I’m in the mood to read more about bipolar depression and hypomania this weekend. I’m considering Getting It Done When You’re Depressed. I’ve read all the Jamison. But I’d like to find more options. The Amazon page is bewildering: I have a hard time separating the fruitless self-help books from the good ones.
Any favorites?
Looking back a few years, to journal entries from December 2007, I see someone with bipolar who doesn’t know he’s got it and who’s floundering, trying to make sense of the emotional turmoil. I had to make lists like, “Things I’m not doing that I should,” and “Things I should be doing to make things better,” and “Things I have not been doing that previously worked.”
I went through months of irritable mania and despairing depressions searching for the reason why things should feel so terrible all the time, and why I should feel like doing nothing all the time. It ate up all my attention – I journaled for thousands of words on this topic, always looking for the answer to the question, “Why?” Why am I feeling the way I do right now, as opposed to just a few days ago when I felt completely differently? Why do the depressions come on so fast and saddle me with unclear reasoning and paralysis? Why are my responses to normal events heightened in a very negative way? What’s the mechanism for this?
I came up with theory after theory. The investigations came up with unsatisfying answers, like loneliness, bad upbringing, leaving grad school, paired with descriptions of the minute-by-minute of my “spirals,” which was the word I used to name my paranoid depressions. “The spiral has me today and I feel like hell,” or, “I’m not in a spiral and thank god for that.” The spiral. I had no better word for it at the time. But the word’s bipolar, and I’m glad I know it now.
I’ve read in many, many places that antidepressants can pitch a person with bipolar into mania. I was willing to risk it. I’d been coming down in mood, sleeping terribly, and waking up hungry at 2am. I asked my doc about getting on an anti-depressant to counter this. My up-moods are controllable, so I wasn’t afraid of what might happen should I get kicked into hypomania.
He was game. He’s a tinkerer, just like me. We like to adjust the medication. I get a burst of hope, and I’m not sure what he gets out of it. It just works out this way.
Hypomania did come: I found myself waking at 3am with an urge to work on something, shop, do something. I thought I was able to go without sleep, that I had too many interests to waste time sleeping. At work I was chatty yet nervous all the time, with sweaty palms. Coffee was consumed at a massive scale.
But the depression went away further. I could laugh more freely and getting out of the apartment (when I wasn’t going to work) became easier.
I reduced the dose. This is Celexa, and I had gone up to 60 milligrams 20 milligrams per jump, so I took it back down to 40. The hypomania eased, though there’s still a little left, and my sleep has been remarkably better.
Tinkering sometimes works, although I think I’m too into it. That hope of finding the right drug this time presses my buttons. Continually looking for that productive, happy, chatty hypomania without the nerves and urges, which I get so rarely – that Teddy Roosevelt vim and vigor.
The other week I went into a lab for a sleep study. A study, specifically, of me. They hooked me up to electrodes – my face, scalp, chest and legs – and put a breathing monitor slightly up my nostrils. I looked like I was on life support.
The room
Despite all this, I fell asleep quickly, mostly thanks to the clonazepam I take nightly.
Then, throughout the night, technicians came into my room and adjusted the wires – it must have been 4 times they woke me up (and who knows how many times they came in and didn’t wake me up). It was strange: they were utterly silent, and in my half-awake, twilight consciousness there was no shock or fear, just an odd feeling, like I’d been kidnapped by gentle aliens. No probes.
I woke up at 5 am, as I normally do. Sometimes earlier, which is what landed me at the study in the first place: waking way too early, hypomanic.
I’d been waking up at 3am a lot, wide awake and ready to go. I often feel a strong desire to shop when this happens, a classic sign of mania. Spend! Acquire! It must flood my synapses with dopamine because it’s so much fun. A funny sense of fun.
I went back to the sleep study center yesterday to get my results. The nurse asked me dozens of questions about my health and sleep habits. Turns out, I do not have sleep apnea or other respiratory problems. I’d been expecting some wild print-outs showing that my brain is out of control. I’d even been hoping for it: evidence in black and white that I do indeed have bipolar II. I long for the day that there’s a blood test or whatever to determine where one stands on the bipolar spectrum. Some reassurance for when I’m badly depressed or paranoid that yes, I do have an illness and these emotions are caused by the disorder.
In the end, I was given a long, detailed and pleasantly professional lecture on sleep hygiene. In other words, we have nothing to help you. They punted back to my shrink. I went home majorly relieved about the sleep apnea (who wants to wear that device while trying sleep?) and pleased that there’s nothing wrong. Maybe I don’t want the print-out after all. I’m happy with normal.
It has been nearly a year. Time doesn’t fly, it feels like more time has gone by since my last confession — er, blog post.
I really should have put the molecular structure for clonazepam up there instead of Abilify’s structure. Because it was clonazepam and my wife that got me to the dentist for the first time in close to 11 years.
I’d developed a phobia about letting another person look into my mouth. They’d find rotten teeth, brown with neglect and cigarette smoke. So last Saturday my wife called the office and made them promise not to scare me (talk badly about my teeth in my presence, take everything at my own pace, etc.) and I took 2 milligrams of clonazepam.
I floated through the procedure. It was painless, and they didn’t use the hooks, those curved spikes I was sure they’d use to scrape away at the 11 years of deposits left beween my teeth and diseased gums. Oh yeah, and I wasn’t worried just about my teeth: my gums played a bit role in my nightmares about going to the dentist. I would have thought about them more if I knew what gum disease was, but I never let myself read anything about it, afraid of anything I read entering my waking nightmares.
