Plodding along nicely.

A post for World Bipolar Day:

In 2016, for the 8th time in 6 years, I was hospitalised. This time for 2 months, with suicidal depression. I have spent time in hospital, both informally & under section, for depression, mania, mixed states & psychosis. I had spent most my teenage & adult life cycling between the various bipolar states with only brief interludes of stability. Despite this, I wasn’t diagnosed with bipolar until 2011, aged 28. I had tried numerous medication combinations & done a number of talking therapies. Nothing seemed to be particularly helpful or if it was, it wasn’t ideal &/or didn’t last long. However, during that last admission the new medication combination I started seemed to help. It took a while for the waters to settle but by the end of 2016 I started to level out.

In 2017 I attended a “therapy” group, which unlike most therapies, is specifically tailored to people with bipolar, as recommended by NICE guidelines for bipolar. It was actually a psychoeducation group rather than a regular “talking therapy.” We were taught in some depth about bipolar & looked at how & why things are as they are for us. The knowledge gave us a chance to find ways to manage our illness. Thanks to medication & the psychoeducation I have not been in hospital since 2016 & I have been mostly stable since the end of 2016. I say mostly as since June 2018 I have suffered trauma & stress that would test the sturdiest of brains & I had a “wobble” in the last couple of months of 2018. A mild depression, which a medication dose increase helped me recover from. In my time of stability I was able to plan & organise my wedding, get married, start swimming & completed the Aspire Channel Swim Challenge, plan & go on our honeymoon to Koh Samui, start playing tuba again & join a First section brass band, start driving again, start reading again etc. Between my medication & learning in depth knowlwdge about my bipolar, I have managed to take back some control. It is hard work & a full time job, meaning I can only manage certain activities in small bursts (e.g. a couple of hours at a time) But I have quality of life now, which I wouldn’t have thought possible 3 years ago. I have been able to do activities that I enjoy & that require commitment (swimming & playing in a brass band.) I am not cured & medication side effects are difficult, but tolerable (e.g. tremors, spasms & twitches, loss of balance control, dry mouth, GI tract issues, constant hunger, hypotension particularly postural.) I am not fully functioning (although this is partly due to other issues as well as bipolar) but I am living with it & not just existing with it, at last.

These are some of therapies & medications I have tried over the years. Even with the correct diagnosis it took around 6 years to find a combination that worked for me. Of course the scary part is that at some point the medications that are working for me now may lose their efficacy & we’ll have to go back to the drawing board. But I am lucky that, for now, something works. Some people spend much longer finding their balance, if they’re able to find it at all.

Talking therapies

• 2007 Intensive group psychotherapy (Year long, 3 days a week)
• 2010-2011 Group therapies for treatment of personality disorder (inappropriate as I had been misdiagnosed)
• 2010- Stop & Think
• 2011-2012 Involvement activities & Recovery college (Courses on psychosis & anxiety as well as a level 2 maths course)
• Wellbeing & Recovery
• 2016?- Distress Management
• 2017- Adapted Barcelona Psychoeducation Programme for Bipolar Disorders (one 2 hour group session a week for 6 months)

Medications

Antidepressants:

• Citalopram
• Sertraline
• Fluoxetine
• Venlafaxine
• Mirtazapine
• Nortriptyline- current

Antipsychotics:

• Trifluoperazine
• Aripiprazole
• Haloperidol
• Quetiapine

Mood stabilisers:

• Valproic Acid/Valproate/Depakote
• Lithium- current

Extras:

• Zopiclone
• Lorazepam
• Clonazepam
• Diazepam- occasionally current
• Procyclidine– current
• Saliveze- current

For All Our Friendships

By Your Side

A poem of friendship, near and far

When everything is tempestuous,
And you feel you’re stuck in stormy seas,
Just remember us;
We’ll stand by your side.

Whether life is unbearable or magnificent,
We’ll be there to share it with you.
Always ready to listen.
Always ready to celebrate.

Hold us in your heart,
And we’ll be there;
By your side.
Together we’ll fight on through.
We’ll hold your hand,
And wipe those tears.

As the stormy seas throw you asunder,
We will be your buoyancy aid,
Until the lifeboats come to rescue you.
We’ll stick it out together.

