Category Archives: diagnosis

The Great Big Cyclothymia Q&A

This Q&A is almost entirely composed of search terms which have brought people to my blog.  I’m no expert, but over the years I like to think I’ve collected some instructive experiences and learnt, often from my mistakes, a few things which may, if not help others, then at least provide them with a perspective to consider as they continue researching these things.

How do you deal with a colleague who has cyclothymia?

I recommend dealing with a colleague who has cyclothymia in exactly the same way you deal with a colleague with curly hair.

If you would like to help a colleague who has cyclothymia then your first stop should be having a conversation with them about what they might need in the work place – it could be a friendly face, a regular coffee break or lunch-date with a colleague, it could be additional meetings with line managers to help flag up feelings of being overwhelmed or excessively stressed before they turn into massive problems.

If you have cyclothymia and you’re thinking about how to deal with this at work I recommend looking at the Mind website. They have extensive advice on being mentally healthy at work and the possible risks and benefits of ‘coming out’ at work about your mental health issues.  I personally have never disclosed a mental health problem to an employer, with mixed results.  The most negative experience was when I was a manager and my staff told me “you’re funny because you’re great to be around sometimes because you’re so enthusiastic and positive but sometimes you’re incredibly grumpy and it’s no fun working here then” which came as something of a surprise as I thought I was hiding my mood swings well.  If you’re considering disclosing your mental health status to an employer or colleagues remember that they probably already know something about you is cognitively….off.

Can you hold a job with cyclothymia?

This really isn’t a question with a definitive answer.  It depends on you, how well you are able to manage your moods, how you respond to stress, how much stress your job entails….Personally. I’ve found jobs which have a degree of flexibility – for example office work which has varied tasks to be completed in a month ranging from mindless data entry to complex accountancy work – to be one of the better positions I’ve held as I was able to set my own schedule for the day or week, and work around my capacity for concentration and originality at any given time.  Conversely, working in customer service, whilst tremendously easy when hypomanic, was excruciating and often-times disastrous when I was depressed.

Holding a job with cyclothymia, like any other mental health issue, is a question of how well you manage your symptoms, what degree of flexibility you need and can have, and how much you disclose to an employer and their response.

Is cyclothymia an excuse/reason for being rude?

It’s not an excuse, but it can often be a reason.

Both highs and lows bring their challenges for social interaction.  I talk over people when hypomanic and am curt with people when I am depressed.  I work hard to remind myself to think first and act and speak second.  But impulse control, as you likely know if you are reading this, can be a huge challenge when at the extremes of mood.

I always maintain that no matter what my mood, I am accountable for my actions – I apologise to friends and family I think I may have offended or upset as soon as I am able, and I try and let close friends know where my mood is so they can be prepared for some irrationality.  How well your friends tolerate your moods is down to a lot of factors – their patience and understanding, your willingness to be accountable for your actions, and sometimes, just dumb luck.

Should I tell my friends I have cyclothymia?

My close friends know, acquaintances and colleagues don’t.  As I say in the above point, having your friends understand why you may act erratically or very differently from one week to the next can help you maintain better relationships. Friends can also offer support and understanding when you really need it.

In the end, it’s up to you – what do you want to get out telling your friends? Do you want to help them understand you better? Do you want to ask them for support in some areas of your life? Do you want them to know that you understand their struggles with mental health because you have your own? All good reasons to share. If you want to tell your friends in order to get a carte blanche to treat them differently or to demand they alter their behaviour around you then you may want to think more deeply about how you relate to these people and what is reasonable, or unreasonable, to ask of people.

Does cyclothymia affect concentration?

Poor concentration is a symptom of depression.  Inability to focus on a task or subject for an extended amount of time is a symptom of mania and hypomania. So in summary? Yes.

Anecdotally, my concentration levels are one of the key ways I monitor my moods.  The moment my concentration drops significantly, I know I’m heading up or down.  We’re talking about something more significant than a tendency to procrastination, or that fidgety Friday feeling we all get; we’re talking staring at a page and reading the same sentence 6 times but taking nothing in. We’re talking abandoning one task to begin another because a better idea just occurred to you.  Lack of concentration, when it’s symptomatic of cyclothymia, describes just not being able to discipline or motivate yourself into acting in any other way than you are; it can mean doing a job is like wading through treacle so hard it is to make your mind process anything, or feeling like a butterfly on speed, flitting from one idea or job to the next without a pause in between, but completing nothing.

