Bipolar 2 From Inside and Out

Posts tagged ‘bipolar type 2’

Brain vs. Brain

Having bipolar disorder is like having cognitive dissonance all the time.

What is cognitive dissonance? When people ask, I usually describe it as when the two halves of your brain slam forcefully into each other and give you a brain-ache. It’s also known as “brain go ‘splodey.”

Take, for instance, the time when I saw excerpts from the musical Cabaret, with the dancers portrayed by women of at least 65. As I reeled out of the theater, my mother saw the dazed look on my face and said, “Don’t you like Cabaret?”

“I love Cabaret!” I replied. Meanwhile, the other side of my brain was saying, ”Oh my God, if they had tried to do the Bob Fosse choreography, someone would have broken a hip for sure!” Slam! Pow! ‘Splodey! Cognitive dissonance.

You can probably see how this relates to bipolar. One half of your brain says, “If you just take a shower, you can go out to lunch.” The other half says, “A shower?!? First I have to find a clean towel and a bar of soap, get undressed without seeing myself in the mirror, fiddle with the water temperature, wash and shampoo, dry off, find clean underwear, and that’s not even thinking about drying my hair and figuring out what I can wear! Oh, my God, I’ve used up all my spoons just thinking about it! I should just eat Cocoa Puffs and go back to bed.”

Instant cognitive dissonance.

Or try this scenario: You see on your newsfeed that the government is considering a new law with a feel-good title regarding mental health issues. “Hooray!” one side of your brain says. “At last! Everyone should support this fabulous bill!” Then you look at the whole article and find that one provision in the bill allows violating the privacy protections of HIPAA, as an example.

“Oh no!” the other half of your brain says. “Any person, even one who’s mentally ill, has the right to medical privacy. What if an abuser gets information about his victim? I’ve got to write a letter protesting this bill. Where are my spoons? Did someone steal my spoons?”

There are lots of these situations, hence the near-permanent state of cognitive dissonance.

I want to be around people but I don’t want to talk to anyone.

I want to be left alone but then I’m lonely.

I really want to make love to my partner but I can’t get aroused.

I want to be cured but I hate the idea of being “normal.”

That degree of cognitive dissonance is positively exhausting. No wonder we never want to do anything but lie in bed, not read, not interact, not reach out, not try to do anything but survive another day.

If we think too hard about anything, our brains may go ‘splodey.

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I Love/Hate My Brain

My brain is special and magical. It makes me who I am and has often seemed to me to be the best part of who I am. I have always been intelligent and a quick learner. And I thank my brain for that.

On the other hand, my brain is deficient in some ways. It doesn’t have the correct balance of neurotransmitters (or has been adversely affected by trauma as I’ve lived my life or inherited from my parents). When it comes to bipolar disorder, I blame my brain. It’s glitchy, unpredictable, and guilty of making my life miserable at times.

So, I have cause to both love and hate my brain.

The thing is, I have no control over either of those perspectives. I didn’t make my brain smart and adaptable. I can’t take credit for that. I also didn’t make my brain misfire and become my biggest enemy. I can’t take the blame for that.

Much of what I am, my brain is responsible for. I am a moderately successful writer. That can be attributed to my brain as well. I’m creative, too, another quality that resides in my brain. But when I’m depressed, I lose the ability to write, and when I’m hypomanic, I lose the coherence I need to write well. It would be easy enough to say that I love my brain when it’s functioning well and hate it when it’s not. That’s not completely true, though. I’d have to say that my brain is my frenemy.

I am notoriously moody and difficult – hardly surprising since I have bipolar disorder. My intellect doesn’t go away when I’m depressed or hypomanic, but sometimes it goes into hibernation. It makes poorer decisions, it’s true. It’s led me astray many times, even to the edge of death. And I can’t always recognize when it does that. My brain is not the best gatekeeper of my behavior. But my brain does help me clean up the consequences when it does occur.

