Tag Archives: Rapid Cycling

A Not So Tough Pill to Swallow

Treatment for Bipolar Disorder is based on a menu of medications.  They Are a diverse group from Lithium, antieliptics, antianxiety to antipsychotics.  Depending on where you lie in the spectrum of your disorder, the med menu will change.  You may be challenged with having to take a polypharmacy and manage the side effects of many pills or be on monotherapy and contend with much fewer side effects.   I am one of the lucky ones because monotherapy has been successful for me.

My treatment was determined by the bipolar symptoms I told my psychiatrist.  This is very difficult because, in my first visit, I could not remember all the key things to tell my doctor.  I did display some pressurized speech so that was a clue that I was in acute mania…again.  But this was my first visit so it was not definitive.  Maybe I was a chatty person.  The doctor did not know.  Determining your mental illness is similar to a treasure hunt. The psychiatrist discusses  your behaviors, looking for bipolar indicators, and determining where you exist in the spectrum.  Do I exist in the spectrum? Or does the spectrum exist as a sliver in me?  We only had one hour to figure this out because one thing was for certain-I was in an episode of some sort.  I sat in the doctor’s office laughing, hyperactive, and certainly mentally ill.  There, I said it…mentally ill.  My initial diagnosis was Bipolar Disorder II but later on it changed to Bipolar Disorder I.

Did I behave a certain way because I was tired, stressed, anxious or because I was in a bipolar episode?  Some behaviors are evident such as manic and depressed behavior, but they have to be witnessed by a medical team in an inpatient setting to be certain; otherwise, they are considered subjective.  In the beginning, my mental health picture had not formed.  So you start with the moving target, and if you do not get it right, you start a “chance” of a med.  The next time, you now have to explain to your doctor why you behaved a certain way but on a psychiatric med.  Layers start to form from the side effects.

Once you are prescribed your med, the waiting game of seeing which side effect will occur begins. Do you need another med to counter a side effect? You have to wait and see if the new med stops mania or if it pushes you into mania.  Bipolar Disorder is push and pull of your mind. You can stabilize, but now you have to be on the look out for break through episodes of mania indicating the med did not work. All this while you are living your daily life, interacting with loved ones, and trying to keep your career from imploding. Exploding. Side winding.  The name of the game is to hang on while snowboarding an avalanche.  Hang on. With your eyes open.  Hang on.

Treatment is not a sure bet in the beginning which caused me great unease.  Some people in our community are treatment resistant which means the menu of meds does not treat the disorder.  Mentally, I was not prepared for the reality of psychiatric meds because of the uncertainty but more importantly, I had this idea that meds were my last resort.  What if they did not work?  I still had a long life ahead of me.  Initially,  I thought I would need them in my twilight years.  Just in case,  you know?  Because now, I am strong, young, and could handle this through pure willpower, but I was oh so wrong.  I since learned that this thinking is backwards.  In order to not be the crazy later on, I have to be on a med plan now.

The uncertainty of it all was disconcerting. I wanted to hold on to something that was a sure thing because I could no longer hang on to my foundation since it was crumbling.  Cracks a mile long were forming.  Mentally,  I was hanging on a cliff and could feel my fingers slipping.  Just hang on.  I wanted certainty.   For instance, I know I can take an aspirin for a headache, and the headache goes away. There is a definite cause effect that can be experienced.  When I realized that my med was not a sure bet, I became scared and opted out the first time.  I was not ready to contend with the “possibilities” of “might” getting well or more worrisome that my med would not work. I stopped Lithium cold, and two months later succumbed to another manic episode.  This one was fast and furious.  I remember each one sort of. There was the one in Salinas, which was a drug and alcohol fueled binge; the second one was a flashback of Iraq and my first psychotic episode; and the third one I call Utah, which was my second psychotic episode. I am a rapid cycler and like clock work, I experienced my third episode in nine months.

During Utah, I called my doctor and well..I was in Utah and refused to voluntarily admit myself to an Emergency Room so my treatment could not start until I returned home.  I have a short story on Utah called, “The Poop Story and Other Tales of Love.”  The good thing about Utah was that I displayed very distinct bipolar behaviors such as psychosis that gave us the ammunition to pick a more precise med. Initially, I was on Lithium, and although this is known as the gold standard, it was not for me.  I felt…like…the sound you make when you place your tongue on the roof of your mouth and click it.  That sound.  For me, that sound was how Lithium felt on my mind.  After I made the click sound with my tongue my doctor asked, “You mean you feel blunted?” Her training and experience was good because that was the word for it. Blunted.  For me, blunted is the sound of your tongue clicking off the roof of your mouth.  After this episode, my diagnosis changed from Bipolar Disorder II to Bipolar Disorder I with Psychotic Features.

