It's bipolar disorder.
Goodbye Celexa, Trazodone, and Klonopin - hello Depakote, Wellbutrin and Zyprexa: this afternoon my doctor diagnosed me as Bipolar Type I.
Talk about racing thoughts!
I don't know where to begin. Why Bipolar I? I run to this site's diagnosis information and reread the diagnostic criteria. It's hard to believe that someone like me, who has such a dark history of depression, could have ever had even the single apparent major manic episode required for diagnosis of Bipolar I - but as I read, I recognize it. A long time ago - but it happened. I was cast in a play, and I flew through the rehearsals, the performances, the cast parties, on two to five hours sleep a night, working my ten-hour a day job without missing a beat ... until I crashed into a serious illness from burning myself out. (Note: my diagnosis was later changed to Bipolar II.)
But that WAS a long time ago! I didn't continue to behave that way - couldn't it have been just the excitement of the event?
Well, I hardly need to look at the definition of a major depressive episode - those have been common in my life. And hypomania sounds just like major mania until you compare the fine print ... it's a matter of being less severe. I guess some periods of my life fit this description.
But the one thing that fits - that seems right - is the phrase "racing thoughts." The noise in my head that is a combination of one or two pieces or phrases of music or song, repeating over and over, plus a repetitive rhythm that is almost as if my brain was a soft drum, plus words in strings, phrases, gibberish. (I have sometimes tried meditation exercises that start with "clear your mind" - IMPOSSIBLE!)
My Mental Health HistoryAll my life I've had serious problems with depression. Then, just under five years ago, someone called me "the poster child for Prozac." I had gone from a paralytic depression, so serious that my employment was in jeopardy due to poor job performance, to having incredible, vibrant confidence. It was a glorious period in my life!
"But it didn't last," said my new doctor, as if he knew the answer.
No, it didn't. Over the next four and a half years I had broad, slow mood cycling while taking more Prozac, and then Prozac and trazodone. And gaining weight. About 30 pounds.
Then last November I quit smoking, and over the winter two things happened. One, I went into another nearly paralytic depression (still taking Prozac and trazodone). Two, my weight increased more rapidly.
On the internet I found disturbing information about SSRIs and weight gain. But I did nothing - then. The depression was in control. I thought probably I was suffering from Seasonal Affective Disorder and hoped I would improve when the weather improved. (Later someone pointed out to me that quitting smoking is in itself powerfully depressive.)
But when my total weight gain (from the time I started taking Prozac) hit 40 pounds, I did do something. I asked my G.P. if I could try Serzone instead of Prozac. I had heard that you could lose weight on this medication.
Well, Serzone was a disaster for me. For several weeks I went around feeling as if my brain was trailing behind me just a little. Diarrhea became common. Yet as spring wore on, I did pull out of the depression, as has happened every year for the past few winters.
Finally, some common sense weighed in, and I looked for a psychiatrist.
A Winner!There was a lot of good information on finding a therapist on this website (see links below). I was fortunate to find a psychiatrist who, among other things, specializes in sleep disorders - a problem for me since my teenage years.
Dr. Meyer listened carefully to all I had to tell him, including the facts that my dreams were so active, vivid and detailed that in spite of sleeping eight to ten hours a night I seldom felt rested, and that I had been diagnosed some years earlier as suffering from fibromyalgia and inadequate delta sleep. He then prescribed a "diet" of Celexa, Klonopin and trazodone.
At the two-week follow-up, I was feeling a great deal better. But some issues arose by the time of the six-week follow-up visit.
For one thing, I felt like I was turning into a Judy Garland - taking pills to go to sleep and pills to wake up. I was sleeping well, but waking up earlier and earlier, no longer getting enough sleep. Second, my mother made me realize that I was responding to a stressful situation by getting extremely grouchy - I hadn't noticed until she mentioned it. And then, on the day of the visit, somebody hurt my feelings - and I found myself crying uncontrollably - for half an hour.
This had not happened in a long time, and it shook me. Why hadn't Celexa prevented it? I realized then that my good mood had started to feel artificial.
Unopposed AntidepressantsIn the article The Use of Antidepressants in Treating Bipolar Disorder, there is considerable discussion of the effect of "unopposed" antidepressants on people with latent or undiagnosed bipolar disorder. In light of this information - that antidepressants, when taken without a mood stabilizer - can induce manic behavior - my history starts to make more sense.
Dr. Meyer pounced on the crying jag and started asking a lot of new questions. Had I ever had a time when I felt like I didn't need sleep? Yes, that one time. I told him about other extended "highs" I had experienced. We discussed my Prozac history.
I didn't even get around to telling him that two weeks ago, I was driving down the road and I saw in a used car lot THE car I want to own - and I went in and bought it. Had to borrow heavily to do so. It was not a wise move. A classic bipolar behavior.
Finally, he said these words: "Mood stabilizer."
I looked at him. "Mood stabilizer? But that's for bi--" I stopped.
"Yes," he said. "I think you have bipolar disorder."
All new prescriptions. Depakote to stabilize mood. Wellbutrin for antidepressant. Zyprexa to help me sleep. Dr. Meyer, a very careful man, has scheduled a follow-up in eight days, so he's going to keep a watchful eye on my responses to the new meds. He also told me to call if I had any reactions that really worried me.
I'm honestly not scared - yet - of the diagnosis. It's not a complete surprise. What I am nervous about is the medications. For one thing, I have got to lose weight - and both Zyprexa and Depakote are associated with weight gain. But it's more than that. I don't feel bipolar. Good moods don't feel like mania or hypomania to me - they feel like - good moods.
But it's only Day One.
The above is not a fictionalized account of a person receiving the diagnosis of bipolar disorder. It is what happened on Thursday, May 20, 1999, to me, Marcia, Guide of this site.
Next in this series: Day 14
Entire series: I'm Bipolar Journal Table of Contents