Change in Moods

For those who follow me on Facebook or Twitter, you probably already know that I’ve been Manic for the last month. I’ve been running simple and complex decisions through friends’ minds because I didn’t trust myself not to **** up. I don’t like being Manic, partly because I haven’t been Manic in 4 years and did things I regret 4 years ago. And looking through my past I see things I did while I was Manic that were of varying levels of appropriate and good or bad things to do. My decision-making ability and energy levels go wacko when I’m Manic. I don’t like feeling so out-of-control!

Over this past weekend, suicidal thoughts increased suddenly and rapidly. And energy capacity dropped. And I was able to tell the difference between an easy decision (should I have diet coke with lunch?) from a hard decision that requires a lot more time and thought (should I foster kittens for a shelter? [Sadly, no. Not the right time or place.]).

I saw my psychiatrist today and we talked about the mood shift. I wouldn’t say I’m depressed, except that my concentration ability and motivation have tanked, suicidal thoughts are through the roof again, and my energy feels drastically lower. (All things that are characteristic of depression.) I did qualify that my energy might just be normal and I’m comparing it falsely with the unreal, increased energy of Mania.

The reality, she told me, particularly regarding the suicidal thoughts, is that I am doing absolutely everything right and need to ride the wave of my illness. It’s cyclical and there isn’t anything I can do to control the symptoms. I use my finely tuned coping skills (particularly from Acceptance and Commitment Therapy, but also Dialectical Behavior Therapy and Cognitive Behavior Therapy) regularly and often. I know when and how to use them. I know when it’s time to call people, go be around people, or get together with people. I know when to call my therapist or psychiatrist and I know when to go to the hospital. I participate regularly in group and individual therapy. There isn’t a whole lot more I can do. She reminded me that the hospital is there and entering it is not a sign of failure if I need the safety. She reminded me that I’m doing what I need to (exercise, eating and sleeping well, socializing, using my brain) and to just keep putting one foot in front of the other. She also said that I don’t tend to respond to medications to help me through the shifts, but that I wait them out and then go back to those actions listed above that make for a full life and one that is full of coping.

So, this is a mood change. Went through one in July when I suddenly went Manic. Anxiety kicked in hard and sent me to the hospital for safety until meds started bringing me back down. Now I’m cycling downward – as my tendency is for these first few weeks of September. Anxiety was high, but has gone back to normal (my normal).

body surfingI will try to use the physical sensations of body surfing that I remember from my 30 years in CA to help me ride these mood shifts. And as I keep using skills over and over and over again. I’m doing absolutely everything I can. My doctor and therapist reaffirmed that in this last week. Remember to let the wave push you but it doesn’t have to roll you.

I’ve complained on Facebook on a day when suicidal thoughts were so bad that all I was doing was using skill after skill to keep from hurting myself and to keep myself out of the hospital. On days like that (like today) it feels like a waste of time I could be doing other life-giving activities that move me toward my values (an ACT-ism that I find helpful). Body surfing feels like another pointless way to waste time that I could be doing something productive and life-giving to me, instead of using skills and surfing the mood shifts just to stay alive.

Bipolar Sucks.

In case you haven’t heard me say that in a while.

 

A Familiar Feeling in the Mania

As I’ve struggled this past week with Mania rising again (pushed along by the prednisone for the rash, my dr says), I’ve experienced what I missed most about Manias Past: the mystical feelings of oneness with the world and the ability to foment ideas that could solve problems well beyond a normal person’s life or ability. I haven’t reached the very top yet, but I’ve seen it. And the heightened senses and sensitivities (even the skin) are very much a part of Mania for me. I just haven’t put those pieces together before, since this past month is the first time I’ve experienced Mania since being medicated for and educated about Bipolar.

Part of me is enjoying the wave. “Oh boy! I remember this. This is fun! There is purpose, and mystical unity which feels so good.”

Part of me is scared $}!~less. What if this goes higher, or I start behaviors with difficult consequences? I need stability. I know this. Sane me knows this. Sane me hates the Mania that clouds my thinking, possibly all the way to delusions and grandiosity. I don’t have energy, means, or cushions to fix manic consequences.

Then there is the potential mixed state where I’m feeling Manic AND Suicidal. All I need are obsessive suicidal thoughts (as happened in July) to be in danger of fatal consequences. If I’ve got the energy and grandiosity to pull off an act (Mania symptoms), and the OCD obsessing about suicide (don’t have to be depressed for this), then I could be in danger. Sane me jumps into coping skills and support systems. But a trigger that starts the obsession, could just as easily cause a delusion that skips coping skills and plans suicide with the obsessive visions in my head that the OCD gives.

