortunately it didn’t do much to help me at the time.

My mind circled back to the idea of ECT. I don’t think my psychiatrist has brought it up lately because I really freaked out on him the first time he did. My reaction was the same as the first time I was suggested lithium, namely;

“Seriously? My symptoms can’t be THAT bad, right?”

Here, three years later, I can’t hold down a job. I’ve given up doing most of the things I love to do. I’ve tried every medication available to me (well, nearly) with no improvement. I yell at people in public uncontrollably while manic, I deconstruct my relationships while depressed, and I can’t tell the difference between reality and delusions while in mixed episodes. Are my symptoms bad enough to warrant ECT? Yes, I dare say I think so.

So… there. That’s an option. And just feeling like I have an option (albeit a bit of a scary one) makes me feel slightly better. After my last hospitalization I’ve always said that if it came to being hospitalized vs. trying ECT, I would rather try ECT.

I’ll try the Seroquel thing first and see how that goes, and I’ve got Saphris to try as well. Having said that, I’m planning on putting the option of ECT back on the table next month when I see my psychiatrist and see what he says.

I know I’m not the only one out there who has had trouble finding treatment options that work for them. I know it is simply the sickly, syrupy voice of depression when I feel singled out of a group that has already been singled out. The truth is not that I’m an “outcast’s outcast”… but so much of our lives involves comparing ourselves to the people around us that the things that make us unique often feel like pitfalls. I have to (and I will) find a way to make life work for me… and given my tenacity I can’t imagine anyone better suited for the job.

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Smartphone App Detects Mood Changes in Bipolar Patient’s Voices

A new smartphone app (currently still in testing phases, hopefully released soon) is being developed to help patients and doctors recognize early stages of mood swings in patients with bipolar disorder.

A novel idea and an interesting article, you can check out the full article here!

Hypomania and Physical Burnout

Oftentimes for me, having a revved up mind can lead to having a worn-out body. After all, jumping rapidly from a severely depressed, sedentary state into one of intense energy and hypomania has typically meant going from walking zero miles a week to walking 20 miles a week (with no real form of titration).

It isn’t uncommon for people to hit the gym harder than usual when hypomanic, and since we can’t seem to feel the strain or pain associated with working out we assume it isn’t there.

Fast forward a few days or weeks or months and what you’ve got is a total physical burnout.

It can be very difficult to rest (or sit still at all) when in the middle of a hypomanic state. Resting can feel uncomfortable, and for me it is a sure-fire way for negative thoughts to creep back into my life, something that keeping myself extremely busy tends to help block out.

Well, Saturday (in the wee hours of the morning) I went to the emergency room. Though the pain I was feeling was  not a product of strenuous physical activity, I believe my hypomanic fast-paced attitude the last few weeks definitely contributed to my situation.

I have a pretty intense case of Irritable Bowel Syndrome, something I normally regulate through what I’m eating and medication I take (errr, am supposed to take) several times a week. As I mentioned above, sometimes when my mind is revved up, I don’t pay enough attention to my body. Not only that, hypomania can often mask the physical pain that lets me gauge how well (or not) I am feeling due to IBS symptoms.

By the time I realized how severely my symptoms had gotten out of hand, I was in a hospital bed at 2 am loaded up on morphine after waking up an hour earlier at my apartment in so much pain I could barely speak or walk. It wasn’t until the doctor asked me how long the problem had been going on and I checked my notes (I keep notes for mood charting purposes on my physical and mental health) and I realized it had been escalating for three weeks and I hadn’t stopped to notice.

Ooops?

I was lucky that even though I was in intense pain, the problem wasn’t life-threatening. Still, as high as I was on morphine, all I wanted to do was kick myself for not taking time out sooner to pay attention to my own body.

Hypomania may make us feel invincible, but the truth of the matter is that we are not. Running our bodies into the ground is a sure-fire way to trigger depression, so taking a moment to rest a few times throughout the week can not only help maintain our physical health but may also help maintain hypomania longer by keeping physical triggers at bay!

I am still planning on going to Florida this week, I am just working hard to rest until then. I’ve already seen improvements in my physical health, and even though my mind keeps saying,

“Go, go, go! There is so much to do and so little time to do it in!”

I am taking my own advice and plopping myself down on the couch for as long as my brain will let me!

The Switch

I’ve been flying high on a cloud made of hypomania the last couple weeks, so high I thought the wonderful feelings and extra energy might last forever.

Then, the switch happened.

