Tag Archives: depression

Subthreshold (Hypo)Mania As A Precursor To Bipolar Disorder

The new Bipolar Spectrum.

“There is growing clinical and epidemiologic evidence that major mood disorders form a spectrum from major depressive disorder to pure mania.”

Subthreshold mania can be seen as a precursor to Bipolar Disorder, subthreshold Bipolar Disorder is defined as “recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania” (Merikangas et al, 2007). Bipolar disorder should be suspected if prominent behavior problems, anxiety, and substance abuse were present during childhood in someone with recurrent depression and a family history of affective disorders. For example, the prevalence of anxiety in children may be prominent in early-onset Bipolar Disorder and may predate affective symptoms. Children with a parent with Bipolar Disorder are more likely to be at risk for early-onset Bipolar Disorder, along with anxiety, depression and other disorders.

Studies have shown that offspring of people with Bipolar Disorder are at high risk for developing Bipolar Disorder because they have a parent with the disorder and generally have significantly higher rates of subthreshold mania or hypomania (13.3% versus 1.2%) or what is known as bipolar disorder not otherwise specified (BP-NOS); manic, mixed, or hypomanic episodes (9.2% versus 0.8%); major depressive episodes (32.0% versus 14.9%); and anxiety disorders (39.9% versus 21.8%) than offspring of parents without the disorder. Subthreshold episodes of mania or hypomania (those that resemble but do not meet the full requirements for bipolar disorder in terms of duration) were the best predictor of later manic episodes.

It should be noted that the American Journal of Psychiatry has a multitude of studies that suggest that people who suffer from Major Depressive Disorder (MDD) have a higher susceptibility to Bipolar Disorder and that subthreshold hypomanic symptoms that are found in people suffering from MDD should be taken into consideration when diagnosing. Placing these people instead on a bipolar spectrum, hence altering their treatment plan by incorporating a mood stabiliser which can also assist with the present MDD.

 

 

The ‘Poster Patient’ of Bipolar Disorder.

When you’re considered the ‘poster patient’ of Bipolar disorder…

I see all my doctors at regular intervals and I take medication daily. That’s the simple side of things, the easy routine and foundations that you are required to build. Depression and hypomania have accompanied me at different interludes, always waiting backstage for the next show to begin. I see myself as so dysfunctional. So haphazard and incapable of maintaining all the demons in check. I’m writing this post because I see myself as all those things, maintaining complete control of my emotions and rhythm is beyond my control, yet my psychologist insists that I’m a ‘poster patient’ for Bipolar Disorder, my ability to be functional when everything has turned on its head. I was so confused when she originally said this. I know my dysfunction, mismanagement and self-sabotage run deep, hence my confusion to the compliment. She referred to how she used me as an example to other patients about what can be achieved. The facts that she presented were right: I have completed a university degree and I am half way through another, I do have a full time job (I work full time as a secondary teacher), exercise, eat regularly and maintain some semblance of social interactions with friends. It hadn’t hit me that this is what is considered to make me less dysfunctional. My moods don’t generally have repercussions on my life, they are damn high mountains to climb over in order to find solace again, but the hike and lightheadedness of the ‘mood mountain’ doesn’t necessarily interfere with my outer world.

I don’t see these facts as things which make me more managed. I am dysfunctional. My ability to manage my life doesn’t make me any less so. As my depression deepened a few weeks ago, I started to have regular suicidal ideations again. Obviously the recognition that the severity of my depression was getting worse, I acted. I wanted to flip the switch. Anything had to be better than those tendencies, those ideations. I have done a lot of research into the vitamin 5-HTP, simply put it can potentially alter the levels of serotonin in your brain which can result in a hypomanic episode. High is much better than being low. Until you’re high….

Then it’s hell, again.

