Update 27.2.2020

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And so, we enter week four in hospital.

I emerged from the manic symptoms about a week ago. Pummelled into exhaustion by the high doses of Lithium and antipsychotic medication, and by the manic episode itself. Even in a hospital setting, taking all the right medication, and having good insight into the symptoms, manic episodes accrue a negative energy balance. It means when you eventually recover you are depleted, bone tired.

And this is where it gets tricky:

That exhaustion can mimic rebound depressive symptoms. One improves with rest and dialling back the antipsychotic medication. The other progresses beyond exhaustion to include other insidious signs that envelop you in a black, poisonous mist. Appetite drops off. The words ‘zero fucks left to give’ cast in a concrete block take up residence in your skull. Motivation evaporates and has to be faked until it decides to return in its own sweet time.

For a week now my psychiatrist and I have been watching and waiting. At first, we were both hopeful. We even (stupidly) dared to imagine I could be well enough to discharge by the end of this week. There is a reason we have a policy of never looking more than two to three days ahead when I’m in hospital. It’s because this illness has taught us – there is no point.

My psychiatrist entered my room mid morning today, looked at me back in bed and said

‘This isn’t good. You’re usually out walking.’

I turned towards him.

I don’t like it when his face arranges itself into concern within ten seconds of seeing me. It confirms what I already know. It also reassures me, because it is evidence of how well he knows me.

I have tilted towards depression, in the opposite direction to where I was headed when I was admitted.

This means we change our treatment plan in the opposite direction. We will cut back the Lithium and we will increase one of the two antidepressants I take. We will give it two or three days.

UNLESS…

My mood begins to shift back up before then, in which case I will inform the nurses and they will page my psychiatrist for further instructions. We don’t want to risk another ascent into mania. I’m not reaching for a YoYo or rollercoaster metaphor here, because they both imply the possibility of fun, which this decidedly is not!

The other switch over is the behavioural management of active Bipolar symptoms. For me it means telling myself to do the opposite to what my body wants me to do. So during a manic episode I should seek out quiet environments, be on my own, try not to overexercise. During a depressive episode it means kicking myself out of bed, engaging with others, and above all else exercise, exercise, and then exercise some more.

What a mind fuck.

While I continue to wait out my life in two to three day increments, I don’t feel inclined toward gratitude. But that’s largely depressive symptoms talking. So, I will do the opposite and stubbornly find something to be grateful for. Here we go:

I am grateful that at their current level my depressive symptoms are much easier to manage and tolerate than my manic symptoms were. The intense manic irritability has disappeared, and my concentration and short-term memory have mostly returned…for now.

 

You may also like to check out:

Interruption To Regular Programming

Misunderstood Mania

Mental Illness Doesn’t Respect Deadlines

Visiting Someone In A Psychiatric Hospital?

What a mental illness can teach you about your mental health

 

 

My 2018 World Mental Health Day

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How was your World Mental Health Day? Mine happened to be pretty shit.

It doesn’t really matter, because mental illness doesn’t respect particular days, especially those deemed meaningful by human beings. I’ve spent enough birthdays, Christmases, and anniversaries in hospital with a mental illness to lend weight to this theory.

Paying homage to mental health (ours or others) on a designated day seems like a nice idea on the surface, but I’m not convinced it does a lot. I suspect it makes people who don’t suffer a mental illness feel good if they remember it or mark it. But is this just another version of tokenism? Does it really make any difference to the lives of people living with mental illness every day of the year?

A very smart woman who ran the SANE Peer Ambassador training workshops I attended recently made the excellent point that we don’t have World Physical Health Day.

And that is because every single day is World Physical Health Day. It would be far better to reach a point in history where caring for ourselves and being sympathetic towards those around us with mental illness is as matter of fact as caring for our physical health. We shouldn’t need World Mental Health Day.

Here’s what today looked like for me:

10 am

‘You look flat’

There is only one person I trust to make this assessment, and it’s the one who spoke to me. My psychiatrist. He and I have known each other and worked together for just over twelve years now. And I have trusted him with my life many times.

For the last four days I have felt flat. It started with a sluggish Sunday. But everyone has those. Right? I am exhausted. That’s ok, understandable. It’s been a stressful couple of months. However, in the space of those few days ‘I’m exhausted’ morphed into: ‘I am exhausted by life.’

I have been on this runaway train often enough to know that feeling exhausted by life is the last stop before suicidal ideations set in. And that is where it turns into not ok. By yesterday, when I made the appointment with my psychiatrist, I was feeling worthless. Black thoughts crept in and crowded out the positive, the motivated, the real me.

Thankfully I have the insight to recognise these feelings and thoughts as imposters. These are symptoms of depression setting in. They have been waiting in the wings for their moment. My Bipolar Disorder is here to collect, on all the stress and sleep deprivation I had no say over in the last few months.

In the past I went to war against these thoughts and feelings. So naïve to think I could somehow out think or out feel them. Such a rookie error. As is waiting to see how it will all play out. That tends to land me in hospital for months at a time. So, after four sluggish days, feeling flat, off, down, irritable, and with my memory and concentration beginning to fray I walked into my psychiatrist’s consulting room this morning. That’s when he proclaimed, before asking me a single question, that I looked flat. And I felt relieved, because I knew I’d been right to come.

I listed my symptoms. He looked at my chart. Then, reminiscent of a pilot attempting to correct a plane out of a nose dive, he said:

‘Let’s increase the Lexapro by 10mg and halve your Lithium dose until your mood comes back up. As soon as your mood lifts, go straight back onto the full dose of Lithium. And keep your appointment for next Friday.’

‘Good. Let’s try that.’

Then we speak of the heavy truth between us:

‘And if I crash before then….’

‘Then you will call me and come into hospital.’

Neither of us want that. Neither of us want the months in hospital possibly having ECT, because I’ve become catatonic. Yet we both know it’s still a possibility.

So, in honour of World Mental Health Day 2018 – here are my thoughts on what will get me well again:

Insight. Communication. Early intervention with a medication adjustment. Fingers crossed. And luck…so much fucking luck…

Making Sense Of It

Treatment

What Does Someone With A Mental Illness Look Like?

Sick Not Selfish

Wedding Breakfast Spoiled

Lessons For A Control Freak

 

Piloting A Jumbo Jet

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The manic symptoms have almost all subsided, probably due to pushing the Lithium dose up. And so far, no signs of Lithium toxicity. I am now waking up every 3-4 hours for more medication instead of every 1-2, which is a huge relief.

So where does that leave me? Fixed? All better? If only it were that simple.

In the first instance it leaves me absolutely exhausted. The energy credit card the manic symptoms racked up with insomnia, over-exercising, not being able to sit still or shut up, and thoughts firing for 23 hours a day, is demanding payment.

Continue reading “Piloting A Jumbo Jet”