What are the habits or behaviours typical to cyclothymia?

I’ve written in various entries about some of the common experiences of cyclothymia, from hypomania, to anxious compulsions, to the suddenness of the onset of mood swings which is characteristic of cyclothymia.  I tag entries dealing with my experiences of specific symptoms of cyclothymia with ‘symptoms and habits’

To a degree, manifestations of cyclothymia are as unique as the sufferers, in other ways, there are a distinct list of symptoms which we all experience to a greater or lesser degree – some of which are also common to other mental health disorders.

Is my psychiatrist right about cyclothymia?

Short answer; yes.  Long answer; no.

Psychiatrists have a habit of telling people with cyclothymia that without treatment it will develop into bipolar II but this seems to be anecdotal and difficult to disentangle from people being re-diagnosed with Bipolar II after not responding to treatment for cyclothymia.  Psychiatrists, in my experience, also have a habit of insisting your life will be dramatically altered because of cyclothymia, and that you cannot successfully manage it alone – this may not be true, or it may.  There are so may variables in anybody’s life which make such pronouncements utterly meaningless.

Seek advice and information on cyclothymia from your GP, psychiatrist, from Mental Health charities or advisers, and speak to other sufferers.  Do not allow yourself to be pressured into decisions or treatments you feel uncomfortable with and feel empowered to ask for second opinions.  Psychiatrists do not have all the answers, they are not sooth sayers, they do not have a crystal ball.

I wrote a little on my experiences of following, and not following, a psychiatrists advice in my post ‘things I want you to know if you have cyclothymia

Can you manage cyclothymia without medication?

Perhaps.  I can.  Or rather I am trying.  Its a continual process and it depends heavily on your lifestyle, your job, your experiences of medication and your ability to maintain healthy routines.

I have written here, and here, about my attempts to manage cyclothymia without medication.  After a few years, it’s still currently the right choice for me; it may not always be the right choice for me and it may never be the right choice for you, but it is possible.

What medication can be used to manage cyclothymia?

I have taken a slew of anti-depressants and the last medications I was on were Seroquel and Mirtazipine which worked to an extent but ultimately I decided the benefits were outweighed by the side effects.

Wikipedia has a very brief list of the medications commonly used to treat cyclothymia as does the NHS choices website (scroll down for ‘How is it treated?’) For detailed information on a drug you have been prescribed I recommend asking your doctor or psychiatrist, and having a look on the Crazy Meds site which I have always found to be both frank and accurate.

How do you live with cyclothymia?

This is the question my entire blog is aimed at exploring.  There isn’t, I am confident, a single answer.  I’m finding careful use of some medications (anti anxiety and sleeping tablets), occasional short courses of talking therapy, healthy physical routines and habits, and being tolerant of my own fluctuating reserves of energy and resolve, all contribute to me feeling in control of my life with cyclothymia.

It’s not an easy road, but it is one that it is possible to walk, with time, and effort put into finding what does and doesn’t work for you – either alone or in conjunction with mental health professionals, and supportive friends and family.

And finally, a google search term I couldn’t turn into a question;

Cyclothymia and stupid people

Unfortunately, cyclothymia does not bestow you with the super power to avoid stupid people, or eradicate them from your life. Sorry.

Have you still got a question that needs answering? Do you want to add to or query any of these answers? Please drop me a line in the comments.

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Filed under cyclothymia 101, diagnosis, medication, self-hood and cyclothymia, symptoms and habits

Builder of Routines

A common symptom of both down swings and up swings for me, is anxiety.  And with anxiety, come compulsions.

Let me be clear, I don’t have Obsessive Compulsive Disorder, nor am I ignorant enough to suggest I’m ‘a little bit OCD’, I’m not.  What I do experience, is an urge to fulfil certain behaviours during times of high stress and/or anxiety.  These compulsions, these habits or routines, are crutches I fall on.  They are as comforting and as irrational as a child’s security blanket.

