Stability comes with a cost

After more than a week of being out of touch, I am now in reasonable shape to talk. However, emotionally I am in a peculiar state - depressed with no symptoms of depression. 

I am worried about the state but I don't know what to do. I'm going to chronicle what I have been feeling and doing. Except for the inability to do things I feel fine. I am clear headed and without anxiety.

I also have a larger fear. Suppose my current meds (400 mg/day Stavzor (Depakote), 600 mg/day Lithium, 50 mg/day Lamictal) don't actually stabilize me at normal. Suppose they stop the cycling and stabilize me at this point below normal. Suppose this is as good as it gets. It's a scary thought.

There is a practical problem associated with this. In the past, motivating myself was not something I did, motivation was something I had when I was hypomanic. In a way, I never had to work hard in my life, all I had to do was to wait for my hypomania to kick in and then ride the crest of all the energy. For most of my life this was quite enough.

Now that I don't have my manic push, how am I supposed to to move forward. Motivation and discipline are learned things and I never had to learn them before. I am finding it nearly impossible to do the basic things to get my life in order. I know what I should be doing to get my life in order. I just am not doing it.

This is not depression. I am clear thinking and I have none of the other symptoms associated with depression. This is being stuck in one place and not being able to move forward.

How does one learn to be motivated anyway? Motivation and discipline are learned things and learning takes time. I keep on expecting to bounce right back into things because my world is stable, but it is a wrong expectation. I now have to spend time learning how to live a normal life.

Acceptance

October 20th at around 2100 was without doubt the worst moment in my life.

I had gotten home from a fourteen day tour in southern Louisiana where I work as a paramedic. I had spoken with Dad the day before and he was cheerful as usual. His usual self. We talked about Mom. We talked about the weather and the happenings back home. "Same ol', same ol'" he always said. After about twenty minutes the phone was passed to Mom like usual. That was the last chance I'd have to speak with him; I had no clue.

On the 20th around 2000 I had arrived home and began to unpack for fourteen days of relaxation before my next tour. I was sitting on the couch watching TV when "Home" showed up on my caller ID. It was unusual to have a call from home at this hour but I wasn't even close to prepared for what I was about to hear. Mom's voice was strained and I could tell something was wrong. I thought Dad may have been sick but that wasn't unusual those days. He'd been sick for a number of years. The smoking, drinking, diabetes, congestive heart failure, chronic obstructive pulmonary disease (COPD) and overall failure to care for himself was slowly catching up with him.

"Dad died." I froze. I couldn't move or say anything. I'm sure if someone were there, watching me, they would have seen the life drain from my body. I lost it and broke out crying. Mom cried. We were alone now. 2000 miles away my family had fallen into disarray and I couldn't be there to help. The phone call lasted 45 seconds. I had to schedule a flight home immediately.

After scheduling my flight and rental car I sat on the floor and cried. I'm not sure for how long. I was numb. I didn't know what to do. Immediately I started texting anyone I knew would listen. I felt alone.

For the longest time I was hard on Dad. I always hated that he smoked and told him regularly. I knew he was only going to hurt himself and that it would shorten the time I had with him. I didn't see him for nearly two years before he died and I will always deal with that fact.

Today I finally think I have accepted his death and moved forward. We all have vices - things that make us happy but may not be the best for us in the long run. Dad's was smoking. Before he died I would have told him to quit smoking, selfishly. But today, I would do no such thing. He died a happy, fulfilled man. He provided for a family the best he knew how. The day before he died he was happy. I could hear his smile through the phone. How could I ask him to give up something he loved so much?

And with that, Dad. I miss you. I always will. You taught me all you could and you did it until the day you died. I love you. Rest in peace.

Home Sweet Home

Got home from Louisiana last night and boy, it's amazing to be back. I find it interesting however that since I've been home I am slightly more forgetful than usual. I forgot my meds this morning despite reminders. Not sure why.

The last few days have been boring. I haven't done or felt anything spectacular. So there is not too much to report. The Stavzor seems to have kicked in and seems to be working.

