We interrupt this blog to bring you a special report on a phenomenon that apparently affects only certain bipolar patients. It’s known familiarly as The Mixed Episode.
For the uninitiated, this is a combination of symptoms from both ‘poles’—mania and depression—and it is pure, unmitigated HELL. I was so screwed up during my recent dalliance with it that I didn’t know whether to pick my watch or wind my nose. I was running around the house, unable to stay still for more than a few seconds; I had the attention span of a flashcube; and I was cleaning everything that wasn’t red hot or nailed down. (Note: I DON’T CLEAN. My stay-at-home husband does most of it, and what he doesn’t get done…..doesn’t get done.)
OK, these behaviors usually give me the idea that I might—just might—be a wee bit manic. But then, I couldn’t stop crying either…..or thinking sad thoughts…..or feeling like there were worse things than death (namely, going on like THIS). There were several nights in a row when I just sat up in my bed and wept silently for hours on end, swinging one foot and rocking back and forth to try to comfort myself with the rhythmic movements, even as my mind raced and tumbled wildly like squirrels in a cage.
I was confused. I was manic. I was depressed. And I was terrified.
One night about two weeks in, I almost called the suicide hotline. Not that I really wanted to die, only that I wanted the pain to end, and I was half-afraid I wouldn’t be able to resist the temptation to gobble the 90 Ativan tabs I’d just gotten refilled. But I was even more afraid of that someone would call 911 and the police would show up at my door to take me to the hospital in handcuffs. So with the last of my resolve (and a promise to myself to call my doctor in the morning), I forced myself to lie still and try again to sleep.
This is a good time to have a psychiatrist who always returns my calls the same day, because he’s good like that. He also knows that I call him between visits only when I’m in big trouble, so it wasn’t more than about 20 minutes before he called me back.
“I’ve crashed and burned,” I sobbed into the phone, and went on to describe my collective symptoms in a manner that could probably best be described as tangential. When I finally finished, he told me that he didn’t see this as an uncontrolled mania since I was able to channel the energy constructively, a statement that instantly made me feel better. But once again I was puzzled: what about the crying jags? The catastrophic thinking? The overwhelming anxiety?
Long story short, what I was experiencing was the dreaded mixed-mood episode, which according to the books is a feature of Bipolar 1, which is NOT the kind I signed on for. Now, I’ve heard of people with BP 2 or even NOS being upgraded to BP 1 with the advent of a defining episode; this one may very well have been mine, even though we haven’t yet talked about changing the diagnosis. (There’s that damned OCD thing about getting hung up on numbers again. Will I ever learn??)
The good news is, doubling the dose of my antipsychotic took care of matters swiftly and relatively painlessly. The bad news is, I obviously NEED an antipsychotic for maintenance as well as acute mania, because not only did I get better, I’ve continued to improve to the point where I don’t feel bipolar at all anymore.
This is not an exaggeration—I haven’t been this healthy in YEARS. And for some reason, it doesn’t feel like a temporary respite from the hell of continuous mood episodes; this is a sense of well-being that I suspect is going to stick around for awhile. There is none of the urgency of hypomania, nor of the feverish drive to move and go and do (even though I have plenty of energy to do whatever I wish). What’s more, I’m coping well through an intensely stressful time due to the deterioration of my sister’s health to the point where I have to put her in an assisted living facility.
So I’m really, REALLY motivated to do what I have to do to stay well. That freaking mixed episode was more than just a blip on the radar screen—it’s as scary as anything I’ve ever been through, and if I never have another one, it’ll still be a day too soon.