A bipolar switch can easily be defined as the moment one mood or episode changes into another. The problem is that the way these switches happen is usually much less straight forward.

Realistically, there are times when folks (myself included) wake up one morning and things have changed. I would say this is the most polite way bipolar disorder can make a shift in mood, but for me that is very rarely the case.

There might also be times where the switch occurs sometime over the course of the day (or night). This seems to be the case most often when an episode is triggered by something, or when one has been holding everything back all day only to get home and have it all explode out in a flurry of emotion. To have your day thus interrupted is certainly inconvenient, and feeling your mood change from one extreme to the next can be uncomfortable, if not totally maddening.

The third (and my decidedly least favorite) option the switch can take is to playfully leap back and forth between moods for hours, days, even weeks before finally settling again on an opposing mood.

This was how my day went down Sunday (yesterday). It was as if my mood had been sent through some kind of cheese grater, switching six times between delightful hypomania and a horrible mixed state.

One minute I was intensely irritable, throwing things in the apartment, stomping around like a child and yelling at the dog, then I would be delightfully enjoying a burrito and moseying along in the Seattle sun. An hour or two later, more scowling, throwing, and stomping, followed by a casual, relaxed couple hours watching a movie.

Unfortunately, this isn’t entirely uncommon for me. There are times when it seems like my brain either wants to ease me into the next type of episode by giving me little hints of it at a time, or wants to “spice up” an episode by sprinkling in all kinds of unwanted turmoil. Either way, going from feeling elated to self-punishing and back to elated within a series of a few minutes can leave one feeling very confused at best, and certainly scared as to what might happen next.

I woke up this morning very alert. I had a dream last night about Las Vegas, which meant mostly waking up with a smile on my face (and you know, I’m not going to speculate why Las Vegas, in my dream, was populated solely by the Chinese) so I feel tentatively optimistic. The problem is that after a day like yesterday, I’m starting my week off very nervously.

After all, will today be a repeat of yesterday? Are my joyous recent days of hypomania over soon, or might I be lucky enough that yesterday’s mixed moments were a product of something fleeting like… hormones? Either way, I suppose being prepared at this point is half the battle, and after yesterday’s roller coaster I don’t expect to let the rest of this switch take me by surprise!

Hypomanics Just Want to Have Fun

I’ve been hypomanic, but I didn’t realize to what extent exactly. Yes, there has been hilarious dancing, yes I have been walking up to strangers on the street and talking to them, and yes, my anxiety around spending money has been lifted and I casually bought a pair of shorts.

When I got into my therapist’s office yesterday (our relationship renewed by medicaid’s promise to give me 33 free sessions) I said,

“Well, I’ve been having trouble sleeping and I’ve been running all over the city for two days straight, but things don’t seem too intense.”

I shrugged and wrote off my symptoms. After all, I wasn’t experiencing any agitation (or even racing thoughts), and things hadn’t reached the point of mania (where people couldn’t understand what I was saying anymore) so things seemed fine.

After about fifteen minutes of talking and filling out some paperwork my therapist looked at me and said,

“I realize this may be coming out of left field, but you’re speaking rapidly, using much more exaggerated hand gestures than usual, and your volume is just short of yelling.”

I was shocked, not that she said that to me… but that I hadn’t any idea that I was doing any of these things.

To be fair, two years ago I couldn’t pinpoint manic symptoms in myself short of starting a fight with a pharmacist or believing I was a werewolf. It seems so much easier to pinpoint symptoms of depression or mixed episodes, because they feel unpleasant. How difficult is it to notice I am experiencing something or doing something that feels great?

When it comes to hypomania, I can recognize insomnia, or a lack of hunger, or high waves of energy, even giddiness and elation. Less straightforward is the part where this becomes funneled through me and introduces itself to other people’s lives.

I don’t really know how to pinpoint symptoms like rapid speech and exaggerated hand gestures, short of someone pointing them out to me. Even then, my therapist asked if he pointing these things out made me want to change my behavior. At the time, sitting there, I said no.

As much as I am afraid of coming off wild and intensely, I know this period also lends itself to a certain hilarity that I can’t embrace quite the same way at other times. It becomes easier to tell jokes, easier to laugh at jokes, and easier to take conversational risks.

I know this can ball itself up and transform into mania (or even a mixed state) but it seems as though the acting excitedly itself isn’t an issue. Just because I am paying close attention, monitoring my sleep and eating to try to keep things wrangled in doesn’t mean I can’t have a little fun.

And after a little depression, don’t we all deserve a little fun?