Our friendship is immeasurable,
We treasure you profoundly,
We will love & hold you as we can.
We will stand by you.
We can persist;
We will survive
The most brutal of tempests.

Together.

19/02/2016

Quantum Affective Disorder

Bipolar is usually described as a spectrum disorder. It is seen as having 2 polar opposites with a spectrum of possible mood states in between. You often see sine wave type graphs when people, even healthcare professionals, are explaining it.

It is often recommended that people with mood disorders keep track of their moods using a mood chart or diary. This helps to quantify what is happening. It allows people to see patterns emerging and therefore manage their moods more effectively. However, even the Bipolar UK Mood Scale and Mood Diary only really allows for one extreme or the other. There is nothing wrong with this per se, but many people with Bipolar, including myself have moods that do not fit into this 2 dimensional model.

Many of us have what is known as Mixed Affective States/Episodes, sometimes shortened to Mixed. In these Mixed states we have some symptoms which are clearly signs of mania whilst at the same time having some of the clear symptoms of depression. It can be the most dangerous time for someone with Bipolar as they can feel suicidally depressed and have the manic energy and impulsiveness to act on it without warning. Another state I have recently discovered goes further than this. I have been calling it “simultaneous opposites.” During these episodes I experience symptoms from moth ends of the spectrum that would normally be at odds with each other. For example, I can feel utterly sad yet euphoric at the same time. I didn’t know it was possible to feel 2 feelings that I had always perceived as opposites at exactly the same time. Yet there I was. I have felt a number of these simultaneous opposites during this current ultra rapid cycling episode.

I often found it difficult to chart my mixed states on a normal mood chart and resorted to writing mixed through the day’s chart. In all honesty, it would be difficult to accurately chart a mixed episode on paper, perhaps someone out there can design a phone app for it. It was during the simultaneous opposites I particularly struggled to chart my moods. It got me thinking about the name Bipolar Disorder. It just doesn’t fit for me.

A graph for me needs a “Time” axis, a “Depression” axis and a 3rd axis for “Mania”. The nature of my moods mean Depression and Mania are not on the same spectrum, they are 2 different trajectory of moods. It is a messy graph, not a pretty sine wave.

I don’t cycle neatly between 2 extremes with the odd nice baseline “normal” in the middle. I have been cycling between hypomania and mixed for 3 months, but all those mixed episodes vary in intensity of various symptoms. Sometimes I was more depressed that manic and vice versa and sometimes I achieved the seemingly impossible, 2 opposites at the same time. To me, it became obvious, all these different erratic mood possibilities plus the ability to be in 2 opposite mood states at once meant Quantum would be more appropriate. A description of Quantum theory can be found in this Independent article. The description seemed to fit my experience of “Bipolar” better Bipolar or its usual descriptors.

I therefore believe we need a new name for those of us who don’t only have 2 extremes. We should have it rename as Quantum Affective Disorder.

 

Like a Bug on a Windscreen.

**Trigger Warning for Suicide**

I went for a walk today. I took the same route I always take, over the train tracks  & along by the river.

I’ve been feeling desperately, frustratingly depressed whilst full of irritable energy most of the day, as is common for mixed affective states. I took some meds & it helped to calm the desperation. Thoughts of suicide were restricted to “I can’t do this again & again for the next 40 odd years.” As the edge had been taken off by the medication I decided to take the calmer opportunity to go for my regular walk. It would help kill time & keep me distracted, as well as ticking the exercise box. I could feel my meds wearing off but thought I’d be back by the time the full force of the mixed affective state kicked back in.

As I approached the familiar train tracks, the warning lights started flashing, the siren beeping & the barrier descended. A train was coming. I stopped about 8 metres shy of the barrier. I always thought I could never kill myself by doing something like throw myself in front of a train. The reason for this is purely that I didn’t want to traumatise an innocent train driver as I go splat like a bug on a windscreen. I couldn’t take someone’s emotional life as I’d be passing on the curse of depression.

