Cyclothymia- A Milder Form of Bipolar Disorder

“I am bipolar, and I am a full manifestation of it in terms of my speech, in terms of my energy.” -Mauro Ranallo

After several years of being called, “bipolar” by endearing family members, I set aside my judgment of them and often wondered if there was some validity in the criticisms.

The depression persisted from my teens up until now, however, the mania wasn’t fully manifested until later in life. I can recall one friend telling me that I was the only person they’ve known that exhibited both a melancholic and hyper disposition simultaneously.

As a female, my moods have always been further compounded by the fluctuations in my hormones (i.e., “pms”, and postpartum).

About 7 years ago, I went to my doctor who diagnosed me with depression and PMDD. Every visit since then, the depression notes remain on my summary. Once, when I tried to contact one of my doctor’s, she stated that none of my conditions weren’t applicable because I wasn’t re-evaluated for them- I had missed an appointment and she seemed harsh and unhelpful.

When I went back for a yearly appointment in 2017, the doctor assumed I was there specifically for a prescription. I told her I wanted to have a thorough diagnosis- that meant I had to get blood tests to rule out physical conditions. It also meant she would refer me to a psychiatrist for the full evaluation.

I met with two psychiatrists- the first might have had a different certification because he made my second appointment with the doctor who conducts evaluations. Again, I think I was scheduled with him first because the staff thought I just wanted counseling or pills.

When I had my evaluation, she told me I was, “a little bipolar.” I told her I didn’t want pills, just a diagnosis so I could manage my disorder on my own. She prescribed something that I never took. Weeks later, I requested my records and discovered the notes about my mood disorder- which didn’t explicitly state that I had bipolar disorder.

This diagnosis leads me to research more about bipolar disorder. More specifically, I wish to learn more about cyclothymia- or, as some people refer to it- “mild” bipolar (a “little” bipolar!).

Cyclothymia is a somewhat rare mental disorder, affecting about 0.4-1% of the population, with women being more frequently diagnosed than men by a ratio of 3:2.

“Cyclothymic disorder is characterized by hypomanic and mini-depressive periods that last a few days, follow an irregular course, and are less severe than those in bipolar disorder; these symptom periods must occur for more than half the days during a period of ≥ 2 yr. Diagnosis is clinical and based on history. Management consists primarily of education, although some patients with functional impairment require drug therapy.” (Merck Manuals)

Many people, such as myself, enjoy the hypomania component of the disorder allows me to be “high-functioning”.

It helps those who are achievers, leaders, or those with an artistic bent, to be productive and creative, even influential and admired by their peers. On the other side of the coin- the “depressed” element of cyclothymia, wreaks havoc on relationships and can create conflict due to erratic behavior in the workplace and otherwise.

Many people afflicted by cyclothymia (or other forms of mood disorders) often turn to drugs and alcohol to a feeble attempt to quell their moods.

How can somebody get help if they think they may have cyclothymia? There is no test for cyclothymia. A doctor usually refers to your medical history and sometimes will refer you to a psychiatrist. Since the symptoms of cyclothymia are similar to bipolar 1 and bipolar 2, it is important to seek an evaluation from a psychiatrist.

Since cyclothymia is less severe than other forms of bipolar disorder, you may decide to examine various methods of treatment, with or without medications.

What works well for one individual isn’t always ideal for everybody else.

You can choose to see a therapist at regular intervals, join a support group, etc. Still, many psychiatrists prescribe medication.

Medications Often Prescribed

Lithium– a mood stabilizer

Lamictal– an anticonvulsant

Tegretol– used to treat seizures and bipolar disorder (anticonvulsant)

In conjunction with working with your doctor and psychiatrist, you can find online resources to provide you with information. The ADA has a screening tool to help guide you.

References:

  1. https://ada.com/conditions/cyclothymic-disorder/
  2. https://www.merckmanuals.com/professional/psychiatric-disorders/mood-disorders/cyclothymic-disorder
  3. https://www.psycom.net/depression.central.lamotrigine.html
  4. https://www.psycom.net/depression.central.cyclothymia.html
  5. https://www.drugbank.ca/drugs/DB01356
  6. https://www.everydayhealth.com/drugs/tegretol
Woman sitting behind green bars, smiling innocently.

