In the Spring of 2011 I was diagnosed with bipolar disorder, same as my Mother and my Grandmother. This is how I came to find out. I arrived to my appointment with my sleep doctor all strung-out. I had been prescribed various doses of Adderall, Modafinil, and Ritalin to combat my daytime sleepiness over the last few years. I hadn't sleep at all the previous night, my heart was racing, I was scared and sad at the same time. My doctor checked my condition. He prescribed Xanax and gave me the card of a psychiatrist to be evaluated.
The first psychiatrist talked to me about how I was feeling on the stimulants. I said great, but I was also feeling exceptionally creative and full of ideas. I said that I was writing a lot. She asked me to bring in a sample.
I said that the stimulants, that were original prescribed for excessive sleepiness and then also for ADHD-like symptoms, had the benefit of making me feel euphoric. I also admitted that I had taken the stimulants more often in order to prolong that bigger-than-life rapidity of thought that was so wonderful. After these periods of exceptional creativity, when I would stop the stimulants for a while, I would feel intense feelings of fatigue, guilt, fear and hopelessness.
Now, you could argue that being on a stimulant and coming off a stimulant medication could result in excitement and depression. But what I was feeling was a king-of-the-world kind of superiority, followed by a sadness so intense I could barely function.
I don't know whether the first psychiatrist said I was bi-polar, but got the impression I was being considered that way.
She gave me the card of a second psychiatrist, one who specialized in complex disorders (I also had Asperger's syndrome and a sleep disorder).
The second psychiatrist also specialized in people who wouldn't take their medicine as prescribed. I didn't like the other label, as I consider myself a creative self-medicator. If you knew how powerful and right and smart and full-of-self-esteem you felt when you were manic, you might understand how someone who would do anything to stay there.
Working with my second psychiatrist, it has taken two years to achieve control and remission of my mood disorder. We are working under the assumption that I have bipolar disorder and bipolar depression. The medications that are working well for me (Lithium, Lamotrigine) are the ones indicated for these conditions.
You can read about these conditions here:
http://en.wikipedia.org/wiki/Bipolar_disorder
The article also talks about "bipolar depression", which is a kind of baseline sadness that continues even after the bipolar cycling is under control.
If you ask me when I became bipolar, I would say that I've always been bipolar, but the symptoms were not as intense and were adaptive in my life. I have found that deadline situations, where I am expected to work jobs back to back long into the night, tend to bring out a crisis mode panic action in me.
There was a period of time when I felt pressured to over-achieve, in my work, in my home life, and in my church. To compound that, this over-achievement required me to act against type, having Asperger's and being unable to understand social cues. And I had a sleep disorder which included sleep apnea. I was competitive in all of these areas and my star was rising. I forced myself to achieve. I was achieving it all: the best company, the perfect family, the exemplar of service. I was busy all the time and couldn't sit still. I was finishing laundry at 11pm and still hadn't finished cleaning the kitchen. I believe that in this time of high pressure and fear of failure that I drew on a kind of low-grade mania to achieve under difficult conditions.
To illustrate the feeling of being bi-polar, I will share with you some parts of messages I sent to my doctor, the second psychiatrist.
Letter #1
Letter #2
These letters convey more of a sense of the depressive side. Looking through my message history with my Dr., the mania exhibits itself in ways I'm not very proud of. My actions show high-energy, driving too fast, staying up all night, cleaning the house after having no sleep, intense bursts of writing, and impulse purchasing.
I am sorry to say that mania has not proved very useful in practice.
Mania is, however, the most wonderful thing.
The first psychiatrist talked to me about how I was feeling on the stimulants. I said great, but I was also feeling exceptionally creative and full of ideas. I said that I was writing a lot. She asked me to bring in a sample.
I said that the stimulants, that were original prescribed for excessive sleepiness and then also for ADHD-like symptoms, had the benefit of making me feel euphoric. I also admitted that I had taken the stimulants more often in order to prolong that bigger-than-life rapidity of thought that was so wonderful. After these periods of exceptional creativity, when I would stop the stimulants for a while, I would feel intense feelings of fatigue, guilt, fear and hopelessness.
Now, you could argue that being on a stimulant and coming off a stimulant medication could result in excitement and depression. But what I was feeling was a king-of-the-world kind of superiority, followed by a sadness so intense I could barely function.
I don't know whether the first psychiatrist said I was bi-polar, but got the impression I was being considered that way.
She gave me the card of a second psychiatrist, one who specialized in complex disorders (I also had Asperger's syndrome and a sleep disorder).
The second psychiatrist also specialized in people who wouldn't take their medicine as prescribed. I didn't like the other label, as I consider myself a creative self-medicator. If you knew how powerful and right and smart and full-of-self-esteem you felt when you were manic, you might understand how someone who would do anything to stay there.
Working with my second psychiatrist, it has taken two years to achieve control and remission of my mood disorder. We are working under the assumption that I have bipolar disorder and bipolar depression. The medications that are working well for me (Lithium, Lamotrigine) are the ones indicated for these conditions.
You can read about these conditions here:
http://en.wikipedia.org/wiki/Bipolar_disorder
The article also talks about "bipolar depression", which is a kind of baseline sadness that continues even after the bipolar cycling is under control.
