Mania #5: What, How, Why

This is Part 1 in a 5-Part Series: 

"When the World is Too Bright: An Intensive View of Mania from On the Ground"

This is my fifth mania in the nine years since I have been diagnosed with bipolar disorder. However, just because this is my fifth mania doesn’t mean that the experience of the mania this time around hasn’t been rough. I have been manic every year since 2013. Yup. 2013. 2014. 2015. And now 2016. My mania manifests pretty similarly each episode. For instance, I typically experience heightened creativity and productivity, a heightened libido, impulsivity, spending sprees, weight loss, loss of appetite, and sleep disturbances.

The creativity and productivity feel incredible. I feel an intense need to create when I am manic. During my third mania (in 2014), I started blogging about my mental health journey. During my fourth (in 2015), I began a memoir and founded two companies. However, this creativity and productivity are not without their share of problems for me. When I first started blogging, I encountered boundary issues with what and whom I wrote about. The two companies I founded set me back about $8,000 in incorporation costs and website creations. I also shop more. Over the life course of my disorder, I have charged around $30,000 on my credit cards. I am currently still in credit card debt. Thus, the temporary nature of my manic episodes have long-lasting consequences for me.

Yet, this is the first manic episode that did not result in a hospitalization. In the past, mania meant being hospitalized. My manias take me so high, so quickly that in order to head it off at the pass, I check myself into the hospital. But for my current manic episode, I am managing with IOP (Intensive Outpatient Program) only. I attend IOP two days per week for 3.5 hours each day.

During this current episode, I got the idea to re-brand my life coaching company as a wellness company focused on promoting self-care. I stayed up all night writing feverishly and researching best practices for self-care for the company. I became really excited because I discovered that I could turn what I once perceived as a manic financial blunder – starting a life coaching company in the first place - into a viable source of income. It was almost confirmation that my manic-self knew something my stable-self did not. However, once I was not sleeping through the night, I knew I was in trouble.

I knew the excitement I was experiencing was more than just normal excitement. I was less vigilant than normal about having symptoms of mania because it was not springtime. All of my previous manias occurred between the months of February and June. Now, in September 2016, I exhibited symptoms. I didn’t know what to make of this change to my norm.  

In response to the appearance of symptoms of mania, I increased the number of acupuncture sessions I received from once every three weeks, to two to three sessions per week. I also started taking my medicine consistently once again. Since the summer, I had been inconsistently adhering to my psychiatric medicine routines for various reasons - chief among them, I am just tired of taking pills. I have been a compliant patient ever since I learned of my diagnosis. With the exception of my first mania and my current manic episode, my manias are generally caused by medicine changes my psychiatrist ordered (e.g. one medicine caused liver toxicity so I had to come off it). However, this current mania is my fault and I can definitely say “lesson learned.” As a result of my veering from my medicine routine, I have added an additional year to my graduate schooling since I am currently enrolled less than half-time. There will be no more inconsistent medicine usage on my part.

Tune in tomorrow for part two in the series...

Mania Season

Every year for the last three years I have been hospitalized for mania. That is, three hospitalizations in three years. To put that fact into perspective: I've been hospitalized four times, my first hospital stay was in 2007 but the second stay wasn't until 2013. That means I was stable for six whole years. But since 2013 stability has been hard to sustain.

All four of my manias have happened in the springtime. There's something about the sunshine and flowers blooming that send me into a tailspin. In fact, I wrote about me, mania, and the spring this time last year.

For the past few months I've been apprehensive about spring's arrival. I mean, three for three, what are the odds? And what are the odds that this year won't continue the trend? My boyfriend is claiming the Law of Averages for me. Meaning, my episodes will even out. I've had a crappy run of it the last three years, so my luck must look up soon. I don't know if I believe it, but I'm hoping that it's so.

Knowing that spring is coming and soon, I've been on high alert for warning signs of mania. For instance, twice in the past few weeks I've stayed up writing until the wee hours of the morning, midnight on the first occasion and 2am this morning. I felt incredibly productive and felt driven to keep working even though I know how important good sleep hygiene is. (Decreased sleep is often one of the first signs of mania and depression for me.)

You see, the mania doesn't care about my sleep. The mania is single-minded. But I can't feed into it, which I've now done twice.

However, I am taking care of myself: I take my psych meds regularly, I see my therapist every three weeks, I see my psychiatrist pretty regularly as well, I increased the frequency of my acupuncture sessions knowing that spring is a trouble time, I'm exercising and trying to eat healthy. On the self-care front I've got it covered. If only I could stop giving into the heightened-productivity impulses. I vow to work on that.

