Bipolar II

Nora recently got a diagnosis of Bipolar II, and a lot of what she describes sounds familiar to me. I have always noticed, in fact, that I have good days and bad days, often coinciding with how much the sun shines. On days when I am most productive, I also find myself very irritable. And the more that I learn about the condition, and the more I read my past journals, the more I wonder if the same diagnosis might apply to me. Given its high genetic component, Nora having it is a risk-factor for me.

Reading my old journals, I can definitely see the mood swings. Not bipolar shifts, the huge swings between long bouts of dangerously severe mania and depression. My mood swings were more frequent and less severe and mostly consisted of depressed and functional, but also involved swings in anxiety. Turns out, that's characteristic of Bipolar II. 

I don't ever get manic episodes, but the description of hypomania sounds like the call is coming from inside the house. I am never frenzied or psychotic, but some days I can do all the things. I am fun and adventurous, social and outgoing. I tend to start new hobbies and household projects, spending too much money on supplies. I exercise and diet and get optimistic about weight loss and my appearance, buying toiletries and cute clothes. 

Then, a few days later, reality sets in, and I return the unopened packages.  

The fact that my reality is more closely synonymous with depression is not just sad, but also a potential symptom. A lot of BII is misdiagnosed initially as depression, because for both the baseline is lower than normal. The difference is the cyclical swings into hypomania--days of feeling normal--which isn't part of major depressive disorder.

For most of my life, the symptoms of depression were manageable by a well-timed nap. My performance sometimes suffered, but it was often the anxiety that followed a depressive episode that hurt my college career the most. Even still, when I learned discipline and hard work, I was able to muscle through. When the lows threatened to be lower, friends and exercise pulled me up.

It wasn't until postpartum that I needed medicinal intervention. And, then, boy did I! Severe postpartum depression is common with bipolar, but it was only ever an independent diagnosis for me, not a symptom of something more chronic. I was lucky that the first antidepressant tried worked wonders on me. I went on it after each baby, and two other times. Zoloft is my friend. Generally, SSRIs aren't very effective against bipolar, but that's another way the two subgroups differ: they do work on II. Well, until recently. 

After the recent emotional rollercoaster, I went to my doctor to increase my meds, only to be told that sertraline loses efficacy about my current dosage. There is a family of mood stabilizers (technically antipsychotics) that pair well with antidepressants. Unlike the latter, they can be a short-term solution to a short-term depression. Just enough to raise my baseline to normal. The fact that I have felt both much more energized (I went off caffeine) and slightly more irritable is another indication that I might have more than just depression.

My nightmares are as much a part of my life as daily eating and, sadly, more frequent than showering. I've had them almost every night for over twenty years. Others are always amazed and dismayed to learn this. According to the interwebs, "People with bipolar disorder are more likely to experience nightmares than the general population. These dreams can be disturbing, well-remembered, and cause anxiety, fear, and helplessness." That sounds about right.

Additionally, the fact that the nightmares started when I was nineteen coincides with the average age of mental illness onset. Typically, bipolar is triggered by a traumatic event, whether physical or emotional. Labor is a common cause. I have often wondered what triggered my nightmares. My own theories over the years have basically boiled down to going home for the summer. I left home the same time my dad did, and going home meant facing the divorce and all its implications. It meant dysfunction instead of the warmth and love I had grown accustomed to in Provo. It meant  breaking up with Kevin. It was heartbreak. While the wounds have healed, the nightmares remain.

In general my sleep is not great. I am often exhausted, needing hours more sleep than others just to function. However, at other times, insomnia hits hard. Oddly, the exhaustion is not part of the insomnia. At those times, I just feel like I don't need the sleep. My body and my mind are just unwilling to stop going. I always blamed the fatigue on the nightmares, but if it was in fact the result of a depressive episode, the insomnia may be explained by hypomania. 

There are just so many things that I take for granted that can be explained by one diagnosis. It may be time I talk to a psychiatrist. But for now, I am grateful to a GP who thought to try a different approach with me, which is so far making a difference.