November 20, 2017

Mental Health Monday: Awareness of Bipolar Symptoms

It's so interesting how aware I have gotten of my moods ever since my bipolar diagnosis. I never used to think much about my moods at all, except that they were either comfortable or uncomfortable. I was happy or depressed.

At first, for a few months after my diagnosis, I was constantly waiting for the symptoms of depression to come back. I had gone through such a long period of depression that I was terrified the bipolar medication wouldn't work, and I'd be depressed forever.


Once I was confident that it was working well, I'm pretty sure I was hypomanic during the summer. The summer went by in a blur, and, in retrospect, I had all of the symptoms of it. It was so odd to me, because I am usually depressed all summer. But again, I was just happy to not be depressed. And I didn't have any of the negative symptoms of (hypo)mania (I'll specify those later).

Over the past few months, I feel like I am finally leveling out. I only have a couple of the hypomanic symptoms, and you need to have three or more for it to be hypomania.

According to the DSM-V, a hypomanic episode must meet the following criteria:

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
  1. Inflated self-esteem or grandiosity
  2. Decreased need for sleep (e.g., feels rested after only 3 hours sleep)
  3. More talkative than usual or pressure to keep talking.
  4. Flight of ideas or subjective experience that thoughts are racing.
  5. Distractibility (attention too-easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
  6. Increase in goal-directed activity, or psychomotor agitation (such as pacing, inability to sit still, pulling on skin or clothing).
  7. Excessive involvement in activities that have a high potential for painful consequences.
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. 

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

F. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment).



On the opposite side, other than be unable to make decisions, I don't have any of the symptoms of depression, either (I'm SO glad). A couple of days ago, I was really worried that I was getting depressed because I felt lonely, sad, and completely unable to make decisions (something that happens when I'm depressed, and it's super frustrating). It's hard not to panic at the slightest negative symptom.

But when looking at the criteria, other than indecisiveness, I actually don't have any of the symptoms of depression. And I have felt back to normal the last couple of days. So, I must have just been having a bad day. What a shocker.

A Major Depressive Episode must meet Criteria A-C:

A. Five or more of the following symptoms have to 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.  (Note: Do not include symptoms that are clearly attributable to another medical condition)
  1. Depressed mood most of the day, nearly every day, as reported by self (i.e. I feel sad or empty) or others (i.e. he appears tearful) Note: in children and adolescents, can be irritable mood.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
  3. Significant weight loss or 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.
  4. Insomnia or hypersomnia nearly every day (difficulty or delay in falling asleep or excessive sleep).
  5. Psychomotor agitation (such as pacing, inability to sit still, pulling on skin or clothing) or retardation (such as slowed thinking, speech or body movement) nearly every day that can be observed by others.
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness or excessive, inappropriate, or delusional guilt nearly every day.
  8. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
  9. 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. 
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

C. The episode is not attributable to the physiological effects of a substance or another medical condition.



I am hoping I will eventually get used to this. When I was unaware that my symptoms were actually that of bipolar rather than major depression, I just thought all of my mood symptoms were part of my personality, and that's one of the things I hated about myself.

Now that I know that there is an explanation for my symptoms, and not just that I'm a terrible person, I feel so much more in control. I am able to think more rationally rather than emotionally--no matter what my mood. 

I actually wouldn't mind the hypomania so much if it didn't come with a couple of big drawbacks: mainly irritability and anxiety.

The irritability is due to heightened senses--mostly touch and sound. I feel like all the nerves in my body are slowly burning, and just touching the surface of my skin makes me extremely uncomfortable. My clothes, or even the air on my skin is irritating. My sheets might feel like sandpaper, when they are usually SO soft and nice.

Funny example: When I was running one day, my hair was in a braid and it kept slapping against my back. The feel of it was driving me crazy (no pun intended). When I was done running, without hesitation, I walked into the house, grabbed a pair of scissors, and cut off my braid. Hahaha! That'll solve that, I guess ;)  (And still, bipolar never crossed my mind)


Also, sounds are so much more intense. I will hear every little noise: from the humming of the refrigerator, to the cat breathing across the room, to the clock ticking, to the breeze outside--all at the same time and very pronounced. It makes it very difficult to concentrate on anything. Again, this causes irritation.


I hadn't felt these symptoms at all since I started my meds for bipolar, and it has gotten to the point where I almost forget what that feels like. But recently, I've noticed that a few things are bothering me again. Noises or sensations, particularly.

When this happens, I tend to feel panicky. I wonder if this is the start of another episode. In this case, it would be hypomania; but just the negative parts of it.

It's kind of interesting, because it can be compared to weight loss. It's been seven year since I've lost the weight, but I STILL feel on-edge about gaining back all of it. I feel like I'm walking on eggshells, and one wrong stop will set me in the direction to gaining 125 pounds.

It's similar with the bipolar symptoms. Now that I'm doing so well on the medication, I feel like I have to just tiptoe around to try and not cause any waves of mania or depression.

Something that has helped me a lot is reading memoirs of people with bipolar. I have had so many "Aha!" moments while reading. "Ohhhh, that's why noises bother me so much" or "Other people have meltdowns over something stupid like their husbands' buying the wrong brand of such-and-such from the store?"

I tend to let one tiny little thing ruin my entire day, and I hate that. In the moment, I know that I'm doing it, too! I just don't have the strength to stop it.

Lately, I've been eating more and sleeping more, which isn't necessarily a bad thing; but I keep hoping that it's not the start of depression. There is such a fine line between depression and hypomania that it's hard to find (and stay at) the correct balance.


