Mood Watch - 30

I was on the road for much of December and had neither the time nor inclination to post much on this blog. But I suppose I’m overdue for an update on the status of my biochemistry.

As far as I can tell, I’ve been on a pretty even keel since my last Mood Watch post, except that from December 10 through December 26 I tended to sleep more than usual and often had real trouble waking up, almost as if I were drugged (which, aside from the usual depakote and lamictal, I wasn’t). This was all the more surprising because for most of that time I was in the company of good friends and was doing work I enjoy. And besides that, as a general rule I have always tended to sleep less than usual when traveling. Yet at no point did I feel depressed.

The most I can say is that now and again I wished, as I often do, that I didn’t have to fool with this stuff. I mean, I’m appreciative of the fact that as mood disorders go, mine is comparatively mild; also that life holds far more severe challenges. But I mean, jeez, this has really gotten old. Bipolar disorder once had the virtue of at least being interesting. Not any more.

Mood Watch - 29

An inability to sleep more than two or three hours at a stretch has replaced that long spell of hypersomnia. Taking a nap here and there mitigates this a bit, but I’m still managing only about five hours’ sleep out of every twenty-four. The good news is that I’m energetic enough to catch up on a lot of things, and I have no trouble focusing on my work (distractibility is a symptom of hypomania and therefore one of the things I watch for). The bad news is, I’m managing only about five hours’ sleep out of every twenty-four.

Last week I had a routine consult with my psychiatrist. I briefly reviewed my mood and energy level over the past month. She wrote the usual prescription for my meds. A thought occurred to me, something I’d heard somewhere. I asked, “Is it true that this illness tends to subside with age, that I’ll ever get beyond it?”

She eyed me sympathetically. “No,” she said. “No. You never will.”

Mood Watch - 28

Sorry to have been away for so long. The month has pretty much been a blur of trips and conferences, which partly explains the dearth of posts. But I’d be less than candid if I omitted to say that I just haven’t felt much like blogging. Although I’ve never regretted taking up this blog, in the nature of the case I’m putting myself and my struggles out in public, and sometimes I don’t feel up to the task.

In fact, I briefly flirted with the idea of dropping this particular blog. God knows I’ve got so much going on that I’ve had to set aside my other blogs temporarily, and indeed, I suspect I will have to put one or more of them on hiatus. But a couple of days ago I received an email that reminded me of why this blog may be the most necessary of any I’ve undertaken.

It came from an undergraduate who had a course with me last year. Because I’ve been public about my bipolar disorder, he felt that he could approach me about his suspicions that he might have something similar. I don’t know whether or not that’s the case, but based on the symptoms he reported, I encouraged him to visit his family doctor and see if a referral to a psychiatrist was warranted.

It occurred to me that his emailing me, a relative stranger, suggested that he had no one else in his life he could approach on this matter, and that if I had kept silent about my illness, he might well have felt completely isolated. In the end, it always comes back to the same stark question: What kind of man do I have guts enough to be?

As for my mood, I can’t recall a time when I have been so busy and yet so easily exhausted. Excepting the brief period I recounted in my previous Mood Watch post, I’ve geared up to do the things I needed to do, and got them done, and then craved nothing but sleep. Except for a few days last week, it didn’t even feel like depression, just a general, unyielding fatigue.

Things got back to normal — or at least what I insist on regarding as normal — two days ago. And what impressed me is that whereas these shifts in mood often seem unrelated to my circumstances, with this one there was a clear connection, and I’m beginning to discern a pattern I’ve hitherto overlooked (or maybe disregarded) between a certain area of my life and these shifts in mood. I don’t mean to be mysterious, but at this point I see no need to get into specifics. It’s just that I’m reasonably sure that this area of my life has become complicit in my depressive spells, and that’s something I’ll have to address.

