As I seem to have posted a lot this week I thought it only right to round off the week with yet another mind-dump. It’s been an up-and-down week, a right rollercoaster of high/low/high and I’ve really, really, not enjoyed it. Things have improved as the days have ticked by and I’m hoping that this weekend will be a chance to do a reset and refill my mental engine oil.
This week reminded me a lot of spoon theory. I suspect that the Berlin business trip meant I needed to borrow spoons many days in advance of their availability, and then I tried to do a full working week in deficit. Usually I am mindful of what I can manage, and lately I have been able to do more things without burning myself out – things like late nights on Mondays so I can go to the pub quiz or doing the food shop with hubs and dad.
My resilience has been lower this week than it had been in a long time. Little things – website malfunctions, Colleague X, an innocent but insensitive comment from a fried – have sent my anger meter sky-rocketing. I’ve been hypo-ish and/or mixed every day, but thankfully as each day passes I can see and feel things settling back to normal. I visualise it like the image below (hastily thrown together in MS Paint!), and I’m aiming to get the indicator back to zero by Monday morning so that I can get back on my best game.
The website is going to be undergoing a redesign in the near future which I am hoping will make things a little easier to find. Things like separating the blog, the creative writing and the ‘Spotlight On’ articles so you guys can navigate to what you want to see without having to trawl through articles. Whilst I’m thinking about it, don’t forget that you can have your say with the polls available via the menu button.
Gosh I’m writing a lot lately, and it is pretty much all just my own brand of self-therapy. If you’re sticking with the blog throughout all this rambling then I sincerely thank you.
I got transitioned to CMHT two weeks ago and had my first meeting with new psychiatrist today (also a Dr P. Can’t replace MY Dr P from the old team!), and it was hard fucking work. There was a waiting room and everything – it all felt so formal and predetermined. As if one new person to deal with wasn’t enough he also had a psych student observing, plus my care co-ordinator sat in too.
We went through pretty much everything in about 45 minutes. Hard to condense around 13 years of history into that little time, but we tried! He wanted to know about the earliest indications of illness, what kind of things put me more at risk, and the things that have helped in the past when things have been tough. Open-ended questions galore. I do much better with structured talking than having to give free-form answers; when I’m left to talk I feel like I miss the point I was trying to make and that my responses aren’t communicating what I wanted them to.
Going forward, New Dr P is planning to speak to the personality disorders service to get me assess for psychological intervention. It’ll involve having an assessment and then being referred to either DBT or psychotherapy, and this can only be a good thing. I took away a sense that he was interested in helping me build skills to cope instead of reacting to every blip with a medication tweak – this makes me happy. From what he was saying, the smaller mood-swings are less due to the bipolar element and more down to poor coping skills; rejection and stress and confidence and so on affecting me.
Luke is coming with me to my appointment with my CC next Tuesday – I want them to meet because Luke is normally the first to notice things going awry so it’ll be an additional layer of safety net for them to meet and talk. It also means I’ll have my greatest advocate with me which will hopefully give me some extra confidence whilst I’m still getting used to a new person. And in the long-term, this should all work out for the best. Right?
In the grand scheme of things it’s not too bad. I am functioning; even enjoying my weekend. I just lost – badly – at Monopoly, and it’s been a laugh. Things are (objectively) good. So why is there this nagging doubt somewhere in the back of my mind that something’s not-quite-right?
I just feel… distant. Removed, remote, unengaged. The feeling abates somewhat when I am engaged with something but when there’s nothing going on it comes back full-force, and it’s uncomfortable. I feel energetic but de-motivated. I kind of want to head to the pub and find a random person to drink and talk with until it’s closing time and I can simply crawl back into bed. Of course, the ‘good’ and ‘responsible’ part of me knows this is pretty unacceptable; this belief in doing the right thing leads to unwarranted guilt and extreme frustration. I want to rebel against my self-imposed rules.
Anxiety is a key feature of this mood that I’m not really sure I can define. I suspect it results from the internal conflict between wanting to do something out-of-the-ordinary and wanting to stay safe/play by the rules. It is unpleasant. I wish I was less conscious of ‘the norm’. On days like today I wish I hadn’t worked so hard on developing insight – if I didn’t have the awareness then I’d have an excuse to simply indulge the part of me that wants to cut loose. As it is, I know that I am potentially going to be a danger to myself if I throw all caution to the wind. But fuck me is it unpleasant to be constantly buzzing with a desire I can’t satisfy.
