Mind Spinning

Let Me Off This Ride

Mind spinning
In circles
Like a hamster
On a wheel
Racing
Round and round
Going nowhere

Going nowhere
Too quickly
To safely
Get off

Mind spinning
Sick to my stomach
Let me off
This ride
Right now

Please slow down
Please brake
Cannot take it
Anymore

Maybe I shouldn’t
Have had
Two cups of
Coffee
This morning

Spring Brings Hypomania

SpringBringsHypomania

This year, as winter has ended and spring has begun, I’ve taken it slowly and protected myself from overstimulation. You have not heard from me as much, as I’ve not been as active writing here or on social media.

You see, springtime triggers hypomania in me. Now I’m experiencing mild hypomania, irritability, and some mixed features. I feel myself internally crying, and on the verge of tears. I have good reason to cry, but my feeling of emotional vulnerability and instability goes beyond my current life circumstances. Perhaps, for I’ve never experienced losing my parents to dementia while raising a chronically ill teenager and living with bipolar disorder type II. Sounds pretty stressful.

My response is to cocoon, to reduce stimulation, to take sleep meds if I must, to reduce stress. When I haven’t been busy caring for my son or visiting my parents, I’ve relaxed and let my husband spoil me.

Hopefully I’ll feel much better once tax season is over. Exhausting and stressful.

Hypomanic Episode Symptoms

By Steve Bressert, Ph.D. for PsychCentral

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility (e.g., attention too easily drawn to unimportant or irrelevant external stimuli)
  • Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

Source: psychcentral.com/disorders/hypomanic-episode-symptoms/

Who Do I Care For, Really?

Definition of caregiver: a person who provides direct care (as for children, elderly people, or the chronically ill) https://www.merriam-webster.com/dictionary/caregiver

I spend way too much emotional and physical energy toward the care of others, aside from myself. Why do I care so much, too much? No doubt due to my upbringing, to my relationship to my parents – trying to please, to earn their love and approval. Why, after decades of therapy, do I still feel and act as an enmeshed parentified daughter? I’ll just leave that question hanging there for now. Not up for explaining alcoholic family dynamics. Too tired. Adult Children of Alcoholics has a good concise description.

Who do I really care for? Good question. My husband and my son are the most important people in my life. I have devoted a great deal of time and energy trying to help my son. Too much, perhaps. No, not perhaps, without doubt. Now, I need to step back, to neglect a bit, to allow for more independence. Time to do just enough. To be just good enough. Just enough. Enough.

My sister, trying to help me set boundaries and stop taking on too much emotional responsibility, reminded me that I am not our parents’ caregiver. They are in memory care. The memory care facility provides their daily care. That’s what we pay them for.

I am not my parents’ caregiver. I am my son’s caregiver, and even he could use less of my care.

Now that my parents both have dementia and live in a memory care community, aside from being their daughter, my role is to be their power of attorney. With my sister, I make decisions on their behalf. I pay their bills. I coordinate their care, which is not the same as giving them direct care.

Before my mother’s stroke, I did not visit my parents regularly. I did, though, talk and play Words with Friends with my mom daily. I miss communicating with her. I miss my parents as they were before dementia. I’m grieving.

Living with bipolar disorder, I must take care of myself. This season, springtime, is a time when I often start mood cycling. I’ve feel particularly vulnerable and fatigued. The longer sunny days trigger hypomania and irritability.

On a more positive note, in January and February and again next week, I’ve been a NAMI Provider Educator for the staff at the hospital where I received both inpatient and partial day treatment twelve years ago. I enjoy educating their staff on what it is like to live with mental illness and to be in mental health recovery. Wish me well next week. We’re increasing the time that we devote to our personal trauma stories, so I must rewrite mine. I may edit my In Our Own Voice presentation for content, or I could take a look at what I have shared here.

Worn Out

Tired Collage

Exhausted

Overwhelmed
Not thinking clearly
Not able to complete sentences
Not able to answer direct questions

Fumbling with language
With spoken language
With what I hear
With what I read

So sleepy
Feared falling asleep
Driving to doctor’s office

Door locked
Looked at calendar
Over an hour early

Went back to parked car
Overlooking hill of eucalyptus
Enjoyed view

Tolerated gardeners
Noisy leaf blowers
Those things should be illegal

Wish I had slept
That extra hour
Though not sure
It would have helped

Seems there’s no refilling
This empty tank
No overcoming
This fatigue right now

Seasonal and situational
Wait it out?
Perhaps
Not sure

Bipolar Disorder and Seasonal Affective Disorder

Spring has Sprung and the Birds are really Busy

Outside a cacophony of birds outside loudly pronounce that they have important work to do, nests to build, eggs to lay, offspring to bring into the world. Spring has sprung. The sun is bright. The season of rebirth is here. Hypomania is officially here, as well, folks. Yes, I have concurrent bipolar disorder and seasonal affective disorder. In spring, I ramp. Ramp I do indeed. Perhaps it’s a good time to visit my psychiatrist. Perhaps I do not need to take an antidepressant on top of my mood stabilizer now.

