When I was a bit younger, I used to have really bad PMS. It was probably bad enough to be diagnosed as PMDD, but if anybody ever did diagnose me as such, they didn’t tell me. Every time I attempted suicide, I think it was just before or during my period. The worst thing about it was that my period was also extremely irregular, so I never even knew when the PMS was coming. Although there was a good side to that, too — I’d suddenly become intensely suicidal, but when my period would come, I’d be so relieved to know that there was a concrete reason for my mood, I wasn’t “going crazy” again, and I’d be feeling better in a few days. That’s an amazing sense of relief to have.

This was a major issue for me until I started taking the birth control pill. I wanted to start taking it a few years before I actually did, but I couldn’t find a doctor who would prescribe it for me. The reason? I was on Topamax, and Topamax can sometimes make oral contraceptives less effective. This only holds true if you’re on 200 mg or more daily, and I think I was on 100 mg at the time, but who’s counting?

How did I eventually get prescribed oral contraceptives? Well, one day I went to a clinic to get the morning after pill (yes, we’d been using protection, but we had a condom breakage issue) and when the doctor was asking me some questions, I told her that this was the third or fourth occasion that I’d taken emergency contraceptives (over a span of three years).

She said, “Polly, Polly, Polly, what are we going to do with you?”

She had never seen me before in her life.

I said, “Well, for starters, somebody could prescribe me the birth control pill!”

And so she did. Yes, she knew that I was taking Topamax and that it could make the Pill less effective. I should point out that the other doctors I’d asked about birth control had all been male.

I never took the morning after pill again. I have never been pregnant. A couple years later, I stopped taking Topamax.

I know that oral contraceptives cause really bad mood swings in some women, but they actually help prevent them for me. It’s also nice having my menstrual cycle regulated, so that I know when a possible time of PMS is coming up. On the other hand, since I now only rarely get depressed and irritable before I get my period, there’s still that element of surprise. If I’ve gone for many months without PMS, I’m not expecting it to happen.

Which is why last week, I spent a couple of days feeling like I wanted to go lie down in traffic, but was cheered up when I realized that I only felt that was because of PMS. Then I got a little too cheered up, because I had an insomnia thing going on, and I got hypomanic. I was so jumpy and hyper that I was seriously afraid that I was going to have to call in sick to work one day because of it. I had a cup of coffee the day before, like an idiot — I try not to drink coffee at all normally, and when I’m hypomanic, coffee is an incredibly bad idea. IT MAKES MY BRAIN FEEL LIKE IT IS JUMPING UP AND DOWN. AND IT MAKES ME FEEL LIKE EVERY NERVE IN MY BODY IS JUMPING UP AND DOWN INSIDE MY SKIN, TOO. And that’s actually a lot of fun, even if my pitiful, inaccurate attempts to describe it make it sound uncomfortable. The uncomfortable part comes because I. Can’t. Keep. Still. and any situation that would require me to stay still is horrible for me. If I’ve got free rein to climb on stuff and do whatever I want, then it’s tons of fun.

You see why this might be a problem when I’m at work, though.

I guess caffeine does this to a lot of people, but if you are not manic-depressive, I don’t think that ONE CUP OF COFFEE can make you feel like this for TWELVE HOURS STRAIGHT before you start to come down a little.

Anyway, I somehow started feeling a lot more subdued, and I was able to go to work, and it was all good.

Um, I have no idea where I was going with this. I’m still a wee bit on the hypomanic side, but not in a bad way. Oh, yeah. I wanted to mention that although I don’t eat as well as I should, for a long time now I’ve been doing really well at trying to make sure my sleep schedule is as regular as possible, because I know how important it is for me to sleep properly if I want to stay well.

Ha ha ha, I’m standing up at the computer again because I’m still not so awesome with the sitting still. Sit down, you.

Anyway, my sleep being messed up through no fault of my own and the subsequent consequences provided me with additional proof that I should definitely stick to a regular sleeping schedule. I’m so much more stable when I do. I know, duh, right? Although the insomnia wasn’t brought on by anything I did, for a few days I didn’t try hard enough to get my schedule back on track, and that only served to remind me that it is dumb not to try to get enough sleep. It is also dumb for me to oversleep, or to sleep at weird times, especially since I have a more-or-less nine-to-five kind of job.