Cue a death in the community this week (previous post). Just the kind of trigger that has caused confusion and ruminating. So far Sane me has been in ascendance. Let’s hope she stays. I wish I knew the way to keep her in ascendance.

One of Our Community Is Gone

Last night word circulated through news sources and social media that Robin Williams completed suicide. He was 63.

Every time a famous person dies, there is public mourning. This time an especially at-risk population mourns while they are triggered. Mr. Williams talked about his depression and addiction. Those in the mental health community remember their own struggles with pain and thoughts that suicide could be an end to that pain. Natasha Tracy speaks about this: Dealing with Depression in the Wake of Robin Williams’ Death.

If you need help right now, contact someone, anyone, or call the US National Suicide Prevention Hotline: 1-800-273-TALK.

This morning, after spending yesterday OFF social media and news because I was so triggered, I’m annoyed that people don’t understand why I’m still triggered.

My thoughts?

1. Natasha’s article helped normalize my feelings and response – yes, one of our community is gone by what we alternately fear and fantasize about. But we celebrate his life and celebrate each other’s life.

2. I hate that I’m still so triggered that I’m thinking about suicide.
I hate that I’m not sure if I’m safe going for a bike ride because my thoughts are disordered from being in a mood transition.
I can distract myself for a little bit.
I hate that the distraction is not enough to reset my thoughts away from suicide.

The mania I’m experiencing makes energy and completion real possibilities. The trigger makes death seem like the only way out of the pain.
I understand. Oh, how I understand!

Community is safety.
Secrecy is the lie our brains tell us because many have told us thoughts and actions are shameful.

I still don’t know if I can ride my bike.
Sitting here doesn’t make it better.

Mania Rising

So, a couple weeks ago I started getting a rash. Didn’t put it together with the mood stabilizer I take that has a common (that can lead to fatal) rash that means an allergic reaction. From mid- to late-July, the dose of the mood stabilizer was nearly doubled in order to ward off a Manic Episode. (See Summer Hospitalization and Summer Hospitalization, Part Deux)

The rash was not getting better, started getting worse and then spreading. I worked hard to get in to see my primary care doctor (which apparently is nearly impossible now). Finally was able to see someone in the same system who gave me some cream but still thought the rash could be allergic in nature. And because the mood stabilizer was the last medication futzed with, the likely culprit.

Next day, the rash was still getting worse and spreading. I called my psychiatrist who unwillingly removed me from my mood stabilizer so that the rash didn’t turn into the potentially fatal rash that can happen from that drug. She hopes once the rash clears up we can go back to the same med since it’s the only mood stabilizer that has worked for me in the 4 years of trying mood stabilizers. She recommends getting  prednisone from my primary care dr to help clear up the rash faster. (Cue same problem as the day before, trying to get in to see a dr. Ended up seeing the same dr who finally prescribes a prednisone relative.)

NOTE: August is a High Time for me to go Manic and Impulsive, and therefore a bad time NOT to be on a mood stabilizer. My psychiatrist and therapist and I know this. I’m scared to death I will quickly switch to mania and do something really stupid through unclear thoughts. I’m especially scared since I had started to become manic in July which started the whole hospitalization thing last month that led to an increase in my mood stabilizer – which WORKED and I was balanced again.

You may be thinking to yourself, “Well, your psychiatrist can put you temporarily on another mood stabilizer to prevent mania.” Au contraire! I have tried just about everything out there and this mood stabilizer is the one that I can tolerate, works, and doesn’t give me horrible side effects. All others have been tried. A couple could be tried but could not reach therapeutic dosage in time since I have to stop the other one immediately. My dr hopes we can try this one again once this rash clears up.

So, since Thursday, I’ve been worried about going off the mood stabilizer so close to the time I finally got the dose increased to prevent mania. Here is the sequence of my time since then:

Friday Evening: 24 hours without mood stabilizer. Brain feeling funny, twitchy (which could be the prednisone too…), but no mood shift so far. More likely it would be the weekend or early next week that I would feel any shifts.

