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.

Lately I have the attention span of a flea on a hot tin roof, but I just wanted to mention that the Globe and Mail is doing a series this week (it actually started last Friday) called Breakdown: Canada’s Mental Health Crisis. I haven’t been looking at the web site, and I’ve actually been buying the newspaper every day but I’ve only been giving the articles a cursory glance. I’ve got to sit down sometime and check it all out.

Heyyy, that is a great typo on the front page of the Breakdown site: “biopolar disorder.” Nice.

Often I think of my life as being described by (an extremely simplified version of) the Second Law of Thermodynamics. The level of chaos always tends to increase. Lately, it’s more like Newton’s First Law of Motion, where a body in motion tends to stay in motion and a body at rest tends to stay at rest. I either spend my time running around like a chicken with its head cut off or sitting around not doing much of anything. Today, it was not doing much of anything. It was yesterday, too. Ah, inertia. Ah, crappy similes.

Wasted: A Memoir of Anorexia and Bulimia by Marya Hornbacher is one of my favourite books. It’s probably my favourite memoir of all time. My eating disorder has never been that serious, but I can relate to the author eerily well. It was often as if I was reading about what was going on inside my own head, only expressed much more eloquently than I could hope to do so myself. I’m a good writer, not that it’s evident on this blog… but Marya Hornbacher is an amazing writer, and I am in awe of her. The book is an honest an insightful portrayal of illness, although I wish she had written about her actual recovery. Even more than that, I’ve often wished that someone would write a book about manic depression that was just like Wasted.

So I was pretty excited when I was reading the People article about “Britney’s mental illness” (no, I’m not even going to go there right now) and there was a sidebar about Hornbacher’s upcoming memoir, Madness: A Bipolar Life. There are some very annoying annoying things in the book description, but at least I know Hornbacher didn’t write the jacket copy herself:

At age twenty-four, Hornbacher was diagnosed with Type 1 rapid-cycle bipolar, the most severe form of bipolar disease there is.

Ugh. Yeah, I’m also rapid-cycling bipolar I, and so what? Do not brag about how your manic depression’s penis is bigger than other people’s, okay? This is not something where you can just whip out a tape measure and settle the matter once and for all, and even if you could, it would be pointless. There are sucktastic things about all flavours of bipolar disorder, and mental illness one-upmanship is really tacky and helps nobody.

Also, Hornbacher’s fiercely self-aware portrait of her own bipolar as early as age four will powerfully change the current debate on whether bipolar in children exists.

This is another one of those don’t-even-go-there things that is probably unfair of me to comment on until I’ve read the actual book.

I can’t say I like the title much, either, but I’m still dying to read the book. Probably there will be parts that will annoy me, and there will be parts that I love, like this passage from Wasted:

People who’ve Been to Hell and Back develop a certain sort of self-righteousness. There is a tendency to say: I have an addictive personality, I am terribly sensitive, I’m touched with fire, I have Scars. There is a self-perpetuating belief that one simply cannot help it, and this is very dangerous. It becomes an identity in and of itself. It becomes its own religion, and you wait for salvation, and you wait, and wait, and wait, and do not save yourself.

Or this part, where she falls down and is too weak from starvation to get up:

Halfway home I began to run, a faltering, stumbling run, eyelashes fluttering with snowflakes, face numb, hair falling into my face with the weight of wet snow. I slipped and fell and could not get up. I sat there in a heap in front of the vice president’s mansion. I, up-and-coming young journalist, A student, maniac, starving artist, invisible basket case, me. I cried with an impotent fury at my legs for refusing to stand when I told them to and thought of my cousin Brian as my hands, pure white, indiscernible in the white snow, scrabbled about trying to collect the contents of my bags which had spilled. I thought of my brilliant and wonderful cousin, dear friend and lifelong confidant, who’d been in a wheelchair since he was small. I thought of how he must feel every day, legs refusing to work, through no fault of his own, through some miserable joke of God, and I thought: This is your own fucking fault. Get up. GET UP. I hated myself with a pure and fierce energy and I wished myself dead.

I don’t hate myself anymore. It’s been a long time since I did. But that excerpt says everything you need to know about the way I felt back when I did hate myself.

The main annoyance that is occurring since I am currently off my meds is that I’ve been having very brief dizzy spells. I also have even less of an attention span than usual. It’s hard to settle down and read books or web sites. Disorganized, forgetful, etc. My mood is very good, though. Except for when it isn’t. It happens suddenly, without warning, and goes away suddenly, too, and the rest of the time I am quite peppy.

It turns out I shouldn’t have been sulking about my one-day weekends, because next weekend I personally get a zero-day weekend. It’s not as if I have to work eight hours every day, but still, it’s just nice to have an entire day where you know you don’t have to be at work for any of it.

I am thinking that I should be more Organized and learn how to Manage My Time, so maybe this will be my newest obsession that I will research, and maybe I will try systems and labelling and colour-coding and be very gung-ho for a month and then forget about it. Or maybe it will work. You never know.

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.

“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.