Between Scylla and Charybdis

As I reported yesterday, I had gotten myself into a state of what I’ve come to call pre-hypomania, which is when I feel like an episode just might be brewing but could go either way. I was a bit over-amped, couldn’t stop wiggling, and talking a little too fast and a little too loud, in addition to feeling somewhat ‘off’ all day.

I found out why when I grabbed for my pill minder last night and found that I’d missed two of my meds from the night before! There sat the mood stabilizer and the antipsychotic, both of which had stuck to the bottom of the box. No WONDER I’d felt strange…..this disease keeps me on a very short leash, and I notice symptoms even when I miss only one scheduled dose. Whew! Dodged a bullet that time. Today I’m back to normal and all is well with the world.

However, this got me to thinking about how slender the line between hypo/mania, depression, and whatever is one’s ‘normal’ can be sometimes. Sometimes there isn’t one, and a mixed mood episode results. (More about this phenomenon can be found in previous posts here @ bpnurse.) But more often, life events will pull a bipolar in one direction or the other…..what can’t always be predicted, surprisingly enough, is which.

For instance, most people would think that the losses we experience in life—of jobs, social status, loved ones—would be a precipitator of depression. But true to form, the bipolar person’s mood may swing in completely the opposite direction and a manic episode may occur instead, which has given rise to the expression “funeral mania” to describe such an episode that happens following the death of someone close. There are also times when ordinarily joyous events, such as the birth of a child, can prompt the development of severe depression and even psychosis in the worst cases.

Where it gets complicated is when a mood shift seems to come out of the blue. As I may have mentioned, I tend to have more frequent highs than lows, and many of them have absolutely NO rhyme or reason except, perhaps, for seasonality—our short but magnificent summers in Western Oregon are almost guaranteed to induce mania in susceptible folks like me. I had one a year ago that was excruciating for everyone concerned, including my boss at the time, who wound up sending me home for a few days to get it under control. (This was one of the few times I’ve called my pdoc between visits; that’s when the big guns came out and I went on my first antipsychotic.)

But then there are times when mood swings literally have NO evident cause and catch us with our pants down. I went through another manic spell in February of this year that lasted all the way through March, which is typically when my winter depression slaps me flat. And three years ago, I actually got depressed in the summer and didn’t pull out of it until early autumn.

Of course, most of this happened before I was medicated, or medicated adequately anyway. But even now, it doesn’t take a whole lot to steer me off course, and then I find myself—again—navigating the stormy seas between Scylla and Charybdis, and praying my little ship doesn’t get dashed against the rocks…..or pulled into the jaws of the monster.