One of the hardest things to work out when you are trying to manage your own moods is how to deal with bleak lows or unending highs. As I chose to manage my cyclothymia without medication, I am continually evaluating and questioning the coping strategies I choose.
I made the decision, after a year on prescription medications for cyclothymia (and even longer on anti-depressants and anti-anxiety medications) to manage my moods without medication, excepting the occasional prescription sleeping tablet, and, a few years ago, a short course in anti-anxiety meds. My GP supports me in this and is happy to prescribe medications when I express a need for a little more support. It’s not for everyone, but it’s the choice I made based on who I am, what I know about myself, and how I live. Due to the frequency with which cyclothymia is misdiagnosed as unipolar depression, or undiagnosed, many sufferers turn to drugs and alcohol to manage their mood swings. Some sources suggest as many as 10% of cyclothymia sufferers also have a substance abuse problem (we won’t speculate now on cause and effect) and the list of symptoms here, includes habitual use of drugs and alcohol to self-medicate. I am conscious that those two pieces of information seem to suggest that un[prescription]medicated, any alcohol or drug use by people with cyclothymia can be judged to be an attempt to self medicate the mood swings. It may also suggest, that simply not knowing what is ‘wrong’ – pre-diagnosis – means people with cyclothymia feel despairing and out of control, and turn to alcohol and drugs as both a comfort and a cure. Can simply being aware of the tendency to self medicate be enough to turn alcohol use into a less damaging or unhealthy practice?
Before I was diagnosed with cyclothymia, whilst on an unending merry-go round of highs and lows, I drank everything I could get my hands on and turned back to the oblivion of drugs which I had previously only sought out when I was a teenager. In the longer term, I came to think of that as a very happy period where nothing seemed off limits and everything was entertaining, but also one which exacerbated my loss of equilibrium. You introduce the artificial highs and lows of drugs and drunk/sober cycles and, inevitably, you are going to push the ‘natural’ rhythm of cyclothymic moods up a gear.
For this reason, I try and avoid excessive alcohol intake (the last hangover I had turned into a two day stretch of dreadful hangover blues, not cool) and I don’t touch drugs at all any more. However, it really isn’t as easy as deciding not to drink for the good of your health, there are always complicating factors.
The trouble with managing a mood disorder is that you can practice healthy routines all you like – good sleep pattern, regular exercise, days off from socialising and work scheduled in, regular meals, tactics for coping with everyday stress – but when you sit down of an evening, flick through a few pages online, or in a magazine, and a low hits you, completely out of the blue, like a blow to the chest, there are few responses which squash those brain gremlins as efficiently and speedily as a big glass of vodka. Conversely, when I’m feeling great on a hypomanic high, I tend to conclude I needn’t be too cautious about my alcohol intake because, obviously, I’m impervious to harm, and have more than once ended up a gibbering, mixed-mood, weeping, manic mess as brain chemicals and half a bottle of vodka fight it out.
I’m also not confident in saying “self medicating is bad” because, like so many other coping strategies – be they healthy or ‘unhealthy’ – it answers a need. How do you deal with the low that comes swooping from nowhere and smashes into your chest? How else do you bring yourself down for long enough to sleep? How do you remove the emotional block that sometimes grows up after a long period of anxiety or instability and open the flood gates to tears and rage and raw emotion? I’ve found ways to deal with a lot of things, but the only way I know to deal with these things is, still, to drink.
Is it healthiest to use a bad coping strategy occasionally if overall you maintain a better balance, or is it best to espouse all unhealthy responses to unpredictable and ultimately unmanageable mood oscillations? I really, truly don’t know.