Tag Archives: Bipolar Disorder Symptoms

How Do You Deal With Unpredictability?

The one thing I dislike most about my mood disorder is the fact it is so darn unpredictable.

If being crazy is described as doing the same thing over and over and expecting a different outcome,  I am not sure if I am crazy.  Experience tells me my mood is a balancing act and doing the same thing definitely does not give the same outcome!

I can miss a night and nothing changes or miss a night and all sorts of mood shifts happen.  Other times I miss a night to get myself out of depression – and it works,  but it’s not a given. Even though I know it is not the best way to deal with mood shifts,  I think we all at one time or other deal ‘unconventionally’ with it.  Yes?

Sometimes I can drink alcohol and all is fine with the world the next day.  Other times however,  I wake up in a funk that can last a while.  I discovered some months ago that when I have a full belly,  I can tolerate alcohol without any seeming side effects.  Since I love me some dry red wine,  I was ecstatic!  But because I haven’t been drinking it for years,  my memory has made it more delicious than the reality proofs to be.  Such a shame 😦

As I am dealing with a lot of tiredness,  from work,  allergies and diabetes,  I sometimes don’t know if I am plain overtired or depressed.  In both cases I end up doing nothing and not interested in doing things I previously enjoyed doing.  I force myself in going to the gym every Wednesday morning.  It helps it is right around the corner at my physiotherapists office in a small group  (up to 6 people) under the guidance of a physiotherapist.  I really enjoy it.  However,  I don’t enjoy getting up  –  which takes me about an hour.  And after fitness,  most of the time I need a nap to recover!

Of course the biggest unpredictable aspect of a mood disorder is when your mind plays its tricks on you.  When you wake up in a funk or hyper for no reason whatsoever.  Also,  you never are sure about the triggers of a mood swing.  I usually know if my mood is triggered and by what or if it is chemical, my brain ‘misfires’.  It does help to be able to distinguish between the two.

When a trigger is the cause,  I deal with the trigger as best I can, which influences the mood I am in.  Or at least,  it should :-).  If the trigger is a high stake emotional response that I can’t deal with on my own,  I know that (usually) within a week I’ll speak with my counselor and we’ll deal with it together.  Since about a half a year,  through knowledge and experience,  I am able to keep going even when the path is rough.

When the reason is a misfiring of the brain – the only thing I do is accept it and ride it out as best as I can.  The survival technique I turn to is mindfulness – staying in the moment and not allowing my mind to wander off too much.

Acceptance is the key word in both instances.  To accept the fact you are triggered and the trigger itself or to accept the fact that this is the way your brain works at times.  This I find not easy,  at times it is a real struggle.  But when I am able to accept either one,  it helps me enormously in continuing my normal life. Whatever normal means,  of course!

What is most important to me is to be able to function whichever is the cause.  I do not allow my mood disorder to define me – so I want to be the one in charge and not the mood disorder.

What are your ways to deal with the unpredictability?  Please share in the comments and link up to your own posts how you deal with this.  I won’t be the only one who is interested in broadening the tool box!

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11 Difficulties of diagnosing bipolar disorder

Photo credit: Abode of Chaos

It is not uncommon for us,  bipolars,  to receive our correct diagnosis about 10 years after we first go to a doctor.  There are a myriad of reasons why this happens.  Below I have compiled a list of the main difficulties of diagnosing Bipolar Disorder (BD).

  1. BD is a complex illness with a wide range of symptoms that play out differently for each person.
  2. Besides,  BD is in reality a spectrum of different types which are easily misdiagnosed as Anxiety Disorder,  Schizo-Affective Disorder or a Personality Disorder.
  3. In addition,  mixed episodes are really difficult to detect since symptoms of both (hypo)mania and depression coexist.
  4. BD usually starts with one or more (up to 5) episodes of depression before (hypo)mania hits.  Hence,  patients are often misdiagnosed with Major Depressive Disorder.
  5. As the medical journey many times starts with the GP it is vitally important that he is able to be aware of the differences in unipolar and bipolar depression.  Sadly this is not the case for the majority of GP’s.
  6. It is an art to be able to ask the right questions in order to find out if someone is also suffering from (hypo)mania.
  7. If the right questions are being asked,  the patient still has to recognize the symptoms in his own life.  This is made even harder since the patient might not be aware of the symptoms,  as it seems to him his normal life.
  8. Also,  because of the stigma of a mental illness (where depression is a far more acceptable diagnosis) it is easy to downplay any possible symptoms that point to BD.
  9. Especially when the patient is (ultra) rapid cycling he doesn’t meet the criteria for BD plus he is even more likely to encounter difficulties in recognising symptoms in his own life.
  10. Family history plays an important part in susceptibility for BD.  However,  the likelihood of (grand)parents being undiagnosed is huge.  Furthermore the family medical history might not be known.
  11. Other complicating factors are certain diseases which mimic some symptoms of BD,  like lupus,  Lyme disease,  thyroid disorder and epilepsy,  amongst others.
For further reading:

