Posted by: Jack Hope | Monday February 4, 2013

2013 Plan: A Theory of Bipolar

Component: Support – Medical

As I’ve mentioned in previous posts, notably in this post The ‘B’ Word, there’s been a question of whether or not bipolar disorder is a part of the mental health issues that I’ve been struggling with.

At one my earliest meetings with my current psychiatrist, Doctor Z, it seemed that it wasn’t a part of what I was struggling with.

Now, that has changed.

Why did we not think that I was experiencing any symptoms of bipolar back in August whereas now we’re exploring this possibility more thoroughly?

One Episode Does Not Make A Bipolar Diagnosis

A single episode of what might be considered ‘hypomanic behaviour’ doesn’t necessarily mean that an individual is bipolar.

One case of atypical behaviour isn’t enough to make a diagnosis and that’s true with many other disorders as well. Just like a person can experience depression once in their life and never have a recurrence again.

Two or more cases though? Well, then we have to take a closer look at this behaviour. And over the last month and a half there’s been instances of questionable mood swings.

Several of these mood swings have had mildly hypomanic behaviour.

A Second Atypical Reaction

This comes hard on the heals of the failure of the previous medication I was on, Effexor, to address the lingering symptoms of my depression. The Effexor had the opposite effect of what was intended, a possibility a small percentage of patients will experience.

I became withdrawn, passive, inactive and lethargic, both physically and mentally. It was a very difficult experience (as outlined in this post) and also a wakeup call.

But this wasn’t my first failure with an anti-depressant. It wasn’t even the first dramatic one failure. This was the second time that an anti-depressant failed to resolve my symptoms and produced rare atypical symptoms in the process.

The first time was the Ciprolex that I was proscribed after I first started seeking treatment in 2012, which had some very negative effects.

After a month on Ciprolex I went off it and didn’t seek treatment until half a year later.

When I did resume treatment, I was far deeper into my depressive episode and extremely withdrawn and morose. It’s hard to believe now how very bad it ultimately got for me.

One atypical reaction to a medication may just be bad luck, the unfortunate roll of the biochemical dice. For it to happen twice with two different medications (in different classes) seems to imply that there is something more going on.

An Impairment or A Relief?

One of the reasons up until now that bipolar hasn’t been considered a major factor has been that the upswings, the upside behaviour has not been particularly debilitating.

It’s often been a relief actually.

More over the upswings don’t result in any in significant impairment and that is a key factor in any kind of diagnosis: does this cause impairment to the patient.

And it’s only once or twice that I’ve gotten so carried away that it has come close to causing any significant impairment. Most of the times, any upswing that comes close only manifests itself as bursts of enthusiasm and confidence in myself.

None of these are particularly ‘unreasonable’ either. I refuse to accept a universe where having some occasional faith in myself to have career and quasi-normal life is unreasonable and pathological.  Even if it were true (which it’s not) I wouldn’t be able to accept it because what would be the point of anything then?

No, mostly these upswings manifest as the starting of projects and a some split focused and some occasional questionable shopping. These periods of time produce useful things quite often. They are also occasionally irritating.

They’re not significantly impairing though. And that’s why neither Doctor Z nor my previous psychiatrists have felt that this constituted bipolar disorder.

It just seems like my moods had a naturally ‘wider’ swing radius than most people.

Let’s imagine for a second that I didn’t have Major Depressive Disorder. That we could just subtract that out of my mental equation and otherwise leave my brain as is.

Doing that we might then see, this behavioural swing might be much more evident without the weight of depression dragging me down. It might even look like the past year or so, but with the downswings being much shallower than they actually were.

This was the idea that formed in my mind recently, as I reviewed 2013 in preparation for my next appointment. And from that a theory was born.

Let’s say that I am mildly bipolar and that when that interacts with the Depression, even when it’s well treated, that it skews everything downwards. Perhaps just out of habit, after all, the pathway of Depression is one that is well trodden in my brain.

So as a result, a bipolar disorder that might only be mildly problematic otherwise, now instead is making the Major Depressive Disorder all the worse.

Internal Fears

I resisted this idea for a long time, large out of two fears: the first being that I had enough to deal with and the thought of adding another issue was unbearable and the second being my own internalized stigma surrounding bipolar.

Especially in light of recent events which have thrust the media spotlight (and collective fear) onto the mentally ill and bipolar disorder.

Also, I don’t want to give up my bursts of energy and enthusiasm.

Yet given everything that has happened it makes sense to consider some kind of mood stabilization medication, such as lithium.

According to Doctor Z, something like lithium was unlikely to cause me any problems, a not insignificant factor given the past bad reactions I’ve had to some psychiatric medications. So lithium it will be.

How to Measure It?

This one’s a little tougher given that the time frames can be months and that it will probably be six to eight weeks before this makes any kind of difference.

Blood tests in the near future will help get the dose right.

But the only way to really know if it’s doing anything will be to start daily mood tracking using some of the options available online.

Hopefully over the next few months, I’ll have a nice steady, positive result.

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Responses

  1. No, mostly these upswings manifest as the starting of projects and a some split focused and some occasional questionable shopping. These periods of time produce useful things quite often. They are also occasionally irritating……..

    This paragraph describes my bipolar exactly. I have Type II ( the mild form). I enjoy the up swings immensely, but the numerous projects going on simultaneously are often never finished and only aggravate my anxiety disorder.

    Wishing you well through this. You’re not alone. I understand.

    • Thanks, I’m adjusting to the idea so far, especially since it seems to be extremely, extremely mild.

      I like to joke that my anti-depressants give me an obsessive-compulsive disorder but it’s not really so much a joke as a reality, that I feel compelled to finish the things that I start in a way that I wasn’t before. I’m grateful for this although it is also occasionally annoying.

      At the end of the day though, I’m still trying to find a way to stop my drop-outs, especially the big ones. Bipolar seems likely to be a component but at the end of the day, I’m still fighting off depression.

      • I understand. I am the same way – except for the finishing projects part. I seem to start too many and lose interest after the initial burst of ideas and energy, which wane too quickly for longer-term projects.


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