Recognizing an Episode
Bipolar disorder is a medical thing. It's not something one wishes on themselves, or their worst enemy. It just happens. It's built into your heredity, and set off by environmental stress.
I would describe it as a loss of control of emotion, with radical mood swings from elated to utter despair. One cannot always, or does not always, want to discipline behavior outbursts when one is bipolar. It's the nature of the beast. What would the old MGM lion be without his roar?
Psychiatrists explain manic-depression as a disorder whereby, basically, body chemicals create themselves from nothing, and then disappear for no apparent reason. These chemical changes happen in the brain and throughout the nervous system. These chemical changes create a change in mood, or a mood swing.
This is not steady swing on a set at the park on Sunday afternoon. A person can be ego-inflated and on top of the world one minute, and be crying hysterically in despair 15 minutes later. I've done that before. A bipolar isn't well when that happens
In my experience, a shift from high to low can happen over a period of three hours, fifteen minutes, or several weeks. I'm what they call a rapid cycler. I sometimes have "mixed states" too, where I'm high and low, in some fluctuating percentage, at the same time. It's a weird trip, but it's life.
Minimizing stress helps to alleviate the onset and duration of my symptoms, but as laid back a life as I try to lead, little things can become frustrating, and then overwhelming.
A mood swing is a state of relatively short duration, in my experience. My mood today is differnet today as I wake, compared to yesterday when I fell asleep.
An episode, to me indicates I've slipped a bit from my usual stability. Little problems, easily fixed are beginning to mount on me. I have to concentrate, and mark off my mental list the things that a person does each day, like eat and sleep. If I don't catch an episode coming on in three or four days of symptoms (I may not recognize myself), I realize I may have to go to the psychiatric hospital because I won't usually be able to get to my psychiatrist fast enough. I need a major medication change. It happens, for no reason or because of stress. If it turns into a hospital adventure, it's more of an episode, a series of events that sort of go together, in a negative sort of way. Medication adjustment in a safe environment is the best place for a hurting bipolar to be.
In my opinion, it's better to get checked in the psych hospital, and be under medical supervision, before the delusions and hallucinations begin. The bipolar begins to experience aquditory distractions and visual hallucinations if their illness intensifies to the state of psychosis.
Several environmental things set off this present episode in 2003. My mom's health is poor, the air conditioner broke the day the temperature hit 100 degrees (and the a/c wasn't fixed for four days), the electric garage door opener quit working with the car stuck inside the garage, the refrigerator quit working and wasn't repaired for two weeks, my friendly neighborhood housekeeper kid probably ripped off my best ring (and I trusted him), the garbage disposal went out, and after it was fixed the dishwasher flooded the kitchen and kitchen cabinets. I keep telling myself I'm lucky to have such insignificant problems. I'm not hearing my positive messages to myself well, and more symptoms are beginning to set in.
Yesterday evening I realized I hadn't eaten for two days. I wasn't especially trying to lose weight by abstaining from food. I live alone, so it's not that I didn't show up at the set dinner table, with yummy prepared food all ready to be eaten. Usually a balanced take-out meal from the nearby cafeteria is my best bet for getting myself a good home cooked meal. I do a lot of kitchen grazing on crackers, veggies, and fruit. I didn't notice it or it wasn't there, and I wasn't hungry. I know I have to eat, but it's a stage of my disorder--I forget to eat, and sleep.
My weight has been a problem because some medications cause weight gain that can't be avoided or overcome. An early doctor in my history of treatment prescribed lithium for me. Lithium requires that patient's blood levels be monitored, as too much medication turns toxic in the blood stream. The doctor decided that lithium made me emotionally stable, and that was her only concern.
Over the short winter months that I began taking lithium regularly, I gained 70 pounds. People would tell me I didn't look overweight, but at 5' 10" and 217 pounds I was. I wore a size 18 in scrubs. I developed back problems and knee problems. I moved slower. I sprained my ankle walking my dog. The doctor was most pleased that I wasn't living on an emotional roller coaster anymore. Now I make sure my psychiatrists deal with my physical state as well as my mental.
