June update

I’m relatively stable at the moment, hence the reason I’ve not written anything here in a while. The sole reason for this stability is my meds. After all, I don’t have any other help or input – in this respect I’m where I was three years ago, before therapy and starting on quetiapine + fluoxetine. I am theoretically in the care of my GP though I never see my GP.

After having so much time off work last year (several months) my main objective this academic year was to have no time off at all. That’s how stubborn I am! But here we are, seven weeks from the end of the school year and I have 100% attendance.

It doesn’t mean I’m “better”. I’m not; there’s no cure for bipolar. No cure for anxiety. No cure for OCD. No cure for the dissociation (DID). There’s just medication; damage limitation.

I still, of course, get intrusive suicidal thoughts. I still don’t sleep well. Surely 550mg quetiapine + 20mg fluoxetine daily should be knocking me out all night? But no, I’ve not slept through the night in decades, if I ever did at all. My short term memory has taken a severe hit (I suspect some of this is memory lapses linked to the DID symptoms) though my long-term memory in many respects would put your average elephant to shame.

Quetiapine continues to function in making me fat. It’s a straight either / or choice with these meds: Fat or Mad. I’ve opted for the former, somewhat reluctantly.

There’s a blog piece to be written about the DID symptoms I’ve experienced through my life and I’ll write than when I’m able to collect those thoughts together.

 

10 tips

My advice, from experience:

  1. Allow yourself, wherever possible, to be not well. Some days are like that; in fact many days are like that. But it’s easy to feel guilty handing your day over to something outside your control. If you have a job, it’s even more difficult. But on those not well days, take it easy: watch TV for too long; don’t shower if it’s not essential (and when is it essential?); indulge, mindfully, in your drug of choice later in the day (thanks, I’ll have a kir or white wine).
  1. Get some sleep. Preferably at night. OK, so this is totally outside our control and I really don’t know what the answer for insomnia is. Mine is chronic and seemingly without reason. It used to be worsened by night-time hypomania but I’m medicated now.
  1. Speaking of which, always – always – take your meds. Don’t change the dose without consulting your psychiatrist / doctor. Follow your medication programme closely. And if you’re bipolar then why aren’t you on meds?!
  1. Exercise isn’t the be-all and end-all; sure, a little walk on a sunny day isn’t going to hurt you. I discovered quite recently that too much exercise can trigger hypomania. So before you decide to climb that mountain, take heed to allow plenty of time and be mindful the whole time that you – not your illness – are in charge.
  1. Treat yourself. Indulge in those treats that ease your moods. Could be music – those old favourite tunes – could be chocolate (tell me about it..), could be a glass of wine (go easy, young fellow!). Don’t let it be anything destructive; hypomania rules that part of you so stand up to it, show it who’s boss. In theory at least.
  1. If you must buy loads of crap, buy cheap crap. And no, that Harley is definitely not cheap, even if it is cheaper than a yacht. I bought four USB drives the other day, didn’t need any of them but I can handle a £20 hit and they’ll get used eventually. Maybe not in my lifetime, but eventually.
  1. Do what the Walker Brothers and Edith Piaf told us and have no regrets. Don’t obsess on things. Just learn from things.
  1. Try not to kill yourself; it leaves a hell of a mess and doesn’t achieve much. It also means you’ve lost.. and you’re not a loser are you?
  1. Talk about it. Preferably to someone with ears.
  1. Get a grip. Do what it takes to stay sane. Yes, of course it’s a battle. A daily battle. Focus on the endgame: not the battle but the war. Be who you are.

22 of them

Time passing fast, almost the end of January.

I’ve been pretty much discharged by my psychiatrist as I’m seemingly one of her success stories; the meds appear to be working. The fluoxetine is clipping the extreme lows, with Quetiapine helping it out and of course clipping the highs as it does so. Poor overworked Q!

I returned to work at the end of last July, just before schoool broke up for the 6 week summer break. And I’m still there, having not missed a single day so far. That’s how stubborn, some would say how strong, I am. I’ve had a lifetime, middle-50 years, fighting, struggling, but ultimately winning.

It takes concentration, a continual fight, to exist. Yes, that’s what it comes down to: maintaining existence.