There’s a hint of the red-flags about this too – those red-flags that we committed to paper a couple of years ago to create a kind of checklist of things to watch out for. Things like voices. Things like Eve. Things that tell me that something’s up. Coping with them is fine; knowing they’re potentially problematic is healthy. One thing I should do is let Luke know all of this; as it happens I am terrified of letting him down so my cheat’s way out is to write this post and communicate with him this way. I am sorry that I am still so hopeless at actually vocalising these things.
Part of me is feeling a little un-supported by any professionals. My time with Early Intervention ended a couple of weeks ago at a handover meeting and I am now under the care of CMHT; I have met my new care co-ordinator once and although I could text him I am both cautious of doing so and unsure that this feeling ‘off’ warrants making contact. On the grand scale of things, on a one-to-ten rating system with ten being my worst point, I am probably around a two. Maybe a three.
And I’m sure – or trying to convince myself, who knows – that this won’t escalate. If I believed in a God I would be praying for a small blip on the radar of health. If I beg the universe with as much positive thought as I can muster, the delusions will stay away, the hallucinations will remain unobtrusive and Eve will stick to her position of mental-passenger. Please.
So, it turns out that keeping track of medication and changes is a useful thing to do. Lately I’ve been feeling somewhat low; kinda-almost-but-not-quite depressed. I was chalking it up to being just one of those things but then the keeper of the medication (aka the husband) reminded me that until about two weeks ago I’d been taking 100mg Sertraline – sorry Doc P, we know you dropped it to 50mg a while back but we forgot to change it down. Sertraline, for the uninitiated, is an SSRI anti-depressant which is known as Zoloft in the US. Like many anti-depressants, it has magical powers that are sometimes too magical – sometimes, for people like me, it sends a person too far ‘the other way’ and triggers hypomania or even full-blown mania.
For me it was somewhere on the spectrum of low-to-mid range hypomania. Not awful, but definitely noticeable. So that’s why Doc P decided to bring it down when we added a mood stabiliser to the equation in the hopes the lower dose would work out better. Probably worth mentioning that when I first started sertraline I was tried on 50mg and it simply wasn’t enough to be therapeutic, so that’s why we bumped up to 100mg. Gosh, this whole meds thing is so confusing and delicate; not made easier by my hyper-sensitivity to weird but not wonderful side effects (yes, I am the girl who was knocked out by a single dose of aripiprazole on the way up the stairs to bed. Also, risperidone gave me incredibly high levels of prolactin and my body reacted as if I were pregnant. Weird.)
When we realised that I was still taking the higher dose a couple of weeks ago we immediately switched to 50mg. To be honest, the 100mg was working but we’re following the Doc’s advice here. We’re not experts on the whole medication malarkey! The lesson here is that I need to be closely paying attention to the changes that happen in my mood and symptoms when meds get changed. It’s taken two or three weeks to realise that this current slump in mood could well be directly related to the reduced dosage.
Of course, this happens whilst my CPN is on leave, but I’m not so bad that I need to call the office and speak to my Pdoc. It can reasonably wait till she’s back (and that’s only tomorrow, so definitely no panic). I don’t know if it’s worth asking to try 100mg again when I know I’ll most likely swing back into the hypo range of moods. Maybe a different anti-depressant? Citalopram is the only other one I’ve been on and wow was that a bad experience – back to the weird side effects; everything I ate tasted greasy and (less weird) it spun me into an extreme mania.
Going forwards from here I know I’ve learnt something; I know I need to be more on top of things when bits and bobs change. Things like going back to diarising moods and meds and various other factors sounds like a good idea. Hopefully next time we change something it’ll finally be the last piece of the puzzle and I can get back to functioning properly!
One of the key features of a hypomanic or manic mood for me is the incredible 180 my mind takes when it comes to routines. Typically I am a homely creature; I like working regular hours and coming home to make dinner for my beloved. We go out, sure, but normally that looks like doing the pub quiz on a Wednesday evening – and even then we’re usually home by half nine. I tend to be satisfied with my job, with my status and income.
But wow, doesn’t that all change when my mood does. The idea of going home to routine sends me frantic (not exaggerating). The steady 8:00 till 4:30 of office work doesn’t challenge me nearly enough. The cups of tea by the fire I usually so enjoy when I have alone time are replaced with alcohol – not to excess, but enough that I feel like I’ve rebelled a little.