There is currently a great debate on whether bipolar disorder even comes from the brain. It may not be because of my neurotransmitters, though I still consider them complicit. It may be because of my childhood trauma (at the hands of children my age, not my parents). But again, trauma is said to make physical changes in the brain, so perhaps it is a brain-related reason as well. The other prevailing theory is that bipolar disorder has a genetic component. I don’t know if that means that my genetic heritage affected my brain development, though I suppose it could have. I just don’t know.

I do know that it feels like my brain is at fault. Bipolar is, after all, a mood disorder, and I don’t know where my moods reside, if not in the brain.

So, what can I do with my brain to increase the love and lessen the hate? First, I try to keep my brain fed. I read every day and play jigsaw sudoku to keep it lively and stave off dementia – and to stretch my brain because so much of what I do is word-related, not mathematical. My reading is varied, from novels to nonfiction. I revisit beloved novels from my past, which keeps me grounded in who I am, and explore new books and authors I find, which keeps me excited and open to the new. I try to lessen the opportunities for hate by keeping my brain stable with medication, therapy, and listening to my husband and my friends when they tell me I am loved.

On balance, I love my brain more than I hate it. But I have to keep an eye on it (as it were) to make sure that the hated half doesn’t take over.

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Three Days in the Life

What’s it like to have bipolar type 2? Here’s a look at three typical days.

It’s a day when I’m depressed. I wake up late and try to decide whether to get out of bed. I do so in order to take my meds, since I have to go to the bathroom anyway. If I have anticipated this depression, I will have left a box of Cocoa Puffs by my bedside, and these constitute my breakfast.

If I stay in bed all day, I am bored, because I can’t even focus enough to read. Everything I try to read means nothing to me. If I get up, I spend a large part of the day on the sofa, watching horrible reality shows that remind me that there are other people with crappy lives too. I skip lunch. I forget that I have an iPod with thousands of songs on it. I skip therapy appointments because I’m unable to get up and dressed and drive there. I feel numb and useless and pathetic. My brain reinforces this belief.

In the evening, I cry. I weep. I sob. Snot runs from my nose. I have circling thoughts about every stupid, embarrassing thing I’ve ever done. I try to wait till my husband’s asleep so he won’t hear me crying. I wake in the middle of the night, still crying.

I have anxiety attacks too, particularly when I’m in bed at night. I wake gasping. My husband holds me and strokes my hair until I fall asleep again. It’s really all he can do for me.

My psychiatrist and I keep trying different meds, but none of them does more than take the edge off a little. I still can’t function.

There is nothing I can do to change any of this. I can’t cheer up. I can’t even see a time when I won’t feel this way. This goes on every day for months. For years, even. I’d hope for an end to this, but I have given up on hope.

______________________________________________________

It’s a day when I’m hypomanic. I wake up early, not exactly refreshed, but with a more-than-usual alertness. I take my meds, then go downstairs and have a muffin and a container of yogurt for breakfast.

I go to my computer and start writing. I may have an assignment – typing or ghostwriting – or I may just work on new blog posts. The momentum of writing stays with me and presses me to keep going. I write lots, but badly. Maybe I forge ahead and write another blog post or volunteer for more typing. I forget that I need lunch.

I jump around from project to project. I scroll and scroll through Facebook. I check my email every few minutes. I go to clothing websites and order underwear and pajamas and blouses. I look at jewelry, too. I check my bank account at least four times.

I don’t read, because nothing holds my attention. I watch competition shows because of the excitement. I try to listen to music, but I can’t finish one song without flipping to another.

I may notice that I’m hypomanic and try to control it. This goes on for a week or so. I hope it ends soon.

______________________________________________________________

It’s a day when I’m stable. I wake up after nine hours of sleep and take my meds. I have a bowl of oatmeal and a cup of tea for breakfast. I check my calendar and see what I have scheduled for the next few days, such as an appointment with my therapist or finishing my writing or typing assignment. I have peanut butter and fruit for lunch.

