Posted by: Jack Hope | Tuesday August 7, 2012

The ‘B’ Word

Dear Terry,

I think it’s time to have the talk with a Doctor again. Previously there hadn’t to my mind seemed to be enough evidence that warranted this. But events of these last few days have forced me to re-consider and most certainly warrant raising the subject again when I resume seeing a psychiatrist.

Bipolar.

Without going into details, this past weekend (which was a long weekend in my end of the universe) featured what might be hypomanic episode, the first that I am aware of. Many of the signs were there, inflated self-esteem, impulsiveness, short sleeping periods and racing thoughts. It was a persistent state for a significant portion of the weekend.

I’ve been over this ground before, with my previous psychiatrist, and we both agreed that my mood dysfunction is unipolar, in the extreme, towards a depressed state. It seemed obvious though that if anything happened that required re-evaluating that we would do so.

I think this weekend definitely qualifies.

While there doesn’t seem to have been any last damage, there is no denying that I made some very foolish choices too that could have gone a lot worse if I’d been a bit unlucky. Perhaps, it was just a burst of enthusiasm and relief given all the positive changes that have occurred to me over these last few weeks, a pent up need to celebrate and release the stress that I’ve been holding in.

It may just be that too. But it has also forced me into some hard thinking as well.

Obviously I have been thinking about my own behaviour and how I felt during this entire episode. But I have also been thinking about my own past behaviour, looking for other signs of hypomania. So far, I’m not finding anything all that outstanding though.

But I have also been re-considering my entire thought process towards the question of Bipolar disorder and whether or not I am experiencing that. I have to admit, whenever this has been brought up, I have been very reluctant to accept that I might have a Bipolar disorder and have often strenuously made a case that I am not experiencing bipolar.

Why am I so resistant to being diagnosed with Bipolar?

Having the right diagnosis obviously is important in order to get the right treatment plan. And at the end of the day, it’s just a label that we apply to what we’re struggling with, a convenient verbal cue that sums up a wide range of experiences that I have gone through.

And yet, a Bipolar diagnosis to me seems wrong.

Perhaps it is because I have almost never experienced the hypomanic periods. I have been down for so long and in a such a brutal, horrible darkness. That is what Depression is.

To turn around and then say that I have Bipolar, a disorder characterized by mood swings seems ridiculous. It’s absurd. In a way, it almost feels like it’s trying to invalidate my own experience.

I suppose that also shows how wrapped up Depression and my struggle with it has become in my own identity. It’s role in my life as Nemesis, as explanation, as reason for much of what I’ve gone through seems firmly entrenched. I don’t know if that’s a good thing or a bad thing. I think it’s certainly a part of the healing process, accepting what I am going through.

I have to wonder though, if part of why I feel this way is because I feel like my identity is being threatened by a revised diagnosis?

I have a lot of thinking to do. Again.

Love,

Jack

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Responses

  1. Hi Jack,

    We’ve talked directly before about bipolar, but for the benefit of anyone else reading this (and with the caveat that I am someone who *has* bipolar II, but has no formal medical training)…

    If you think you might have had a hypomanic (milder than manic) bipolar mood-swing episode, then there’s a clear list of typical characteristics/symptoms you might want to check out here…

    http://www.helpguide.org/mental/bipolar_disorder_symptoms_treatment.htm?no_redirect=true

    A few things to note: Most people with bipolar spend *much* more time in depressed and stable mood states than in (hypo)mania. In fact, according to this entry in Wikipedia, the minimum for a formal diagnosis of bipolar II is just *one* (hypo)manic episode lasting just four days or more…

    http://en.wikipedia.org/wiki/Bipolar_II_disorder

    Bipolar can come on gradually as one gets older, and especially the (hypo)manic states. The depressed moods are typically more common and/or noticeable. Consequently it can take a long time from first onset to diagnose correctly (because it’s often assumed to be the much more common so-called “unipolar” depression).

    I suffered from depression on and off and by various degrees from the age of eighteen. But I had my first *distinct* hypomanic episode at fifty. Looking back I can identify others, but they were generally milder and not at all obvious to me that they were a symptom of an illness. During one particular episode I thought I was merely “happy” (especially as I was in a new relationship). But there were clear signs looking back. In particular, I recklessly talked myself into a job I would normally have known wouldn’t be suitable. I subsequently swung into a deep depression as I came out of hypomania and realised I couldn’t cope with the job – a typical pattern for bipolar.

    Sometimes some signs of a mild hypomanic mood swing are difficult for the person experiencing it to spot. It helps to ask others who know you well. They may have spotted behaviour that is significantly out of character for you, and go beyond a normal “happy” mood for you. For example, they may have noticed that you’ve suddenly become much more sociable than usual, less guarded in conversations, and/or that your speech has become particularly rapid (“pressured”). They may spot that you seem abnormally optimistic or interested in things, or have been out on unusual spending sprees. You may be unusually restless (flitting between activities). Irritability is another sign – particularly if someone suggests “you calm down a bit”. Generally you don’t want to calm down at all! – because (hypo)mania feels so good (especially compared to long periods of depression). It’s best to specifically ask friends/family if they’ve spotted any such signs. They might well not remark otherwise, simply because they’re just relieved to see you so happy for a change!

    One other minor but potentially significant point is that (hypo)manic episodes are more common in summer months when it’s sunny (conversely bipolar depression is more common during dark winter days).

    Finally, you seem particularly concerned about the possibility that you may have bipolar disorder rather than major depressive disorder? But it is manageable with care, and many people with bipolar disorder lead mostly happy and fulfilling lives. But the management is different of course – particularly mitigating the effects of (hypo)mania.

    If you think you might have spotted signs of a (hypo)manic episode, it’s important to talk through your experiences with a psychiatrist and get a correct diagnosis (one way or the other). Bipolar is believed to have a different underlying physiology to unipolar depression (the influence of brain chemistry), so treatment is different. Medication in particular requires a “mood stabiliser” as the primary med rather than an anti-depressant (although it can *sometimes* be combined with anti-depressants). Any talking therapies and “psycho-education” are I believe different. I don’t have much experience of these aspects, but it sounds logical.

    Hope all this helps. I’m definitely *not* trying to diagnose here of course (for you or anyone else). I’m just drawing on my own experience and readings to try and help you identify and match your own feelings/behaviour with a *possible* bipolar hypomania episode to discuss with your doctor.

    Best of Luck and Take Care,

    Phil

  2. Give yourself a break. We all need to go a little ‘off the rails’ sometimes as depressives. I think you’ve been doing great with the running and things are starting to look up a bit. You are allowed to celebrate without over analyzing yourself. So you made a mistake, or 12, big whoopie. Most constant depressives go overboard when they feel good because its so rare that we wanna do everything at once, while we can.


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