Sit Down, Buckle up, and Hang on Tight: Riding the Bipolar Roller Coaster

(If you’re curious about the cover picture, it’s a self-portrait I drew a few years back with mania and depression anthropomorphized into fictional characters. I’ll let you figure out which is which.)

What is bipolar disorder?

To quote Wikipedia:

“Individuals with bipolar disorder experience episodes of a frenzied state known as mania, typically alternating with episodes of depression.”

It’s a teeny-weeny bit more complicated than that (<– please note the sarcasm in this statement). I’m not going to launch into a full, in-depth explanation, because plenty of books have already been written on the subject (for an excellent, highly entertaining book check out Welcome to the Jungle by Hilary Smith. It’s the first book I read about bipolar disorder, and it’s by far the best. I guarantee you’ll get a laugh– something you won’t be getting from most other books on the subject). Instead, I’ll just walk you through the terminology I make use of:

Manic episode – You’re bursting with energy. Sleep is impossible. You’re either euphorically happy, alarmingly irritable, or paranoid, or some combination of all three. Some people fly into rages (thankfully I’ve never had that problem). Your thoughts are speeding along at roughly a million miles per minute, which starts out exhilarating, but it gets old very quickly (just staying focused on one conversation is difficult, let alone trying to read something or plan your day). The speeding thoughts can enhance your creativity, but you have the attention span of a gnat, so you might start a dozen new projects in the course of a day, but you won’t ever finish them. Your judgement goes out the window. You do stupid things: driving recklessly, maxing out your credit cards on spending sprees, breaking up friendships, quitting your job. Hypersexuality is another symptom. Ordinarily you might be a very chaste, conservative wall-flower, but in the throws of mania you are liable to get into a lot of trouble if you’re in the wrong place with the wrong person (or people). You aren’t in your right mind, so you aren’t morally culpable, but when sanity returns you might end up facing some devastating consequences (this is something I’ve never had to deal with, thank God, since my only major manic episode took place while I was safely with my family). If things progress far enough you can become psychotic. You have delusions of grandiosity that leave you convinced that you’re a celebrity, or that you’re Jesus (this is actually a very common delusion, even among non-religious people), or you’re on a mission to save the world, or you’re invincible, can control things with your mind, can fly, etc. Hallucinations are also a possibility. The symptoms of psycho-manic episodes are very similar in some ways to the symptoms of schizophrenia.

Hypomanic episode – This is another way of saying “mild mania.” Take manic symptoms and turn them down a few notches. It still interferes with your life, but you’re able to function at least semi-normally. Sometimes hypomania can actually be a positive thing, since the extra energy and creativity isn’t compromised by incapacitating racing-thoughts. It can also be quite enjoyable if euphoria happens to be a symptom.

Depressive episode – In other words: depression. Anyone who has ever experienced it probably doesn’t need an explanation. Bipolar depression is very similar to major depressive disorder. Symptoms of depression include utter misery and despair (that’s not an exaggeration), crying, lethargy, exhaustion, apathy, loss of interest in formerly enjoyable activities, inability to feel pleasure, morbid thoughts and suicidal ideation, excessive and irrational guilt, intense self loathing, insomnia, loss of appetite and weight loss, and withdrawal from friends and family. There are three potential differences in bipolar depression: firstly, antidepressants usually kick in immediately and have the potential to shoot you over the moon into mania, so you have to be very careful with them. Secondly, some people experience hypersomnia rather than insomnia. They are unable to get out of bed for days. This is not due to laziness, but rather absolute exhaustion (the intensity of it defies description) and apathy.  The third potential difference is an increase in appetite, rather than a loss, which can result in impressive weight gain (eating a whole tub of ice cream every day, for example, or sitting down and eating spoonfuls of sugar straight from the bag. It doesn’t help that a number of medications used to treat bipolar have weight gain as a side-effect). When someone experiences hypersomnia or increased appetite  it’s considered an “atypical depression.” I’ve never had either of those problems. My depressions are pretty typical. Unless they’re mixed episodes.

