2 months down. Down. Down…

It’s about 2 months since I came off sertraline, which I did about 6 months after withdrawing from quetiapine. Med free.

Why did I do that? That’s something I have been asking myself recently. The answer? I did it because I hated the side effects: drugged, unrefreshing sleep. Nausea and dizziness when missing a dose. Because my “symptoms” were not worse than the side effects. Those are the reasons I share most readily, at least.

I also did it because I believed I would be ok without. I believed I could be ok. That’s what carried me through the withdrawal; the belief that gave me the resolve to reject the (predicted) psychiatrist’s verdict that I shouldn’t and couldn’t.

So to feel sad is to realise I’ve failed. Which makes me angry at myself. My hubris tricked me into trading down. What an idiot I am. What an absurdly arrogant, ignorant fool I am. How many times will I do this, and fail, before I learn my lesson?

But then a little stubborn part of me pipes up: “it’s only been two months, your brain chemistry is still settling. This is a blip”

What if it isn’t?

Am I seeing things again or are there all kinds of bugs everywhere? I genuinely don’t know. Was it imperceptibly raining earlier, without any moisture I could feel on my skin or see on the ground, or was that my brain putting a fuzzy haze over the world so that it looked like the picture produced by an overworn VHS?

I can’t remember if this is what I normally feel like, or if my emotions are turned up and I’m hypersensitive. Everything feels huge and knocks me off track for hours or days. For instance: an acquaintance had a frustrating radio interview the other day in which they attempted to speak about being autistic but were challenged by the host on how the behaviours they were describing were common to all people. The host concluded by saying my acquaintance was “obviously at the mild end of the spectrum” and “doing well”. A verdict he felt confident to render because they were able to speak articulately and hold a stable job which involves lots of interaction with other people.

I have been in knots about this ever since I heard about it. The result of some sort of excruciating over-identification with being told the things that feel impossible to you are “mild”. The guilt that comes with claiming otherwise when “objectively lots of people are worse off than me”; the feeling of being caught between knowing it’s not as simple as just giving up but dearly wanting a couple of weeks off being a human who is required to function. Wanting to say “fuck you, just watch how broken I can be” to anyone and everyone. The temptation to believe the person who will tell you directly or indirectly that “you just need to buck up: stop feeling sorry for yourself and making out like you’re special, we all feel blue.”

Three weeks ago I sent a letter requesting all my notes from the psych team. I used a letter format I’d found online somewhere, citing my right to see them, giving them a time frame. Every time the postman comes to the door I tense, waiting for what I imagine to be a heavy thump as an envelope full of paper lands on the mat. Ready to read some garbage written by people who never met me, or only spoke to me for 20 mins in 2 years, and it never comes. And I’m relieved it doesn’t, but angry too. I know there will be no answers in it, but I can’t shake off the feeling there absolutely will be some great moment of revelation, of clarity and self knowledge, in seeing the notes.

What have I traded to be free of medication? Is this the final version of this deal? Am I still paying the toll or is this just who I am – how I am? In a trade off between medication side effects and cyclothymia brain: which way is down?

Surprise! Emotions

I have historically not got on with therapy. One key issue for me has been the sense that I am being asked objectively impossible questions. Questions like “how do you feel?” or “what were you feeling in the run up to a significant period of depression?”. Even statements which propose a feeling have seemed improbable to me; “that sounds like it was a very upsetting experience”, “I can imagine that was very stressful”. I have been greeted with barely suppressed disbelief when I’ve shrugged and said “not really?”. I have never felt I was lying or denying an emotion. I simply had no recollection of having an emotion at those points or in response to specific events.

I have written previously about how various breakdowns or collapses have looked, in hindsight, inevitable. But I am still struggling to move from recognising in retrospect that things are overwhelming me, at the time that they are building to unmanageable levels. I believe that part of that is a result of an inability to index feelings on a daily or even weekly basis. I just don’t have much awareness of emotions happening inside of me until I am on my knees and unable to keep functioning.

