I’m still rapid cycling. At first I was keeping things under control so well that no one could tell there was something wrong. Now I’m keeping things under control so well that only my boyfriend can tell there’s something wrong.

I don’t want to lose any more control than this. I don’t want friends or coworkers or random strangers to know that there’s anything wrong.

Last night, irritated as hell by everything, wanting to knock down pyramids of cans displayed at the grocery store, just because they were there, but not, of course, doing it. (I say “of course” as if it’s a given that I wouldn’t do such a thing, but I guess it’s not. Just because I haven’t before doesn’t mean I wouldn’t ever. Although I don’t think I would.) The night before that, crying and crying and crying and thinking that there was no point to anything.

Tonight? Happy and peppy. Tra la, tra la. Hey, maybe I’m finished with the rapid cycling for now. Maybe it’ll stay this way. Hey, maybe I’ll be happy for the rest of my life! Tee hee hee.

I am doing better with the eating thing, mainly because I seem to be getting some of my appetite back. So now I am eating food and feeling guilty about it, which I guess is progress from eating almost no food and still feeling guilty.

There were plenty of Important Topics that I would have liked to post about in the past few days, but I could never manage to unscramble my brain enough to actually do it. Now I can barely even remember what they were. Maybe tomorrow.

Philip Dawdy’s post Texas Teen Commits Suicide After Taking Lexapro contains a link to a streaming video of a newscast. At one point in the news story, the dead girl’s father talks about how Kayla was going from highs to lows, typical of most teenagers. Then the newscaster’s voiceover says, “But when the highs became higher and the lows lower, a doctor placed Kayla on Lexapro.”

Now, it’s very likely he could have gotten this wrong. The media gets quite a lot of things wrong. But if he’s right, and Kayla was vacillating between abnormally low lows and abnormally high highs, then it’s not just Forest that her parents should be thinking of suing. Prescribing an antidepressant alone for someone who shows signs of being manic-depressive is criminally stupid, especially if you don’t provide them with adequate information and follow-up care.

I am tired of tragedies happening to families all because of people who should know better, or who should care, and don’t.

“My head is killing me, my throat is killing me, my stomach bubbles with toxic waste. I just want to sleep. A coma would be nice. Or amnesia. Anything, just to get rid of this, these thoughts, whispers in my mind. Did he rape my head, too?”
~ from Speak by Laurie Halse Anderson

Last night it occurred to me that I should mention there is an additional reason for my recent rapid cycling. May 7 is the anniversary of the first time I was raped, and I don’t do well with anniversaries. “Last night” I couldn’t fall asleep until 8 a.m., and I have been all over the place — tearful, then relaxed, then snappish, then hyper, and so on. I’m at the point where I wouldn’t even mind being depressed and staying that way for a bit, because it’s so jarring to keep abruptly going from fine to Definitely Not Fine.

I am expecting tonight to be bad, but maybe things will ease up somewhat in the next couple of days.

I’ve taken Zoloft on and off (but mostly on) for over eight years. If you’ve read the posts Philip Dawdy made last month or last week about an article in The New England Journal of Medicine, “Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression,” or read this news article about it, you know that this study shows that antidepressants aren’t effective in treating bipolar depression.

Okay, so you probably could have figured that out anyway.

At this point, I am taking Zoloft for two reasons:

1. I’ve mostly been feeling good since I started taking meds again, so I don’t want to screw with my medications in case Zoloft is helping me avoid depression.
2. Some medications have made me extremely tired. Since Zoloft does the opposite, I assume it is helping me wake up in the morning. I have trouble falling asleep, but I wake up and I can function. I think it’s balancing out any drowsiness that my Epival might cause.

I don’t know if either of these are valid long-term reasons to be taking Zoloft, but they’re good enough reasons for me in the short term.

Zoloft is the only SSRI I’ve ever taken, but I took Effexor in January and February of 2006. Three weeks starting on it, and then three weeks coming off it. See, I was taking it all by itself without a mood stabilizer or an antipsychotic. I had gone off all of my medications in the fall, felt fine, then got really suicidal really quickly and wound up in the hospital. The psychiatrist on the unit discharged me with a prescription for Effexor although I told him I didn’t think it was a good idea for me to take an antidepressant without a mood stabilizer.

He told me it would be fine, and I figured I might as well listen to the doctor, because stopping all my meds all by myself hadn’t worked out too well for me. I was also not thinking very clearly and it didn’t occur to me that this could have more dire consequences than a mild hypomania followed eventually by another depression.

So what happened? Well, I once read the phrase “rapid cycling/mixed state hell” on an online forum, and that describes it perfectly. I don’t feel like going into any detail today, but suffice it to say that I wound up back in the hospital exactly three weeks later. It wasn’t pretty. It was, in fact, really ugly. I mean the situation, but come to think of it, the hospital was ugly, too.

I’m sure my being bipolar rather than unipolar had a lot to do with that in my particular case, but we all know that you don’t have to be manic-depressive for antidepressants to make you flip out. So it’s nice that the FDA has finally ordered updated black box warnings on antidepressants “to include warnings about increased risks of suicidal thinking and behavior, known as suicidality, in young adults ages 18 to 24 during initial treatment (generally the first one to two months),” whereas the warning only applied to those under 18 before that.