I’m trying harder now, though. For really.

I’ve been having a rough week. This used to be de rigeur for me, but now that I’m so stable most of the time and don’t have random severe mood swings caused by nothing whatsoever, I tend to forget that I can still have major mood swings triggered by physical things such as my sleep schedule being all messed up. Which it is right now. I try to keep a much more regular sleep schedule than I used to, because I know how important it is to my mental health. Overall, it works out pretty well… but no matter how hard I try, it doesn’t work all the time.

So now there is insomnia leading to rapid-fire mood swings, and even though it’s not nearly as bad as it used to be a few years ago, I still find it disturbing. I find it disturbing simply because I’m not used to it anymore. I didn’t used to have a normal baseline mood. Now that I do have one, it’s kind of freaky to watch myself deviate from it. I’m not even worried that things will get worse; I’m really not. I know I’ve got everything under control. It’s just unsettling to be going along for a while not having to try particularly hard to keep everything under control, and then all of a sudden having to work at it again.

Things I wanted to do tonight: Heat up frozen mini-pizzas and eat them, take a shower, do two loads of laundry, write a long blog post, pack my bags for the long weekend. This doesn’t sound too hard, does it?

Things I managed to do tonight: Eat Lunchmates (using the oven and washing dishes seemed way too complex), do one load of laundry, start writing a blog post, get distracted in the middle of it because I’m trying to find a certain envelope that had stuff written on it, wander around looking for the envelope, get really frustrated that I can’t find it, think I should clean the bedroom but I don’t want to, sit back down and try to write the blog post but instead find myself rocking back and forth. I’ll pack in the morning. I’ll shower tomorrow night. No, I’ll take a bath tomorrow night. You don’t even have to stand up to do that. Scrap the blog post that was supposed to be long and semi-meaningful, and start writing this one instead.

I hate that sometimes, even when I’m not particularly depressed or hypomanic, I still can’t do things that everybody else can do. I mean I literally can’t do them. At work, I am always organized, often hyperfocused, and have no problem multitasking. In the rest of my life, though, the simplest tasks frequently seem unbearably complex. Tonight the thought of washing my hair or turning on the oven made me want to crumple into a little heap. I’m not even sad. I’m not even tired. I’m not having particularly intrusive racing thoughts. I’m not just being lazy, either. Trust me — I’m lazy frequently enough to know when I’m being lazy! I’ve got plenty of experience in that area.

I’m not always like this. Just far more often than I’d like to be.

“…how are things since the decision?” Gabriel asked in a comment on my last post, which I wrote over a month ago. I had decided that I didn’t want to ask my doctor to increase the dosage of my Epival. I figured I would ride it out and be all right on the current dosage.

This was indeed the way things were working out, but then I went off meds for a few weeks. On purpose, because I am stupid. Hypomania can be fun. It is not fun nearly as often as most people assume it is, though, or at least it isn’t for me. The times when I am sure I am connected to every other atom in the universe are few and far between compared to the times that all the overload is too much and everything in the universe annoys me. For every hypomanic episode where I am actually productive, I have tons where I go to bed and try to go to sleep but I can’t, so I wind up staring at the ceiling and around the room for six hours, because I am too awake to manage to close my eyes. I am not up at night writing the Great Canadian Novel or cleaning my room or even blogging, because I am too tired for that, but I am still. so. damn. AWAKE and my thoughts keep racing but there’s nothing I can do with them. Even though I’m exhausted, I still have so much energy that I can’t keep still while I lie there. Instead I kick and fidget so much that my muscles are sore for days afterwards, and I flap my hands and hit them off things until I worry that I actually might break a finger.

Anyway, that’s not even what’s been really bugging me lately, although of course I have been having some nights like that. I’m mainly just ashamed of myself. I know I shouldn’t go off meds without telling anybody, but I did it anyway, and I’m ashamed of that. When I am ashamed of myself, I don’t want to write any posts. I don’t want people to know that I’m being a dumbass. I’ve held things together quite well overall, but now I’m starting to scare myself a bit, so I’m going back on meds. My bank account can’t handle this hypomania, and it hasn’t done anything positive for me except make my life a little bit more interesting. It would be fun to have an I Love Everything and Everything Loves Me episode, but this isn’t one of those. You would think that by now I would have realized that I can’t make them happen.