But in that moment I forgot all that. I realised I could end it all, right here, right now. The lights & siren were drawing me in. Calling to me. Inviting me to step out onto the track. I had a few seconds before the train would be here. I walked towards the barrier, but realised I’d need to run to be in place in time. I didn’t have it in me to run. Instead I stood right by the barrier & felt the train whoosh past. So close. I closed my eyes & visualised what could have been my demise. For a split second I felt a moment of bliss as I imagined my almost instant death as I’m hit by the train.

Then the train was gone, & I wasn’t. I was still there stood waiting to cross the train lines. As the barrier lifted & the lights & siren stopped I walked on, tears streaming down my face. I heard another train pass by & considered running ahead of it but I’d never make it. Instead I must carry on. Living this life of persistent mental torture. I envy those bugs on the windscreen right now.

Stop The Ride, I Want To Get Off

I can’t keep doing this. I just can’t. I can’t keep thinking I have a shot at a life and having it ripped away from me. I can’t do it. I just can’t.

I am so sick and tired of attempting to survive these Bipolar episodes. They do nothing but hurt me and everyone around me. Those periods of stability I get to enjoy temporarily are marred by the inevitability of the next episode. When I finally feel able to make steps towards actually living my life it feels amazing. But then just as I get on that first step the stairs collapse.

http://fineartamerica.com/featured/broken-stairs-jennifer-lyon.html

I had 7 months of stability. It wasn’t perfect but I was able to live. I finally had the ability to work towards my dream of being a nurse again. My plan was a long term plan. I would start with some volunteering 1 day a week. When ready I’d increase it. Eventually I would go into paid employment when I knew I could work consistently over a period of time. Then I’d work as a Healthcare Assistant/Auxiliary Nurse and/or study to be a qualified nurse. I know I can do the job, I thrived as a Student Nurse. But my Bipolar had other ideas. And, so it would seem, it has other ideas again.

I went through the process of preparing for and appyling for voluntary positions in health and social care. I was upfront about my Bipolar and after meeting with someone who runs a day centre they were keen for me to join them. I didn’t even need a formal interview. I did the mandatory training and was ready to start as soon as my DBS check came back. I had no concerns as none of my interactions with the police whilst ill (or any other time) had resulted in an arrest. I just had to wait. Bipolar had already started to rear its ugly head. On the training day I was in such a mixed affective state it’s a miracle they still wanted me. I thought the hypomania would have died down after a week or 2. But it didn’t. I was in no fit state to be starting a new job with vulnerable adults.

And there we have it. I am still waiting for my moods to settle and therefore still waiting to start my new voluntary job. My DBS came back a few weeks ago. The ONLY thing we’re waiting for is this mixed episode to calm down or disappear enough for me to start. But how long can they keep my position waiting for me? I’m too afraid to ask. All I know is that it throws into stark relief my reality. No matter what, my Bipolar will always be waiting in the wings to ruin everything when I try to make a life for myself. Somehow, I suppose, I have to accept I will never be a nurse. I probably won’t even get to be a Healthcare Assistant and this is breaking me.

http://plitsche.deviantart.com/art/Ferris-Wheel-Spin-366402872

I’ve had enough of this messed up ferris wheel. It never stops long enough for me to enjoy the view. I’ve had enough of the ride and now I just want to get off, permanently.

Time to Talk & Lies

One of the first things we say to each other on meeting an acquaintance, colleague, friend or family member is something along the lines of:

“How are you?” or “How are you doing?”

It seems like a polite and fairly innocuous question. But for me and many other people it is a question of dread. How the hell do I answer that?

The usual response, which is somehow more socially acceptable is something like:
“I’m good” or “I’m fine thanks.”
You might be able to elaborate a little:
“Busy, but good” or “Stressed, but getting by.”
From these you might be able to have a brief chat about what’s going well for you or why you’re so busy. But it is soon swept under the carpet and we move on. It’s like this interaction is purely social protocol, noone actually cares about the answer. A complex or unexpected answer is very rarely welcome. A difficult answer puts the person asking in a position they probably weren’t expecting and they are very rarely sure how to deal with the strange situation. Sometimes it all works out, but often everyone is left feeling awkward and embarrassed.

