Rapid Cycling

Rapid cycling is described as a pattern in an individual’s bipolar disorder. The individual must experience at least four or more episodes in one year. These episodes can be either manic or depression, I’m not sure if mixed episodes count. My specific diagnosis is Bipolar 1, rapid cycling, with psychosis. Maybe, my previous post where I was wondering if I was crashing is just another part of my rapid cycling. That could be why it feels like my episodes come in waves; they happen so often I have a hard time keeping track of them all.

People who are rapid cyclers can still crash; I guess the crash just doesn’t last as long. However, rapid cycling is a diagnosis that is not necessarily permanent. It can change as time goes on. A person’s bipolar symptoms tend to change with time, generally based on their experiences and treatment. This makes it possible for the rapid cycling diagnosis to be temporary for most individuals, although the diagnosis can come and go.

I find rapid cycling difficult to manage. Just when it seems as if I’m getting a handle on current emotional status and its symptoms, my episode changes to something else. Lately, it’s changing slowing, which is nice, but it’s hard to keep up with. One day, I can be cleaning, getting stuff done, and reaching out to others, and then the next day I can’t get off the couch. It usually takes me a couple of days to mentally realize and accept my current state, and that is extremely difficult when things are always changing.

I have a couple of questions. Is it even possible to cycle daily or weekly? What I find tells me that rapid cyclers usually cycle at least four times a year. Are there any other individuals diagnosed with rapid cycling bipolar? Do mixed episodes count towards rapid cycling? It would be great if anyone wanted to tell me about their experiences; I would appreciate hearing from you and finding out how often you cycle and how you handle your cycles.

What’s Coming? I Hope It’s Not A Crash

I wouldn’t necessarily say that I’ve been manic lately; I’ve been in a mixed episode more or less. Everything changes day by day; whether or not I’m able to get things done, how much energy I have, my emotional state, how much I reach out to others, if I can complete my goals, and how impulsive I am. These are my major signs that show what state I’m in; manic, depressive, or mixed. Since I had an ECT treatment yesterday, I generally slow down for at least a few days as my body recovers.

When I’m manic or mixed, I tend to get a lot of household responsibilities done. I can go all day without stopping. I make sure that I can complete every goal I set out for myself. I can’t stand not being able to cross off every item on my to-do list. I also usually reach out to others, both friends and family, when I’m manic or mixed. I withdraw as the depression sets in. I usually don’t have elated feelings to begin with during mania or mixed episodes; I still tend to feel bad about myself, unable to see the good things that I have done.

Every day, I see certain symptoms changing. For example, today I’m having a hard time getting things done. It is the day right after ECT, so I’m trying to give myself a break, but reaching out to others is also very hard. I’m also feeling the emotional depressive symptoms, wishing I wasn’t around is a common feeling for me. I’m not sure if there’s a crash coming, or if I’m just reacting to life’s circumstances. The worst part, in my opinion, is I keep gaining weight. It’s been happening for a few months now. I’m up 30 pounds, and I don’t have the will power to fight it. I have been wondering what’s coming for a little while now. Sometimes I think my episodes happen in waves; often never-ending and they don’t often last long enough to realize what’s happening, which is an improvement from before, now that I think about it.

If this is a crash coming, then it’s probably the easiest one I’ve gone through. Or maybe the new medication, Clozapine, is helping ease the fall a little bit. Other times, I have spent all my money, gained 80 pounds, or withdrawn completely from my loved ones. I’m still productive, no matter how difficult it is, and I’m working at keeping my relationships healthy, which is extremely difficult for me. I’m still trying, that’s what matters. Maybe I should just be grateful that I am still able to work at it. When my depression hits, it doesn’t matter how hard I try, I still don’t get things done like I want to.

Gift Giving Is A Gift Itself

Everyone has something they enjoy doing. When you’re dealing with depression, those things you normally enjoy seem to become work instead of fun. One of the things I like to do is search online for gifts to give my loved ones. I even tend to enjoy it when I’m going through a depressive episode. I greatly enjoy giving people personal and meaningful gifts, something that they would enjoy. I don’t always know why I like doing this so much; I just do. Better yet, I’ve been told by many family members that I’m really good at it. I suppose that when I’m looking for the perfect gift for someone, I think back through all of my memories I have with that person. I think about that individual, what they enjoy, and I get to replay our good times together. Then, when I give the person their gift, I get to see the enjoyment on their face and/or in their voice. All of that is a gift that I get.

For example, my brother just got married and I gave them a set of four stone coasters. Each coaster had a different vintage map on it; his new wife is into vintage things. I put a different map on each coaster. For their honeymoon, they went on a cruise. I looked up their cruise and found out where it was going. I put the different places they went during their honeymoon on the coasters. That way, every time they use the coasters, they would remember their honeymoon. I wasn’t sure if they would like them or not, but they ended up loving them. I really enjoyed hearing the excitement in their voices and their thank you card when I heard from them shortly after they returned, which was a great gift to me.

