I Don’t Know What I Want

The frustration is the worst thing about days like today. In all honesty, I am pushing myself further than I should and trying to achieve a goal that ultimately doesn’t really mean anything. Pushing myself to the limit because I don’t want to leave my colleague to cover my Friday afternoon jobs (report, report, repeat). A bit of reflection over the past three days highlighted a possible link between slow days at work (read: under-used, under-valued and generally b o r e d) and heightened mixed moods. Today goes against the grain; I’ve been a busy, busy woman playing the high-powered executive that my mask demands yet I am finding myself drifting into the muddy waters of mixed-mood.

Back to that frustration then. It’s hard to write eloquently about it because it is so confusing. It is the conflict between doing what I ‘should’ do and wanting more. I work so hard at just being a regular person who can do a regular job with regular hours. It is this kind of mood that leaves me yearning for an adventure, needing to rebel against the 9-5 existence and break free. I am sick of fighting with myself. You can’t let anyone down argues with screw the lot of them. And I honestly don’t know what to do about it. I know that it would be a lot easier to just allow myself a little slack in the reins; I keep them pulled tight out of a sense of obligation to society to fit in.

On my referral to the Personality Disorders team I had to answer a few questions about the things I wanted to achieve from talking therapies. I can’t remember my exact words but I wrote a lot about wanting to learn how to be satisfied with what I’ve got, about feeling trapped by my wonderful life. Writing this out now feels like a betrayal of my husband who I know will read this; once again I feel like admitting things is hurting him. There’s nothing in the world that makes me happier than being with him. So why this need to bust open the back door and invite the world for a party?

I Don’t Know What I Want

Is It Just Me, Or Did The World Just Slow Down?

One of those things familiar to anyone who has lived with hypomania or mania is the feeling of time standing still around you, whilst you whizz through the world at top-speed.

Time drags on. You look at the clock every few minutes and you’re surprised that you’ve got so much done in a matter of moments. On days like this (taking Friday as an example) I can process 36 emails in 20 minutes; and even then it feels like I’ve not worked at full capacity. My 100 mph brain is relentless in presenting myriad thoughts in quick succession. There’s barely enough time to register thought one when thoughts two, three and four come flying in for consideration.

Even Twitter can’t keep up, which really should serve as an example of just how quickly my brain flies through the day. I am forever grateful to Twitter for serving as an outlet for the random thoughts that I feel the need to express; I am also apologetic to those who have to read them (I don’t mind if you don’t!)

The other thing that happens – along with Father Time hitting the pause button – is a certain vividness that takes over the planet. It’s like I just switched from an old television to a Full-HD, 3D, ultra-clear-and-bright screen. On a day like today that is gloomy and overcast, I see the world as if it were a 28⁰C midsummer’s day. The pine trees are glorious green with wonderfully contrasting brown trunks, and the grey of the building is more akin to shimmering silver that is truly eye-catching.

I’ve refreshed my inbox at least ten times since I began writing this post. Nothing’s happening. I check the spam folder in case something interesting pops up. Still nothing. The benefit of this kind of hypomanic mood is that I am incredibly productive; with the caveat that I find it impossible to stay focussed for very long. In the little bursts of attention I get so much done though, that it hardly matters that I don’t stick with a task for more than a few minutes.

All in all, I love this kind of mood. Sure, it can be a little overwhelming, but the benefits far outweigh the discomfort. I pray to a God I don’t believe in that it stays steady; that it doesn’t go overboard or turn to a mixed mood. Whatever happens, I will thank my stars that at least one aspect of this diagnosis has a benefit.

Is It Just Me, Or Did The World Just Slow Down?

Spotlight on Bipolar

Bipolar is the modern diagnosis of ‘manic depression’. There are people out there who prefer the old way of saying it. The bipolar label just isn’t as descriptive of the issues faced by those diagnosed with it.