For years it has been unacceptable to air your dirty laundry. You don’t talk about your problems in public. You hide behind closed doors and battle them silently. Society drilled this into me. I spent years giving the same false answers because I knew people couldn’t accept the real answers. They would either not know what to do or judge me. Admitting to having a mental illness can be terrifying. I have lost people I thought were friends over a diagnosis. They didn’t understand and weren’t willing to learn. Others have gone because they just got fed up with the depression. They didn’t want me bringing them down. As a result of years of holding back, lying about how I’m feeling has become my default setting. I was eventually able to open up to mental health professionals. But even now, when meeting new professionals I hold back. I don’t tell them everything, I can’t. A lot of it is I just don’t trust them.

The other people I end up lying to are my friends and family. My partner probably gets it the most. It’s not deliberate. I just feel so much guilt for being a burden on him. I don’t want him worrying about every little emotion. I don’t want him being dragged down even more by me because at that moment I’m feeling crap. I’m not suicidal so he shouldn’t have to worry. But he cares about me, so he does worry, so giving honest answers is even harder.

There is a wonderful campaign called Time To Change. It is trying to encourage people to start talking about mental health. It encourages discussions and highlights that talking about mental health doesn’t have to be scary. They produced some lovely postcards with comic strip type prints. Each one has a “scary” conversation e.g. with a King Kong type creature and a “mental health” conversation, which is just someone asking someone how they’re doing and the person with mental health problems gives a nice socially acceptable answer. It’s great. But for me it perpetuates this need for people with mental health problems (and other problems) to lie. People making that “brave” step to engage with us are unlikely to want or be prepared for a genuine answer. I appreciate their effort and I give them the nice answer they can deal with. But what’s really happening:

Them: “How are you doing?”
Me: “I’m getting there.”
Inside: “I am drowning, I want to die I feel like I’m stuck in a swirling vortex being ripped limb from limb. Please don’t ask me again.”
Me: “Yeah, things are on the up. How are you?”

An Unexplainable State

I’ve been trying to figure out how to describe how I’ve been feeling the last couple of days. I have nothing. There are no words I can think of that suitably describe what’s happening. I think it is safe to say that I am finally out of hypomania. I think I would be classed as being in a mixed state. But I really don’t know. The last few weeks has seen me cycling through manic, hypomanic and mixed. The mixed has usually consisted of agitation, irritability and frustration. There were certain depression symptoms but I was clearly still manic. I didn’t feel depressed.

Now I would say I’m starting to feel the depression. I still have some symptoms of my mania (no need for sleep, lots of energy, racing thoughts, lots of ideas) but I feel low. I’ve actually felt mostly apathy recently. I just didn’t care about anything. I started to feel disconnected from the world. I was interacting with the world around me but it felt like I wasn’t in my body. Someone else was driving.

This is where I start to struggle to explain myself. I feel so intensely. A desperation. Yet I also feel dulled. It’s like I’m feeling the ghost of the real emotion. I felt like I desperately needed to curl up in a corner and cry my eyes out. Yet my body couldn’t seem to work out how to actually achieve this. I feel perpetually an inch from tears. But they just won’t fall. They’re trapped on the otherside of the glass wall.
I am struggling to cope with these feelings. I can feel everything but rather than my emotions stabbing or punching me hard, they seem to be slowly smothering or poisoning me from the inside. It all got a bit much so I took diazepam. It made no difference. I didn’t really expect it to. For the 1st time in years I was desperate for alcohol. I needed alcohol.

The previous night I had had a few drinks. Being drunk gave me the ability to feel normally again. I wanted to stay in that drunk state forever. The following day I battled with myself, trying to avoid resorting to the alcohol. When the diazepam didn’t work, I fought with myself to stay in the house. Leaving the house, I couldn’t say where I’d end up. Maybe I’d just go to the shop and come straight back home, but maybe I’d take a walk in the dark by the river, or maybe I’d just walk and walk and walk and end up goodness knows where. Instead I managed to stay in, but the alcohol won. I managed to stick to 1 drink. It helped a bit. But I really just want to be drunk.

I fear all these weird feelings are a precursor to plain old depression. Already, the thoughts of suicide that terrified me only a few days ago, are less frightening. They almost seem like a welcome option. I feel dulled but definitely not numbed. More like an attack that uses a thud rather than a thwack. The pain is radiating and penetrating just as much, it just hasn’t been delivered in the same way.

