Bipolar 2 From Inside and Out

Posts tagged ‘depression’

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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Ratting Out Max

I knew Max and his wife Sheila for a long time. We went to large gatherings together. We all loved mysteries and fantasy books and swapped them back and forth. Max and I both studied martial arts and compared styles. Whenever I wrote an article for a martial arts magazine, he had me autograph it. When they moved to a big house in the country, I spent time there. We went antiquing. I got to know their children, some of whom are still my friends today.

When I was editing a magazine, both Max and Sheila wrote for me. Max sent me copy in envelopes addressed to Fearless, Crusading Editor and variations thereof. He called me a lot too, about the magazine or just to talk, back in the day before bosses monitored their employees’ phone calls quite so assiduously.

They weren’t just a couple to me. They were individual friends. And they trusted that I wouldn’t go running to the other if they told me personal things. I didn’t tell Sheila that Max had a financial reverse that he hadn’t told her about. I didn’t tell Max that Sheila had a medical issue she wasn’t ready to discuss. I figured such things were theirs to work out. And I didn’t tell Max that Sheila meant to divorce him on a certain date. Again, it seemed to me that it was not my place to be a go-between.

It wasn’t an amicable divorce. Max didn’t want a divorce at all. Sheila was adamant that she did. Max asked me to find articles on how bad divorce was for the kids and talk to Sheila. I never did. I didn’t feel it was my place.

Then one day Max called me. I knew it was going to be a serious, difficult conversation. In it, he expressed suicidal ideation. I tried all the things you’re supposed to do. I asked if he had eaten or slept recently. I encouraged him to do so. I asked if he could listen to the music he loved. I asked if he had talked to his psychiatrist or a religious counselor. I asked if he had a plan.

He did. There was a gun in the house.

And I ratted him out.

I knew the name of his therapist, and I called him. And I called Sheila, and I told her. I didn’t want her to come home from work and find his dead body.

Max forgave me for calling his therapist. He never forgave me for calling Sheila. I saw him in public a few times after that, and he was dismissive and rude. I didn’t try to maintain the connection after that.

I stayed close with Sheila for a while until she gave up on my depressive behavior, fearing that I might be suicidal, too. But that’s another story.

To this day, I miss Max’s presence in my life. I read a book or an article and think, “Max would like that.”

And to this day, I can’t feel regret for ratting him out. I feel I did what I had to for my friend. If the same situation arose today, I would do exactly the same, even though it meant losing my friend. At least he’s still alive.

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Mental Health

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Murder and Mental Illness

Murder is associated in the public mind with brain illnesses, particularly schizophrenia, bipolar disorder, and PTSD. David Hogg, anti-gun activist and mass shooting survivor has a lot to say about the topic: “If you believe it’s mental illness, call your reps and ask that they fund mental h[ealth] programs in our schools and communities. I don’t agree it’s mental illness that causes these shootings But we do need more funding for mental health programs to reduce the growing rate of suicide.”

Hogg has said that systemic poverty, race, and hatred are bigger motivators of mass shootings than mental illness. He also notes, “I do think it’s important to note the shooter at my high school had tons of mental health stuff. From my understanding, … there were school psychologists, there were therapists, there were all these different things involved. And I don’t think one more therapist would have made the difference for him. We need to put our politics aside, and get something done.”

The assassination attempt on former President Trump has stirred up the debate again. The assumption that mental illness is the cause of public acts of violence persists. The usual suspects include bullying, psychotropic medication, and social isolation. There have also been a lot of conspiracy theories and blame tossed around. It was Democrats. It was a “false flag” operation. It was staged. It was a foreign plot. The injury was minor. The injury almost took his life. (There may well be more I haven’t heard.)

I fully expect the mental illness hue and cry to start. In fact, it’s already begun. There have been reports that Thomas Crooks sought information on major depressive disorder and was bullied at school. (He was 20 years old when he fired at Trump. Apparently, he committed no violence while at school.) I stress that these are not facts. They have only been reported in the media and tempered by the term “allegedly.”

Personally, I don’t accept such reports at face value. Media reports in the aftermath of a shooting have so often turned out to be unwarranted, misguided, or premature. I prefer to wait for more reliable, less heated reporting that comes from official sources who have actual knowledge of the situation.

I will say that major depressive disorder is a disorder that leads to violence against oneself rather than others. Even if the Crooks did have it (not proven), it seems unlikely that it was a factor in the incident. Depression more often results in suicidal ideation or attempted or completed suicide than in homicide. That he might have been seeking “suicide by cop” is even more unsupported so far and probably unknowable.

