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Anatomy of a Mixed episode


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2 March 2010

09:14 I’ve decided to abandon the 'sunny side up' strategy. It uses up energy I can’t afford to spend, and since I’m not stuck in any one mood state, and it swings so arbitrarily, it seems better to just let it happen and like you say musemuse, ride it out and bumble through.

If no-one minds I’d like to record what is happening so that when I phone my pdoc, I have something to speak from. And maybe someone here can identify with it.

I slept well last night, a whole 7 hour stretch. You’d think that’d make me feel better, right? – but it’s done the opposite. With too little sleep I get the adrenal energy + coffee lifting me up into mania a bit. So I woke up groggy and glum. Cried a bit, now I feel very restless and antsy. I’m playing Freecell compulsively as it keeps my mind from that useless ruminating. I have some art I am doing, which has a deadline for an entry but it just holds so little interest. When I sit down to do it, I get anxious from sitting still and leap up again.

It’s been raining and now it’s drizzling softly so I am going to take a little walk because I love the fresh smell in the air from the rain. It’s also been dreadfully hot here so it’s a welcome relief.

10:33 Back from the walk I dragged myself out for. I never understand why people say they feel energised after exercise. I don’t over-exert, and I never feel anything other than pooped. Even when I walk daily with a friend for a few weeks, I’m only ever pooped. I can’t even remember the fresh smell really making any impression and the best thing I can say about the walk is it’s done!

11:02 Tearful again. And so tired I could fall over. But restless with it.

11:27 Clunk. That was the sound of me falling over. Creeeaaak. That’s the sound of me getting up again.

11:37 Madly anxious, OMG! Not anxious about anything I can think of, just what they call “free-floating”. Except it’s not floating free, it’s sitting right under my diaphragm and pushing up into my lungspace. How can I be so anxious all of a sudden? There is an obsessive tune of about 7 notes that I have to play over and over and over, compulsively, in my head. It's driving me crazy!

13:23 Just popping by to say the anxiety just “free-floated” away, I looked at my art, started getting interested, sat down and have been happily working away, feeling peaceful, calm, my mind just drifting. I’m getting some new ideas for where I want it to go. Oh, but now I have a raging headache.

14:08 OOPS! My daughter phoned, I had said I’d bring lunch to her at school, she’s staying to write an English Olympiad. I’d forgotten! I think almost all moms will recognise what came to mind next: “BAD mother! What kind of message do you think it sends to your child that you just FORGOT her???”

Feeling guilty as sin, I charged down there like a bat out of hell with some hastily grabbed food. I apologised to her and she didn’t seem very fazed by it. Now home again, breathe deeeeeply - and breathe again – “she is ok, I am ok, I’m allowed to make mistakes, I’ve done what I could to make it right”. I had to take myself firmly in hand to drop the guilt, it wasn’t “good guilt” (the kind that pricks your conscience and goads you into doing the right thing), it was baggage guilt. “I.Will.Not.Spend.My.Valuable.Energy.On.This.”

14:30 Now I feel good. I’m thinking about writing a treatise on the Seven Deadly Sins – I believe I could make it quite witty! Gotta grab that brilliance when it arises, you know... damn, I’m can really write when I’m in this state! I’m good! Then I’ve decided the time is better spent on my art. Two very valuable resources: my time and my energy. So I’m going back to my art and I’m trying to set aside all my sparkling ideas for that essay. I start too many of these essays in fits of inspiration and never finish them and just exhaust myself. “Back.Away.From.The.Keyboard.Now.”

15:23 Who wrote that? What was I thinking? The Seven Deadly Sins? I am so, so tired. And just irritated. I have to make supper for tonight and it feels like an insurmountable task. I hate cooking at the best of times. My oldest loves to cook. She didn’t get it from me! But I keep delegating supper to her and I really should try to make an effort. She’s tired when she comes home after a day of lectures. Let’s just eat yoghurt, I’m not hungry anyway, they can have all of the yoghurt.