Without going into specific details of my episode, 5-HTP worked by flipping the switch. The worst part about flipping the switch is when you remember how horrible it is to actually be hypomanic at times. My memory had conveniently let myself forget. My mind has the useful ability to allow me to forget how bad things have been at both ends of my imaginary scale, the thermostat of my mind. It’s a protection mechanism, allowing me to move on and forget the consequences of all my subsequent moods. I took 5-HTP for three days before stopping when my head started to *whoosh*. I find everyone’s interpretation of ‘racing thoughts’ to be different, but then again, each episode I have had resulted in ‘racing thoughts’ which were different from previous occurrences. I see these in the following categories: Actual racing thoughts, when you have too many ideas at once – excitement usually accompanies this variation. Then there is the static or *white noise* head background pressure ‘racing thoughts’ which is usually accompanied by irritation and finally there is *whooshing*, when there isn’t an exact thought but your mind is just doing the simple cycle of the washing machine with your ears blocked, accompanied by a bit of depersonalization. It sounds absolutely nuts. Which it is.

I was never meant to be this broken, popping pills, waiting for the next mountain to climb.

At least I know that I can climb and conquer.

The Morning After I Killed Myself, I Woke Up.

*Thought this was a pretty epic story by Meggie Royer – for anyone who has thought about the day after it’s all over. 

I made myself breakfast in bed. I added salt and pepper to my eggs and used my toast for a cheese and bacon sandwich. I squeezed a grapefruit into a juice glass. I scraped the ashes from the frying pan and rinsed the butter off the counter. I washed the dishes and folded the towels.

The morning after I killed myself, I fell in love. Not with the boy down the street or the middle school principal. Not with the everyday jogger or the grocer who always left the avocados out of the bag. I fell in love with my mother and the way she sat on the floor of my room holding each rock from my collection in her palms until they grew dark with sweat. I fell in love with my father down at the river as he placed my note into a bottle and sent it into the current. With my brother who once believed in unicorns but who now sat in his desk at school trying desperately to believe I still existed.

The morning after I killed myself, I walked the dog. I watched the way her tail twitched when a bird flew by or how her pace quickened at the sight of a cat. I saw the empty space in her eyes when she reached a stick and turned around to greet me so we could play catch but saw nothing but sky in my place. I stood by as strangers stroked her muzzle and she wilted beneath their touch like she did once for mine.

The morning after I killed myself, I went back to the neighbors’ yard where I left my footprints in concrete as a two year old and examined how they were already fading. I picked a few daylilies and pulled a few weeds and watched the elderly woman through her window as she read the paper with the news of my death. I saw her husband spit tobacco into the kitchen sink and bring her her daily medication.

The morning after I killed myself, I watched the sun come up. Each orange tree opened like a hand and the kid down the street pointed out a single red cloud to his mother.

The morning after I killed myself, I went back to that body in the morgue and tried to talk some sense into her. I told her about the avocados and the stepping stones, the river and her parents. I told her about the sunsets and the dog and the beach.

The morning after I killed myself, I tried to unkill myself, but couldn’t finish what I started.
By Meggie Royer

People Are Strange. Wine Is Better.

Lately I’ve become so self-absorbed, I’m not happy, I’m not anything, but maybe that’s just how I’m meant to be. We don’t get born into this life to be happy, I guess we get born to experience, whether it be happiness or sadness or anything in between. I have no reason to be unhappy, I’ve tried enough medication to know that maybe this is just the way I’m meant to be, contained in a simple and sometimes satisfactory existence, I haven’t helped anyone, I can’t even help myself.

I miss hypomania, at least I felt something more. Instead I look calm and collected on the outside, my mind constantly trying to stay afloat among the negativity on the inside. Running away will never make anything better, I need to keep reminding myself this. It seems like humans have reached a point where we keep trying to teach ourselves how we are meant to be or feel, but this doesn’t make it right. It’s not like all the other species in the world go to extreme lengths to achieve happiness from an introspective position. I keep plastering a smile on my face, going through the daily motions of the expected emotions, I keep hoping that this will get better. Maybe it will matter later, maybe it won’t, maybe I will just keep drinking my wine, and hoping sleep comes quicker, daylight always keeping the darker notions at bay.