It may be true that Crooks had a mental illness, but we don’t know that yet—if we ever will—and there are other possible explanations for his actions, including garden-variety hatred, violent extremism, and political motivation.

What I do think we know is that mental illness will once again be assumed to be the cause by both the public at large and the media. They may even find some psychological “experts” who never met Crooks and never treated him to expound on his diagnosis or motivation in media interviews. That’s usually the course these things follow. Lilliana Mason, a political scientist at Johns Hopkins University, said today, “It sounds like he was relatively isolated and troubled, sad and looking for attention.”

I also firmly believe that this incident will make no difference whatsoever in the debate on gun control. And if mental illness is the cause, it will be acknowledged as a Bad Thing but will not result in any initiative that would provide funding for better care of those with SMI. A massive tut-tut and a hearty shrug are about all I expect.

I’d love to be proved wrong.

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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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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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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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Structure in My Bipolar Days

I used to be a fly-by-the-seat-of-my-pants kind of gal. Work provided the only structure to my days, back when I was able to work in an office. It wasn’t always the same structure, depending on the job, of course. I have worked various shifts over the course of my checkered career—first, second, and third. I adjusted to them fairly well (except when I was working third shift and going to grad school in the mornings).

That all changed when I quit my last office job. I remember feeling so free. I basked in the ability to do freelance work whenever, run errands whenever, go to sleep and wake up whenever. Of course, I was hypomanic at the time, which I should have recognized because of the golden glow that seemed to envelop my days. Naturally, the crash came, along with the absence of freelance work to do. Then, when I fell into a deep depression, anything resembling a schedule fell apart. I didn’t have a specific time for going to bed or waking up, for eating, reading, errands including bill paying, and even showering. Without that structure, I had trouble finding a reason to get out of bed.

Now I’m stable on medication and therapy, and my days have fallen into more of a pattern. I still work at home, but for a company that gives me ghostwriting work. It has a built-in rhythm to it. Most of my assignments are 30,000 words long and due in 21 days. They want us writers to average 1,500 words a day. I divide that up into 750 words in the morning and 750 in the afternoon. I work weekends at this pace, too.

Fortunately, I find 1,500 words a day eminently doable. My daily schedule consists of mornings spent breakfasting, paying bills, keeping track of appointments, or making necessary phone calls (which is my usual role in running the household).

Then, mid-morning, my husband calls on his break from work. Part of the reason is to make sure I’m okay, but most of the time I’m fine and we simply talk, often about what I’ve scheduled for the rest of the week. (I keep track of his appointments and phone calls too. Sometimes I feel like I have a second job as Dan’s secretary.) After we talk, I begin my first stint of writing for the day, my first 750. I’m generally done in time to have lunch around 12:00. Dan calls again in the early afternoon, and I begin my second 750 afterward. When he gets home, we spend time together and have dinner around 7:00.

Those are my daily schedules, which I don’t really need a planner for. When it comes to weekly schedules, I do use a computer app. Our “weekend” is Sunday and Monday because of Dan’s work, but I work on my writing anyway. My calendar is filled with bills to pay by a certain date, appointments we each have to go to (which I remind Dan about), and notes indicating when my 30,000 words are due. I also make note of which weeks are for recycling. (The day before trash day, there’s frantic cleaning.) I have this and another blog that I post in on Sundays. I have a weekly internal schedule for that, too. I start writing them on Tuesdays, have them at least mostly finished on Fridays, tweak and tag them on Saturdays, and publish on Sunday mornings at 10:00.

Having these systems in place keeps me on an even keel which, after all, is my goal as a person with bipolar disorder. My days are predictable, but not boring because I don’t find writing boring, even if it’s on someone else’s topic. Does it seem too regimented? All I know is, it works for me.

This past week, I went on vacation, so for one week, my schedule was largely out the window. I looked forward to staying up late, sleeping late, having meals whenever we felt like it, spending time reading or shopping or sightseeing or watching movies whenever we wanted. Because, as much as I like my structure, I need a break from it at times. Sometimes I take a few days off between book assignments to work on other projects like organizing my jewelry armoire or my desk.

It’s a balancing act, really. Enough structure to keep me focused, but not so much that it becomes a rut. Dan’s phone calls help. Having time in the mornings and evenings before and after I write helps. And my most important routine, of course—taking my meds in the morning and at night. That’s a part of my day’s structure I never want to neglect.

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What Does Body Temp Tell You?