Mixed episode (also known as Dysphoric Mania or Agitated Depression) – You’re depressed and manic at the same time. I’m not joking. This happens rather frequently (in my experience, anyway). Take the emotional anguish of depression, along with its self-loathing, guilt and suicidal ideation, and mix it with the energy, impulsiveness and racing thoughts of mania, and you have a very dangerous cocktail. According to the stats, about 40% of people with bipolar disorder attempt suicide at least once in their lives, and roughly half of them are successful. In other words, 1 out of every 5 people with bipolar disorder end up killing themselves. Mixed episodes are the main reason for this. In straight depression, exhaustion and apathy make suicide less likely. Exhaustion and apathy are probably the only two depressive symptoms missing in a mixed episode. Energetic impulsiveness + thoughts of suicide = dangerous. In my experience, mixed episodes are also the time when self-harm urges hit you the hardest (if you’re someone who has that problem).

Rapid Cycling – In ordinary bipolar disorder, a person doesn’t get more than 4 episodes per year (that doesn’t sound like much, but one episode can last anywhere from a few days, to months). But it doesn’t always work that way. If you have more than 4 episodes over the course of a year, you are considered to be rapid-cycling. It’s a common problem in bipolar teens, and antidepressants can play into it in a big way as well.

So there’s your brief overview. If you have any questions, drop me a comment.

Take care, and God bless!

Kasani

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My Story – Part 2: The Aftermath

After the ship of my old life had been shattered on the rocks of hospitalization, I was dragged aboard a new, unfamiliar vessel, and I wasn’t sure how to feel about it. Fully coming to terms with my diagnosis would end up taking several years.

But I’m getting ahead of myself.

While still in the hospital, after medications had grounded me once more in reality, my doctor tried to explain to me that in bipolar disorder, what goes up must come down. A depressive episode almost always follows on the heels of a manic one. But I was still hypomanic, and thus cheerful and optimistic and feeling great. I assured him that I was overall a very happy person and I was sure I’d be fine. And I wasn’t deluded in thinking this. I was going on experience. For most of my life I’d been a happy, well adjusted person. Happy was my norm. I had no way of knowing just how radically that would change.

Not surprisingly, I did experience a depressive episode a couple weeks later. At the time, I thought it was the worst experience of my life, mainly because it contrasted so drastically with the euphoria of the preceding manic episode. But looking back, I can see it was pretty mild. It only lasted a little under two weeks, and I didn’t end up needing antidepressants. After that episode, God granted me 7 months of almost total stability. This allowed me to get back on my feet and start trying to live my old life again, but it did nothing to prepare me for the reality of my disorder.

By the time August rolled around, I was completely adjusted to my disorder (so I thought) and not the least bit embarrassed or uncomfortable talking about it. It was a bit like a cool new label that put me in a separate category from most people– like a weird sort of bragging right (boy, did that ever change over the next several months…). My best friend, who had been diagnosed with ADHD within the same month that I was diagnosed with Bipolar (funny how these things work out), was amazed by my nonchalant attitude towards my disorder. She had been having a difficult time coming to grips with her own diagnosis without it completely destroying her self-esteem.

The difference between her and me was that she had been struggling with the effects of her illness every day of her life without fully understanding it, and now she was still having to deal with it every day but with the added bonus of having a label slapped onto her that essentially declared her “defective” because of it. There was no way to deny the reality of it. It was part of her life 24/7. The fact that she was a straight-A student, whom her friend’s thought the world of, did nothing to ease the initial sting of the diagnosis. She did eventually come to grips with it, and even met and befriended some fellow sufferers of the disorder, but adjusting to the diagnosis of a mental illness takes time.

For me, the fact that I had a mental illness hadn’t yet sunk in. While the events surrounding my hospitalization had been very dramatic, the disorder seemed to have vanished into thin air after a month had gone by. Once I stabilized, it was as if it had never happened. The only changes in my life were that I was now on medication and I had to monitor my sleep and stress levels to avoid triggering another episode. Other than that I felt normal. It wasn’t compromising my ability to function like a normal person. I didn’t feel the least bit embarrassed about it.