In the altered words of the monopoly man: “Go directly to Depressiondo not pass go, do not collect $200″. Its ok, I never win at monopoly anyway.

alice-in-wonderland-crazy-deep-depression-Favim.com-1960257

Three Months of Freedom. I’m Back.

It’s been three months without thinking about Bipolar Disorder. Three months ago my psychiatrist started to think that I could potentially be Borderline Personality Disorder comorbid with Bipolar Disorder, it’s taken me two months to even acknowledge this. Borderline Personality Disorder can often co-occur with Bipolar disorder, having numerous overlapping symptoms. My psychiatrist sees the disorders linked in some people, existing on a mood spectrum where they interconnect. I’m against this analysis, I was mad, I’m still a bit mad. I slowly began to take myself off my medication. I cancelled all my other upcoming appointments, in my mind it was a big f*** off to mental health. I was good, I was on university holidays, no stress, nothing to trigger mood instabilities, and it was nice. University went back 4weeks ago, so I took myself back to the doctors, my psychologist, in contrast to my psychiatrist she doesn’t believe I’m BPD, but reaffirmed her belief that I need to monitor my moods and stay on top of my emotions. My psychologist forced the importance of Bipolar Disorder awareness back into the forefront of my mind. I’m still medication free, but the reality of mental illness is scary.

For anyone else who is or potentially has both Bipolar Disorder & Borderline Personality Disorder.

Development/Nature of the Illness:

Borderline personality disorder is a type of “personality disorder” which essentially means that it is a developmental condition – something that has evolved through the entire development of a person’s emotional/behavioural infrastructure.

Bipolar disorder is an illness that presents acutely or sub acutely (less than acute) sometime in a person’s life and is not, at least as we define it now, a condition that is part of a person’s core personality structure.

Course/Presentation of Symptoms:

Borderline symptoms are present as a person’s baseline– their difficulties with mood regulation and impulsivity, their ups and downs, are part of their life all the time. They are always up and down.

Bipolar symptoms present in episodes that must be a change from the person’s baseline – that is part of the diagnostic definition. Their episodes of depression or mania are a change from who they are when they are feeling well.

So the most annoying part of all of this: HOW CAN I BE BOTH! Uh… Having to exist on a spectrum with both, I don’t exhibit all symptoms of either.

Would love to hear from other people’s experiences.

Hope everyone has been well and happy. Love Alice.

*image by ahermin

Euphoric or Dysphoric? Ramblings… I’m Probably Nuts.

Looking at this post in the daylight I can definitely tell it’s been hypomaniacally induced. Sorry to anyone who read this post earlier, to those reading it now – it could’ve been worse.

*CRINGES* What an awful week. It’s been is an emotional riot, my emotions lashing out, stress setting them free (or the anti-depressant which has been added to my cocktail…), the dissent is definitely making itself at home.

I’m pretty sure I experienced a hypomanic episode for all of one day, I think. Wanting to rearrange all my furniture at 9pm at night and starting to sand back other furniture for my DIY projects is usually a giveaway for me. It’s like I have to do something, but not any of the things I’m meant to be doing (sorry university work, you will still be there in the morning). After recognising this and my annoying/over the top behaviour which my partner told me was annoying, not to mention talking too fast and having snowball like ideas – they are always great ideas, anyway – point being I quickly took all my medication because I didn’t want to sleep (doubling the sleep meds) and proceeded to knock myself out. Waking up the next morning I felt extremely normal, except the following days I became so discontent that I’m just not happy with anything, it’s usually furniture (I swear I can be obsessive compulsive sometimes). I’m still discontent, I don’t want to go home and deal with my head being even more unhappy. I’m currently in my university’s 24hr library at 1am, who needs sleep anyway?!