Bipolar disorder is characterised by extremes of mood. There are varying degrees of it; from cyclothymia (more chronic but less extreme), bipolar I and bipolar II. All forms feature a mix of depressive and manic episodes, but the severity of the episodes can vary between diagnosis.

Bipolar I is a disorder in which the person experiences full manic or mixed episodes. They only need to have experienced one manic episode for diagnosis to be made, the severity of which causes impairment to everyday activities. The manic state is characterised by extravagance, grandeur, elation, pressured speech, irritability, reduced need to sleep, along with potential risk-seeking behaviours. There should also be, during a depressive episode, at least three characteristics of major depression.

Bipolar II is differentiated from BPI by the absence of full mania. Instead, the person can experience hypomania that lasts at least four days. The depressive state can be the more common and the intervals of well-being are generally shorter.

The risk of self-harm and suicide is increased in those with BPII, and especially those in a mixed-mood state. This can be due to an increased motivation to engage in risk-taking behaviour, coupled with depressive hopelessness. Substance abuse disorders have high co-morbidity with the bipolar disorders.

Treatment for bipolar disorder involves the use of medication. Mood stabilisers act to suppress the swings between highs and lows. In addition, an anti-depressant can be used to combat the depressive episodes, especially in those with BPII. Some atypical anti-psychotics also have a mood stabilising effect.

Talk therapies such as cognitive behavioural therapy can be used to support well-being and help the sufferer with learning skills to cope, triggers and help with awareness of early warning signs of an episode.

Living with bipolar can be a challenge. Episodes of depression and mania effect the ability to conduct everyday life.

Spotlight on Bipolar

The Why Me Moments

It happens to all of us. Whatever illnesses we face, there comes a moment in which you ask ‘Why Me?’ Whether you believe in God/Gods/a higher power or not, it is a question that comes up for pretty much everyone with chronic conditions.

Getting down to it; I’m having a ‘Why Me?’ moment today. I’ve been feeling pretty good lately (read: normal mood, normal appetite, and normal sleep). Since my last crisis in December and the big medication shake-up things have been running pretty smoothly. I’ve felt… normal. First time in three years I’ve not had to battle hallucinations, delusions, rage, hopelessness, frustration – I’ve not been fighting to live a normal life. It’s been a wonderful respite and it has been gratefully received (thank you olanzapine).

Was I foolish to hope it would last? Was it naïve of me to think we’d finally cracked it? I’m starting to think the answer is ‘yes’. It’s one of those things that starts gradually – with a little experience I’ve started to have more insight and more awareness of when things aren’t on such an even keel – but it quickly gets to be a problem if I don’t make my support networks aware of the issues.

Having said that – it’s been a week tomorrow that I’ve noticed these subtle differences in my mood and today is the first day I’ve told anyone. Bad move I guess. The anxiety is ramping up every day too. I’m simultaneously tired and hyper (not sure how that one works). I am finding my patience thinning out and my internal anger building up. The temptation to engage myself in retail therapy is there. Red flags the whole way down.

It’s a Why Me moment. The cycle propagates endlessly and I can’t seem to beat it. I can find respite for a few months at a time but then I feel like I regress back to square one.

Counting my blessings helps. I have a lovely, supportive husband who will do whatever he can for me. I have a great psychiatric nurse/care coordinator who genuinely cares and listens. I’m still in work and seem to be finding success in the office. I have greater insight these days and can spot the episodes rising. And, thank heavens, I’m not hallucinating or delusional or paranoid.

This rollercoaster keeps throwing up loop-the-loops. Stop the ride, I want to get off.

The Why Me Moments

Spotlight On Depression

So often in life I hear the phrase ‘I’m so depressed.’ Around the office, in public, with friends; depression has come to be the buzz-word of choice for emphasising just how sad a person is. The fact is real depression is not just sadness. Whoever decided to call it depression rather missed the point.

A huge number of people are affected by depression worldwide. The stats are something like 1 in 4 people will either suffer depression or support someone who does in the course of a year. But depression is a mixed-bag diagnosis just like other mental health problems and it doesn’t affect everyone in the same way.