If you ask me when I became bipolar, I would say that I've always been bipolar, but the symptoms were not as intense and were adaptive in my life. I have found that deadline situations, where I am expected to work jobs back to back long into the night, tend to bring out a crisis mode panic action in me.
There was a period of time when I felt pressured to over-achieve, in my work, in my home life, and in my church. To compound that, this over-achievement required me to act against type, having Asperger's and being unable to understand social cues. And I had a sleep disorder which included sleep apnea. I was competitive in all of these areas and my star was rising. I forced myself to achieve. I was achieving it all: the best company, the perfect family, the exemplar of service. I was busy all the time and couldn't sit still. I was finishing laundry at 11pm and still hadn't finished cleaning the kitchen. I believe that in this time of high pressure and fear of failure that I drew on a kind of low-grade mania to achieve under difficult conditions.
To illustrate the feeling of being bi-polar, I will share with you some parts of messages I sent to my doctor, the second psychiatrist.
Letter #1
hypomania
Hi Dr. Hope you are having a good Thanksgiving. I'm reporting a hypomania episode for the record, to prime our next discussion for meds dose change (which I'm not sure I'm advocating). Its been a while since my last episode. What's improved over previous is that I've needed no extra medications. The episode has corresponded to my son having come in to town this week. I've wanted everything to be ready and perfect and I've been pulling 'heroic' acts of multiple hard tasks in a day and pushing myself to have it all and give it all. Well this morning I took him to the airport and immediately I felt this pressing gloom and strong guilt and worthlessness descend. Today has been the opposite of the last few days, sadness, wanting to cry, hopelessness, guilt, unworthiness, fear. I'm really aware of the aweful lowness. But even so I am able to use selftalk and keeping busy and keep marching forward to get some things done and go through the motions. I really feel it, but I also have more presence of mind and less impatience. Even though I am not impaired, I have noticed I am not driving well today as I am not paying attention well and I'm making stupid decisions. It doesn't help there are a million drivers everywhere today. That's the report for the record. One hypomania for thanksgiving. Regards,
near overwhelming depression
Hello Dr., I've been putting off writing you a letter. No emergency. While I don't want to take too much of your time, I feel like I need to communicate to you the vividness of my feelings at this point in time, so we can talk more broadly about how I am, at other points of the week besides Friday. I've just taken a Xanax and we'll see if that helps. Now that a lot of the pressure is off in my life (cold season, allergy season, helping children with college applications, transitioning to new boss and new work) I am left with just myself as I am and my thoughts. There is crisis, no must-do checklist, no emergency or death-march. There is just me adapting to live a normal, non adrenaline life. And as I contemplate my day, my week and onward, with nothing forcing me or nothing to hide myself, I feel tremendous sense of emptiness. Of despondency, of inadequacy, of fear of the future, a sense of ambiguity and uncertainty in my job and work. When I'm not in a crisis, when I'm not in pressure cooker or a terrible situation, I am alone and empty and faced with just myself. I don't know that I have ever learned to face myself and live with myself as I am. I don't know what I should do. I eat. I read. I do the chores. I watch movies. But right now, there is this tremendous overwhelming sense of despondency when I am not busy and when I am not putting on a brave face for others. This terrible fear of myself and my empty life has been creeping back over the last few weeks. Last week during easter I went through the motions with the stim med, and it just magnified the struggle against the pointlessness. I hope and have some faith that tomorrow will be better and I will find a way to accomplish the kind of open-ended leadership my new boss wants of me, but I am terrified and lacking confidence I can do it (but I usually can). Is this fear for my new role. I am being asked to be a technical facilitator and guide what needs to be guided and unblock what needs to be unblocked for a team with an open-ended deliverable and an open-ended deadline. For some, this might be a dream job for creativity and interpretation and self-direction. But I am overcome by the lack of structure in my work, and in my life. I don't know what to do and how to live when I am not in a crisis or forcing myself toward a deadline. In some sense all my deadlines have come and gone for me in terms of work goals and getting the kids through their year at school and getting their college choices ready for them. We are all left now with playing out our choices. And my lot is really not a bad lot - its a pretty good lot in terms of job, money, family, health, possessions. And if things were to keep going as they are, well things are pretty good all and all - certainly nothing to complain about. But me, my life, my living - right now is directionless and without any hope or interest. Anyway, let me try to wrap up. I feel that the use of meds in the past few weeks, and the lack of real utility to the current meds, is that they aren't addressing this consuming sense of despondency, this 'post partum depression' of my life goals having gotten through the worst and now not knowing how to enjoy going on. I think back to the meds I have used and I keep thinking about the wellbutrin. It was flattening to an extent, but I remember also feeling not-sad and accepting of my life state. I don't feel comfortable in being myself at the moment and have felt so despondent this weekend that I would bear some flatness just not feel so said and alone and inadequate. I am not a danger to myself. I am just sharing with you the profound incompleteness and emptiness that I think is at the core of mental state. Or maybe this is my true baseline and it is a depressed one. I'll use the Xanax today. I'll go work a normal day tomorrow and I have some faith I will bounce back and keep going.
These letters convey more of a sense of the depressive side. Looking through my message history with my Dr., the mania exhibits itself in ways I'm not very proud of. My actions show high-energy, driving too fast, staying up all night, cleaning the house after having no sleep, intense bursts of writing, and impulse purchasing.
I am sorry to say that mania has not proved very useful in practice.
Mania is, however, the most wonderful thing.
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