I actually had a point to this post which wasn’t meant to be drowning in my current whinging and whining state. POINT: I liked to believe that to experience hypomanic symptoms you were meant to have the episode for 4+ days, they failed to mention that these mood extremities could take place daily and leave as quickly as they came without being classified as an ‘episode’. Some people only experiencing (hypo)mania once, others (apparently) have daily mood swings regardless of their diagnosis into our ‘categories’, each individuals pattern is distinctive. My only hypomanic episode was one which lasted around a week, I’m now realising that other times I have experienced the same symptoms for shorter durations – “hypomanic episodes tending to last a few hours or a few days”. I’m under the firm belief that I don’t have rapid cycling; instead I have fluctuating moods based on stress levels.

John Preston, PsyD, Psychology: “During euphoric hypomanic episodes, people have a heightened sense of well-being and are very productive and gregarious. During dysphoric episodes, people are agitated, pessimistic, and restless.

Even people who always take their medication and are careful with their health can still have mood swings from time to time. That’s why it’s important to catch changes in your mood, energy levels, and sleeping patterns before they develop into something serious.” – What arseholes.

People with bipolar disorder are seven to eight times more likely to experience an unwanted, extended period of extreme mood shift — failure of their usual coping mechanisms — in response to a stressful life event,” says Dr. Bennett.

Ramble: Appetite suppressants have been linked to manic episodes…great, no quick fix skinny pills for me then.

Interesting abstract from a site I found:

“Anxiety, mood and energy, all waving up and down, sometimes with each other, sometimes one going off without the others:  a total mess, right?

People with such instability have big changes in their mood, or energy, or creativity over time. Here the green curve represents mood, the red curve represents energy, and the black curve represents “intellect” (speed of thought, creativity, ability to connect ideas).

KraepelinWavesAs you can see, if they all go up together — and far enough “up” — this would be what is commonly called a manic or hypomanic episode, as shown at point A on the graph. If they all come down together, far enough, that would be an episode of “major depression”, as shown at point B. But now we can see how “agitated depression” could be part of a bipolar problem, when the energy curve is up while the others are down, as at point D.

Point C represents an unusual combination usually recognized only on inpatient psychiatry units, when a person is agitated yet hardly moves, so-called “manic stupor”. But imagine what a milder version of this would look like: the person would know she needed to get moving, indeed she would be thinking of many things she needed to be doing, and she might really want (in a very powerful way) to be doing them, and yet her body would refuse to go along. She would be lying there on the couch, miserable yet not really depressed, wondering what was wrong with her and why she couldn’t get herself going.

Point B represents another very important combination we psychiatrists see commonly: the energy wave is up, but the mood wave is down (in this case, the timing is such that the intellect wave is up too, but not as high as the energy — yet there are many combinations, as you’ll see in a moment). This could be called “dysphoric mania”: energized, as in a usual manic phase, but mood is very negative.”

**********

Okay, new point:

  • Bipolar Disorder is clearly handled with medication first, bipolar-specific psychotherapies coming second.
  • Self-harm: Isn’t always about the excessive depressive/self-hate/suicidal times, sometimes it’s an attempt to ‘treat’ severe agitation or as a punishment. The behaviour often disappearing quickly when the agitation is reigned in.
  • It’s getting sadder, the more I have to face my own reality, I can’t deny Bipolar Disorder anymore, it’s becoming too blatant and overbearing
  • Caffeine can cause hypomania ‘like’ symptoms…yay…
  • Current evaluation: I get super excited for particular activities (DIY/buying furniture etc), start doing a bunch of things, only to run out of steam, spending way too much money, asking myself why am I doing this?! I have much more important other things that need to be completed – needless to say, I’m here typing instead of doing all the important things, looking up journal articles about Bipolar Disorder to seek comfort in knowledge.

♩ ♪ ♫ ♬ ♭ “Everything that kills me makes me feel alive…Everything that drowns me makes me wanna fly” ♩ ♪ ♫ ♬ ♭

Medication: 400mg Lamictal, 25mg Quetiapine & 3mg Haloperidol. Mostly taken consistently.
*image by angrymikko

 

The Rise Of Psychiatry Has Augmented The Rise Of Madness Through Medicalization

When psychiatry is ‘curing’ the deviants of society and is invested in the restoration of normality.

