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hypomanic

Bipolar II – Really?

Is it Bipolar II – or just plain Bipolar Disorder not yet recognized?

Google “Bipolar” on the “news” tab and see what you find.  It is astounding how many semi-celebrities have come out and said “I have Bipolar Disorder”.  Unfortunately, the story is often about Bipolar II, which somehow makes it “better”.

Bipolar Disorder is still a serious stigma – prevents people from getting jobs and such.  Technically, as Bipolar Disorder is considered a disability, an employer who did not hire or fired an admitted bipolar patient based only on that fact would be in violation of the American Disabilities Act, but few people are willing to go to the carpet on that.  Plus there is the little issue of being “able” to perform one’s job.  I can perform a job if I am taking meds.  If I am off of meds, I become highly unreliable with a lot of other liabilities – risky behavior that I have decided not to discuss.

Only a couple of years ago, I was warned by a well-meaning family member against posting too much on social media about Bipolar Disorder – and this in his mind included “liking” too many Bipolar pages.  He was concerned about my ability to obtain a decent job.  I don’t know if I have a “decent “job today – I have made my own way which works out better for me – no boss to annoy, no dress code, nobody else’s time clock.  For the most part, I don’t worry about social media – I don’t think I will ever have a “real” job again – no more frequent flyer miles for me.

Bipolar 2I was once diagnosed as Bipolar II – but really, both the doctor and the therapist thought differently – they both knew that I had regular Bipolar Disorder but wasn’t ready to accept it.  Actually, I am pretty sure my doctor tricked me into taking Lithium for the first time by telling me that it would help boost my antidepressant activity.

In retrospect, I am astounded that I believed him since I know so much about medication – but I took the medication.  How many of these people really have Bipolar I Disorder and just don’t say so.

It is much easier for people to say and accept that they have Bipolar II.  In my opinion (which is obviously vast and knowledgeable – just kidding, no really), Bipolar II is a way of sliding by the real diagnosis.  As in “I have Bipolar Disorder but not really”.  “I have Bipolar Disorder but I am not crazy”.  “I have Bipolar Disorder but I am not dangerous”.  “I have Bipolar Disorder but I won’t embarrass you”.
When it gets down to it…wasn’t that true for all of us at one time?  Or at least didn’t we believe it at one time?  I still fit some of the criteria – I am “functional”, “productive”, “hypomanic” – except when I am not.

I often confuse my doctor when he asks how it is going by saying “good enough”.  What I mean is that I am not manic exactly, I am not depressed.  Actually it works better for me if I am teetering on the edge of mania.  If I am just crazy enough that I know that I am crazy – then I will keep taking my meds.  Because I forget.

I originally sought treatment for severe depressiondepression bad enough that I had to decide whether to kill myself or study (I had a big exam the next day).  In retrospect, I was actually in a mixed episode with plenty of energy but in a really bad mood.  Oh, and then there was the slight issue of the hypnogogic hallucinations which I denied at the time.  See, even if I know that I have Bipolar DisorderManic Depression – I still forget.

It would be easier for me to say that I have Bipolar Disorder but it is “just” Bipolar II.  I thought that too.

Melissa

What Type of Bipolar Disorder Is It?

Each bipolar disorder illness is unique!

Uniqueness of Bipolar DisorderWhen nearly anyone thinks about bipolar disorder, they think of the symptoms of “regular” bipolar disorder.  Not that any person with bipolar disorder is “regular” (and most would not want to be), but there are several different subtypes of bipolar disorder.

One big problem with bipolar disorder is that each illness is unique.  Psychiatrists may classify them into categories – but they don’t always fit.  Here are some case scenarios: (bipolar episodesbipolar groups)

•    Jennifer has episodes where she is extremely agitated and unhappy and never seems to sleep very much.  These periods seem to last for a long period of time – but can alternate with months where she is simply unhappy and doesn’t feel like doing anything.
•    Max has had periods of depression before.  A lot of times, they go away after a couple of months and then he seems normal but recently he “disappeared” for a couple of weeks after some really bizarre behavior.  His friends never knew that he was any kind of bipolar until he told them he had been at the hospital.
•    Ben has periods of depression that can last for several months but when he is not depressed, he is productive and seems quite outgoing.
•    Sandra’s mood state can switch erratically.  One day she is all about shopping and the next time you call her, she is still in bed at noon.   This is a constant issue – and you never know what you are going to get.

