About two weeks ago, I took a break from blogging and all my other crazy squirrelly pursuits at the recommendation of my psychiatrist, who told me I should take medical leave. I promised an update on or around July 1, so here I am.
It turns out I am apparently really bad at taking medical leave because I immediately felt like I was going stir crazy and started work on an animated multimedia web series (more on that another time). However, things got a lot more crazy when I learned I could have bipolar disorder.
I am currently awaiting a referral for psychological testing and perhaps cognitive testing with a neuropsychologist. If you just want to know what the next steps are for this blog, you can scroll down to the last section.
Since I have this blog partially to prevent others from ending up in my shoes, I feel that discussing bipolar disorder is beneficial even if it turns out I don’t have it. Demystifying mental illness is important.
Bipolar disorder is, most broadly, classified as the cycling between a depressive state and a manic state. We’ve all seen the pop culture stereotype of “the bipolar person” flipping back and forth between happy and sad on a dime, but this is incredibly inaccurate.
All types of bipolar involve a fluctuation between a manic (or hypomanic) state and depression. The bipolar individual “cycles” back and forth between these states.
This is a very unscientific way to think about it, but bipolar seems almost like the brain is incapable of self-regulation but is trying. In the case of depression, the brain is chronically lacking in certain chemicals and cannot replace them, which leads to a constant state. In the case of bipolar, however, the brain is not regular in how it distributes the chemicals, which leads to cycling.
It’s like there’s a little guy with a valve in the brain. The valve releases serotonin and norepinephrine and all those other happy molecules. The little guy starts reading the newspaper and suddenly realizes, well shit the levels are too low! This is depression. He opens the valve as far as it will go and floods the brain. Now the person is manic. The little guy must now wait for the levels to decrease to an acceptable level in order to release more happy molecules, so he goes back to reading the newspaper.
And so it continues.
There’s two-and-a-half types of bipolar. I say this because it seems that some professionals don’t actually classify the third type as a form of bipolar.
I had a really handy-dandy chart for this I made, to demonstrate the cycling, but the file corrupted, so unfortunately I don’t have it but I am going to try to describe these as best as I can.
Bipolar type I is the most “classically bipolar”. People with this version cycle between full-blown mania (often accompanied by psychosis) and depression.
Bipolar type II is more subtle and is often mistaken for depression until someone has an episode of hypomania. Hypomania is a lesser form of mania without psychosis. (I’ll describe the difference in the next section.)
Cyclothymia is the debated type. It’s like bipolar type II, but on crack. With this version, people cycle rapidly between hypomania and depression, but it may not be as extensive in terms of symptoms as type II.
In a normal bipolar brain, cycling occurs over a period of years. Mania can last for months on end and require hospitalization, especially when psychosis is involved. Cyclothymia involves cycling over a period of days, and can be referred to as “ultra-rapid cycling”. Some people also have what’s called mixed episodes and present with symptoms of both mania and depression.
As you can imagine, if I’ve gone this long without a diagnosis, it’s not likely that I am facing a type I diagnosis. I have never had full-blown mania. My money is on cyclothymia, or my medications are speeding up and toning down the cycling.
ADHD is often found in high comorbidity with bipolar disorder, so much so that it is oft recommended (at least in the literature I’ve read) that a psychiatrist or psychologist test for ADHD every time bipolar is suspected or confirmed. Some studies feel that the odds of having both conditions is as high as 1 in 2.
Dr. Daniel Amen made a case for seven different types of ADHD. I don’t trust Amen as far as I can throw him, but as far as I understand the seven types are valid. There is one type called ring-of-fire ADHD.
I discovered this type when doing my initial Googling about bipolar and ADHD (after it was suspected I had it). Specifically, I wanted to see the differences in an MRI of an ADHD brain versus a bipolar brain. I wanted to see if there were any similarities.
Turns out, there’s a whole bunch of similarities between how the ring-of-fire ADHD brain and the bipolar brain looks on an MRI. The same areas (roughly) light up. Furthermore, ring-of-fire ADHD is linked to sensory issues, such as overstimulation, which I also suffer from.
In my own psychology, I experience weeks of hypomania interspersed with weeks of depression. I always chalked these up to ADHD shortcomings; while hypomanic, I wasn’t noticeably “crazy”, just more energetic, clear-headed, extremely productive, and sleeping only eight hours, so I just assumed when I “crashed” into depression I just couldn’t keep up with the rigors of being normal.
Depression can cause symptoms similar to inattentive ADHD. In fact, in my early fledgling adventures in medication management, my first psychiatrist believed very strongly that the symptoms I was describing (which I didn’t even know could be ADHD) were actually just really severe depression.
There’s also the fact that ADHD can cause depression, as is what I assumed was happening. I am meant to be a type-A person, but it has always felt like there’s something in my brain that is stopping me from being that way. This has, in turn, contributed to depression.
Regardless, I do not have a bipolar diagnosis yet, only the well-founded suspicions of my team of health professionals.
At this moment, operating on four hours of sleep and extremely depressed, I can only say that I am not going anywhere. I still have my grand plans, but everything has now been put on hold as I struggle to plan for what I cannot plan for.
If I am diagnosed with bipolar, then that will mean medication changes, which means dealing with adjustment symptoms. Since I was already put on Lamictal with ill effects, the other courses of action is either antipsychotics or lithium. I want to avoid the latter if at all possible, but antipsychotics also seem to have the potential for severe difficulty.
I think the only thing I can promise is that I will be here and I will for certain update with the diagnosis and what to expect on the course of treatment. I will try to be here in the meantime with some content periodically.
Thanks for understanding, and I hope you’ll stick with me through this weird period.