I do my work. I reread what I wrote when I was hypomanic and immediately start revising it – if I haven’t already submitted it. I take on new assignments and try to space them out so they’re not overwhelming. Sometimes I even succeed. I keep a calendar on my computer with dates of appointments for both me and my husband, when assignments are due and when bills need to be paid, and which week is recycling week.

I meet with my therapist once a month via video chat and see my psychiatrist four times a year for medication updates. The only time I miss one of those is when my car is at the mechanic.

I’m very close to “normal.” I hope this goes on forever.

This post first appeared on The Mighty.

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The Difference a Diagnosis Makes

I thought I had depression and that’s what I was first diagnosed with. Later, I learned that I really had bipolar disorder, type 2, with an anxiety disorder on top of it. Here’s what I learned on my journey to a proper diagnosis.

Understanding. Once I was diagnosed with bipolar disorder, a lot of things from my life started making more sense. I finally realized that some of the inane things I thought and did as a child/teen were attributable to hypomania. Being idiotically happy when I won a goldfish at a carnival, carrying it before me, grinning like a loon. Near-constant mirth when I read a novel parody, laughing long and loudly every time someone used a word or phrase that reminded me of it. Luckily, I didn’t have any money to spend, or I would have done that too, based on my later behavior. Even things I did as an adult before my proper diagnosis made more sense – flight of ideas, pressured speech, and the like.

Second opinion. Going to a different psychiatrist and finally getting the right diagnosis was, in many ways, like getting a second opinion. We don’t often hesitate to get a second opinion on matters concerning our physical health (and insurance companies may require it). Why is it different when it comes to our mental health? I’m not saying that doctor-shopping is a good idea or that a diagnosis of depression did me no good at all. It just took a different psychiatrist to put together all my symptoms in a way that made sense to me as well as to him.

The “Aha Moment.” When I got my bipolar diagnosis, it was like a wake-up call. I instantly understood that my psychiatrist was right. Once I had that insight, I was able to explore my actual disorder in various ways – further sessions with him and with my psychotherapist, reading books and reliable online sources, sharing with other people who have the same diagnosis and listening to their experiences.

Getting the right meds. I had been taking medications for depression for many years. Then I learned that I might – did – need treatment with anti-anxiety medications, mood levelers, and other kinds of drugs that specifically targeted bipolar symptoms. I still needed meds for depression, but I needed a “cocktail” of drugs that addressed all my difficulties, not just one.

Going on maintenance meds. The process of settling on that cocktail of meds took a long and difficult time, but once I had the right diagnosis and the right meds, I was able to cut back to seeing a psychiatrist four times a year to get renewals on my “maintenance” medications. The process that stabilized me also allowed me and my doctor to make “tweaks” to the dosages to correspond with increased or lessened symptoms.

A new revelation. My learning about my disorder didn’t stop with my new diagnosis. Recently I learned that my depression could be what is called “dysthymia,” a type of depression that is roughly equivalent to the difference between mania and hypomania in bipolar 2. I wasn’t sure this applied to me, as my depressive episodes seemed long enough and severe enough to be considered major depression, but after consulting my therapist and other reliable sources, I began to see how a dysthymia diagnosis actually did correspond to my symptoms.

Having hope. The most important thing that the right diagnosis gave me was hope. Properly understanding my disorder and the correct treatments for it allowed me to hope that I could achieve stability and healing from all the years when I didn’t realize I was suffering from hypomania as well as depression. I could at last look forward to a life where my disorder didn’t control me. With help from my psychiatrist and the medications he prescribed, I have been able to live a contented and productive life. Work, stable relationships, and the other benefits of having proper treatment are achievable – and I have largely achieved my goals in life.

And my new diagnosis has been responsible for it.

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Releasing Old Ghosts

I don’t know what the proper term is (exorcise? banish? reject?), probably because I don’t believe in ghosts. What I do believe in are memories – persons and situations that haunt you, follow you, and inhabit your dreams.

I’ve had my share, especially of the dreams sort.

