Mania and happiness

I think that most people who don't know much about bipolar equate mania with feeling really happy and depression with feeling really sad. This is a gross distortion of the reality of living with bipolar. In this post I focus on the relationship between mania and happiness.

First of all, when you are manic you have a number of symptoms, only one of which is feeling euphoric. Other symptoms may include risky behaviour, racing thoughts, flight of ideas, decreased need for sleep, increased energy, distractedness etc. These symptoms are not just about the mood you are in but about your mental processes, your energy levels and your behaviour. In other words, bipolar is not only a mood disorder. Therefore it is not just a case of feeling happy.

Second, the euphoria experienced during mania isn’t just the feeling of being happy. It is an extreme emotional state whereby your thinking becomes completely distorted. You feel giddy and on top of the world like you could do anything. This leads to poor judgement, poor decision making and generally strange inappropriate behaviour. The feelings of euphoria are also often completely inappropriate to the situation.

In fact you don’t even need to feel euphoric to be having a manic episode. You may not feel happy at all but instead feel distressed by your symptoms. Some people (myself included) may present with all the symptoms of mania but instead of feeling euphoric they feel dysphoric and present with an agitated and irritable mood. In this case describing someone who is manic as happy is completely inappropriate.

Even when people experience mania as an elated wonderful feeling,  it is hard to see how such a destructive state of mind can lead to long term happiness.

Olanzapine

Well I have eventually calmed down from my evening bursts of mania. Instead it has been replaced by just straightforward depression the last couple of days. I don’t know why my moods change so rapidly or what mood I am going to wake up to on any given day. It is so confusing and disorientating.

One thing I can almost guarantee is that when I first wake up, I will be pretty zoned out. I have been like this ever since I first started taking olanzapine. This is an anti-psychotic drug used to treat both psychosis and mania. I first went on it two and a half years ago when I had my first major manic episode (technically a mixed episode as it was dysphoric). I was really excitable, agitated, talking lots, teary, paranoid and hearing voices. The drug instantly calmed me down.

Don’t get me wrong, it wasn’t a miracle drug. I was still pretty agitated and suddenly had developed a great interest in drawing. I was also obsessing over a friend, following them online and reading everything I could about their interests. All pretty wired up behaviour. However, I was no longer pacing up and down as much and the best effect of all was on my sleep. I wasn't sleeping until 4am and olanzapine fixed that right away. When I take olanzapine I can guarantee that I will fall asleep 3 hours later and will not wake until the morning.

One downfall of olanzapine is the rapid weight gain. All I craved were carbohydrates and sugar. I never felt full and was always looking for more food. Nothing satisfied my cravings. I put on ten pounds in a couple of months. The biggest problem though is the feeling that it gives you of being really spaced out. You feel a bit disconnected from reality. Sometimes you don’t really feel ‘all there’ and like you have nothing to say. Basically you feel like a bit like a walking zombie.

These kinds of side effects make a lot of people not want to take olanzapine. I completely understand why people would want to not take it and have great sympathy for anyone on olanzapine. The side effects are really shitty. However I still take olanzapine because I think (and I hope) that for me anyway, it takes the edge off the manic episodes when they do happen. 

Racing thoughts

Racing thoughts are perhaps the most common symptom I get with my bipolar. I have racing thoughts when I am manic, when I am mixed and sometimes even when I am depressed. 

Experiencing racing thoughts doesn’t sound like a very serious problem. The common misconception is that it is just a case of your thought processes being ‘sped up’ which is surely not a bad thing. However, this is too simplistic in several ways.

First of all the thoughts are sped up to such a degree that you can’t keep up anymore. Every time you have a new thought it quickly gets replaced by another and then another and so on. You forget then where you were to begin with. You may forget which thoughts were the important ones that need further rumination or action. For example you may think ‘I need to book that appointment soon’. Straight after this thought (or even at the same time) you may quickly switch to another.  Like ‘I wonder what I will wear later?’ followed by something like ‘I wonder who invented the skirt?’ and ‘during what historical period have men worn skirts?'. In a few seconds you have had so many thoughts that you can’t remember the important one about booking the appointment.  

