I sat on the couch in my psychiatrist’s office with my arms crossed and steam billowing out of my ears.
“Are you on cocaine?” he asked without a hint of sarcasm.
“No,” I shot back, completely bewildered but appropriately defensive.
“Then you’re bipolar.”
Yup. That was how I was diagnosed. And to my memory, that was really the only major piece of information my psychiatrist gave me that day. There was no supplemental information given to me, no sort of enlightenment or introduction into the all-consuming project that would be managing my difficult and sometimes debilitating condition, and I left the office with what felt like a really random label and a higher dose of Abilify. I was nineteen years old, I was a chemistry major in college, I’d kicked the hell out of an eating disorder, and I was bipolar. The facts didn’t matter too much. Right?
Over the next several years, I really didn’t hear the word “bipolar” all too frequently, in or out of my psychiatrist’s office, despite the increasingly, uh, intense fluctuations in my moods and energy as well as steadily growing anxiety and irritability. Weird, am I right? For a diagnosis that impacts pretty much all aspects of a person’s life, in one way or another, to not be mentioned nearly enough times? There are more fitting words, but sure, we’ll go with ‘weird.’
By the time I graduated college, I knew my diagnosis was playing a larger role in my life that I originally assumed it would. I started keeping track of when I took my meds (and with that tried not to miss any doses). I recorded my moods more frequently. I did some cursory research into my disorder. And I finally started noticing patterns in my cycle and knew to watch out for specific warning signs. And mind you, doing all of that was a pretty big accomplishment for someone who was given virtually no guidance. Not to mention a medication regime that was significantly lacking.
The first thing I realized was that my episodes often began with feeling “emotionally itchy,” or “like I want to rip my face off” and “jump out of my skin and out of who I am as a person.” Thanks to the knowledge I have now, I can use different language to describe what actually goes on as I inch ever closer to a major episode. I become incredibly irritable and experience what’s called “dysphoric mania.” I have the racing thoughts and flight of ideas that come with manic episodes, meaning my brain is running at a million miles a minute and I can’t keep myself focused on one idea long enough to think it through, but it’s not what anyone would call a happy feeling (not that mania is to be confused with mere happiness). In my dysphoric state, I have too much energy, so much so that it physically hurts me as it swells from within me and threatens to burst open at any second. I often cut myself in such a state because I need the assumed and metaphorical emotional release as well as the physical release of endorphins in response to injury.
Then I began to see that if I missed my meds for any period of time longer than a day or two, I felt the effects about two weeks later. If I forgot (or “forgot”) to take my Abilify for let’s say a full week, I’d be in the middle of a relentless and torturous depression in about fourteen days. Sidenote, I shouldn’t have missed ANY days of meds, but lo and behold, I wasn’t exactly warned all too well against it. But to see a pattern, to determine the cause of a specific (and dramatic) dip in my moods, was hugely influential in my life. Not to mention, it brought me to google how the medication I was prescribed actually works. And, spoiler, every single human being who is prescribed any medication at all should be aware of what the fucking medication does and how it works and all of that. Seriously. So important. Turns out Abilify is “long acting” and takes about two weeks to leave my system.
Furthermore, Abilify is a type of drug called an “atypical antipsychotic.” Those types of drugs are frequently used as mood stabilizers. They’re the second generation of drugs that you’ve probably seen being used on dramatic medical shows or movies about psychiatric hospitals that knock people who are acting “insane” out. They’re used as tranquilizers. Haldol is an example of one that works fast and Thorazine is an example of one that works somewhat slower. Those are called typical antipsychotics. Atypicals like Abilify have fewer side effects. They work to influence serotonin (the neurotransmitter sometimes called the “happy molecule”) as opposed to blocking signals from dopamine (the “pleasure and reward” neurotransmitter).
