I have a mood disorder known, these days, as bipolar disorder.

In my youth and young adulthood it was known as manic depression. Are you old enough to recall the song “Manic Depression,” by Jimi Hendrix? In it he sings, “Manic depression is a frustrating mess.” I agree.

The variation of bipolar disorder that I have is called BP Type 1. This is the most severe form of BP. In it, a person has both depressive episodes and also manic ones that usually require hospitalization. I’ve been hospitalized fairly many times since my 30’s. My most recent inpatient stay was a week in May of 2017, when I had originally planned to go to Iceland.

It wasn’t that episode that directly caused me to miss the trip, though.

Instead, I had to cancel the long-awaited journey because in a manic moment I climbed on top of my dining room table in order to change a light bulb in a recessed ceiling fixture. While standing up there, I got dizzy and fell to the floor, narrowly missing striking my head on the basement railing.

The narrow miss was fortunate, when I think of what could have happened to my head, but my numerous other injuries were still too unhealed to permit me to go on my trip. They were also extremely painful and also aggravated the fibromyalgia and osteoarthritis that I have.

So my doctor increased the Lyrica I was already on for the fibro pain, resulting in a psychotic break from the medication. That is not an unusual occurrence with Lyrica.

It was the psychotic break that saw me hospitalized during the time that I would otherwise have been in Iceland if I had not fallen in the first place. It all started with my manic ill-judgment in climbing to the top of my dining room table, and then falling off.

So that was then.

Since then I’ve had a lot of trouble with depression and with mania, too, but not to the point where I had to be admitted as an inpatient.

However since the summer of 2017 I’ve done two rounds of intensive group therapy in what are called partial hospitalization programs. In those, you spend half a day or all day in the program, but the rest of the time you are at home or work or school (or all three!).

The last partial hospitalization program I did was last December 2017, but I didn’t finish it because I got the flu and “flunked out” of the program for absenteeism, although I had doctor’s notes for each of the three days I missed.

That program was inflexible regarding missed sessions: it didn’t matter if you had a valid, proven reason for your absence. Three strikes, and you were out. So I was out.

Anyway, to cut to more recent times, I got manic again after I was hospitalized for ischemic colitis for five days at the end of this past March 2018. I wasn’t able to sleep while I was there, because they drew blood from me every four hours to see if I was losing too much blood (irony of ironies!). That was in addition to, and at different times from, being woken to have my vitals checked.

Result: no sleep.

Result of no sleep for 5 days: mania.

I left the hospital floating on a cloud of euphoria. The euphoria should have alerted me to my mania. But the problem with mania is that most of the time you have no insight into the fact that you are indeed manic. If you are an adult living alone, there’s usually no one around who can offer you that insight, either, except for your psychiatrist or psychologist.

I was on a three-month visit schedule with my regular psychiatrist (meaning she wasn’t the one I would see when I was either an inpatient or outpatient in psychiatric programs, but would see me on a followup or interim basis). I have been seeing her around 20 years, so she knows me very well, but unfortunately we didn’t have anything scheduled soon after I got out of the hospital for the colitis stay.

And my psychologist was new. She had only seen me very depressed, as I had been in December 2017 when I started with her.  She didn’t pick up on my mania, because when I’m manic I usually present in a fairly subtle manner, unless I’m psychotic, too.

So my mania ran pretty rampant all spring and early summer. I had a great time (another irony).

A great time, that is, until the crash at the end of June. Since then I’ve been really depressed. Although both my “psych’s” knew I was very depressed, since I wasn’t actively suicidal, we weren’t addressing it except through talk therapy and my usual mood stabilizer medication.

Finally, though, last week, my psychologist and I both thought that I should ask my psychiatrist if there was an add-on med that might help alleviate some of the depression.

The real issue with bipolar depression, as opposed to “normal,” or unipolar depression, is that it cannot be treated with antidepressants, because they trigger mania, especially in people with BP Type 1, like me.

This is a really difficult problem for those of us in this situation.

Add to that issue the fact that I have other problems with many, if not most medications–allergies, paradoxical reactions, severe side effects (see the Lyrica example, above)–so that, even though my psychiatrist and I have tried the gamut of medications for both mood stabilization and bipolar depression during these twenty years together, we’ve pretty much struck out most of the time.

But we decided to add on a tiny dose of Abilify, an antipsychotic, to my mood stabilizer to see if that would help the depression.

It did, but within days I started getting manic. Luckily this time I was alert to the signs and as of yesterday, we are now adding on a third med, Risperdal, another antipsychotic, to counter the mania being triggered by the Abilify, which is at least helping the bipolar depression to some extent.

Even though Abilify and Risperdal are both antipsychotics, they have very different kinds of effects on brain chemistry. Unfortunately, most of the time you don’t know what effect they will have until you try them. However, experienced psychiatrists and psycho-pharmacologists keep up on the studies aggregating these clinical results in relatively large populations.

Luckily for me, my psychiatrist is also a psycho-pharmacologist, so I benefit from her double expertise, as well as her long experience with me an an individual patient.

Still, the ups and downs and trials and errors are  all very trying, in more sense than one. 😛

I am pretty tired, and more than a bit sad, although not as sad as I was before starting the new meds.

But at least I’m looking forward to my re-scheduled trip to Iceland! 🙂 If only it weren’t so far in the future…. Who knows what my physical and brain-chemical health will come up with between now and then that might once again lead to my trip being canceled?

Please send me your thoughts and prayers if you are the praying type, that my health won’t get worse and that, if I am very fortunate indeed, I will get to Snaefellsnes. ❤

 

Snaefellsnes, Iceland. Photo credit unknown.