When thoughts race this quickly I usually spend hours on the internet. I suddenly want to look up all the answers to the questions that keep popping in my mind. However, I usually get distracted before I can find the answer as my thoughts have moved on. This leads on to the second way in which the idea of thoughts just being sped up is too simplistic. The thoughts often don’t occur naturally like they usually do in a good logical order, but they sort of tumble out in rapid, chaotic sequence. You end up feeling lost because you can’t remember where you began and can’t stop you brain from ploughing onwards. There is never a break from this rapid, disjointed thinking and you feel exhausted.

A final point I want to make about racing thoughts is that sometimes your thoughts can become so fast and disjointed that you don’t even recognise that you are having thoughts anymore. At least this is what can happen to me. Your brain ends up just collapsing in on itself and you can feel this constant imperceptible buzz. You have no idea what your thoughts are any longer but you can feel your mind is jumping around. It is extremely unpleasant and you find that you have become so distracted you can’t do anything. It feels like all the radio channels are on at the same time and have merged together to create this static, indistinct buzzing.  

When racing thoughts get to this point I usually end up either rocking backwards and forwards, wailing or even screaming. I can’t fully describe how unpleasant this feeling can be. Your mind is being electrocuted and you would do anything to escape. At times like this you can feel desperate and maybe resort to all sorts of bad self-soothing techniques. Some of them such as self-harm and drinking, can be helpful at the time but ultimately damaging in the long-term. However, when you are in this much distress anything will do.

Bipolar and the mask

A few days ago I was invited to go to a dinner for six with my friends. They are good friends and they all know to some degree that I have bipolar. Of course, they never talk about it as I think they feel awkward around the subject. I have only spoken with complete (well  almost) frankness to the person that was organising it and I consider him to be my best friend. The problem was that I went quite manic before going out to this meal and had to warn him that I may not be able to come. He said fine and that he understood and it all worked out in the end as I managed to go.

However, when I got there I behaved completely normally. I somehow managed to completely suppress down all my feelings and my urges to act in strange ways. I put on my everyday game face I have for dealing with the outside world. I talked with people, drank beer, played games and didn’t get overly excitable. Nine times out of ten, when I feel ill I can fake being well and normal in front of people outside of my immediate family. This sounds like a good thing. I didn’t embarrass myself or make people feel uncomfortable. Yay!

The problem is that this comes at a cost. People don’t believe that there is anything wrong with you. The other guests that were there would have no clue that I was going through an unwell period. Because I put on a mask, many people I know struggle to believe that I am ill. When I describe some of my symptoms they look confused; they never see this behaviour and so find it hard to imagine. I can see the disbelief on their faces. Even my best friend doesn’t realise the full extent of my illness as I modify my behaviour with him too. People tend to have to see to believe.

It is only when I am very severely ill that I can’t hide it anymore. In these cases I just withdraw completely and don’t go out. My friends then never get to see me when I am very sick. I think they wonder why I can’t do certain things like work etc. It is hard to feel judged in this way but I guess by hiding it so well I am causing part of the problem. How can I expect them to understand when they never see it?

It still hurts though. And I feel lonelier than ever. I am living a sort of double life and people outside of my immediate family only know half of it. I have to keep doing it though. I have to keep hiding it. I can’t bear the thought of the rejection I might have to cope with if they saw the ill me. I want so badly to be liked by people. I don’t want to see fear or judgement in their faces. 

Manic bursts

The last ten days or so I have being having what I call ‘manic bursts’. I seem ok for most of the day and then suddenly I burst in to a frenzy of manic behaviour. It is weird because I wake up feeling depressed and really tired but as the day goes on I seem to get more and more agitated.

At first my brain starts to jump around many topics and I spend lots of time flitting between articles on the internet, never finishing reading anything. Then I start to feel like I am experiencing sensory overload and every little noise and light feels bizarre and intense and I get really irritated. Then when the evening comes round I will feel euphoric. I scream with excitement and run around laughing, jumping up and down, rhyming and annoying my family. I will try and pin them to the floor and be laughing in their face, squealing with excitement, even though they are not finding it funny at all. Apparently I look and act like I have taken illegal drugs. This lasts for a couple of hours and then I may start acting normally again after I have taken my medication. The next day the same cycle begins. 

