My bipolar journey from diagnosis – Part 1

Journey

This blog is going to cover my bipolar journey from diagnosis to date – of course my journey is still in progress so I will post blogs as a new part.  I should also caveat that my experiences are just that, my experiences, therefore the medications that I mention and am on/tried please remember that everyone is different.  Any concerns speak to your doctor.

In my previous post I outlined why I sort help and thus got diagnosed with Bipolar II disorder. So I have received my diagnosis with bipolar and began treatment with Quetiapine (Seroquel).  I like to read up on my medications to see all the side-effects I am going to get; I am semi joking of course as I know not everyone experiences all the things that can be experienced.  However, I did find out that Quetiapine is one of the few mood stabilizers that treats both the hypomania and depression – this I was pleased about.  My experiences with starting to take Quetiapine were very good – it helped me sleep it made me feel good, but I did still notice that my mood wasn’t stabilizing after a few weeks on it, of course this resulted in increases to compensate and each increase brought me closer to stabilization.

However, a problem, arose with my psychiatrist’s discovery of heart issues in my family.  Of all the questions they asked in my initial consultation this one was overlooked, however, I don’t believe was a bad thing as I will explain later.  Now the heart concerns are: my maternal grandad has angina; my maternal nan has a leaky heart value, my mum has too but hers has developed into heart failure; and my paternal nan died of a heart attack.  I’ve had my heart checked and my heart function is also showing signs of potential decline – my left ventricle (the chamber that pumps blood around the body) is enlarged and slightly sluggish.  However, the output of this chamber is within normal parameters so technically all is fine.  However, the effect Quetiapine has on the heart is it can extend the electrical recharge the heart goes through with each beat – in other words it can delay this recharge.  Now before I scare anyone this listed as a rare side effect (any concerns speak to your doctor – I was toying with the idea of adding this, but its important I feel for my story).   Furthermore it’s not a straight forward delay of the recharge ability, say there’s a scale of 1-10, for example, where 10 is a very slow recharge ability, mine was a 5/6 – it’s simplistic but hopefully gets the point across.

This, of course, and probably naturally, caused me concern and I began to worry.  I started to have regular ECGs to keep an eye on this and only really had an ECG following an increase to make sure this wasn’t taking me too far towards the ‘we-must-now-start-to-worry line.  Either way, when you are concerned that a drug may be causing you harm you start to lose faith in it and hinders it’s working ability somewhat.  On reflection I feel that it was doing what it needed to to an extent but my concerns outweighed the benefits I was receiving and thus ignored it.  I was also becoming concerned about the weight gain, but in hindsight it was only an increase of about 6 lbs in 6-7 months but I had been obsessed with my weight for a couple of years prior to this.

Anyway, by September the anti-depressant (refer to a previous blog) I was on was discontinued and in October we decided to introduce another mood stabilizer to help with the depression and so I started Lamotrigine (Lamictal).  This being a very temperamental drug had to be titrated slowly to avoid an adverse reaction and took about 4-5 months to get to the dose I am on now.  However, instead of waiting for Lamotrigine to work, in January I grew impatient and requested to change so went from Quetiapine to a Olanzapine (Zyprexa) as this had less of an effect on the heart, but had a greater weight gaining side effect, but decided this was the lesser of two evils.

So titrating now to Olanzapine I got to 15mg and again decided that it wasn’t doing what I wanted, I was concerned about my heart and weight and my depression had worsened since coming off Quetiapine and I was still concerned about the effect on my heart.  I was therefore changed to Depakote (a derivative of Valproate).  OMG (and I dislike using that term) it was the worst mistake I did.  I experienced extreme nausea; digestive issues; it made me feel flat as a pancake; panic attacks; blood sugar issues (if I didn’t eat something fast acting and sugary every couple of hours it would induce a panic attack); and it made me feel like my stomach was in a vice.  I did separate the withdrawal effects of Olanzapine to factor this (insomnia, restlessness, etc), but while some subsided, the others remained.  I did also experience another issue during this change which I do not know if it was bipolar depressive, Olanzapine withdrawal or Depakote introduction, or all three, but despite my previous blogs mentioning suicidal idealizations, I nearly convinced myself to do it; I felt it.  This terrified me.

The benefits of course was that it was stabilizing my mood (albeit flat) and it was helping me sleep once the Olanzapine withdrawal ceased.  Either way I after a several weeks I could not tolerate the side effects and I requested a change!