It’s been a long while since I’ve last written, I’m not exactly sure why. Maybe, just maybe it’s because I’m not feeling too high or too low, the lows always lasting longer than the highs. Psychiatry has been playing on my mind lately, pills and potions; we’re overdosing, sick, sick, sick, I hear them say it. The pills fail to fill the void, has the void always been there or are the pills’ telling me that something needs to be fixed.

I was never meant to fix myself, the bruises on my thighs are like my fingertips, eerily matching the darkness that I feel. The darkness is like beautiful cherry blossoms that are always about to bloom, they are always so pretty, but they are always gone too soon. 

An attack on psychiatry: The original rise of asylums has allowed the confinement of madness to be ‘treated’, reclassifying a non-medical problem as a medical problem. Medicalization is the defining of non-medical problems in medical terms, usually as an illness or disorder, and usually with the implication that a medical intervention or treatment is appropriate (Zola, 1972). Medicalization leads to “normal” human behaviour and experience being “re-badged” as medical conditions. Rebadging “deviance” as a series of medical disorders, the engines driving medicalization have been identified as biotechnology (especially the pharmaceutical industry and genetics), consumers, and managed care. The hubris of psychiatry, believing originally that they could cure all psychological problems with psychoanalysis, psychiatry still failing to improve the average levels of happiness and well-being in the general population. Psychiatry is able to pump out psychotropic drugs, not save mankind, attempting to alleviate our ‘age of disenchantment’.

We are treated, analysed and regulated scientifically, living by a manual which fails to understand the sociological impacts and failings of society. Have we potentially been manufacturing our own madness? Postmodern psychiatry seems to have become a tailor-made diagnosis for an age of disenchantment. Are these psychiatrists potentially manufacturing madness? Is the medicalisation of madness reducing creativity, the creative aspects of people commonly misinterpreted as deviants? Centuries of creative people from all modalities have suffered from mental illnesses, resisting treatments which could potentially ease their conditions, fearing that it could cloud or alter their mind, drugging them into submission, proceeding to quash their inner creative impulses.

Edvard Munch: “I want to keep my sufferings. They are part of me and my art.”

Van Gogh: “Men have called me mad; but the question is not yet settled, whether madness is or is not the loftiest intelligence, whether much that is glorious, whether all that is profound, does not spring from disease of thought, from moods of mind exalted at the expense of the general intellect.”

Psychologist Maureen Neihart: associates the shared characteristics amongst creative production and mental illness, which include mood disturbance, a tolerance for irrationality, greater openness to sensory stimuli, restlessness, speed of thinking, and obsessiveness of thought.

Marcel Proust: “everything great in the world is created by neurotics;”

Seneca quoted Aristotle as having said, “No great genius was without a mixture of insanity.”

Many psychologists believe that artists use their work to heal and soothe their minds. But if drugs heal artist’s minds for them, is their work still needed, or would it even be produced, would their work even be needed? I always found that my over-sensitive and stimulated mind would always find so much more beauty in the world, glimpsing the magical and maniacal way of being present. Sometimes the pills keep me from spiralling into the abyss of the rabbit hole, the terror, but also the creative language which comes from seeing both sides, the place that is sometimes so warm and comforting but at the same time cold and hard. We’re definitely a pill popping society, whether it be vitamins or hard core anti-psychotic sedatives (Haloperidol…I’m talking about you, you’re such an exhausting and all-consuming prick). I’m not writing off psychiatry as a professional form of medicine, I just believe that they are infested with conflicts of interest, most commonly the extensive influence of the pharmaceutical industries over modern medicine.

End note: I do not mean the use of the word “madness” to be taken in any offensive way; it is used in the same way that sociology and psychology have referenced it in academic journals.