These are three examples of bipolar disorder that don’t seem to fit the “normal” pattern.  None of these patients seems to be “regular” bipolar.

Bipolar disorder is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) as:

Bipolar Disorder TypeBipolar I Disorder: manic or mixed episodes that last at least 7 days – or if manic symptoms are severe enough to need hospitalization.  This, usually, includes periods of depression that last at least two weeks.
Jennifer and Max both fit into this category.  Even though Max never had a severe manic episode, having a bipolar episode that warrants medical attention, he qualifies for the Bipolar I category.  Jennifer has mixed episodes – rather than euphoria or traditional mania – she has periods of “dysphoria” where she is agitated, irritable and irrational but with an excess of energy.

Bipolar II Disorder: depressive and hypomanic episodes in a pattern – but manic episodes are not severe.
Ben has Bipolar II disorder.  He has periods of depression that are debilitating, but his non-depressed periods are quite productive, and he doesn’t exhibit manic behavior.

Bipolar Disorder Not Otherwise Specified: (Bipolar Disorder NOS) symptoms of illness don’t meet any other group, but the symptoms are clearly not within the standard range.
Sandra has BP-NOS.  She is what is commonly called a “rapid cycler,” meaning that she switches back and forth from mania to depression much faster than other people with bipolar disorder.

There is also a very mild form of bipolar disorder known as cyclothymia.  It is a cyclical pattern of hypomania alternating with periods of mild depression.  Many people would not even realize this is a problem.

Bipolar disorder is hard to classify.  It may be easy to determine that someone has a problem – but the uniqueness of each bipolar case makes it more difficult for even a patient to identify with the diagnosis.  Each type of bipolar disorder is, usually, treated the same medically. With an anti-manic agent (Lithium), anti-epileptic (Lamictal, Depakote) or atypical antipsychotic (Abilify, Zyprexa) – and sometimes with an antidepressant.

Melissa Lind

Bipolar Disorder Research Funding – Poorly Directed

Prepare yourself for a bit of a bipolar rant!

An article entitled “Bipolar Disorder in Youth Not as Chronic as Thought” in Medscape Pharmacists e-newsletter came across my email and while I was initially quite interested, I soon became annoyed.
Bipolar and Borderline (BPD)A recent study done at the University of Pittsburgh School of Medicine shows that bipolar disorder may not always be a chronic condition. While this may look like good news and you might see it pop up in the media as a big positive – cheerleader kind of thing, it really isn’t.

The study followed 413 children and adolescents who were 7 to 17 years of age and diagnosed with bipolar disorder at the time of study enrollment.  The patients and family members were interviewed about every eight months, for eight years.  What they found was that some of the patients were “ill” most of the time, some were “well” most of the time, and some were both ill and well.  Sorry, but that result isn’t astounding.

I find a couple of things wrong with the published results.

  1. They didn’t say whether the patients were stabilized on medication during the study – what medication, whether the medication was changed, whether the patients took the medication – in fact the publication doesn’t mention medication at all.
  2. The data collected was based on “interviews.”  Sorry, but being bipolar inherently predisposes you to lack of complete transparency.  Bipolar patients are likely to hide and lie – whether it is purposefully or subconscious behavior, it is a known problem.
  3. The patients were ages 7 to 17 when entering the study, meaning they were 15 to 25 at the end.  Many of the patients went through puberty during the study and what pubescent child or the post-pubescent adolescent is truly stable…or honest for that matter.  Interviews with the family may have partly balanced this but we also know how “well” our families may know us…some, not at all.

What I did find a little more relevant was that the patients tended to be “well” more of the time if they:

Though true, this is not astounding either.  It is easily recognized that if your family has a history of mental disorder, you are more likely to have a mental disorderBipolar disorder and substance abuse go hand in hand, and sexual abuse makes nothing more manageable.