This time we went back to Olanzapine as, based on my individual profile, there were few options left.  There were, however, two benefits of actually going on Depakote 1) we found out that the anti-psychiotic class of medications do work for me and 2) I was introduced to a beta-blocker for my heart function.  My psychiatrist originally suggested a beta blocker back in February time to help with my palpitations when I was on Olanzapine.  My doctor agreed and also said that because of my heart issues (enlarged left ventricle and potential for heart failure) they wanted me on a beta-blocker anyway, alongside Ramipril that I was put on by my cardiologist.  Originally, I was going to wait until I was more stable before starting with my beta-blocker (Bisoprolol) as I didn’t want too many changes going on at once.  However, because of all the panic attacks my doctor and Cardiologist decided that to wait would cause more harm than good.  Thus I started it and my panic attacks started to subside; except with the blood sugar issues on Depakote I mentioned above.  I did test about two weeks later to see if Bisoprolol was relieving my panic attacks by coming off it with approval from my doctor, and after a couple of days, my panic started to return.

Therefore in May we went back to Olanzapine.  So at that point I was titrating to Olanzapine, on two lots of heart medication and still on Lamotrigine.  Over the next two months we found that a) Olanzapine was actually less effective compared to Quetiapine; b) the weight gain was significant compared with Quetiapine; and c) that beta-blockers actually help and can reverse the effects of prolonged QT (the recharge ability I mentioned above).  So, we are now in July and we are making another switch back to Quetiapine.  How do I feel about this?  Well I feel positive this time because I am now on a beta-blocker and have increased this dose since starting it and have more scope to increase again, as such I am no longer concerned about my heart.  I am also no longer concerned about my weight.  I have discovered that over the last few years I was becoming obsessed with my weight, wanting to be thin, and I needed to change this outlook.  I am therefore happier about my weight and don’t really wish to lose too much of it – I am looking healthy and young again, not old and withdrawn like I used to.

So, where am I now?  I am in the process of transitioning from Olanzapine to Quetiapine, I’m keeping my fingers crossed that this works and I am pleased in a way that it has worked out this way – we’ve learned a lot since initially going on Quetiapine so hopefully this time around it will all come to together and get me back into employment. In time I will post another part to my journey to keep you updated.

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Bipolar depression – what it meant for me? (pre diagnosis)

DEPRESSION

This post is going to cover what my bipolar depression meant for me since I have had my diagnosis and can reflect back over this period.  This ‘list’ is by no means exhaustive and in another post I will outline what bipolar depression has meant for me since my diagnosis.

In my previous blog I outlined what my understanding of bipolar disorder was.  For me the depressive times were incredibly frustrating as I didn’t know why this was going on but could only acknowledge how I felt.  It’s difficult to function in life when you feel lethargic; your concentration is low; your memory is shot to bits; your attention span is only five seconds long; you have sleep issues with waking up early and waking up during the night took an hour to get back to sleep; when you hate being alive and who you were (weight and looks); devoid of emotion; wished you were dead; when you had pockets of blackness that threatened to swallow you hole with no way out; and when making a decision was a week long process of inner turmoil and self-doubt – suffice to say this all was crippling.

Although, do not get me wrong, I fought these feelings for as long as I possibly could, looking to preserve rather than give in and go see the doctor.  As far as I was aware, this did all signify depression and I had no doubt that had I of gone to the doctors they would have prescribed antidepressants.  However, as I said in my previous blog, because I wasn’t down all the time with periods of normality and even highs, I couldn’t be depressed surely?  This was the conclusion I reached and thus did not seek help for these depressive times.  As I mentioned previously in my blog, I had mentioned my erratic moods to my doctor but this didn’t ring any alarm bells! So I was reluctant to go there again to just say I was depressed.

I think the problem I had during this period was that some of what I was experiencing was manageable – like decision making and trying to sleep properly.  Yet it’s hard to pinpoint which was worse or fed into the others as all seemed circular.  The self-loathing was one of the most prominent things for me.  When you hate who you are it’s difficult to get through each day and circumvents any recovery in other areas of depression.  I also had to couple this with detesting life so much and all I wanted to be was dead and over with.  If it wasn’t for my spiritual beliefs that life doesn’t end upon death and I would have to pay for that choice, I would have committed suicide a lot time ago.  It was very hard at times to hold on to that tenet but it become a core element of my understanding so helped me get through some darker times.

