Being bipolar, even after a twenty-years-back diagnosis, can be such a faff. A few weeks ago, I had a fit of the self-pities, crying to my husband/shrink/CPN/anyone-who’d-listen that it was such “an effort” just to be me. It’s not like I do sun-beds, waxing and hairdressers twice a week!
There are, here it comes, certain things I’m supposed to do in order simply to function in a human way on a daily basis – without being placed in a mental hospital, without being arrested (oh, how we roared) and without upsetting anyone else. Let alone the daily stuff of living. Much of the suggested bipolar advice involves reducing or avoiding stress and stressful situations but, whether filling the car with petrol, opening an envelope, answering the phone or a visit to the hair salon, it can be a stressful situation to me/us, and life can take some organising.
The reason bipolars need to avoid stress, as I understand it from my psychiatrists (Dr. Elizabeth Parker, who taught other psychiatrists at the Maudesley, and now Dr. Chaloner in Havering), is that stress can tip me over into either a life-threatening high or life-threatening low mood swing. I am therefore walking a tightrope, if I don’t try everything possible to deal with my condition.
There are many kinds of bipolars. Actually, when I was diagnosed, it was still “manic-depressive” and I did wonder whether I should carry a hatchet about with me to fit the then current image. Hmm that was fun, not. Still, the chief common bipolar “management” ideas for us bipolars seem to be to:
- accept the condition, pretty though it might not be (it could be worse, how we lolled) – then to comply with mood-stabilising and other medication, visits to psychiatrist/medical services/doctor/therapist and make partners and family aware and, if very lucky, prepared to help; if we have a CPN visit once a week/month, we are lucky – they help us feel supported amongst much other stuff; this can also mean attending therapy of any kind;
- reduce stress and stressful situations;
- avoid alcohol and other social drugs and not to take the wrong doses of prescribed drugs; and
- take all the little actions we find helpful in order to stay stable.
1. Taking the medications is easy. Simply pop in mouth at the suggested times of day. And that’s it! I don’t know about anyone else but there have been times when I didn’t realise I was going high or depressed and I resisted medication, which was actually part of being high or depressed, and, of course, what happened eventually was that I would go into a dangerous high mood swing lasting three weeks or more (I can be suicidal in a high mood swing as much as in a depression, contrary to certain opinion), to be plunged immediately afterwards into severe and occasionally suicidal depression – for months or years. Never, ever be afraid to call the numbers for help if necessary.
That’s no fun for anyone, least of all my family and me. That’s my cycle. After a period of “normal”, it tends to be the high first – where I have been known to have wildly racing thoughts (a firework display of the mind, never able to follow any particular thread), to play with the traffic, go out on my bike naked, stay up all night every night playing loud music and singing along, irritate the life out of friends and colleagues by talking rapidly or being grandiose, grab a policeman by the balls, and, erm, actually write a novel.
And I have also had extended periods of depression – everything is grey, feeling hopeless, weeping for no reason, e.g. in newsagent, unable to leave bed, ignore phone, leave letters unopened, disconnect with friends and family, disengaging with life, wanting to kill myself – which have cropped up, seemingly for no apparent reason. Though as I look back with my shrink, I may have been taking meds erratically or succumbed to stressful situations, of which more later.
I remember being in a mental hospital to be stabilised on Lithium which, after 16 years on Carbamazepine/Tegretol and Valproate, I’d finally accepted. The first weeks on Lithium, I was having not just visual but aural (people sounded as though they were talking underwater), 3D tv and touch (leather felt like hessian) hallucinations as it settled into my mind/brain. One day, Paul, my husband, found me talking in very broken, staccato sentences and called the CPNs in. They all thought I was having a stroke but I knew it was another side effect of being “broken into” Lithium. It passed and I settled into a future without the extremes of mood I’d always known. In a way, that was a kind of loss: I had actually liked what happened when I began to go high: massive creativity, loving everything and everyone – but was embarrassed by the talking people’s heads off, talking so fast people had to ask me to stop, buggering up the system at work!
I am lucky. I have a wonderful husband and family who can usually spot the signs of an approaching swing one way or the other. Say, a high can begin with my sleeplessness. Even though I have an alarm set for it in the evening, Paul will also remind me to take my meds. I am also lucky that Lithium has worked for me – alongside a great antidepressant (Mirtazapine) which also helps me, a chronic insomniac whether high or low, to sleep.