It is a mental rebellion of the strangest kind. The studies all say that bipolar mania includes risk-taking behaviours and I see that in myself when I am running fast. Thankfully I don’t seem to become hypersexual, I don’t turn to drugs and I don’t go parachuting. But the lust for change and excitement that lurks behind the need to take risks drives me up the wall.
It becomes a mental battle of wills. The aspects of me fighting each other – my intellectual knowledge that I really should <stay home>/<meditate>/<take a bath> vs the impulsive side that craves <a night out>/<a night-time walk>. And it is beyond frustrating; it often gets to the point that I am raging angry with the people around me who are trying to keep me safe.
Really, it’s no fun. Taking Freud’s model, it is classic Id vs Ego and Superego. My need to find adventure is contrasted by the sensible thinking me; the me that wants to keep within respectable, ‘normal’ behaviour as dictated by our respectable, normal society. Even writing this now I am finding it hard to describe the levels of annoyance that come with temperance.
I know it’s not just me who experiences this urge to ‘be bad’. Taking an extreme example; a study published on the National Institute of Health library site suggests that 8.4% of individuals with bipolar committed violent crime – this is contrasted to the control population study that found the incidence of crime being committed to be 3.5%. The brain seems to be the cause of this increased risk taking behaviour. A study by Manchester University last year found that there was a dominance of the brain’s ‘pleasure centre’ when assessed using fMRI scans.
Knowing the possible causes does not make things easier however. All I can do is attempt to channel the energy that comes with the impulses into productive activities; baking bread, achieving targets at work and exercising. Unfortunately being a good girl isn’t as satisfying as the acts of rebellion, and I have no idea how to get over this particular bump in the road.
There’s a lot of publicity surrounding mental health awareness, and the mission to bring the general public to a better understanding of mental illness grows stronger every day. The fact is that mental illness sucks, but it’s not all doom and gloom. Here’s a few things that make it a little better for me each day (unfortunately they are in no way a reward for the struggles we face).
Depression has taught me empathy.
I am highly creative when manic.
My productivity and output at work benefits from hypomania.
Understanding delusional beliefs gives me insight into my own psyche.
I have a passion to make the world a better place.
My supporters have shown me true love (parental, societal and romantic).
I can relate to my father in a real way by understanding what it means to be depressed.
Writing is my outlet and I’ve been getting better at it.
Therapy has given me great skills and taught me how to be kind to myself.
I learn a lot about anger and sadness through my ‘alter’ – I am able to observe her pain and talk to Her about it. (Still not comfortable calling Her an alter, but I guess it’s as good a word as any!)
I get to see the world as a vibrant and exciting place.
When depression lifts I get to feel pleasure in things in a meaningful way.
What are the benefits you see in your mental illness? I think it’s harder to see the ‘good’ in relentless depression than it is to see it in bipolar disorder. And I’ve not got personal experience of any personality disorder, so I’m definitely not qualified to comment there!
We’ve come to call these little trip-ups ‘blips’. It’s our euphemism for ‘maybe it’s a little rough at the moment’.
Blip: an unexpected, minor, and typically temporary deviation from a general trend.
Yes, that’s the right word then.
This blip is coming up on two weeks old. In the grand scheme of my three years since initial melt-down, two weeks is nothing. Compared to the long months it took to get stable initially it’s no big deal. Right?
The problem with a blip is that it feels a lot like failure. During it, it very much feels like the health I’ve fought so hard to gain is gone for good. In the moment, when dysphoric and anxious, the term blip offers no solace.
My CPN has suggested that I panic when faced with a blip. Another euphemism here – we call it ‘having a wobble’. The issue lays in the way my mind catastrophizes a very simple thing. So your mood is elevated? You’re definitely going to end up back in crisis care!
There’s no real reason for me to believe that this minor episode won’t pass innocently by and I should probably have faith that I’ll normalise in a week or so. It doesn’t stop the worry, the anxiety, of being unwell again. It’s one of those things that always stays with you after the experience has ended. Mania = psychosis = crisis.
I’m not even sure this blip is bad enough to warrant calling the team. With my CPN on holiday this week, I don’t want to waste the psychiatrists time over what is potentially nothing. On the other hand, maybe the sertraline is kicking my mood up a notch. We’ve long been aware that 100mg is my therapeutic dose; but it also has a tendency to send me high.
The balancing act of staying well is tough. I’ve been getting better at it but it’s taken a lot of trial and error along the way. For now, I will continue to track my mood, watch for the red flags and hope this passes without incident. Fingers crossed.