Near midnight, I resort to taking clonazepam to fall asleep. In fact, just one dose won’t do it at times like this. I lie in bed, then take a second pill, the bottle of which I keep bedside for just this purpose. I even chew the pills so that I don’t have to wait for my stomach to digest them. I want sleep. I need sleep. I beg the mucus membranes in my mouth to quickly absorb the medication into my bloodstream. Then, I lie in bed some more, mind hyper-alert, body fatigued, and finally go to the medicine cabinet to add melatonin and antihistamines to the mix, hoping that now I can somehow turn off that brain and rest. Past midnight, my mind is wide awake thirsting to get back online and work, which does not help, not at all.

To top things off, tomorrow – Tuesday morning – I have a Social Security Disability Mental Status Exam. Oh, joy.  Yes, I am anxious. Crap. Very anxious.

Worst of all and perhaps what I should have led with, one of my brother-in-laws is fighting for his life and perhaps losing the battle against lung cancer. He is still in his 50s. He is one of my husband’s two older fraternal twin brothers, both once Marines. My husband has always looked up to his older brothers and turned to them for advice on how to fix things. They looked out for him when he was a kid.  My heart goes out to my husband who is in great pain. Someone he loves dearly is dying, will be entering hospice care soon, and he can do nothing to fix it, to make his brother’s pain and cancer go away. I can do nothing to fix it. All we can do is love, pray, and reach out to share that love and those prayers.

September 2013, I started writing this blog when my father in law was hospitalized for sepsis. We almost lost him, but he is still with us today, thank God. Crisis, my inability to do anything to help with the crisis – aside from loving my husband and praying – triggered my hypomania then.

Now, a little technical know-how on the seasonal triggers of mood cycling:


Is seasonal affective disorder a bipolar variant?

Curr Psychiatr. Author manuscript; available in PMC 2010 May 21.
Published in final edited form as: Curr Psychiatr. 2010 Feb; 9(2): 42–54.
NIHMSID: NIHMS189860

Seasonal affective disorder (SAD) is an umbrella term for mood disorders that follow a seasonal pattern of recurrence. Bipolar I disorder (BD I) or bipolar II disorder (BD II) with seasonal pattern (BD SP) is the DSM-IV-TR diagnosis for persons with depressive episodes in the fall or winter and mania (BD I) or hypomania (BD II) in spring or summer.1

Table 1: DSM-IV-TR criteria for seasonal pattern specifier*

Table 1: DSM-IV-TR criteriia for seasonal pattern specifier: A - A regular pattern of major depressive episodes (MDEs) at a particular time of year (such as fall and/or winter). B - Full remission or change to mania or hypomania at a particular time of year (such as spring or summer). C - 2 seasonal MDEs that followed the pattern described in (A) and (B) occurred in the past 2 years (and no nonseasonal MDEs). D - Seasonal MDEs substantially outnumber nonseasonal MDEs across the lifespan.

Table 2: Physiopathologic findings and clinical management for SAD vs BD

Table 2: Physiopathological findings and clinical management for SAD (seasonal affective disorder)  vs BD (bipolar disorder). Differences: SAD - May be unipolar or bipolar. Defined by seasonality. Light therapy and antidepressants indicated. BD - Increased risk of psychosis and psychiatric hospitalization. Most BD is not seasonal. Mood stabilizers indicated. Risk of switching states with light therapy and antidepressants. Similarities: Atypical depressive symtpom presentation. Highly recurrent. Predictable season of recurrence allows proactive treatment. Assess for mania and hypomania in both disorders. Light therapy requires clinical supervision. Psychotherapy may be beneficial.

Proposed mechanisms for seasonal affective disorder

Etiologic hypotheses of seasonal affective disorder (SAD) include:

  • photoperiodic hypothesis (shorter winter days cause SAD,a perhaps mediated by a summer vs winter difference in duration of nightly melatonin release)b
  • phase shift hypothesis (less available light in winter may lead to an inability to synchronize circadian rhythms with sleep/wake rhythms).c

Some case studies of rapid-cycling bipolar disorder (BD) suggest that mood is correlated with daily hours of sunshine and light therapy is antidepressant. Rapid-cycling patients may be hypersensitive to day-to-day changes in photoperiod, analogous to mood changes in response to changes in photoperiod across the seasons in SAD.d

Circadian phase delays–in which internal rhythms lag behind the sleep cycle–are correlated with symptom severity in BDe and are implicated in the core pathology of BD.f Phase delays also are present in some individuals with SAD and are associated with severity and treatment response.Preliminary evidence suggests that variation in circadian clock genes is related to both BDf,h and SAD.i

Source: For reference citations, see this article at CurrentPsychiatry.com

Etiologic hypotheses for both BD and SAD propose that an external event (life stress in BD; decreased photoperiod in SAD) leads to circadian dysregulation and, in turn, mood episodes. Circadian-related hypotheses for SAD and BD are supported by evidence showing efficacy of treatments that manipulate behavioral and circadian rhythms.

Source:  Curr Psychiatr. Author manuscript; available in PMC 2010 May 21.
Published in final edited form as: Curr Psychiatr. 2010 Feb; 9(2): 42–54.
PMCID: PMC2874241
NIHMSID: NIHMS189860