The strange thing is I am still sleeping loads, which is atypical of a manic episode. I also feel tearful for much of the day. I am not sure if this is a mixed episode, rapid cycling or a manic episode mixed together with the doping effects of the drugs I am taking. I am currently taking olanzapine for the mania and lamotrigine for the depression. Olanzapine makes me really sleepy and calms me right down so it could be that I am sleeping a long time due to the drug. Or maybe this is just really a mixed episode. It is so hard to tell. I would love to know if other people get these kinds of confusing episodes that are not ‘textbook’.

Feeling persecuted by others

A couple of days ago I had a strange paranoia episode similar to one I have had a couple of times before.

It started off with me being quite manic. I sat at the kitchen table with my legs up on another chair and watched my husband and Mum as they tidied up after dinner. I was watching them closely and was very wired up. I was loud and yelling everything in a sometimes excitable and sometimes angry way.  I was laughing a lot but also snapping at them. The mood quickly turned sour.

I started seeing their faces in a strange way. It was almost as if they were laughing at me rather than with me. I felt like they were mocking me. When they stopped smiling I felt like they were ignoring me. I started to feel like they were colluding against me in some way. My mind was saying to me that they had bad intentions somehow. I am not really sure how to best explain it because I don’t really understand what happened. These were some of the thoughts that were popping in to my mind:

‘These people are making fun of you’.

‘They are out to get me’.

‘They are ganging up against me’.

‘They have bad intentions’.

I completely believed these things on an emotional level. However somewhere deep inside I realised that I wasn’t well and I was probably being paranoid. However this intense feeling persisted and none of my more logical thoughts could overcome the deeply seated belief. I felt like I was being persecuted by the people I loved.

This feeling lasted maybe an hour or two during which I remained very hyped up and agitated. I would sometimes say mean things to my family for reasons I can’t explain. Perhaps because I felt they were being hostile and menacing, I became those things myself. The funny thing was, even though I believed my family was out to get me, I didn’t want them to leave me. I felt really scared and paranoid in general and so I wanted some company even if it meant being with people I thought were ganging up on me.

The episode gradually wore off as I calmed down and hung my head upside down for a while (this strange behaviour soothes me and I have no idea why!). It worried me that I can have this kind of deluded behaviour even if it only lasts a short period of time. It destroys your confidence and makes you feel like you are loosing your grip on reality. It makes me realise how difficult it must be for people who have more serious mental health conditions and experience paranoid delusions regularly or all the time. 

Stress triggers bizarre episodes

I have not been feeling very well for the past few weeks. I was mainly depressed but in a very agitated way. I felt all the feelings of despair, hopelessness and emptiness but I didn’t feel all lethargic and slowed down. Instead I felt agitated, anxious and wired up. But my mood all changed again a few days ago.

As I am on a break from university due to my health, I thought I had better add some structure to my day. Besides, I needed to do something that I felt was worthwhile. My self-esteem is pretty low right now and I needed a boost. So I joined a creative writing class. Big mistake. I had hoped that the class would mainly be a taught one. I expected to have to write a story for homework each week to be marked. Perhaps some volunteers would read their work to the class if they wished. However, the class wasn’t like that at all. We were asked to write something on the spot and then read it out. I was so nervous and could barely think straight enough to write anything down. I managed to come up with something that made people laugh but I felt so utterly exposed that I felt devastated. My legs wouldn’t stop shaking throughout the rest of the class. I kept trying to move them in to different positions so they would stop moving but they wouldn’t. I could barely breathe for two hours.

I found out that in the other weeks there would be more of these exercises and that everyone would have to have their homework read out to the class to be critiqued. My worst nightmare.  All those people staring at you and judging you on something you had put your heart in to creating. I left the class feeling absolutely shattered and emotionally frail. I didn’t talk to my husband on the way home. My brain was all over the place. However, when we got back a strange thing happened: I started to go manic.

I know that, like depressive episodes, manic episodes can be triggered by stress. However, it still seems like a really strange thing to happen. How can you go from feeling incredibly anxious and distressed to high as a kite? But that is exactly what happened. I started laughing wildly and jumping up and down around my husband singing songs. I pinned my husband to the bed because I felt playful but he told me that I was being really creepy. I somehow picked up on this word and started mimicking him by screaming ‘creepy’ over and over again in funny voices whilst touching his face. This lasted for about half an hour. Eventually I stopped and just stared straight ahead at the wall in a complete trance. I didn’t talk for a long while and when I did tears started rolling down my face.