Simple Ways to Manage Anxiety and Depression

“Once a week, I like to slip into a deep existential depression where I lose all my sense of oneness and self-worth.” -Bo Burnham

The most helpful part of managing my mood disorder is the fact that my moods are fairly predictable. In more severe cases, it is much more difficult to manage, at least not without the help of doctors. I’ve battled these moods since I was a teenager.

I’m almost certain, however, that I experienced strange things when I was younger. These things I’m talking about are the symptoms one sees when they have experienced trauma. Dissociation, depersonalization, and even involuntary, but subtle, nervous ticks.

So, I’ve battled these moods for many years- anxiety, depression, GAD, OCD. I am familiar with the alphabet soup of mental illness- although, that doesn’t qualify me to dispense medical advice. It simply means, my conditions are much more manageable, so manageable now that I can tell the psychiatrist I don’t want to take the Lamictal or any other drug.

And, I’ve spent so many years on the prescription-drug rollercoaster, to no avail. Well, that’s not entirely true- Prozac wasn’t too bad, except for the occasional electrical surge. Lexapro wasn’t so bad, either. Definitely a pass on Paxil, Buspar, and Serzone.

You might be able to pick up on the fact that I haven’t written regularly for the past few weeks. Today I began to see an improvement in my mood. Soon I will be scribbling away, hopefully finishing some artwork. Now that I am feeling better, I wish to share some simple things that help me feel “at peace.”

Thrive Mindful- Ways To Feel “At Peace”

Shop when the stores are empty.

Get a haircut.

Study a free online course through Coursera.

Play board games with family.

Prank-call a family member.

Play a musical instrument.

Enjoy an open-air, free concert.

Organize photos.

Visit the library.

Ride a bike.

Adopt an animal from a shelter.

Call a long-lost family member.

Wash the car.

Donate unwanted clothes to charity.

Do some yard work.

Explore other WordPress blogs.

Read a good book.

Write a poem.

Organize computer files.

Go for a car ride at dusk.

Watch the sunrise.

Make a list of goals.

Write down 3 things you enjoyed when you were ages 9-12.

Do a free, online personality assessment.

Draw (or doodle) some pictures for your poetry.

Draw a self-portrait.

Rearrange living room furniture.

Invite the opinions of others on topics with universal appeal (i.e, favorites lists of anything)- Promotes diversity and fresh ideas!

Take the family or a friend out to lunch.

Watch a band at the coffee shop.

Schedule a yearly health exam.

Play tennis with some family or friends.

Mental Health Communities And Forums

Finding relevant information and maintaining privacy are key issues for individuals suffering from mental health issues such as anxiety or depression. I’ve included some resources that may be helpful for questions and answers.

www.uncommonforums.com: Topics include psychology, depression, anger management, addictions, eating disorders, and anxiety/panic attacks.

www.dailystrength.com: Online support groups for anxiety, addiction/recovery, mental health, men’s health, women’s health, teens, children’s health/parenting and many other health issues in general.

www.sane.org: An Australian mental health website that includes a well-organized forum area. The aesthetic appeal and non-spammy feel make the website worthwhile.

www.beatingthebeast.com: “Beating The Beast” touts itself as an online depression support community, but I’ve discovered useful advice on anxiety disorders, as well as bipolar and other mental health issues.

If you were to write a list of things that make you feel happy or relaxed, what would it include? Is there a pattern in your list?

My list includes a little socializing, some solitude, and purging of unused things that others might want to use. Note that much of my joy comes from reading, writing, and drawing.

No matter how depressed or anxious I become, I try to make an effort to pursue my faith (reading the Bible, watching or reading content online about my faith). One key difference between how I handle my moods now, as opposed to when I was younger, is the fact that I pursue my spirituality. Even when I feel I’ve lost hope or control, there is always something more that governs life and the world around me.

A lady with long, dark hair stands outside on a cloudy day.

Understanding Moods at Various Life Stages

“I don’t wait for moods. You accomplish nothing if you do that. Your mind must know it has got to get down to work.” -Pearl S. Buck

The complexities of the mind never cease to fascinate me! With so many factors to be considered by the medical community, it’s no wonder the DSM-IV lists over 297 disorders!

I’m no doctor or therapist, but simply a person with an intense curiosity about mental health issues. As I look back on my own mental health history, I’ve noticed many changes. Parallel to my mental health history, I must consider my environment at each stage. Was I surrounded by supportive people?