Right. So as you see I’ve become fairly well-versed in the goings-on of impending episodes and the key pieces of information surrounding them. Again, this is phenomenally helpful. But my point is that I should have been given this information from the get-go. I should’ve been prepared and taught, should’ve been armed with education given to me by a human being who knew what the fuck was happening to me and how bad it would potentially get if I didn’t have the fucking said information! I got there myself, and I’m damn proud of myself for doing so. And it still brings me peace of mind and a sense of control to research bipolar disorder, and learn new things about treatments and meds and biochemistry, and to work through my recorded moods and symptoms to find existing patterns or warnings. But for fuck’s sake, why wasn’t I told about the importance of recording the fluctuations or about psychoeducation as a tremendously powerful tool?
Alright alright, not going to continue dwelling on the past and how I was royally screwed (at least not in this particular blog post). Because as I look to the future, I know things will at the very least make more sense. I’ll at least be able to understand this bullshit and from there hopefully combat it better.
Which brings me to a few months ago as I began to embark on a new and more um, intense journey of self-discovery and understanding –which, in turn, is allowing me to feel significantly less dread about my eventual (and inevitable?) next episodes. It started when I wound up in the emergency room for the first time in October 2018 when a depressive episode took a terrible turn for the worse. I was 27 years old and at the end of my rope. Exhausted from years of worsening symptoms and my cries for help going unheard, my begging and pleading remaining unnoticed, I collapsed into chaotic despair.
The good that came from that particular visit to rock bottom was that I subsequently found a therapist (no, I hadn’t been in therapy previously and yes, that was really dumb) who is literally the coolest person ever, in addition to being really fucking good at what she does. And a few months after that, my amazing therapist helped me find a better psychiatrist, and from there we all began the arduous task of getting my act together and trying to stabilize the shitshow of my life.
As it turns out, since I was on a medication that didn’t do much for me for such a long time, my bipolar disorder was able to “mature.” To further develop and overall just get worse. Literally look it up. It’s a known thing that bipolar worsens if left untreated, and I absolutely feel that mine at the very least wasn’t being treated properly. Lucky me.
But since beginning to see my therapist in November and my new medication provider in February, I’ve learned like, so so so much. I know to stop and breathe when I start to get worked up, because I know I have gone for long periods of time without inhaling and exhaling like a functioning human. I know that I fidget around and repeat purposeless motions (“display signs of psychomotor agitation”) because it comforts me when I’m anxious. I know I have issues with control, with the desire to feel safe, with things that aren’t fair.
Also. Insomnia is a huge red flag for me and for the majority of bipolars. It’s both a symptom of approaching mania and a trigger for it. Meaning, when you start staying up all night long, you’ve gotta find a way to get some sleep before it gets worse and leads to an episode. It also means that you can’t voluntarily pull all-nighters (if you can help it) because that might land you in the middle of a manic break as well. And as if that wouldn’t suck enough, a despairing depression would most certainly follow the agitated (hypo)mania.
Alcohol is another one. Now, I’m not huge on drinking. I never partook in any of that before I was of legal age anyway (which is perhaps a testament to my nerdy younger self haha), and once I started drinking, I had trouble getting past the gross taste. I still do. But when I drink as an adult (which I haven’t done in a few months, mind you), I drink to get fucked up. So basically, I drink in a way that’s literally terrible for my bipolar. It’s a cycle, too. I’ll have a bad day and come home and take five shots of fireball, and I get shitfaced so I have a terrible day the next day. It’s similar to insomnia in that it perpetuates itself and that I’ve gotta be responsible about it.
[On that note, by the way, I should say that maintaining stability involves quite a few key things (such as sleep hygiene, med compliance, the nutrition you fuel your body with, the way you move your body, being mindful and having the ability to focus on breathing, following pre-set routines, your support system, your coping skills and crisis-management tools, and your healthcare professionals…to name a few). It’s imperative to keep up with each thing to prevent all hell from breaking loose.]