I want to cry. I need to cry. I just don’t know how to break the bubble surrounding my feelings and with them, my ability to cry.

Dark Thinking (TW Suicide)

Yesterday I was calm for most of the day, however my partner assures me I became very distinctly manic in the late afternoon/early evening. I was disinhibited and looking back I was probably behaving rather inappropriately in the Cooperative. I was possibly a little too affectionate with my partner. As much as I still think it’s ridiculous and bizarre that they are selling chocolate Easter bunnies when we haven’t even had Christmas yet, it probably wasn’t entirely necessary for me to shout my disdain for the ENTIRE shop to hear. I was looking for the Lindt chocolate reindeer and found their Easter chocolate bunnies as well as generic chocolate Easter bunnies wrapped in Spring and Easter Egg themed foil.
I was playful and talkative in the evening but it didn’t get out of hand. Then bedtime happened.

I took my medication at a reasonable time in the hope I’d be asleep before 3am. I took my quetiapine and zopiclone at about 11.30pm. I may as well have had Smarties (other confectionery are available). I lay in bed staring into the dark. I desperately willed myself to be sleepy. I wanted to just give up and go play on the Xbox 360 (other consoles are available). But if I got up I definitely wouldn’t get any sleep and it would fuel the mania. I needed to allow myself to sleep and it just wasn’t happening. I took more quetiapine. I started to feel desperate and frustrated. I was bored and irritable. Then the thoughts started.

This manic episode has been mostly enjoyable for me. I have had some terrifying moments, awful and hideous ones. But on the whole it’s been ok. One of my fears has been my looming descent into depression and what that can mean. But I have in no way been suicidal. It is not something I want at all. But in the dark, another night of desperate insomnia my mind turned to “options.” I started to think about taking larger and larger doses of sedatives. Maybe then I would sleep. But rather than thinking about increasing the dose within a reasonable parameter, I started working out how much I actually had and how much I would have if I held on to them and added them to my next prescription pick up. I get my medications fortnightly. I am on a low dose of quetiapine and there is plenty of leeway for dose increase.

I suddenly realised I was working out how to stock and stash my medications. Why? I have no desire to die, so why was I lying there in the dark trying to work out how long it would take to reach a potentially lethal dose??? I tried to throw the thoughts away. I wanted to tell my partner. Warn him that I was getting dark, intrusive and compulsive thoughts. But I was desperate for him to get a good night’s sleep. He’s so run down. He’s been ill for weeks and my mania has exhausted him. He needed the sleep. I wasn’t in any danger, but I will need to tell him.

I finally fell asleep around 3am. I woke up 6 hours later. 6 hours is my minimum threshold for “healthy” sleep. Less than 6 and I am in the danger zone for my mania. The fact that I am on quetiapine and zopiclone to force sleep and still wake up after 6 hours night after night, isn’t a good sign. However, I actually felt groggy and managed to semi doze for another hour and a half. I think this is good. Although I feel hideous. My mind is still raring to go but I appear to have caught a cold. I thought it was happening yesterday, I kept sneezing then kept coughing last night. So the grogginess is almost certainly the cold and not quetiapine hangover or tiredness.

I had to pick up my Movicol prescription from the pharmacy (thanks to a less than glamorous side effect of quetiapine). It was whilst I was putting it away and sorting out my animals’ medications that thoughts kicked in again. I stood in the kitchen counting how many quetiapine tablets I had. About 1/2 way through I realised what I was doing and promptly stopped. But then I started to work out how much diazepam I had as well. Yesterday I’d deliberately gone through the medication drawer and bagged up all the “no longer used” and “out of date” meds. I was going to drop them into the pharmacy to be destroyed. There was a worryingly large amount. I forgot to take that bag when I went to the pharmacy. So now I am alarmingly aware of all those excess medications that could go with the surprisingly large amount of current medications. The only medications I don’t have excess of is zopiclone and lithium, because they’re not PRN. These intrusive thoughts about my excess medication is starting to become obsessive. For now they are just unwanted, irrelevant thoughts. But if I enter a darker mixed state, a dark psychosis or slip into depression I will already have knowledge that I really don’t want to have.

