Bipolar 2 From Inside and Out

Posts tagged ‘anxiety’

What Was I Feeling?

It wasn’t supposed to be journaling. I thought I was writing a blog post to be called “On Happiness.” It was about the fact that, even though my bipolar disorder is well controlled, something was sucking the joy out of what should have been joyful times—our dream trip to Ireland, for example, or the fact that I just got a work assignment after a long drought. Not even a mid-winter trip to Florida lifted my spirits.

It didn’t feel like depression, though. That’s a creature I know well, and this wasn’t it. Oh, the lack of joy was the same, but there were no unexplained fits of crying or immobility. In fact, I was experiencing a flurry of activity getting ready for the Florida trip. Putting money away from every paycheck. Making sure we had enough meds for the week. Arranging boarding for the cat. Downloading directions to Google Maps. Checking the flight reservations at least twice a week. Planning what goes in the carry-ons. Juicing up my e-readers and my laptop so I could work on my new assignment and my blogs while we were away.

No, this wasn’t depression.

What it was, was anxiety. Where was this coming from?

Suddenly, I remembered. I had gotten a copy of my file when Dr. Ramirez had to prepare it for my disability application (which failed, of course). On it I read, bipolar disorder, type II, which was expected. But it also said anxiety disorder. And I forgot about that.

All these years, I’ve been concentrating on the bipolar diagnosis—keeping my moods level through a combination of meds and therapy, readjusting levels and times as needed.

But I had been ignoring my anxiety. I was taking one small dose of an anti-anxiety med, with permission to take an extra one as needed. Mostly, I just took the one at night to help me sleep. Unless I was under severe, immediate stress, I ignored the ability to take a second one. That only happened in Ireland, when we were driving on the unfamiliar side of unfamiliar roads with the first roundabouts I had ever encountered. After that, it was back to one a day at bedtime.

But then, as I was trying to write my blog post about how bad I was feeling, it occurred to me (duh) that what I was feeling was not depression, but massive anxiety. All my planning for the trip, all my worrying about our budgets and my work, were clear signs of it, even if I had somehow missed them.

By now, everything for the trip is planned, a few days early even, and my blogs are prepared to post while I’m away. I could relax. But you know I won’t, and I know it, too.

What I will do, though, is to start taking that extra anti-anxiety pill as part of my morning regimen. Unloading some of the remaining tasks like packing on my husband. And trying to distract myself by losing myself in a book.

And, of course, remembering all this for when we return and I have another appointment with my psychiatrist. Who knows? Maybe the twice-a-day pill regimen will have made a difference by then. And if it hasn’t, we can discuss it and see what else might help. (I know, I know. Breathing. Meditation. Mindfulness. Exercise. All of which are difficult for me to practice regularly. I haven’t been able to turn them into consistent habits.)

My husband helps me with my moods. I check with him when I start feeling manicky. He gives me loving attention when I start sliding into depression. He has proven that he can recognize extreme anxiety in certain unusual situations and recommend that I take that second anti-anxiety pill. What I plan to do, at least until my next med check, is not wait for that extreme anxiety to hit and work the second pill into my routine to see if it helps. And ask Dan for help in remembering to do that.

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Mental Health

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Why Can’t You Just Get Over It?

That’s a question we all get—and we all hate. It implies that we can just get over it, but haven’t, for whatever reason.

The questioner may believe that we just aren’t trying. That we can pull ourselves up by our metaphorical bootstraps or choose to be cheerful. That we aren’t doing all we can to “regain our sanity.” That we haven’t tried the right diet, the right exercise, the right supplements, or the right therapy. Everyone has an answer.

Parts of their answers may be part of our answer, sort of. Diet and exercise are important, to be sure. But one food, like apple cider vinegar or acai berries, is not a secret remedy. A healthy, balanced diet of meat, veg, fruit, and grains is ideal. But many of us are simply not able to cook like that. I’ve had days when all I could manage to eat was Cocoa Puffs straight from the box or peanut butter straight from the jar.

Exercise and fresh air are good, of course, but again many of us are simply not able to accomplish it. Some can’t leave the house except for absolutely necessary errands and appointments. Then we bustle back to the safety of home. Or, if we have someone to help, they can do the errands for us. My husband can sometimes get me out of the house for a meal, but usually not a healthful one. If a friend invites me over for dinner, it’s a very special occasion and I make sure to hoard my spoons for it. Those are times I’ll even take a shower and get dressed for. As for exercise, I just can’t. I have severely arthritic knees that need to be replaced, so I can’t even do yoga or tai chi. Plus the whole getting out of the house thing.