No- in the most difficult times in my life, I was either isolated or surrounded by negativity. I use the term “negativity” loosely, mostly because in many instances, I lived in a dysfunctional environment. In the case of my teenage years, I lived with an alcoholic mother from whom I sought approval. Every time I skipped a meal, it was to win her approval. It was also an erroneous effort to remain fragile and adolescent.

Postpartum Depression

After I had my children, I experienced postpartum depression. Being a new parent is hard enough, let alone being a new mother with no happiness emanating. My depression made me feel unworthy. I didn’t measure up to what I felt a new mother should look like or feel like. The mothers I observed were smiling, singing to their kids, and they had energy. I often felt catatonic but through prayer, I was able to push through the sadness. I tried to get enough rest and get my kids out of the house- even when it meant I had to face what felt like a harsh world.

Reflecting On The (Painful) Past

My first-born had colic and cried frequently for the first few weeks. Although I read books and scoured the internet for information, I couldn’t escape feeling at fault. Babies with colic love white-noise, music and motion. They also like a change of scenery, so car and stroller rides were key to help ease my son’s symptoms.

Walking helped me and my kids get away and connect with each other, away from the toxicity of alcoholism and unsupportive people. I remember getting a double-sided stroller for my kids- right before I knew the time was nearing for us to move on from our home. In 2007, during our stay at the women’s shelter, we used it quite often when the staff arrived at 8:00 A.M each morning.

Children playing outside in the Fall season.

My children and I lived in utter chaos for many years as a result of my husband’s drinking and verbal abuse. At this juncture in my life- with very little emotional resources (or resources of any kind), I couldn’t overcome my depression and anxiety issues, become the kind of parent I desired to be in a marriage riddled with so much strife.

My mind couldn’t take anymore. I wasn’t getting enough rest, and as a result, I wasn’t always attentive to my children’s needs. Fast-forward ahead, divorce, new job, and relocation. It’s hard to believe how much has changed in life, and with my health.

Looking back, I was very withdrawn, anxious, and depressed for 15 years. Then I suffered from postpartum depression and recovered. I went to the doctor and tried Lexapro, then switched to Prozac. I took it sporadically because I felt fine sometimes. I quit taking it when I started to experience electrical surges in my brain. Sometimes I felt like it was too much medicine, even though it was the lowest dose and I usually broke it in half!

In 2017 I was told by a psychiatrist that I was “a little bipolar.” My speech was sped up when I spoke to her, but I honestly didn’t feel I fit into all the typical patterns of a person afflicted with bipolar disorder. She prescribed Lamictal, which I never took.

When Joy And Sadness Are Natural Reactions

At this point, I’m betting that I need to go get an MRI to see if I have something else wrong with me. Sometimes I feel overwhelmed with joy and laughter. Then there was that time at church a few years ago that I couldn’t stop crying at the Mother’s Day service.

Maybe the crying has to do with actual grief of the loss of relationship with my mother, or that motherhood itself has many strong memories- memories of my personal failures attributed to my depressed mood- the times that I isolated my family from what I perceived as a harsh world.

Over the years, my moods have seemed to improve, with a few exceptions (when exposed to conflict, harsh conditions, and disrespectful attitudes). I am not subject to the empty, hopeless feelings of my twenties. The anxiety- GAD and agoraphobia, that I was plagued by in my thirties has diminished significantly. Consequently, I am no longer under the influence of certain family ties.

Sometimes I feel that I have been delivered from the depths of depression and anxiety. I often prayed to have any other affliction except those dueling monsters of invisible mayhem! Maybe all the years of taking SSRI’s have chemically altered my brain. But I took the medicine sporadically- if at all. I relied more on prayer than human wisdom during those years, so I am a little biased to feel it wasn’t pills that helped me.

I rarely have bizarre nightmares. I feel happy or at least, content, most of the time. Sometimes I get bursts of mania and creative energy. Seldom, I get depressed and can’t find the desire to write or draw.

With my moods taking shape in different ways, I’m becoming more curious about the human mind. As I get a little older, I certainly cling to the hope that I never lose my mind.

 

What You Should Know About Bipolar Mania

Know The Difference Between Hypomania and Mania

The symptoms of hypomania and mania are very similar. You may feel more social, excited, confident and creative. However, the two conditions differ in severity and length.