When I first got out of a truly destructive relationship, I was undiagnosed with bipolar disorder, medicated with valium (prescribed for temporomandibular joint syndrome) and self-medicated with wine. I was not in good shape.

For a long while, anything associated with that harrowing relationship, I shunned. Rex had like blue spruce trees. I avoided them. He had collected cobalt blue glassware. I could barely stand to look at them. He gave me heart-shaped boxes as gifts. I threw away every one I had, even the ones that were actually pretty and useful. He shamed me for my cooking. I gave it up. I gave up things I enjoyed, things that had been part of me. And I didn’t allow myself to explore things that Rex once loved.

He haunted me. I would have dreams in which I was going to meet him, where I was in a place I knew he might show up. I dreamed I was in his house, with cheerful parties going on around me as I panicked. I would have flashbacks to cruel things he had said, such as an obscene song he had written “in my honor.” Times when he said I had “betrayed his honor” for something as simple as cooking the wrong dish for a gathering. Plenty of others.

Now, it seems, the dreams have faded. I have reclaimed parts of my life I used to enjoy. I have banished things that were only his obsessions. The flashbacks are nearly gone.

What has helped me banish these destructive ghosts?

Time, of course, though you’d be surprised how many years it took. And it was gradual. He didn’t vanish from my brain like a puff of smoke. At times I still remembered music in particular – festivals and concerts we had been to together, the obscene song. (As I write this, they come bubbling up again.)

People. A few even from the time that the relationship was going on, who have helped me realize that I should not have been there, that I should not have gone through what I did, that I should have left sooner. I treasure these people. They saw me at my worst, knew me as I was recovering, and are still my friends today.

Other people – friends I had from long before Rex – have steadfastly remained in or reappeared in my life. I may have been bipolar and undiagnosed when I knew them, but these people stood by me, put up with my mood swings and odd behaviors. They have been part of my support system. And new friends, who have no association with those times, but who have had similar feelings and experiences.

Psychiatrists and therapists – also important parts of my support system for all these years. Ones who diagnosed my illness and medicated me properly so that I could deal with the issues that remained. Ones who helped me realize that I had some good memories from those times, that I could rebuild myself by retaining anything that I liked, that I had tools and techniques that I could develop and use to help me do that. I had done bargello needlework for Rex. I switched to cross-stitch. He called the kind of music I liked shit. I delved even further into it, reveled in it. Having developed a love of cats when I lived with him, I’ve never been without one again.

Love. One of the people I met during the next-to-last weekend of my time with Rex is now my husband. He has been with me through the dreams, the flashbacks, and the memories and has been the mainstay of my support system. And there are other people I love, and who have loved me back.

It seems strange that I was with Rex only a little over a year and it has taken me decades to work to this point where the memories have faded, the ghosts no longer haunt me, when it all seems like simply a bad time that has receded into, if not oblivion, at least only a clog that has slowly been removed from my psychological plumbing.

Now I know the right word. It’s time to flush those ghosts that plug up our mental and emotional systems.

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When Depression Doesn’t Go Away

Back in the day, I suffered from treatment-resistant depression. (This was likely due to the fact that what I had was actually bipolar 2, but never mind that for now.) My psychiatrist prescribed me medication after medication, but none of them worked, or at least not for long. We got into a seemingly endless spiral of trying one drug, adding another, weaning me off one drug and ramping up another, then another and another.

Some of them just plain didn’t work. Others had intolerable side effects, from vivid horrible nightmares to making me feel like I was about to jump out of my skin.

All this went on for certainly months – maybe years. (Memory problems were one of the many intolerable side effects.)

Eventually, my doctor reached the correct diagnosis, and then there were months of trying medications that were targeted for bipolar disorder instead of plain depression with anxiety. Again, nothing worked, or didn’t work adequately.

Nowadays, there are non-pharmaceutical methods of coping with treatment-resistant depression, including ECT (better known as electroshock), TMS (transcranial magnetic stimulation), and ketamine treatment.

