A Mixed Bag?


I am terrified of myself right now.

When I first began As the Pendulum Swings, I had started off with a post called, “To See If I Still Feel” which described a similar episode with self-injurous behavior that I blogged about recently in “Confessions of the Pain of Payment”. Soon after my original blog post, I described an incident which I thought was a mixed episode in “Shifting Gears”.  It was the first time I had ever experienced both hypomanic symptoms and depressive symptoms at the same time.

Last night, I didn’t sleep more than five hours.  I had taken three and a half milligrams of Xanax and 30mg of Temazepam.  I should have been knocked flat on my back.

My brain was buzzing, ablaze with thought and compulsions.  There was a sensation of vibration all throughout my body.  I surveyed my kitchen and drearily thought, “My house is disgusting.  It’s an absolute nasty, repulsive, filthy hut.  I wish I could burn this place to the ground.”  But that wasn’t my compulsion.  I wanted more than anything to clean.

First, I showered and scrubbed myself raw with a luffah.  Shampoo ran through my fingers and foamed as I clawed my scalp, three or more times.  My quest continued in the kitchen.  The skin on my hands was raw, red, and peeling as I ripped through the dishes.  I meticulously wiped down every surface with Clorox.

It wasn’t enough.  I gathered every piece of paperwork that had been piled up on my counter and threw it in a box.  I set it atop a large laundry basket and hauled it up the stairs.  Everything in it’s right place, everything in it’s right place, my mind’s voice frantically whispered.

I sorted through two months worth of paperwork, cleared two desks and organized their drawers, and cleared, then rearranged my dresser.  It was immaculate.  It was also 3AM.  I didn’t want to stop.  I had so much more I wanted to do.  But I feared that I would be too tired in the morning to even think about getting up.

My eyes opened in a flash when the first alarm went off.  And I didn’t even consider hitting the snooze button seventeen times this morning.  I laid in bed for a few minutes and felt the dread and dismay of my life.  Everything was still wrong.  It was all wrong.  And now, I was falling behind in my own life.

So, I sprang to action.  T.D. had Occupational Therapy at 9am.  I was compelled to clean the house some more.  I went through emails and started getting back on the horse and back into my life.  I went to work and disciplined sassy fifth graders.  I entertained Kindergarteners with new games.  And I rekindled old friendships with my third grade group.

Not once did I yawn.

I suspected that what was happening to me now was what happened three months ago.  Opening my web brower, I began my investigation into what a mixed episode is really classified as.  The NIMH states:

Bipolar II is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.

What?

Again, I verified it. DSM-IV Criteria for Bipolar II specifically states that “There has never been a Manic Episode or a Mixed Episode”.

How is this possible?  I have never had a full-blown Manic Episode.  I don’t think, anyway, at least not diagnostically so.  But, I know that I am having feelings of despair and hopelessness while having boundless energy, racing thoughts, and pressured speech.

Bipolar II, as described by Psycheduation.org, is very fitting.  I have more depressive episodes than anything.  My episodes don’t really last longer than a few months, if even that long.  The longest hypomanic episode I ever had was for two weeks.  They usually only last about a week and then are followed by crushing depression for a few weeks to a couple of months.

What the hell is this?  I feel like I’m losing touch with reality.  At the same time, I don’t even think I want to be in touch with reality anymore.  I don’t want to take my medicine and I’d rather give in to my impulses than keep fighting this constant, tedious, exhausting battle.  I want to stay up all night and do whatever I’m compelled to do.  I want to lay in the yard in the middle of the night in the rain.  I’m being hit with all of these illogical and sometimes sinister thoughts at light speed.

I’m going downstairs to try to continue the conversation I was having with C.S. at dinner.  He asked what I cut with because he had already thrown out all of the razors.  I’m crafty, what can I say?  I’ve contended with worse than him.  I didn’t want to answer, partly because I want to hold on to my little box of lies, and partly because I didn’t think it was appropriate dinner conversation.  I asked if he rememberred to buy band-aids.  He told me that he refused to buy me band-aids because he’d rather shame me into not doing this again. He told me that he’s taking a tough love approach.

Do you know what happened the last time someone took a tough love approach with me?  I suffered while I bided my time.  I waited until I had a reliable and self-sustaining source of income.  And I ran like hell while never looking back.

I’m up to like 919 words.  If you’re still with me, please, help me with some of your insight and personal experience.  At least insight into what I’m dealing with here with this seemingly mixed episode.

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13 thoughts on “A Mixed Bag?

  1. What you describe to me sounds much more like ultra-rapid cycling – going from depressed to (in your case) hypomanic in less than 24 hours. I used to do this with full-blown mania, and even now it still happens to me from time-to-time.

    Fun, no. But I wouldn’t worry about having progressed to Bipolar I. Most psychiatrists will only make a diagnosis of full-blown mania if they see a severe and pervasive pattern. My first visit with my psychiatrist, he actually wrote Bipolar II as my diagnosis, prescribed me some Lamictal as monotherapy and sent me on my way. Less than three weeks later, as we got to talking more about my symptoms and life course, he was almost frantically shoving lithium at me, because he was sure Lamictal did not have strong enough anti-manic qualities for me.

    Additionally, your hypomania seems to have a dysphoric, rather than euphoric quality to it. You’re wanting to crawl out of your skin instead of feeling positive and up. My mania – well I haven’t had a pure euphoric mania in many, many years. It’s motivation to keep myself better medicated, because not only do I know that if I go up, I will come down – way down – up isn’t even really up for me.

    I hope this gives you some insight, I can’t really tell you what to do because as I said, this is one behavioral pattern I have not broken.