I’ve mentioned before, briefly, that I am a Manic Street Preachers fan.  The most recently released album included a track called ‘Builder of Routines’ which articulates the feelings I have around the routines, or compulsions I sometimes feel (You can listen to the track here).  In order to talk about how this mood takes me, and the experience of being gripped by compulsions, I’m going to work through some key sections of that song.

I have sealed myself in /Laminated all of my skin/Sellotaped my world in bits/I must embrace paralysis
I go into a closed loop, no new experiences or sensations in – the very idea petrifies me – but so doing closes off the world to me. Everything outside my front door is overwhelming, too much noise.  But working within the closed loop, closed system, robs me of any creativity or originality. I become paralysed as I repeat the same actions and activities over and over.

Builders of routines/It makes me safe and clean
Everything calms down when I start going through a routine. Cleaning the kitchen, picking pieces of fluff from the floor, remaking the bed, brushing my teeth in a particular order with rinsing/spitting/brushing, listening to the same song again and again until I get it right…I can’t even articulate that last one properly.  I have to go through it, singing, or running through the lyrics, again and again until I get it right. Or I practice conversations – how will I introduce a funny anecdote? What is every possible response I could get? How will I reply? How will I pronounce each word?  Over and over, running through every scenario, past present future.

It doesn’t make me safe and clean, as such though, because the execution of the routine is never perfect. But trying, doing it over and over, silences the frantic parts of my mind for a few minutes at a time. And a few minutes silence can be worth every agonising moment of precise action.

It crucifies parts of me/But never seems to make me bleed
There’s a numbing quality about doing things over and over, be it eating the same dinner every night for three months (it was beans on toast when I did that) or cleaning the kitchen just right, making it ‘safe’ enough to rest.  Part of me goes to sleep, is silenced, is numbed, is crucified.  It doesn’t leave a mark though – the hours, the days, spent doing the actions that bring temporary quiet to my mind – no evidence of the violent compulsion that came before.  Not a drop of blood spent.

 

Writing this entry has been excruciating.  I am going through a period of compulsion and anxiety and getting each successive word down has been like pulling out a piece of me. I’m left exhausted after each sentence. Pushing out of the compulsion, pushing out of the places I feel safe, in order to write something ‘new’ is a huge undertaking. It’s easier, maybe even safer, to stay sealed in.

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Filed under diagnosis, media &c, symptoms and habits

Mania Misunderstood

I’ve written previously about cyclothymia being misunderstood, and that having cyclothymia is not only and always characterised by bad things/negative symptoms, but I want to revisit parts of both of those posts and talk about a common belief that mania (or in the case of cyclothymia, hypomania) means feeling incredibly happy and positive.

It is true that hypomania can sometimes be an enjoyable stage in the mood cycle; hypomania can be characterised by feelings of happiness and well being, but it doesn’t end there.  To illustrate just how difficult hypomania can be, let me describe the circumstances which led me to be diagnosed with cyclothymia.

I had come out of a long term relationship and had a messy break up.  I moved into a new flat and I started going out.  All the time. With everyone. Dancing, drinking, a snifter of drugs here and there.  I’d go to work with a raging hangover on 4 hours sleep, then do it all again the next night.

In itself, probably not that remarkable.  But instead of levelling out, having my moment of grieving, and moving on and dropping back into a normal rhythm of life, everything got faster.

Drink, fall in to bed, sleep a couple of hours, work, drink, dance, fuck, sleep, drink…repeat.

I was at every party every night of the week, and if there was no party, I’d down a bottle of vodka at home.

I couldn’t rest, I couldn’t sit, I couldn’t be quiet.

One day I got up after almost no sleep and rolled into town.  I started shopping. And I didn’t stop until my credit card was maxed-out.  I remember calling my best friend as I walked from one shop to the next. I was annoyed because I couldn’t find much to buy in the last shop I’d been in.  I gabbled down the phone to her for a few minutes and she cut in; “are you drunk?”

And so it continued.