So it’s you, wifey, and it’s you, clonazepam, that got my mouth back into health. No cavities, nothing major going on. Some gum receding from brushing my teeth too hard.
That’s it, I’m going to look up the molecular structure for clonazepam now and adorn this plain-looking blog with a diagram.
There’s a metaphor many people use when talking about being on anti-depressants: the floor. The idea that a floor is raised when you take anti-depressants, up from a nearly bottomless chamber, to the light, where it stops just short of feeling normal, and rests. This recessed floor serves as the bottoming-out point for the patient from now on. They’ll say, “There was a floor past which I could no longer go down.” That’s why it’s called a floor – you can’t go down from there. And anti-depressants raise that floor for everyone I’ve heard from who took the drugs.
I think there must be something in the metaphor here, that “the floor” means something. Of course, it’s obvious that the floor is the bottom, what we tread upon, which is how the depressed person often feels: walked all over by life.
But is there something else to the “floor” metaphor? I think it’s about the return to feeling like other people. Walking around without a floor, the depressed person is lacking something that everyone else has, a bit of architecture. When the floor is raised, or created, by the drugs, the depressed person suddenly feels human again, a part of the collective, because they, too, now have a part of their house that’s so important.
This leads to a loss of that solitude that depression brought on. The depressed person begins to feel the inklings of connection with other people, an affinity, an understanding of one another. Hey, I’ve got a floor under me, too! I can live with the confidence that any little thing that might happen today will not destroy me, as it used to.
Having a floor brings us back from depression in two ways: by providing a baseline of mood that cannot be crossed, a new bottom that’s acceptably high enough to keep us out of trouble; and it gives us a metaphor for our intangible emotional disturbances, making them easier to visualize, to see finally that we’re back from the brink.
I’ve been having flashbacks — not of the LSD variety, but just as vivid. Ordinary revisits of scenes from a life, nothing particularly significant. In fact, notable only in their total lack of note. The flashbacks don’t seem to have anything to do with what’s going on around me, what I’m thinking about at the time, they’re not situational. They come on quickly and fade quickly, leaving an emotional residue, usually one of wistfulness, although many have been neutral. They occur most frequently when I’m bored at work, doing repetitive tasks. In writing, I’ve been taught never to rely on the flashback to move the story forward, but how can I not think that’s bad advice when it seems to happen so often in real life?
They disappear almost as quickly as they appear. I’m going to start keeping a journal — that makes three journals now — of them, and I’ll be back with a couple of the buggers soon. Hopefully with some insight into what’s causing them. Wikipedia
focuses on childhood abuse. Mine are garden-variety memories, no abuse here.
I imagine this is how other people feel all the time, but I know intellectually that this is not true. Too many speak of the pleasures of Zoloft, too many people are afflicted with anxiety, for this to be the case. But when I take clonazepam it’s like the world shifts and I want to re-embrace it.
I don’t know what I want to do first, read, write, talk to my wife, go see a movie, fuck around on the computer composing 2,000 word journal entries. Anything to keep my brain engaged and my feelings focused on the present moment. This is why reading’s out most of the time. I don’t want to escape this feeling, this relaxation of anxiety, don’t want to miss out on it while I inhabit someone else’s world. I want my own world, transformed by sheer lack of hard-driving fear and self-hatred. I can almost literally feel the hand that had been gripping my skull relaxing itself, and I wonder why so many people I encounter on the web have come out against milligrams of all kinds. I know that my life has improved dramatically through the introduction of a large amount of medications and I wouldn’t have it any other way now.
I may occasionally threaten myself with discontinuation for reasons I can never remember just a few days after I have the thought. So goes the bipolar mind — always thinking that everything’s either all right or permanently fucked and nothing in between. But clonazepam allows me a brief window into that time when things don’t have to be black or white, when there’s a nice grey zone of neither here nor there in terms of mood, a respite from the spikes I’m prone to. I feel less lonely on clonazepam, understanding that I can always get in touch with any friend I wish to at a moment’s notice. But I normally don’t, which is a topic for another post.
Relatively soon, I’ll switch psychiatrists. This is some occasion for relief, because I’m going back to my original doctor, the one who diagnosed me and prescribed me all these grand milligrams. I had to leave him because of an insurance problem, but that looks like it’ll be cleared up by the beginning of the new year. I most definitely don’t have mixed feelings about this. Some doctors just “get” you, and many don’t . Unfortunately, this doctor is the first in a long line to get me, so going back to him will in many ways be like going home. The others in the long line simply prescribed me anti-depressants, which kicked me into a mild hypomania. A not-entirely unpleasant hypomania, but, according to my wife, I was not myself on those particular milligrams, so I stopped them. (more on this later)
I’m concerned that the new-old doctor will have forgotten many details about me and my situation, and that we’ll have to play catch up. But if that’s the price to pay, so be it. I’m extremely lucky to be able to go back to him, so I won’t look this gift horse in the mouth.
Bipolar seems to have this way of robbing you, when you’re not manic, of decent conversational skills. One day you’re doing fine, talking to everyone you know, having a fucking ball, then the next you’re barely able to smile when you’re supposed to. The people around you get that particular rhythm in their conversation — they pause, ever so imperceptibly, for something from you. And of course it never comes from you, because it can’t come from you because you’re feeling like this, so incapable of speech.
My doctor calls it self-censorship, but I think he’s wrong again and think it’s something deeper. I think there’s a biological component to this lack of speech; verbal portions of the brain are shut down during depressive bipolar attacks. People talking circles around you, stunning you not so much with their wit as with their capacity to access phrases, and even words, at the right time and pace. No amount of milligrams seems to have protected me against this deficit. This is where the drugs have let me down the most.