Hypomania is a milder form of mania and lasts a shorter period of time- days, instead of weeks. Mania is a condition that is more severe and lasts longer than hypomania- generally, mania lasts a week or more.

Often, those who experience hypomania enjoy the bursts of energy and creativity. On the other hand, individuals who experience mania may feel quite uncomfortable with their symptoms. A person experiencing hypomania may simply be more friendly and active. The sudden burst of energy often leads them to take on many projects at once, or accept more risks and responsibilities.

Somebody experiencing mania will also feel excited, but it is much more difficult to manage the sudden bursts of energy. Instead of simply feeling more creative, the manic individual has difficulty harnessing their energy. Their words pour out quickly and frequently, thus making it difficult to engage with others and allow them to interject. Accompanying that desire to talk frequently and quickly, they feel overly confident, grandiose- as though others don’t have the capacity to understand their special abilities and talents.

The person experiencing hypomania feels that they can perform tasks more efficiently and better than normal. They feel happy, have boundless energy and creativity, and seem to be able to manage their energy, racing thoughts, and ideas.

When somebody is experiencing mania, however, it is difficult for them to organize and direct their energy.

Key components of mania may include:

  • Jumbled, unorganized and racing thoughts.
  • Inability to concentrate on tasks and/or easily distracted.
  • Lack of insight, which hinders the ability to mania as problematic.
  • Delusions and paranoia
  • Seeing, hearing, or feeling things others can’t observe (psychosis).

Managing Hypomania and Mania

Boundless energy, feeling more attractive and social- people often enjoy hypomania and mania and seem no harm. Their distorted beliefs about hypomania and mania may lead to an incorrect diagnosis, or they fail to follow-up on their treatment.

The first step should be to get a physical to rule out other potential causes. If you are taking any medications, your doctor needs to assess if these medications are the cause of your symptoms, or if any medications or other health issues are affecting your treatment.

Many patients are advised by their doctors to take antipsychotics or mood stabilizers. If you are taking medications, it is essential that you take the medicine as prescribed and follow-up as needed with your doctor.

In combination with taking medications, or instead of taking medications, many people are advised to participate in therapies that involve talking.

Talk Therapy includes:

  • Family-Focused Therapy, which involves working with members of your family to identify certain behaviors and traits that need attention. Problem-solving methods are employed as part of therapy.
  • Interpersonal Therapy examines your relations and how to improve and interact more effectively.
  • Psychoeducation is a type of intervention that helps people learn to cope, either on their own or as part of a group.
  • Mindfulness-Based Cognitive Therapy (MBCT)- Therapy that focuses on living in the present and becoming more attentive.
  • Cognitive Behavioral Therapy (CBT)- A type of therapy program that is practical and short-term, that helps people identify and change behaviors associated with hypomania and mania.

How To Help Yourself

Learn to identify triggers:

  • Avoid excessive amounts of caffeine and alcohol.
  • Avoid skipping meals.
  • Not allowing yourself downtime to enjoy rest, pursue recreational activities, or enjoy time with family, friends or solitude.

Make a plan to manage hypomania/mania episodes.

A management plan may address your triggers. An example of a management plan may include:

  • Keeping track of your moods. Record the day, time and other factors important to the event.
  • Avoiding situations, places, and people that may put you at risk to engage in dangerous behaviors (such as taking drugs, spending too much money, etc.)
  • You may opt to avoid places that are over-stimulating, or too chaotic, busy or crowded.

Apply daily routines to help manage episodes of hypomania and mania.

  • Get plenty of sleep and try to go to bed at the same time each night.
  • Practice proper nutrition and eat regular meals. Avoid skipping meals.
  • Keep balanced! Avoid taking on too many responsibilities. Seek relaxing activities to counteract the stimulating/stress-inducing activities. Relaxing activities include meditating, journaling, reading, working on puzzles, etc.

Support System As Part Of Treatment

Many people who suffer from mood disorders lack quality relationships with family or friends. Take steps to correct this if possible! Many family members or friends don’t have specific knowledge about hypomania and mania, and they may reflect this lack of knowledge in the way they deal with their loved ones!

Clearly, but kindly, express your frustrations with them. Educate them on your symptoms so they don’t falsely attribute every “good” day to hypomania/mania. Tell them how much you appreciate their efforts to make sure you are getting enough sleep, nutrition, etc.