Mood Watch - 27

I’ve been getting a little less sleep than usual lately: maybe 5-6 hours at a time. I think this is mainly due to an upcoming conference for which I’ve been the principal organizer. Especially as the date gets close, there are a lot of last minute details to handle or reconfirm and a few little fires to put out. Otherwise I feel pretty good, and have been since about October 29 or so. If you compare this to my previous Mood Watch entry, you’ll see how suddenly I emerged from that period of hypersomnia. That’s classic for me: abrupt drops in mood, abrupt recovery of mood. In an odd way it’s reassuring, since it underscores the biochemical nature of the disorder.

Mood Watch - 26

It’s been over two weeks since my last post, and my situation continues to be much as I reported it then: sleeping more than usual and having trouble waking up. To that I would add that my energy level and what might be called my mental coordination are much less than usual. The phrase “mental coordination” is something I picked up several years ago from a psychiatrist after hearing me describe the way in which bipolar disorder generally affects me. It seemed to him that I often had mild depressive episodes whose main impact was to reduce my ability to think as quickly and creatively as I can when I’m feeling more myself.

That’s pretty much how it’s been for the past three weeks. I can’t seem to get much done. When called upon to give a lecture, manage a meeting, etc., I function okay — in fact I would say few people can tell any difference. But whereas usually such experiences are energizing, I walk away from them feeling anything but.

The principal good news is twofold. First, aside from the symptoms I’ve described I don’t feel actively miserable. Second, I had a physical exam recently in which I checked out surprisingly well. I say “surprisingly” because I am within a few weeks of my mother’s age at the time of her death, and seven years older than my father at the time of his first heart attack (by the time he was my age he’d had a quadruple bypass).

I’ll be curious to see if I’ve rounded the corner just yet. Several times now I have felt as if my energy level were returning to normal, only to find myself mistaken. I think I’m starting to improve again, but have no way of knowing until it happens.

Mood Watch - 25

Still feeling OK except that a couple of days ago I began sleeping more than usual: I got drowsy easier and had trouble really waking up. Other than that, not much to tell.

Mood Watch - 24

I slept normally last night: In bed around 1 a.m., up at 7:30 a.m. to walk the dogs. This morning I feel normally refreshed — which is to say I’m reasonably awake but still occasionally yawning — and normally energized. Not much to say except that it’s surprising how good normal can feel.

Mood Watch - 23

Rats. Despite taking an Ambien CR at 11 p.m. in addition to the usual meds, I still woke up at 2:30 a.m.: just 3.5 hours of sleep. The bad news is, I can’t get back to sleep. The good news is, I feel far from fully rested. I imagine that after a few hours I’ll get back to sleep again. Luckily I have no appointments until mid-afternoon.

It’s odd. I feel almost the same irrational shame when I get too little sleep as I do when I’m depressed and sleep as much as possible. In both cases, I have to bear in mind that these are manifestations of the illness, and that beyond taking my meds and keeping a careful watch on myself, there’s not much more I can do. The best thing, I’ve found in my current situation, is to remain quiet and relaxed. Some activity is okay — it seems to keep my mind from over-revving — but it’s not a time for something like, say, cleaning the house from top to bottom. (I once knew a woman with bipolar disorder who would actually do that in the middle of the night, but until she happened to mention it by accident, and I happened to say it sounded like clear evidence of hypomania, it had never occurred to her to connect these bursts of nocturnal energy with the illness. And this was a highly educated woman, too.)

UPDATE, October 5, 1:20 p.m. - Presently I did dose off, while sitting in my office chair. Unfortunately I had a glass of Fresca in my hand and thus baptized a good portion of my lap, which woke me up again. But just temporarily: I slept until 5:30 a.m., got up, fed and walked the dogs, then crashed again until around 11 a.m.

Mod Watch - 22

Still feeling OK, but my sleep schedule has gotten knocked out of whack. I’ve been falling asleep early in the evening and by midnight am awake again. This is actually a pattern that comes naturally to me. In my early twenties, I worked a full-time office job from 4:30 p.m. until midnight, then turned to my free lance writing and continued to labor until dawn. Similarly, I composed most of my doctoral dissertation between 11 p.m. and 5 a.m.