I went to bed later and woke up feeling depressed again. However, this strange pattern has repeated itself over the last few days: lethargic and depressed in the morning, with agitation increasing as the day goes on, followed by an eruption of manic energy around dinner time. Yesterday for example, I started laughing excessively and making jokes. I am told that my voice went all loud and high-pitched but I barely noticed. However, my eyes felt like they were popping out of my head. I was staring wildly at my Mum and my husband, trying to get them to ‘play’ with me. I sung silly songs and said strange things. Sometimes I erupted angrily to various things they had said. For example when they said I should calm down I would scream at them that I was calm and hit my hand on the table. Obviously I proved myself wrong!

Joining a creative class then has sent me ‘mad’. Strange that such a minor event to most people could lead to such a rollercoaster of mood swings. But there you have it. It is the nature of the bipolar beast.

The stigma around mental illness

I have been fortunate enough to have a really supportive family to help me cope with my bipolar disorder. Obviously they find it difficult to understand and sometimes they get annoyed with my mood swings. It is hard to cope with someone’s mood, energy levels and ability to function changing for no obvious reason. On the whole they are patient, they listen to me and they realise that it is not my fault. I am extremely grateful for their support.

However, this does not mean that I have been immune from the stigma around mental health conditions. Often it is unstated and subtle but it is there nonetheless.

Although many of my friends have been very kind and supportive they will never bring up my condition. Friends won’t ask me how I have been coping or anything like that. I understand that they find it a difficult subject to broach. I too perhaps would find it difficult to directly ask someone else about their mental health condition. You don’t know what to say or how much they want to give away. Perhaps they wanted to tell you they had the condition but don’t want to bring it up again. 

The trouble with this avoidance of discussing mental health conditions is that it is often based on a separation of mental health conditions from other illnesses. You wouldn’t hear that someone had been diagnosed with cancer or with heart disease and then never again ask them how they were coping. There is this divide created between mental health and physical health which seems unfair.

As far as I am concerned my bipolar illness is a physical illness too. Bipolar changes everything in my body. My sleep pattern and my appetite are affected.  My body can feel heavy and tired or wired up and ready to go. How fast my mental processes are running is affected. My vision is affected when I see things moving around or observe strange colours. Bipolar is an illness of the brain and the body. 

Often when I have told friends about some of my more severe symptoms they have been shocked. On the whole they have been very kind and listened without saying anything judgemental. However, I do have people saying things like ‘but you seem fine right now’ as if someone with bipolar can’t possibly act normally for a while. Or ‘but I have never seen you act that way’ as if they must have seen evidence of your illness for it to be real. These comments aren’t said with any bad intentions but they do demonstrate a lack of understanding.

The most hurtful but honest thing someone has said to me was ‘I used to think that you were just a weak person’. After suffering from an anxiety condition later they realised that anyone can be affected by a mental illness and it does not demonstrate a lack of character and will power. I also got asked in a rather judgemental fashion about who was paying for all my treatment. I care a lot for both of these people and I don’t think they intended to hurt my feelings but they did.

I am sure that people think other negative things about me due to my condition but would never say them. It is because I feel a great sense of shame and stigma around my illness that I chose to blog here anonymously. I just hope that as people start to talk about their mental illnesses to their family and friends a greater level of understanding, sympathy and patience can be achieved.

Mixed episodes

People who read about bipolar will have heard the disorder summarised as follows: bipolar disorder is a mood disorder where sufferers will experience both manic highs and depressive lows. When someone is manic they feel elated and on top of the world. They may spend more, talk rapidly, take on new projects, have grandiose ideas, feel sped up, indulge in risky behaviours and may be extremely restless.  When they are depressed they have a low mood, feel alone and worthless, have no energy or motivation and may have suicidal thoughts. The textbook bipolar person has periods maybe lasting a few months of both mania and depression and will have periods in between this of normal mood.