Family and friends can play an important role in treatment. They may be able to let you see your blind spots (this theory can be applied to all people- not just individuals with mood disorders).

Conversely, if you lack quality friendships or family relationships, you may prefer to find a group that deals specifically with mood disorders. Such groups can be found locally, but more often, people with mood disorders enjoy connecting with others online- for example, online forums, or online therapy (if covered by insurance).

Why I Love My Bipolar Mania!

Mania Can Feel Like Euphoria At Times

Although experiencing “flight of ideas” in of itself is not a mental disorder, it is a symptom of those with bipolar disorder. All that mania and energy needs to be channeled somehow- it is best used in creative endeavors. When I experience the highs of mania, I become the idea person– the person who conjures up dozens (or more) ideas, concepts, processes, etc., only to never really follow through any of them. By the time the idea(s) is(are) manifested and it is time to develop the ideas, my mind is off somewhere else…perhaps I am so down again that I can barely find any desire to become “goal-directed”. This is not a particularly desirable quality for my vocation.

As a result of the flaws of my manic episodes, I can use my moments of mania to augment my work life, but I can’t allow myself time to pursue anything loftier than my menial job. As a middle-aged worker, I am able to look back upon my vocational lifespan and know that I don’t consistently have all the qualities necessary to get the sweet, 9-5 job in an ad agency. Those people, as far as I can see, have a different kind of attitude when it comes to creativity. 

In the arrogance of my youth (or the ignorance of my youth), I figure I would benefit from going to college. I never obtained even a two-year degree in any one course of study. I was neither inspired or encouraged as a young person- I had a desire to go to school, but I lacked the tenacity to finish the one class that was standing in the way of my moving on in college.

Drawing for me is a release- I am able to focus and generate some clarity through these lines and shapes. Through these seemingly benign and naive patterns, I can somehow see the patterns of my life, even if they are mere fragments of a shattered lens.

So, I never completed my Marketing & Sales certificate- or the Graphic Design degree in which I transferred. The Sociology degree I desired to obtain was just too impractical and unlikely. It doesn’t mean I’ve given up on education or enrichment. I simply had to change the way I sought these things.

Mania- it can make me feel more creative. Bipolar disorder isn’t as simple as many are led to believe. It’s can be difficult to focus on complex tasks without the help of notebooks, post-its, and my trusted computer. These tools serve as ways to process many simultaneous thoughts and ideas.

When it comes to employment, the volatile and changing nature of the bipolar disorder can limit one’s career choices and success, no matter how much skill or talent one possesses.

Many people who struggle with mental health issues (like myself), may find menial jobs comforting- for they are predictable and help us to feel anchored in some regards. I find that my mind has time to wander, instead of being consumed by mental-overload.

I try to make the most out of an otherwise undesired and limiting aspect of my life and choices. I still have dreams and creativity.

 

When I Realized I Was Addicted to Bipolar Mania

The Calm Before The Storm

When I am feeling “level”, that is, “cool-headed”, or balanced and mellow, I am neither depressed nor elevated and manic. I sometimes wonder when I will become manic or depressed, which will come first. I might have taken good care of my health during these times of feeling balanced. I may have felt in control of my environment and circumstances. It sometimes is a chance that everything is balanced in my life- I might not have been actively involved in shaping my level mood. I sometimes miss the rush from feeling manic.

Sometimes this surge in energy helped me through a tough day at work, or I was particularly motivated to take my family on outings…which is usually a seldom occurrence because I am introverted and do not like to be out with at places where there are crowds of people. I get elated when I see an empty theater or restaurant- makes me feel safe and cozy!

Addicted To Mania?

I surmised that maybe I am addicted to my manic moods. When I say “addicted” I mean that I am aware of the fact that my moods get elevated, as well as depressed. I am aware of this fact, yet I ride the proverbial wave of mania each episode, savoring those elusive times of feeling “on top of the world.” I do nothing to manage my mania or depression before the moods overwhelm me. When I am exposed to environments, situations, behaviors or people that may influence my moods, I do not mindfully assess my triggers. Sometimes, I think certain things are good because they contribute to making me feel happy…these things can also overstimulate my mind, sending it into chaotic bliss, as well as a chaotic abyss.