I like the peace and quiet and the lack of distraction. As a rule, I find that I focus better and get more accomplished. Nevertheless, any change in my sleep schedule always gives me pause. And although I am not running much of a sleep deficit just yet, I’m down to around six hours of sleep in every twenty-four.

Emails continue to appear in my mailbox thanking me for the Inside Higher Ed article last week. Most are a pure pleasure to read, but one was a bit disconcerting. It came from an individual with bipolar disorder who was inspired by my story but at the same time determined not to take medication, work with a psychiatrist, etc. I didn’t want to give the person advice, since often people will not accept unsolicited advice. Even so, I couldn’t let it pass without at least underscoring my own convictions on the subject:

I hope you won’t mind my saying that, for my own part, I regard taking medication, seeing a therapist and psychiatrist, etc., as being of fundamental importance to managing the illness. I’m a military historian, and after a lifetime of studying war I find that using combat as a metaphor comes very naturally to me. As I said in one of my comments under the IHE piece, I regard myself as being permanently at war with an enemy that will never cease in its efforts to kill me, either through a psychotic manic high or a depression so deep I commit suicide. Carl von Clausewitz, perhaps the best known of military theorists, acutely observed that, “In war, the best strategy is always to be very strong.” In the context of managing the illness, I interpret that to mean that I should avail myself of every resource I can possibly bring to bear.

Frankly, I doubt it will do any good. People generally have to learn such things in their own time and in their own way. It took me eleven years to really face up to the reality of my situation, so I certainly have no right to find fault. That said, in retrospect I can clearly see that I was immensely lucky not to have suffered disaster during those eleven years.

Mood Watch - 21

I’m still in good spirits. Indeed, very good spirits since “An Inappropriate Illness” was published. The response it generated, both the online discussion and private emails, has really given me a sense that my life means something, that I have found a way to be of service, and that’s a feeling of extraordinary power. (To cap things off, a bipolar disorder support association in Perth, Australia, has asked permission to reprint the article in its quarterly newsletter.)

I’ve been sleeping adequately, but my schedule has been thrown off a bit by dint of getting up rather early most days this weeks and being so drowsy at times today I literally could not keep my eyes open. Thus it’s 12:30 a.m. as I write this, but I’ve just awakened after a nap of several hours.

My concentration has been good. I’ve gotten a lot of work done lately, and it’s work I’m supposed to be doing, not new projects dreamt up and pursued on a whim. My impulse control is OK. True, I did go out this evening and spend over a thousand bucks, but that was on a) a new hot water heater whose purchase I’ve delayed until the failing old water heater forced me to take action; and b) the best vacuum cleaner I can afford, because with three dogs my Significant Other and I live in a perpetual desert of dog hair. Lesser measures simply haven’t gotten the job done.

Mood Watch - 20

The publication of “An Inappropriate Illness” generated a great deal of constructive online discussion. In addition to a number of attaboys from my colleagues in the history department, I also received about ten private emails from people around the country who knew of, or were themselves struggling with, a serious mood disorder.

The rough consensus in both the public comments and private emails was that disclosing the existence of a mood disorder or anything like it remained, even in academe, a risky thing to do. Thus I had people tell me how brave I was. I don’t know about that. I do know that some of the emails were so affecting that they moved me to tears. I felt honored to have been able to strike a blow, however modest, against the stigma that still imprisons too many people with mental illnesses behind walls of silence.

I have also been engaged over the past couple of days with a totally unrelated matter that has reinforced a sense that I can and am making a constructive difference. Thus, on the whole I’ve been feeling about as good as a man can feel. And the very best news is that I continue to sleep around six hours a night.

The only symptom I notice right now is a certain sense of feeling “scattered” — trying to keep track of two many things at once — and that seems less attributable to biochemistry than to how hectic the start of a new school year tends to be.