Of course there was a point that everything just became too much for and I did seek help.  I had no choice.  I spoke to a doctor about what was going on (again with the ups and down) and even tried to investigate cardiological and neurological causes for what was going on with me.  The depression needed to be dealt with but a poor memory, lethargy, lack of concentration and poor attention span, could have been the result of heart issues (there’s a lot in my family) or something neurological (the neurologist I saw believed initially that I was suffering from brain shrinkage) could have been the cause.  Yet, when these avenues proved to be fruitless, I had no other choice but to listen to the doctor that it was depression.  So, I started on a course of antidepressants (Sertraline/Zoloft).

However, I started this course and within two weeks I needed to be signed off temporarily because the side-effects were a little unbearable.  It was then during this signed off period that my depression escalated and begun to acknowledge the deep black holes of despair were my entire outlook on life was black and my mind was drenched in dark thoughts.  It wasn’t long before my suicidal idealizations resumed and grew more intense.  I planned my death many different ways and lived them in my mind.  The one thing that I realized later was that while I was planning this I didn’t ‘want’ to do it; I just felt compelled to plan, plan, plan.  It was only later in my journey (post-diagnosis and going through drug changes), that I did feel compelled to do it and that scared the hell out of me, brought me to tears and made me sit around others for fear I’d do it.  My ideology of life after death was at stake and I was seriously convinced I was going to do it because I felt I had to.

Dark a? Well, I did wonder later if Sertraline was partially to blame as my moods circled a lot, I was darkly depressed and then just depressed and then darkly depressed and depressed – I’ve read that anti-depressants are unwise for Bipolar’s as they can trigger episodes, but usually manic, but when I experienced was circling depressions as stated.  It wasn’t until I started Topiramate (Topamax) that my bottoms began to lift and suicidal thoughts eased.  I know Topiramate isn’t licensed for mood stabilization, but my understanding is that all anticonvulsants (antiepilepsy) have some degree of stabilization.  Either way it was was fortunate and enough to get me through to seeing a psychiatrist and getting on the path to recovery.

Hypomania: what it meant for me (pre-diagnosis)

 

stress and bipolar disorder

This post is going to cover the hypomanic episodes I had pre-diagnosis but have been able to reflect on afterwards.  Of course this ‘list’ isn’t exhaustive but I’m noting the most memorable ones.  In another post I will describe what my hypomanic episodes are like post-diagnosis.

As I said in a previous blog about what bipolar is, I am going to expand on those points more and with particular emphasis on what it means for me personally – the stuff I explain here is what I experience/have experienced.

I suppose the first part to start with is the happy stuff.  I have memories of being so happy that I felt the world was made just for me.  The sun was shining and the sky was cloudless again just for me.  I felt energetic, needed less sleep (or couldn’t sleep), euphoric, productive, feel like I can tackle the world and solve world peace along with it.  The laws of man didn’t apply to me because I was beyond mere men – after all the sun was shining for me!  A lot of times I felt I was sexy and knew that everyone wanted me when I was at the gym, I felt that when I was working out people would be looking at me and saying to themselves ‘he’s so hot, look how he works out!’ So I’d strut my stuff down that walkway like a supermodel.  This sounds kinda fun and a couple of periods in my life I did have a lot of “fun”, but it can have its drawbacks, I once felt I was so better than everyone else that I quit one of my previous jobs!  The idea just popped into my head, ‘hey, you’re more important than that job, quit and demand to not work your notice but still get paid for it’ – this I did and got my own way, so didn’t help with the ego there.

I did, however, particularly liked the productivity and the endless amount of energy that came with hypomania – my outlet was writing, of course didn’t matter if it was rubbish, at the time it was going to be the best thing ever!  I graduated from the Open University last June having completed a degree and those productive times meant I was able to bang out essays of sheer brilliance! I knew when typing them that my tutor was going to be so amazed that they came out of a pre-degree student and I was going to get top marks and exceptional feedback.  I mean the thoughts came in and the productivity went out – it was great!

What’s not to love about that?

Well, the only way I can now describe it is following two/three/four days of these episodes and/or a of lack of sleep, it starts to catch up with you.  After a couple of days productivity and thoughts that won’t stop changes to feeling like having an internet exchange in your head with all that noise and chatter going on at a thousand miles an hour.  All of a sudden those gifts turn into a nightmare and they won’t stop, they keep pounding their way into your head and there is nothing that can be done to stop it.  It’s times like that I have become so agitated by a mind that will not shut up that I had on numerous occasions punched my head several times to try and stop my mind.  Of course with this concentration is out of the question so trying to study and not being able to is frustrating and resulted in my lashing out by shouting at myself and throwing things round, looking to break things.  Luckily for me my current work is repetitive so I don’t get as worked up about it unlike study.  This minimized the outbursts and severity considerably and while I didn’t have much control, I had enough to stop things like that