Another common comment is, “Get some therapy.” I have and am and most of us are. What people who say this don’t realize is that therapy doesn’t work quickly, even if you can find the type that’s right for you. Personally, I can’t handle group therapy. I’ve tried. I have problems with the idea of CBT and DBT, currently two of the most favored forms. Talk therapy is the one I choose, and that helps, but I’ve had to go to the same therapist sometimes for years. A quick fix is not what I need or can get.

Also, there’s “Have you taken your meds?” which really pisses me off. First, there’s the assumption that I’m even on meds (I am, but it’s rude to assume that), plus the idea that a layperson can tell me when I need them.

No, I can’t just “get over it,” and neither can most people with depression, anxiety, phobias, bipolar, PTSD, or schizophrenia. They’re just too complicated.

Think about it. There are three causes considered likely to be the cause of brain illnesses: genetics, psychological trauma, or brain chemistry. None of those is something that can be gotten over by choosing happiness. If the origin is genetic, pulling yourself up by your bootstraps is not even a possibility. It will likely take years of therapy and medication to achieve stability, if that’s possible. If the cause is trauma, you can’t just forget about it. Imagine all your worst nightmares hitting you suddenly, asleep or awake, as though you’re experiencing the triggering event just as you did when it happened. Think about how it would feel to have grown up with repeated abuse that you couldn’t escape because you were a child. And if your brain chemicals are out of whack, there are dozens of meds that might work and dozens more that won’t. Finding the right combination is a lot more complicated than just popping a pill.

When you get hit with the question of why you can’t just get over it, you might be able to take ideas from this discussion and try to educate the person who asked it. Or you can print out the whole post and give it to them. (I give you permission.) They probably won’t realize they’ve just insulted you. At the least, you can tell them that they have. Maybe that will stop that one person from coming at you with the same question over and over.

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Mental Health

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Overthinking Night and Day

Like many people with SMI, my superpower is overthinking. In fact, even as I write this, it’s 2:30 a.m. I can’t sleep because I have hamster brain, a phenomenon I’m sure will be familiar to most of you.

I’ve got plenty to overthink about. I’m starting a new writing assignment and am confronted with a big, messy outline that I didn’t write and have to make into a coherent book. We don’t have the money to get a plumber, only the downstairs toilet works, and there’s only a trickle in the showers. Between the two of us, over the next six weeks, we have a total of six assorted doctor appointments coming up, for everything from nail fungus to heart meds to psych meds to test results to steroid shots. There’s the trip we have booked in January to see Dan’s 96-year-old mother. There’s our senior cat whose health is holding for now, but who knows? Pick any one. Or two. Or more.

If only overthinking were productive. Wouldn’t it be great if all that thinking led to creative problem-solving? But no. The problems remain and continue rolling over and over.

Overthinking is tied to anxiety, at least in my case. I do have an anxiety disorder, so my overthinking is something prodigious. And, as exemplified by the hamster brain analogy, it’s cyclical. Anxiety causes overthinking causes anxiety and so on and on. The more out-of-control your problems are, the more out-of-control your thoughts become.

Overthinking is also a symptom of other mental disorders, such as PTSD, OCD, and depression. Another perhaps related phenomenon is intrusive thoughts, the ones that seem to appear spontaneously in your mind for no apparent reason. Perfectionism can be involved, too, if you obsess about doing everything just right. Catastrophizing and all-or-nothing thinking can also contribute to overthinking.

But those are facts. And overthinking has little to do with facts. Take that upcoming trip, for example. The flights are booked, the accommodations are arranged, the rental car is reserved. All three are already paid for. All this was taken care of months ago. But I still overthink. I check the airline reservations to make sure they haven’t changed (they did at least once, with a layover in a different city). I hope we can get an accessible condo. I worry about paying for gas and food. I feel panicky about getting to the next gate during layovers. I have done everything I can think of to make sure the trip runs smoothly, but still…

It’s exhausting, so it’s ironic that I can’t sleep.

