Bipolar: The Facts

All this time I’ve been talking about bipolar, mania and depression...but I’ve never actually formally described what these things are. I suppose I have assumed my expression of the experiences I have had have provided a description of the disorder. And I do believe experiences trump a cold clinical description any day. But there is so much misunderstanding and stigma surrounding Bipolar disorder, so today I thought I’d look at the facts. :)

Bipolar disorder is a universal mental illness. It doesn’t discriminate. People of all ages, nationalities and from all walks of life can experience bipolar. Perhaps this is due to the genetic component of the disorder. Scientists have identified several genes, including the Dysbindin, Neuregulin and G72  genes which when damaged contribute to Bipolar disorder. As such, bipolar tends to run in families, although episodes can be triggered by significant stressors, and in women, childbirth. It is estimated that about 1.1% of the population suffer from bipolar disorder

People with bipolar disorder are 50 times more likely to commit suicide than the general population. That is huge. The suicide rate for the average population is around 0.01%, in the Bipolar population it is around 13%. What’s more, nearly half of individuals with Bipolar disorder will attempt suicide at least once. Extreme depression and psychosis resulting from lack of treatment are the usual cause for suicide.

A bipolar depression is nothing less of horrific. Unlike Major Depression, often there is no apparent cause for bipolar depression. A bipolar depression can persist for months and may become so severe that psychosis results. Traditional anti-depressants used alone generally have little effect, and can even trigger manic episodes. Unfortunately, because many individuals affected by bipolar seek help during depression rather than mania (which may be enjoyable), they are often misdiagnosed with Major Depression and treated accordingly. Individuals who present with mania may be misdiagnosed with Schizophrenia. Consequently bipolar is one of the most difficult mental illnesses to correctly diagnose.

Symptoms of mania can include pressured speech (or talking REALLY fast), racing thoughts, needing less sleep and not feeling tired, grandiose beliefs (for example, I started to believe that I was superior to everyone else because I didn’t need sleep to function but they did), and general euphoria. People may become impulsive (e.g. spending lots of money, quitting their job) and promiscuous.  But there is a dark side to mania; during a manic episode people can quickly turn irritable and even aggressive. They may experience hallucinations and delusions.

There are three main types of bipolar disorder; Bipolar Type 1, Bipolar Type 2, and Cyclothymia. Bipolar 1 is often described as your classic manic depression. Individuals experience episodes of depression and ‘classic’ mania. Episodes are generally severe (particularly manic episodes) and often result in hospitalization.

Bipolar 2 is often described as a less severe form of Bipolar. But I’m not sure I agree with that. People with Bipolar 2 spend more time experiencing depression, which can be incredibly severe. While individuals with Bipolar 1 may have months or even years between episodes, those with Bipolar 2 are more likely to rapid cycle between episodes and experience chronic mood swings. People with bipolar 2 are also more likely to take their own life. However people with Bipolar 2 do not experience full manic episodes. They experience hypomania instead. Symptoms of hypomania are similar to mania, but on a lesser scale, and there is rarely any psychosis. As it was described to me once; during a board meeting someone with hypomania may talk excitedly and present many ideas. On the other hand, someone with mania may dance and sing upon the table. Hypomania is difficult to detect because it can be disguised as productivity. Hypomanic individuals often feel creative, complete many tasks and feel exceptionally confident.

Cyclothymia (or ‘Bipolar Lite’ as Stephen Fry once described it), is a milder of form bipolar where individuals experience mood swings from mild depression to emotional highs chronically over many years.

If you are wondering what type I am...I’m not actually sure ;) Out of curiosity I have asked two psychiatrists whether I am a Type 1 or 2 and neither were able to answer. One told me that she didn’t believe in ‘typing’, that if an individual had bipolar, they had bipolar. The other told me that it was very difficult to fit people into a specific box, that everyone experiences their own illness differently. Looking at the symptoms I can’t even decide for myself what I would be, and I’m guessing this may be the case for others too.

So there it is. A description of Bipolar disorder. I promise I will write about something more meaty next time ;)

An accurate representation of Steven and I ;) 

Toxic

I'm fine, but I'm bipolar. I'm on seven medications, and I take medication three times a day. This constantly puts me in touch with the illness I have. I'm never quite allowed to be free of that for a day. It's like being a diabetic.

- Carrie Fisher

Hats off to Carrie Fisher! I couldn’t have said it better. For me, medication is a daily chore. No different from brushing my teeth or making my bed. I’m on four different medications twice daily. I take up to ten pills a day.

I am bipolar in my attitude towards medication. On good days I will dutifully take my pills, thinking how much they have helped me. On bad days I will complain about them, how they make me feel flat, how they shackle my creativity, how they nauseate me.  Perhaps I’ll ‘forget’ to take a dose.  But it’s less of a choice and more a responsibility. A trade off between side effects and stability.  I have a little one to look after now.

After a night of violent vomiting a few weeks ago, I came to the conclusion that I must be suffering from lithium toxicity. It seemed the only logical explanation for my nausea, mood swings, and shakiness. My recent bout of illness and dehydration could have easily resulted in concentrated blood levels. It all made sense. Lithium toxicity can be serious, even fatal. My nurse was at my place to assess me within an hour of my phone call to the hospital.