In my chaotic bliss (mania), I become more extroverted and talkative. I also talk louder and am prone to using an edgier tone (I curse more). It was more intense when I abused alcohol in my youth. People that have mental health issues need to take special care of their minds and be more diligent to steer clear of drugs or alcohol, as these things tend to worsen symptoms of mania and depression.

Medications Diminish Desired Mania

I have tried several variants of antidepressants from the SSRI classification. Prozac, Paxil, Effexor, Zoloft, Lexapro, Celexa, all to no avail (The Journey Begins). I never wanted to be on medications forever and it seemed that the pharmaceutical industry wants us to use the medications indefinitely. Doctors would tell me, “You have to give it time for them to work effectively”. A few years ago, I tried using medications one more time. This time, I had very bizarre nightmares– morbid in theme, disturbing in context.

I felt I was being disobedient to God by continuing the drug. Also, I did not feel happy- ever! Just one, single, solemn and dull, level mood. I could not even bring myself to crack a smile because my face felt like a somber mask. A mask of plastic- I felt like I had a lobotomy! My thoughts started to become disordered too. I quit the medication cold-turkey and suffered painful withdrawals for a few days. I was agitated and mean and couldn’t wait to overcome the medication!

Self-Awareness To Tame The Beast

In my past, I have been with depression and anxiety disorders. I have always suspected that I may have bipolar disorder (my mother and sister can attest to my moods as well). I feel like there are three energy forces within me- balanced and cool, dark and depressed, and excited/manic. I am not sure if these “forces’ are all attributed to my moods or are components of my personality.

I enjoy my level moods, although they are far and few in between. I loathe my depressed moods and wonder why I am plagued by them periodically. When I haven’t had a manic episode in a few days or weeks, I start thinking about how I can induce happiness in some other way. I do not drink or take drugs. I do listen to music- very manic music. Sometimes I shut off the music and enjoy the clarity that comes through silence. I am learning to recognize music as a mood trigger and limit the time I am being influenced by exciting music, but oftentimes, I want to be the person experiencing the excitement. Excitement- yes, I can manage excitement. Mania, it is my addiction to an unhealthy level of excitement, or so I am beginning to discover.

A woman sitting alone in nature writes in a journal.

How Journaling Helps Bipolar Disorder

For those suffering from bipolar disorder, much of their life is filled with chaos and the uncertainty of when they will experience another episode of mania or debilitating depression.

In a post at the health and wellness website http://www.sharecare.com, Dr. Thomas Jensen, answering on behalf of International Bipolar Foundation, states,

“The mood state that we want a bipolar person to spend as much time as possible in is the euthymic state, which translates from Latin into ‘true mood’ or normal mood.” (https://www.sharecare.com/health/bipolar-disorder/what-euthymic-state-bipolar-disorder).

Unfortunately, this “normal” euthymic state is not the predominant mood in those suffering from bipolar disorder.

In a 2002 study by Lewis L. Judd and colleagues at the University of California at San Diego, “people with bipolar I experience depression three times as often as mania. For bipolar II, the ratio of time spent in depression versus mania is a whopping 40:1.” (http://www.bphope.com/everything-you-ever-wanted-to-know-about-bipolar-depression/).

Journaling is a form of writing that goes beyond the elements of keeping a diary.

While a diary merely allows individuals to record events, writing a journal involves self-expression and creativity. “Journaling allows you to dialogue with parts of your psyche that are frozen in time,” states Laurie Nadel, Phd., and author of Zen and the Art of Windsurfing.

The art of journaling helps organize thoughts, purge the mind of mental “clutter”, and gain insight into your perceptions of your moods and life experiences- a type of creative, and safe, inner-dialog.

Journaling can be viewed as an interactive way in which individuals can process their moods and emotions. Once the words are written down on paper, the writer has power over those feelings, and they may opt to keep the pages of their journal or destroy the pages after processing and reviewing their entries.

Although writing can help everybody manage anxiety and depression, it seems particularly beneficial to the 2.6 million people over the age of 18 suffering from bipolar disorder. (National Institute of Mental Health). Often, the stigma associated with bipolar disorder (and other mental disorders) makes it challenging to find support and talk to others. Furthermore, people suffering from episodes of bipolar depression may become so debilitated by their moods that, not only will they physically isolate themselves from others, but that they may withdraw emotionally from family and friends as well.