Mood Watch - 19

Staying up all yesterday worked — I got a good night’s sleep without having to take an Ambien CR or anything, and feel fine today.

Mood Watch - 18

A week ago I felt physically fine. Then within 24 hours I got walloped by the fiercest head cold I can recall ever having. “Three days coming, three days with you, three days leaving” is the conventional wisdom about head colds, and it usually holds true with me. This one compressed the first three days into an afternoon. By Tuesday evening I could breathe only through my mouth, and then with so much difficulty I sometimes literally felt as if I were on the verge of suffocation.

It wasn’t quite so bad on Wednesday and Thursday, but it was midday Friday before I felt even slightly like doing any work. Still, as the cold began to subside, my mood and energy level rapidly picked up, and from Saturday until now I’ve been in perfectly good spirits, able to focus on my work (even the stuff that requires creative thought), and very productive.

Needless to say, I slept a lot during the worst of the cold, and as late as Saturday night I slept a good eight hours, and so deeply that I didn’t wake up until after 9 a.m. But that has ended my eleven-day run of hypersomnia. I didn’t feel even slightly tired last night, so I just plowed through a back log of work, and as is my usual practice I’ll try to stay awake today so as to get back on a normal sleep schedule tonight.

Mood Watch - 17

I continue to sleep more than usual and more easily than usual, though the hypersomnia isn’t quite as pronounced (or maybe I’m just getting used to it). I feel okay when I’m around people but when alone I often feel a sort of free-floating anxiety; and either way my sense of self-worth isn’t much. I try not to think of reasons to justify the lack of self-worth, which is the way one’s thoughts tend to drift. Instead as far as possible I consider it simply an artifact of the illness.

I wrote that column for Inside Higher Ed. The editor had some minor suggested revisions. I made them and sent back a final copy. The piece will most likely run next week.

Mood Watch - 16

Still sleeping a lot. At such times it’s surprisingly difficult to stay awake, and when I am awake my energy level is perceptibly lower than it has been. I’m starting to feel sort of anxious as well — nothing major as yet, just a vague sense of important things undone, rather the way it feels to leave the house and think you’ve left the stove on. I’m still able to forge ahead with my work, though, and that’s a positive sign.

Mood Watch - 15

Fell asleep around 11:30 last night; woke up at 2 a.m. By mid-morning I was very drowsy and slept from noon until about 6 p.m. I was awake only an hour before the z-monster got me again and I slept a further three hours.

This sounds pretty ho-hum, I imagine, but sleep is the single biggest indicator of an impending hypomanic or depressive episode, and the rules of the game with bipolar disorder say that “good sleep hygiene,” as it’s called, is imperative. That’s why I pay so much attention to it.

At the moment I still feel fine otherwise, but maybe a shade or two less buoyant. It’s hard to tell what will happen next until it does.

UPDATE, September 13, 4:27 a.m. - Slept an additional four hours, from midnight to 4 a.m. In and of itself that’s a good thing, as it has set me back on what is more or less a “normal” schedule. But the ease with which I did it, having slept so much during the day, is noteworthy, and not necessarily in a good way.

Mood Watch - 14

Took a 90-minute nap yesterday afternoon and slept from about 11 p.m. to 6 a.m., albeit with frequent awakenings. At such times you feel kinda like a zombie that death itself cannot keep down. Nevertheless, even including interruptions I must’ve gotten seven hours of sleep in the last twenty-four. That’s a good sign.

Mood Watch - 13

I’m still getting less sleep than usual — only about four hours last night — but otherwise seem okay. That is to say, I detect no grandiose thoughts, flight of ideas, pressured speech, distractibility, or “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).” I did rent a 10×10 space at a self-storage place a mile or so away and I just now dropped $300 on two four-drawer filing cabinets, the idea in both cases to help myself get better organized. If that sounds nuts, so be it.

While I’ve been sleeping less, I sure don’t feel refreshed after only a few hours’ sleep, which is the hallmark of that particular symptom. On the contrary, sometimes I get drowsy and doze off, albeit only for a couple of minutes at a time.