The Hypomanic Ascent

My episodes are not always straightforward. Instead of looking like a game of tetris (lovely solid interlocking chunks), my mood charting the last two weeks looks more like the work of a seismograph.

One day of depression. One day of mixed symptoms. One day with a depressed swing and a hypomanic swing. Two days of hypomania. One day with a depressed swing. One day with two depressed swings. One day with a hypomanic swing and a depressed swing.

And so on.

Around the first day of spring, I knew things were beginning to change for my mood because I was experiencing increased insomnia. That, and Corey (my boyfriend) was heading out of town, and I wasn’t pulling my usual hysterical, “I’m going to die without you,” bag of tricks.

Actually, for the first time in the six years we’ve been dating (and countless projects he’s gone across the country to work on) I felt fine about his absence. Confident. Relaxed. Awake. Giggly. Awake.

It wasn’t until I was dancing around the grocery store with a cart full of tater tots, laughing wildly and scaring the other customers that I realized it had come.

Hypomania!

I was elated (well, literally) about finding myself feeling so good. Despite almost wanting to talk in whispers (as not to scare it off) I shouted loud, animated, boisterous jokes.

Despite being as careful as I could about my sleep schedule (and taking Ambien without it doing anything except causing me to black out and wake up with paragraphs of nonsensical, albeit passionate writing on my phone) the hypomania stuck around for a few days.

Going, in a matter of days, from a deep place of loathing toward everything to suddenly loving everything can be a very interesting experience. After all, depression has this obnoxious ability to make it seem as if it will last forever. It seems like every couple years I reach a point where I begin to believe it, and this has been one of those years.

Having said that, it might be doubly frustrating to experience things in the opposite direction, as I did Monday. Going from feeling great, to crashing miserably in hysterics and despair, another instance of those mood tremors I was talking about.

At this point I am grateful for a change, even if it is an erratic one. Feeling great (even for a small fraction of the time) is preferable to feeling great none of the time. If my ascent out of deep depression into hypomania involves a lot of peaks and valleys I don’t feel like I can complain, because at least I feel like I’m moving forward again.

Physical Symptoms of Anxiety

Most people consider anxiety to be something of internal stress and struggle, constant worrying or over-thinking, but there is really much more to it. Anxiety has many physical symptoms that can pop up without warning or seem to eat away at us over a period of time.

This topic has been on my mind the last week or so because the closer I get to my SSDI hearing, the more of these physical symptoms of anxiety begin to manifest for me. My mind can only worry so much, but when it hits something of a peak, that is never the end, is it? For anxiety to blatantly “get worse” it often means other parts of my body being subjected to something akin to torture.

Maybe you’ve never considered the ways anxiety can physically obstruct someone from being at their best, so here is a list of a few of the ways anxiety can effect us physically.

  • Difficulty breathing (feeling out of breath all the time or having trouble catching one’s breath)
  • Breathing too quickly (hyperventilation)
  • Racing or pounding heartbeat
  • Trembling or shaking (generally in hands or feet)
  • Stomach pain (like an acidic feeling or a scraping pain)
  • Stomach cramps
  • Vomiting
  • Diarrhea
  • Tense muscles causing general body pain potentially in neck, back, or abdomen
  • Tension headaches (from tense head muscles)
  • Sweating
  • Blacking out/fainting

Of course, one might also include the ever-dreaded panic attack which often includes many of these symptoms at once as well as the overwhelming sensation one is about to kick the bucket.

Understanding that anxiety manifests physical symptoms can help us better gauge 1. how anxious we are, and 2. what we can do about it.

For example, noticing that my body has been in a position where I have been sitting rigidly and very tense for several hours gives me some insight about my anxiety level. At the same time, combatting this particular symptom with a hot bath or a hot tub or even a massage from someone will not only make the symptom lessen, but will also help lessen my anxiety.

When it feels like I have been trying to digest a handful of gravel for a week I don’t usually run out and consume a bottle of tequila and the spiciest Indian curry I can find. I generally stick to, you know… yogurt and macaroni and cheese.

If I feel like I can’t breathe, I try to avoid situations that might exacerbate it. Trying to do very physical things (running, even walking at times) can make me begin to panic if I feel like I can’t breathe, which can ultimately trigger a panic attack. Taking it easy, breathing deep, and moving slowly for a bit tends to help me in that arena.

Ultimately, recognizing physical symptoms of anxiety (as well as the mental symptoms) can help us gain a better understanding of what we’re dealing with as well as give us some clues as to what we can do to help ourselves feel a little better.