I never had any of these treatments, since my psychiatrist and I finally worked out a drug combo that brought me back to balance, with only minor tweaks in dosage over the years. Nonetheless, I’ve become interested in the alternate means of dealing with treatment-resistant depression, and here’s what I now know. (If you want a patient’s own experience with ECT, TMS, and ketamine treatment, look up Kitty Dukakis or read some of the Bloggess’s posts.)

ECT, or electroconvulsive therapy, is what used to be known as shock treatment. For a long time it went the way of prefrontal lobotomy, stigmatized as a cruel and harmful procedure. The portrayal of ECT in Ken Kesey’s novel One Flew Over the Cuckoo’s Nest and then the movie of the same name were major influences in terrifying the general public, leading to a nearly complete disavowal of its use.

It’s making a comeback, though. The theory behind it is that electric stimulation of the brain will shock the brain back into normal functioning. The American Psychiatric Association notes that it is now performed under anesthesia, with medical personnel attending the procedure. They report improvement in 80% of patients.

(ECT is the alternative treatment that I was ready to try when none of the drugs prescribed for me proved effective. Then my doctor wanted to try one last drug, and that was the one that did the trick.)

TMS, or transcranial magnetic simulation, is described by the Mayo Clinic as “a noninvasive procedure that uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.” It’s also called rTMS, or Repetitive Transcranial Magnetic Stimulation, because more than one treatment is generally needed. The theory is that the magnetic pulses stimulate areas of the brain involved with mood control and depression. It doesn’t cause seizures or require anesthesia. The exact mechanism of how it works isn’t really understood, but that’s true of many other treatments for depression, including medications.

Harvard’s Health Blog reports that rTMS helps about 50% to 60% of people who did not respond to drug treatment “experience a clinically meaningful response.” They do note that treatments, “while encouraging, are not permanent,” which is true of many other forms of treatment.

Ketamine is the newest of the treatments for treatment-resistant depression. Ketamine was once known as a “party drug” called “Special K,” described by the DEA as “a short-acting anesthetic with hallucinogenic effects.” As a treatment for depression, however, it is thought to “enable brain connections to regrow,” according to scientists at Yale. The American Association of Nurse Anesthetists notes that ketamine “is not a first-line therapy for psychiatric disorders,” but then, neither are ECT and TMS.

Ketamine can be administered via nasal spray, but for psychiatric purposes (including to treat bipolar disorder and PTSD) it is often given as a series of infusions. An article in The Lancet says that “Ketamine is thought to act by blocking … receptors in the brain.” Another article by doctors at the National Institutes of Health comments that ketamine “has a robust and rapid effect on depression, which was seen immediately after the administration of ketamine and sustained at the end of 1 month.” Repeated treatments are generally necessary.

I don’t know about other patients and doctors, but after years of drug therapy not working, I was ready to give almost anything a try. ECT was next on the list, and the only likely alternative, as TMS and ketamine were not available at that time. I’m just glad that now patients and their doctors have more options when depression resists drug treatment and “talk therapy.” And I hope that even more alternatives become available for people with depression who are desperate to find a treatment that works for them.

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Manicky June, Anxious July, Overwhelmed August

Once upon a time, when I was diagnosed with unipolar depression, I wished I had bipolar disorder so that at least I could get things done when I was manic. Then I met someone with bipolar disorder and learned how foolish that wish was. Her manic phase led her to begin projects she would never finish, make loud, inappropriate jokes, and have difficulty with social interactions.

I have bipolar 2, and am fairly well controlled on medication, so I don’t get hypomania often, and when I do, it doesn’t usually last very long. Last month, however, I had a manicky time, and the results of it will affect me for several months. In June I also started on a new medication – though one for my physical health, not my mental health. My primary care physician doubled my dose of thyroid supplement. It had an almost immediate effect. After about a week, I became stronger, steadier, in less pain, and – oh yes, – rather manic.