There’s a playschool across the road from me, I always enjoy the sound of the kids playing. What have I actually accomplished today? Nothing. I can’t wait to get into bed. I’m grumpy. I never get anything done, the end of the day arrived and I’ve essentially done nothing. I am SO glad I am single and don’t have to hear the constant nagging about how I just can’t get it together and I have no goals, yadda, yadda.

15:55 I’m ready to cry and I just want to escape from my head. It’s so exhausting in here. At times like this I can almost wish I did drugs, so I could escape, numb out. But I know I don’t want that; I just won’t have the energy to deal with the consequences. So I plod on.

16:10 Now I’ve got that compulsive tune running in my head again. “Hah dee ah dee ah, ho”. If I try to sing over it, it just drones on regardless, like a drumbeat. My stomach is tightening again and I’m anxious. And fed up!!!!

16:33 I wish I could just go stark raving mad and get it over with!! No I don’t really wish it, because that time I was convinced I was dying was bloody scary. So instead I just get to sit here, crying with frustration. And sorrow. So far I am managing to keep the self-pity away because I know I’ve got it good.

16:55 This time I remembered. I have to go and fetch my daughter from school. My head is pounding again.

17:57 Trying not to sit and weep in front of my daughter. It’s not like I’m pretending to be all fine and smiling, I’m just managing to hold back the tears. I dpn’t think I will cope with supper. Maybe tonight is a pizza night.

19:15 Fetch my other daughter from university. It feels like a complete mountain to go out, but I cannot bear the thought of her walking home in the dark, it’s really unsafe and I’d never forgive myself if something happened to her and I was in bed. Now both my chickens are in the coop for the night.

Waiting, waiting for 20:00 so I can get into bed.

20:15 I can get into bed now. I feel better, possible because I can now ‘give up’ and switch off for the day. It’s so sweet and I deserve it.

Edited by Luna-
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4 March 2010

I’m calling it. This IS a mixed episode. Whether it is going to go to mania or to depression, I don’t know. It’s very, very uncomfortable, but I am so reluctant to phone my pdoc. I’m 95% sure he will pull the plug on my Efexor. Before he put me back on it, he was thinking aloud and said “I don’t want to make you switch” but put me back on Efexor because it’s the ONLY thing that has lifted me out of all the depressions in the last 8 years or so. Efexor has made me switch before and now it’s done it again – there’s a clear timeline on it. And if I phone him and he stops it, then I will have to go back to that soul-destroying hunt for another med that works for my depression. And sooner or later, he will raise the topic of ECT again. (If ECT is effective, I’ll do it, but there is no guarantee it’ll be any better than meds I have tried and I won’t know until I try it.) Efexor can worsen BP and induce rapid cycling and this is exactly what it has done in me. This is already my third episode this year (one depressed, one manic and now a mixed). Faster cycles are harder to treat, as LindaMomOf7 will attest to!

I’m living for today, but in that choice I might be exchanging a better today for a worse tomorrow. Can I risk phoning him? Can I risk NOT phoning him?

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Hi Luna, I am so sorry you are going through this and it's good that your sharing it, tough for me to see because it really hits home :) :) but keep sharing!!!

My pdoc brough up ECT aso and I had it about 3 yrs ago and had a still have memory blocks and I have MORE processing problems I think from it, BUT I will always suggest someone trying it because I have seen it work on others. Just like meds react different, so does the ECT. And as far as rapid cycling and ECT, having the ECT it's purpose is to knock the cycle enough to where it is somewhere other that rapid cycling (depressed or manic) at least this is more treatable so to speak but the cycling isn't....

Know I have this spasm/twitching thing going on in my hand I hope its not from the meds, I have had it more then a month and it is getting worse and my MRI showed some stuff going on so off to a neurologist I go!!!! Great more questions, more Docs!!! UGH!!!! and with a thumb with a mind of it's own!!!! :)

Hey Luna I forgot are you taking anything for your hormones??? I started on HRT to help minimize I know it wont totally fix it but minimize my moods.....