I was told to stop the Lithium, and because I was worried (and because I was angry at the potential effect that medication had caused) I stopped all other medications as well. That was a mistake. I spent the weekend grumpy, depressed, and dissociating so badly that it was hard to walk.

When the blood results came back I wasn’t toxic at all. In fact, quite the reverse. My level’s were too low. So I restarted all the pills and quickly returned to my ‘normal’ (but really, what is normal? ;)) self.

How did my lithium levels become too low? Partly, I suppose, due to the IV fluids I was given during my recent hospital visit. But mostly, I suspect, due to my careless attitude towards the medication. Skipping a dose here, a dose there. I’m not crazy anymore. I don’t need that stuff.

I seem to hold a deep distrust in the opinion of the medical profession. Somehow I believe my limited knowledge on psychopathology and pharmacology is superior. Then I get upset when my  medication experiments backfire. Funny that ;) Recently I have been seriously questioning my diagnosis. Am I really bipolar? Was I really that unwell? Perhaps it was all a strange dream. Now, while I am stable, I simply cannot believe I became that unwell.

I talked to both my psychiatrist and psychologist this week about this issue. I remarked to them that I felt like I was making the whole experience up. I can’t imagine feeling that depressed, or that unstable. I felt angry that I couldn’t remember aspects of my experience. But the recollections I had and others provided just didn’t seem like *me*. Rather than telling me to move on, that the past is the past and the present is the present (what I have been telling myself!), they both explained that I had been through a kind of trauma. Not the hospitalization itself, as my experience there was a positive one. But the very fact that I became so unwell and so unstable. I had assumed my inability to remember key parts of my hospitalization was due to being...well...mad ;) I had also assumed my somewhat flattened affect and reduced emotionality now was medication induced. But both are apparently symptomatic of those who have experienced some kind of emotional trauma. 

Now don’t get me wrong, I don’t feel traumatised. Not in the least. But I suppose that is part of what is going on. I don’t really feel any emotional response to what I have been through. It’s just something that has happened, no different to going to the shops for groceries. Apparently this will change, and my experience will become integrated with my sense of self.

Writing, talking to people, and my weekly therapy all help me piece together this puzzle of myself. It’s fascinating. I have learned more about myself in the last three months than I think I ever knew. I say now, and I will say again, that the experiences I have had (however apparently traumatizing they may or may not be) are one of the best things that have ever happened to me. I feel a confidence in myself that I never had before, and I have learned what is important in life. I’m happy being me, something I wasn't for a very long time. 

I assumed I had lithium toxicity when really it was the lithium I needed to become well. I assumed that a diagnosis of bipolar disorder was negative, when it resulted in an area of personal growth I may never have attained otherwise. It’s funny how something so potent, something so seemingly toxic can actually be the remedy.

Feeling Good

It's a new day, it's a new dawn, it's a new life
For me.
And I'm feeling good. 

- Nina Simone

I knew something was going to happen because my eye kept twitching. Twitch, twitch, twitch for four days, like a ticking bomb. When I was in hospital the exact same symptom preceded my manic episode.

I didn’t even realise I was immersed in it until it was over. But let’s get the facts straight, this certainly wasn’t a full manic episode. I never lost touch with reality, I never believed to have magical powers. I didn’t put myself in danger.  To the best of my knowledge I didn’t irritate the people around me.  Infact, I don’t think even the people closest to me realised anything was any different to normal. Maybe it was the more discreet ‘hypomania’, which literally means ‘below mania’. Perhaps my symptoms were prodromal of mania. Perhaps it was just one of those things.

What I did experience was euphoria, and ideas, projects. Despite the fact that I was physically very unwell, I couldn’t sit still. I had to start these projects. The only thing was, while I was in the middle of one project, I would spy something else that needed to be done and would move onto that. My ordinarily organised life was becoming somewhat chaotic. Highly productive, but chaotic. I absolutely loved playing with my little boy, we laughed and laughed together. I felt confident in myself. I felt in control. I felt good.

Of course there were some down sides. I  started experiencing psychomotor agitation again. All the pacing, twitching, jogging that I remember from before. I had amazing problems sleeping. When I went to bed my body suddenly felt like it wanted to run a marathon. I would get so angry at this that I would leap out of bed at 2am, storm into the kitchen and take two or three times my normal dose of medication just to try and get some shut eye. Sometimes it worked, sometimes it didn’t. My thoughts raced, or sometimes I would just have one thought that would repeat over and over again in my head. I seemed to get bored easily, even when doing things I usually enjoy.

But all in all, it wasn’t an unpleasant experience at all. I think I enjoyed it. Nobody was hurt in any manner, and I did get an awful lot of things done. Does that make it ‘disordered’? Is it ‘symptomatic’? Or is it just pleasurable?