I’ve recently encountered the concept of alexithymia.  Sometimes termed ’emotional blindness’ or an inability to identify and name emotion.  Out of interest and without any expectation of having a significant result, I took an online test. I was initially sceptical of a result which suggested ‘high’ traits – being entirely convinced that nobody was walking around feeling things all the time. Some chat with friends on the topic revealed I was mistaken; a majority of people have a different relationship to emotion than I do.

It never occured to me that there could be a different way of feeling.

This presumption of the universality of how I feel (or don’t) meant that I had assumed everyone found those questions in therapy as perplexingly impossible and inaccessible as I did, and it was simply that I was worse at overcoming that challenge than others. Lots of the writing in those first two links in the above paragraph is quite pathologising, but set that aside and I have found ‘alexithymia’ a really useful way to understand where part of my difficulty with therapy, and in managing cyclothymia may stem from.

Take, for example, the last week. I had to complete a small amount of work which I had found difficult to concentrate on before beginning annual leave. I then had two seperate hospital appointments, one routine on Monday, one on Thursday to follow up on an odd test result. The first was straightforward, although while going through the necessary steps for the appointment I began to feel very tight-chested and hot as I navigated the strangeness of a NHS hospital during a pandemic – I named this ‘stressed’ although I felt objectively quite in control and unworried. In response to questions from friends, I gave an account of being ‘worried’ about the second appointment, although I didn’t have a very present sense of worry – no tightness in my chest, restlessness, or nausea – until Wednesday night. I concluded that I had therefore only started really worrying about it that night and not 6 weeks or so earlier when the appointment was scheduled. Last night – Thursday night – I slept heavily and well. The first time I have done that in perhaps a month.

Alongside this sudden change in my sleeping habits at the conclusion of the hospital appointments and the positive resolution to necessary investigations, I also noted a shift in how my body felt and how easy I found it to think. I had been slogging through work with a foggy brain for more than a week, and had had a stiff neck for days. I had experienced some dissociation on Tuesday which resulted in a brief return to bad habits. But upon waking on Friday all of those impulses, tightnesses, detachments, confusion, were distant.

I have been incredibly stressed – breaking point stressed – for more than a week. And somehow, I had no idea. I had only some general impressions on my physical responses but no sense of their connection to feelings. Without this access to feelings, I struggle to see how I can manage my cyclothymia better. More than this, it seems like many cyclothymia symptoms are in fact a sort of pressure valve for emotions which build and have no conscious acknowledgement, and therefore no resolution or processing.

I don’t have a neat conclusion to this entry. Only perhaps a new way of understanding how I end up struggling and why things like day-to-day stress build to cause such significant problems. The big problems I experience – or emotional collapses – seemingly arrive fully formed and entirely without warning. But these big breakdowns do not arrive without warning; it is just that I don’t have access to those warnings. The challenge to managing cyclothymia for me now is not going to be about monitoring my feelings – something the GP suggested some months ago and I boggled at the difficulty of – but of finding ways to even note these feelings are present.

Happy new me (or not)

Living with a chronic mental health condition is not what you might anticipate, it’s certainly not what I imagine it is – and I’m living with it.

For months at a time, I’m fine.  At least, in the last few years I have been. Despite knowing that I’m not cured when I go 6 months without significant symptoms, I also seriously reflect on the fact I am obviously….cured. At those times, those long stretches on the calm water of life, symptoms of cyclothymia seem like something I read about which happened to someone else.

For example, in the run up to the 2019 General Election, a meme circulated on Twitter in which people shared their voting history. Whilst I am certain I voted in 2010, I have absolutely no memory of doing it – or who I voted for*.  It was during a period I was really unwell, my memories for the first half of that year are really patchy. I know I drank a lot. I know I took drugs whenever they were on offer. I know I spent a fortune. I don’t know the texture of those times.

It’s hard to reconcile that description with the biography of me I carry around in my head. It was me but it feels much more distant to me than the recollections I have of what I did and who I was in 2007. Being ill doesn’t seem like something I ever was, when I’m not.

When cyclothymia rears its head again, when I feel the nausea of looking over the precipice of the rollercoaster, note the insistent tug of gravity pulling me over the edge, I experience a rush of memories of the times I’ve felt like this before. No longer safely distant or abstractly ‘other’, they feel urgent and real and entirely ‘mine’.

