by Amy Stringer
TW/CW: bipolar disorder, depression, mania, medication
“I am the victim of my own moods, more than most people are perhaps, in as much as I have a condition which requires me to take medication so that I don’t get either too hyper or too depressed to the point of suicide.”Stephen Fry
If you haven’t already, I suggest jumping over and reading part 1 of this post before continuing here.
Here I talk about the different mood episodes I have experienced. My bipolar was diagnosed early, and it’s lucky it was because according to my doctor, episodes left untreated get worse and worse over time. If you read Stahl’s Essential Psychopharmacology on depression and bipolar disorder you would see that these days there around 8 different “bipolars” and depending on which you have, your treatment might be slightly different. I asked my psych about this recently, as he’d never given me a diagnosis other than just bipolar, and he assured me that my bipolar was what he refers to as “typical bipolar” which is somewhere between bipolar 1 and bipolar 2 (not flat bipolar 1, because this often has psychotic features and we never let me get to that state). This was surprising to me as I have always felt that my bipolar was relatively mild, but perhaps I only think this because I’m used to the symptoms, or because my expectations of bipolar were molded by media representations. In any case, let’s get into it.
I intend to tell you about hypo-mania, rather than mania, purely because that is all I have experienced. We’re learning new thing here, so let’s see what wiki has to say…
Hypomania: “Hypomania (literally “under mania” or “less than mania”) is a mood state characterized by persistent disinhibition and mood elevation (euphoria), with behavior that is noticeably different from the person’s typical behavior when in a non-depressed state. It may involve irritability, not necessarily less severe than full mania… hypomania is distinct from mania in that there is no significant functional impairment; mania, by DSM-5 definition, does include significant functional impairment and may have psychotic features.” – wikipedia
It may involve irritability. Now I’ve heard that mania can feel quite good, but that’s not what I’ve experienced. I’ve heard that mania can be kind of like when you’re playing Mario kart and you get the little rainbow invincibility star. Nothing can hurt you, you’re on top of the world, you are the best and you are FAST. This is not what I’ve experienced and since it’s just what I’ve heard, it may not be what anyone experiences.
My mania, or hypo mania, is irritable in nature and my fears of death (and fears in general) become heightened leading to severe anxiety. Something I didn’t realise before starting this blog was that the irritability experienced in a hypo-manic episodes is not necessary less severe than that of full mania, despite most of the other symptoms being so. This is news to me, but given my irritable experiences, I believe it.
I do still get some of the usual symptoms; racing thoughts, decreased need for sleep, intense senses, talking fast, reckless spending etc. but these things only fuel the looming anxiety. Then sometimes I get stuck, getting anxious about the fact that I’m having a manic episode. I start to worry that it’s visible to others and I wonder if they think I’m crazy and then I realise I sound a little paranoid and then I can’t help but think what if it turns into a full manic psychotic episode? What if I end up like him?
… That’s a talk for another time. This doesn’t always happen, sometimes the episodes are very mild, just a lack of sleep and some zoomy thoughts. I think the medication helps with this, it makes it much more manageable. Due to the fact that my antidepressants induce hypo-mania, I have to be very careful with them, and it’s usually up to me when I have to stop them. This means I need to be able to recognise when I’m entering in to an elevated state.
What are the tell tale signs? Well, I start to notice it when my money starts disappearing and I can’t figure out where it’s all gone, or when I wake up really early in the morning and somehow feel energised. Maybe I actually want to go for a run, or I start booking myself in to all kinds of things like jobs or meetings or social events. Most often though, I get snappy and irritable and it’s my partner who notices this first. Once I’m aware of it, sometimes it’s a little bit easier to manage, though it’s not exactly a walk in the park. Po takes over your entire personality, and it feels like you. When you’re in a particular mood state it feels like you’ve always been that way and second guessing how you feel in any one instant is like second guessing anything you’ve ever felt. Things like “what do you mean I’m snappy today, why is today special, I’m always like this”.
When my medicine is perhaps not working so well I tend to get more manic symptoms. One time I simply couldn’t stop tapping my foot. It was so bad that I ended up with pretty extreme pain in my shin by the end of a day and it wouldn’t stop moving long enough for me to get to sleep in the evening.
Mania is something, like all bipolar episodes, that can get very severe and may impair functioning if left untreated for too long. The racing thoughts make it difficult to concentrate on anything for any reasonable amount of time and the euphoria you feel can lead you to participate in more risky behaviour than you otherwise would. Some people spend all of their savings in one manic episode only to come through the other side, realise what’s happened and plunge into a deep depression.
Depression is like an old friend to me at this stage. He’s been in close company for years now. If it wasn’t for the drugs sending me into hypo-manic states, I could have easily ended up with a major depression diagnosis. Due to the “flattening” effect of the bipolar drugs I sometimes find it hard to distinguish between depression and my normal mood. You see, the drugs aim to stabilise your mood but they don’t make you happy. Typical symptoms of depression (for me) include, but are not limited to:
- irritability (yes, more irritability)
- difficulty concentrating
- lack of appetite or increase in appetite
- an uneasy, unwavering feeling of sadness or despair
- lack of emotional displays outside of sadness or disinterest
- feeling… heavy, like someone is sitting on your shoulders
- excessive crying
Again, these symptoms may manifest differently in different people. Some people also experience feelings of worthlessness, delusions, difficulty sleeping, self harm or suicidal ideation.