My husband and I have a dynamic that’s common to many couples. I’m always too cold and he’s always too warm. This becomes apparent at bedtime, when he has the window open and a fan on, and I’m wrapped up like a burrito in assorted quilts. When I ask how the weather is and he says it’s comfortable, I know I need to put on at least a sweater before we go out.

What does this have to do with mental health? Well, the stats on major depressive disorder are alarming, especially among teens and young adults. “This is particularly concerning as the disease course is most likely to be malignant, and the costs of depression in terms of lost opportunities across a lifetime are likely to be highest in youth and young adulthood,” note the authors of a recent study. They also suggest that current pharmacological treatments show “significant limitations in efficacy.” So the quest for better treatments is pressing.

That “TemPredict” study found that body temperature correlates with depression. The study involved more than 20,000 people from around the globe, so from that standpoint, it’s likely to be valid. Over approximately seven months, the participants wore a device that recorded their body temperature (an off-the-shelf Oura ring) once per minute via a smartphone app. They also kept daily subjective records of their body temperature and level of depression, so the data collected included that from the wearable sensors as well as self-reports.

“People with depression have higher body temperatures, suggesting there could be a mental health benefit to lowering the temperatures of those with the disorder, a new UC San Francisco-led study found,” according to UCSF. The study was reported in the journal Scientific Reports.

The results? People with depression have higher body temperatures than those without, particularly at night. This had been suggested by smaller studies, but the new one is much more comprehensive. Of course, the study couldn’t really say whether depression causes higher body temperatures or whether higher body temperatures cause depression. The authors caution that “although no single biological or behavioral abnormality will characterize all individuals with MDD [major depressive disorder], the identification of an abnormality associated with MDD may open the door” to new treatments.

The study’s authors also indicated that “it is uncertain whether the elevated body temperature observed in depression reflects increased metabolic heat production, decreased ability to induce thermoregulatory cooling, or a combination of both.” In other words, “depression [may be] tied to metabolic processes that generate extra heat perhaps, or tied to cooling biological functions that aren’t operating properly. Or there might be a common shared cause, such as mental stress or inflammation that impacts both body temperature and depressive symptoms separately.” So there are still aspects that need to be studied further.

What’s also interesting is that the study suggested that warming people up has a more cooling effect than directly cooling them with ice water, perhaps because of sweat’s cooling effect. At any rate, people who soak in hot tubs have a rebound factor that actually cools them off. (Personally, I wouldn’t mind if someone prescribed me a hot tub.)

The hope is that the results of the study will lead to new treatments for depression.

I don’t doubt the study’s findings. But anecdotally, my spells of depression tend to be deeper and longer than my husband’s, but my body temperature runs lower. Am I an outlier, a data point that falls outside the trend of the study? Oh, probably. I’ve never been much for fitting in with norms.

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Running Out of Meds

Isolated Empty Pill BottlesRunning out of your medications is scary.

I know. It’s happened to me several times.

Sometimes it was a matter of supply. My usual pharmacy ran out of a sleep aid and wasn’t going to get any more until after the weekend. Fortunately, they recommended a mom-and-pop pharmacy (yes, such things do still exist) just down the street and helped me transfer my prescription there.

Another time the problem was the prescription. I ran out of an anti-anxiety med, but when I called in for a refill, I was told that it wasn’t time for one. When I looked at the bottle more closely, I discovered that they had given me 60 pills, as if I were taking two a day, instead of the three a day actually prescribed. (I was changing doctors about that time and there was miscommunication.)

Yet another time, it was money. I ran out of an antipsychotic and was told that even with insurance, it would cost me $800 for a month’s supply because of the out-of-pocket required minimum. I spent a couple of days arguing with the insurance company, researching solutions online, and making sure a local pharmacy would take the coupon I found, which lowered the price to under $200. That was still a hefty chunk of our budget, but we managed to scrape it together until the drug went generic a couple of months later. (I also had to stand in line while the pharmacy called the coupon people and the insurance company to see how to enter it all in their system.)

And of course there are the everyday screw-ups. My husband forgot to pick up my scrips (one time he remembered to pick them up but left the bag in the car and drove 500 miles away), or he forgot which pharmacy they were at, or he didn’t hear me say that I was completely out, or the pharmacy didn’t open until 10:00, or they had my pills in two different bags and only gave us one. There are lots of ways it can happen.

Once I even took my entire supply on a weekend getaway and left them in a drawer at the bed-and-breakfast. I know. Stupid.

Most of the time running out of drugs isn’t a crisis. It just feels like one.