I was prescribed an antipsychotic that has worked well for me. Up until today,  I have been in denial and embarrassed that I have to take an antipsychotic.  It is the word is it not?  A med that clearly states that I can become psychotic.  This is a tough pill to swallow.  However, the antipsychotic is helping me by allowing me to be mentally free.  It keeps me somewhat in hypomania which is where I want to be.  I am more of my creative self then mania ever allowed me to be.  My med also helps me manage my daily stressors, which I am not so good at anymore.  Stressors mentally fatigue me in ways I never could imagine.  I am on a new path in my journey. It use to be that I was a “mental mountain.” Now, I need help.  Even though I am managing my disorder, my core being is changing.  It has to change I think.  Not so much outwardly that people might notice right away. Certainly, your thoughts change; therefore, be and then become happens.  You become a new normal.

The good thing about meds is, when you get the right kind and dose, the effect isolates the mood disorder. This enables you to see the paths to managing a stable daily life.  You can separate from the disorder.  It helps you discern trigger effects on your mood and behavior.  Enables you to develop stress release actions and form crisis plans.  Also, they reduce the cycles of bipolar episodes and protect my beautiful, sweet brain, which I love so much.  Meds can be effective.  It is what I call my good, hard work.  My goal is to swallow this pill and stay of healthy mind, peaceful, and loving of heart.  For this, it is not such a tough pill to swallow.

 

 

Rattlesnake, Dreamer, Child, and King

BIPOLAR DISORDER

I suffered my third bipolar – mixed state episode in seven months this past week, and it was and still is painful. Mixed states are nasty and disgusting things to myself and those around me.  Those around me are usually the people I love the most.  I lash out when I feel uncertainty to my “self” and that means at those closest to me because well… they have a close proximity to me. They are there during the most intimate settings where my “self” is exposed.  Not if, when I go into mixed state condition, it will manifest itself in full force through me. My loved one’s presence and their reasoning with me perpetuate my mixed state. They reason with me because I look reasonable, but I’m not.  I’m paranoid, irrational, and delusional which are psychotic characteristics with mania.  I’ve been told it’s like being around a rattlesnake.

Bipolar presents in various ways.  The common understanding is that a bipolar person’s mood will swing from an elevated state to depression or vice versa and are separate from each other.  The least discussed and misunderstood state is known as a mixed state and considered the rattlesnake of the bipolar clan.

In mixed state, I become vicious and can verbally strike anyone near me that presents an uncertainty to my “self” if I am triggered by lack of routine, lack of sleep, alcohol, too many months in high level hypomania; and again, uncertainty to “self.”  Medical literature defines mixed state as elevated state and depression occurring at the same time.  The fact that it is close to simultaneous is hard to wrap your head around, but it is true.

The risk associated in this state is primarily to relationships.  You teach people to walk on egg shells around you. You are at risk of hurting yourself emotionally, spiritually, and physically. You are at risk of hurting others emotionally with words that do irreparable damage to your relationships.  The guilt and shame of the aftermath are overwhelming and cause you to experience a kind of shock.  It is never the same.  A more detrimental risk associated is the high risk for suicide.  When a person experiences mixed state, they are having intrusive dysphoric, maybe suicidal thoughts and now have the energy to take action.

My normal state is neutral to positive, full of appreciation for family and friends.  I’m funny.  I’ve been an overachiever most of my life and try to be a kind and loving person. However, I exist primarily in a hypomanic state which means I am hypomanic more than normal state.  It use to give me what is known as the hypomanic edge.  My hypomania without depression does not have intrusive thoughts.

HYPOMANIA

Low grade hypomania without depression is the dreamer of the clan.  I view life in merriment and wonder.  People and objects are effervescent and bright making everything more interesting.  I describe this as, “shiny.”  It makes life so wonderful.  There is very little self doubt involved, and when done right, it is an absolute positive freedom of the mind.  I am sexual. Racing thoughts do not occur during low grade.  The risk involved is similar to most who are enjoying life.  I consider risk but more outgoing than people without bipolar disorder; therefore, more exposed to doing risky things such as surfing or climbing. I’m “on.”

As hypomania increases it becomes middle grade hypomania without depression which is the child of the clan.  I become self-centered and try to empathize and be a good listener but because of my self-centeredness these qualities start to wane.  Good judgement starts to escape me. I become naive and gullible to the feelings and intentions of the adult world. I believe what I am told.  I just do.  My justification for my behavior and perceptions of disregarding adult ways is by believing the adult world is un-enchanted.  I happily skip around them full of mirth.  I am playful, flirtatious and more sexual. My ability to read social cues starts to loosen.  Racing thoughts rarely occur.  The risk to self increases because I am more outgoing and safety judgements are reduced. It is primarily about having fun, pushing it, and feeling exhilarated.  I find all things fully fascinating.   Ideas and problem solving skills seem to become enhanced.  When I’m hovering in this mood, I call those with bipolar disorder – primarily hypomanics,  “the cool kids.”