Incidentally they also showed that patients would be more stable if they:

•    Had less history of severe depression, manic or hypomanic symptoms
•    Had fewer subsyndromal episodes

So basically, if the patients had a history of fewer episodes, they would have fewer episodes……really?
Not discounting the fact that any academic attention given to bipolar disorder, especially in juveniles should be welcome, I am disappointed because the study results didn’t show anything.  This is all information that anyone could guess – and the funding for mediocre “non-results” could have gone elsewhere.

This sort of news can easily lead to an “it will go away” thought process, lack of medication and lack of attention to and acknowledgment of the real and long-term challenges that a bipolar patient can face.  Yes, let’s all believe that bipolar disorder is not a chronic medical condition… let’s undo all the progress that has been made.

Melissa Lind

Academic attention given to bipolar disorder should be welcome!

Curse of the Ferrari Brain: the Other Side of Bipolar Disorder

Manic Episode: Another Side of Bipolar Disorder.

Welcome back, my friends!

My apologies for the extended absence. I’ve been very busy with other projects, which I’ll have to return to soon. Also, I wanted to make sure this article was perfect, because this one’s a little tricky.

So far, most of my articles have focused on depression. As someone with type II bipolar disorder, that’s the side I know best. Also, it’s the side that’s easiest for a person who doesn’t have bipolar disorder to understand. Everyone has been bummed at some point. Wanna understand bipolar depression? Take your depression, magnify by about a jillion, and there ya go. Pretty easy to understand, right? The other side of the coin isn’t as straightforward. A good metaphor, I hope, will make it easier to understand.

Let’s say that the average human brain is like a Volvo.The Volvo gets great mileage and is one of the safest, most dependable cars on the road. You wanna get to work on time, day after day and with very little fuss and worry? A Volvo is the car for you.Average human brain - Volvo

The bipolar brain is more like a Ferrari.

Bipolar brain - like a Ferrai

“Farrah”

The Ferrari is fast and flashy. Its sleek, predatory looks practically demand that you drive it at dangerous speeds. You want to make it to work in forty seconds flat? Then the Ferrari is the car for you. Unfortunately, it guzzles gas like your Aunt Janie guzzles gin and tends to spend more time in the shop than on the road. The insurance premiums are astronomical and you are almost guaranteed to wrap it around a tree someday.

Now then… bipolar depression is like the times when the Ferrari is in the shop. It’s up on the lift, and you’re going nowhere. You can’t even show it off by rolling it into your driveway. Not only that, but you gotta walk to work while all the Volvo drivers practically blaze by at 35 mph. In your mind’s eye, they laugh at you as it starts to rain. Your anxiety tells you they are ALL aiming for puddles near you, and the occasional sociopath WILL soak you for his or her amusement.

But then the shop owner calls. Your chariot awaits! You go down to the shop, pay the exorbitant bill, and fire up that 16-cylinder Italian ego trip.

“I’ve missed you, Farrah,” you say, not caring about the look the shop owner gives you. If HE had a Ferrari, he’d name her Farrah, too. Your foot barely taps her gas pedal and she purrs delightedly. She’s missed you, too.

“Good girl,” you say, then ease Farrah’s shifter into first, the action so smooth that instinct alone tells you that she’s out of neutral. You pull out of the shop’s parking lot and into traffic. At first, she’s just glad to be off of that horrible rack and back on the road where she belongs, but every red light, every school zone is an irritant, and sand only makes pearls in oysters. Sand in an engine is death, but Farrah complies and stays below the speed limit… for now.

As you pull into the parking lot at work, all eyes turn to you and your beautiful machine. You pull into your space and reach for the key to kill her ignition, but you stop short.

“It’s been so long. Just once,” she begs. “Pretty please?”

You know this is how it starts, but you’re still in control. Just once won’t hurt anything, right? It’s not like you’re doing anything dangerous. Besides, what’s the point in owning a car like Farrah if you can’t show her off?

With Farrah’s gears in neutral, your foot presses hard on her accelerator and her engine screams ecstatically. Those who weren’t looking before certainly are now. Many are impressed. Many others are jealous. And Farrah, at long last, feels warm and tingly.