I was a little stumped, though, on seeing my new psychiatrist in my new area, when she said something along the lines of Lithium being sooo three years ago and “of course, now Quetiapine is the thing”. I don’t particularly care, though, as long as Lithium works for me. Mental note: ask for Quetiapine if Lithium ever stops working!
2. Reducing stress and stressful situations is something that takes practice, patience and time. I mean, when depressed or veering towards high, the slightest thing that Paul deems to be normal can be a major epic to me. Go and have coffee with a friend in nearby town? Absolutely fraught with panic at the thought! Booked in diary, alarm set for 3 hours before, things to do/wear/make-up. This is supposed to be a pleasant outing with a mate who accepts me as I am!
But what I do is make sure I do not overload myself with things to do in any one day or week. If there’s things apart from normal life to do on three days a week, really I’ve learned that that’s quite enough for me. Because if I overload myself, then that can tip me over into a high/low mood swing. And then I can end up in mental hospital again, or I can be arrested. It’s all happened. Or at the very least upset or worry someone dear to me. The bottom line is that overloading myself can mean life or death to me and my family, so it’s vital that I keep it in check. Any slight alarm bells – and I cancel.
Of course, they talk about good stress and bad stress. Good stress being say a house move you’ve wanted, or a family wedding. Bad stress can be the house move you’ve wanted, or a family wedding. The answer there is that it’s all stress. These are the times I have to make sure I slow down and take good care of myself.
3. Avoiding alcohol or other social drugs is not such a problem for me now I’m older. When I was younger, all that stuff was a fairly standard part of life, depending on how you grew up and with whom, and the choices you made. What my shrinks have always said is, if you shove other drugs/alcohol on top of your meds, what happens is that the meds don’t get absorbed as well as they should do – and therefore become ineffective.
Self-medication through the use of alcohol or other drugs is another issue and, because these things often seem a normal thing to do, I have been one of the guiltiest parties to this particular fail. The thing is (my shrinks have said), alcohol and other drugs get absorbed very differently through the liver, and so what happens is that the meds I am taking won’t be absorbed or utilised properly, so I might as well not be taking them. Their effect is negated.
Also, the effect of the alcohol/other drug is increased because it is taken on top of the meds. The meds therefore mean that the couple of glasses of wine I used to be able to have as normally as anyone else now can mean my being drunk sooner than everyone else. It’s embarrassing enough the stuff I do when high, let alone getting drunker quicker!
I had to learn to love other things. Admittedly, sometimes it was chocolate when down and chocolate when up! But hey, chocolate wasn’t going to change the way my meds were absorbed. I have to say, I am now on a strict diet. I learned that Lithium, Valproate and other meds can reduce my metabolism by as much as 15% and, to add insult, increase the appetite. Which I figure is a 30% drop on calories I can have compared to those not on Lithium or similar drugs.
4. This is a great one. I was first seeing a psychiatrist 40 years ago – diagnosis: teen depression. The thing is, unless you actually go to your doctor or report to a hospital, no-one will ever know there’s something wrong. You will suffer; you will never get the appropriate treatment. Family and friends suffer, and I can only imagine what thoughts will come to mind, pretending to be valid, normal thoughts.
So there are some little actions I do on a daily basis that mean (1) my meds are taken (2) stress is reduced and (3) alcohol and drugs not taken and thus meds work and I can live, ha, as normally as possible. Here they are and in no particular order:
- Prior to her retirement, Dr. Elizabeth Parker (Maudesley) recommended I take 1,000 mg (1G) of EPA fish oil a day (check out the research online for EPA and depression.) If you buy, say, Lloyds Chemist’s version, you have to take 4 a day. They are buggers to take (like horse pills) but I think they work with depression. It can’t do any harm and it seems to work for me.