Instead of sailing on to a clear horizon, just about able to spot those dark times through binoculars, I feel like I’ve got my shoulder to the door as water leaks in the cracks, waiting for the tsunami to crash through the walls and totally consume me.

At times like this, madness, real madness, feels terrifyingly close.

Every day is a war – the stakes couldn’t be higher. Lose, and that door is going to be kindling and you’re going to drown. Win, and you just get a reprieve of 24 hours. It’s always there, looming.

Perhaps most challenging – and difficult to understand – is the impulse to give in. When I feel well I do all the things I need to care for my body (and soul). I exercise, socialise, cook, and more, with pleasure. When this looming darkness closes in it’s a battle with myself not to just give into it. I learnt long ago there isn’t a bottom to the spiral, you just keep going down. There’s certainly no rest or reprieve for giving in. But it tugs at me. And I make bad choices. Douse myself in booze, ingest anything on offer, rage at people closest to me and try to isolate myself.

Why does my destruction come from within but feel like it is something creeping up on me? Is the difference between good mental health and poor mental health a question of willpower – the ability to turn away from that instinct to self destruct? How can I learn that skill? Is it practice or is there something fundamental in me which needs to change? Have I brought my own misery upon myself?

I don’t know. I just know that right now it hurts, and I am fearful, and I want to sink.

 

* I know for certain it was ‘not Tory’, of course. But I know that in the same way I know that gravity continued to function that day and I breathed air.

Being chased down

There’s not much worse than knowing a low is coming and throwing all your energy at trying to avoid it.

At a glance, it might seem like the low itself is the worst part. But in the midst of a low, there is only the low. No real belief there was a before, very little faith there will be an after. It is, as Sylvia Plath so memorably termed it, a bell jar. Suffocating, inescapable, sealed. Not desirable, by any stretch – but it demands and enforces absolute immediacy in your relationship to it.

By contrast, the period before a low comes crashing down is marked, for me, by panic as I try and rearrange the things I want to do, and cling desperately onto the last rays of hypomania or baseline-mood. This period is increasingly characterised by me frantically trying to hang on to the good feelings; a task as hopeless as holding water in your hands. No matter how closely you grip your fingers, it’s going to run away from you eventually.

I am a control freak. I schedule my work and life carefully; I plan social stuff months in advance, I always have a to do list. My organisation in packing and filing is legendary amongst my friends and colleagues. I completed a PhD, despite cyclothymia, through relentless planning and organising. I have the past 10 years of carefully recorded personal budgets saved in Excel. I genuinely think storage solutions, year planners, week-to-view diaries, filing and planning are fun activities or items to enjoy on a quiet afternoon.

There’s a significant degree to which I struggle to accept I can’t schedule my moods, or rearrange them to suit a larger timetable. This has been exemplified in the last week or so, in which I’ve attempted to run from this mood, with varying degrees of success.

Perhaps most foolishly, every time I manage to alleviate or defer (or perhaps I should call it ‘drown out’) the low mood on the horizon, I think I’ve cracked it. Believe I’ve finally achieved just the right combination of beta blockers, cigarettes, social activities and work.  This makes the resurfacing of the low mood all the more discouraging and distressing. I become not only depressed, but angry with myself for not being able to turn back the tide. In this context, it’s not just a low mood: it’s a failure.

Living with cyclothymia is a constant tightrope; how hard should I fight and push back against my moods? How much should I accept my mood changes and aim to work around these largely unpredictable fluctuations? When I do work to manage my mood – doing things that take me away from day-to-day stresses or actively fleeing the places and people that I associate with negative moods in favour of fantastic escape – where is the line between ‘restorative, boosting well-being and net gain’ and ‘borrowing too much energy for a short term boost’? The latter being what that I find myself facing down now, with a deep ache, a sense of loss for the mood I could not cling on to and must now live without for a while.

In terms of the length of the extremes of mood, cyclothymia is fleeting. It’s getting to the point where I spend longer running from, and dreading, and pouring energy into avoiding, these moods than I do actually living through them. And that certainly isn’t living with cyclothymia, it’s fighting an unwinnable fight. I’m just not sure if I’m too stubborn, too much of a control freak, to accept I need to let go a bit to get back some sort of control.