How to stop overthinking? Mindfulness and meditation are often recommended, but those don’t work for me. I just can’t shut off the over-thoughts long enough to accomplish them. Distractions are another recommendation, and I try that, but they only provide temporary relief. Reframing negative thoughts is yet another suggestion, but I don’t know how to reframe having to go downstairs to pee in the middle of the night. Self-acceptance or self-compassion, forgiveness, and gratitude—nothing seems to work.

I do take antianxiety meds, and I do have permission to take an extra one if I have more than usual anxiety. I have a prescription for a sleeping aid, but I don’t like to take it very often. More often I just say the hell with it and get up, read or write or watch TV. My sleep-wake schedule is off for days, along with my meals, but if I can just stop the thoughts for a while, I’ll take it.

For me, overthinking happens mostly at night, but it doesn’t have to. There’s plenty of fodder for overthinking during my waking hours. Perhaps I just don’t notice it as much because during the daytime I’m usually doing something that distracts me from my thoughts. Today I was overthinking how to get an accessible room at the condo where we’re staying in January. I made phone calls and stayed on hold, but I got put off until four weeks before the trip. That started me overthinking about what to do if we can’t get an accessible room. I’d have to get one of those shower substitute wipes they use for people who are bedridden. Then I started looking those up online. Maybe I should order some, just in case. Or, I thought, I could wash up in the sink every day. Or some combination of the above. It’s ridiculous how long I spent contemplating the possibilities. All I really have to do is request an accessible unit when I show up, and they’ll tell me whether one is available that day. But do you think I’ll be able to wait until we show up? No, I’ll keep overthinking it. And get the wipes just in case.

Because that’s just what I do.

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Mental Health

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Sleeping or Not

Sleep is one of the most problematic aspects of bipolar and many other brain illnesses. With bipolar disorder, you tend to sleep too much when you’re depressed and not enough when you’re manic. For adults, the recommended amount of deep, restorative sleep is 7–9 hours. That allows someone to have the proper proportion of REM sleep, which is when you dream and when your brain consolidates memories and experiences.

To this, many of us say, “Hah!”

Right now, I’m torn between the two extremes. I’ve been having mixed episodes, so there are days when I want to stay in bed all day. On other days, I can’t get that restful, uninterrupted sleep. I wake up at around 2:00 a.m. and can’t get back to sleep until at least 6:00. I take a nap in the afternoon, and then can’t get to sleep until around 2:00. Or I’m so exhausted that I go to bed by 8:00 and again wake up at 2:00. Once in a great while I go to bed around 9:00 and wake up in time to see my husband off to work at 5:30. Those are the good days.

It’s true that I’ve had a lot of stress lately. Financial, legal, health, and emotional problems have been piling up for both me and my husband. I read at night after taking my bedtime meds, and I feel sleepy in about half an hour. But when I put down my book and try to sleep, I get racing thoughts about every impending disaster—and there are plenty to choose from. The anti-anxiety med I take does nothing, even if I take a second one (which my doctor allows).

If and when I finally do get to sleep, it’s not restful and restorative. I know that I do enter REM sleep, because I dream. One night recently, every single impending disaster combined into a vision of ultimate dread. It wasn’t just that everything that could go wrong did. They all were over the top, all my fears taken to the extreme with vivid color and sound. Worst of all, I couldn’t talk to my husband about my disturbing dream as I usually do. He was dealing with the same fears and facing the same disasters. It seemed unfair to dump my terrors on him. Although he was involved in the dream, I didn’t want him to think I was blaming him.

Along with the terror dream, I’ve had the normal variety of unpleasant dreams that express frustration or inadequacy—missing a plane, losing a competition—the kind that I can generally shrug off. Now, however, they seem to linger in the back of my brain all day.

There is one thing that helps, but I know I shouldn’t do it. That’s taking a sleeping pill. I don’t currently have a prescription for it, though I did in the past. I stopped taking it when I learned that I slept okay without it. But I still had half a dozen pills and didn’t get rid of them. I thought I might use them if I needed to sleep on a long flight. Instead, I remembered I had them during the current series of crises. And they work. But I have to dole them out carefully. I don’t see my psychiatrist until next month, and he doesn’t prescribe over the phone. I tried to make an appointment to see him earlier, but I don’t have transportation on the days he sees clients.