I will speak to my partner. I think it might be time to ask him to monitor meds. Maybe even ask him to take control of them-put them in the lock box. I’m not a danger but I don’t trust these odd intrusive thoughts.

Managing the risk:
I told my partner about the thoughts I’d been having. It seemed strange to be discussing overdose risk when I feel so far from that state of mind. However, we agreed the thoughts were enough of a risk. We searched the flat for all medications. My partner has locked them in a secure box with a 6 digit combination code which I do not know. A locked drawer has, unfortunately, not been enough of a barrier in the past. We have left no more than 3 days of medication immediately available to me. I don’t feel at risk but I am not taking any chances. My partner, has kindly taken on the responsibility of my medication for now. He has also taken the bag of medications we don’t need to the pharmacy. Whilst searching for any hidden medication I also found an old blade that I’d used for self harming. I have asked my partner to get rid of it safely. Whilst I still have access to blades they are not as immediately usable for their unintended purpose. If that risk does start to manifest then I will deal with them then. For now, my potential risk appears to be overdose and this has now been minimised. It is such a surreal position to be in. I don’t really know how to handle it.

Scared of Me (TW Suicide)

I am scared of myself. No, terrified. I am scared that I will die. I will die by my own hand. I will think, feel & be absolutely convinced that it is what I want & even need.

I will be wrong.

I don’t want to die. I am not ready to die. But at some point my brain will convince me otherwise.

I will become so depressed that existing will become unbearable. I will become a shell, a shadow of my true self. I won’t be able to live like that. I will feel destroyed inside. Like my soul has been mangled & I will believe I’m destined for eternal torture. After a few weeks I will genuinely believe I can’t carry on, I will feel I am a burden on those I love. I will genuinely believe they would be better without me.

I will prepare to take my own life. I will make contingency plans. I will lie to the people who care about me, not maliciously, simply to be able to carry out my plans. I will believe I am protecting them, may be cushioning the blow of losing someone to suicide. I will know it will hurt them, but I will believe it is best for everyone.

I will make attempts to take my life. My partner knows me well enough to know when something is wrong. So I will attempt to deceive him, and right now I hope I fail.

I may get as far as attempting suicide. Let me be clear now…

I DO NOT WANT TO SUCCEED!

I am terrified that my depressed self will not be able to hold on to this. I am terrified that my partner might miss the signs. I am terrified that I will make an attempt to end my life, and succeed.

I do not want to die.

Resulting hatred

By trying so hard to keep my partner safe from being harmed or taken by the YO’s, I’ve driven him to hate me. He’s felt like I’m keeping him hostage. He just won’t recognise and doesn’t care about the danger. He’s so convinced I’m ill, even though my Mental Health Assessment concluded I was fine. But this morning he is filled with anger at all the services. Apparently he even called the police yesterday as well. But because noone responded he hates them all. And he hates me. Trying to keep him safe was probably a selfish act. I have to let him go. I have nothing to lose now. I just hope he doesn’t suffer in the process. I love him. He clearly blames me for all this. Somehow I suppose it is my fault. For whatever reason the YO’s chose me to target and by extension him. He’s been targeted because of me. How could he not hate me? 9am

I just want to give up now. I’m so sick of noone believing me. I’m sick of the contempt I’m being shown. Fuck them. Fuck them all. If they get hurt now I will know I tried my best to protect them. They’re on their own now.

I cannot bear to be around anyone now. I’ve spent the day dosed up on quetiapine and sleeping in bed. I actually want to push my partner out the door whilst shouting at him “I don’t care!” Of course I do care. But it is dragging me into such a painful depression. If I just let go of everyone, it’ll be easier to cope with when they do get taken or harmed.

In the past when I’ve been told I’m psychotic, I took the anti-psychotics in the hope they were right. This time they’ve said it’s pseudo psychosis and I have no idea what that means. But if it’s not ‘real’ psychosis how am I supposed to get rid of it. Surely meds won’t work if I’m not ill. So I can’t even cling on to the hope I’m ill. This is real. It is happening and I am so alone with no hope of an ending. 2.40pm