I’ve already started my Christmas shopping this year; actually, I started at least a month ago. I keep a list of all of my ideas, that way I don’t forget since my memory is so horrible. Then I buy a couple of things here and there. This makes it easier for me when Christmas comes along; it takes the stress off during the holidays. I don’t have to spend one large sum of money all at once; I just spend a little bit at a time. I’m not pressured to come up with gift ideas in a short amount of time. Why didn’t I think of doing this earlier? The only problem is that I get so excited about the gifts when I get them in the mail (since I do almost all of my shopping online) that I have a hard time waiting to give the gifts to each person. I’m doing well so far this year; I haven’t given anything away early.

Monthly ECT

At 8:15am I had my 32nd ECT treatment (I miscounted before). I now do the treatments every 4 weeks; they’re maintenance treatments. They’re done under general anesthesia; the treatments only take a couple of minutes. I usually leave the hospital within 90 minutes of getting there. Normally, I get home and go to sleep for a little while. When I first started the treatments, I could go back to sleep for a couple of hours, but the amount of time I’m able to rest afterwards has been decreasing with every treatment. Today, I got home from my treatment and was unable to go back to sleep at all for the first time.

I’m not a fan of the recovery and after effects. My jaw hurts so bad that it hurts to chew anything and my entire body is muscle sore. It feels as if I just ran a marathon, or two days after a massive workout, when you have to brace yourself for every movement you make. My memory gets even worse than normal after the treatments; the memory issues last longer than the physical ones. The memory issues make me feel like an idiot. I’m constantly asking questions, and I usually ask the same questions over and over again.

I’ve been doing these treatments for so long now, I wonder if I will ever be able to stop them. My psychiatrist wants me to be stable for 6 months before stopping, and I just don’t see that happening. I could just tell him I want to try stopping the treatments, but then what happens if I end up in a huge depressive or manic episode? Then I would have to go back to doing the treatments 3 times a week. I don’t want to do that, and I’m not sure if my body can even handle that. I wonder what the long-term effects are of ECT; maybe that’s something I should look into.

Venting: Letting Out My Day

Normally, I just push through my days, no matter how bad they are; I find some way to make the time pass. I can usually hold it together; I can put a fake smile on and say what I need to in order to make others think I’m fine. Today, however; was not one of those days. My psychiatrist is worried and wanted me to be checked for Clozapine-induced myocarditis. I went to the doctor, and it was a waste of time. I checked her notes afterwards, and she only listened to about half of what I said. I also couldn’t get the ultrasound they referred me for; I wonder when I’ll actually have that appointment. My psychiatrist isn’t taking me off the Clozapine yet, but I’m just guessing that based on my luck, there’s going to be some reason to take me off it.

I’m overwhelmed by life. I don’t know how much more of this I can take, or how much I want to take. Aside from my mental health diagnoses, I’m also diagnosed with interstitial cystitis, a painful bladder disease. The treatments that I am using for it are called “installations”. Basically, every three weeks, I get catheterized so medicine can be put directly into my bladder. I’ve been doing this for over a year now. Most patients can go longer in between treatments, but since stress is a huge trigger for pain, it gets really bad every time I try to stretch out the treatments. However, because my stress has been greatly increased lately, so has my pain, so my doctor is having me do treatments every week for three weeks. The treatments help somewhat, but I still have a lot of pain and frequency problems.

Every four weeks, I also get to go to ECTs (electroconvulsive therapy treatment), and tomorrow is that lucky day. I hate doing it; I don’t want to go. Even though I admit that it was extremely helpful and was a big part of getting me out of a depressive episode I had last year, I still don’t want to continue with this treatment. It’s too much for my body; the past few times it tends to hurt more and more. My psychiatrist said since the treatments are further apart, my body isn’t used to them anymore. I also have a lot of memory loss from the treatments, but it has gotten better than when I first started. However, I don’t stop them because I’m too afraid of what will happen if I do.

A relationship of mine seems to be changing a little; it seems more strained than normal. This friend means a lot to me, to my entire life, and I guess the stress on the relationship is scaring me. I just thought I would say that, because I haven’t actually said it until now. I don’t let a lot of people in, so I don’t have a lot of friends; hopefully I’m not the one pushing this person away.

