Mental Health Awareness Month: Mania

 

Mania (or being manic) is the opposite of depression in the up-and-down swings of bipolar disorder. It’s also the other half of the no-longer-used term manic depression, which was changed to bipolar disorder in the 1980 third edition of the Diagnostic and Statistical Manual of Mental Disorders (or DSM) in the interest of reducing stigmas related to the words manic and depression.

Bipolar disorder is subdivided into bipolar I (which has more extreme swings in each direction) and bipolar II (which manifests with lower levels of mania—clinically called hypomania—and deeper depressions). I’m bipolar II.

Like depression, mania can manifest itself over different lengths of time in any number or combination of symptoms, including these:

• High, uncontrollable energy
• Extreme, rapid talkativeness
• Racing thoughts or flights of ideas
• Feelings of elation or euphoria
• Feelings of irritation or agitation
• High distractibility and inability to focus
• Decreased need for sleep while still feeling rested
• Inflated self-esteem or grandiosity
• Feeling full of great new ideas, important plans or exciting activities
• Involvement in risky activities—like extravagant shopping, improbable commercial schemes, recreational drugs, hypersexuality—with a high likelihood of negative consequences

Some bipolar people claim they like or actually love their manic episodes. I can understand that sentiment from the perspective of having a little more energy or euphoria, but I find that anything more than that can be terrifying. And exhausting.

It’s terrifying because I know from experience I’m prone to do impulsive things with no consequences alarms going off in my head. After more than a decade on the bipolar coaster, I’m finally self-aware enough that I know I’m doing (or at least reminding myself not to do) those impulsive things and I need to summon the alarms myself because they won’t go off on their own. Thankfully my impulsive behaviors tend to be rather benign and fixable, like buying shoes and clothing online. But there’s always the possibility I might escalate, and who knows what my impulsive brain could be capable of.

It’s also terrifying because my manic episodes often plummet directly into the deepest of my depressive episodes. Again: I’m finally self-aware enough to know that the depressive episodes are coming and I can do what little I’m able to do to prepare for them, like canceling plans and setting out Tylenol PM to help me hopefully sleep through the worst of them.

Everyone experiences mania and depression differently—to different degrees, for different lengths of time, at different intervals and even in different environmental conditions. Neither is better or easier than the other, and both in their own way can control or disrupt your life.

You’ll probably never encounter me in a depressive state because I become immediately reclusive. But if I’m talking rapidly and visibly distracted by everything and more jittery than normal, please do your best to keep me away from the Nordstrom website.

Mental Health Awareness Month: Depression

Everyone can feel occasionally sad, lonely or unmotivated as a result of anything from grief to just having an off day. But when these feelings become exponential and overwhelming and prevent you from functioning, you could be suffering from clinical depression.

And there isn’t a single kind of depression. It’s diagnosed when you present any long-term combination of symptoms including feelings of worthlessness and hopelessness, trouble concentrating, insomnia, fatigue, loss of interest in pleasurable things, restlessness, suicidal ideation—and even physical symptoms including body aches, digestive problems and appetite loss. Depression symptoms also vary widely based on age, gender and personal circumstances.

There isn’t a single kind of treatment either; depression can be managed with any combination of psychotherapy, antidepressants, exercise, certain supplements (vitamin D and fish oil have noticeably increased the efficacy of my meds) and in extreme cases electroconvulsive therapy (ECT)—with focused attention paid to people expressing suicidal thoughts and reckless behaviors.

Depression can also present itself along with other clinical disorders including psychosis, bipolar disorder and seasonal affective disorder. In my case, I have both bipolar II disorder and major depressive disorder—which means my shutdowns are almost always epic: I collapse into a deep, deep hole of despondency, exhaustion, physical pain, dull panic, slurred speech, a metallic taste on my tongue, and a fog that feels like a hot, wet, suffocating blanket I can’t find a way out of. All I can do is sleep in a drenching sweat, lose all track of time and frequently wake up with the pain of an oncoming migraine that thankfully never fully manifests itself.

Plus I’m totally no fun at parties. :-)

On a personal note, I have serious issues with the word “depression” in itself. I know it’s impossible to find a word that succinctly encompasses all these symptoms, but colloquial English has appropriated depression to mean feeling kinda blah, and people also associate the word with low spots in the ground, dips in the road and economic slumps, so they tend to think that clinical depression is just sadness. And if we depressed people had a nickel for every time someone told us to cheer up or decide to be happy, we just might be rich enough to actually BE happy. I know people who say these things are often coming from a place of not understanding and of just trying to be helpful, but the word depression is exactly the reason they’re confused and ultimately unhelpful.

And on that note, if you know someone who’s depressed or struggling through a depressive episode and you want to help, just ask what you can do. Some of us want to be left alone, but some people may want you to sit quietly with them so they don’t feel alone … or bring them some ice water … or call 911 … or some people may genuinely want you to try to cheer them up.

This is way off-topic and completely unhelpful given most of what I’ve just said, but if the latter request is the case, I recommend you start with my all-time favorite joke:

What’s brown and sticky?

A stick.