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Mood charting revisited

The history of mood charting

The history goes back to the beginning of the twentieth century,  to a German psychiatrist Dr. Emil Kraepelin (and no,  I can’t pronounce his name either :)).  Photo credit: public domain.

He worked with color codes to chart episodes on a monthly basis.  The National Institute of Mental Health – Life Chart Methodology ~ NIMH-LCM™  (grief,  what a mouth full and I haven’t even said anything yet!) was built on Dr. Emil’s developed chart.

Dr. Kraepelin’s early studies found that patients often undergo a progressive increase in cycle frequency, or a decrease in the well interval between episodes; that initial episodes were often triggered by external events, but later episodes emerged spontaneously; and that affective illness tended to continue in families (genetic vulnerability).  (Source)

Two studies,  one conducted in 1997 and one in 2000,  proved the validity and reliability of the use of the NIMH-LCM™.

What to chart?

In no particular order:

  1. Sleep patterns – how many hours slept;  time we went to bed & got up; how well or fitful we slept.
  2. Stressful situations – be it related to family,  work, study etc.:  it has impact on our mood.
  3. Severity of mood – can be difficult at first;  at least I found it hard how to compare and compare to what,  but eventually when I kept on it I developed a feel for it.
  4. Medication use – particularly revealing when changing dosage or meds.
  5. Highest and lowest mood of the day.
  6. Exercise (or for me:  the lack thereof…) – and the effect on our mood.
  7. Physical health – what influence does being physically well / unwell have on our mood?
  8. Energy levels – could it show a possible upcoming mood change?
  9. For women: hormonal imbalances during our period and the influence on our mood.
  10. Side effects of our meds.
  11. Weight – jotting it down once at a certain day of the month.
  12. Therapy / Counseling sessions.
  13. Full moon – make a note of when the moon is full that month.
  14. Life / daily events – the good,  the better,  the bad and the ugly  (arguments;  disappointments;  fun happenings;  holidays etc.)
  15. Alcohol consumption.

By no means do you need to chart the whole list.  Find what you need,  make your own chart,  use existing charts  (printed or online).  In short:  find what works for you!

Why mood charting: 

  1. To identify early warning signs – like sleeplessness or too much sleeping.  (A sure sign for me that something is up!  Or down.)
  2. To manage our illness more successfully – knowledge of how we react to life’s daily challenges is power!!
  3. For medication management – with the numerous meds available these days,  it’s vital to know how we respond to whichever med(s) we are prescribed.
  4. To discover patterns otherwise difficult to detect.
  5. Because we think that we remember well,  but the truth is:  we don’t.
  6. It shows our progress – and when we deserve a slap on our shoulders!!
  7. Ultimately because it helps to keep ourselves well – by understanding which aspects of life interfere with our moods
Here you can find an earlier post I wrote about mood charting.

Finally

Keeping a daily journal is the only way to find out what is really going on in our lives in relation to our moods.  It is important to know what influences our moods and what in turn is influenced by our moods.  Besides,  it gives us more reliable and useful information  for us as well as our doctors / therapists / counselors.

If you find it difficult to use,  have initially a family member or good friend help you.  You might gain some valuable info that you yourself don’t see or notice.

When a good friend of mine helped me,  she told me she noticed that every time I was getting hypo manic I started to ‘talk’ with my hands and my eyes were getting big.  Signs that were impossible for me to ‘see’.  Now I know,  so I pay attention to these pointers.

Once we have more insight,  when necessary we can get help faster.  Consequently,  we might not dip as low or go as high as before.  Wouldn’t that be cool?!