I'm going to talk about this with my psychiatrist next time I see him. I'm not sure what else he can do. The hypomanic symptoms don't last day after day--I just notice it once in a while.

Anyway, I think I am just hyper aware of everything going on in my body. Each emotion seems like it should be hugely significant, but it's really just a normal emotion. I've always been either depressed or hypomanic, so I don't really know what it feels like to be in between. Maybe this is it!

Regardless, I am getting so much more in tune with my body, and I think that will help in the long run. Today, for example, I was ravenous (which tends to happen on the first day or two after I start my period) and I just couldn't get satiated. I started to feel bad for eating so much, but then I realized that my body really did want more food. I wasn't just making it up.

So, I indulged a little (or a lot). Hopefully, tomorrow my appetite will be back to normal, and if I gained any weight, it'll come off. This tends to happen just about every month, and it always works out. But again, I have that catastrophic thinking, as my therapist calls it--where I assume the worst. I've been working on that in therapy, so I'm trying to think of other outcomes that are more realistic.

Well, after eight months of feeling really good, I'm starting to have the symptoms that worry me a little. Nothing drastic yet, but a little naggy. I knew this day would come! Medications work well, but they don't cure the problem. I'm still going to have periods of depression and of hypomania. But this time around, I feel like I have a better handle on it. Now I know what to look for, and what to expect. I also know it won't last forever. Recognizing and being aware of what is happening has helped wonders!


8 comments:

  1. Katie, you also must keep in mind that you are also a human being and a woman. It’s normalto feel sad, lonely or depressed from time to time. I can understand why you get worried when certain feelings associated with your diagnosis make you worried, but perhaps it’s just feeling the normal human emotions on the spectrum instead of extremes. I’m so happy that you’ve found the cause of these bothersome intense shifts and your treatment is working for you. Do keep an eye on them, but also allow yourself to feel emotion for what it is and accept that you will still always have those wonderful days as well as those horrible ones. I don’t feel you give yourself enough credit sometimes. You’ve been through a lot and I love keeping up with your blog- it shows what a courageous journey you have been on and it has evolved in so many ways just as you have. You inspire so many people- no matter if it’s about your weight loss or the bipolar disorder it’s still 100% Katie and discovering new aspects of just who you are. I think you’re wonderful and look forward to your posts every time. Thank you.
    Also- have you considered meditation?

    ReplyDelete
    Replies
    1. Thank you so much! I do know that it's normal to feel sad or lonely sometimes, but it's so hard to know whether it's normal or the bipolar part coming out when I start to feel that way. After having such bad depression last year, I'm sure you can imagine that the first sign of sadness makes me worried that it's starting again. But I think as I get used to my diagnosis and medication, as well as my mood shifts, I will stop worrying about what it all means, and just live in the moment, even if I'm feeling sad (the "normal" kind of sad). I haven't tried meditation, but I'm not opposed to it. I just never really think of it!

      Delete
  2. The more I read about the type of bi-polar you have, the more it seems like a possibility for me. I am diagnosed with an anxiety disorder, but the only medication that has ever worked (referring to long term meds) is not an anti-anxiety med, but a medication normally used for treating bi-polar. But, given that I have been seeing a psychiatrist, I feel like she would have been able to diagnose bi-polar if that is what it was...

    On a different note, because I know how much you have raved about "cookie butter" in the past, I wanted to mention that Tillamook has a limited edition ice cream flavor that is "pumpkin cookie butter" that I saw yesterday.

    ReplyDelete
    Replies
    1. Anxiety sucks, doesn't it?! I get really bad anxiety when I'm hypomanic. Maybe that's why you may feel like your anxiety disorder could be a sign of bipolar? The age of onset of symptoms plays a big role in diagnosing bipolar as well (I was very young when I had symptoms!) so your psychiatrist is probably taking things like that into account with your diagnosis. Just a thought!

      And anything involving cookie butter in ice cream is a win in my book! Yum!

      Delete
  3. So funny, the other day I ate a ton....I wanted salt and sweets and I hadn't had a "freak out" feeling like that in a long time. (Like I had to have it and there was no skirting around the craving).

    Naturally I gave in and it felt great....then I kind of regretted it but in the end I too realized I hadn't eaten that kind of food and in that way in soo long so I was ok with it. I chalk it up as the body just knew I needed it ...ha!

    (Side note: I have been on some meds for 2 weeks now and I feel SO MUCH BETTER! I am so glad I found something that is working for me currently)

    ReplyDelete
    Replies
    1. Yes, sometimes our bodies just want those things! ;) Now that I've been much more aware of my hunger and satiety, I knew that I wasn't just eating out of boredom or emotions. I love that I have learned to trust my body!

      I'm SO glad that you are feeling better! Finding the right meds is such a relief. I hope it continues to work well for you :)

      Delete
  4. Katie, I'm loving that you are writing about this. I'm not bipolar but I have a friend who is and I do suffer from mild depression. It's really fascinating to hear your insights (as well as all the other stuff you write about, which is why I've been reading you for years).

    It's thanks(not sure if that's the right word hah) to you that I'll be running my first marathon in January - your blog got me into running in the first place.

    ReplyDelete
    Replies
    1. Thank you so much for the kind words! I'm glad that you enjoy reading my blog, and I'm sorry that you can relate to the depression. It's such a hard thing to live with sometimes!

      That is SO exciting that you'll be running your first marathon soon! Please let me know how it goes--I'd love to hear about it :)

      Delete

I'd love to hear from you! I read all of my comments, and if you have a question, I do my best to respond; sometimes, however, I get busy and forget to go back to reply, so if it's important, just email me! :)