I’ve also come to see that, for whatever reason, my major episodes usually have a definitive end but not a clearcut start. As in, I can identify the specific day my depression ends, but the irritability and frenetic energy and aggressive outbursts start out kind of slowly and increase steadily until my moods surrender into despondent melancholy. At this point, I believe the phenomena has to do with my tendency to ruminate and nearly drown in repetitive thoughts. I really struggle with redirecting my brain away from negatives. It could also be because of my coexisting ADHD, but either way, I can’t knock myself out of a bad mood as easily as most people can. So even something small going wrong has the potential to send me spiraling. I can’t think myself out of it. But I can easily make it worse –by ruminating and letting the negatives repeat like a broken record in my head. The decline, therefore, moves like a ball rolling down a ramp. On the opposite end of a “crazy spell” (as I called them way back in the day before I learned all this enlightening information) we have the ball being yanked back up as if it was attached to a string or something. As in, something good can happen that completely “snaps me out” of a major depression. It’s wild to think about. Like, fuck, why can’t more good things happen? Maybe then I’d spend less time wanting to die. I have, however, come to learn how to put myself in the line of things that have the potential to knock me off the crazy train. File that under “bitchin’ coping skills.”
Thanks to psychoeducation, I’ve also come to understand some of my personality traits. I’ve often called myself “volatile.” I fly off the handle fairly quickly, I accelerate from zero to 100 faster than the Kinga Ka roller coaster at Six Flags. My therapist calls it being reactive, and I prefer that phrasing now. My reactivity is part of my personality, but I understand it more clearly by looking at it through the lens of what I know about bipolar disorder. Similarly, in addition to reacting more, I react bigger. I guess some people might call it being dramatic, but again, I prefer to think of it in terms of how my therapist explained it: I’m wired intensely. I feel things in a bigger way. She once said something along the lines of “you can light up a city with your emotions,” and I don’t think she used the word emotions, but that was the gist. My intensity if a part of who I am. And honestly, as much as it can be super annoying and anxiety-producing, it’s not all bad and I choose to label it as a good thing.
Oh, and I pretty much knew this already, but I like to write/type because in my bipolar brain, the thoughts move more quickly than my mouth can move. It causes me to stutter, or stumble over my words, or lose my train of thought because I didn’t say something the right way and I can’t make my mouth move in a way to correct myself because I have fifteen thousand other thoughts flying through my mind and I can’t focus on any of it now. I exhibit pressured speech. Oh yeah, that’s one of my faves.
Thanks to psychoeducation, I’ve learned why I cling to my routines with a death-grip. Doing so is legitimately helpful to people with bipolar. Which is why going on vacation or starting a new job or a new chapter in life can throw bipolar people off in such grand ways. Circadian rhythms are screwy in us. We need to work hard to keep that shit in check. And the sleep-wake cycle and yes, routines, are part of that.
Okay then. With all of this knowledge being attained and a few more trips to rock bottom (and the emergency room) since October 2018…here I am. Still holding on, and doing better at that holding than I have in a while. A month and a half of normalcy without anything rocking the boat? I feel pretty damn good, thank you very much.
Oddly enough, stability can be just as scary for me as the complete and utter chaos of the rest of it. Like, now I have no excuses for not moving forward. Ugh, I have to move forward. But ya know what, I will. Because I’ve got the bipolar symptoms under control at the moment. There’s really nothing stopping me, so I’m sure as hell not gonna stop me.
Keeping records is absolutely fucking necessary. I’ve got no choice but to record my moods, anxiety, and irritability. I’ve gotta take my meds every fucking day and keep track of if I ever miss a day (which I shouldn’t). I need to write down other factors that play a role, such as my periods and when I have therapy and life stressors and stuff like that.
It’s taken, holy shit, so much work to acquire the awareness I currently have. And moving forward will require consistently working on what I know and actively seeking more information. But dude, I’ve come this far. I’m not gonna stop now.