The Signs of Mania
Euphoria or irritability
I was happy most of the time but there were days, even weeks, when it took everything I had not to snap at everyone. At some points I was experiencing rage so intense that I very nearly got into physical confrontations with people.
Increased energy and activity
This is one stage that most bipolars secretly enjoy (to a degree). This stage involves a lot of projects started and subsequently being abandoned half way through. I stayed up all night painting my room because it just had to be done. In hindsight I know it could have been done the next day but at that moment in time it had to be finished. Nothing else could come first. I had to finish it. Then there was the time I stayed up all night, the night before the SATs, just to do an art project. Once again, it just had to be done. I couldn't function until it was done. This is all fine and dandy when you're wanting to get all the cleaning or laundry done. But when it starts to affect your work, grades, sleep and family life then it becomes a serious problem.
Excessive talk; racing thoughts
I don't know if I talk excessively, but I probably do. I do know that my thoughts have a tendency to run amok in my head. My typical thought process in a 5 minute span:
I need to do the laundry. What are the kids doing? What should I make for supper? The Bug needs a haircut. I need to finish planting my flowers. The dog really needs a bath. I need to trim the trees out back. When is Michael going to be home? Has it been five minutes yet? I'm horny. I want to read. I need to vacuum. I wish I made more money. Meg needs to go out. The fence needs to be repaired. What should I make for supper? I need to do the laundry. I don't want to fold clothes. Has it been five minutes yet?That's five minutes in my head. It can get dizzy in there.
Inflated self-esteem
I know, I am awesome. But it does go beyond that. I often found myself saying "Just let me do it," when I really meant "I can do it faster and better than you. Because I'm supreme." Even if the end result wasn't better or faster, it would never be my fault. I would end up blaming others or situations or objects on my failure. Because it couldn't be my fault...I'm awesome.
Impulsiveness, a reckless pursuit of gratification (shopping sprees, impetuous travel, more and sometimes promiscuous sex, high-risk business investments, fast driving)
I stole golf flags once. Another time I played chicken with a semi. I would hang out with people I knew had things like walking pneumonia or the flu. I got piercings when I'm actually allergic to steel and I have an immune disorder that makes it really hard to heal. I spent money I didn't have. They may not seem like big things, but they were way outside my "normal" range for behavior. The Signs of Depression
Depressed mood and low self-esteem
Seems rather self explanatory: you feel like crap, everything seems to be piling up against you, and no matter what you do nothing works. Your hair is ugly. Your face is wrinkled and covered in zits. Your ass is too big. Your gut hangs over your jeans. Your boobs sag. Your teeth are yellow. And it's all. your. fault.
Low energy levels and apathy
The phrase "lay down and die" is very apt here. Why bother cleaning when stuff will just get dirty again? Why bother brushing my teeth when I'm just going to eat again? Who cares if the laundry is done, no one is going to smell me but me. I don't care if people come over. I'd rather watch TV or play a video game.
Sadness, loneliness, helplessness, guilt
This is when I like the rain, but hate being by myself with my thoughts. I feel like nothing is going to get me out of the funk and there's no point in trying. But it's my fault that I'm like this. I shouldn't be so hard on others. It's my fault that we can't get along. Obviously if I could just do things differently or be different we'd be fine.
Slow speech, fatigue, and poor coordination
This strange phenomenon happens to me frequently whenever I fall into this phase: I hurt myself. Not on purpose! But I'll end up banging my head on something or stubbing my toe or continuously smacking my shin into the same piece of furniture. Hurts like hell and it's usually a sign that I'm feeling down on myself for some reason. The need to nap and just close my eyes and ignore the world is also pretty strong.
Insomnia or oversleeping
I tend to have insomnia. I just can't get my brain to shut up. It will play scenarios over and over, or make plans, or just fantasize about different things (not all of them are sexual, thankyouverymuch). No sleep + depression = unhappy Kate.
Suicidal thoughts and feelings
I used to have suicidal thoughts but I'll be honest, my kids usually pop me back out of them. I know it would be selfish and wrong to leave them without a mom. There are days when I just don't want to wake up or face another morning. But I do, because I have to. Suicide has never been high on my list of symptoms.
Poor concentration
I'm sorry, what were you saying? Sometimes I have a hard time focusing on things like reading or watching a movie. I just kind of drift off, not really able to get engrossed in anything. I try to focus but my mind is busy in it's own world.
Lack of interest or pleasure in usual activities
Things start to not really matter to me. Why go outside and work in the garden? I don't really feel like it. I don't want to bake anything today, I'm too tired. Nah, I'd rather stay in bed and sleep than read that new novel by my favorite author. All these reasons go through my head.