Ordinarily I take only Depakote (a prophylactic against hypomania) and Lamictal (an anti-depressant), plus, if necessary, Ambien CR (a sleeping medication) at night. But by a standing arrangement with my psychiatrist, at times like this I add Clonazepam (aka Klonopin, a mood stabilizer) to the mix, just to be on the safe side.

Actually, aside from being a little tired, I feel as “normal” as I can recall having felt in quite a while. I’m trying to appreciate it while it lasts, because it won’t. What’ll happen eventually is that all of a sudden my sense of being an ordinary person like everyone else will vanish, my reasons for thinking so will seem illusory, and it will seem crystal clear to me that my life is a waste, that I will never recover my old productivity, and that the attempt on this blog, for instance, to chronicle what it is like to have bipolar disorder will seem not constructive and maybe even courageous, but pointless and even inappropriate. And then I’ll just have to suck it up until things improve again.

Mood Watch - 12

Wednesday night (September 6/7) I got about four hours of sleep, but was so bleary that by mid-morning I took a 90-minute nap. Thursday evening (September 7/8) I went to bed around 10:30 p.m. and awoke — once again feeling it must nearly be dawn — a little after 2 a.m. Which makes 3.5 hours of sleep, or about nine hours in the last twenty-four. I feel OK otherwise, but until my sleep pattern improves, there’s still some danger of, to invoke the jargon, decompensation. Well, I’ve been here too often to get alarmed. I’ll just have to keep an eye on things.

Mood Watch - 11

Last night I went to sleep at about 10:30 p.m. This morning I awoke around dawn; I figured 6 a.m. or so. It took me fifteen full minutes to realize it was barely 2 a.m. Except for a bit of clumsiness in my typing, I don’t feel tired at all.

Luckily, I don’t feel like doing anything generative or creative or audacious or whatever. I’m just making a cup of coffee and starting to get on with my day.

Mood Watch - 10

Slept an unbroken seven hours last night — always a reassuring thing in the context of an overall pleasant mood. Had a good, productive day yesterday and look forward to another today. I sure hope it’s productive; I’ve got a lot to do.

Mood Watch - 9

I’m wrapping up my trip to Washington and flying home this afternoon. I’ve had a very good time — was interviewed by a film crew making a documentary about Sherman’s March and got to visit with a couple of friends, one of them a fellow Civil War historian, also flown in to be interviewed, whom I hadn’t seen in two years.

As often occurs when I travel, I have been sleeping less than normal. Thursday night it was more or less my own fault: I stayed up late and got up early in order to be as well prepared for the interview as possible. But last night I went to bed around 2 a.m., having spent the evening chatting with my Civil War friend over several pints of Guinness, and awoke around 5 a.m. I was and remain a little bleary but no way was I going to get back to sleep. It just wasn’t in the cards.

It’s always impossible to know for sure what influences my moods — how much is biochemical, how much is existential. Often I have the feeling that, because I am depressed so much of the time, the experience of just feeling normal gets amplified into exhilaration. Thus, paradoxically, feeling normal can feel a bit like the first stirrings of hypomania. And maybe it is the first stirrings of hypomania. To repeat, it’s impossible to be sure, so one just has to be ceaselessly vigilant. And it probably wouldn’t hurt to take a klonopin tablet (an anticonvulsant that, in the Alice in Wonderland world of bipolar biochemistry, is effective as a mild mood stabilizer).

Mood Watch - 8

The night before last, I was sleeping just fine, thank you, until an excruciating muscle spasm in my calf brought me wide awake. After that, there was no chance of returning to sleep. Instead I got up and I got started on my day, having had maybe four hours of sleep.

I felt reasonably upbeat about the world — how different life seems during the “normal” times — and had a good, solid, productive day. True, I was kind of red-eyed throughout, but it was no big deal. Slept just fine last night: a full seven hours of deep, uninterrupted sleep. And when I awoke, I was glad to face the new morning. Is life routinely like this for most people?