Well, I just needed to vent today. It was a rough one for me, but at least now it’s close to bedtime. It just seems that crap keeps happening; over, and over, and over again. I just wonder when it’s going to stop. I try to be positive all the time, whether it’s real or not, hoping that it will help, because I feel like that’s what I’m supposed to do. However, someone today told me that I don’t always have to put a face on, and I really appreciated that. So I decided to be 100% honest and admit that today, things suck. I have been extremely stressed out, very frustrated, overwhelmed, and I still made it. I even was able to clean my entire house, that’s how I like to get out my frustration. I’m unsure if tomorrow will be any better, but at least I’ll start with a clean house.

Clozapine Rechallenge – Day 16 Problems Arise

So apparently I have to go to the doctor today. It was either that or the ER, and luckily my PCP’s office had an opening. I was shocked. My psychiatrist was concerned about my most recent blood work, which took 3 times as long to complete as normal. My psychiatrist wants me to be checked for Clozapine-induced myocarditis. His reasons are because of my recent symptoms (which are now gone) such as shortness of breath, fatigue, chest and throat pressure, and eosinophilia (this is his concern from my blood work); as well as my previous reaction to Clozapine the first time I tried it, which was a high fever; and of course my genetics. When he refers to my genetics he is talking about my Ashkenazi genes.

I have an appointment in less than an hour and I’m ready to go. I’ve printed out my last 3 weeks worth of blood work and my psychiatrist’s notes. Hopefully nothing is really wrong; I’m sure it’s all fine. However, my stomach is killing me right now, probably from the anxiety.

Update: I went to the doctor and I’m not even sure that she really listened to me. I read the notes after the appointment was over, and half of them were wrong. It was extremely frustrating. Either way, they did more blood work and referred me to my cardiologist for an ultrasound. I asked if they could call to make the appointment, that way I could get in sooner, but they said they couldn’t do that. Then when I called the cardiologist myself, they said they don’t have my referral and can’t make the appointment until they have it. Now, I’m even more frustrated. My psychiatrist said I can wait on the ultrasound; I don’t have to go to the ER today, which is the first good news I’ve heard. I really am pretty sure everything is fine, I think it’s just a precaution. Although, the likelihood that I will be able to stay on this medication is decreasing. I’m doing everything I can to be able to continue taking the Clozapine, I’m just not sure if that’s enough.

Treatment-Resistant Bipolar Disorder

Treatment-resistant bipolar, also known as med-resistant, is something that most of us know too much about. Sadly, it’s extremely common. Being diagnosed as treatment-resistant generally depends on the number of medications a person has tried during the phase that individual is in. Many individuals have been through all sorts of different medications without much success. And then of course, if a person finally finds a medication that helps even a little, it comes with side effects that are too much to handle. I have been considered treatment-resistant by my doctors many times throughout my diagnosis. I have taken so many medications that I’ve lost track of them all. I’ve even lost track of the horrible side effects. I know that for me, Abilify sends me into a huge manic episode, Depakote causes me to lose my hair, and I gained 80 pounds on Risperdal. Those are just a couple examples of medications that I couldn’t handle.

Treatment-resistant doesn’t mean that there’s no answer; there are several individuals that are treatment-resistant that have gone into ‘remission’ for multiple years. I am one of those individuals. Somehow, I was able to live a regular life, work a full-time job, and have a full-time social life. I don’t know what happened or what changed, but after a little more than 2 years, something changed. I was still taking my medication and seeing my doctors, but it was as if I was a ticking time bomb. Then I exploded into such a massive manic phase that I had to leave my job and go live with family. I haven’t been stable since that time, but I do know it’s possible. Sometimes I wonder if I can ever get back to the place in life that I was at before. Honestly, I don’t know if it will or will not happen, but I haven’t given up.

There is always hope, even for those that are treatment-resistant. New treatments and medications are always coming out that could help. Sometimes, a certain combination of medications or treatments is the key to remission. It’s not easy to be patient, or willing to try new treatments, but you never know when one of these new methods will be the key to our health. I am always willing to research and usually try new treatments and medications. I am doing ECTs, electroconvulsive therapy, every month (I’m doing the maintenance treatments at this point), and I am doing a rechallenge of the Clozapine medication. The ECTs helped me get out of a major depressive episode. The Clozapine is supposed to help take away my suicidal ideations; it’s too soon to tell how effective it will be. My conclusion regarding treatment-resistant bipolar is that you never know when some new treatment or medication is going to help; don’t give up before the miracle happens.

Bipolar Disorder Affects Our Friends and Family

Personally, I mostly think of how much my bipolar disorder affects my life. Bipolar disorder causes my personality and capabilities to change over time. I can be happy one moment, and then suddenly I’m crying. It’s not always this extreme, but my moods do shift without having the power to control them or even know when they’re coming. I’m lucky to have family and a couple friends that are extremely supportive of me. However, no one is perfect. Sometimes one of them may say or do something that upsets me and my mind automatically thinks, ‘Don’t they know what I have to deal with? And they’re complaining because of how my disorder affects them?’ It takes me a little while, but then I realize that my disorder has a huge influence on those around me, especially those I’m close with.