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writing down these moments to moments will certainly let someone help understand their own, although it may be a bit different because of different surrounds and conditions. Wonderful:confused:

I am not saying wonderful that you are going through. Just wonderful that you are recording. It will help someone else.

Someone interrupted my thoughts with a phone call, but I'll get back.

You know (or don't know, but I telling you now) I ride that mixed horse a lot. Right now, though (praise God from whom all blessings flow), I'm sort of settled. No continuous crying. Some of the sadness is still with me, but I'm mostly wondering. It is like something is going to happen. I don't know what. Some kind of change in my life, maybe?

So dear, ride that mixed horse, go through all those emotions and know that a good benefit will come. Even if it is some further knowledge about yourself. watch

Blessings to you

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You two are dear... :)

I scraped all my courage together and emailed what I wrote here to my therapist and sent him an SMS/text to ask him to check his email and that I would phone him on Monday. There, it's done. I might well rue the moment, if the pdoc pulls the plug on the Efexor and I nosedive, with all the grace of a shot pheasant. :)

I am so over these stupid cycles. I'd scream if I could muster up the energy. Or in an hour or so, when the next manic swing arrives. Although by then I'll have forgotten that I wanted to scream and will probably be writing another ream of stuff about who-knows-what. Things are pretty wild inside this head right now. If we dimmed the lights and lifted off the top of my skull, I bet all the neuronal firing would make a spectacular fireworks display. uh-uh, did that manic swing arrive ALREADY???

If this carries on, I could just start to think I'm crazy. Mad! You know as in ... insane ... :)

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Sigh. I still don't feel like I really know what is going on, maybe I'm still a bit mixed, but moving towards depression, not towards mania. Not even an itsy little wee bit of mania. No more moments of feeling brilliant and witty and entertaining, not even for a short while. :) I feel down, uninterested in anything, aimless and the embodiment of inertia, although still quite restless and anxious. I'm also starting to feel inadequate, which is a red flag for me. I have pdoc and therapy appointments in 3 weeks' time so I guess I'll last.

I can't stay asleep at night, so I'm not getting enough sleep (5-6 hours). So where is this mania that not enough sleep is supposed to induce? I'm very tired when I wake up, but I'm not tired during the day. Odd. Tonight I'll take some of those benzo sleeping tablets the pdoc gave me that I don't like, just so I can get at least one full night.

I must keep reminding myself that this is far better than the horrible black hole. Sigh. I'm not suicidal, but to be honest, I wouldn't mind if the Grim Reaper decided to pencil me in on his to-do list. I know that is a terrible thing to say - but I'm so tired of this game. :)

Edited by Luna-
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Hey Luna hope your doing better?? I think from a blog you were? Sorry the dates are just flying by and I need to get back into my old habit and keep on top of things but this beautiful weather has me a bit manic or trying to do to much???

I can't work outside if I have to be inside to do things and vice versa....

Now that constant conflict gets me every year!!! I can't do it all and sometimes yes I feel like the grim reaper is someone I want to meet. And even with my loving and supportive family, it sometimes doesn't matter to me if I am here or not and would prefer to not be.....

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Hmmm, guess I am better. :confused: I'm still mixed, but not as extremely. (BTW Linda, I just use my blog to store quotes I like, nothing else.)

I got home at 10am today after a 27 hour shift taking bloods for a clinical trial. Strict timelines, high stress, broken sleep, broken routine, irregular eating, altered medication times, let's see, how many other elements were there, that could worsen a mixed episode? :( Don't try this at home, folks, this is how NOT to manage BP. :o

But... but... I needed the money, it's what I used to do, so I know how to do it, and it's weekend which means the hourly rate is higher than usual. It was the second of 2 such shifts, so not ongoing, it's over. But, there'll be fallout, like after the 1st shift, two weeks ago. Sigh. I already feel down.

