“If I could control tomorrow’s haze
The darkened shore wouldn’t bother me
If I can’t control
the web we weave
My life will be lost in the fallen leaves”
–David Bowie, “No Control”
I mentioned in a previous entry about the difference between mania and hypomania that there are other states besides those and depression that can affect a person with bipolar disorder. These states can be just as devastating, if not more so, than the expected swings between hypomania and depression. Some of these I’ve experienced and some I haven’t, so I can’t completely talk about them from a personal point of view, but what I can, I will. The one thing all of these other states have in common is that, just like bipolar disorder itself, there is no way to control them.
The first of these are what as referred to as mixed mood episodes. It is a combination of mania (or hypomania) and depression. These episodes can be very dangerous because they can combine the suicidal ideations of depression with the abundance of energy of hypomania. The thoughts of suicide and self-hatred mixed with manic restlessness can be problematic to say the least. Not only are there thoughts of suicide, but the energy to act upon them. Mixed mood can last anywhere from a few hours to a few days. On the roller coaster that is bipolar disorder, this is the most out of control part of the ride.
I’ve experience mixed mood on rare occasions, but luckily not for long and they ended before I was worked up enough to physically harm myself. I hated myself, my life, my actions and even my own uncontrollable thoughts. My brain kept hammering me with the fact that every shitty thing in my life was my own fault and nothing I did could ever change that. As is usual with hypomania, my thoughts were racing and constantly battering me with the fact that I was a worthless asshole and I kept replaying everything I had ever done to hurt not only myself, but those around me that I cared about. It was a repeating slideshow of painful memories.
Another danger to the bipolar person is called rapid cycling. Rapid cycling is when a bipolar person experience four or more hypomanic, manic, or depressive episodes in a 12 month period. This doesn’t mean, however, that episodes follow any predictable cycle. The pattern is quite random. The quick mood swings of rapid cycling can occur within a few hours or a few days. This roller coaster carries a high risk of suicide. Diagnostically, mania lasts one week, four days for hypomania, and two weeks for depression. These minimums are for the purpose of diagnosing bipolar disorder.
I’ve been lucky enough not to have experienced rapid cycling. My depression can last for months and my hypomania is usually several weeks. But again, they are not predictable cycles. Through therapy, medication, and educating myself on my illness I have become better at identifying certain cues as to what I may experience next. In addition tracking my mood, there are other signs as well. Sleep patterns are the most telling for me. If I’m not sleeping, I know something is happening. If I can’t sleep but don’t feel tired during the day, and I feel tense and restless, I know hypomania is to blame. If I can’t sleep and can’t bring myself to get up and get moving or begin sleeping during most of the day, it’s a sure sign depression is creeping in. Identifying what are called prodromal (early) symptoms is a key for me in trying to hold off a bipolar relapse. I can never control my moods or change the way my brain thinks, but as long as I continue with my treatment, I can manage the symptoms somewhat, and that’s about the best I can hope for.
The last thing I would like to share is the concept of what have been called “breakthrough events”. Breakthrough events usually occur during days when I am feeling average. I may be having a good day by my standards and something happens. It could be anything, a song on the radio, something on TV, or even a comment someone makes and it sends me into a completely irrational emotional state, usually depression. Whatever progress I’ve made or episode I’ve overcome is just shattered. Everything just gets shot to hell without any warning and I wind up sitting and crying over something I’ve read or heard or watched. Again, this is part and parcel of bipolar disorder. It is an irrational disease and the breakthrough events can be lasting. I have to accept this as part of my illness and learn to deal with it. My brain fucks with me on a daily basis, sometimes sending me into self-loathing with no warning at all. Like I said, I can only manage as best I can and keep trying to make it through. I take my meds and stay in therapy and track my moods. These are my weapons in this particular fight.