Cycling Uphill and Trying the Brakes

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23: Cycling Uphill and Trying the Brakes

21 Feb 2000 – Diary

Today I wondered why my hypomania hadn’t kicked in. After all, nine days had passed since my depression begun. My down cycle usually lasts seven days. I had missed my period (as it were), and I was beginning to get that edgy feeling that I am told women get.

To make matters worse, like other people in the office, I felt as if I was catching the flu – a bit feverish, sneezing occasionally and headachy. On my way home after work I began to get the slightly dazed feeling I associate with depression – that everything is happening through a thin pane of glass and I don’t quite understand any of it or make proper decisions.

I plugged away though and after some effort and about an hour of procrastination disguised as answering e-mail, I made it to swimming. I even made my normal thirty lengths, which was a fight, but I felt really good afterward.

So there I was ready to go to bed and wondering how long the depression would last. Then I decided to redesign the Contents page of the website. At my fixed bedtime, C. called me to sleep and was ignored. After five minutes of, well, not quite an argument, C. went to bed in a huff and left me working on the design.

An hour and a half later I couldn’t concentrate on the screen anymore, but I couldn’t sleep. I picked up a book to read, went to the couch to read for a while and realised that my heart was racing as if I had just been running. Since this was a signal for mania, I revisited what had happened at bedtime.

I had gotten caught up in a project, had a spat with someone I loved even though I was in the wrong, and then worked to exhaustion to complete a project. My shoulders and jaws were tense. I couldn’t even concentrate on the book I was reading. All mania signals.

It’s not clear whether the spat with C. triggered the mania or vice versa. It’s really hard to separate cause and effect. But I suspect that the mania was building, which explains both my easy ability to be pulled into the work and my easy anger with C.. Shall we say the argument merely brought it into full focus.

Of course once I recognised that I was in my hypomanic stage, I grabbed control. I started the usual deep breaths to relax myself, and I took 100 mg Tegretol to calm myself. About twenty minutes later I felt calmer and my heart did not feel as if it was racing so fast.

Then I went to bed, where C. was still awake and missing me.

I fell asleep, loved and being hugged.

All muscles still tense though.

22 Feb 2000 – Diary

Even though I had two hours less sleep last night, I’m wide awake the instant the alarm goes. Am unusually talkative this morning, but finding it hard to articulate my words and I am repeating pieces of sentences. Definitely hypomanic.

I keep myself under control by breathing deeply. I also concentrate more on what I am doing and try to do it more methodically – I usually forget more things when I am hypomanic. I ignore the feeling of impatience I am getting. The schedule I have set for the last two weeks imposes specific things to do in order, and I follow it rigidly. It’s written so I don’t have to remember it – all I have to do is check my list. I don’t feel hungry but I have breakfast anyway.

At work, the fixed schedule and my to-do list organised the day before keeps me on a even keel. The tendency to argue with clients is starting to well up but I recognise it as a hypomanic trait and compensate. It’s a bit difficult to stop my thoughts from taking of on tangents, but since I am looking out for it, it is easy to rein in once it starts going on for more than four to five minutes.

At about 10:00 am, I take a Tegretol which gives me temporary relief from monitoring myself continuously. The symptoms fade into the background. I notice that I no longer feel ill at all even though everyone else who was sick yesterday feels worse today. I suspect that being hypomanic protects me to some extent from feeling ill.

At 1:45 pm I have a meeting with my psych whom I have not seen since October. I tell her my story with Epilim (Depakote) and Christmas and then I tell her that I am on St. John’s Wort. She is a little concerned. Anti-depressants on bipolar people tend to trigger mania. I tell her that I am no worse than any other time and that I have a good grip on controlling my hypomania.

She’s a bit concerned still and suggests that perhaps I like being hypomanic. I say it’s better than being depressed, which was what the Epilim was making me. She suggests perhaps I was normal but because I am so used to being hypomanic that normal feels depressed. I reply that if hypomanic makes me functional and normal doesn’t then perhaps “normal” for me is hypomanic. She is still not keen on my taking St. John’s Wort alone.

Neither of us is budging from our stance. But I feel very comfortable with her and I trust her enough to argue with her. Good psychiatrists are hard to find.

I suggest Tegretol. We discuss the possible effect of St. John’s Wort as an MAOI and we both decide that Tegretol is less safe than we like. So I can’t take Tegretol. We discuss my taking Epilim and I argue that I don’t need to go back into that slightly zombied state again.

Tegretol should not be taken with MAOI drugs. Although the evidence for St. John’s Wort’s activity as an MAOI is not conclusive, we both decided to be safe than sorry.

She, uneasily, suggests that I take no St.John’s Wort when I am manic and take it when I am depressed. I think it is a good idea, particularly since my cycle is so predictable and because I react to drugs so rapidly, but tell her that since I slide very rapidly from mania to depression I would need to be on a constantly low level dosage of St. John’s Wort. Otherwise I would slide fully into depression and won’t take my medication. She is still not happy with my taking an antidepressant at any dosage while I am hypomanic.

She suggests Lithium. I say it seems to have no effect on me, but that I have only tried it in combination with other mood stabilisers. After a bit of discussion we agree that I will take Lithium as a mood stabiliser and St. John’s Wort on a varying dose depending on my state. Sounds good.

Too good. I tell her that I ended up in the hospital with chest pains in January. Although I was cleared with a very clean bill of health, she wants the cardiologist to clear me for lithium before I can start taking it (Lithium shouldn’t be taken by people with some heart problems). I agree with the rider that if he doesn’t allow me to take it I’ll be in her office first thing the following morning to restart the discussion on medication.

So I start on a new medication regime. Number five, to be exact. I hoping it works because I really don’t feel like breaking in a new drug.

Went swimming. Did my thirty laps with less effort than doing twelve the day before. Still hypomanic.

C. has just checked my pulse rate. I was saying I felt as if my heart was racing. My pulse rate is 75 beats per minute. My normal resting pulse is 60-62 beats per minute.

Clearly this is not all in my mind.

23 Feb 2000 – Diary

Got clearance from my doctor and started Lithium. No effect as of this afternoon.

Hypomania can be handy if reined in properly. I’m starting renovations on my house and I was able to spend the day focusing exclusively on all the tasks I need to do to get it done. It took a bit of effort to prevent fussing around with irrelevant details, but I was still efficient enough write out all the details I want done.

It’s also hard for the contractors to out-talk me when I am manic too. And I don’t feel nervous about asking for outrageously low prices.

Of course I’m wondering if I can hold this together for the three weeks the renovation will take. But if I don’t risk it I’ll never know.

I ‘ll just have to keep the tendency for doing everything I wish for in check to prevent overspending .