So last week, I outlined where all of this started, the initial crash out of hypomania into deep depression, crawling a little bit out of it into less deep depression, heading to Nashville to finally address an issue I’d been skirting around for a while. That’s where we pick up.
Note: I want to make it very clear that everything I’m going to talk about is meant to be descriptive NOT prescriptive. This is simply a look at some of what happened to me, what’s happening now, etc. So don’t read anything I’m writing as a recommendation for self-treatment or anything like that. This is only about me.
Home Again, Home Again Part 2
So it was about the middle of December and now I was back in Nashville for an indeterminate time; as I mentioned there is something about Nashville that I don’t like (I’m about the only one, everyone LOVES Nashville but me) and being home was a bit of a stressor itself.
Some of this is that I am very much a creature of habit and being out of my normal environment, eating habits, life habits, stresses me out. The dogs were also an issue. My mom’s neighborhood was not great for walks and she doesn’t have a back yard. Norman is used to peeing fairly often and usually I just let him out back.
Without that it was constant walking; he also had no way to let me know when he needed to poo. Usually he sits by the door staring at me. Now my computer was nowhere near the front door. There were a lot of accidents and this did nothing for my (or my mom’s) mood.
Although it was Christmas time, outside of the fact that the people turn into absolute idiots, that alone wasn’t stressful (I know it is for some people). My family would be coming in but that’s normal and we all get along. I’ve always wondered at folks who tell the stories of holidays turning into drunken scream fests since my family has never been like that. The dogs would be the biggest issue.
The weather didn’t help. It was gray and overcast and this does nothing for my mood. A hint of sunlight and I’d try to do a longer dog walk. It also got bitterly cold during the second half of my stay and I detest the cold.
Depression Phase II
I was still in my Phase II of depression. Very little energy, I had a tough time dealing with a lot of things I needed to deal with related to the previous hypomanic phase. I’d put them off, convincing myself they would be far harder than they were and then, when I finally got around to doing them it was never that bad. I’d get up, deal with the dogs and then crawl back into bed.
I still wasn’t back to training, I hadn’t brought a travel pass and walking the dogs was it. My eating was still off the rails mind you. In that vein, my mom was a bit surprised that I had any desire to go to the various holiday parties she was invited to. I’m usually not that social.
What she didn’t realize at the time was that being social was not my motivation. I wanted to camp the food tables. And I did. I could feel the fat coming on, my belt getting tighter, my shirts fitting worse and this did nothing to help my attitude. But I wasn’t quite there to start fixing it.
Into Treatment
I had already made an appointment at the afformentioned Nashville Center for Hope and Healing but it was about a week away after my arrival. In the interim, I’d go to a single session with a counselor but, without going into details, let’s just say he was not a good fit. I’m sure he’s right for some; he was not right for me.
I’d also attend the first of several Depression and Bipolar Support group meetings. My mom had been attending for a while, mainly to get more information on what I was going through. There were several during the week and I’d attend one before my primary appointment.
The Nashville Center for Hope and Healing
I’ve mentioned this several times and will continue to do so as this is just an amazing group of folks. The primary physician has a couple of decades experience with bipolar and everyone else I dealt with was equally amazing. Again, after seeing some of the terrible treatment others are getting, I got really lucky.
My initial intake would take two hours. The first hour was with my counselor with whom I clicked instantly. He was brash, sarcastic, had a foul mouth and just got right to the point. My kind of guy. I think it was during that time that he introduced me to a concept I’ve already mentioned which was GSR (guilt, shame and regret).
He also talked about MVP (meaning, value, purpose) and how finding it again would be part of all of this. It was something I’d lacked since I turned 40, just a sort of drifting through the world without much of a goal.
Narrowing the Road
Perhaps the most interesting concept he described was something he called “Narrowing the Road”. So think of bipolar II with the HUGE swings from hypomania (way high) to depression (way low). The difference between the high and low is just massive.
Part of the goal of bipolar treatment is to “narrow the road” to keep the highs lower and the lows higher. It’s a normal part of life to have good days and bad days (even if many people have this skewed idea that if life isn’t perfect all the time, they are failing in life) but they are fairly moderate.
In bipolar the swings are just bigger and, of course this makes the crash from high to low that much more profound. Imagine jumping off a curb to jumping off a cliff; the first is a small fall, the second is enormous. And emotionally hits you that much harder because of it.
He also made an interesting point that “You won’t even know who you ‘really’ are until you get stable and narrow the road.” For years, I’ve always laughed at people who think that there is some inborn human essence or person. Because in a year span I can be about 5 different people depending on where I am in my cycle, whether I’m on meds, etc.