“Mmm… baby,” she purrs. “You’re the only one who knows how to touch me right. Again. Please.”

“Sorry, babe,” you say, a little defeated. “I gotta go to work now.”

Farrah pouts as you shut off the engine, sputtering just a little to let you know she’s put out. You promise her a full tank of premium and a stretch of deserted highway tonight followed by a loving sponge bath. You know that will make her happy, but she’s still sulking.

When five o’clock rolls around, you dash into the parking lot to find Farrah waiting. It’s a beautiful day, so you decide a little sun would be good for you both. You drop her top, fire up her engine and gun the accelerator—just a little—as you exit the parking lot. No harm done, and at last you’re out on the open road where both of you are more happy… for all of about twenty seconds.

Gridlock. No one’s going anywhere fast. The traffic jam drives you nuts, but you try to smile regardless. You’ve gotten so many “nice car, man” comments from the Volvos that your ego has slipped into overdrive. Eventually, though, it gets old. You’re sick of hearing how nice your car is. You wanna FEEL how nice she is, and in this traffic, how can you? You can’t even get out of first gear! You’ve got to MOVE!

Speed isn’t Farrah’s only good quality. She maneuvers like… well… like a gdamn Ferrari! Each time you see an opening in traffic, you seize it. At first, you make sure there’s plenty of space, but soon ANY amount of space is enough as long as it moves you forward. Other drivers stop saying “nice car” and start saying “watch it, a-hole!”

“Fuc.. them,” Farrah says. “They’re just jealous, baby.”

Finally, you come upon a stretch of open highway, just begging to be devoured. You stomp Farrah’s accelerator and instantly know that what she said is true. Who wouldn’t be jealous of this speed? This freedom?

“At last!” she screams as you tear away from the nightmare behind you. The wind whips your hair as the speedometer climbs. This is what she’s DESIGNED to do, you tell yourself. It’s just you and Farrah and all is well in the world. You drive off into the sunset, victorious, just like in the movies.

But real life isn’t the movies, and sunset only means the end of the day, not the end of the film. You pull into your garage and park Farrah for the night. You have to work in the morning, but you’re too wired to sleep. You try watching TV. You try a hot shower. Nothing works. Sleep just won’t come, not with Farrah calling to you from the garage.

“Sleep is for those Volvo people,” she says, spitting out the word Volvo as if it had the arsenic taste of bitter almonds. “You’re better than them, baby. All you need is me. Come on. Let’s go for a drive.”

But you know better. You’ve been down this road before. With the help of a few Benadryl, you ignore her voice and drift off, but your sleep isn’t like real sleep. Your body lays motionless but your mind spins like a screeching tire. Dreams and reality melt together for a few fitful hours of sleep and traffic nightmares.

You’re awake long before sunrise, but you force yourself to stay in bed until the alarm goes off, then you’re up in a flash. You sing in the shower. You skip breakfast. You rush to the garage.

“Good morning, sexy,” she says. “Ready to play?”

“Are you?” you ask, smirking as you sink into a kid leather bucket seat that fits you like a glove. You deftly slip your key in her ignition and give it a twist. As you pull on your driving gloves, the temperature gauge begins to rise. “Like that, do you?”

“Sailor baby, you get me hotter than Georgia asphalt,” she purrs.

You bet your sweet a-h I do, you think as the garage door rises to release you from your prison. Your house isn’t your home. Here with her. This is home. This is where you belong.

Now, there are two different ways this scenario can end…

END #1

The garage door is barely up before you’re skidding out of the garage and into… another fu–ing traffic jam! No! No no no no NO NO NO!!! You honk madly. Farrah’s engine growls at any Volvos who get too close. The admiration in the Volvo drivers’ eyes is gone. Today, they look upon you with fear, but you don’t give a damn. They’re just in your way, anyway, right? One Volvo tries to pull in front of you. You stomp the accelerator and he weaves out of your way just in time.

“My lane, a-hole,” you shout. “Mine!”

Your lane or not, the traffic light turns red and you’re stuck. Time stands still. You scream and rev your engine, both you and Farrah quickly reaching redline. The temperature warning light comes on, but you ignore it. It just wants to slow you down, too. You smell oil smoke, but don’t care.