Unwelcome noise

It’s been some time since I last blogged, happily this is largely because I have had a fairly stable period. Inevitably though, this has to end.

Over the last two months my moods have been – and I apologise for cliché – a rollercoaster.

I’m currently taking a break from Twitter as it seemed to have become primarily a platform for miscommunication rather than positive communication and networking. Initially I placed blame for this outside of myself – why did everyone assume I was being shady? Why did everyone jump to the worst conclusion? As always though, I endeavour to look inside myself with the same cynicism I regard others with and, perhaps inevitably, I found failings there too.

I realised the number one issue with twitter was that, as my mood plummeted and I communicated this, my friends and followers weren’t able to offer me what I wanted: a cure. People weren’t reading imaginary hostility in my tweets; I was angry with them, with everyone.

I tweet with reasonable frequency about my mood – primarily because when it’s bad it’s the only thing I can think about. For this reason I suspect my followers are rather tired of hearing how wretched I feel – and as an aside, this really underlines how imperfect language is for expressing emotion. Whilst it looks boringly repetitive to anyone reading, each low has its own distinct flavour and texture. From the inside, it’s always new, always different, and frequently unexpected. Perhaps, then, it’s natural people have little left to say when I once again bemoan my low mood.

But I need something, and find myself desperately scrambling for a solution, a balm, a shortcut to lifting the cloud and moving on.

Which leads me to getting angry with my Twitter followers for not offering the cure I become inexplicably certain they are withholding. All these people seem to know how to be happy, to know how not to be alone, to know how to live – why won’t they share their secret? Why won’t they, in 140 characters, do what medication and psychiatrists couldn’t, and save me from myself?

And round and round my mind goes. Refreshing my mentions every few minutes, increasingly furious that nobody is proffering the solution. Increasingly paranoid, increasingly frantic.

So I stepped in my own way and took twitter out of the picture – you can’t be furious nobody is replying to a tweet you didn’t send, right?

Well, perhaps inevitably given we’re dealing with illogical thought patterns and, as of two days ago, that horrible anxious kind of hypomania, yes, you can still be angry. Why haven’t these people, whom I have unfairly decided have The Answer, not come to find me elsewhere online? Doesn’t that just prove I was unwelcome noise on twitter? Why do I have to do this alone? What did I do wrong? Why won’t anyone tell me how to fix myself?

Stress Intolerance

A few months ago I saw an ad in the local hospital for a bipolar support group.  It said “having bipolar is like being allergic to stress”.  That’s about the most accurate description I’ve seen, I think.

I haven’t posted much on here in the last few months because I have been finishing up my doctoral thesis, then I took a holiday (my first in 5 years) and now I’m working on job applications.  It has been, in every sense, an exceptionally stressful few months.

It is perhaps curious, then, that it is only in the last week, a month and a half after I submitted my thesis, a month since I got back from a lovely holiday, and a week after I got a job application in, that the crushing anxiety, panic and low mood has really set in.

Whilst bipolar is an ‘allergy’ to stress, the reaction is often delayed and it can be hard to deal with that.  Immediately after submitting my thesis I braced myself for a downswing, cleared my diary and prepared to meltdown.  But it didn’t come. ‘Perhaps it’s not going to!’ I thought. ‘I’ll just get on with preparing for my holiday!’.  In the first couple of days of my holiday, whilst I was in Zagreb, I began to feel the black edging into the edges of my thinking – ‘ah! here it is! Best take myself off somewhere quiet to mope’.  But again, it never really came through – I travelled south in Croatia to Split and the sun was out and my troubles seemed to lift. ‘Maybe I really am cured!’ I thought.  ‘Perhaps the secret cure for cyclothymia is writing 80,000 words followed by sunshine!’

There was a nagging sense, deep inside me, that all that was happening was that the holiday was delaying the inevitable.  That low, that allergic reaction, was just waiting for me, biding it’s time.