But which is the “real” one. Phase II depression me, Phase I depression me, middle of the road me, or ramping up to hypomania me or hypomanic me? That’s 5 effectively different “people” and none are any more or less real than the other (please don’t confuse this with Dissociative Identity Disorder, what used to be called Multiple Personality Disorder).
Diagnosis: Part 1
He and I would set up an appointment for the week following and I’d go to the second part which was an hour with the psychiatrist and the nurse practitioner. I spent about an hour with them just pretty much describing what had happened, what was going on, my fouled sleep patterns, etc.
They felt that I was having a mixed episode (this is another form of bipolar where you have elements of both depression and mania) since I was talking fast but I always talk kind of fast so I’m not sure that was correct. When I’m hypomanic I talk like someone on cocaine, this was just my normal speed.
They would talk to me about regular exercise, I told them that I used to train pretty much daily. They’d suggest fish oils, I told them that I had been taking them religiously for years. Vitamin D status, I told them I took supplements and had for years. Lots of fruits and vegetables; well, inconsistently some times. They offered that I might have escaped major problems for years simply due to having done a lot of the “right” things.
It Can Always be Worse
Both they and the counselor would make the point that I could have had it far, far worse. There is a very common association between bipolar and substance abuse, just a lot of drug and alcohol abuse. I’ve been drunk once, rarely drink and I’ve never done recreational drugs (ephedrine doesn’t count). I am probably one of those people who would benefit from smoking pot but it’s just not a path I choose to go down. I prefer stimulants but ephedrine is the hardest I’ll go.
Many act out sexually and end up with STDs. I define “couldn’t get laid in a whorehouse” and I’ve never not been safe even when I did have a regular partner so that was never an issue for me. At the extreme, some end up in jail or institutionalized when they truly lose it.
Many do so much financial damage they end up living on the streets. Others lose careers. My career outside of what got me into trouble isn’t really “losable” and despite the damage I’d done financially, I still had income and had stopped before things got really bad. I had some debt but it wasn’t unfixable.
They also pointed out that I fit the description of high-functioning, essentially intelligent, productive, successful in my field, etc. Not everyone suffering from mental illness is in that camp and it certainly doesn’t help when you aren’t high-functioning AND have a mental illness. As a friend once put it to me “I don’t know a lot of people who are as messed up as us who can still function.” Yeah.
Somehow all of this made me feel guilty, hearing about how much worse many folks have it and how much worse I could have had it. There was an element of “Dude, just suck it up.” to it to me. Yes, that’s insane and some of it was assuredly driven by the depression. But that was a partial effect.
Diagnosis: Part 2
I’d finish the diagnosis with recommendations to get some blood work (hormone panel, thyroid, Vitamin D) and they’d give me a DNA test by a company called Genomind which is looking into genetic markers for various mental illnesses that can help guide treatment. I’m not joking when I said it was thorough. It was also very research and evidence based which I certainly can get behind.
They also entreated me to get back into exercise on some level. Not just for physical reasons but for mental reasons; apparently some research suggests that “crud” (a technical term) builds up in the brain with mental illness and exercise helps remove it. Of course there is a problem, despite exercise being hailed as one of the best things you can do when you are depressed, the simple fact is that it is one of the last things you want to do.
When I asked how much they said “Daily for 30-60 minutes would be ideal and the main reason we say that is that if we tell people to work out 7X/week they might make it 5X/week. If we tell them 5X/week they do it less.” Having trained enough people, I fully understood that.
Starting Treatment
They’d give me samples of my first medication with instructions to take it at bedtime to help me sleep. It was a basic mood stabilizer, not lithium (about which I had heard horror stories), called Depakote. It also wasn’t one of the atypical antipsychotics that can cause enormous weight gain. I’d make a followup with them for like 2 weeks and go on my merry way.
I’d get my blood work done dutifully and eventually end up joining the scourge of the fitness world, Planet Fitness, so I could get back into some sort of training. It was cheap, no contract and close (and I hadn’t brought a travel pass for World Gym). It would take me about a week to get back into any kind of habit (2 days beginner weight training followed by a bit of cardio, 3-4 days easy cardio) but it was a start.
Mind you, for someone who has been highly active and fit, going back to the gym almost makes you feel worse acutely. When you’re used to training at a high level and are coming back after months off, you don’t just feel depressed; now you feel fat, out of shape, have no work capcity and get really sore from piss-ass training and now you feel more depressed.
And that’s where I’ll stop for today. Tune in Same Bipolar Time, Same Bipolar Channel for Part 3.
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