Medication Mishaps

Hypomanic to Exhausted

This week I’ve been completely exhausted. Twice I forgot to take my mood stabilizer at night. The first time, I didn’t realize it until late the next afternoon – too late to take my missed dose. The next time I realized it the following morning and immediately took the previous night’s dose.

I became hypomanic due to the first error, publishing three (or more?) posts on Sunday. The second mishap compounds the first and explains why I feel like I’m dragging myself through molasses this week.

Although I’m physically exhausted, I cannot fall asleep without taking sleep meds, resorting to twice my prescribed dose (which my psychiatrist okayed in the past – it’s still a reasonable dose). When I’m stable I do not have to take meds to fall asleep.

Oh, and Friday my husband and I attended our next door neighbors’ daughter’s quinceañera, which was lovely, but probably threw me off. Social stimulation triggers my mood cycling.

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

Ramping Up

Have not been falling asleep on my own recently. Have had to drug myself, dosing myself with a combination of clonazepam, diphenhydramine (Benadryl), and a sleep aid herbal supplement. I chew the clonazepam and herbal supplement to get them to act more rapidly.

Find myself up until the wee hours of the morning, intermittently reading ebooks and blog posts, commenting on blog posts, responding to comments on my posts, researching any number of things that come to mind. One thing leads to another. Read something that I must then write about or research. Mind all over the place. Mind thinking. Not tired. Crap. At least taking the clonazepam knocks me out. Wait too long until I take it. Well, maybe one am isn’t that bad. At least I still get a decent night’s sleep. But this morning I dragged. Never been much of a morning person.

My husband, on the other hand, is the Energizer Bunny in the morning. So annoying. I drive him nuts at night, reading in bed beside him as he tosses and turns. He drives me nuts in the morning as he rattles off his ideas and the projects he wants to complete for the day. It’s as if I have a hangover. Shut up. Be quiet. Stop talking so much and so fast. I’m not awake yet.