Buoyed along by a busy schedule and post-holiday glow (literal and metaphorical, managed to get a lovely tan in 7 days in the sun), the week following my holiday was pretty solid.  But, little by little, I began to slow down. Waking later, sleeping longer, heating up meals from the freezer instead of creating culinary masterpieces from scratch.  It was coming.  Having terrible dreams, waking up sweating and gasping for breath.  The first signs of the inevitable reaction – the mental health equivalent of itchy skin, fuzzy tongue, sneezing.

And so, we come to today. Woke up, after another night of terrible dreams. barely able to walk in a straight line (anyone else experience low swing as significant impairment in physical-coordination?) Ate breakfast.  Fell asleep again for 2 hours.  Stumbled about for a few hours, tried to boost mood with music, ended up crying to Vivaldi, of all things.  Tried to work – read the same sentence of an article 4 times in a row before giving up.  Tried to sew – took me three times as long as normal to do a small section, abandoned. Considered visiting family, decided it wasn’t worth risk of an argument. Digestive system, which has been merrily melting down in response to stress since May, reaching it’s peak in pain.

Do I feel stressed? No. Do I have any urgent jobs, bills, or commitments? No. The peak stress is gone.  There are, of course, still various tasks and events on the horizon which will be challenging and likely stressful, but nothing in the immediate future. This is cyclothymia.  This is what stress does.  It goes in, gets absorbed, and then, when there’s nothing pressing, when there is time, it’s released throughout your mind and body, disrupting all the vital systems, leaving you on your knees amidst apparent calm.

I’m falling to pieces in a house well stocked with food, bills paid, jobs done.  I’m struggling to sleep in a large bed when I don’t have an alarm set for the morning and I couldn’t tell you the name of the thing that is worrying me half to death.

For people with bipolar spectrum conditions, stress is so like an allergen.  It’s a constant presence in life, ebbing and flowing with the season and the location. And it is almost impossible to protect yourself from – it sneaks into your world, leaking through the cracks in whatever plans you make or precautions you take.

Right now, it feels like the UK is in meltdown.  As the government and new Prime Minister push ahead on the disastrous Brexit plan, the main opposition party is in disarray and entirely incapable of coordinating a strenuous response to the inevitable public funding cuts, Brexit, and the terrifying rise in hate crime and hate speech.  This is stressful.  And, along with the undefined worries which already plague me, I can feel my mind absorbing it all, quietly storing it away, ready to top up my anxiety at any moment.

Sometimes it feels like cyclothymia disqualifies you from living in the world at all.

Sleep

I am obsessed with sleep.

How much did I get last night? What’s my average this week? This month? How many times did I wake up last night? What arrangement of pillows gives me the best sleep? Did I sleep too much? Do I have a real headache or have I slept too much/too little? I could go on and on.

Sleep – too much or too little – both reflects my current mental state, and dictates it.  When I’m on a fairly steady keel I find I sleep a solid 8 hours, usually waking once, invariably waking groggy (I’ve never been a morning person) but rested.  Running into, and during, a depressive period I sleep terribly but frequently – upwards of 10 hours at night and often napping during the day – and walk around in a fog of exhaustion and anxiety.  During manic periods I sleep little, sometimes as few as 3 or 4 hours a night

I have a sleep tracker on my phone and have been coveting a fit-bit ever since I learnt they too track your sleep. Right now my sleep tracker tells a sad story – more than a week of sleep below my ‘ideal’ 8.5 hour line punctuated by 1 night of 11 hour sleep followed by an especially miserable 5.5 hours.  The mood cost of this? Anxiety, exhaustion, slow thinking, poor attention span and a niggling feeling the world is about to fall down.  Am I sleeping badly because I’m in a low or am I in a low because I’m sleeping badly?

There is quite a bit out there in internet-land about the importance of good sleep patterns if you have bipolar [spectrum] disorder.  A few online sources suggest that lack of quality sleep can trigger a manic period.  I’m not sure my own experience corroborates that and one might also question presumption of cause and effect implied in that conclusion (i.e. does sleep deprivation trigger a [hypo]manic episode or is the first sign of a hypomanic episode reduced need for sleep?). As I say above, I find lack of sleep corresponds with the beginning of a depressive period (although again, is it lack of sleep, or is it that I don’t sleep much because I’m hypomanic and then I, inevitably, have a depressive period?).