To end I quote Stephen C. Murray :

Mood charting is a tool and like all tools it depends on both the quality of the tool and the skill of the person using it. If you have not used a mood chart you should give it a try to see if it helps with your therapy. The key to mood charting is in doing it daily, stay with a chart for a couple of months and see if it helps.

For more information on mood charts / charting:

Bipolar Network News – The latest news on bipolar disorder research and treatment.

Articles from Stephen C. Murray – Executive Director of the Cheryl T. Herman Foundation. The foundation promotes treatment, education and understanding for Mood Disorders.

MoodChart – MoodChart was developed by Dan Lieberman and Fred Goodwin, who are psychiatrists at George Washington University in Washington, DC.

Other interesting posts:

What is Bipolar Disorder?

Symptoms

Medical treatment

Peeps that are important

Why mood charting?

How to help people with a mental illness

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Depression is on my mind…

…and in my soul.  Wanting to write about depression for a week by now,  I became depressed several days ago.  Maybe that’ll help?  Nah,  guess not.

What does depression mean?
Depressed and depression are words we hear a lot nowadays.  It seems that everyone and his neighbour are depressed.

However,  the term is highly overrated.  Whenever that happens the true meaning of the word gets lost in the overuse of it.

Sure – we all have days when we feel down,  tired,  pessimistic,  inadequate and don’t want to do anything as a result.  But normally this will last a couple of hours or at most a couple of days.

The depression I am talking about here continues for several days or weeks or months (and for some of us years) when we are in a state of despondency,  dejection,  melancholy,  overriding sadness,  downheartedness,  mournfulness and anhedonia so severe as to require clinical intervention.  Anhedonia means that one loses pleasure in activities that are usually enjoyed.  I had to ask my p-doc when he first used the word :).

Note that the main issues here are the severity and the duration.  It doesn´t resolve itself,  as it would under normal circumstances,  so that is why medical treatment is needed.

Photo credit: 3Neus

How depression feels (for me)
The tiredness hangs as a dead weight around my neck.  I don´t really know what to do with myself.  Sometimes I am simply existing,  because that is all I am capable of.  My heart feels so sad and down that it seems impossible to pick it up again.  I mourn my loss of hope which turns in despair which in turn pulls me ever more downwards.  Whenever I think I can’t go further down,  it turns out the bottom of the pit never ends.

In fact,  it can get so bad and so painful that it becomes impossible in my mind and soul to live any longer with this burden.  That is when I start thinking about suicide.  (This has happened to me,  but thankfully hasn’t in the last few years.)

It is vital to understand that we do NOT want to DIE,  but that we can NOT longer live with the PAIN!

It is critical for those around truly depressed people to understand this.  The intervention is geared (or should be turned) towards relieving the pain in the first place.  Relief of the pain in turn takes away the biggest reason for wanting to commit suicide.

The reason depression happens to me is because my brain is wired differently,  my brain chemistry works differently,  I respond to life events differently.  Bipolar (disorder) depression is a complex and serious illness.

What not to say
I hope that those who stand by a loved one or friend with depression start to understand that:

  • We cannot “Pull ourselves up on our boot straps”;
  • We can not “Cheer up!” or “Think positive!”
  • We can not “Just get over it!” or “Just snap out of it!” either;
  • To say that we “have nothing to be depressed about” doesn’t quite cut it;
  • We are not “feeling sorry for ourselves”,  so it’s no use to tell us to stop doing that;
  • To say to us that “lots of others are worse off”,  falls flat on its face.

Well,  I could go on,  but I am sure I’ve made my point…

What to do?
When someone has pneumonia,  we don’t say to that person: “Hey,  you’re not really sick,  get out of bed and go have some fun.  I am sure you’ll feel better!”  Nor do we say to a diabetic that (s)he is better of without her/his medication.  We accept that it is a chronic illness that needs to be treated and that it has consequences for someone’s lifestyle.  A diabetic can not decide not to be ill and expect by choice to be cured of the illness.  We all understand that it doesn’t work that way, right?

We might ask what we can do for the sick person.  Maybe we do some household chores,  shopping or something else practical.  Maybe we make tea,  sit by their bed,  show compassion and give comfort.

In short,  we accept the person with his/her sickness and take care of the person in a way that is beneficial to him/her.  We respect the boundaries of the illness the person has and do our best to  make the person more comfortable and at ease.

So why would it be any different with a mental illness?

