Recently I've had to come to terms with something quite disturbing. For a few years I've had the word "bipolar" thrown at me, including by my own mother. As one of my best friends is bipolar herself and said I was exhibiting classic symptoms, I was rather sceptical and thought it was simple transference of symptoms, which is quite common to do. I wondered if I was doing the same with Richard when I said I really thought he had depression.
My personal idea of bipolar was someone who had frequently changing moods of great strength. I knew my moods could change but always put it down to hormones, general crap happening and lack of effectiveness of medication. Being told yesterday that I have sudden mood changes which I can't even remember happening... That scared the hell out of me. I'm a bit more clued up on bipolar now, but for those who aren't, here's the Wiki definition:
Bipolar disorder or manic–depressive disorder (also referred to a bipolarism or manic depression) is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated mood clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes or symptoms, or mixed episodes in which features of both mania and depression are present at the same time. These episodes are usually separated by periods of "normal" mood, but in some individuals, depression and mania may rapidly alternate, known as rapid cycling.
Seems the rapid cycling is what I'm getting. I was also informed by Jenny (one of my counsellors) on Monday that taking anti depressants when having bipolar disorder can make you a lot worse. That explains why prozac always made me feel worse! When I was first diagnosed, I only spoke about my lows, especially as I was having a low day.
The onset of full symptoms generally occurs in late adolescence or young adulthood. Diagnosis is based on the person's self-reported experiences, as well as observed behavior. Episodes of abnormality are associated with distress and disruption, and an elevated risk of suicide, especially during depressive episodes. In some cases it can be a devastating long-lasting disorder; in others it has also been associated with creativity, goal striving and positive achievements
I kinda already knew that bipolar disorder comes on around my time of life. From a more laid back attitude, I can see now that it really is hereditary in my family. I first started trying to kill myself when I was 15. you'd have thought that in ten years I'd have got it right by now :P My lows do cause me to write more... My best musical compositions were written when I was on a low. I try to take that as a positive. It doesn't mean I like being this way, but if I can turn a weakness into a strength, then I see that as a great achievement. It's comforting to know that it's not a forever state and can be treated.
Bipolar disorder can appear to be unipolar depression. Diagnosing bipolar disorder is often difficult, even for mental health professionals. What distinguishes bipolar disorder from unipolar depression is that the affected person experiences states of mania and depression. Often bipolar is inconsistent among patients because some people feel depressed more often than not and experience little mania whereas others experience predominantly manic symptoms
As I was suicidal when I first went to my GP back in 2005, he prescribed me fluoxetine (prozac) which is the bog standard treatment for it. It wasn't very effective and just caused really bad insomnia, so my dosage was upped first to 40 mg then to 60 mg and I had zopiclone (sleeping pills) thrown at me. So things continued for the next 5 years until last summer when I went to a different GP and asked for my meds to be changed as fluoxetine wasn't working. This was just after my suicide attempt last July. I was given venlafaxine which again, didn't really do much apart from make me feel worse. While I was sleeping rough in November, my doctor refused to prescribe me anything as with my past ODs, he was worried that I'd try to do something again. When I was moved into temporary accomodation, I had enough support from others to be able to be medicated again, said that venlafaxine wasn't working and they put me onto mirtazapine. At the start, it was fine. Not sure how much of that was me thinking that it'd work so I felt better.
Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation. In severe cases, the individual may become psychotic, a condition also known as severe bipolar depression with psychotic features.
Well... let's see how many of those apply to me... When I get on a downer, I can't sleep. MANY people know this from my conversations on IRC/MSN in the wee hours of the morning. I'm thankfully not at the psychotic stage. As far as I know. I've often had very bad nightmares and recently they've been getting to the point where they're waking me up. I'm not sure how much of that is sleeping alone now. I seemed to sleep better when I had someone next to me. I think the only thing I've not had there is lack of interest in sex. And if you know me at all well, you'd know I'd have to be dead for that to happen :P
Mania is generally characterized by a distinct period of an elevated, expansive, or irritable mood state. People commonly experience an increase in energy and a decreased need for sleep. A person's speech may be pressured, with thoughts experienced as racing. Attention span is low and a person in a manic state may be easily distracted. Judgment may become impaired; sufferers may go on spending sprees or engage in behavior that is quite abnormal for them. They may indulge in substance abuse, particularly alcohol or other depressants, cocaine or other stimulants, or sleeping pills. Their behavior may become aggressive, intolerant or intrusive. People may feel out of control or unstoppable. People may feel they have been "chosen," are "on a special mission," or other grandiose or delusional ideas. Sexual drive may increase. At more extreme phases of bipolar I, a person in a manic state can begin to experience psychosis, or a break with reality, where thinking is affected along with mood. Many people in a manic state experience severe anxiety and are very irritable (to the point of rage), while others are euphoric and grandiose...