My best bet at this point is to hope that some of the crises resolve before my appointment and I don’t need the sleeping pill anymore. There’s a chance that some of them will, but then again, they may not resolve in our favor. It looks like more hamster brain for me.

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Mental Health

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Meltdown

I haven’t had a meltdown in a good, long while. And I’d prefer to keep it that way. But this week, I had one.

What brought it on? As usual, too many crises all hitting at once. One of every kind—financial, legal, emotional, work, medical, and family. The kind with no obvious solutions.

Individually, I’ve had versions of all these crises before, and gotten through them somehow. I’ve developed any number of coping mechanisms that I can pull out of a hat if I need to. But the hat holds only so much. I can’t keep pulling things out of it if there are no more in there. Hence, the meltdown.

I often turn to my husband when I have a meltdown, but this time I can’t. He’s having a meltdown of his own. It isn’t identical to mine, but they do overlap. Neither one of us has much to offer the other. We do try to support each other to the extent of our abilities. But there’s no denying that we’re both depleted, with not much ability to soothe or strategize.

One thing I could do, and did, was call on a friend so I could let it all out. I’ve known him for years, and he’s seen this happen to me before. And, wonder of wonders, one of the first things he asked was whether I needed advice on my problems or just a listening ear. I chose the listening. What I needed most at that point was to let it all out. And I did.

Once that happened, I was able to pick myself back up and start coming up with solutions. Moving money around. Getting a lawyer. Gathering phone numbers and making calls. Taking notes. Helping my husband calm down when he was having a panic attack and a meltdown of his own.

Another thing I did was reconnect with my therapist. I hadn’t had a session in a few years. She had moved to another practice, I was fairly stable, and our sessions had gotten shorter and shorter because I just didn’t have issues that needed addressing. I had sensibly put the new practice’s number in my phone, just in case. I used it, and within a day heard back from her. I have an appointment scheduled for next week.

I know I’ve done the right things, the things most likely to help resolve the problems, but somehow that doesn’t help yet. I need to get all the assorted crises worked out or at least put on hold before I can return to something resembling stability. Next week will be a rough one, and my phone friend may just get another call. I don’t want to overburden him, but honestly, it’s been years since he’s dealt with me in the middle of a meltdown. I anticipate that Monday will be particularly difficult, with two crises, one major and one relatively minor coming to a head then.

I’m trying to shut down my emotions as much as possible in order to get through all this. I know that’s not ideal, but honestly, I don’t see how I’ll manage without doing that. Of course, that makes the meltdown afterward more likely and potentially more severe. I need to make sure that all my meds are refilled and try to establish a better sleeping schedule, which has been eluding me lately.

Time to make phone calls now, and more later. Wish me luck.

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Mental Health

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An Irrational Thought

I just bought a laptop because the air conditioner isn’t working. If that seems like an irrational thought I acted on, it is. It’s also a measure of my anxiety. And a consequence of my current mixed state.

Let me explain.

Our central air conditioner puts out a tiny bit of coolish air, but not enough to make the house comfortable. The weather has gotten up into the 80s, and the temp in the house is sometimes higher than that. And I know that July and August are coming, so temps over 100 degrees are likely. I’m afraid I’ll have heat stroke and die or at least have heat exhaustion and be incapacitated. I spend most of the day working at my desk, with fans on and cold beverages readily available, but still the heat gets to me. And I really need to do the work. We need the money, modest as my pay is.

So why (I hear you ask) don’t we call an AC repair service? My anxiety plus hoarding mean we don’t let people in the house. I suppose there’s a chance that they would only have to look at the outdoor unit, but I can’t count on that. There’s still a possible solution my husband can try. He’s going to get a tester and check the fuses. If that’s the problem, it’s easily fixable.

There’s the anxiety. What about the mixed state?

When I get hypomanic, one of my behaviors is online shopping. And there was just a sale at Best Buy on Apple computers that lasted three days. I ordered a laptop. I made sure it was a refurbished one to keep the price down, but I also bought the mouse, the subscription to Microsoft Office, and a carrying case. It was a tidy sum, money that we don’t have because of car repairs, but I put it on our Best Buy credit card. I also told myself that it was still cheaper than air conditioning repair. (A quick Google suggests that it’s likely a wash.)

How does this solve the air conditioning dilemma? If I have a laptop computer, I can take it to Panera, McDonald’s, or some other air-conditioned place and do my work while sipping on iced tea. (Panera has plugs and outlets conveniently located, I know.) Work accomplished. Body temperature regulated. Achievement unlocked.