Overall, I am fine, though. You likely wouldn’t notice that anything was out of the ordinary. But I do. It’s good that I can keep the slight trouble I’m having with things like anger and paranoia under control… but I’d really rather that I didn’t have to wrestle with these things. I’d really rather that they were non-issues. Hence, meds.

Speaking of keeping things under control, though… You know those statistics that tell you that (some large number)% of people who suffer from manic depression also have substance abuse problems? I’d thought for a long time that I’d dodged that particular bullet. In the past few months, though, I’ve realized that I have a problem with what Experimental Chimp wonderfully termed “binge drinking and consequent inappropriate-yet-impossible-to-remember-behaviour.” I don’t think I really want to say any more about that right now, though. I’ve already babbled enough.

I don’t like writing posts that are All About Me, by the way. Or at least not all about me as I am right now. I’d rather talk about something I read in the newspaper or on another website, or tell stories about stuff I did/that was done to me Back When I Was Crazy. Because, you know, for the most part, I am “well” now. Whenever I mention currently having any symptoms whatsoever of bipolar disorder, I feel that it smacks of failure. I guess if I was really 100% “well” and “recovered,” I would be so mentally healthy that such things wouldn’t faze me at all and I wouldn’t see them as failures. But I don’t think I’ll ever be that well.

New Year’s. A friend asked all of us what we hoped for in the year to come.

“I want to not fuck up,” I said. Felt tears pricking at the corners of my eyes, realized these people had never seen me cry, which feels so weird, because I have always been used to absolutely everyone who comes into contact with me at all seeing me cry at one point or another. But although the people present were close friends of mine, they have only been so for less than a year and a half. During most of that time, I have been the New, Improved Polly on medication that actually works for me.

Did not want them to see me cry now. Had to explain that I wasn’t really being upset and maudlin, that I was actually trying to be positive.

“It’s just that I went all through 2007 without fucking up,” I said. “I was sick for so long, and the past year was the first year that I’ve been well. I just want things to stay that way.”

I then almost immediately proceeded to come dangerously close to fucking up.

I spent the next few weeks hypomanic in a bad way. Yelled at people for no reason. Obsessed endlessly about certain things. You don’t even want to hear about my sex drive during those weeks (hint: really, really high). Drank way too much, alone. Spent too much money.

With little warning and absolutely no fanfare, I slipped into a mild depression and stayed there for a few more weeks. Believed I would never be happy again. Wondered what was the point of anything. Continued to occasionally drink too much, alone. Had to try very hard to keep from cutting myself. Sent disturbing emails to friends about wanting to cut myself. Only managed not to cut myself because I knew my two-year anniversary of not cutting would be coming up soon, and I really wanted to make it to two years without screwing up.

Then woke up one morning and felt better, just like that. Not caused by anything. Nothing had changed except for my mood. The weather was still utter wintery crap, but it suddenly wasn’t bringing me down anymore. (Seriously, if you are not in Canada right now, stay away from this country until at least May. I am not joking.) I still had the same slight personal problems I’d had for a while, but I was suddenly able to look at them rationally and not blow things out of proportion. It’s so weird when you wake up and all of a sudden you are well. It’s also weird when you wake up and all of a sudden you are unwell, but I don’t like that one quite as much. I can’t help but think of it as some cosmic dude or dudette mucking about with a remote that controls my emotions.

I had been seriously considering asking my doctor about increasing my medication when I saw her, but ultimately I didn’t, since I wasn’t having problems functioning and my mood swings were quite tame compared to the way they used to be a year and a half ago. I figured I could deal with it without more drugs, but afterward I worried that maybe it was stupid and pigheaded of me.

Now that I feel better, though, I’m pleased to see that this was indeed the best decision for me at this time. I’m glad I got through that rough patch while remaining on only a minimal amount of medication.

Lately I am trying very hard not to do inappropriate things or to overshare, which is why I haven’t been posting. The Internet is not a good place for oversharing. Hello, world, here are all the stupid things that are going on in my head lately, all the stupid things I am trying so hard not to say and do. Nope, not gonna happen.

My current state of mind is the result of recent personal issues. They might not be the sole cause of it, but they’re definitely the main cause. I am trying to deal with these issues in a healthy way, instead of drinking too much, not sleeping enough, spending too much money, and sending people inappropriate emails. So far, I am only being mildly successful at this, but I’m trying.

