Acceptance

It’s been 3.5 years since my diagnosis.

My original reaction was *TRIGGER WARNING* a suicide attempt *END TRIGGER*. Having been diagnosed with major depression in 2004, I took years to learn what it meant, how I can fight it, what I can do about it. Depression became a part of my personality; I tamed it, and I was victorious. Or so I felt. The six months before diagnosis were my best period ever – I thought. It was blazing hypomania, and everything about it felt perfect. I thought: this is the real me, finally. Free of fear, free of tiredness, full of ideas. I spent money because I knew Gods would make sure I get more of it, and soon. I tried to start two businesses at once (graphic design and coaching, and I knew nothing about the latter but people loved confiding in me so I felt qualified enough), while juggling a part-time job as a bartender AND learning what my dream career was. I slept 3-4 hours per night, overexcited with all the ideas and power I seemed to have. I have never been more creative, seductive, simply happy.

And then a mixed episode hit and I was majorly confused. I thought my antidepressants stopped working for some reason. I went to a psychiatrist demanding a fix. Instead I got a new diagnosis, and was told that the period when I felt so good was actually an illusion. It was all fake, chemistry malfunctioning in my brain. I was absolutely heartbroken. It wasn’t only that I had to learn living with a new word in my medical dossier; it was the fact that while depression can be cured and not return, the same is not true with bipolar.

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“Why can’t you just get better?!”

For some of us, this is a question that our families or loved ones ask us. For some, like me, it’s a question we ask ourselves. We’re taking our pills. We’re sleeping eight hours every night. We aren’t doing drugs or drinking. So why the hell can’t we just get stable?

When I published my book, one of the people who read it told me that it felt very strict, particularly in the guidelines about not drinking. Personally I haven’t had a drop for over a year now. I haven’t used any illicit drugs for many years. I religiously take my pills (since diagnosis in 2011 I forgot my pills only once) and no matter what, sleep eight-nine hours. Every. Single. Night. Yet I am still rapid cycling and finding it hard to keep appointments, because while on Tuesday I felt great making an appointment for Friday, on Thursday evening I turned into a plant and stayed in this state until Saturday, when I jumped out of bed energised by the thought of buying a new Macbook Air. (I can’t afford a Macbook Air.)

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Question: Is my girlfriend bipolar?

Hello and sorry about a break in posting. My bipolar was acting up (I’m sure you can relate). I’m back though, with a question from a reader:

Hi, I would like some advice. My girlfriend Jane [name changed] is showing symptoms of bipolar. I think she’s hypomanic (but I am not a doctor). I’m scared, confused and I don’t know what to do. Could you give me some information? Most of all, what can I do as her boyfriend, and how to help rather than harm?

Lost in Miami

Dear Lost,

I’m not a doctor either but here are my thoughts.

First of all, symptoms resembling hypomania do not have to mean bipolar disorder. They can also be a sign of thyroid problems (I found this hard to believe for a long time until I met a few people who, indeed, exhibited all symptoms of bipolar, only to find out they had malfunctioning thyroid). They can also feature in other illnesses, such as borderline, schizoaffective disorder or schizophrenia. Only a professional can give you a clear diagnosis.

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“I don’t think I’m sick”

Oddly enough, one of the symptoms of both unipolar depression and all phases of bipolar disorder is the idea we aren’t sick.

In depressed phase, it is associated with lowered self-esteem. Together with all other negative thoughts comes the idea that we are just lazy, and we’re just pretending, and we don’t have depression at all. (This is greatly aided by having relatives or friends who provide us with helpful phrases along the lines of “why don’t you just pull yourself by the bootstraps” and “you know, you could just try not to be depressed”.) And so we find ourselves on the floor, curled into fetal position, thinking we’re just imagining all this and in fact don’t have any reason to feel bad, so why don’t we get up and do something. Then we don’t get up and we don’t do something, because depression won’t let us move.

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Bipolar and addictions (Dual Diagnosis)

According to www.dualdiagnosis.org, 56% of people with bipolar disorder suffer(ed) from addiction to drugs or alcohol at some point. According to www.drugabuse.gov, the rate for general population (in America) is 8.9 percent.

Obviously there is something about bipolar disorder that correlates with high addiction rate. While I am not a medical professional or addiction counsellor, I will hazard a guess that bipolar makes you predisposed to addiction, not the other way round. There are some drugs that can trigger a bipolar episode (in particular marijuana and LSD), but they do not create bipolar disorder in a mentally healthy person. They may only make it manifest earlier.

There are a few obvious reasons why bipolars tend to become addicts. One of them is self-medication. I used to self-medicate my depression with alcohol for years – it seemed to be the only way to make the black dog go away for a few hours. I knew that alcohol is a depressant and on some subconscious level I probably realised that I am making things worse for myself long term, but at those times the only thing that counted was quick relief which the bottle provided. The same scenario happened daily: I’d be terribly depressed, I’d get drunk, depression would be replaced by euphoria, I would do some really stupid things, go to sleep, get up in the morning and scream “F–K!!!” (I never blacked out; I always remembered what I did the day before, and it was always terrible and make me more depressed.) Repeat. Repeat.

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Hypomania vs. mania

The book definitions of hypomania and mania seem to make the difference between the two pretty unclear. They generally either list hypomania as “mild mania”, or — the other way round — mania as “stronger hypomania”. Then list the same symptoms next to both.

Here in the Netherlands the definition is a bit clearer: mania requires hospitalisation (or arrest, but hopefully the former). Hypomania is what you can cope with by yourself; mania requires help. While this still isn’t a 100% clear division — how are you expected to know, especially when manic, that you have now crossed the threshold and you need hospitalisation? — it’s helpful, because it gives a clear and understandable difference.

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