I claim that this year I won't be hospitalized.

But if I am, I will commit myself to recovery as I have done the previous four times. Neither mania, nor depression, will bring me to my knees.

I am more than my bipolar label.

SAD, Springtime, Mania, and Me

Most people have heard of SAD. Seasonal Affective Disorder. Some people get depressed during the winter months due to the shorter, darker days. I don’t tend to get depressed during the winter. Instead, all of my manias (and hospitalizations) have happened during the spring.

I’ve been depressed three times and manic three times. But I have only been hospitalized during the manias. I’ve had a 17-day stay, then a 10-day stay, followed by a 5-day stay. The three hospitalizations have been over the course of the last eight years. During my hospital stays, I've found that most people there are admitted for depression or age-related illnesses like dementia. I have been the only manic person each time.

For me, my manias have been a lot worse than my depressions. I have Bipolar Disorder Type I. What distinguishes type I from type II is the mania; hypomania, a lesser form of mania, defines type II, among other features. WebMD says:

People with bipolar I disorder experience full episodes of mania -- the often severe abnormally elevated mood and behavior described above. These manic symptoms can lead to serious disruptions in life (for example, spending the family fortune, or having an unintended pregnancy). 

In bipolar II disorder, the symptoms of elevated mood never reach full-blown mania. They often pass for extreme cheerfulness, even making someone a lot of fun to be around -- the "life of the party." Not so bad, you might think -- except bipolar II disorder usually involves extensive and disabling periods of  significant depression, which can often be harder to treat than if episodes of hypomania had never occurred.

When I am manic, I am super creative and productive. Ideas come to me easily and often. Ideas about career paths, writing topics, and projects. When I am manic, I spend uncontrollably, racking up thousands upon thousands of dollars on my credit cards. When I am manic, I sleep and eat less than normal. When I am manic, I lose weight. When I am manic, I talk extremely fast. In short, the mania is wholly disruptive to my normal routine.

Jessie, from Saved By the Bell, saying: "I'm so excited!"

My last manic episode occurred in June 2014, mere months ago. Since then, I've returned to "normal", but over the past month I’ve felt the stirrings of mania. I’ve been speaking quickly. I’ve been posting more to social media. I’ve been a bit grandiose. Thankfully, I have not spent any money. I’m still digging out of the tens of thousands of dollars I charged this past summer. But still my sleep has been off.

I’ve had sleep issues since the depression set in in June 2013 (the depression would last a year; insomnia is a common symptom) and it hasn’t reverted back to normal despite me being in a stable mood. I was on Lunesta, a prescription sleeping pill, for the past fourteen months. However, over the past two weeks I have stopped the Lunesta and am now taking Melatonin, an over-the-counter supplement recommended by my psychiatrist. The Lunesta caused intense grogginess. The morning after taking Lunesta I would lie in bed for too many hours of the day, halfway between sleep and wakefulness. I cannot be productive in a permanent state of grogginess and tiredness. The Melatonin has been working okay. But I still wake frequently during the night and I wake super early in the morning. I’m not sure if this sleep pattern is my new normal. Fortunately, my psychiatrist is aware of all of this and is keeping an eye on my mood.

 In short, I have to be careful with my sleep. Keeping consistent sleep hours and getting adequate amounts of sleep is crucial to stave off both depression and mania.

I was out of town at a conference this week. The entire week I was there I had anxiety around my sleep. Lying in bed, I would be thinking about the following: how long will it take me to fall asleep, will I fall asleep, will I be rested in the morning, and will I wake up (thoughts of mortality frighten me from time to time). Mid-panic attack, I called my boyfriend to process the experience. Trying to console me, he offered some suggestions. After hanging up, I did some deep breathing to calm myself down. I believe I fell asleep not too long after. However the next day, when my friends asked me how I was feeling, as I would be presenting a workshop later that day, I shared my anxiety around my sleep and started to cry. Heightened emotions are also a sign of mania for me. One of my friends present who was at the conference with me is also my acupuncturist. Thankfully she was around. She gave me a quick acupressure session and I did some deep breathing and all was right in my world again.

I’m not sure if I’m headed for a manic episode or not, but to be proactive I will be: increasing the frequency of my acupuncture appointments from once every three weeks to once per week for the next month or so and I have appointments with both my psychiatrist and therapist soon. I will also keep to my normal schedule and routine as much as possible.