This afternoon I fly to Washington to be interviewed tomorow for a prospective History Channel documentary on Sherman’s March. I was supposed to return tomorrow night, but asked to have the flight pushed back a day when I learned a good friend and fellow Civil War historian would also be in town. I’d like to see and catch up with her a bit. I’ll also be visiting a couple of other friends, including the Army officer with whose family I recently vacationed in the North Carolina Outer Banks. He’s back at the Pentagon now.

Mood Watch - 7

I didn’t sleep at all last night, Ambien CR notwithstanding. It’s a bit frustrating when that occurs but not, in itself, cause for alarm. I just keep an eye on how I’m doing otherwise. Do I feel tired, the way one normally would if sleep-deprived, or do I feel energetic and raring to go? Are any other symptoms present? If not, my usual practice is to work through the day without a nap, so as not to throw off my normal routine. As they say, good “sleep hygiene” is an important element in combatting the disorder.

The one downside, and it can’t really be helped, is that I’m too tired to do anything that requires serious mental creativity. I can answer email and do more or less mechanical tasks, but that’s about the extent of it. Actually, “downside” is probably the wrong word. It would be cause for alarm if my brain were anything else but sluggish.

Mood Watch - 6

People unacquainted with bipolar disorder typically think of the mood swings as being like those of a pendulum: a period of elevated mood, followed by a gradual shift to “normal,” and then eventually on to a period of depression. In fact, for many people with the disorder it isn’t like that, and in my own case I would say that the simile doesn’t apply at all. Instead I tend to drop quite suddenly into depressive spells and recover from them almost as abruptly. When I do, I generally feel a great deal of energy and a certain resistance to going to sleep. That’s how it’s been for the past few days.

The energy is, not, in and of itself, a bad thing. To some extent I think it owes to sheer relief at being part of the human race again. The things I have to look out for are along these lines: flight of ideas, pressured speech, distractibility, reduced impulse control — e.g., making a lot of sudden unplanned purchases — and so on. As long as these symptoms are absent, and especially provided I can focus on the main tasks at hand, things are more or less okay. I say “more or less” because I can never let down my guard. This is an illness that is trying to kill me, one way or another, and if it can’t kill me it wants to derail my life. I never forget that.

As for sleep: I’ve always been a night owl and the sort of person who lies awake for an hour or two before drifting off. At times such as this, when I feel a decreased need for sleep, it’s imperative to intervene with something that can reliably put me out. Historically that proved fairly hard to do. I went through quite a few medications before getting a prescription that worked — in my case Ambien CR. The previous options tended to be too clever by half; e.g., anti-seizure meds that had the side effect of causing drowsiness.

Sometimes — not at the moment, but sometimes — even the Ambien CR won’t put me down. I start feeling like a zombie in a Grade B movie: The Thing That Would Not Sleep. Luckily about a year ago my psychiatrist and I discovered, almost by accident, that Geodon is the equivalent of a headshot to that metaphorical zombie. The only problem is, when I wake up I’m groggy for hours afterward.

One final observation is in order concerning the relationship between the illness and working for long periods at the computer. Without a PC I simply could not get my work done. Even so, a hallmark of the disorder, as I have experienced it, is that working with a computer functions somewhat as catnip to the manic side of the illness. I can’t exactly dispense with it. The best I can do is walk away from it and do something else for a while.

I noticed this yesterday, for instance, while refurbishing . . . a political blog I started briefly in early 2005 before realizing I simply didn’t have time for it. For reasons I’ll get into some other time, it’s a blog I need for the next few months, so I didn’t begrudge the time. And I enjoy tweaking the templates and HTML code, etc. For me it’s like doing the New York Times crossword puzzle. But it can really suck you in. You fiddle with the code, check to see how it works, tweak it until you get it right. . . . The continuous incremental feedback seduces you to stick around for just one more fix.