Any assumption that my life is back to normal is just plain wrong. I feel like I have spent the last few months spending all my energy just trying to stay afloat in the ocean of life. 

The Stavzor seems to be my life raft. It's truly amazing that I no longer struggle to be alive but there's a down side. Now that I'm in this raft, I woke up and looked around. All I see is the vast, featureless ocean. The real challenges still lie ahead. I must find a rock to stand on - to build my life upon. There's lots of work to do.

I've felt sort of depressed for a while now. But I'm not sure I truly am. I just don't know what to do next.  I've been making lists of the things I can do, and the things I want to do. I have followed my feelings and that of others and aimed high. But at the same time, it is still difficult visualizing myself doing these things.

As a potential fix for this problem, I've decided to enroll in school. Again. But this time I think it will take me in the right direction. I am no longer attempting to make a break from my career of seven years and instead I've chosen to advance it. Maybe my life raft has found its way to the surf of an incredibly large island. And maybe, just maybe, that island is volcanic and will grow over time.

There is one downside to my new possible life. It's not safe and that terrifies me. So for now, I am stuck between two extremes: the comfort and relative stability of my old life and the possibility of a much more productive and possibly safe life. I don't know how to do this.

Is it Hopeless?

I realized that the horror / hopelessness I have been feeling stems mostly from not being able to sustain any project. My current imagery is that of being stuck in the here and now without having a future or even being able to imagine a future. Or of sitting on the sidelines and watching the world go by and not being able to take part because I can't keep up with the people.

My friends will in their everyday lives do the little or big things that move their lives one step further on - you could say they move on further down the road of life. I won't be able to do that. I'm trapped at the location I am at and I can't achieve any more. And so they will leave me behind.

Everyone creates a script for their futures. We will get a good job as an accountant or a doctor, we will get married before the age thirty, we will have two children, we will own a house by the time we are thirty five, we will raise the kids, we will go on the dream vacation to Australia within the next eight years...and so on. And although real life doesn't follow the script exactly, and although the script needs adjusting from time to time, there it is providing a structure for the future and the actions we will take.

My problem is that I can't seem to develop one. I mean I can create a general life script, but I know that anything written for more than three weeks is pure fiction. And because I know that, the script is effectively meaningless. So unlike most people who have some tapestry of a future life, I have a piece of blank cloth with a little bit of writing in tiny letters on the bottom right hand corner. And I have no idea what else to draw on the cloth that won't be fake.

It is generally assumed that not being able to remember your past denies you of your identity; there are lots of stories about people with amnesia. But I am realizing that it is equally true that not having a future just as effectively robs me of my identity. If I can't cast forward my dreams, then there is no person inhabiting my body now.

The Day I Knew

March 12th, 2010 was the last day I thought I was normal like everyone else.

On March 6th I was working a street shift as a paramedic like usual. My relationship at the time hadn't been going very well and an unfortunate situation resulted in a breakup after nearly two years of dating and 1 year of living together. It happened at 0300 after we had just gone available from the hospital. I remember every second. But that's where my memories end.

The next six and a half days are nothing but a blur. I truly remember nothing of the events of those days. I do know that I was awake for nearly 76 hours without so much as a nap. And I remember coming down from what I now know was a fully manic phase where I completely destroyed the once clean home I knew. A tornado could not have produced the mess that was present.

Projects seemed to have started and ended before completion. There were papers spread throughout the house, dishes stacked in the sink and groceries left unsorted. Friends have told me some of the events of those six days and I am not proud. I flirted endlessly, spent most of my money and drank in excess. My irrationality got me in trouble at work. I was irritable beyond anything I thought was possible. I became physically violent and had multiple outbursts. I was truly manic.

A few days later I had my first appointment with my psychiatrist. I was less than pleased. After showing up more than forty five minutes late, she asked me why I was there and what problems I'd been having. She then had me fill out a questionnaire that had twelve questions. I circled them dutifully and handed her the piece of paper. She handed me another. I repeated the steps and passed it back. She looked up after reviewing the results and said "You are Bipolar." My jaw hit the floor I'm sure. I asked her how she could tell after only about ten minutes. Apparently the tests I took were standardized tests. Who knew? I left her office after about thirty minutes with a Bipolar I diagnosis and a sample of Lamictal. She charged me $165 after insurance for 30 minutes.

