Category Archives: medication

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

Honesty is the best policy

I started this blog with the intention to share my experiences of living with cyclothymia, and some of the things I’ve learnt to make life a bit easier.  I’ve had a great response to some of the posts I’ve put up so far which has been really gratifying, and I’m working on a cyclothymia FAQ based on search results that are bringing people here (and please feel free to submit your own questions – and answers if you want – in the comments and I’ll include those too).  The flip side, however, is that this aim has become self-silencing.

I don’t have all the answers – I struggle with cyclothymia from month to month but also, sometimes, from day to day.  If I can’t tie up an experience with a “and this is what I’ve learned” I’ve become disinclined to blog about it.  I’m also reluctant to admit that dealing with cyclothymia is not an up and up process.  There are as many steps backward as there are forward ones.  Things go wrong. I fuck up.

I’ve been through more than a month of near constant cycling; straight into a high after every low, no respite, no calm.  My highs have been anxious nightmares, my lows have been crushing, numbing, long.  I spent 12 days sleeping for no more than 6 broken hours a night.  I argued with friends and family and ran away to the other side of the country for 3 days.  I’m self harming occasionally.  I’m failing miserably at maintaining any kind of schedule, getting work done, or socialising.  My occasional honest tweets or conversations where I reveal how I’m feeling are causing friends to become concerned for my well-being which in turn causes me to fall into a guilt spiral of self recrimination and self loathing.

I’ve idly considered going to my GP and asking for a referral to a psychiatrist to discuss medication options but then I remember how many medications I’ve tried over the years, the total disregard for my wishes last time I tried to tackle cyclothymia with meds (“oh you have horrible side effects on a mind-blowingly high dose? Tough luck. And no, we can’t discuss other options. I’ve met you twice now so I’m discharging you back to your GP.  No, I still don’t care you’re not happy with this treatment”), and the massive amount of ambivalence out there in medical-knowledge-psychiatry world about whether treating cyclothymia with meds is ever a good plan.

So here it is; cyclothymia really bites.  It’s biting really hard right now.  It’s sunk it’s teeth in these last few weeks and I can’t shake loose.  And I’m not managing to always win, or even sustain my small gains in some places.  It’s not an easy road. And more than once this week I’ve wished for a new brain.

That’s how it is.

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Filed under asking for help, medication, NHS and Professional Services, self harm

Self Medicating and Being Healthy

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.

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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