The odd thing about it is, there are other times when I can scarcely stand to look at a blog, much less post an entry or do any fine-tuning.

Anyway, that’s the status for today.

Mood Watch - 5

Had enough energy yesterday to take care of a back log of chores, most notably the laundry, of which there was quite a stack following my return from vacation. Also spent at least a couple of hours uploading our new church directory to the web site, though for privacy reasons, I’ve limited access to church members only. And I caught up with the ceaseless rain of incoming email correspondence. Doesn’t seem like much. Point is, I felt like a member of the human race again.

Recently this blog has been getting a number of visits from one Shazer, aka Shae (hi there, Shae!), a 20-year old undergraduate at Brigham Young University. Shae, as you can see from her blog, has been writing with unusual honesty about her own experiences with counseling. As I’ve watched her blog evolve to incorporate a short blogroll, I’ve naturally been intrigued by her selections and this has led to my discovering several other interesting blogs, all of them concerned, in some way, shape, or form, with mental health issues.

Finally I stumbled upon Bipolar Planet, a recently created blog that serves as a gateway to a Net Ring devoted to blogs whose prominent theme is the struggle with bipolar disorder. It occurred to me that this was both an audience inclined to be supportive of my venture and also one to which I might have something to contribute. So I threw my blog into the ring, so to speak, and embedded the relevant code at the bottom of the main page. It isn’t active yet, since apparently someone has to visually inspect each applicant blog to make sure it’s indeed appropriate for the ring and not something like Manic Nymphos on Webcam.

A reader comment about the stigma that still attaches to mental illness got me poking around the web in search of sites devoted to extinguishing it. I was particularly interested in finding a sort of patch, like “Another straight for GLBT rights,” that would be a suitable addition to the blog’s sidebar. I did find a few things here and there, but not as much as you’d think, and certainly nothing of the scope that is usual for many other social concerns. And no patch; at least, not one that was sufficiently self-explanatory.

Well, anyway, I’m out of time for this entry. It’s off to church. Oh joy: another chance to warm a pew!

Mood Watch - 4

Woke up this morning feeling like a normal human being again, whatever that is. In my case, it means waking up from a good night's sleep -- 7 or 8 hours -- and wanting to get up and on with my day. Over the years I've learned to trust this as a good augury.

It also highlights the nature of my depressions. They are not, as some might suppose, like the swinging of a pendulum, with a series of up tempo days eventually giving way, gradually, to a series of bad one, and then slowly vice versa. In my case, depressions arrive and depart quite abruptly, like wading in the ocean and suddenly stepping into a hole in the bottom.

Anyways, it's about time. I've got a lot of chores to catch up on.

Mood Watch - 3

I'm back from vacation. In general I had a great time with some terrific people, but about midway through I could begin to feel my spirits slip. It's almost impossible to pinpoint a significant change in mood within a day or two, because it takes time for the pattern to become obvious. But by the weekend I definitely felt out of sorts, and for most of this week I've been so low that I've had little energy or interest in anything.

In some ways I've come to regard such times as no different from having a bad chest cold. You don't beat yourself up about having a cold and you give yourself permission to be ill. But in others I still retain a gut-level feeling that this is something to be ashamed of, or at least hidden discreetly away. It's only now that my spirits are improving that I can nerve myself to compose this post.

Coincidentally I saw my psychiatrist today. I have an appointment with her about every other month, mostly just to manage my medication. There's a small arsenal of meds available to deal with bipolar disorder -- both the underlying illness and its symptoms -- but the two principal ones are 1) a prophylactic against manic episodes (typically lithium carbonate or, in my case, depakote), and 2) an antidepressant, for obvious reasons. The depakote works fine for me but in two decades I've never yet found an antidepressant that did any good. I've tried at least a dozen at various dosages and so far, no dice.