Being [hypo]manic is like being drunk, but it stops being the fun kind of drunk really quickly.  It’s more like being drunk at the end of the night, everyone has gone home or fallen asleep but you’re only just hitting your stride. Except unlike being drunk, you’ve been ‘hitting your stride’ for days. Unlike being drunk, you can’t use tried and tested strategies to sober up. A good sleep, rehydration sachet, a jacket potato, black coffee, none of it works. And some of it, like a good sleep, is flat out impossible.  I’ve stayed awake through a triple dose of sleeping pills.  I’ve slept fitfully for 4 hours, felt exhausted but simply been unable to close my eyes and drift off. Day after day. Night after night.

And then there’s the spending. It took me over a year to pay off the credit card I maxed out in a day. People like Stephen Fry can, I am confident, afford their hypomanic spending sprees, I can’t.

Nothing is interesting enough to occupy you for more than 20 minutes.  You run rings around people at work and they look like they are moving at a snails pace to you.  Nothing you can smoke, drink or snort hits your brain where you want it to, occasionally it just takes the edge off long enough for you to fall exhausted into bed and sleep properly for a few hours.

It was in this state, nervous, anxious, exhausted, unsettled, bored and overwhelmed, that I went to my GP. I sat down and it all poured out of me; can’t sleep, exhausted but can’t stop moving and thinking and doing.  Calling my friends because I can’t bear to be alone but none of them having the energy or time to keep up with me.

He prescribed me sleeping pills. Assured me it would be ok, he would help me get help.  And I sat there, feeling empty and lost.

Later came the referral to a psychiatrist (although my GP was as good as his word, I recall only waiting a week or two) the anti-psychotics, and finally, a diagnosis.  And with the diagnosis came recognition and, over the years, an understanding of my mind.

Hypomania? It doesn’t mean happy to me, it means being afraid of the speed and volume of my thoughts. It means urges and compulsions that just cannot be quelled.  It means go, go, go.  It’s means exhaustion, it means an energy debt that’s going to be paid, really soon, with an almighty down-swing. It can be fun – free-wheeling confidence.  But it can take me to the very same dark places that depression does, and further, because insatiable desire and unquellable tongue are difficult to be around.  I think it can be harder to support someone who is manic than depressed because they barely know where to begin with what is wrong.  Even now, I rarely know what will help.

Sometimes I ride it out, grabbing at the good things that go past.  Other times hypomania is a terrifying ride in a car with no brakes, and I hold on terrified I’m a moment away from being smashed to the ground.

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Things I want you to know if you have cyclothymia

When I was first diagnosed with cyclothymia in 2009, I followed the advice of the psychiatrist – along with heeding his dire warnings of the inevitability of developing ‘full blown’ bipolar – and dutifully began a lengthy course of anti-psychotics (Seroquel) and anti-depressants (Mirtazipine).

They hit my body hard – I put on about 2 stone and tottered on the edge of being clinically overweight.  I slept 12 hours a day and when I missed a dose I felt like I had bugs crawling around in my skull.  After about a year battling through such fog, fatigue and feelings of ‘fugliness’ I decided to come off the meds and give self management a crack.  I approached my GP for assistance with this. but he refused to assist as I – foolishly – admitted I still had all the same mood symptoms which had prompted the psychiatrist to prescribe them.

So I did it alone, cold turkey.

I sometimes wonder, 2 years on, what damage I did to my brain chemistry in coming off meds like I did – I certainly wouldn’t recommend anyone else end their usage in that way and I think the ‘bounce back’ effect such a sudden removal of chemicals had on my brain, caused the 6 months or so following that decision to be extremely difficult.  It really underlines the need for better patient advocacy and support for mental health patients.  Nonetheless, here I am.

A combination of life events and going completely med-free for the first time in many, many years, caused a number of physical symptoms and illnesses to arise and I now suffer from a small number of physical problems relating to anxiety and stress which were diagnosed after rounds of physical investigation and tests.  Management of aforementioned physical ills can be done through drugs or through lifestyle changes and self management.  After experimenting with medication, as I did with psychiatric drugs, I found a more holistic route to managing my physical ailments.