The other nature of hypomania is obsessions.  Many years ago, I was so obsessed with a car that I got rid of the one I had for two months and took out a loan for, to get it; which took me further into debt.  Don’t get me wrong it was a nice car, but I had to have it, and didn’t care about the consequences of it; including that the maintenance was very expensive!  Then after a few months and another episode and I did the same again yet this time I took the next car out on finance and traded my ‘fantastic’ car for a low value than its worth.  But these obsessions have smaller monetary consequences, too, when you make loads of little purchases, like replacing a series of DVDs because the covers have been updated (I did this for two T.V. series I was watching!) or purchasing loads of DVDs at a time just because I wanted them.  Obsessions are an unfortunate evil with being bipolar and depending on what the obsession is about can depend on whether a lot of money is involved or a load of holidays are really well planned – or worse, when I booked a holiday and then during the next phase of hypomania (the noisy mind!) canceled it and lost about £400 in non-refundable fees.  I suppose a case can be argued that I saved myself a lot of money in the long run but obsessions, like other elements of hypomania, can be an evil in disguise.

What made me seek professional help?

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So I was diagnosed with bipolar II disorder, but what made me seek professional help?  For me the mean reason I wanted to get professional help was because I had no control over my mood/emotional regulation and I was struggling with no idea what any of it meant.

I have suffered with bipolar since mid-late teens but it’s only been over the last few years that it has been more troublesome.  I’d been suffering from what’s called rapid cycling which means that I experience a lot of bipolar episodes a year and have been doing so for about three years.  So the lack of control I had during these times (if you refer back to my previous post What is bipolar disorder?) meant my exuberant behavior, uncontrollable thoughts and periods of depression was like trying to reign in a resilient stallion.

Furthermore, I was trying so many different things to make myself feel better, thinking my diets were to blame so tried keto, vegan, low-carb high fat, high protein low carb, supplements (legal kind) as well as exercise and meditation.  However, nothing was working.  I also begun to notice those around me weren’t as episodic in there moods as I was.  They seemed relatively stable from one day to the next.  Okay, some people seemed really excitable or melancholic but where like that every day, while others could be in a bad mood one day but fine the next, so why was I so different?

I tried to explain this to my longstanding G.P. that I never knew from day to day if I was going to wake up as Dr Jekyll or Mr Hyde – this was a bit of an exaggeration because my moods weren’t changing that quickly – but it was the best way I could describe it (I’ll explain more in another blog on the patterns they followed).  However, still they never picked up on it, instead telling me that people differ on the instability chart and I was more unstable than others – in their defense my psychiatrist told me there is very limited training in the NHS for mental health among G.P.’s.  To put it in perspective, it eventually took four different doctors to get myself into see a psychiatrist and get the diagnosis!

With each doctor I battled with ‘hey this is happening to me, what does it mean’ to then get shrugged off by a second G.P. and given an anti-depressant.  What was fortunate for me was I was signed off long term sick with depression and my employer has excellent benefits so paid for me to see a private G.P. to get a second opinion.  I spent 60 minutes with this fourth G.P. talking about my health and about my mood instability with them asking questions to then say something along the lines of ‘I think you need to see a psychiatrist’.

I was relived to say the least, but If I am honest here I had already contacted a psychiatrist before seeing this private G.P. because something I didn’t sit right as I was off work with depression and on anti-depressants which were causing more problems than they solved.  For example, I was bumped up to the max dose within 4 months, however, I still kept cycling in my moods – I was very depressive to better in comparison and to suicidal idealizations again.  So, I contacted this particular psychiatrist because they took self-referrals and in initial email said that it sounded like Bipolar II disorder but couldn’t confirm until seen me.  Unfortunately, however, they were withdrawing from the private practice!  This was a bummer for me, but hey, I had the private G.P. whom said something similar so it was enough evidence to take with me back to my third G.P. and get a referral!

 

What is bipolar disorder?

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I think the first place for me to start is an explanation of what bipolar disorder is and what it means for me as someone living with it.  In my first post Living with bipolar disorder I mentioned that people find it hard to understand what bipolar if they haven’t experienced it themselves.  So, for me I’d describe it is a mood disorder which effects my life through having periods of highly elevated episodes and periods of depressive lows. With both of these, I have little to no control over them as I’m very much a slave, like you’ve boarded the bipolar train which goes up and down and with no way to get off.  I will explain my hypomania and depressive parts in more detail in later posts but here is the brief version of a very long subject:

For the purposes of this I am going to focus on type 1 and type 2 bipolar definitions.  I am type 2.