The latest candidate is Lamictal. Like any drug it has potential side effects, the worst of which, in this case, is a horrible death, to wit: "severe and/or life-threatening rashes and hypersensitivity reactions." For that reason you begin by taking a 25-day starter regimen that builds up the dosage very gradually so that if you're one of the unfortunate small minority who develops "skin rash; fever; hives; swelling of the lips, tongue, or face; sores in the mouth or around the eyes; or swollen lymph glands," you can discontinue the drug in time to avert the worst.

The fact that anyone would even fool with this should give some indication of just how bad these depressions can be. Actually, it's not how bad they are per se; it's how unrelenting they are.

Mood Watch - 2

Third day of vacation. Mood still good and I'm sleeping better. Got nearly ten hours last night, and needed it after two days on the road.

Mood Watch - 1

A couple of days ago I was talking with my therapist as I usually do most weeks. Since I have bipolar disorder my insurance is happy to pay for the visits. It's a lot cheaper to spend money paying for a therapist to supplement my psychiatrist and meds than it is to pay for a two-week hospitalization.

Anyway, I invariably begin the sessions by reporting on my mood. After that we typically move on to other subjects. Because my therapist -- a clinical psychologist -- is a standout in her profession and because I've been seeing her for a bit over eight years now, the experience has proven very helpful in coming to grips, not just with the bipolar disorder, but also with a lot of old wounds. Since I doubt I would ever have landed in her office except for the bipolar disorder, I suppose having this particular illness has not been entirely devoid of an upside.

On Friday we talked mainly about this blog and the direction I've decided to take it. I think she has seen this coming for a long time. She wasn't surprised. She thinks, more than I do, that I know what I'm doing. But at the same time when I mentioned the idea of using the blog as a place to keep regular track of my moods, she thought that was a good idea too. Hence the first in what I expect will be a series of posts published every day, or nearly so.

For the uninitiated, here's the basic symptomology, shamelessly cribbed from Harbor of Refuge.

Bipolar disorder involves cycles of mania and depression.

Signs and symptoms of mania include discrete periods of:

• increased racing and rapid talking
  
• Excessive "high" or euphoric feelings
  
• Extreme irritability and distractability
  
• Decreased need for sleep
  
• Unrealistic beliefs in one's abilities and powers
  
• Uncharacteristically poor judgment
  
• A sustained period of behavior that is different from usual
  
• Increased sexual drive
  
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
  
• Provocative, intrusive, or aggressive behavior
  
• Denial that anything is wrong
  

Signs and symptoms of depression include discrete periods of:

• Persistent sad, anxious, or empty mood
  
• Feelings of hopelessness or pessimism
  
• Feelings of guilt, worthlessness, or helplessness
  
• Loss of interest or pleasure in ordinary activities, including sex
  
• Decreased energy, a feeling of fatigue or of being "slowed down"
  
• Difficulty concentrating, remembering, making decisions
  
• Restlessness or irritability
  
• Sleep disturbances
  
• Loss of appetite and weight, or weight gain
  
• Chronic pain or other persistent bodily symptoms that are not caused by physical disease
  
• Thoughts of death or suicide; suicide attempts

Got all that?

My mood for the past two weeks has been good. I have been able to focus and enjoy my work and I have not experienced any racing thoughts, euphoric feelings, or increased distractability. The one thing I have noticed is a decreased need for sleep. I get maybe five or six hours in any twenty-four hour period, and usually not all at one time. For instance, in the day just past I slept a total of six hours but in three two-hour increments. That's the one element right now that bears watching.

I'm up early this morning because I'm about to leave for a week or ten days of vacation. I travel first to Abingdon, Virginia, to see some old friends, and then on the Outer Banks of North Carolina where I've been invited by an Army lieutenant colonel to spend a few days with his family at their seaside condo in Duck, just north of Nags Head. As far as I know, I'll have regular Internet access, so at the moment I see no reason I won't be able to compose these daily posts. But if I miss a day or two, consider it no big deal.

This Is NOT the First Post

The actual maiden post for this blog is here.