Most of us have experienced situational depression at some point in our lives. This can be linked to life events such as the breakdown of a relationship, loss of a job or bereavement. It is short-term and usually has an onset within three months of the event that triggers it.

The DSM (Diagnostic and Statistical Manual of Mental Disorders) outlines the criteria for Major Depression. The symptoms can be the same for situational and clinical depression – the difference lies in the impact it has on normal life. For a diagnosis of major depression the person will have at least five symptoms simultaneously, and those symptoms will be severe enough to prevent their engagement with regular living.

The symptoms can vary depending on the individual and includes sadness, hopelessness, anxiety and worry, lack of concentration and lack of pleasure (anhedonia). There is usually a withdrawal from normal work, leisure and social activities. For some people, suicidal ideation is present.

Treatment for depression can include the use of anti-depressants and talk-therapies such as CBT (cognitive behavioural therapy). In very severe cases ECT (electroconvulsive therapy) can be used. This treatment uses electrical stimulation to induce seizures and is administered under general anaesthetic. It has proven to be very effective (mind.org.uk suggests that 74% of people treated with ECT responded positively), but is a last-resort option.

My own experience with depression started when I was 13. In the last few years I’ve battled with mixed mood episodes that have landed me in crisis care twice. A mixed episode for me is characterised by rage, restlessness, agitation, hopelessness and suicidal ideation. Commonly I have experienced a total inability to see past the present; a feeling of no hope and no future.

I read somewhere (Matt Haig possibly?) that depressives do not wish for happiness, they just wish for nothingness. Happiness is a luxury. A good day can mean a day in which symptoms are mostly absent. A bad day is the kind where the symptoms are overwhelming and feel endless.

I would love to hear of your experiences with depression. Connect with me on Twitter @dontsayimcrazy – or leave a comment below.

Spotlight On Depression

Spotlight on Mania

I was thinking of doing a post on Bipolar, and still will, but I think mania and hypomania deserves a post of its own.

Mania is a state of mood associated with an elevated energy level. The polar opposite of depression (not withstanding mixed mood episodes) it is often distinguished by heightened irritability, rapid speech and racing thoughts. Hypomania is the term given to a milder occurrence of this. Those in a manic episode are often wildly productive and creative. There is a feeling of being able to take on the world and a heightened sense of self-esteem. Sleep often falls by the way-side. Another hallmark of mania is indulgence in high risk activities – hypersexuality is an example of this.

As well as these features, a manic episode is defined as lasting over a week continuously and causing a negative impact on the persons’ ability to conduct day to day living. This would include causing difficulties at work and in social situations.

Mixed mood is defined by co-existing symptoms of mania and depression. One of my favourite words in the English language is ‘dysphoria’; think of it as the high of euphoria with the hopelessness of depression. Dysphoric mania describes a mostly manic state with depressive symptoms. The other version of a mixed mood episode is agitated depression – a major depressive episode with hypomanic symptoms. Mixed mood is associated with higher incidence rates of suicidal actions, as the mania imparts a motivation to act on ideation.

My experience of manic and mixed episodes has always been characterised by the perception of the world as ‘high-definition’ and ‘Technicolor’ – the world becomes like a movie in the cinema where the volume is too loud and the screen is too bright. Sleep becomes an elusive thing; during my first episode of mania I not only didn’t feel I needed to sleep, I also didn’t want to as I saw it as wasting time. Thankfully I never sought risks whilst I was manic, but I did turn to self-harm as a way of coping with the overwhelming, racing thoughts and energy.

Mania is a wicked beast. It brings great feelings and low insight. I’ve written a bit on here about the way I would insist I was better than great whilst in a manic episode. It took the people around me paying attention to the warning signs to get me help.

I would welcome comments on how mania has effected you. Or connect with me on Twitter @dontsayimcrazy.

Spotlight on Mania