I tend to have the rapid cycling version of my disorder, so when I do get hypomanic, it seldom lasts more than a few days. This time, however, I have had a longer time to experience the hypomania in a way I can’t remember having had before.

Some good things happened and some bad things happened. I got tickets to two live music events that I desperately wanted to see, one in August and one in September. We went out to eat at least twice. I made appointments for tattoos for both myself and my husband, both also in August. I booked us for a weekend getaway vacation in August. I bought myself a pair of earrings to replace ones I had lost.

In other words, I spent a lot of money.

Then July came and I don’t know if we will have enough money to get through it all. I snapped out of the hypomania and reverted to anxiety, which is how my depression often expresses itself. I paid the major bills during the first week. I put us on a strict budget for groceries. I put a little money aside so that I could possibly get a t-shirt at one of the concerts. I determined that the tattoo studio takes credit cards. (I don’t really want to take this option, but if we run out of cash, I may have to.)

Money worries are among my triggers for anxiety and depression, along with thunderstorms, overscheduling, noise, and too many people. When August comes, I will certainly need the bed-and-breakfast getaway, because my nerves will by then be frazzled.

The real question, though, is will I have enough energy to enjoy all the plans I have made for August?

A friend, who goes to DisneyWorld fairly often, learned that he should not do what he calls the “Bataan Fun March,” trying to cram every possible attraction and experience into a single visit. Now he prefers a more leisurely Disney experience, visiting a few of his old favorites and a few new attractions, while leaving time for relaxed dining and time in the pool.

This would probably have been a better approach for me to apply to August. A few events then, a few in September.

It would be convenient if my hypomania returned in August, to allow me to do all the fun things I have committed to. But as we know, bipolar disorder is an unpredictable beast. In the past, I have missed concerts that I had no more spoons for. I have rescheduled appointments that I wasn’t physically or psychologically in any shape to attend. (Most of these were appointments with my therapist, who sometimes agreed to a phone session instead.)

But these commitments are ones that I can’t phone in. All of them require my actual, physical presence. I don’t want to cancel any of them, some I can’t cancel at all, and I can’t phone in any of them. My best hope is that my symptoms will allow me to both attend and enjoy, if that’s possible.

Maybe the new pep I am experiencing from the thyroid meds will help. It does seem to help regulate my moods a bit, as well as affecting my body. Maybe it will allow me to have more spoons for August. Maybe in September I can decompress. Maybe in October, I will be back somewhere near level ground.

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On the Mind and the Body

The mind and the body are inseparable, part of the same organism. You can’t have one without the other. And each affects the way the other works.

Triggers are a good example. You see (or read) or hear or smell or touch something that unlocks an emotion in your brain. You then have a visceral reaction to that feeling – sweating, shaking, nausea, panic flight, or another physical manifestation.

These reactions are most commonly seen in severe PTSD and trauma related to abuse, but they can happen in less severe circumstances as well. Even something as seemingly innocent as tickling can put the brain in command of a bodily sensation. For example, once I was tickled to the point of pain, with the other person refusing to stop when I pleaded for him to. Ever since, my reaction to tickling is both physical and mental. My brain tells my body to shut down the physical sensation of touch. That may seem – and is – comparatively mild, and I don’t want to diminish the experiences of people suffering with PTSD and reactions to trauma. But it shows how my body and brain interact, almost in a feedback loop.

In circumstances like these, the body signals the brain and the brain tells the body how to react. It’s not like a person can choose whether to be traumatized or not by a trigger. The brain takes over.

Lately, I’ve been facing a fairly deep depression and have faced a lot of things that are triggers for me – financial problems, relationship troubles, overwork, etc. I’ve been feeling the bodily lethargy, exhaustion, psychic numbness, and neurasthenia that come with depression. These certainly affect my body, making me twitchy and nervous and unable to sleep (or to sleep too much), or unwilling or unable to face the world outside, some of the more noted hallmarks of depression and anxiety.