What I have found, conclusively, is that maintaining a reasonable sleep pattern and getting enough sleep (8 hours) each night is the best method I have available to maintain a stable mood.  I usually make it to about 3 weeks feeling ‘normal’ if work/life stress is average and I get a regular, uninterrupted, 8 hours.  It’s not much, it’s the time I live for though. The time I think least about whether I am happy or sad and, therefore, the time I am happiest.

Right now, I’m under quite a bit of pressure at work and over the last month have spent more time sleeping on friend’s floors, hostel beds, hotel room beds and buses than I have in my own bed.  It’s getting to the point where I’m fantasising about a week where I don’t have to set an alarm for any time before 11am (because, my brain is still out to get me and if I don’t set any alarm at all I sleep for 12 hours) and wondering if I’m setting any new records in surviving sleep deprivation without actually being technically sleep deprived (7 hours sleep on average the last 2 weeks)

Identifying how important decent sleep is to my mood is more than half the battle, I’m sure of that.  What is harder to deal with is what my obsession with sleep means for social and romantic life.

Ever fallen into bed with a new lover, then checked the clock as you finish and realise you needed to be asleep an hour ago? Then immediately ruled out anything else by turning over and concentrating on going to sleep? Ever left parties early, not because you had an exceptionally early morning or important shit to do the next day, but because you didn’t want to ruin the rest of your week with one disrupted night’s sleep? Ever refused a friend a place to stay because one night with someone else in the room means sleeplessness, and sleeplessness means a lost week?…And on and on it goes.

I love sleep.  I really do.  I love getting into bed, burrowing down, hitting ‘sleep’ on my phone.  I love waking up but not needing to go anywhere and just lazing in the in-between-haze of asleep and awake.  I just don’t love needing that more than almost anything else in my day if I want to be functional, coherent, and, most of all, sane.  I’d love just the odd late night without consequences.  Just a few sneaky early mornings without feeling like I have bugs crawling under my skin or that my brain is going to vibrate out of my skull.  And I do wish I wasn’t so obsessed by everything to do with sleep, because I think it’s a dead giveaway that I’m nuts when I meet someone new and my entire life is quickly revealed to be dedicated to a Good Night’s Sleep. It’s surprisingly hard to make an obsession with sleep – something we all, quite clearly, do – seem normal.

You’ve Got that Manic Feeling

I’m back on the roller-coaster.  Or rather, I never got off the roller-coaster and right now I’m cranking back up to the top.

I felt it coming, as usual.  Over the last week I’ve had groggy morning brain which evaporates in the shower and leaves me with LOADS OF FUCKING ENERGY.  Today and yesterday I’ve barely slept – or rather, I’ve slept for the usual amount of time except for the second 4 hours I sleep lightly, waking frequently, drifting in and out of trippy dreams.

And there’s the anxiety.  That’s the other clue.

Skin crawling, brain itching, restless body anxiety. Tick tick tick tick….can’t sit still, can’t rest, can’t focus, can’t calm down.  This is shaping up to be a period of unpleasant mania.  It was perhaps inevitable because my last couple of hypomanic periods have been relatively mild and largely positive.

Last night I mentally composed an entry for here about dealing with anxiety; dealing with the oncoming wave of hypomania.  I was going to recommend my two preferred activities; sewing and swimming.  The former is repetitive, time consuming, and mind-numbing, the latter burns off loads of nervous energy in a really productive way that is energising in a ‘natural’ way rather than a hypomanic way.  Today I’ve been sewing for 5 hours, went swimming for an hour this morning, and I’ve cleaned the flat top to bottom. Unfortunately like almost all of my ‘coping’ strategies, when I get to the extreme end of high and low, they just don’t cut it.