To be continued

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DISCLAIMER:
Please,  note that I am not trying to be critical of anyone trying to lend a hand to a truly depressed friend or family member.  But I think it is important to understand what this friend or family member is going through in order to give or decide to get adequate help.  I am trying to show what depression means,  what it does and what can be done.  By no means is this post complete,  there is a whole lot more to be shared in future posts.

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A taste of my Bipolar Disorder challenges

Just in case the previous post has given you the idea that my life with Bipolar Disorder is a breeze,  here are some points to take into consideration:

  1. The meds I am taking caused me to gain weight.  A lot of weight.  Trust me,  you don’t wanna know how much.  And it’s not easy to get rid of.
  2. Never thought I would be actually meeting a dietician.  Me on a diet?  Bwahahaha!  Well,  I won’t be.  Which brings me to the second point.

  3. The meds I am taking suck even more, because now I am struggling with the onset of Diabetes.  Cuz,  you know,  I gained a lot of weight.
  4. But even worse,  certain meds that I need from time to time actually seriously increase the chance of getting Diabetes.  Hence the dietician in my very near future.

    I already have made certain food changes, but I need to make some more to combat further development.  No diet – that is temporarily.  Those changes?  They are for real and most likely for life.

    Truthfully – most changes don’t bother me.  Okay – giving up drinking dry,  red wine because the alcohol in combination with my meds make me depressed,  wasn’t fun.  But giving up chips (crisps,  for the British among you) and liquorice?!?!  Real.Bad.News.

  5. I am a night owl and have lived an irregular life since…. well,  forever,  I guess.  BUT.  Right now?  I would serve myself best if I would keep a pretty regular schedule.
  6. You know,  things like going to bed and getting up at the same time every day, taking my meds at the same time every day,  eating all my meals like breakfast, lunch and dinner at the same time every day and have regular healthy snacks in between to keep everything on an even keel.

    No big deal, right?  But,  for me, it is.  Cuz changing life-long habits is hard people,  really hard.  Also,  at heart I am a rebel.  I just wanna do things my way,  whenever I want to.  *sigh*  No,  change that to *very BIG sigh*.

  7. Having to cancel whatever plans I have,  because I ended up in one of my funky,  unruly,  unmanageable moods,  be it the up or down swing.  Can be pretty challenging for friendships.
  8. If you have a friend or family member with Bipolar Disorder,  please understand that we do this not on purpose. Truth is,  I hate to cancel plans at the last moment as much as the other party.

    But trust me,  very few friends can handle being around me when I am severely depressed or getting over-the-edge hypo manic.  Even in my hypo manic or ‘just’ depressed state I am pretty intense for them.  It is not fair to expect them to handle more than they are comfortable with.  Difficult and painful for both parties.

  9. Not being understood.  A few examples.  People not understanding why I was not diagnosed earlier.  People thinking that you can or should just ‘snap out of it’.  Or that you should use your will power.
  10. Believe me – if I had a choice in the timing of my diagnosis,  or if I could just ‘snap out’ of depression / hypo mania,  or if I could change it all by will power – I WOULD.

    The problem?  It doesn’t work that way.  The biggest problem?  The people who think they know how to deal with what I have,  but really don’t.

    Because after several years and hard work,  I am now well on my way of accepting my particular life-mood-swing,  it has become easier to deal with the fall out of point 5.  Unfortunately,  it doesn’t mean that it doesn’t hurt.  You know what I mean?

Even though there is a whole lot more to say about it,  this is enough food for thought for now,  me thinks. 😉

Any questions?  Please,  leave a comment.  I am very happy to try to answer them.

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Bipolar Disorder: Symptoms

Depressed 😦

We all feel a little blue or ‘depressed’ at times.  Having a major depressive episode,  though,  doesn’t even begin to compare.  The word ‘depressed’ and ‘depression’ are used so loosely nowadays that I feel they have lost their real meaning.

So what does ‘real’ depression look like?  Bad,  dark,  sad,  angry,  irritable,  sleepy,  weight loss,  weight gain,  hedonic (beautiful word meaning ‘having no pleasure in things you previously received pleasure from’ ),  listless,  time just passes,  isolation,  hermit,  dropping out of social life,  not taking care of yourself (i.e.  no cooking,  eating habits down the drain,  no showers,  no brushing teeth),  no housekeeping,  hopeless,  restless,  despair,  thinking about death and ultimately (trying to) commit suicide.