What would I tell someone else looking for advice on how to live with cyclothymia based on my several years accumulated knowledge?  A few things;

  • As ever, remember – tell yourself, your family, your friends, your doctor – this is not a mild condition, it is a milder form of a very serious condition.  It destroys lives and rips apart relationships. Do not let anyone, or yourself, underestimate it.  But don’t fear it.
  • Cyclothymia kills – when you wake up depressed you lose all sense of perspective, you believe you’ve felt this way for days, weeks, months, not hours.  You can only remember any other state as being terrifying, free wheeling mania and, because you are depressed, all you feel is anxiety and guilt over the times you were manic.  People with cyclothymia – as with other psychiatric, depressive conditions – make stupid, short-sighted, snap deicisions.  And some of those decisions you don’t – can’t – come back from.  Never let being told you have a ‘mild’ condition stop you from picking up a phone/walking into A&E/screaming for help.  Do not become a victim of cyclothymia.
  • You probably won’t get better from cyclothymia or ‘get over it’.  But you will, very likely, find a way to manage it.  Sometimes the highs and the lows will be worse than others, sometimes they will be better.  Cyclothymia is a living thing – it waxes and wanes, grows and shrinks.  If you can work – alone, with friends, in therapy, with a CBT workbook,anything, to find a way to identify what exacerbates or contributes to periods of acute depression or unending mania then do it – in the long run it will help you tremendously.
  • You will not definitely get ‘full blown’ bipolar.  Psychiatrists do not have crystal balls, they have not met every person with cyclothymia and followed them for the whole of their lives, they cannot know how your mental health will unfold over the next 10, 20, 50 years.  Do not let them bully you into decisions because they are telling you to be afraid.   Ask for an advocate – such as from the charity Mind – to be present at your meetings.  If you have sympathetic family and friends, ask them what they think about you taking meds; my friends helped me decide it was the right choice for me when the psychiatrist told me I needed to take anti-psychotics and anti-depressants, my friends also confirmed what I suspected when I felt I was ready and able to live med free.
  • Don’t believe that living ‘med free’ means living ‘medical help free’.  Sometimes I get to a point where I haven’t slept for a week, or I haven’t sat down for 48 hours, or I can’t stop cleaning the kitchen because the little anxious ticks have blindsided me and I’m useless.  When that happens I seek out the help I need – sometimes that is sleeping tablets or anti-anxiety medication (although I recognise I abuse meds and alcohol, so I choose the least addictive, least easy to abuse option) and sometimes it is a talking therapy session.  I am lucky in that I am currently enrolled at a university so I can use their counselling services for free and at short notice.  If you have a good GP and/or CPN you should be able to quickly access short term talking or counselling therapy on the NHS.  If you have money, you can always go private.
  • You haven’t failed: sometimes I go months without acute mood swings – I recognise they are there and I feel the ebb and flow of the ups and downs but they don’t inhibit my movement or life – sometimes I get the very worst of the ups and the downs for a few months in succession.  Whilst I am not able to recognise it in the midst of the black – and most likely you won’t be able to either – I try and reflect back on those times afterwards, see if I can identify what contributed to such a bad period, or what I might be able to do differently, but I also do something nice for myself – buy a new cd, have a long bath, take a day to myself watching my favourite movies – you don’t fail when cyclothymia symptoms become pronounced, you succeed when they fuck off again.
  • You are in control; ultimately, how you handle the ups and downs, how you respond to other people/how you treat them (it might be an explanation, but it’s not an excuse for being rude/evasive), and how angry you feel about cyclothymia ‘picking’ you, is up to you.  Let it consume you and it will.  Focus on it and you will see nothing else in your life.  Kick it in the arse whenever you can, forge strong and meaningful relationships and friendships with as much or as little explanation as you want, make plans to help yourself – I give myself permission to nap after work when I am particularly low, I set a ‘2 day’ limit on time off work without a doctor’s note for when I am so anxious or unhappy I can’t face myself in the mirror.  Yes it is hard, and yes sometimes it does feel like a unending battle, but it is all I know and sometimes, albeit only sometimes, I’m pretty sure I’m a step and a half ahead of where I was in 2009.