Interesting post at Furious Seasons recently (heh, as if there were not an interesting post there nearly every day!) regarding manic depression as a dangerous gift, as a personality disorder, and as something from which one can completely recover.

I know I am going out on a limb here that someone will likely chop off for me, but I believe that much of what we call bipolar disorder is in fact a personality disorder or constellation of behavioral issues.

I’m not looking to chop off this limb. I view manic depression as a dangerous gift as well, and as something that maybe at least some people can completely recover from. I also understand that Philip is not saying all a person with bipolar disorder has to do to recover is pull themselves up by their bootstraps:

I think bipolar disorder can be a personality disorder–and, nitpickers be warned, I am using the term very broadly–more often than it is a mental illness.

Depression–and here I am not discussing major or clinical depression–is widely known as having a huge personality component.

Mania itself–and here I mean the bad old wild delusions, hallucinations and declarations of Godhead mania–is not a personality disorder. When it’s in full flower, mania is straight-up insanity.

Dysphoric mania is possibly the least fun thing in the world, but there is at least one good thing about it: once you’ve recovered from an episode of psychotic dysphoric mania, it’s really hard to convince yourself that it was a character flaw. You can easily convince yourself that you weren’t depressed, just stupid and lazy, and that you weren’t hypomanic, you were just being a silly, reckless whore… but after having auditory hallucinations for a few weeks straight, once I finally stopped, I realized that something had been really wrong and that this time it wasn’t my fault.

I was aware that most of the time, medication either made me a zombie or made my moods even worse. So sometimes I would stop taking medication, be fine for a few months, and then be much, much worse than before. I learned to do things that sometimes stopped mood episodes, but more often just allowed me to cope with the symptoms I experienced, so that I functioned very well as one of the walking wounded. For quite a long time, I honestly believed that there was no such thing as getting better, there was only becoming a better liar, so that you could hide your pain from others and even from yourself. Or at least I thought that was the only option for me, because I’d read about other people who were asymptomatic for long periods of time, who claimed to experience “growth” and “healing.” I didn’t disbelieve them, but I didn’t think that anything would work for me. I tried CBT, DBT skills, family therapy, couples therapy, group therapy, exercise, meditation, hospitalization, acupuncture, journalling, medication, medication, medication, and other stuff… but the hits just kept coming. I kept getting depressed, I kept getting hypomanic, and I kept getting manic.

Some of those things helped. Some didn’t. (Acupuncture, for instance, was supposed to make me less stressed, but instead it turned me into a stressed person with needles in her ears.) For nearly a decade, though, none of them prevented me from having mood episodes, which I dealt with using a combined method of actual coping skills plus being way, way too hard on myself. I have been essentially non-syndromal for the past year, though, and it seems to be solely because I’m finally on medication that’s working for me.

I am better, and I want this to be an accomplishment. I wish this were something I could take credit for. But it’s not.

The journey to get to this point was so long and arduous that I want the current solution to be complex. (I say “current solution” because although this has been the solution for the past year, I don’t assume it will be the solution that works best for me forever.) It’s not complex, though. It’s not intricate. I-take-two-pills-a-day-and-now-I-am-well. If I am experiencing any side effects, I am not aware of them. I still have emotions. I can cry when really bad things happen, I can take joy in something as simple as seeing furry gray squirrels race across tree branches, and I can write really bad fiction.

Despite how hard I tried to get better, I still can’t take any responsibility for it. It’s true that I learned plenty of things along the way, including just how vast the extent of my own ignorance is (and how ignorant many of my doctors were), but nothing I learned was instrumental in my actual recovery. I tried and tried and tried to save myself, yet I did not.

I wish I’d fixed it. I know I should be careful what I wish for. I’ll say that I wish I’d slain the dragon myself and the next thing you know, the meds will poop out and the dragon will pop back up, all scaly and fire-breathing, saying, “You called? Here I am, bitch. Come and get me.”

But still. I wish I’d fixed it.

Stumbling back, blinking confusedly and wondering what happened to the past week.

My brother was released from the hospital after nine days there. My mom says he is doing okay, but she worries about him all the time. She is worried about what he’ll do the next time he and his girlfriend have a fight. They’re always fighting. He told her that if she took that job this summer, he’d kill himself. She took the job, he didn’t kill himself or try to kill himself, but he did have to spend nine days in the hospital.