Saturday Noon: Feeling impulsive. Slowing myself down with schedule and rules. (Tricks that also help with living with anxiety.)
1. No buying anything.
2. Laundry
3. Gym
4. Start researching my blog posts for stuff that could be good for a book (not for publication, just self-understanding based on what I know now that I didn’t know 3.5 yrs ago when I started it).

Saturday Evening: Made it through laundry and workout. Now in post-workout recovery/hangout in the gym’s cafe.
* Each minute is lightening speed and endless, simultaneously. I’m anxious, fearful, nostalgic, emotional, and thoughts all over the place. I’m impulsive and working Really Hard to stick to the plan, stick to the plan, don’t deviate, don’t deviate.
* Holding on tightly by my fingertips is not going to last forever. I’m not sure how low or high this will go.
* “You are watching the onset of mania, friends. Glad I can be a teaching moment.”

Saturday Night: And now I and my manic self will attempt sleep. A feat which has not been a problem in previous manic states, but this one feels different.

Sunday Morning: Just up and thoughts racing so hard and fast it hurts. Energy pounding through heart and limbs.

Mania releasing.

Summer Hospitalization, Part Deux

Yes, I was again in my favorite psych hospital, for 6 days this time. I had a good 4-5 days after the last hospitalization. Strong. Back on track. Feeling good. Still a bit wired, though. But racing thoughts manageable again and suicidal ideation back to a dull roar.

Then I had an anxiety attack on that Thursday as I was getting ready to go to a concert. I was going alone, but knew I would have a great time once I got there. The anticipation of driving 30 miles on routes I didn’t know and to a venue I didn’t know set off high anxiety. I even considered not going.

BUT, using my ACT (Acceptance and Commitment Therapy) skills, I put the anxiety in the back seat and let it ring like an annoying phone and went anyway. Soundgarden and NINThe concert was important to me on a lot of levels (i.e., my ex would have loved to go and we would have had fun but I could have fun on my own too). And yes I had an amazingly fun time at the concert! Dancing, yelling, enjoying good, fun music, and memories of discovering the bands for the first time.

I planned the next day just to lay low. I felt like I had a hangover (I had had nothing to drink, mind you). An anxiety hangover. By the end of the day when I went to my friends’ house for dinner, I felt better. Noticed I was still talking quickly and more than usual – for me.

Saturday dawned, I had my monthly massage, I went to a movie I was looking forward to seeing (not an emotional movie), and expected to go to a MeetUp group after the movie. In the middle of the movie, however, I started bawling and had serious suicidal ideation with intent. I focused on the movie as best I could. After the movie, I called my therapist from a quiet place in the theater and went to my car to await her call back. I didn’t feel safe driving, as crashing my car was one of the strongest visions I was having of hurting myself. We agreed that I would call a friend to drive me home to pack for the hospital and a friend would drive me to the hospital. The anxiety was still mixing with the beginnings of mania that had not quite resolved (see Summer Hospitalization).

This time I felt anxious and manic. The doc I see on the inside is a colleague of the doc I see regularly. They used to argue amiably about what meds to put me on and change. It’s a running joke when I show up in the hospital that we are continuing the feud. At least his jokes lighten the mood of our brief consults!

So, increased med for anxiety, increased mood stabilizer for mania. Stir. Wait a few days. Reduce some of anxiety med. Wait a few days. Discharge!

I feel so so so much better! The energy I had after hospitalization a few weeks ago is gone. So I think we got the oncoming mania under control. My anxiety is better medicated to help me come down from the concert anxiety and, I hope, to help me deal with other activities in my life I’d like to take part in but that anxiety is strong enough to keep me away.

An important outcome of these 2 hospitalizations, and the reflection with my therapist in the middle of them, is the reality that I cycle through several moods a year. A rapid-cycling bipolar person has 3 mood shifts a year. I think I have 8?

  • Early – Mid January – depressed (post-Xmas)
  • Late January – balanced
  • February – depressed
  • Early March – balanced
  • Mid March – April – depressed
  • May – June – balanced
  • Mid July – August – manic
  • Early September – depressed
  • Late September – Mid October – manic
  • Late October – Mid November – balanced (sometimes  just hypomanic)
  • Late November – Mid December – manic
  • Late December – depressed (post-Xmas)

And the cycle starts again. This has gone on for at least the last 5 years. I can look back further and see many of these shifts most years of my life starting as a teenager. I Am A Rapid-Cycling Bipolar Person! I and my Care Team will have to follow this schedule to adjust meds appropriately and try to avoid hospitalization for the med changes.