Health Canada had already issued a warning about this:

Health Canada is advising Canadians that Selective Serotonin Re-uptake Inhibitors (SSRIs) and other newer anti-depressants, now carry stronger warnings. These new warnings indicate that patients of all ages taking these drugs may experience behavioural and/or emotional changes that may put them at increased risk of self-harm or harm to others.

The new warning for each of these drugs, which are listed below, appears in the information package received by patients and in the prescribing information available to health professionals.

Patients, their families and caregivers should note that a small number of patients taking drugs of this type may feel worse instead of better, particularly within the first few weeks of treatment or when doses are adjusted. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or harm to others…

That’s from a press release issued June 3, 2004.

It’s a bit different, though — it applies to all ages, not just people under 25; it includes harm to others as well as self-harm; and it doesn’t include all antidepressants, just newer ones.

Welcome to Rapid Cycling. Population: me.

(The image above is a magnet I have on my refrigerator.)

Lately I have been up-down-up-down-up-down. Usually rapid cycling is a February-March-April thing for me, and I start easing out of it around this time of year. Susan at Bipolar Wellness Writer recently wrote two good posts about seasonal aspects of depression and manic depression, Ebbs and Flows and Seasonal Affective Disorder. I can relate, as there is definitely a seasonal component to my illness.

I tend to have an overarching mood pattern of being very depressed from late September to early February, then hypomanic/manic until mid-May, then relatively normal or mildly hypomanic until late September. But I also tend to have cycles within cycles, especially in the February-to-May cycle. Then I often bounce from euphoric to dysphoric hypomania (and occasionally mania) to depression and back again, in random order, for random periods of time. The spring is my prime rapid cycling time, but that doesn’t mean it never happens at other times of year. I usually feel good during the summer, but sometimes I have episodes of depression then. I’m usually depressed during the fall and early winter, but sometimes I’ll be Doing Just Fine or I’ll have brief periods of hypomania.

For nearly five months, I have been Doing Just Fine with some ventures into mild hypomania now and then. For the past few days, though, I have been up and down frequently. I know some reasons why, of course. My current jobs have very variable hours and I don’t do so well when I’m not following a stricter schedule of sleeping and eating and working and leisure time. My problems with finding adequate treatment have also been frustrating me lately. (Experimental Chimp does a good job of blogging about his struggle to find adequate treatment, by the way.)

You ever notice that if someone already has you tagged with borderline personality disorder, then any time you admit that an actual life stressor is affecting your mood somehow, it’s seen as further confirmation that you have BPD? I know there’s supposed to be a “marked reactivity of mood,” but aren’t manic-depressives, or, God forbid, even people without any psychiatric diagnosis, permitted to have some reaction to things that have actually happened to them? And when some of those things are clearly physical reactions rather than psychological ones, too? It’s not rocket science that I’m going to be more unstable when my eating and sleeping and general living patterns are irregular.

Just an observation. I mean, I know that I currently don’t make a strong case for my own point at all, as my extreme rapid cycling as of late is actually typical of someone with BPD. I mean “extreme” in the sense of frequency/length of episodes and not at all in the sense of the behaviour that I am exhibiting. The most “extreme” I’ve been behaviour-wise lately was that Tuesday I cried a bit, and only the mental health nurse saw it the first time and nobody saw the second time.

At this very moment, I feel great, just so you know. At this very moment, I can’t imagine being depressed about anything. Don’t you love how even in the middle of rapid cycling, somehow I manage to firmly believe that whatever mood state I’m in is permanent?

I love Stephany’s post Who is a mental health advocate? Read it.

If you know where the title of my post came from without having to Google it, then I love you.

Last night I started crying for no reason at all. Just suddenly got depressed, not triggered by anything that I could think of, and everything in the world seemed terrible and pointless. I’m feeling considerably better today. I know how lucky I am lately. I used to feel much worse than that for months at a time, so intense, inexplicable emotional anguish for one night is practically nothing.

This is going to sound sick, but sometimes it’s comforting when something like that happens. I’ve been feeling really well for months, and when I’m stable for a long time I start to worry that much of the past decade — the hospitalizations, the essays I handed in late, the crying, the cutting, the not sleeping, a million other things and how bloody awful I felt most of the time — were my fault, that I always should have been strong enough to deal with everything and the fact that it’s not so hard for me to deal with stuff now proves I should have been stronger all along.

Getting depressed again out of the blue from time to time blows that theory out of the water, though. This may or may not be logical, but it’s good enough for me.

And I am stable now. I can tell you exactly where I was one year ago today, though, because that was the day I started attending a partial hospitalization programme. I was at the psychiatric hospital from about nine to three, four days a week, for seven weeks. Last year I probably wrote a journal entry about that first day, but right now all I can remember about it is that when we had break time, I locked myself into a bathroom stall and cried. One of the other patients came to talk to me and she told me that I should come into the lounge and talk to everyone else if I really wanted to get better instead of hiding and crying, and I was surprised that she gave a fuck. I didn’t go off on my own because I didn’t want to get better. I was hiding because I thought it would be terrible for anyone to see me cry, because they might think I wanted them to help me or pay attention to me, when really I hated the idea of bothering anyone.

If you want to know what I particularly remember about the second day of the program, it was spraining my wrist playing volleyball during exercise period. I’m not going to forget that anytime soon.