My enemy (well, part of the pack) is still that damned intrusive suicidal ideation that looks for any glitch in the system, any gap atomically small. And says “hey, do it! Why wouldn’t you?”

Why wouldn’t I.

And I’m in this war alone; single for almost 2 years. Almost friendless, alone. I was pretty much discharged by my psychiatrist at my latest appointment in the shadow of the New Year. Now I really am on my own. Me and my meds. Featuring battles such as “fat or mad” – I continue to put on weight despite my best efforts.

I don’t trust the meds; it would be extremely foolish to do so. Madness still breathes and creeps inside me. I still don’t sleep. I’m sedated much of the time, I’ve stopped writing (poetry, fiction). Meds and me, we’re like that chess game in “The Seventh Seal”.

 

 

Bipolar psychosis

There was no doubt a process that led me from Saturday night to Monday morning

I haven’t been very low for a long while (thanks to the 20mg fluoxetine / 550mg quetiapine meds) but I felt it had arrived during the night. Although I was wide awake at 5am Sunday morning I just couldn’t get out of bed. When I eventually did, I could barely move all day.

What dragged me down further was having to think through the logistics of the aftermath of the 3rd World War in 2030. And the 4th World War in 2032. I’ll be old and possibly not even still around, but my son will be.

This morning I knew I really shouldn’t go into work, but I’m stubborn and I pretend I’m in control of my own illness. Call it stupidity if you like.

So I went to work. And the day was marked with memory- and cognition issues. I must have appeared stupid and clueless to my staff. So of course I began to worry about that too, and decided at one point that I should hang myself from the overhead projector while the kids and staff were out at lunch.

Maybe doing this I could avert the next two world wars, seeing as how they and everything else anyhow are my own creation because life isn’t real.

Life isn’t real, I’ve mentioned before, because there was some kind of accident – probably car-related – and I am in fact in a coma or catatonic on a psychiatric ward. I am there creating all that is the world and being; nothing is real. (This is my most common, and overriding, ‘delusion’ – of course I don’t accept it is such a phenomenon.

All this is going on while I’m trying to work, either at home yesterday or in class today. It’s going to be one of those evenings where I can only laugh because it’s so ridiculous, so absurd, that I’m ending the day still alive. Driving home on the rush hour motorway was interesting, to say the least, as one of my planned suicide methods is to drive into a concrete pillar at speed.

But hey, I’m still alive. Again.

Exhausted

‘You want to know why I feel exhausted?’ I asked.

‘No, not really. But go on, if you must..’

I haven’t slept right through the night even once in perhaps 30 years. Not once. I ache down to my very soul; if you thought bipolar is solely a mental illness then you’re mistaken. It’s also a physiological illness, a painful one. Between the disease and the medications they pound away at muscles, joints and bones 24/7.

Then I have to hold down a job. A stressful job at that. And when I’m not holding down a job I have to run a house and be a single parent. Not wanting to end up living in a sty that has hundreds of baked bean cans stacked on the stairs or newspapers going back to the 80s, I have to cook and clean the same as the rest of you. Pride, necessity. Being civilised and human, I guess.

And the moods.. they’re all over the place as I have a layered illness, that’s the best I can describe it. I might be hypomanic for months and depressed for months but on top of this I have acute shifts in mood, often very brief intrusions of one mood type upon another. Ultra-rapid cycling. Ultradian.

That means my mood can shift dramatically within one day: periods of hypomania and periods of depression, and most significantly periods of mixed-mood which for me are always the most dangerous and unwanted. When I’m mixed I am depressed enough to want to die but high enough to be able to make such a thing happen.

Today I stood by the kerb at a pedestrian crossing. Lorries were thundering past at 30mph and it took all that I had not to take one step forward just as the next lorry was approaching. Fighting this urge is exhausting. On the way to the crossing I’d experienced some kind of hallucination (more than, I think, a delusion per se) where I was suddenly walking along seeing the ground from 7’+ high. I’m 5’ 5”. That lasted just a few seconds, but dealing with this was tiring nonetheless.

It’s all one thing on top of another. Chronic, acute, a bit of this a bit of that.

Then there’s the meds: 20mg of fluoxetine in the morning (slightly sedating) with 100mg of quetiapine (more sedating). Then another 200mg of quetiapine mid-afternoon, followed by yet another 200mg of quetiapine in the evening.