The Types of Bipolar Disorder
There is no clear consensus as to how many types of bipolar disorder exist. In DSM-IV-TR and ICD-10, bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. The DSM-IV-TR lists three specific subtypes and one for non-specified:
- Bipolar I disorder-One or more manic episodes. Subcategories specify whether there has been more than one episode, and the type of the most recent episode. A depressive or hypomanic episode is not required for diagnosis, but it frequently occurs.
- Bipolar II disorder-No manic episodes, but one or more hypomanic episodes and one or more major depressive episode. Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are without psychosis), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression.
^This one is me^
- Cyclothymia-A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. There is a low-grade cycling of mood which appears to the observer as a personality trait, and interferes with functioning.
- Bipolar disorder NOS (not otherwise specified)This is a catchall category, diagnosed when the disorder does not fall within a specific subtype. Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient.
The bipolar I and II categories have specifiers that indicate the presentation and course of the disorder. For example, the "with full interepisode recovery" specifier applies if there was full remission between the two most recent episodes.
The Treatments
There are lots of treatments for bipolar disorder. The usual methods are therapy, learned coping mechanisms, and medications. And oh, the medications!Mood Stabilizers
- Lithium: This simple metal in pill form is highly effective at controlling mood swings (particularly highs) in bipolar disorder. Lithium has been used for more than 60 years to treat bipolar disorder. Lithium can take weeks to work fully, making it better for long-term treatment than for acute hypomanic episodes. Blood levels of lithium and other laboratory tests (such as kidney and thyroid functioning) must be monitored periodically to avoid side effects.
- Depakote: This antiseizure drug also works to level out moods. It has a more rapid onset of action than lithium, and it can also be used for prevention.
- Lamictal: This drug is approved by the FDA for the maintenance treatment of adults with bipolar disorder. It has been found to help delay bouts of mood episodes of depression, mania, hypomania (a milder form of mania), and mixed episodes in people being treated with standard therapy.
Antipsychotics
By definition, hypomanic episodes do not involve psychosis and do not interfere with functioning. Antipsychotic drugs, such as Abilify, Risperdal, Seroquel and others, are nevertheless sometimes used in hypomania and some (notably, Seroquel) are used for depression in bipolar II disorder.
Benzodiazepines
This class of drugs includes Xanax, Ativan, and Valium and is commonly referred to as tranquilizers. They are used for short-term control of acute symptoms associated with hypomania such as insomnia or agitation.
Antidepressants
Seroquel and Seroquel XR are the only medications FDA-approved specifically for bipolar II depression. Common antidepressants such as Prozac, Zoloft, and Paxil are also sometimes used in bipolar II depression, and are thought to be less likely to cause or worsen hypomania than is the case in bipolar I disorder. Other medicines sometimes used to treat bipolar II depression include mood stabilizers such as lithium or Depakote, and occasionally Lamictal (although the proven value of Lamictal in bipolar disorder is stronger for preventing relapses than treating acute episodes of bipolar depression). Psychotherapy, such as cognitive-behavioral therapy, may also help.
Because bipolar II disorder typically involves recurrent episodes, continuous and ongoing treatment with medicines is often recommended for relapse prevention.
I currently only take Zoloft, but I'm thinking I may need to add something to it. I'm swinging kinda far and fast these days and I'm at the top dosing for Zoloft. Thankfully I don't think the anticonvulsants and antipsychotics are something I really need to look into.
What this means for you people
Honestly? Nothing. But here's something you may not know: bipolar disorder patients don't want to be bipolar. It's not fun. It's not cool and hip. It's not a neat way to get out of something. It's an actual disease that deserves the respect and treatment any other disease would get. If I said I had heart disease or cancer and needed to take medications but was refusing them I would be pressured by friends and family to take the damn meds! There would be no shame in seeing a doctor for one of those diseases or having to take medications for them. But a person with bipolar disorder happens to pop a pill in front of others or even makes a comment about their meds and therapy they get ridiculed. My favorite?"Just don't think about it. Just don't be depressed any more! I mean, I was depressed once and all I had to do was think 'Yea, this is dumb. I need to get off my butt and fix this!' and I was fine! I never had to take any stupid medicine. It's all in your head!"
Yea, it's all in my head and that's the damn problem! I can't just snap out of this! This isn't something you just wake up one day and go "Okay, I'm done with that! Let's do something else now" and skip merrily on your way. This is every day, all the rest of your life, always coping mental disease. If I didn't have to take the medications I wouldn't. But...this is me. This is who I am and what I do and how I do it. There is no shame in asking for help. There is no shame in taking medicine. The only shame comes from knowing you have a problem and refusing to get help for it.
Excellent post Kate.
ReplyDeleteNatalie Jewell