For both types there are two distinct phases from highly energized and euphoric stages called mania and the lesser form hypomania, to depressive stages.  These moods persist for the majority of the day and every day for a few days depending on the typical duration for each respective period.  The main difference between type 1 and type 2 is that type 2 do not hit mania, we have hypomania and our periods do not often last as long as type 1’s; I’ve read that type 2’s last for 3-5 days (as mine do, sometimes a week) but type 1’s from week upwards.

For Type 2 sufferers these hypomanic events can be rewarding – you have feelings of elation and creativity and periods of joy, feel really good about yourself like your sexy, but there are down sides with excessive talking and obsessional behaviors and risky adventures – spending money or promiscuity.  Type 1 sufferers have a much worser deal because all the above is intensified further.  The behaviors and how they effect others are different between the two types, as type 1’s often need medical intervention as they are more disruptive to society/friends/family and themselves.  Both also have grandiose ideals and can believe things that aren’t quite true – like one is a god! but again this is different with hypomania compared to mania.  I once quit my job and refused to work my notice period because I felt I was better than others and had more important things to do.  The fortunate part is that not every time I have an episode do I experience all the things in one go!

There is also another element of mania and hypomania and that comes in the baggage and that is when feeling happy and creative it’s often that you have fleeting ideas and thoughts enter your head quickly enhancing this productivity – everything you think and feel is amazing!  You also need less sleep than normal, type 1 sufferers, I’ve read, can usually go without sleep for a few days, as can type 2 but for me a few hours sleep is fine.  However, there is a flip side to this coin which is what both sides suffer with (or at least I definitely do) is that the insomnia and chaotic thoughts don’t let up and as the days go on, what was once a welcome idea and thoughts because so loud and and chaotic that a daydream becomes a nightmare that you can’t wake up from – it’s like trying to block a busted water main with just your hands.

The depressive periods, however, are the same for both type 1 and type 2 sufferers, but some arguments can be made for type 1 experiencing more suicidal idealizations while type 2 suffer more/longer periods of depression.  It is for this reason that type 2 sufferers seek professional help for the depression side of equation but don’t seek it when they are elated.  While type 1 sufferers often need medical intervention with the highs.  With the depressive episodes, I can feel dispirited, dejected, disheartened and desolate.  I’ve often planned my death a hundred different ways and relived them in my head, feeling them as if they have happened.

Sorry to end on such a downer, but I hope I have covered everything!

Living with bipolar disorder

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Okay, so why did I create this blog?  Having never done anything like this before, it wasn’t something I thought of doing on a whim but something I’ve been mauling over for a months now.  When considering if my experiences are actually worth telling I have kind of thought that even if one person finds it insightful then it’ll be worth it. If it helps someone struggling with similar issues then again it’s worth it.

My purpose of my blog is to tell my experiences of living with bipolar disorder and possibly the history surrounding it over the last 20 years (if I can get my head around blogging!). My name is Jake and I’m currently 35 and was only diagnosed with Bipolar II Disorder last year. Initially when I got the diagnosis I was relieved, relieved that at last someone was actually listening to me and that something was being done about the persistent mood disturbances I couldn’t control and were impacting my quality of life.

For me, I would imagine that trying to explain bipolar to someone without bipolar is like a woman trying to explain to a man what childbirth is like – unless you actually experience it then you’re not really gonna understand.  I may be wrong and may just be from my experience of telling friends and family and my employer what bipolar actually is and being faced with a quizzical look of ‘it’s just a mood issue – everyone has them’.  My therapist told me that one of his clients described it as a train – you don’t really have any control over it you just have to go with it.  For me, nothing could be further from the truth – if I could sum up one phrase from the last 20 years of my bipolar episodes is lack of control.

From being so exuberant and energetic that you can do two days worth of work in one to being so depressed that the blackness feels like that it will never leave you again and life is over, I think describes it very well!

I will go into this in more detail as I take you on my journey but I wanted to give you a taste of what this blog will entail to see if it’s something you’d actually be interested in. My posts may not always be regular as my mood will very much dictate how, when and what I write. I may also write during periods of hypomania or during the depressive times. Hopefully at least this will give you some understanding of what it’s like and if you have bipolar, some recognition and appreciation. For me I found reading other people’s experiences helpful in understanding myself.

When writing this, I decided I liked the picture that WordPress assigned to my first post as I found it quite symbolic of a bipolars’ journey – trying to find stability in an ocean of emotions and waiting for the rising, shining sun to illuminate the darkest periods of bipolar depression.