“Go baby,” Farrah shrieks. “Go! Go! GOOOO!”

KABLAM!

Something snaps. Thick gray smoke boils from the engine compartment. Farrah’s engine chokes and sputters as the light turns green. She’s got just enough strength to ease to the side of the road.

“This is all your fault,” she says, dying. You weep at what your anger has done.

The tow truck guy clucks his tongue as he winches Farrah’s front end into the sky. “Damn shame,” he says. “Such a nice car.”

In your mind, you finish his sentence. If only you knew how to treat it.

Welcome back to depression.

Or, it could end like this…

END #2

The garage door is barely up before you’re skidding out of the garage and onto the open road. Your floor it and Farrah jumps over the speed limit like an antelope. There’s no traffic, no cops, nothing but miles of open road. You cut each corner closer, but not because you’re out of control. You do it because you’re fucking amazing! Every move you make is the right one. The world is yours and everything is perfect…

…until you run out of gas in the middle of nowhere during a thunderstorm and have to walk to the nearest payphone (you forgot your cell in your hurry to hit the road) only to find you don’t have any change, so you have to walk all the way back to your house. Once at your house, you reach into your pocket and find that you’ve lost your keys somewhere along the way.

Welcome back to depression.

George Carlin, one of the funniest men to ever live, once said that the cliché phrase “more than happy” sounded like a medical condition.” Well, he was right. “More than happy” is called euphoria, and euphoria is sometimes a symptom of a manic episode. Sometimes, bipolar disorder feels WONDERFUL. At the beginning of the upswing, you have hypomania, and hypomania can be very, very good. It’s your chance to really shine.

Sometimes, when you’re hypomanic, you are the life of the party—charming, witty, friendly and filled with energy. Your mind becomes razor sharp, your reflexes like those of a kung fu master. You make friends easily, accomplish incredible amounts of work, and have flashes of brilliance that astound and amaze everyone around you. I LOVE it when hypomania works that way!

Sometimes, however, it doesn’t. Sometimes when you’re hypomanic, you are the total buzzkill—cranky, bitter, sullen… and yet still filled with energy. Your mind is sharp, but it’s your tongue that’s the razor. You’re nerves are so jittery you twitch. Fine silk feels like sandpaper against your skin. You still have that keen focus, but all you focus on is the neighbor’s g-damn stereo and if you had one ounce less of willpower, you’d crash right over and shove the thing straight up his a-h. But that wouldn’t fix the problem, because dammit, you’re pissed and you’re gonna stay that way. I HATE it when hypomania works that way.

Now, if you’re bipolar type II like me, hypomania is the ceiling. You hit it, stay there for anywhere from a few hours to a few weeks (depending on how rapidly you cycle) and then spiral back down into depression. If you’re type I bipolar, then hypomania is just the beginning.

Hypomania basically means “little mania,” so for a full-tilt manic episode, take my description of hypomania and magnify it exponentially: the occasional sleepless night becomes days on end without sleep; the occasional ego trip gives way to full-blown narcissism and delusions of grandeur; euphoria becomes psychosis; irritability becomes hostility and anxiety becomes outright paranoia. Some even experience hallucinations.

No matter how high the ladder goes, unless you drop dead from exhaustion (which does happen occasionally) or wrap your Ferrari around a tree (yes, those on the upswing really do tend to speed) then you’re going to find yourself right back where you started. For some, that’s a relatively normal mood. For others, it’s welcome back to depression. Hope you enjoyed the ride.

And on that note, I hope you, my readers, have enjoyed the ride. I’ll be taking a break from this blog now, but I’m sure I’ll be back I’ve got so many other stories, poems, screenplays and articles to write. I’ve got sketches to draw and music to compose. I’ve got a life without bipolar disorder… or at least a life without thinking about it all the time.

The one thing I want you to remember most of all is that NO ONE IS A DISEASE. They are a person with a disease. Their disease is not their life, at least not unless they allow it to be. Don’t do that, folks. It sucks. Be people. People are OK unless they won’t turn their g-damn stereos down.

Keep fighting, folks!

-Bruce Anderson