    • Usually, I’m positive and up. But, when I’m depressed, it’s something entirely different. Sometimes, I’m angry and almost violent with hypomanic episodes. That’s rare. Usually, I’m off making grand plans and thinking that I’m the best thing that ever walked the Earth. I think that I can take on the entire world and fix everything. I am suddenly better than everyone else and my ideas are incredible and revolutionary. Sounds arrogant, but it’s not meant to be. It’s just a major boost in self-confidence really and it helps me aspire to greater things. I’m glad for it because it keeps me going when I’m back down again. I’m obligated, and no matter what, I’m a woman of my word. I will always follow through.

      I know I’m rapid cycling, but I didn’t think it could be this bad! Seriously? I’ve had more than 4 episodes in a year, which qualifies as rapid cycling, but it’s never been going from one to the other in a few days! And I’m exhibiting both symptoms. It’s 1:38AM. Why the hell am i still awake?

      I’m all kinds of things at the same time. I’m talkative. I’m rambling. I have too much to say. My brain is flying. My emotions are dark. I feel hopeless. i can’t sleep. I don’t miss the sleep. I have all kinds of irrational compulsions. I want to start walking and see how far I can make it by morning. I don’t care that the weather is turning. But I’d never walk out on my son. I feel so bad that he has a mother like me. I feel so bad that there is a good chance that he’ll have to face the same demon I’m dealing with. I am having crying spells while I’m angry and pounding my fists on things.

      Seriously. What the hell is going on? Why is there both at once? I’m really confused and pretty scared of myself right now.

  2. I agree with Ruby, Lulu. It sounds like you’re rapid cycling. You’ve got to reach out to someone, though. To be scared of yourself isn’t good, and if you really are slipping into a full blown mania/BP I then you’ve got to arrest it now. Can you get in touch with your doc today? Hang in there and just shout if you want to chat.

    • The earliest I’d even be able to get to the doc would be Thursday. But you guys were absolutely correct. It’s some kind of severe hyper-cycle.

      Bizarre. I have to read more about this. I do cycle frequently, but never oscilating that badly within such a short period of time. It was like moment to moment.

      I’m still on the hypomanic side, and definitely dysphoric. That’s unusual too, because I usually get the euphoric kind. But, it’s understandable if I’m coming off of an extemely brief and severe depressive episode.

      I’m doing better in relation to what was happening. I had 18 waking hours yesterday and 7 hours of sleep last night. I usually need about 8 or 9, so I’m still running on high, but not too high.

      Cross your fingers that I don’t have an insane crash. Depression usually follows hypomania. I just want everything to go back to being stable.

      Really, I want to feel like I have more control over myself than I do now. I didn’t know what was going on and I don’t have enough control. That’s why I was terrified of myself. Not predictable and no pattern to go from.

      • I’ve seen what you’re going through up close and it ain’t fun. I met a woman in the hospital who was a rapid-cycler. It was really amazing – I could watch her cycle three or four times during one meal. She hated it, and the docs made her stay longer so they could get the dose of Abilify raised to a point that it stopped her cycling. She did stabilize and is doing really well today. I hope you can at least talk to your doc Thurs and I hope you got some good sleep last night. Hang in! Keep us posted!

  3. I wasn’t doing this before I started treatment. And I wasn’t doing this in my treatment before I started taking the Wellbutrin.

    Oh! I get it! Everytime they raise my dose of Wellbutrin this happens!

    I’ll see what my doc recommends. Likely, he’ll ask if it happens regularly. It only seems to happen a few weeks after I get my medicine adjusted. And he’ll probably tell me to wait and see… He just loves that wait and see approach.

    • Wellbutrin is evil!

      Seriously, it has caused problems for everyone I know that’s ever been on it (myself included). I hope doc doesn’t do the wait and see. He’s got to cut you back or get you off. I hope you’re doing OK today.

      • Originally, I had a phenominal response to it. Before Wellbutrin, I was going through very long spells of depression. Lamictal calmed the cycles down, except when I did have one, it would be rated amongst the longest. And I had fatigue to the point where I couldn’t function.

        Any ideas? He suggested Prozac before but I’ve heard that causes serious sexual dysfunction. And I have to be careful about weight gain because I’m already prediabetic.

  4. Wow – I think we’re related somehow 🙂 I just talked to my psyc about Prozac during our last visit. I’ve been on a low dose of Wellbutrin for a while. Too much makes me manic. He said the same things about Prozac…weight gain, sexual dysfunction, possibility of hypomania (not very high). We decided to forget it in the end. Do you think you could raise your mood stabilizer and lower the Wellbutrin a bit? That’s the only option I have at this point. I’d like to get off antidepressants completely at this point. Did you talk about that option at all?

    • Long lost cousin? LOL. I’m at 250 on Lamictal and 300 on Wellbutrin. I don’t want to get off of the antidepressants, because I face this problem. Either I rapid cycle every three months for a few weeks or I stay in a depressive state for four straight months. The rapid cycle is more severe but I can ride it out better than the long depressions. What’s a girl to do? At the last visit, we increased both dosages because I seemed to be going back to the lond depressive cycles and very short hypomania.

      Honestly, if I could get a hold on the rapid cycling, I’d rather ride that one. At least if I know it’s going to happen when I have a med change, I can be ready for it. Like, schedule med changes to happen during winter, spring, and summer breaks. I could make environmental changes like reducing stressors and finding better coping mechanisms. Rapid cycling is actually less disruptive than long depressions.

      Edit: Actually, I’d prefer to not have any symptoms at all. But I fear that’s probably impossible for me. So the only other option is to strive to have fewer and / or less severe symptoms. But if I have to make some changes in my life to ride the wave, then so be it.

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