When my mind is gurgling mania, I may slip into a bit of a concept of anorexia. I've always been taller than my peers, and too heavy for a boyfriend to pick up and hoist over the threshold--but I am 5' 10". One episode, weight was falling off me like water in the rain. My metabolism was faster, and my food intake was minimal. I lost down to 117 pounds. I was eating only vegetarian then. I was the size and stature of a runway model.
Seeing pictures of myself later assured me that I wasn't carrying enough weight on my body. It was the first time in my life I had that problem. And I know the medication that did it. I don't take that medication anymore, and my weight presently, at age 57, fluctuates between 135-150. I'm not physically fit, I'm just thin. I'm content with my weight for now, but always worry what will happen to my appetite when my medications are changed.
When I change sizes I need to buy new clothes to fit, or I used to. My closet holds clothes from size 4 to size 18, but I generally wear the 10s and 12s. I don't think I should clear out all the clothes that don't fit, because a change of medication could blow me up like a balloon again. I won't take lithium anymore. My body carried so much salt that my face and cheeks were perpetually puffy. I didn't look like myself, or feel like myself anymore
A change of doctors led me to a diagnosis of borderline personality disorder, and that psychiatrist took me off lithium. There are lots of medications that can be used as mood stabilizers. However, when the side effects begin to effect your quality of life, it is the patient who has to bring the matter up, and encourage the psychiatrist to let the patient try a different medication. In the end, what I take is somewhat regulated by the side effects I'll tolerate. Some anti-psychotic medications send the patient into what I call Zombieland. No doctor has the right to deprive me of neither my personality nor my ability to function comfortably in my own skin
My sleeping hours are also irregular, so I generally don't eat until my body tells me I'm hungry. Mania interferes with appetite. I do try to graze through some pieces of fruit, crackers and cheese, peanuts or peanut butter to keep my stomach occupied. Every day or two I invest calories in a healthy balanced dinner. My path hadn't taken me in the direction of the kitchen, or there wasn't anything I wanted to eat there. Something like this can go on three days before I realize it. By the forth day, I usually need outside help to get my routine back to regular.
I know this loss of appetite, or forgetting about food, is a symptom there's been a change in my body chemistry. Pills that work on changing body chemistry, like anti-depressants, take a week to14 days before the patient will notice a change. Patience is a golden virtue where meds are involved.
When I understood why my body felt so drained, I went to the kitchen and started eating eating healthy food, trying to make up for the empty stomach space. I still feel physically drained. My whole body hurts--muscles, back--but that's just my general tension going to my body parts. Orange juice or Gatorade would probably help me recover more quickly. I'd take a walk if I had the energy. Orange juice would be better for me than coke because the caffeine can mess with my chemicals, but I like Coke. I know what I'm doing to myself when I drink Coke, but I like it--and for gosh sakes, it's only Coca Cola I'm talking about.
I'd told my doctor on the previous visit that my predominant medication dose was too high. Altered bipolar states are difficult to explain. Sometimes I just feel "wrong". I couldn't feel feeling. At the same time my brain wouldn't work without producing an intense emotional response. I had lots of racing thoughts, so many ideas that I couldn't keep up with them, much more deal with them. The doctor, with discussion, let me cut my meds back, but "we" cut them back too much. I feel like I just want to cry until I run out of tears. This is a miserable emotional space in which to be stuck: clinical bipolar depression
This morning I made a positive, active effort to improve my attitude. I pampered myself with a manicure and pedicure. An hour and a half later I felt like the melted whipped cream sitting on top of my IHOP pancakes with strawberries. I almost choked getting my food down. My symptoms are getting more serious, more intense. My throat closes up on me, and the food doesn't want to go down. My appetite is gone, nothings sounds good to eat, and that's not a good thing for me.
This too shall pass. Things will get better, and get worse. I can tell I'm three days into my Summer 2003 episode. It may be three weeks, or it may last until October. I can keep a grip with meds, and prayers, and regular visits to my psychiatrist.