I’ve written about how I generally love the mania, but I’m not sure that the mania loves me back. I mean, I’m super productive when manic. This summer alone: I started two blogs, wrote a proposal for a charter school, wrote a curriculum for a mental wellness presentation, applied to graduate school for social work, and started a memoir. Yup. I did all of that in three months. But the mania is very disruptive and expensive for me. Not to mention, exhausting -- as I’m sure you can imagine.

I would appreciate not being manic again for a long time to come.

Note: My title is an homage to Ellen Forney’s captivating graphic memoir (comic book memoir) about living and working with bipolar disorder. Check it out: Marbles: Mania, Depression, Michelangelo, and Me.

How I Manage My Disorder

I went six years between my first (2007) and second (2013) hospitalizations. I pride myself on that. Through my three hospitalizations and three IOP's I've met people on their 10th or 15th hospitalization. Some people are chronically unemployed or on disability. They've let their illness dictate the course for their life.

It doesn't have to be this way.

To make sure I stay stable and highly functioning, I do a number of things:

1. For the past 7 years, I've seen my therapist every 3 weeks and my psychiatrist every 3 months.
2. I'm a compliant patient; I take my medicine faithfully, go to all follow up appointments.
3. I make time for leisure (reading, hanging out with friends, going out to eat, getting massages, shopping, watching TV, etc)
4. For the past year I've been getting acupuncture regularly. I'm trying to balance out my reliance on Western medicine with more holistic practices.
5. I'm protective of my sleep. Not getting enough sleep can trigger depression or mania.
6. I exercise two to four days per week. There are numerous health benefits gained from exercise.
7. I try to eat healthy. I can definitely do a better job at this. I'll be going to see a nutritionist next week.
8. I try to minimize my stress triggers. Grading my students' essays normally stresses me out. So I try to manage my procrastination. I don't always succeed at this. But I'm trying.

Sleep

"Sleep plays a vital role in good health and well-being throughout your life. Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety.

The way you feel while you're awake depends in part on what happens while you're sleeping. During sleep, your body is working to support healthy brain function and maintain your physical health. In children and teens, sleep also helps support growth and development. The damage from sleep deficiency can occur in an instant (such as a car crash), or it can harm you over time. For example, ongoing sleep deficiency can raise your risk for some chronic health problems. It also can affect how well you think, react, work, learn, and get along with others" (NIH).

For the past year I've had chronic sleep problems. At first I thought it was a withdrawal symptom of coming off of the Seroquel. Seroquel is highly sedating and I was on it for six years. If I missed a dose, I couldn't sleep. In June 2013 I started not being able to sleep. So my personal psychiatrist increased my Seroquel dose from 600mg to 800mg (the highest dose possible). This is why I gained so much weight. I was tapered off the Seroquel in November 2013 because of the 52 pounds I gained. My psychiatrist replaced it with 5mg of Saphris, a relatively new medicine.

I was still having sleep issues. I had trouble falling asleep, trouble staying asleep and I woke up early. I was so tired at work. I would lay down during free periods. I even got special permission from my principal to come in late. For the last few months of the 2013-2014 school year I came in late one, two or three times per week if I didn't have a first period class. I would fall asleep during our every-other-Thursday 7:45am faculty meetings. It was so embarrassing. I would be doing the "crackhead nod" -- you know what I'm talking about: your eyes can't stay open, your head falls to the side, you jolt awake and catch yourself, repeat.

I told my psychiatrist and he prescribed Xanax. It didn't help. He then prescribed Trazadone; that didn't help either. I even saw a sleep specialist in January. He prescribed Lunesta, a sleeping aid. It worked 66%: I could fall asleep and I could stay asleep, but I still woke up early. I became resigned, figuring that this was my new sleep pattern. It really sucked.

When I was hospitalized this month I told the psychiatrist about my sleep issues. He said that according to old research it was thought that sleep issues caused mood disorders. Turns out mood disorders can cause sleep troubles. The classic chicken or egg situation. The reason I wasn't sleeping was because I was depressed. And the medicines I was on wasn't working on the depression. Once the depression ended I became manic. Once the mania was treated with Lithium and Latuda my sleep issues went away. The hospital psychiatrist prescribed Temazapem for sleep, but I no longer take it since I don't have sleep issues anymore. And more importantly, I'm no longer groggy during the day. I don't do the "crackhead nod" anymore. And I've only had one cup of coffee in the past two weeks! (I only started drinking coffee seven years ago when I was first medicated; my meds made me so groggy).

A number of my family and friends have commented that I post to my blog at all hours of the night. Thanks for your concern! But I wake daily between 3am and 4am. I guess I'll always be an early morning riser now.