But after a recent visit to my primary care physician, I began to wonder if my body was influencing my brain in a rather direct way. Of course, before I got to see the physician, I had to fill out the depression screener, and as usual, I underplayed my symptoms by a bit. After all, I’m already under a psychotherapist’s and a psychiatrist’s care for it. It’s to be expected if I don’t present as all cheery and “normal.”

After chatting with the doctor about my symptoms (most, I thought, related to growing older), he ordered a bunch of tests for me. I’m to have a mammogram, a ColoGuard test, a bone scan to check my bone density, and had a whole bunch of blood tests.

The mammogram and bone scan I’ve scheduled, though they couldn’t work me in until September. (Evidently there is a lot of pent-up demand for hospital-based testing, as the hospitals weren’t doing non-elective stuff during the pandemic.)

Then the results started coming in. White and red blood cells, okay. Liver function, okay. Glucose and triglycerides, okay. Nearly everything within parameters.

I say “nearly” because I got a call from the doctor’s office saying that he wanted to double my thyroid medication. I had been taking a small amount, but now he figured I needed more.

I looked up the symptoms of hypothyroidism on the Mayo Clinic website, which seems trustworthy. They noted that that the condition may be attributed by the patient to growing older. I definitely noticed those: sensitivity to cold, muscle weakness or aches, and joint pain, all of which I feel.

Then there were other symptoms, which I had attributed either to my psychiatric diagnosis (bipolar II) or to the medications I take for it: fatigue, weight gain, thinning hair, impaired memory, and the biggie – depression.

Between the two sets of symptoms, I could see that the doctor had good reason to suspect my thyroid was out of whack and to prescribe an increased dose of the medication. I am now taking the higher dose and waiting to see what happens.

But it struck me: Maybe my symptoms were a combination of bipolar disorder and thyroid hormone deficiency. Maybe my body was trying to tell me something – that not all the symptoms I feel were caused by my glitchy brain. Maybe some of them were caused by my glitchy thyroid.

I have not been taking the new dosage long enough to see any effects, but I have hope. Perhaps, if and when the new dose kicks in, I will feel less of the lethargy, hopelessness, and other attributes of bipolar disorder.

Maybe my brain and my body have conspired to make me feel the way that I do. Maybe there is some relief to be had from treating my body with hormones, rather than just my brain with psychotropics. Maybe I’m not spiraling down into depression as thoroughly as I thought I was. Maybe a little tweak in my medication will help me to feel better.

Maybe if my body problems get worked out, my brain problems will not assert themselves so aggressively.

It is devoutly to be hoped.

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Functioning While Bipolar

Bipolar disorder is a funny thing. Mine leaves me alone part of the time. Until it doesn’t.

I have had full-blown depressive episodes, with the sobbing and the immobility and the wretchedness and everything else associated with it. I have had one major episode that lasted for three years straight, plus everything else from minor breakdowns to that vague, lingering miasma that comes when you’re untreated and you don’t know that what is really happening to you is clinical depression.

I have also had full-blown anxiety attacks, the sort that leave you twitching all over, feeling like you’re about to jump out of your skin, gasping for breath, and imagining that every driver on the road is swerving into your lane. I’ve twitched and shaken and stammered. I’ve scratched myself. I’ve hidden under the covers until I can’t breathe. I’ve taken anti-anxiety meds that did nothing at all.

Right now I am sufficiently medicated and have been relatively stable long enough that I think what I have is functional depression or maybe high-functioning depression, or whatever you want to call it. I have enough wherewithal to work part-time from home, do other writing-related projects (like this blog and my other one), and do assorted tasks like paying bills and making business-related phone calls. (Occasionally, if the phone tree is lengthy enough and the person on the other end is uncooperative enough, I have a small-scale meltdown. My voice goes up in pitch and tears start rolling down my face. My husband takes over the transaction when he notices that.)