For me, high grade hypomania without depression is the philosopher King without a Kingdom of the clan. Now, I become interested in the un-enchanted adult world and want to change it through my wonderful ideas, philosophies and fearlessness.  During this phase, I lose filter, and say what I think people need to hear to help them.  Is she a helper, a lover, a parent, a friend, a controller, a sage, a leader, a caregiver? I am all these things. Still very self-centered and impatient because after all – I am the King.  My patience and filter decrease, and my opinions and actions are abrupt.  Flight of ideas occurs with the need to tell everyone my thoughts and pressurized speech picks up the pace.  My ability to read social cues diminishes greatly. I experience expansiveness and lose more control of my behavior, my emotions, my reactions.  My sexuality goes into overdrive.  The risk to “self” increases as I become grandiose and uncaring about safety. My senses change and things like food lose flavor.  My visual field seems larger and sharper.  I described it to a friend as “it feels like my eyes are open real big.”  My capability for complex understanding ideas and problem solving at work increases and I can work at a faster pace.  I call high grade hypomania without depression being “Amped.”

Hypomanic existence is all well and good because at its best, I’m fun and exciting to be with, and at its worst, I am grandiose and hard to follow.  Still, I am well intentioned. My perception of the world is skewed by positivity and grandiosity not negativity.

High grade hypomania is not to be confused with mania.  The line between high grade hypomania and full mania is very wide.  However, if depression sets in at this stage or is spurring it to occur then the line between the two becomes very thin and can vanish.

MIXED STATE

When the depression starts the hypomania stays and the two mix.  Depression mixed with hypomania attaches intrusive, almost constant doubts and dysphoric thoughts to my hypomanic energy which amplifies the depression.  The depression does not force me into isolation;  worse, I have the energy to interact with people.  It is here that the trouble begins for me and everyone who comes into contact with me.

The combined moods cause a mixed state which begins with irritability.  If lucky, just stays as such.  If in the wrong situation, depression can spur hypomania into full mania that can last one hour and enter acute mania for up to a week.  I’ve received medical intervention by my doctor before I experienced full mania.  Mania causes a disconnect from time and space until medication brings you out of the episode.

My risk to self greatly increases as the depression mixed with hypomania spurs it into mania; where, I experience paranoia and mild delusions of persecution and become unpredictable with my actions.  At this point, risk to self is significant because I am terrified and can make a sudden decision and/or movement out of defense of my “self” by using harsh language.  I have not been physical against anyone or myself.  I believe that I am hopeless and worthless and can scream it loudly in order to gain your sympathy, compassion and love. My mind turns on the “self.”  I stop sleeping and eating. For me, mania is a fully agitated, paranoid mixed state.  It is the image of the frenetic and paranoid person.

Low grade mixed state can be fraught with intrusive criticism of self and others and complaining. Mid grade mixed state can be fraught with alcohol, drug use, and sexual escapades.  High grade mixed state can involve a confrontational attitude, quick tempered arguing, paranoia and always the nasty verbal lash out to someone.  It can escalate to even worse-mania- with verbal abuse of loved one where irreparable damage to the self and relationship occurs.  My behavior is not always identifiable in such clear delineation and sequentially as provided, but it does normally happen this way–it is the rule for me at this point in my life.  The exception to the rule are the grey areas between low, medium and high that bring out many unpredictable behaviors.  When I start touching mania, the paranoia and delusions spur new types of thoughts and acting out.

All of my life, I could keep my hypomania in check with proper sleep, diet and exercise.  However, my depression has become greater and more frequent and mixing with hypomania because bipolar disorder is a progressive disorder.  Now, I require medication to prevent depression which stops mixed state and prevents me from going into mania and being hospitalized.

Depression hits in waves and then a Tsunami if I’m not carefully monitoring triggers.   Last week was the Tsunami, and it emotionally and spiritually pummeled me and the man I love.  He left me.  So here I am, Saturday afternoon on the beach making sense of it all. My bipolar episode occurred because I refused my medication. It was the worst decision because I hurt him.

CONCLUSION

Due to increased depressive mood states that caused mixed state,  I sought help from the mental health community and was clinically diagnosed in September 2015.  Now, I’m back on a medication treatment plan  in order to live a healthy and good life for myself and others.  My goal in life is to be lovable, and I know deep down inside I will be.  I’m going to live the life I deserve. All of it and with passion.