I’m a little angry with myself this evening; hypomanic confidence has assured me that I didn’t need to work on a piece of work  which is due on Tuesday. I’m battling my brain over this even now; the little voice of rationalism is saying: “but it really would have been good to spend just an hour on it to assess how much additional work is needed tomorrow” whilst the booming voice of hypomania confidently shouts it down: “if we get in at 10am tomorrow that’s an hour to work on it before 11am meeting. 12-1pm planning Tuesday’s seminar and then the rest of the afternoon to work on Tuesday’s piece of work. Really, we needn’t have even worked on it yesterday. In fact, maybe we don’t even need to get in for 10am, we can definitely just wing it on Tuesday, now how about a nice triple vodka and orange?”

I’ve got a glass in my hand.  I think the comforting, friendly, fun voice of hypomania might have won this round.  It usually does.

New Year, New You?

I’ve been weighing up a New Year post in my mind for a couple of weeks now.  In all honesty there are two big things that have stopped me.  Firstly, I’ve been feeling pretty good for some of the last month or so and, as I’ve written about before, when I feel good I’m always sure I’m not going to be unwell again and I certainly don’t want to think about the possibility I could be.  Secondly, I’m more inclined to reflect on the last 12 months, and look ahead to the next, on my birthday.  There are lots of positives to this: it means you begin every ‘year’ by having a party about how awesome you are for being alive; it means (as my birthday is in September) it happens during my favourite time of year – lovely lovely autumn and even if my annual review makes me sad I get to revel in the crisp fresh air of autumn; and it means I’m not influenced by the resolutions and triumphs of those around me.

A lot of people talk about how Christmas is a really difficult time for many people, and I’m not going to argue with that.  I personally find Christmas quite easy – your proverbial man-on-the-street tends to be more polite and charitable around Christmas, most things on tv are about the strength and qualities of the human spirit, and there’s lots of good food.  New Year on the other hand? Everything on tv is telling me I need to Be Better, Lose Weight, Shape Up.  The proverbial man-on-the-street is angry, hungover, skint, and filled with rage at the dying of the light (aka Winter Nights).  There’s very little good food, and often a lingering sense of indigestion.  And everyone else seems motivated and resolved to make themselves over, no matter how fleeting their resolve might be.

New Year, and January in general, are a hard, long, self-hating slog.

Naturally, I’m not one to abstain from the spirit of the season so I’ve committed to a schedule of self hatred, despair, and introversion.

I jest.  Well…I exaggerate slightly in an attempt to wrench comedy from my current low mood.

So I’ve decided to make January into my own personal mental health review month.  What went well last year? How I am going to make this year better?

Last year was punctuated by one of my 3-5 yearly major lows.  In 2014 this took the form of an almighty argument with a friend which turned into an almighty argument with my family which turned into an almighty throwing-stuff-in-a-bag-and-running-away-and-not-telling-anyone-where-I-was.  Not one of my finer moments.  It did, despite it’s car-crash execution, achieve what I needed at that time which was a release of the tension, anxiety and sense of being trapped which had been building for months.

When you are on a tight budget – which I permanently am – it can be hard to give yourself what you need.  Especially if the thing you need (and it always seems to be) is a break from your everyday life and a brief period of self-care and self-indulgence.  Self care.  That’s a phrase that sticks with me – sounds too much like ‘woo’, too new age, too indulgent.  And, as perhaps I will one day write about – the working class chip on my shoulder doesn’t stand for any of that woolly, wussy shit.

But this is what my 2015 needs; more time, more acknowledgement I can’t keep pushing and pushing myself and hope that the crushing anxiety and exploding stress in my chest will simply dissipate of its own volition.  It won’t.  In 2015 I need to take more time to refresh myself, give my brain some breathing space, and allow myself to break a little so that I don’t break absolutely.

Will I be able to do that? Well that’s another reason my 2015 is currently driven by sadness and a shunning of human company (haven’t spoken with anyone since Tuesday, oops?).  2015 is provisionally the year I intend to submit my thesis and to achieve that I do need to drive myself.  I’m not, and never have been, tolerant of anything other than perfection in myself and this will be a year that instinct is tested to breaking point.  Working out how to balance the need to push myself to my limit to produce the very best thesis I can at the very highest level I have ever worked and the very real need to hold my sanity together is going to be my biggest challenge this year.  I think it begins with taking time off and being kinder to myself.  I’ll have to see if I can learn how to do that.

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.