This isn’t even a lot of meds for someone with bipolar (plus anxiety and OCD). I’ve met people who are taking 15+ doses of meds per day.

Spending most of the day (and night) sedated is physically wearing. I have to fight myself to leave the house, to walk, to exercise. To live rather than simply to exist. Plus, I self-medicate with alcohol by late afternoon though thankfully I’m in control of this and I manage to keep within my weekly recommended consumption as an adult male. That’s a miracle in itself!

I have to put on a brave face, a smile for my son so he doesn’t worry about me too much. This act requires energy and focus and tires me out also.

All of this, and more. Not just for a day, a week, a month, a year; I’ve been battling this more seriously for a couple of decades and on the whole since my late teens and indeed probably my childhood. I’ve only been on meds for several months, only sought treatment 2 years ago.

Everything I’ve described happens almost every day. Most of it happens every day.

It’s no wonder I feel exhausted.

 

So happy I could die.

 

 

Suicide is a complicated business. Or rather, bipolar suicide ideation is a complicated business.

Being ‘suicidally depressed’ and wanting to die is how most people imagine the subject. To be so low, so clinically depressed that life has no meaning other than that it should end. Wholly and completely. It is utter despair with, in that moment (which might be a prolonged moment; linear time doesn’t always apply here) nowhere to go, no escape route. No solution other than un-life.

But as I say (and of course I can only speak about my own, personal experiences) suicidal ideation in bipolar can be a very different kettle of fish. So to speak.

Medicated (Quetiapine 400mg, fluoxetine 20mg) I haven’t had an extreme low or high for a while. What I do still have however is the hypomania and mixed mood episodes I’ve always had. Rapid – or ultra-rapid – cycling, at least they don’t last long. Not long enough to dig themselves a sizeable hole or system of clogging trenches I have to drag my metaphorical feet through.

Having suicidal thoughts because one is ‘happy’ is where the complicated bit comes in. And I imagine those people who’ve never experienced it – personally or with a family member perhaps – find it impossible to comprehend.

Put some favourite music on, loud: maybe those old or new Underworld tracks, that Oceansize song, anything from ‘Definitely Maybe’ or the first Strokes album – basically anything upbeat and rowdy, something singalong.

Have a glass of wine or three. Get lost in the moment.

I’m never happy, per se. Never have been. Anhedonia. So when I feel like I might be, like in these moments I’ve mentioned, I get suspicious. I’m aware (but perhaps not entirely aware, consciously) of the mood; but it’s a very welcome relief from the usual overwhelming pain of bipolar and anxiety (with its associated mild OCD).

Fuck, yeah… I’m happy! I’m dancing, one with the music. With the wine. With the universe at that moment!

WBBcc

So hell, yes, why wouldn’t I kill myself? Why on Earth not? It’s the logical thing to do. I’m – unknown to me at the time – depressed enough to want to die but high enough to have that energy, that ultra-rare joie de vivre to carry it out.

Mixed mood suicidal ideation is the most dangerous for me, by far. Then, it makes absolute, perfect sense to kill myself. As I say, Yes! Whyever not?! I’ll never be as happy again as I am at this moment and I want to celebrate, to prolong this happiness.. by dying. Confusingly and ambivalently however, I want to live forever. In fact, I will live forever! How could that fact possibly not be true?

“Life has no meaning the moment you lose the illusion of being eternal.” – Jean Paul Sartre.

Fortunately this kind of mood state pays me a visit at home. Occasionally it descends (or ascends?) upon me when I’m driving, alone. Music playing, sun shining, countryside slipping by each side of that motorway or A road. I’m so happy that I see a lorry speeding towards me in its own lane and for a moment think I want to remain in that ecstatic moment by turning the steering wheel sharply and ploughing into that vehicle. Did I mention the sun’s shining? I’m doing 60, he’s doing 60.. that a 120 mph impact. Sorted!

Then the moment passes. For now at least. What was the trigger? Well, it was probably nothing external. Just me; my electricity.

Was I aware at the time? No, or at least barely. Was I ‘myself’? No. Was I in control of my actions? Subconsciously, automatically, hopefully. Consciously, no. But I’m alive. At least, for now, same as it’s ever been.