Over the next week I contemplated what this meant. Bipolar? What the hell is that? I spent countless hours reading everything I could get my hands on. I needed to know everything I could. There's a lot to learn, and I'm still learning today.

Afternoon Update

This afternoon I feel anxious. I don't have any reason to be anxious at all, not that I can identify at least. My chest is tight and I have some heartburn. Those could be related to each other but who knows. I feel a little tired too, but if I sleep now I won't sleep well tonight and that would be a bad idea.

Overall I felt very disconnected today. I wasn't able to really focus on any specific task. As I write this post, I have 8 tabs open in my internet browser and have been trying to read them all simultaneously while watching TV, texting and listening to my co-worker's conversations. None of which have been going well. It's a shame ADD medications tend to cause mania to get worse...it would probably help.

To heat or not to heat

Woke last night a couple times but fell asleep quickly. Was in bed by 2200. This morning went well. Woke up at 0430. Morning routine as usual.

I feel slightly less drowsy this morning as compared to yesterday. I wonder if it's because I took the Seroquel earlier or if the fact that I was hypomanic when I took it. In either case, the less groggy me appreciates it.

While I was in the bathroom, before my shower, it took me nearly 5 minutes to decide wether I wanted to turn the heater on or not. I must have flipped that switch at least 5 times. It's irritating when simple tasks for some seem to take an eternity for me to act on. Does it ever get better? Or am I destined to be seen as an indecisive, unreliable person for the rest of my life?

Emergency Bail Out?

I'm sure my Psychiatrist would roll over in his grave if he knew I was taking my Seroquel as a means of emergency mania management. It seems that a 12.5mg dose works as a means of controlling the anxiety / anger of a violent manic phase. I hope it doesn't cause issues physiologically.

I can tell that I feel more relaxed and much less anxious than before.

Manic Anger. Period.

I engaged in a conversation at the end of the day that is near and dear to my heart with at least one, and as I understand it now, three individuals that seem to have it out for law enforcement. The discussion was about the OHP Trooper that caused a situation a year or so ago. The conversation went well until I was interrupted and interjections were made before the entire story was told. Furthermore, ignorance was interjected and caused me to lose my grip on reality. I became violently defensive. Yelled, swore and acted as if I were three years old. My heart was racing, my BP must have skyrocketed. I was waiting, poised for a fight. I guarantee my blind rage would have consumed me if my co-workers had not managed to carefully mention that I was out of control. Twenty minutes later, my mind races. My heart rate is still nearly 120 and I am clenching my jaw. Breathing exercises haven't made any discernible difference. I'm scared of what might happen should my buttons be pushed again.

I'm terribly anxious. I feel like crying...but only after I beat someone's face in.

Maniacal Metronome, defined

Maniacal Metronome seems a befitting title for my blog / journal as my natural rhythms tend to be variable in time, length and often swing towards mania before it swings towards depression.


According to dictionary.com, a maniac is:

1. a raving or violently insane person
2. any intemperate or overly zealous or enthusiastic person.

It is therefore understood that maniacal is:

1. affected with or characteristic of mania
2. characteristic of or befitting a maniac

According to dictionary.com, a metronome is:

• a mechanical device which indicates the exact tempo of a piece of music by producing a clicking sound from a pendulum with an adjustable period of swing.

An Introduction to Bipolar Disorder

According to the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association (DSM-IV):


The essential feature of Bipolar I Disorder is a clinical course that is characterized by the occurrence of:

• One or more Manic Episodes or Mixed Episodes.
• Often individuals have also had one or more Major Depressive Episode

The essential feature of Bipolar II Disorder is a clinical course that is characterized by the occurrence of: 

• One or more major depressive episodes accompanied by 
• The occurrence of at least one hypomanic episode (Hypomanic episodes should not be confused with the several days of euthymia that may follow remission of a major depressive episode).