In the fall, that changed.

Part-way through September, 2012, I crashed into a depressive episode. I didn’t know it at the time, but it was the start of what would turn into nearly two years of rapid-cycling. After September, I went on to have 12 more episodes over the course of the next year, and 6 the year after that. The first year of that very nearly killed me. From December 2012 to May 2013, I went straight from depressive episode, to hypomanic episode, to depressive episode, to hypomanic episode, with only a day or two of stability here and there. The depressive episodes typically dragged on for close to a month, while the hypomanic episodes usually lasted a couple weeks. If I hadn’t had a very effective antipsychotic medication (Zyprexa), the hypomanic episodes would almost certainly have progressed into full-blown manic ones, and I likely would have had to be hospitalized again. Thankfully that didn’t happen. But most of the hypomanic episodes were dysphoric. In other words, they were mixed episodes. So to say that they didn’t lead to euphoric happiness would be a very impressive understatement. I was miserable.

It was around this time that I began to feel very insecure about my disorder. When I was stable,  I had successfully taken several university correspondence courses and passed with flying colors. In 2013, I failed a university course because I was hypomanic for my midterm and depressed for my final. I began to think I would never be able to attend an actual university. If I couldn’t handle just one correspondence course, how could I possibly handle a full-time course-load on a real campus?

I withdrew from all my friends except my previously mentioned best friend (most of my friends at that time were not a very positive influence anyway). I muddled along putting one foot in front of the other, and stumbling into a number of pitfalls along the way. I came to have a very intimate understanding of why people self-harm, and thoughts of suicide were rarely far from my mind. As far as I can remember, my faith life did not deteriorate, but it certainly didn’t improve either. To be honest, I’ve forgotten large chunks of that period, especially some of the depressive episodes, and what I do remember is foggy at best. The only reason I know most of what took place in my head in the years of 2012 and 2013 is that I kept a journal. It was one of the coping mechanisms I latched on to.

The year 2014 marked the beginning of my recovery. It was a much stabler year, thanks to changes in my medication. The first mood stabilizer I was put on when I was diagnosed was Lithium. It didn’t work, and over time it began to give me alarming muscle weakness as a side-effect. Any muscle strain at all caused me to shake like a leaf. I looked like a caffeine addict whenever I so much as raised a tall glass of water to my lips, and walking up a single flight of steps left me gasping for air and utterly exhausted. Thankfully those symptoms went away when I was taken off the drug. The next mood stabilizer I was put on was Lamictal. Once I reached a high enough dose, it worked marvels. I’m still on it now, and I don’t experience any side-effects from it at this point. But it took quite a while to build up the dose to the level at which I’m currently taking it, and I experienced some strange initial side-effects until I adjusted to it (disorientation, lightheadedness, panic attacks). It controls the depressive episodes better than the manic ones, so I still have Zyprexa on hand to cut off hypomania before it progresses too far. I’m also on Wellbutrin (an antidepressant). This combination of medications works very well for me. Over the past year (2015) I’ve only had one hypomanic episode, and one depressive episode. I don’t have any side-effects (well, Zyprexa can turn me into a zombie, but that’s kind of the point. Thankfully I don’t have to take it much). I am very, very blessed to have discovered this in only a few years. I know many people have a lot of trouble finding medication combinations that work, and many of them have to deal with unpleasant side-effects from them.

December 23rd, 2015 will mark the end of the fourth year since my diagnosis. A lot happened in those 4 years that I’m not going to try and summarize here. Some of it will appear in future posts if it’s relevant to the issue I’m discussing. To wrap up, I am finally adjusted to my disorder. Having experienced the full range of symptoms that it can throw at me, it’s no longer a frightening thing. I’m comfortable talking about it. I’m back to living a relatively normal life. I’m happy again. Whether that will last or not is in God’s hands, and I’m content to leave it there. One of the most important lessons my disorder has taught me is that we have to live in the now. The future is impossible to predict. Life is much less stressful when we let go of the illusion that we’re in control and instead trust God to take over the navigation of our vessel. He knows where we’re supposed to be heading, and he will give us all the grace and support we need in order to get there. We just have to be willing to accept it.