But secretly, I know depression is lurking and can rear its ugly head again with little or no provocation – a trigger or nothing at all. So can anxiety, which is how my brain usually responds to hypomania. It’s a little like those commercials for psychotropic meds you see on TV, where the person has a little sign with a smiley face and hides behind it. Except that’s not quite accurate.

I understand that high-functioning depression is also called “smiling depression.” That’s not my experience of it. I’ve almost never been able to “fake it till I make it,” slapping on a happy expression when inside I’m dying. Besides, it doesn’t work, as far as I can tell. The depression or the sorrow always leaks out around the eyes. I’ve seen this in myself and in other people.

Before I was treated, I used to have what you’d call “resting sad face.” Once a boss of mine encouraged me to smile more (and is there anything more annoying?). I didn’t feel particularly sad at that moment, though I’m sure that I had at least a low-grade depression, like a low-grade fever. But I was at my job, and functioning even then, if not very well or cheerfully.

The phrase “high-functioning” gets used a lot to describe certain varieties of autism. I don’t have autism and I’m not an expert on it, but my suspicion is that high-functioning depression is similar in some ways. I don’t always react the way other people expect me to. I feel out of my depth a lot, especially in environments with lots of people or lots of noise. But that doesn’t stop me – or lots of other people – from carrying on with what I need to do to be a functioning member of the populace.

But back to bipolar disorder. Even if someone seems to be “high-functioning” doesn’t mean he won’t have a meltdown sooner or later. Even someone who “slaps on a smile” may let it drop once she is alone. Even someone who is “coping well” may not be coping at all tomorrow or next week or next year. Sometimes you can’t tell on the surface what someone is going through inside. Like I said, bipolar disorder is a funny thing.

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How Depression Sneaks Up

I had a blog post all written and ready to go. It was about my fluctuating moods and my writing, and how they affected each other. Some of what I wrote is still true. The depression I suffered during my early years and the exceedingly depressive poetry I wrote during that time allowed me to learn something about how poetry works and something more about how depression works.

I wrote about how hypomania affects my writing, and that is still true. Hypomania pushes me to do my writing, even when I don’t feel like it. In fact, at times it pushes me into doing more writing than I can probably handle. Case in point: This week I wrote three samples for a work-for-hire outfit when I should have been writing or at least outlining my WIP (Work In Progress), a sequel to the mystery I have already written and have been sending around to agents.

And last night, that’s where I hit the wall. I figured out that I have sent out about 180 or so query letters and gotten only the most minimal results – rejections that said I had an interesting premise that was not right for them. Most, though, have received plain rejections or the dreaded “no response means no.” I am now second-guessing myself and everything about the manuscript.

Last night, the depression caved in on me. I spent the night in bed, not sleeping except for nightmares, and not wanting to get up in the morning.

Because my identity is invested in being a writer, though, I did get up (late), sent a few more queries, and got to work on rewriting my blog posts, which I had determined were wretched. In the blog post that I abandoned, I had pontificated about how keeping a schedule kept me going with all the writing projects and various other work I do. 

I had also crowed about my relative stability and how that was helping me keep that schedule, which was supposed to be keeping depression at bay. I found out that I lied. The fact that I have maintained functionality for some time did absolutely nothing to prevent the depression that hit me.

Admittedly, this is probably a reactive depression, with my lack of success being the trigger. The thing is, it’s awfully difficult to tell apart from endogenous depression. In fact, I have known the first to melt into the second. At first you have a clear cause that would depress anyone, then you find it clinging to you long after what would seem to be reasonable. (This is subjective, of course. What is the “right” length of time to be depressed over 180 rejections?)

What’s left? Self-care, of course. Trying to sleep if I can, and squeezing in a nap if possible. Eat something, even if it’s only some guacamole and chips or a bowl of soup. Take my meds religiously. Try to cling to that schedule even when I don’t want to.

But the truth is, I’m running out of agents to submit to. I’m running out of energy to try. And I’m running out of the frame of mind to keep me functional. I’ll be okay, I know, but it may be a long, hard climb. 

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