Of course, I realize this is a slightly ridiculous plan. I know that my anxiety and hypomania are largely responsible. Ultimately, though, I’m responsible.

There’s still the chance that Dan can get the AC working again, if the fuses are the problem. If that happens, I can return the laptop (within 15 days after I receive it). So I have options, which I love.

I’m still left with confusing feelings. Maybe I’m too fearful of the heat or too dubious about being able to do my work in an overheated room. (I don’t think so, because I’m older and have had bad reactions to heat before. Computers also have bad reactions to heat.) Maybe I was too impulsive when I ordered a new laptop and all the fixings. Maybe even with the money I earn, the credit card expense will strain our finances further. I fortuitously just received a raise at work, so maybe that will help make up the difference.

I’m not asking for advice. I’ll work this out on my own somehow or at least with the help of my husband. He knows I’m in a mixed state, but the family finances are my responsibility and he usually goes with what I think we should do.

Things should be clearer by the time I post this.

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Mental Health

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Loneliness Reigns

For some of us, those with bipolar disorder, depression, agoraphobia, and anxiety, it’s like the COVID restrictions were never lifted. We remain at home as if we were still sheltering in place. We’ve lost touch with many of the people in our lives. The thin threads of social media aren’t enough to provide solid connections, though we’ve had practice during the pandemic.

There’s also the “reaching out” problem. We’re perpetually advised to reach out to others when we’re lonely or having difficulties. But of course, reaching out is too much to expect for many. Often, we’re not even able to make a connection when someone reaches in. Whether it’s a matter of not believing that we’re really worth someone else’s time or being submerged in misery, the loneliness of depression or anxiety does not allow us to respond.

Lately, though, there have been a lot of headlines and articles saying that America in general is experiencing an epidemic of loneliness. I don’t know about you, but for me, loneliness is nothing new. Depression does that to a person, even if loneliness is not one of the diagnostic criteria in the DSM.

Of course, the articles point out that the loneliness epidemic coincided with the COVID epidemic. People were sheltering in place, many working from home. We couldn’t get out and see our friends or go to school, church, or family gatherings. We missed weddings, birthdays, reunions, funerals. We missed seeing coworkers and friends. We even missed chatting with the people we encountered in our daily lives—nail technicians, servers, sales clerks, plumbers, and all the other people you don’t even think about missing until you miss them. Even our doctors and therapists took care of us online instead of in person.

But that’s largely over. What’s driving widespread loneliness now? Apparently, it’s a chicken-and-egg dilemma. Does loneliness come first? Do psychiatric illnesses? Recent research “suggests a correlation between loneliness and depressive symptoms, with one potentially leading to the other, although the causal direction remains unclear.”

The Journal of Clinical and Diagnostic Research has published a study that says there are three kinds of loneliness: situational, developmental, and internal. Situational loneliness involves environmental factors such as interpersonal conflicts, accidents, and disasters. Developmental loneliness appears with conditions including physical and psychological disabilities. Internal loneliness is associated with “personality factors, locus of control, mental distress, low self-esteem, guilt feeling, and poor coping strategies with situations.” Two other kinds of loneliness have been reported as well: emotional and social loneliness. It seems to me that those are the two that are behind the “loneliness epidemic” that headlines tout. Among the psychiatric and other disorders they say are associated with loneliness are depression, suicidal ideation, personality disorders as well as bereavement, Alzheimer’s, and physical illnesses.

The research is all well and good, but what’s to be done? The usual remedies don’t work very well. The report cited above recommends developing social skills, recognizing maladaptive social cognition, giving social support, and developing opportunities for social interaction. Not much help there. The last two rely on other people to provide intervention, which is obviously uncontrollable by the person experiencing loneliness. And the first two require therapy of one sort or another.

At any rate, the continued advice of the general public remains, “Cheer up,” “Get out more,” and variations on “Get over it,” as if the loneliness were the sufferer’s fault. Antidepressants may help but they don’t attack the root cause of social isolation. There are still social media, which help me a lot. But I interact with various people and groups, which not everyone is able to do. My husband gets me out of the house at times, usually with the lure of a restaurant meal. And that primarily connects me with the person I’m already most in contact with. He’s my social support. I have a high school reunion coming up, with a number of different events scheduled, but so far I’ve only talked myself into the most casual one.