I’ve been medicated ever since my first depressive episode, and the episodes I’ve had since then have still been pretty awful, so I can only imagine how bad it could have gotten if I didn’t happen to be seeing the psychiatrist for something else around the onset time of my bipolar. This is something I am grateful for.
There are many different ways in which depression presents itself. Depression, like most things, falls on spectrum. I can describe a few of these different ways, but I’m certain there are others that I may not necessarily experience. With the medication, it’s almost like I experience depressive symptoms one, two or maybe three at a time, and different combinations of two or three symptoms result in different depressive experiences.
Often I might be de-motivated, overly tired and have difficulty concentrating, let’s call this d1. Other times I may have overwhelming sadness, difficulty concentrating and impaired thinking, let’s call this one d2. Other times again, I may be irritable and lacking emotional capacity, d3.
D1, I think is the most common for me. In these states, I don’t want to do anything and even if I can be persuaded to do something, I gain no satisfaction from it. That being said, in this state I can still see and understand the fact that the feeling will end (due to the cyclic nature of bipolar), and this provides some comfort. This kind of depression is like walking up a hill whose angle gets harsher the worse you feel. Every step, every breath, is effort, but at least I can still think.
D2 is hard. It often comes on suddenly, like all of a sudden I can’t think. All I can do is feel. It’s literally like your head is in the clouds, you look around but things don’t register. You move but you’re barely aware that you’re doing it, barely aware that you’re even in control of your body. The most accessible example I can think of is waiting at the traffic lights. You’re somewhat aware that the little man is red, so you stop. You wait, but it barely feels like time is passing. You’re just so sad, and that’s all you can concentrate on. The little man turns green, but you don’t move right away. You look at the green man, you look at the other people walking, you look at the stopped cars, and then without any input from you, your body starts to cross the road. You’re on autopilot. When I’m in this state, it doesn’t matter that it might end soon, because all I can concentrate on is how I feel in that moment, and how I feel is devastating.
There doesn’t need to be a reason for the sadness either, and this is true of any depression. If someone tells you they’re depressed, you shouldn’t ask why because there probably isn’t a “good” answer.
D3 is also hard. Look, I guess they’re all hard, that’s the whole point of this. I didn’t come into this with the intent of telling any of you that any of this is easy. Irritable Po also doesn’t care that it might end soon, she just wishes it would end sooner, and the very concept of “soon” is annoying. Irritable Po is only concerned with getting through the day with the least interaction possible. She likes to be hugged or touched even less than Amy and she can’t stand small talk. The difference between irritable mania and irritable depression is in how the irritability is projected. Depression typically takes aim at me as the source of the irritation, and mania takes aim at others (because I can do no wrong and everything revolves around me).
How can you help?
A friend asked me to include some tips for friends and family, and it’s hard for me to do so generally, because anything I say will be deeply personalised and may not apply to others in a similar boat.
Where I am at in my mood cycle is often a sensitive topic. While talking to me, you might notice that I seem a little zoomy, or that I’m not really paying attention, or that I’m REALLY excited, or that I’m scratching and shifting a lot. In these circumstances, unless I’ve mentioned that I’m feeling a little manic, it’s probably best not to point it out. I’m probably painfully aware of the fact already and trying my best to look normal. I think in general, I just want things to be as normal as possible.
In the face of depression, I ask for patience. The beautiful thing about bipolar depression (and mania too for that matter) is that eventually it will go away again, even if I can’t see it at the time. Sometimes I will just want someone to complain to, not someone to fix my problems, or to comfort me. If I’m complaining to you, I dunno, get on board, contribute your own complaints. I can be that person who will sympathise and sometimes this kind of back and forth can lift my mood a little. Sometimes I will also just want to have someone nearby, but please don’t hug me. Your presence is enough.
Because of my bipolar, I rarely trust the way that I feel about things. Maybe I just think it’s a good idea because everything seems like a good idea. Am I saying no to this because I don’t want to do it or because Po is sitting on my chest telling me not to do it? Am I accepting work I can always keep up with, or work that only mania Po can maintain?
These kinds of things make life a struggle, I don’t really know what normal is anymore but I spend a lot of time trying to maintain some sense of normality. Po will literally never go away, she’s with me for life. Until relatively recently, I did what Stephen Fry says you shouldn’t do. I always tried to pretend it wasn’t raining, and go out anyway. I’ve learned that this is the wrong thing to do, sometimes routine really helps, other times you need a day or a week or a month off, and that is perfectly okay.
I wouldn’t say that I’ve mastered living with Po just yet, but I am learning every day.
If you are seeking help, follow the link below for a list of Australian resources