Of course, there are exceptions. It is a crisis if you run out of certain anti-anxiety drugs and you don’t get any for several days. You can have withdrawal – actual, physical as well as psychological withdrawal. I’ve heard that benzo withdrawal can be as bad as opiates. That’s one reason it’s important to replace your meds as soon as possible.

A lot of psychotropic medications build up to a therapeutic level in your bloodstream, so a day or two without them probably won’t even be noticeable. When you start taking them again, your levels will even out.

But even if the med you run out of is one that you can easily tolerate a day or two without, you may have some psychological effects. When I run out of a prescription, even for a short time, I become twitchy and agitated – my hypomania kicks in and comes out as anxiety, the way it usually does for me. I fear crashing back into that deadly unmedicated space where all is misery and despair. Intellectually, I know that likely won’t happen. But it sure feels like it will. This is one way my none-too-stable mind plays tricks on me.

It’s like the opposite of the placebo effect – believing that a sugar pill will help you and experiencing gains until you learn that the pill is fake. In my version, I believe that not taking the pill will cause relapse, even though it actually won’t.

Whatever else you feel or do, DO NOT use missing a couple of pills as an opportunity to go off your meds entirely. This is another lie your brain can tell you: “You’re doing fine without it. Why keep taking it?” It may not in the short term, but you will feel the effects of not taking your meds, and then there you are, back in the Pit of Despair or rocketing to the skies. It won’t be pretty.

For me and a lot of others like me, the key to effective medication is consistency. Once you find the right “cocktail,” stick with it. But if you run out, don’t panic. Keep Calm & Get a Refill.

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Christmas, Bipolar Style

This post will go live on Christmas Eve, and the holiday has been much on my mind of late. My reactions to the holiday aren’t necessarily what you will experience, but as a bipolar person, I wanted to share what depression and hypomania do to me during the holiday season.

Hypomania

I’ve tried the traditional giving of gifts on Christmas Day, but this year our gifts are all either pre- or post-holiday. Last year, I was hypomanic and overspent. I was disappointed, though, when my selections for my husband didn’t garner the response I thought they would. He still hasn’t used the camera I got him last year on the grounds that he didn’t have the time to figure it how to use it. (I’m going to suggest that one of his gifts to me will be to learn its workings.)

This year, I’m slightly less hypomanic. We got a present for both of us, a little early. We got matching heart, lock, and key tattoos. Since the tattoo shop is closed on Christmas and the tattoo artist is much in demand, we booked the appointment early and have already had these done. I’ve bought Dan another item or two on sale—oven mitts and a bathrobe—that I’m telling myself aren’t really presents, just things he needs, so he doesn’t have to get more presents for me. I honestly don’t mind if he doesn’t get me anything else. He gives me little gifts all year long—just things he finds at the store he works at that he thinks I’ll like.

This year I’m working at home, and I plan to work on Christmas Day, at least for a few hours. Realistically, I could take the day off and not risk missing my deadline, but the routine of working helps keep me centered. I have been exploring what local restaurants are open on Christmas Day so we don’t have to cook. For New Year’s Eve and Day, we actually have a tradition—champagne and appetizers on the Eve and Chinese Buffet on the Day. We often ask friends to join us for that.

Depression

I don’t think I’ll be too depressed to go out New Year’s Day, but then again, who knows? Dan has invited friends from work, so there will be people there I don’t know, as well as two that I do. I don’t really feel up to small talk these days, so Dan can handle that with his work friends.

I’ve given up trying to get into the “Christmas spirit” by dressing for the occasion. It never works for me. I’ve had Christmas earrings. One year I had a Grinch t-shirt. I once worked at a place where everyone wore holiday sweaters and sweatshirts. I didn’t have any and felt left out, but I didn’t want to pay the prices for the sweaters. After the holiday, I bought a couple on sale for the next year’s festivities, but I lost the job before I had an opportunity to use them. Oh, well.

My Lack of Advice

I know there are a lot of articles this time of year giving advice on how to deal with the holidays while in a shaky mental state. I’m not going to do that, because you already know all the standard advice—self-care—and I have nothing really insightful to add to it.

Except that it’s okay to have your own traditions or to ignore the holidays altogether if they’re just too much for you. If you’re alone, you could be subject to depression or just feeling numb, but that’s a natural reaction if you’re like me. Scale down your celebrations to suit yourself. If you’re experiencing anxiety, you can skip big celebrations and have your own small—or private—one. If you’re hypomanic, you may be up to some festivities, but you don’t have to be the life of the party at every one. And keep track of your spending. Most people prefer to get only one or two thoughtful presents rather than a flood of random ones.

I don’t wish you Happy Holidays, just survivable ones.

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Mental Health

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