Why? I would say it was something to do with the fact that I was physically unwell. Lithium will only work if a certain level of the drug is maintained in the bloodstream. Too much will result in toxicity, too little will result in very little at all. This is why if you are dehydrated, such as during gastro, you need to stop taking the medication. I had fevers for a week, and became very dehydrated. I also took medication which interferes with Lithium. I suspect that my blood lithium level went a little awry and precipitated this experience. The lack of sleep would have further exacerbated the symptoms.

My ‘high’ ended rather abruptly one night in a rather humorous manner. I woke up in the night, sure that something had bitten my rear end. Envisioning all sorts of poisonous critters, I leapt out of bed, turned on the light and thrashed around trying to see what had bitten me. At 4am, Steven was less than impressed, but still agreed to perform a thorough examination of the bed and my bum (have I mentioned that I love this man?). After, I lay in bed fuming. Now I had probably been bitten by something hideous, I’d have to go to the doctor AGAIN. Probably add another prescription to my collection. It was such a trivial thing, but I’d had enough!

Since then I’ve felt....flat. Certainly not depressed. But, it’s true, I miss the excitement and the euphoria and the energy. I miss being ‘high’.  The colours just seem to have faded. And as if for illustrative purposes, the sunshine outside has bleakened into rain. Steven calls this ‘the crash’. And in a day or so I will be fine.

I still feel like I am learning so much from this experience. I still don’t feel like I know the first thing about bipolar disorder, and my bipolar disorder in particular. I’m trying to chronicle and examine and evaluate what I feel. I’m trying to make sense of everything. Is it ok to enjoy the ‘highs’? Isn’t the high part of the problem? How can something that feels nice be a bad thing?

The mind, and the mind-body relationship fascinates me. Perhaps one day I’ll be a step closer to understanding it all J

Bipolar Bear

The first time my doctor told me that she thought I had bipolar disorder I almost choked on my Tim Tam (sneakily purchased from the local supermarket...I can assure you the public health system does not provide such wonderful chocolate snacks). “You’ve got to be kidding me!” I spluttered. “I have been horribly depressed for months...I FINALLY feel good, and I’ve got a disorder?!”

Of course I was in the midst of a manic episode at that moment...but we’ll get to that some other time ;)

The point is, I had a fairly strong and ignorant idea as to what bipolar disorder was, and was of the utmost confidence that I certainly didn’t fit that category, thank you very much. bipolar disorder, to me, conjured images of really crazy people. Take the word ‘manic’ add a letter and you get ‘maniac’. Coincidence? I think not. Postnatal depression, I thought, well that’s one thing.  But bipolar? Woah man...let’s  not get carried away!

What is interesting is that I am by no means  uneducated in terms of clinical psychological knowledge. I have an undergraduate degree in psychology, have volunteered as a telephone counsellor, and have spent time with many individuals who live with what society describes as a ‘mental illness’. Logically, I knew that all psychological distress has a place on a continuum and there are shades of grey. Yet when I was faced with a potential diagnosis all I saw was black or white: crazy or sane. And I didn’t want to be the crazy one.

When my mania started to ease I finally started to think seriously about my potential diagnosis. My doctor took care to take time to describe the symptoms, explain why she suspected I had the disorder, and encouraged me to ask as many questions as I pleased. One day I decided to conduct my own research on the matter. I read website after website, page after page of symptoms and clinical descriptions, determined to find something that didn’t fit. Something I could gleefully take back to my doctor to prove her wrong. But at the end of it all I just sighed and sat back in my chair.

“Oh crap.” I said out loud to myself. “I think I’ve got bipolar”. 

One evening at the hospital I voiced my concerns to Steven. “Do you still love me....even if I’ve got bipolar.”
Steven barely looked up. “Course I do” he said, as sure as if I had asked him if he likes Star Wars.
“But I’m....” I struggled to find a word, “INSANE!” I spluttered.

“You’re not insane” Steven said, stroking my hair. “You’re going through a hard time. And I’m here...for better or worse, in sickness or in health, remember?”. I breathed a sigh of relief. “There is one thing though...” Steven said “I can’t call you my Chi Bear anymore.”

I looked at him, startled. Chi Bear was his nickname for me.
“Why not?!” I asked.

“Because I will have to call you my Bipolar Bear now!” We both collapsed into giggles. It was the first time we had joked about my illness. Now, of course, we’ve graduated to fully fledged piss taking where any mention of maniacs or arctic dwelling bears is sure to set us off.

It was then that I realised that I was still me, I hadn’t changed. Bipolar had been with me all along but it just didn’t have a name. A diagnosis is simply a word. A term to describe a collection of symptoms that I happened to have. A tool for categorizing individuals such to predict their likely response to various treatment protocols.  “We diagnose” my doctor had told me, “not to label, but because it’s easier to treat someone if we know what we are dealing with, and what usually works for people with similar symptoms”.

Now I feel that bipolar disorder is merely an aspect of my life. I no longer feel shame in what I have experienced, and feel comfortable to talk about my story to those who ask. I feel relief that there is an explanation for the experiences I have had, and that I have access to a treatment which is currently working. I feel grateful for the lessons I have learned throughout this experience, and for the strength I now feel I posses. But I won't ever let it define me. I'm not bipolar. I'm Rachael, and I have bipolar disorder.