Phew.  And the list is probably not even complete,  depending on who you ask.

What can I say?  I have felt it all,  sometimes all at the same time.  Obviously I have never committed suicide.  But I have come oh so very close several times…
Here am I,  but by the grace of an awesome God!!    

(Hypo)Manic 🙂  Are you crazy? 
The official meaning of the word mania, which comes from Greek,  is: “to be mad, to rage, to be furious”.  Giving me one more reason to like the name BD instead of manic-depression.
Hypomania means “below mania”.  Let’s start with that one first.

What hypomania means is: being very intense (for other people,  that is),  having a flight of ideas,  talking a-mile-a-minute,  racing thoughts,  needing less sleep (4-6 hrs),  very active,  driven,  throwing caution in the wind,  higher sex drive (the fact that I am single doesn’t make me sexless,  even though I don’t have sex with someone,  you know.  However,  I do feel a bit blue in the face for sharing this.),  constantly interrupting people,  irritable,  easily distracted,  being impulsive, over-sensitive to sound, smell and light (or in other words: heightened senses).

Examples from real life (Yep,  mine. Who else?)
What I share here I realised in hind sight,  after my diagnosis.  A sort of aha-erlebnis.  Aha,  so THAT is what was going on.  It makes sense now.

Throwing caution in the wind / easily distracted for me it meant  simply crossing the road without looking at the traffic, for instance.  A good friend told me once that she can tell by my driving what mood I am in. Oops!

On being impulsive,  I once decided I was going to be a missionary in England and terminated my health care insurance.  BIG mistake!  My insurance broker had to move heaven and earth to get me back in.  Also,  while a friend had loaned (sp?) me money because I was short of it,  I suddenly decided that I simply needed to buy this beautiful ánd expensive book.  When she later confronted me,  I only could look at her sheepishly.

Irritable? – I have been known to erupt in anger outbursts.  Very uncomfortable, especially since at the time I didn’t know what was happening with me.  Had to ask forgiveness many a time and thankfully was extended it just as many times.

Talkative –  you can say that again!  I remember very well that as a child I became at occasion a virtual chatterbox.  Now I start talking to complete strangers.  Not only that,  I share with them personal stuff.  Boohoo… this hurts, peeps.  When it comes down to it,  I am a little shy by nature,  so baring my soul to a complete stranger is a big no-no.

Racing thoughts My thoughts never stopped.  Even during sleep I could ‘hear’ my thoughts.  I never knew that wasn’t normal (whatever ‘normal’ is,  is up for debate of course, but alla),  since continuing thoughts while sleeping were completely normal to me!  I was a light sleeper in any case.  Occasionally I would sleep as ‘normal’ people do and wake up totally knackered and broken.  To me, thàt was not normal!  Hence my love-hate relationship with sleeping aids.  Like ’em because they make me really sleep at night,  hate ’em because they can make me feel sleepy during the day.

On to the Manic
Everything that hypomanic is,  but more in the extreme.  Especially:  irritability,  needing very little sleep (about 3 hrs), risky behavior (i.e.  improbable business plans),  over indulgence (spending sprees,  promiscuity), expanded self-esteem.  Mania can also include hallucinations and delusions.

I am sorry,  but I don’t feel qualified to say more than this,  since I don’t speak from experience.  However,  I do suspect that my hypomanic has manic tendencies.

My one (and hopefully last) manic episode
Actually,  I have had one manic episode.  It was about 4 months after my diagnosis.  I became delusional.  Totally paranoid that people were after me.  Not trusting anyone.  And consequently not talking to anyone.  I slept in the church for several days and lived literally out of my car.  There was a beautiful “Presence Room” for people to pray and sit quietly.  Since I had my own sleeping gear,  I sneaked into church around midnight,  slept on the floor and got up early enough to get out.

Unfortunate for me,  my counselor was on holiday.  After a couple of days I called a dear friend who was in Ukraine at the time.  She finally, after several days, convinced me to go to my p-doc (BD talk for psychiatrist – sweet and short).  When he saw me,  he put me immediately on antipsychotics.  That intervention saved me from a total break down and possible hospitalization.  A ghastly experience!!

Other posts:

What is Bipolar Disorder?

Medical treatment

Peeps that are important

Why mood charting?

Mood charting revisited

How to help people with a mental illness

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