Take care, and God bless.

Kasani

My Story – Part 1: The Diagnosis

When I woke on the morning of December 24, 2011, the sky was cloudy. I could tell this, not because I could see the sky, but because the light coming in through the metal grate over the window was a cold, grey shade. The window looked out on an enclosed courtyard covered by a large dome of honeycombed skylights. There was a tree in the courtyard and some benches.I can see these things in my mind’s eye now, but they were not what initially captured my attention. What I first noticed, as I raised my head, were the claw marks on the walls. Someone had dug their nails frantically into the drywall over and over, and perhaps had applied their teeth to it as well.

The first question that came into my mind was not why am I in a child psych ward? I recognized that I was, but it didn’t matter much to me at that moment. What I wanted to know, as I eyed the marks with a certain amount of horror, was whether or not I had been the one to make them. In my drugged haze and the scattered confusion of the still prominent mania, I couldn’t remember any of what had taken place.

Some of my memory came back to me in bits and pieces as the mania diminished, but the first few days of my stay there have remained a fuzzy blur to this day. I do remember being profoundly relieved to learn I had not made the marks on the wall of my room. What little else I remember is both cringe-worthy and amusing. For instance, I have a vague memory of being locked in a padded room in the unit–the one saved for unruly patients when they threw fits–not because I’d been violent but because, as a fellow patient later explained to me with great amusement, they hadn’t been able to get me to stop singing. I hope the nurses in emerge had a similar sense of humour, because I sang Christmas carols at the top of my lungs for the majority of the nine hours that I spent waiting there, my exhausted mother at my side having long since given up the task of quieting me.

I don’t remember being told I had bipolar disorder. I must have been told at some point, because I remember sitting in a room with my parents as the doctor gently explained to them why they assumed I had the condition. Then the doctor took me aside into another room to discuss the matter with me. I have no memory of what he said, but I do distinctly remember asking him why he sounded like Darth Vader and feeling convinced he was breathing oddly just to see if I would react. I remember his laughter and his assurance that he simply had a cold. And I remember remaining convinced that he was lying to me.

Looking back at my level of paranoia during those first few days of treatment is quite comical.

(For an explanation of the symptoms/terminology I use in reference to bipolar disorder, check out my post on the subject)

My parents received my diagnosis with a certain amount of relief. Whatever was going on, they hadn’t lost me forever. It was treatable. And it wasn’t, as my mother had feared, schizophrenia. But none of us really knew what the diagnosis meant. It was close to a year before I began to really understand what I was dealing with. In those first few weeks, all I knew was that I had been through an incredible ordeal and my life would never be the same. If I had known at that point just how true the latter statement would prove to be, I’m not sure I would have survived it. But as humans, we are blessed with not knowing the future. It’s a greater mercy than any of us realize.

But how had I gotten to the extreme point of needing hospitalization in the first place?

To continue with the boat analogy from the homepage, my little boat had been sailing along without too many glitches for most of my childhood. As I grew into my teens, the waters grew rougher, but what teenage-hood isn’t rough at times? As the waves grew higher and the troughs between them grew deeper, I struggled to keep my little vessel from capsizing. I didn’t understand why the moods I was experiencing were so uncomfortably intense, but I chalked it up to hormones. “Moody” and “teenager” go together like “peanut butter” and “honey.”