Here are some ways to motivate yourself to keep a journal:

Integrate journaling into your daily routine

Just as you should make time to eat, bathe, and exercise each day, setting aside just a few minutes each day will help you become more disciplined recording events, as you would in a traditional diary. Journaling moves beyond keeping such records, as it allows for self-expression and creativity. However, recording events and experiences is a necessary part of the journaling process.

Choose your own method of writing in your journal. Sigmund Freud “free association” with his patients, that is, he allowed them to sit on the couch and speak of their dreams and experiences.

Free association as used in the realm of psychotherapeutic technique, allowed Freud to unlock insights from a deeper level when he engaged patients in this type of spontaneous dialog. (http://aycnp.org/Self_Help_Writing_Journaling_Mental_Health_Self_Help.php).

Control Your Audience.

Opt to share your journal with whom you trust, or share it with the world by creating a blog. Use the journal to help organize thoughts when you visit your doctor, or simply, throw away any negative entries. Once you have processed the emotions and experiences, they are yours to share or discard.

References:

What is a euthymic state in bipolar disorder? Sharecare.com. Retrieved on September 3, 2017. https://www.sharecare.com/health/bipolar-disorder/what-euthymic-state-bipolar-disorder

Everything You Ever Wanted To Know About BIPOLAR DEPRESSION. BPHope.com. Retrieved on September 3. 2017. http://www.bphope.com/everything-you-ever-wanted-to-know-about-bipolar-depression/

Writing Your Way Out of Depression. WebMD.com. Retrieved on September 3, 2017. http://www.webmd.com/depression/features/writing-your-way-out-of-depression#1

Journaling For Mental Health Self-Help. AYCNP.org. Retrieved on September 3, 2017. http://aycnp.org/Self_Help_Writing_Journaling_Mental_Health_Self_Help.php

Journaling For Mental Health. Urmc.rochester.edu. Retrieved on September 3, 2017. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=1&ContentID=4552

A woman wearing dark clothes and hat walks in a field of daisies.

When People Pretend to Understand Bipolar Disorder

Don’t assume anything about Bipolar Disorder.

It is much easier for me to tell people I have been diagnosed with bipolar disorder now that I have had an actual psychiatric evaluation. It has taken me years to be led in the right direction for such a diagnosis. Five years ago, I believed I suffered from PMDD (premenstrual dysphoric disorder). A few times a year, when I would become so distraught over my moods, I would schedule a doctor’s appointment. I believed my periods were causing me such psychological problems that they were the major culprit in any interpersonal relationship conflict I had with family, friends or co-workers.
In 2016, I penned an email to my family doctor:

“I am no longer taking Lexapro. I tried for 3 weeks and had some nightmares and discovered I grew a tolerance for it. I felt really hostile on it the final week. I was seemingly fine until my period this week.”

She gingerly replied:

“Unfortunately you did not follow-up at your scheduled appointment where we would typically re-evaluate symptoms of anxiety, depression, PMDD, and any side effects. Therefore none of this is actually documented.”

I had been to the same office for “mood” problems since 2012 when the doctor tried to put me on birth control pills. The “pill” was not effective in treating my mood disorder. Each time I visited the doctor, they tried to give me another antidepressant. Mostly, I was given medication in the SSRI class of antidepressants. Then, I was prescribed Wellbutrin, a medication in the NDRI class (norepinephrine-dopamine reuptake inhibitor). My doctor determined that I was “sensitive” to medications, which is why she tried me on Wellbutrin.

I was afraid to mess with the new prescription she recommended. Then, my mood would improve, I’d get a euphoric feeling. I felt creative and happy about half of my life, then I descend into depression. It was always with that period of depression that I sought help. My doctor’s office replaced the previous physician with a new doctor. I explained that I was not there for “meds” as the nurse remarked on my intake form. She reviewed my symptoms and gave me a referral to their partner clinic- the clinic that deals with mental illness, therapy and psychiatry. A wave of embarrassment and shame poured over me. The psychiatrist asked me many questions. As I spoke to her, my speech became more rapid. “Do you realize how fast you are talking?” I said I was moderately aware of how my speech changes but nobody else has ever remarked about it.