For both Bipolar I and Bipolar II Disorders, episodes of substance-induced mood disorder (due to the direct effects of a medication, or other somatic treatments for depression, a drug of abuse, or toxin exposure) or of mood disorder due to a general medical condition do not count toward a diagnosis of bipolar I disorder.

In addition, the episodes are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.

Criteria for a Manic Episode

• A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
• During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: 
• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

• The symptoms do not meet criteria for a Mixed Episode.
• The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
• The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatments) or a general medical condition (e.g., hyperthyroidism).
• Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.

Criteria for a Hypomanic Episode 

• A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood. 
• During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree: 
• Inflated syllabify or grandiosity. 
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
• More talkative than usual or pressure to keep talking. 
• Flight of ideas or subjective experience that thoughts are racing. 
• Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli). 
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation. 
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).

• The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
• The disturbance in mood and the change in functioning are observable by others. 
• The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
• The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
• Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar II Disorder. 

Criteria for a Depressive Episode 

• Five or more of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
•  Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g. appears tearful). In children and adolescents, can be irritable mood. 
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others). 
• Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains. 
• Insomnia or hypersomnia nearly every day. 
• Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down). 
• Fatigue or loss of energy nearly every day. 
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
• Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others). 
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

• The symptoms do not meet criteria for a Mixed Episode. 
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 
• The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism). 
• The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation. 
• Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

 Criteria for a Mixed Episode 

• The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
• The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. 
• The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

So, what does all this mean? Bipolar is a spectrum of clearly identifiable problems. The diagnosis of bipolar is not as straight forward as there are many, many factors that are taken into consideration including time, duration, severity and frequency of the above episodes.

According to my Psychiatrist I have been diagnosed as Bipolar I, specifically after my only true manic episode to date. More on that day when I am able to recall more clearly the events that unfolded


I found a website while surfing. Moodtracker.com. Seems pretty solid. It apparently allows me to send myself reminders about taking my meds. I think I'll give it a try.

Sunday February 6th, 2011

Up at 0450. 20 minutes late. Feeling a little cloudy after seroquel last night. I only took 12.5mg...didn't expect to be groggy. Maybe take 6.25mg tonight? Despite being drowsy I was able to complete my morning routine including meds! The MoodTracker Email seems to have helped this morning. Went to bed around 2230 last night and slept uninterrupted until 0430. Not bad. Seroquel helps for sure. Im nervous about the dyskinesia I experienced with abilify as they share a drug class.

Been having headaches in my left lower occiput for the past few days off and on. Nothing debilitating, just there.

Looking forward, I wonder what will happen next. The mania / depression moods are no longer as bad as they once were, but their onset is so rapid that they are still disruptive. And I still lose days to depression when I stay home and do nothing much. Practically it means I can't be reliable. How can I take on a long term job or study if I can't predict my state of mind / being over the next two weeks. This really throws into question the type of work I can handle. It upsets me, because my intelligence hasn't changed.

I fear I may be stuck doing work that is below my intelligence capability, but rather is based on my ability to function (or not function). I haven't figured out how to deal with this and I don't think I have come to terms with it yet.

The current model for depression / bipolar disorder is that it is the inability of the body to properly regulate and balance some of the chemicals in the brain. Well, perhaps. But the effects of bipolar disorder cannot be fixed simply by helping the body to rebalance these chemicals. Bipolar disorder is something other than me, but nevertheless it contributed to shaping who I am today. Even if I do not like what it has done to me and even if I am on medication to release me from its thralls, it will still take quite some time (and therapy?) for me disentangle my true identity / self from the person I appear to be now, and to reshape habits bent by being bipolar.

As the day draws on I find myself becoming slightly irritable. Everything is annoying and all I want to do is sleep.

Saturday February 5th, 2011

Early morning. Was up by 0415. Went to bed late last night. I'm exhausted. Stopped taking meds again. I can't seem to remember to take them even though I know I need to.


I didn't get this posted yesterday as I forgot. Seems to be the norm recently. I can't wait until the meds start working again. I think I'll start them tomorrow.