Mental Health Awareness Month: Bipolar Disorder

I’m starting my series of essays with something I know on a cellular level: I was diagnosed bipolar II over a decade ago, and I’ve spent a lot of time since then trying to learn everything about the illness, how the medical community’s understanding of it is evolving, and how we all can work to manage it both day-to-day and long-term.

Bipolar disorder in general involves one- to two-week swings between two opposite poles of mood, energy, focus and function. The top pole is mania, which manifests itself with elation, irritability, energized behavior and lack of impulse control. People in manic episodes experience racing thoughts; an inability to focus or stay physically still; and delusions and hallucinations that can inspire irrational or risky behaviors including gambling, sexual activity and drug use without regard for what can be catastrophic consequences. The bottom pole is depression, which manifests itself with hopelessness, indifference and despondency. People in depressive episodes experience extreme sadness; suicidal ideation and attempts; and difficulty functioning, thinking or experiencing pleasure (which is called anhedonia).

There are three types of bipolar disorder. Bipolar I Disorder involves swings between both poles—sometimes both at once—that are so severe they can require hospitalization. Bipolar II Disorder—sometimes called bipolar depression—involves mild manic episodes (called hypomania) and often more profound depressive episodes. Cyclothymic Disorder, which isn’t as common, involves hypomanic and depressive episodes that last at least two years.

As I’ve said, I’m bipolar II, where my hypomanic episodes involve restlessness, fast (well, faster than normal) talking and thinking, and buying shoes online that I don’t need. I usually post these purchases on here to broadcast that 1) I bought awesome new shoes and 2) I’m currently hypomanic off my ass. My depressive episodes are soul-crushing in their extremity. I can’t think, I struggle to breathe, my vision is blurred, I feel like I’m wrapped in a wet wool blanket that I can’t kick my way out of, I sometimes have visual or aural hallucinations (including seeing people in black clothing lunging at me and hearing stupid, irritating circus music coming from another room), and I often contemplate suicide but I have no energy or initiative to carry it out … I generally feel like everything is completely hopeless and I just want to have never existed. And when I emerge from these episodes I’m exhausted to my core.

Bipolar disorders can be managed with psychotherapy (talking with a therapist), psychiatry (drug therapies) or a combination of both. I’ve never found much benefit from my visits with various psychologists, but I’m a HUGE believer in better living through chemistry. Psych meds (which are awesomely called psychotropics) affect me strongly, for better or worse. They involve a lot of trial and error, but I’ve been highly functional for the last five years after finally finding a magic cocktail of three psychotropics (there’s that cool word again).

I do want to stress, though, that what works for me is indicative only of what works for ME. If you’re living with a mental illness, don’t abandon a combination of therapies that might be working for you just because someone else is thriving on a different combination of therapies. And for God’s sake, ALWAYS TAKE YOUR MEDS.

Bipolar disorders were classified as manic depression through most of the 1900s. In 1980, the third edition of the Diagnostic and Statistical Manual of Mental Disorders (called DSM-III), officially changed the classification to bipolar disorder to reflect a wider range of nuance and understanding of the disease. This paragraph is a broad generalization of the naming history, but I wanted to explain that manic depression and bipolar disorder are essentially the same thing.

There is a lot more I could discuss here, but I want to keep these essays short(er than this one) and digestible for anyone who cares to read them. Feel free to share this with anyone you think might be interested, and I hope to have another short(er than this one) essay posted soon. Stay healthy!

Mental Health Awareness Month

May is Mental Health Awareness Month, and as your designated Bipolar Friend Who Can’t Seem To Shut Up About It, I’ll be spending the month posting short essays on a broad range of mental-illness topics and issues that I hope—if you want to read them—will provide helpful information and insight to give you a more nuanced understanding of the world occupied by people living with mental illnesses and the sainted people who take care of us.

I was diagnosed bipolar over a decade ago, when a friend’s suicide made me suddenly aware that—instead of mourning the loss of him like everyone else around me—I was jealous that he actually killed himself … and I’d been living in a state of just-under-the-radar suicidal ideation for as far back as I could remember. When fantasizing about when and how to kill yourself is your everyday normal, it doesn’t raise any interior red flags until something jolts you into the objectivity you need to stand outside your head and realize that you have a problem. A very serious problem. So going on nothing more than the foggy, horrifying, embarrassing realization that I had this problem, I wandered into what would prove to be a long, frustrating, flying-blind journey to erase—or learn how to manage—the crashing malfunctions in my poorly wired head.

As with most people living with mental illnesses, I’ve been to hell and back many times trying to figure out the magic cocktail of therapists and therapies and medications I need to achieve some sense of normalcy. And since there’s no basic training on what to look for or how to find a competent, ethical, moral mental-health doctor—especially when you’re yet-undiagnosed mentally ill—I stumbled into some even deeper horrors before I finally found a doctor who knew what she was doing and who had my overall health and best interests at heart.

So here I am with my fancy green-and-white Mental Health Awareness Month graphic and my list of topics to cover, and if you’re interested I hope I can give you something useful and meaningful to know this month whether you’re living with a mental illness, caring for someone with a mental illness, or just looking to understand more about the roller coasters lurching in and out of Mental Illness Land.