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.

Yup, I’m still around; I’ve just been too tired to blog lately. It is several hours before my usual bedtime, but I am already seriously considering crawling under my covers. The good thing is that so far I still haven’t gotten the flu that everybody else has. Exhaustion is better than exhaustion plus vomiting plus headache, but it still kind of sucks. I tried to fight the tiredness for a few days by not taking my meds exactly as prescribed, which was a poor idea, because it didn’t bring me back to normal, it just propelled me into a Zoloft-induced state of wakefulness where I felt like jumping out of my skin but I didn’t actually accomplish anything. I’ll take sleep instead of that, thank you very much. I don’t usually get enough sleep, so I just have to keep reminding myself that a temporary surplus of it is A Good Thing.

I started this blog a year ago today, but I’m far too tired to come up with any blogiversary-worthy Deep Thoughts about What I Have Learned in the past year. I’ve been really tired all week. At first I worried that I was getting depressed, but then I realized that almost everybody I know has a cold or the flu or some virus or other. I am not sick, but it seems highly likely that trying to stay not sick is completely exhausting me. Being run-down like this is certainly better than having stomach flu, though, so I ain’t complaining. Since I am not up to spewing forth Really Deep Thoughts (not that I ever am), instead I will simply share with you what are probably my favourite lines of poetry ever:

On a razor edge of reality,
I knew I would come out of this, bleeding and broken,
and singing.
~ Gwendolyn MacEwan, “Deraa”

Speaking of What I Have Learned, yes, it’s true that a year ago, I knew that I had already come out of “this,” bleeding & broken & singing, and that I would be likely to do so repeatedly. I do become surer and surer of this fact as time goes on, though, and I guess that’s a kind of learning, too. Sometimes I forget that I’ll get better every time I get worse, but I have been remembering it more and more often in the past couple of years, and for longer and longer periods of time.

“…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.

It’s been a year since I was in the hospital. Although there were nearly five years between my second and third hospitalization, last year, in the space of six months, I had two brief inpatient stays and spent seven weeks in a partial hospitalization programme, which I completed last June. I’ve also gone exactly sixteen months without cutting myself, which doesn’t really seem like a big deal because I pretty much quit and have only cut myself three times in the past six years, anyway.

My mood has been fairly stable lately, and, for a change, it is holding steady at “Very Well, Thank You” rather than “Rock Bottom.” So of course I’m being dogged by insomnia again. You know that saying, “It’s like putting an octopus to bed?” As soon as you’ve got one thing under control, another tentacle pops out from under the covers. It’s always something, isn’t it?

“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.

As I think I’ve mentioned before, I’ve had a few job interviews lately. Preparing for them has taken up much of my time. I’ve been pretty enthused about it. Okay, make that REALLY enthused. By which I mean that I stayed awake for over forty hours at one point last week. I’m not worried, though. Maybe I have ideas for a bunch of new projects and I REALLY want to go shopping and one night I purposely didn’t take my pills just ’cause I didn’t wanna, but I’ve been sleeping okay since that forty-hour stretch of wakefulness and I haven’t done anything stupid yet.

Since I recently spent eight years being a mentally ill university student, and also since I’m a human being who cares about other human beings, of course I’m deeply troubled by the Virginia Tech shootings. I don’t know if I’ll have any meaningful commentary on it in the future, and I don’t have any now except to say that my thoughts and prayers go out to those students and their families and friends.