I have to work very hard at remembering that I’m not the only person my bipolar disorder has an impact on. Even when my loved ones are educated, they’re still human, and some of my symptoms can be extremely difficult to live with. This is true especially when I’m in a manic or depressive episode. Recently, I was experiencing a mixed episode, some of my manic symptoms included constant fidgeting, increased talking, and was barely sleeping. It took me a while to realize that my symptoms were also affecting my family, especially those I live with. One family member recently said something that hurt my feelings. All I could think was how I didn’t have control over what I was doing, and I felt as if this person was blaming me for that. It took me a while, but now I realize that my family has to live with bipolar disorder as well.

Many individuals diagnosed with bipolar disorder at some point struggle to work. Personally, I went through a huge manic episode with psychosis that caused me to be unable to work at all. I have been on Social Security Disability since 2009. I still bring in some money thanks to SSDI, but I don’t make the money that I used to make. For many people, this type of situation often causes problems in families and couples. Our support systems often feel helpless because they can’t fix us, and they often can’t even understand us when we’re manic. But they’re not helpless. They can help to make sure we are taking our medication, help us come up with strategies to reduce stress, encourage us to contact our doctors, and if necessary they can contact our doctors if given permission when we have failed to do so. These are things that my family helps me with.

It’s a lot of work to be the support system for someone with bipolar disorder, or any mental health illness. Our loved ones can experience emotional and financial distress, they often have interruptions to their routines, they have to learn to handle our unusual and sometimes reckless behavior, and the stress they experience can often cause health problems. There are support groups and meetings for our loved ones, just as there are support groups that we can go to. It’s vital for our support system to receive support; otherwise, they won’t be able to be there for us. If we want someone to be patient with us, then we need to be patient with them. It’s much easier said than done.

Anxiety While Shopping

Running errands is a difficult task for me, and it always seems as if the errands are never ending. I’m comfortable in my own home for the most part, but when I leave my house, all of my fears start to take over. One of my biggest fears is having someone I don’t know come up behind me. My anxiety kicks in when I’m in public. I constantly look from side to side and front to back to make sure I’m aware of everything that’s going on around me.

There are certain stores that I hate going into on my own or at all. These stores have bright and fluorescent lighting, narrow aisles, and large display cases right at the entrance. These aspects cause anxiety and make me feel trapped and uncomfortable. I would prefer to go to a store that ends up costing me more money, than go to a store that brings out my anxiety. Even the regular store that I go to can sometimes cause anxiety; it all depends on how many people are there. It’s important for me to plan when I go shopping to avoid the crowds.

I also hate standing in line when it’s time to check out. There always seems to be someone behind me that doesn’t know what personal space means. This isn’t just at grocery stores; it happened to me the other day when I went to buy dog food. I despise going to the mall. I’ve actually only been once in the past year. I wasn’t alone, and despite that, I was still freaking out on the inside. These are some of the reasons why I try to buy as much as I can online.

There are so many things that I struggle to do, inside and outside of my home, which is why it’s important that I have a support system. My husband is great when it comes to helping me feel safe while we’re out. He will walk behind me so I know that he is the only person directly behind me. This especially helps while standing in lines. When I feel trapped in an aisle, I normally freeze, but he helps guide me through the store. He will put his arm around me, hold my hand, or hold onto my belt loop, making me feel more secure and ensuring that I don’t get lost. I can also go in on my own if absolutely necessary as long as I’ve taken Valium. I have progressed over time with the different activities that I’m capable of doing. Hopefully, over time, some of the regular errands I run will become easier for me to do.

Clozapine Rechallenge – Day 14

I’m still on the 100mg dose. My psychiatrist says that he’s keeping me at that dose because of the energy and fatigue that I’ve been experiencing. He doesn’t want to increase my dose until I can do some regular activities without having to nap for a couple hours afterwards. I’m very grateful that he’s not pushing the dosage increase. I’m supposed to start keeping track of this symptom using a number scale of 0 to 10, where 0 is none and 10 is the worst. This will be difficult to do, but I’ll try.

Today I woke up again with no side effects, and I even slept through the night. I won’t know how my energy and fatigue is until later in the day. I will rate yesterday’s energy and fatigue as a 5. It’s better than most days, but I’m still falling asleep if I sit down and rest for even a couple minutes.

I think I’m going to stop posting about my Clozapine rechallenge every day because it seems to be the same thing each day. If there are changes I will definitely post them, but I’m finally at 2 weeks, so I think I can cut back on these posts.

My Side of the Pole

Bipolar – Mental Health

Author: My Side of the Pole