According to the National Institute of Mental Health, "A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present."
This seems to be my other predominant state. I joke about how I have a short attention span and take conversations off on tangents. I had no idea it was actually a form of mania. In the past I used to go on crazy shopping binges (I do to a minor extent now) followed by drinking heavily. On RARE occassions my temper gets out of control. When it snaps, it snaps hard. I'm ashamed to say there have been many occassions where I've wanted to hit someone for no reason whatsoever or because of something very minor. I do have a bit of a habit of arguing when I'm in those sort of moods too. On the positive side, I rarely let that part get out of control. I take that to mean that I can get better as I at least have control over one aspect. If I can manage to hold my anger back, I can learn to control my other extremes.
What I feel I have on the manic side is:
Hypomania is generally a mild to moderate level of mania, characterized by optimism, pressure of speech and activity, and decreased need for sleep. Some people have increased creativity while others demonstrate poor judgment and irritability. Others experience hypersexuality. These persons generally have increased energy and tend to become more active than usual. They do not, however, have delusions or hallucinations. Hypomania can be difficult to diagnose because it may masquerade as mere happiness, though it carries the same risks as mania.
Hypomania may feel good to the person who experiences it. Thus, even when family and friends learn to recognize the mood swings, the individual often will deny that anything is wrong.
I have never hallucinated when not on various substances nor had serious delusions. Other than thinking my arse looks great in my black jeans. But a few people have told me it does :P
Some limited long-term studies indicate that children who later receive a diagnosis of bipolar disorder may show subtle early traits such as subthreshold cyclical mood abnormalities, full major depressive episodes...
Evidence suggests that environmental factors play a significant role in the development and course of bipolar disorder, and that individual psychosocial variables may interact with genetic dispositions. There is fairly consistent evidence from prospective studies that recent life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes, as they do for onsets and recurrences of unipolar depression. There have been repeated findings that between a third and a half of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated on average with earlier onset, a worse course, and more co-occurring disorders such as PTSD. The total number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder compared to those without, particularly events stemming from a harsh environment rather than from the child's own behavior. Early experiences of adversity and conflict are likely to make subsequent developmental challenges in adolescence more difficult, and are likely a potentiating factor in those at risk of developing bipolar disorder.
While I can't remember any mood cycling as a child or as a teenager (until I hit about 18/19), I certainly had major depressive episodes from the age of 14 onwards. Prior to that I can't really remember being a very happy child due to the amount of crap I had going on at home and my mother's own very messed up ways of dealing with things. Maybe that was part of the reason that I found the idea of myself being bipolar so hard to deal with. I knew her behaviour wasn't normal but never really associated it with any mental health issues and just thought she was a very messed up woman who is a complete bitch (which she is but...). In some ways I'm a bit more understanding of how she treated me, but I still feel anger towards her non acceptance, her delusions of what actually happened and how she tried to mess with my head by convincing me that what I knew to be right was wrong. I feel some degree of pity towards her now which I didn't really have before.
The use of antidepressants in bipolar disorder has been debated, with some studies reporting a worse outcome with their use triggering manic, hypomanic or mixed episodes, especially if no mood stabiliser is used.... Rapid cycling can be induced or made worse by antidepressants, unless there is adjunctive treatment with a mood stabilizer.
Well... that explains a hell of a lot. It certainly proves that recently I've been cycling so much because of mirtazapine.
A naturalistic study from first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years. 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). However, 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19% switched phases without recovery. Many therapists treat individuals with Bipolar I and II by helping them identify the return of symptoms, and actions that will prevent symptoms from getting worse
This... has made me feel a lot better. The reassurance that it CAN be dealt with and I WON'T be like this forever. The statistics look pretty damn good to me and I know I can beat this. I want to. Well, I do right now... Don't ask me in a couple of hours when I'll feel like shit again.
Studies show that tobacco smoking induces a calming effect on most bipolar people
SO SCREW YOU ALL TELLING ME TO GIVE UP!
The only thing I'm really having trouble coping with is knowing that I can't predict when my moods happen. I spoke to Shaun last night and he said he's never seen any of these mood switches and he's spent a HELL of a lot of time with me. I know some of them I've felt coming and been able to prevent but sometimes they just flash out of control and I say something bitchy or that is a result of my inside thoughts getting out of hand. What I really hate is how damn rational I am about all of this...
I know I can get better. I want to. It's time for change.