Am I lonely? At times I am. But my loneliness is not the overwhelming sort that attacks many people. There are some ways to ameliorate the condition, but most of them require getting out of the house, which many lonely people are simply unable to do; having good friends who reach in (assuming that we have the wherewithal to reach back; and the long, slow slog of antidepressants and therapy, which may or may not “cure” the problem. Advertisements are beginning to address the problem of loneliness with advice to reach in and talk to friends and acquaintances who aren’t doing well, those these are minimal compared to all the ads for the latest drugs.

Obviously, there are other aspects of brain illnesses that the experts are working on more vigorously. But I, for one, hope that more research and interventions can be devoted to solving the problem, not just defining it.

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Mental Health

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Anxiety and Big Life Stuff

Anxiety about health is a common phenomenon. It’s only natural to worry about the human body breaking down, especially as one ages. But how much anxiety is too much? How little is too little?

When anything goes awry with my body, I get panicky. I catastrophize, imagining the worst. I have anxiety disorder in addition to bipolar, so that’s not surprising.

Once, for example, I woke up in the middle of the night with something strange happening to my arm. There was a hard spot along the side of it the size and shape of a cuttlefish bone. Instantly, I got dressed and headed to the emergency room. They took x-rays (which were ambiguous) and sent me home. If I hadn’t been so panicky, I would have realized that the problem could easily have waited until the next morning or whenever I could get in to see my doctor. But I was frightened and anxious because it was something I had never heard of and couldn’t explain.

It turned out to be sarcoid, which was treated with steroids. (There was also a spot of it on my head, which my doctor biopsied, so I now have a divot on my forehead.) The sarcoid backed off, leaving me embarrassed at having reacted so strongly.

My husband, who doesn’t have anxiety, is just the opposite. He takes injuries and illnesses much more lightly. He’s a bit accident-prone, often cutting himself or otherwise mangling his fingers and hands cooking or doing repair work. I used to have to burst into tears to get him to go for treatment, stitches, or whatever was called for. He would wrap the injury in a paper towel and some duct tape, which I understand is a guy thing. (A heart attack that he almost waited too long to get help for changed his ways. Now I don’t have to cry. He goes to the ER as needed.)

Now, however, we’re facing more serious medical possibilities. I won’t go into Dan’s, since he’d prefer to keep that story private, but it’s Big Life Stuff.

I have plenty of anxiety to talk about. Over the past few years, my knees have been getting worse and worse. At first, it only affected my balance, which was enough to make me anxious right there, fearing that I would fall in public. I started using a cane. I did fall once, at a student union where my therapist’s office was located. A flock of young women (nursing students?) swooped in, picked me up, and offered me a hot beverage. Ever since, my anxiety about falling has increased, exacerbated by a couple of falls at home.

Now, however, I’m facing more serious anxiety. My knees have deteriorated to the point that I need steroid shots every six weeks and am afraid to walk. (The doctor’s words were “bone on bone.”) The steroids work for now but won’t last. Eventually, I’ll have to get both my knees replaced. And that ramps up my anxiety to new levels.

Today, I stumbled on the stairs and my left knee almost gave out. My right knee took up the slack, but I envisioned myself lying in a heap at the bottom of the stairs. Since then, my left knee has been twinging, and I’m doubting its ability to hold up until the next round of steroids.

The orthopedist says I could need the knee replacements anytime from six weeks to six years from now. So, of course, I’m anxious that it will be sooner rather than later. I’m catastrophizing, envisioning weeks lying immobile on the couch, taking pain pills, and unable to care for myself. I understand that the doctor said it might not happen for years, but I’m reacting as if it will be next month.

To me, this is Big Life Stuff, and not just because it’s a major operation (two actually, one for each knee). I fear losing control of my body. I worry that knee replacement won’t help. I anticipate going downhill rather than improving. It’s not that I don’t trust my doctors. I’m just consumed by anxiety. I’m looking at ads for mobility scooters and fold-out chair-beds for my study. I can’t envision a future in which things will be any better.

I’m being crippled with anxiety about being crippled. And no amount of reassurance, education, or time is lessening it.