However, this picture is too simplistic. Bipolar sufferers may not (or only rarely) experience normal moods. They may experience many other mood states that sit somewhere between these mood poles. First of all, it is very common for bipolar sufferers to experience periodic or constant anxiety. I have always had an unhealthy level of anxiety. I worry about everything and often withdraw from situations that lead me to feel anxious. I suffer with the constant feeling that something bad is going to happen and sometimes this gets so bad that I have panic attacks. This can happen whilst I am manic, whilst I am depressed or in between mood states.

The other kind of mood state which many people suffer from is called a mixed state. I am unsure of how many people suffer with these (I can’t find reliable statistics) but I think they are a fairly common occurrence with bipolar sufferers. Basically a mixed state is when someone experiences both elements of mania and depression simultaneously or in rapid succession.

When I suffer from mixed states, I may feel an incredible sense of well-being and euphoria for a few hours and then crash into a depression where I feel hopeless and worthless and can’t stop crying. These rapid mood changes are very disconcerting and seem to occur for no obvious reason, i.e. there are no external events that seem to justify the mood change or certainly not its intensity.

Even more confusing is a mixed state where you feel depressed and manic at exactly the same time. How can this be possible? Mania and depression appear to be opposite kinds of moods. However you can have some symptoms of mania and some symptoms of depression happening together. This is the kind of mixed episode that I experience regularly. These mixed states may occur in a number of different variations.

I sometimes experience what I call a mixed-manic mood state (this is just my terminology, not an official diagnosis). In this state I primarily have symptoms of mania but also have one or more symptoms of depression. When I have mixed-manic states my brain feels like it has been electrocuted. I have racing thoughts where I am thinking too quickly and my brain keeps jumping around topics in a hectic, unpleasant way. I may start rapidly talking about a favourite topic without making much sense whilst pacing up and down. I feel an intense drive to get on with things and start new projects. I approach them in a chaotic and disorganised way. I start to see things moving and the colours look all crazy and bright. Basically I have all the energy and sped up feeling of a manic episode but I feel none of the euphoria associated with mania. Instead there are feelings of despair, distress and irritability. I want to hurt myself and stop the horrible buzzing brain feeling. You feel like you have been wound up tightly and sped up but your mood is all negative.

Another state I experience is what I call  a mixed-depressive state. In this state I primarily have symptoms of depression with one or more symptoms of mania. I am in this kind of state now. I feel like I have no energy and there is no point to anything. I can’t concentrate on anything or think straight. My head is full of negative thoughts about myself and the world. My whole body feels slowed down and heavy. I don’t want to wake up in the morning as it means another day is ahead of me. I have all the low mood of a depressed episode but also something else: my brain feels like it is buzzing. Unlike a typical depression I feel mentally alert. I feel agitated and like my brain and like my body don’t belong together. I end up crying and wailing on the floor and I can’t stop thinking about hurting myself. It almost feels like someone is scratching a blackboard with their nails inside my mind. I want to scream to make it stop.

I have just described two kinds of mixed states which I have experienced but I am sure that there are many kinds of combinations of mania and depression. I personally find mixed states by far the hardest to deal with. You have all of the dysphoria of a depression but somehow the mental agitation of mania. It is a state that for me often leads to some of the more serious symptoms of bipolar. For example, I may start to feel very paranoid that I am being watched. Probably because I am having the negative thoughts associated with depression but the extreme mental energy that leads to excessive rumination. I may hear voices telling me that I must die. I may experience agitated catatonia where I can’t stop pacing the room round and round in circles, often screaming, crying and babbling words over and over again. This is down to the horrific feeling of both mental agitation and dysphoric mood.

In my experience, severe mixed episodes are not treatable by cognitive behavioural therapy (CBT) or relaxation techniques. Although these may help many people in other scenarios, when you are experiencing a severe mixed (or manic) state you are too ill for any rationalising or calming. You need medication to physically force your body and brain to come down from their extreme energised state.

CBT and relaxation techniques may prove to be useful when you are calm enough to be able to engage with them. Hopefully, a combination of approaches together with medication can help prevent mixed states from reoccurring. I have yet to find the right method of coping with these states and hope that mine will become less severe as I learn new techniques and try new medications.