I’m a bit hypomanic. Nothing extreme, mainly I’m kind of hypersexual and I’m also feeling like it’s stupid to be taking my medication. Usually, if I’m not taking my medication properly or if I stop taking it altogether, it really is because of the side effects. I am not the stereotypical “she stopped taking her pills because she thought she didn’t need them anymore” manic-depressive. (Almost nobody is, by the way. People just think that we are because they don’t actually believe us when we tell them how bad the side effects are.)

But I am that stereotype right now. Or at least I would be if I actually stopped taking my pills, which I have not. I want to, though. I feel so good right now. How could there possibly be anything wrong with me? Why would I possibly need drugs?

Twice in the past, I went off all of my meds without telling my doctor. I didn’t think that I wasn’t manic-depressive; I just thought I could handle it better without the drugs. Both times, I felt fine for a little while. Both times, things changed. The first time was a bit more gradual. It started out as mild paranoia, then moved to severe paranoia and delusions, and then added auditory hallucinations. Now, that was a fun six months. The second time was much more sudden. A case of severe insomnia turned overnight into serious suicidality and helped set off a chain of hospitalizations. All of that funstuff is why I decided that although I would try taking lower dosages of medication, and although I would stop taking Dope-a-max and atypical antipsychotics, I probably shouldn’t take no medication at all.

Right now, though, I feel like I’m talking about someone else. I have a hard time believing that I was ever ill. It feels like it was all a dream. I am fine. There’s nothing wrong with me. Why would I need pills?

Everybody has already read about this study and its claims that there is something called “subthreshold bipolar disorder,” and as far as most of us can tell, SBD equates to “simply being human, but big pharma thinks you need antipsychotics for it anyway.” I’m lazy, though, so I haven’t commented upon it until now.

CL Psych posts about the incredibly loose criteria for SBD and the media’s claims that there is “appropriate” medication for it in Subthreshold Bipolar: The Giant Sucking Sound and Subthreshold Bipolar: Media Blitz and Lilly.

Philip Dawdy has also written several posts about subthreshold bipolar disorder, including Name The New Bipolar Disorder, in which he urges people to come up with a better name for SBD. I haven’t come up with anything yet, or rather, I haven’t come up with anything that no one else hadn’t thought of and posted already!

I am vastly confused by the stats from the article in the Archives of General Psychiatry. No, they’re not too complex for me to understand; they’re too stupid for me to understand. Only a 2.4% prevalence of Americans who, twice in their lives, meet half of the criteria for hypomania? I would expect it to be more like 99% than the 4.5% it winds up as in this study once you add the 2.4% to the 1% prevalence for bipolar I and the 1.1% for bipolar II.

I am more of a fan of the bipolar spectrum than some people in the blogosphere are, but this subthreshold nonsense is taking things way, way too far. Honestly, sometimes I like the things that Akiskal has to say, and he’s one of the authors of this study. Some doctors overdiagnose bipolar disorder, and most people who diagnose it overmedicate their patients. But there are still plenty of health care professionals who don’t recognize bipolar disorder. Sometimes, it’s not their fault — they don’t see the patient when he or she is hypomanic, and even if they do ask him or her about past symptoms of hypomania, the patient, in the middle of a depression, is pretty much unable to remember ever feeling okay, let alone hypomanic, and doesn’t — can’t — answer accurately.

Then sometimes there are shrinks who think you’re not manic-depressive if you haven’t, like, married someone you’ve just met and then bought five cars. Doctors who think mania equals euphoria and if you’re having a dysphoric mania, you’re just an asshole. Who think that mixed states or rapid cycling must always be borderline personality disorder instead, and even, believe it or not, doctors who are always going to assume that if you’re psychotic, you’re schizophrenic.

Yes, this “subthreshold” stuff is ridiculous, but within limits, I like the idea of the bipolar spectrum because it makes people aware of things that actually are bipolar symptoms but aren’t necessarily the most classic ones. It’s when you start pathologizing mild things that occur infrequently that it gets to be harmful.

No, I don’t know where the line should be drawn. But I’d say somewhere way before “subthreshold bipolar disorder” as defined in that journal article, anyway.

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.