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The Overwhelming Problem

screaming (Uma painting)It’s been said that time is nature’s way of keeping one damn thing after another from being every damn thing all at once. I know that taking things one at a time—eating the elephant one bite at a time—is a sound idea.

However, every now and then the damn things gang up on you. The elephant is starting to go bad and you have to eat all you can right away – to use a disgusting metaphor that I will not take any further. (You’re welcome.)

Last month was one of those months. They happen every so often. But if they happen very often, I tend to get overwhelmed. And when I get overwhelmed for too long, my brain breaks. I have a meltdown, or I decompensate, or whatever the proper psychiatric term is. In practical terms, it means that I’m severely depressed and non-functional, for longer than usual. Days. Weeks. Months. Even years.

The things that overwhelm me are quite predictable – financial difficulties, health problems, relationship glitches, and free-floating anxiety of all sorts, either my own or my loved one’s. I know that these are situations that cause difficulty for everyone, but to a person with bipolar disorder, they can seem—or even be—insurmountable. Especially when they cluster and refuse to go away.

Over the years I have become good (or at least better) at recognizing when I am about to be overwhelmed. I know the symptoms—the whirling thoughts, the jumping-out-of-my-skin feeling, the insomnia, the inability to concentrate, and the feeling that doom or disaster is impending.

There is little I can do to stave off these feelings. But I know I have to. I have to keep functioning at some level, higher or lower, to maintain the things that I want to have – productive work, a loving relationship, a nice house, caring friends, and so forth. At the time of my last major breakdown, I came uncomfortably close to losing much of that.

I try my usual remedies for anxiety, of course. I distract myself. I color. I watch mindless TV. I play stupid clicky games on the computer. I turn off my phone. But if the anxiety builds up too much, if the feared disaster is real and really is impending, none of these works. The anxiety shreds my last nerve, and the depression starts to settle in. I isolate. I stay in bed. One task at a time, I stop being able to function.

I have taken one step that has helped, however. An anti-anxiety pill is one of my daily medications—one in the morning and one at night. A few years ago, as the stress was building and approaching overwhelming, I asked my psychiatrist if I could have permission to take one more a day if I needed it.

He agreed.

I have not needed to take the extra pill every day. Sometimes I take one in the mid-afternoon if I start feeling jumpy, twitchy, or panicky. Sometimes I take one at night if I haven’t gotten to sleep within 2 – 3 hours after taking my regular nighttime pills. I know it sounds strange that a depressant helps me stave off depression, but my diagnosis is actually bipolar disorder and anxiety disorder. The med catches me at the point where the one starts to turn into the other.

I’m glad my psychiatrist trusted me not to abuse what I consider a privilege as well as a necessity. By the time I made this request, of course, we had been working together for a number of years and had built up a certain trust. I think there have been only a couple of times when I have had to take two extra pills in a day—one in the afternoon and an additional one at night. And both times, I felt guilty about it and made sure I didn’t make it a habit.

I don’t want to start gobbling pills at the least sign of difficulty. All I want is to be able to eat my elephant in peace and in pieces.

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Mental Health

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You May Be Bipolar

If you take three different meds at night and two more in the morning…you may be bipolar.

If your therapist is on your speed dial…you may be bipolar.

If you know the difference between rapid cycling and ultra-rapid cycling…you may be bipolar.

If you have depression clothes and mania clothes…you may be bipolar.

If you’ve stayed in bed for three days and not gone to bed for three days…you may be bipolar.

If your significant other is also your emotional support animal…you may be bipolar.

If all your Facebook friends have psych diagnoses…you may be bipolar.

If your refrigerator door has 40 affirmations on it…you may be bipolar.

If you know who Gabe Howard is…you may be bipolar.

If you have a semicolon tattoo…you may be bipolar.

If you’ve ever watched a show with a bipolar character and said to yourself, “No, that’s not it”…you may be bipolar.

If Carrie Fisher is one of your heroes and you call her “Space Mom”…you may be bipolar.

If you’ve gone through a dozen medications trying to find one that works…you may be bipolar.

If you’ve ever felt depressed and jazzed at the same time…you may be bipolar.

If taking a shower is a major event…you may be bipolar.

If you keep a box of Cocoa Puffs beside your bed…you may be bipolar.

If you’ve had a yearly raise and spent it in a month…you may be bipolar.

If all these statements apply to you…you’re DEFINITELY bipolar.

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Mental Health

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