- I got a SAD lamp! Well, it seems to cheer me up. I have absolutely no idea how it does it but it does! 40 minutes every morning. I like it and I think I might use it all year round. Not obsessive at all, you understand…
- Eating well – actually am now on diet but think lots of veg (oh, lovely veg) made me feel better, amongst other things, like yay Slimfast for the odd meal. I have met many bipolars on the Lithium I take. We have all gained weight. We agree, we then need to cut calories. But also, to aid sleep, I have decaffeinated coffee and tea after 1pm. Caffeine can wind me up no end. There are plenty of interesting teas out there, too. I particularly love Yogi Liquorice Egyptian Spice tea, my comforting soul-tea.
- Exercise: yep, we all hear this one. But… I think walking the dog helps me. It’s not just the walk, it’s talking to other dog-walkers, too (thank you, Linda!) While walking, I can mull over the knots in the novel I’m currently writing – and come back refreshed. We are planning a weekly swim next. I think every bipolar could benefit from walking their dog. Preferably, like ours, a black dog!
- Getting Out Of Self – Helping Others. This one has proved itself useful every day. Even when I’m feeling shit, this one does it for me. I could help someone do, err, something/anything (e.g. helping neighbour with garden), and behold miracles/stuff happens and I feel better. I helped my Emmanuel College, Cambridge University student daughter by proofreading and copy-editing her University Dissertation. There wasn’t much for me to change but 40 pages later I’d done it. Then I got a parcel. It was her complete and bound dissertation. It meant the world to me. I struggle, really, to help someone every single day but, when I do, it works.
- Read favourite books, listen to chilling music, watch television and films that feed the soul. Look them up. Find them. Borrow from the library.
- Engage with Twitter or Facebook friends – can be amazingly supportive – plus never forget real-life friends who could be going through something, too.
- I do something creative as and when I can. There’s so much out there. I tend to write. But there is decorating the house, writing a blog post, there is playing guitar, there is cooking or making jam, there is painting a picture, knitting a scarf, gardening.
- Next up: favourite supportive websites. Thing is, we will all find our own but here’s mine: www.blackdogtribe.com and Mind – loon around these for a while and I will find something or someone who is talking my language.
- Once a week I do 40 minutes relaxation, during acupuncture sessions. This week I ‘mentally visited’ some favourite countries – Tibet, Kashmir, Thailand, Malaysia, Singapore, Indonesia (Bali) and Hong Kong – during that 40 minutes. I came back that afternoon feeling that I’d just got back from the Far East and so very relaxed.
- Play some music and relax. I really love this album: Fairy Ring and another is Music for Stress Relief – I’m not exactly wild about fairies but the music is amazing, sometimes bringing up emotion, sometimes pure relaxation.
- Final little action – just being me! I need to remember to be as patient, loving and kind to myself as I would be to an ill or struggling friend. Although I can forget this at times. Equally, I must remember that bipolar may be a condition I have but it, of itself, does not define who I am. One of the things I have about being bipolar is that “I’m different” in some way, which can feel lonely. Yet organisations, websites and individuals are showing that there need be no more stigma about having bipolar disorder than there is about having varicose veins. We are not any more different than we are all unique. Lots of people have cancer, asthma, strokes, and other conditions. They use coping mechanisms and then… carry on. That’s it….
You know, if we all walked around with a big sandwich-board declaring our problem, there would be people walking the high street with “Cancer”, “Stroke”, “Crack Addiction and Three Kids to Support”, “Man With Arthritis All Over” and “Woman with Terrifying Depression”. I tend to pack my bipolar sandwich-board away and get on with life, whilst at the same time bearing in mind the above points. But, if I can use my experience of my condition to help anyone else who may be just coming to terms with diagnosis, or beginning to learn about bipolar, then I’m happy to do so.
When you read through my lists, it’s not actually a vast amount to do. And just one of these things per day can help. If you are like me and the slightest thing can seem like a pressure, an anxiety actually life-threatening, then, for sure, let your doctor/psychiatrist/CPN know or tell me – and then I’ll mention telling your doctor!
Depression? How do you even get out of bed and somehow face the day? Manic/Elated/Soaring? How do you cope and try to prevent the worst? How do any of us deal with a terrible day? A rise into high mood swing? A knowing we are going down?
I don’t particularly like being bipolar (and all the images that go with it). But I do my best to cope whatever it means… The alternative is not fair to anyone: my husband, my children, my family and friends… All I have to do is comply with a few simple rules. I’d love to hear your views…