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Filed under asking for help, cyclothymia 101, diagnosis, medication

Cyclothymia is not mild

The first thing I did when I received a copy of the letter from the psychiatrist to my GP was to Google this strange new diagnosis; cyclothymia. I had been in the mental health services system since I was 16 with anxiety, then ‘disordered eating’ and, most recently and for the longest time, depression. Deep down, I always knew I was only ever telling GPs, therapists, counsellors, and psychiatrists half the story; it wasn’t only feeling unhappy that made me afraid of my own mind, sometimes it was being unstoppable, unsilenceable, inspired, frantic…manic.

Every result I found on Google described my experiences up until then; often undiagnosed or misidiagnosed as unipolar depression due to the fact people can make allowances in their life and ‘get by’ with the manic end of cyclothymia, alternating periods of high and low mood with no more than 6-8 weeks without any symptoms, quick temper, hypersomnia and insomnia, easily distracted, lack of concentration…..but again and again, in page after page the same word kept cropping up; “mild”.

‘Mild’ was like a kick in the teeth to me. I had gone to my GP on my knees; I had maxed out my credit cards in a 4 hour spending spree, had a pregnancy scare after unsafe, impulsive sex with a stranger, I’d been sleeping 4 hours a night and my head had been so noisy with thoughts, ideas, self-recrimination, and I had had enough. He had scribbled it all down and got me in to see a psychiatrist who prescribedanti-psychotics on top of the anti-depressants I was already taking. The anti-psychotics were like a hammer to my exhausted mind but I luxuriated in the quietness of my mind.  ‘Finally!’ I thought, ‘I know what’s wrong with me; bipolar is a real illness, with real, famous sufferers who nobody blames for their inability to get out of bed some days, or stop talking on others!’  Later, finding out, on site after site, that what I was suffering was ‘mild’, and frequently undiagnosed as people with it are busy getting on with their lives rather than going to their doctors, the triumph went out of my relief; was I just weaker than all these invisible, untreated sufferers?  Was it just something fundamentally unpleasant about me that meant I found it so hard to maintain relationships rather than, as had thought for a while there, the impact of dramatic and unpredictable mood changes?

Eventually though, after looking at a lot of websites, I started finding small online communities of other people with cyclothymia.  They told stories that I recognised myself; alienating friends, family and partners through their unpredictable changes of mood, being unable to hold down a job or work reliably because some days depression might body slam them back onto bed when their alarm goes off or because on a manic day it’s better to drive to the other side of the country or take a short break in Europe than go into the office.  They were telling each other something important; cyclothymia isn’t mild, it is a milder manifestion of bipolar symptoms.  Bipolar is to cyclothymia as a rock shattered in a massive earthquake is to a rock worn down to dust by steady, reliable, constant erosion; either way it gets worn away*.

The problem with the classification of cyclothymia as a mild mood disorder is that it gives rise to any number of misconceptions about what sufferers of cyclothymia, like me, experience. Trying to explain anything about the unpredictability and disruptiveness of your moods when they are officially ‘mild’, sounds like posturing and attention seeking. My depressive periods may only last a week or two at a time, but in the middle of them I can’t see the end, and I can’t remember ever being better. My manic periods might be read by people who don’t know me so well as hyperactivitiy or enthusiasm, but they leave me exhausted, embarrassed, and frequently poorer.

And the saddest, most dangerous thing about calling cyclothymia mild is that not only do some mental health professionals not take it seriously (I was advised it would eventually become ‘full blown bipolar’ and more help would be available to me then, but to get on with things until then) but some people diagnosed with it begin to believe they are exaggerating, or overstating their troubles.  I frequently remind myself that it is acceptable to shout for help when nobody is listening – that when a depressive mood takes a particularly viscous hold, or I have racing-negative thoughts, or I am so manic I can’t sit down or sleep – that those things are as real, as urgent and serious as any other manifestation of a mood disorder and I, just like everyone else with cyclothymia, deserve to be helped.

* This analogy was borrowed (with permission) from this great post

This post was originally published on the Mind blog, on Tuesday 26th March 2014 but has since been deleted in their site overhaul so the above link is via the Wayback Machine

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