Trying to feel like myself, without the peaks and valleys

It’s been a long, long road to this point, but I’ve arrived at a place — with the help of my family doctor, multiple residents, some psychologists and social workers and my blessed psychiatrists — where I’m confident about a diagnosis for my mental health problems.

Turns out, it’s roughly the place I started from, but the devil is in all those details.

Based on my symptoms and the medications which best treat those symptoms (and those who haven’t done much good), we’re fairly confident I suffer from a form of bipolar disorder, or, more specifically, cyclothymic disorder. We haven’t ruled out other, co-morbid disorders (like borderline personality, others).

Let’s explain what this means in a few steps.

Bipolar people differ in type. Like make this into three (that’s roughly accurate):

1. Bipolar type I: suffers from mania (elevated moods) and depression (very bad low mood);
2. Bipolar type II: suffers from hypomania (less than mania, still bad) and depression; and
3. Cyclothymic: suffers from somewhat milder hypomania and depression, but cycle between those states faster than the above two.

For a bipolar type I person, the phases of mania can be so bad they’re lead to becoming destructive. They might start fights, risk their lives, end relationships or start affairs, and just about make a total mess of their lives. Hospitalisations catch more than a few bipolar type I people.

Then, they come down from the mania into a depression that’s as bad as anything people with “just” depression may face, but the deep down after than highest of highs is crushing.

Lithium is one of the first, effective treatment for bipolar type I people. And there’s been more since, but they’re different (anti-psychotics).

Type II people enter into hypomanic states. These are problematic forms of elevated mood, lead to disruptive behaviour but they’re more subtle, and pernicious in how they’re harder to notice. This person might do inadvisable things, but not quite so bad as the manic person.

At a glance, type II is in some ways easier to live with, but harder to get help for. The type II person isn’t as likely to damage themselves so obviously as the type I person, and so getting help and a diagnosis may take much longer. These folks nevertheless need and deserve the same level of care as type I.

The difference between bipolar type II and cyclothymic disorder lies in how the depressive and hypomanic phases cycle rapidly. From one week to the next, even from one day to the next, the mood swings for the latter can be violent and jarring, especially for loved ones.

To most people, this will just seem like moodiness. But the cyclothymic cycles lead to other behaviours, in my case, at least:

• The maddeningly sudden onset of fatigue — esp. after a meal;
• Excessive and very loud talking — uncomfortably so for other nearby;
• Getting looped into a pattern of obsessive thinking (and talking);
• Overwhelming cravings for sugar (and at other times, for alcohol);
• Being overly invested in a paranoid, grandiose and delusional sense of self;
• Vivid, lucid sexual or erotic fantasies or obsessions; and
• Impulsive spending, and mostly on really weird things.

What complicated the process of this diagnosis for my healthcare practitioner lay in:

• How my bipolar profile wasn’t typical, even for cyclothymic disorder;
• I checked diagnostic criteria for a variety of issues, including and especially borderline personality disorder;
• The wait list for a psychiatrist meant my family doctor had to guess how to help; and
• Most of my therapists aren’t trained diagnostic concerns and aren’t doctors.

After a long process, we’ve settled on effective medication and it’s a matter of getting to the therapeutic dose. This is by no means the first medication I’ve been on. They, the previous ones, all helped and hurt in different ways.

What complicated my case, beyond the obvious that no two people are quite the same when you’re considering something complex like a mental health diagnosis, in how I worked very, very hard to self-bias the process to get the outcome I thought I wanted (to get to effective treatment, faster).

Further, to the occasional consternation of my healthcare team, I present as exceptionally high-functioning and introspective. I have a defence mechanism — I’m sure many do too — where I refuse to show weakness. Not so much physically as emotionally: I conceal how I feel by trying to sound smart.

My diagnosis would shift between borderline personality disorder and bipolar, also. There’s always been a hesitancy to prescribe SSRIs, which could make the mania worse, but we were never completely sure how core to my issues the mania is/was.

As it stands, if the current option fails, we’re trying SSRIs, and if those fail, we’ll restart the process. I’m on a low dose of an anticonvulsant medication which is good for mood swings. It’s effective, but we’re at a point where the dosage needs an increase.

I’ve hoping, by the time the mood strikes for the next of these posts, I’m feeling able to be my best self, more of the time, and with less primary symptoms. I’ll take a few annoying side-effects, if the overall result helps.