We talked about my family history, specifically, how members of my family used alcohol to mask what was possibly their own mood disorders. In the past, there was more stigma against mental illness. People kept problems hidden from others, or at least they tried. The alcoholism simply created additional problems. My grandfather was a WWII survivor (USS Indianapolis). He was quiet and held his liquor well. It was socially acceptable to throw down a few beers. He was dealing with traumatic memories that he wanted to suppress. Grandma, on the other hand, was a talker. She was also a drinker, as was my mother. As a child, I witnessed interesting discussions when they all drank together in the kitchen. My grandfather seemed to have much composure. I can’t say the say for the rest of the family.

I told the doctor about my experiences with Lexapro, and how I had very disturbing nightmares. These nightmares dealt with the macabre- death and decay. I found it very difficult to shake these dreams from my waking moments. When I quit taking the medication abruptly, I experienced unpleasant withdrawal symptoms. I prayed that I would avoid getting into trouble or jeopardizing any relationship. The other medications made me feel dull but balanced. While on the meds, I was neither happy nor sad. My face felt like a mask. Any creative inclination I had previously experienced during my “manic” episodes had all but diminished.

My psychiatrist said that my periods likely trigger my underlying condition of bipolar disorder. She told me that more than likely, my mother and grandmother had mood disorders and drank to cope with their issues. The nightmares that I experienced while taking antidepressants was common in bipolar patients.

“Your family doctor sent you here because she didn’t know what else could be wrong”, she explained. I read that in order to be diagnosed with PMDD, the doctor must rule out any mental health issues that could possibly be causing the symptoms. Although I was not thrilled with being diagnosed with any mental disorder, bipolar disorder was less-embarrassing than PMDD. PMDD is not socially-acceptable and most people misunderstand the meaning of “being bipolar.”

When I need to tell people about my disorder (so they don’t think I’m speaking rapidly because I’m strung-out on drugs), I am met with a dismissive attitude. The term “bipolar” has become synonymous with being “edgy”. The term “bipolar” is used to broadly define any rebellious, hip, or bold attitude. Mood disorders are NOT attitudes.

Bipolar disorder is defined by the American Psychological Association as “a serious mental illness in which common emotions become intensely and often unpredictably magnified. Individuals with bipolar disorder can quickly swing from extremes of happiness, energy, and clarity to sadness, fatigue, and confusion. These shifts can be so devastating that individuals may choose suicide.”-APA.org

As a society, we have all but surpassed the days of unrelenting stigmatizing of mental illness, at least for bipolar disorder. In fact, we now must contend with the ignorance associated with bipolar disorder. Much of this ignorance is due in part from people not recognizing bipolar disorder as a real medical condition.

During a manic episode, people suffering from extreme cases of this illness may indulge in risky, foolish or erratic behavior. They may spend money and put their family in debt. They may become promiscuous and wreck their marriage by having affairs. During a depressed cycle, they may experience psychotic episodes, or attempt suicide and/or self-harm. While I have not experienced those elements of bipolar disorder, I have become so depressed that I have ruminated over my own death. I am certain that such dark moods are not appealing to my family.

Bipolar disorder affects each person differently. My variety of this trendy illness doesn’t involve getting tattoos, drinking and driving, or staying up all night like a rock star. Rather, my bipolar can be managed most days, and I have been given the ability to function enough to hold down a full-time job.

Others are not able to work or even manage to get out of bed and get dressed when they are debilitated by depression. When weekends arrive, I am partially relieved because I can rest at home, or so I believe. Often, I become so manic in the afternoon that I am not able to sit down. Weekend mornings, when the kids are still asleep and my worries are quenched for a little bit of time, are the only times I can spend writing. I “binge,” write during such times, except when I am depressed, or when I am trying a new medication.

When I was in my twenties, I started to become aware that something was not right about my moods. Listening to music from Jimi Hendrix and Nirvana opened my mind to certain mental health issues (i.e., “Manic-Depression”, “Frances Farmer Will Have Her Revenge”). I was old enough to drink and I drank exceedingly to suppress or to accelerate my mood shifts. Those were some of the worst years of my life!

When people passively listen to me talk about my mood issues, they appear to be dismissive or they appear to “know it all” about manic depression/bipolar disorder. They do not care or they wish to remain blissfully ignorant. After a while, I let them stew in their ignorance or I pretend to not have a mood disorder. Such people love to use a broad lens when depicting bipolar disorder. The lens they prefer to use, however, does not liberate, it merely conveys a broad, generic perspective of the term “bipolar”.