Summer Hospitalization

So, a week ago I started thinking about the psych hospital I usually go to, thoughts that have almost always led to a hospitalization. (Begging the question: Do I intuitively know when it’s time, or are the thoughts a self-fulfilling prophecy?)

Then, on Monday I started having an unusual amount of suicidal thoughts, some bordering on obsession. I noted it and knew I would call my psychiatrist if the thoughts got worse.
The thoughts got worse.

Tuesday morning while working out in the pool I realized how I was obsessing about suicide, had a rather sudden increase in energy and my racing thoughts increased velocity and were becoming more muddled. I feared how the obsessions were part of the muddle and also part of the clarity that occasionally occurred. And with so much energy I might/could follow through impulsively.

And so I called my psychiatrist who, instead of adjusting my meds over the phone as I expected, sent me to the hospital to get an assessment. Which 95% of the time has led to hospitalization.

I felt so defeated. How was I ending up in the hospital after only 3 1/2 months? That time frame was my usual M.O. I thought we had not only started a new chapter, but opened a new book where I lived a life without hospitalizations.
The only difference this time was that I was displaying manic symptoms instead of depression symptoms. All of my hospitalizations in the last 4 years since diagnosis have started with suicidal depression.

Good news! I was only in the hospital 92 hours with only one small tweak in one med. Had strange symptoms of random body movements due to excessive energy (and not working out every day?) and extreme sensitivity to sound. Sound physically hurt! And the unit was crowded because of a high census and there were some people who always have an opinion on everything and need to share it. At great length. Repeatedly.

Bad news! I’ve been out for 7 hours and still feel institutionalized, that feeling of being in an alternate reality with different and very structured rules and expected behaviors. Taking meds is harder in the hospital because the computers mess up what I take and when I take it, making me on high alert the whole time that I’m getting what I need. Then there’s the constant foul language and talk of alcohol and illegal drug use, even though all of it is verboten. And the misogyny among the male patients. Do you want your sisters, daughters, mothers talked about that way???

I’m glad it was a short stay. I’m glad it was one of my easier stays. I’m glad to be back in my regular environments and that I can trust myself in them.

Here’s hoping we can catch any other mood switches faster and change meds without hospital intervention. I thought I was catching it early and calling my doctor quickly. I guess I need to call on the first day of any symptoms. But it seemed like an anomaly. Maybe we don’t know whether it’s an anomaly or a pattern until it’s a bit too late because the tipping point of the mood change moves quickly.

Days in the Life – Not Up to Par, But OK

I haven’t written in a while because my days are dictated by a new routine and brainstorming solutions to a new health problem.

ellipticalI am exercising 5 days a week – 3 days in the pool, 2 on an elliptical. My care team reminds me that first and foremost reason I’m doing this exercise is for my mental health, and weight loss is secondary. I tend to think of it more as the routine is for my mental health, and the movement is for weight loss. I do not feel, nor have I ever felt, endorphins after exercise, no matter how hard or how long I exercise.

But I have a medical problem with the exercise. My lungs and windpipe hurt after a work out. I have asthma and it is completely controlled except for exercising. I’ve been taking albuterol before I exercise and it only helps sometimes. My current pulmonologist thinks bariatric surgery will help. Um, what??? How will that help my windpipe??? He had already referred me to a cardiologist for pulmonary hypertension, which we discovered I Do Not Have after an invasive angiogram.

So, I’m getting a second opinion. I’d like to workout to capacity and not have to take the intensity down several notches so that I don’t cause an incident with my lungs. Dealing with this medical issue (since mid-May) has taken an awful lot of mental energy, increased my anxiety, made me scared to exercise because I could hurt my lungs. All that’s not helping my mood, really.

Meanwhile in MoodLand, I had a plunge in mood in mid-June, two weeks after a change in meds. Called psychiatrist and upped one med back to where we started and I seem to be better now. I see her today for a check-up. I’m doing better, but I am having trouble with mood with having enough to do each day to keep my mind active even though I feel like my mind has its arms tied behind its back with the difficulty in memory, focus and concentration. I need more social interaction too. Taking exercise classes helps with social activity, but those are very superficial conversations – not the kind of real social interaction I crave. Intellectual stimulation and social interaction – crucial for my mood stability. I’ve applied to volunteer a few places. Starting over with work-related activities to see if that will help on both accounts.

So, I’m mostly stable, but still room for improvement. Overall, a decent place I think.