It was my riding instructor, of all people, who rang the first alarm bell. I had been horseback riding for about 6 years. My riding ability, once cemented at a slow but steady rate of improvement, had begun to fluctuate between skilled, and utterly incompetent, right alongside my moods. It was infuriating and disheartening, and my horse was none too pleased with me either. My instructor was at her wit’s end. How was it possible for a student to excel at challenging manoeuvres one lesson, and fail miserably at even simple warm-up exercises the next? Having worked with horses for over 50 years, she had developed what I can only describe as a sixth sense. She could see what was going on inside me just by looking me in the eyes, and what she saw concerned her. She spoke to my dad about it.

“Have you ever considered that your daughter might have some sort of disability?”

My father was utterly taken aback. How could someone suggest such a thing? I was a high functioning, capable individual. There couldn’t be anything wrong with me.

Things continued along in this way for several years, a storm brewing secretly beneath the veneer of my everyday life. Then in December of 2011, a month shy of my 17th birthday, the storm broke. I had no way of knowing I was in dangerous waters. I didn’t feel normal, but I didn’t feel bad exactly. I began taking on more than I could swallow in commitments and failed to feel stressed out by it. I began to feel I could accomplish anything I put my mind to, regardless of the challenge. I was invincible and life was my oyster. Those of us who have been diagnosed with bipolar disorder recognize such feelings of grandiosity as a major warning sign. In type 1 bipolar, when you reach that point, there’s nowhere to go but up. And I kept going up– much, much too high.

My riding lessons began to turn into rodeos. My horse was highly sensitive and intelligent, and whatever it was he sensed going on in me, he was not happy about it. I was unable to get through a lesson without him trying to throw me. My guardian angel was definitely looking out for me because my horse employed nearly every trick in the equine book to get me off, from bucking and crow-hopping to rearing and bolting. My riding instructor was floored. My horse and I had gone through a lot of ups and downs together in the preceding months, but he’d never behaved anything like this before. Something was wrong. But we didn’t know what.

That was when my ship finally crashed into some rocks.

My parents didn’t initially recognize that I had become delusional, but they were getting concerned by my increasingly erratic behavior and they kept me home. I knew something was wrong with me, and I had crying spells in which I sobbed out all the various things that had bothered me over the years. This alternated with ecstatic excitement over the belief that I was reaching a whole new level of existence. I had numerous bizarre insights into books and other things that my parents couldn’t make any sense of. I exclaimed “Oooh, I get it. I get it!”  with alarming frequency (which, oddly enough, has been an inside joke in my family ever since. Whenever I become unusually cheerful and giddy, my father invariably asks me “Do you get it yet?”). Finally, one evening, after telling my parents good night, going to bed, closing my eyes for several minutes, and then leaping out of bed and skipping back into their room declaring “Wow, I had such an amazing sleep!” with total sincerity, my parents realized I was no longer living in reality.

They rushed me to the nearest hospital, an hour away from our small town. By the time we arrived, I was conversing amiably with my guardian angel, convinced I was a prophet from God and that I had the cure for cancer. I was also at some level aware that my behavior was not what it should be, and decided it must be because I had a brain tumor.

But, of course, I had the cure for cancer, so everything would be okay.

We spent the entire night in emerge. I had gotten the idea into my head that the key to moving on into a higher level of existence was demonstrating that I was able to breathe correctly. I spent the night making repeated trips to the reception desk to earnestly inform the nurses there that “I can breathe!” and then returning confusedly to my bed after receiving their forced smiles and nods.

Morning arrived without me having slept a wink. My poor mother had spent the night keeping track of me while my father grabbed a bit of rest so as to be fit for driving the next day. We were sent to another hospital in a larger city, another hour away. A nine hour wait in emerge later (during which time I began to hallucinate and my delusions grew even more convoluted) I was finally admitted to the child psychiatric unit. After going for nearly 72 hours without sleeping, the cocktail of medications I was given kicked in and I slept for most of two days. December 25th found me still in the scattered, confused grip of mania, but my delusions and hallucinations had ceased and my parents were able to come and attempt to celebrate Christmas with me, bringing me a number of presents that would make my stay in the hospital more comfortable.

But the largest, most life altering present had already been delivered to me: I was Bipolar.

(Click here for Part 2)