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It seems that shift doesn't work well for you Luna. I know you need the money and it is a job you feel good at doing BUT... BUT... your health is what needs to come first :) I hope you can look around and see if you can get a "normal" shift that works for you... we are very susceptable to changes and our bodies do not like the changes!!! Hope you level out and feel better :)

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Thanks Linda... :)

It's done, it was only 2 shifts for Phase 1 and Phase 2 of the clinical trial. Yeah, to think I had that stress for 7 years! - it's hardly any wonder that my bipolar intensified so much in the last 2 years that I eventually came apart completely. But back then I didn't know I was bipolar, so I thought I just couldn't hack it.

It was a calculated risk for the sake of the money. :) But don't worry, I don't plan on doing that again soon.

The following day I was SOOO down. But it's evened again. I'm still only sleeping 5 hours a night, I'm tired when I wake up, but not during the day. Sounds like a manic symptom, doesn't it? But I'm not manic. These mixed episodes are enough to make you feel crazy. :)

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I would imagine that marathon professional vampirism would take its toll on anyone, regardless of pre-existing condition. I would also imagine the donors were pretty empty by the end of it, but that's just because I don't know how many there were. :-)

I once stayed up for 36 hours for work, but no one tried to ask me anything important towards the end. I'm surprised I managed to drive home. And, never again.

I hope you're trying to stabilize your hours, since then. Life is hard enough without messing with the old circadians. ;-)

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Maybe life itself is a mixed episode. :) Maybe life is paradoxical and things can be true and untrue at the same time. Things that happen can be both good and bad. We feel ambivalent about many things. Hey, perhaps this is NORMAL!

We awoke to repeated "boom, boom" sounds this morning and my daughter asked me what they were. So I said, in my half-awake state, "Either they're having shooting practice up at the army base, or the extra-terrestrials have landed and have begun to demolish the planet to make way for an intergalactic highway."

She gave me an amused look and said "Mom, you're talking rubbish again". (Has she heard this sort of thing from me before, perhaps?)

I have no idea why I wrote the above. Total tangent. (There was a tenuous connection somewhere.)

There is a playschool right across the road from me. Every morning I can hear pre-school kids arguing then shouting, then crying. then laughing. Boy, do they rapid cycle! And we call them normal...

How do we really know if life isn't really a brainwashed illusion, to cover up the fact that we are actually plugged in like batteries generating energy for a planet that has been taken over by machines? You know, a shared hallucination? If we all share it, is it a hallucination?

Now, I had a point somewhere... what was it? Oh yes, mixed. I'm feeling calm, drifting... I didn't sleep much, as is my pattern these days. I've unhinged my mind from what is, to what may be. Oops that was a bad choice of word!

And maybe I am talking rubbish...!? I'm practising to become a gentle old eccentric woman with too many cats, with just enough of a grip on reality that I don't need to be hospitalised. Hell, I'm 48 and if people don't like me, they can leave me alone.:)

Crap. I am crazy. Better keep my tongue in my cheek. :)

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I feel really shy about bringing this up but I have just sat and cried and cried about it this morning, I have a headache now – and I feel… well… heartbroken. I guess I should have put this in Sexuality, but because I feel shy I’m burying it here in my Mixed thread so maybe less people will see it. It’s also long so maybe that will dissuade some folks.


It feels as if BP has taken so much from me and the price of treatment and staying well is so high. And it keeps getting higher. I’m not talking money-wise (although there’s that too) but in terms of what I’ve lost and have had to give up along the way.

So my problem is … well, it’s not actually a problem because problems can be solved and this one I just have to come to terms with…

I don’t have any libido left in my life at all. It dwindled and dwindled over the years until it is now non-existent. I lost it to countless depressions and I lost it to the treatment of these depressions. (We know what meds can do to libido; kill it.) It’s a “damned if I do and damned if I don’t” situation and I have opted for the treatment because with the drugs I at least have a chance of actually being able to function and have some good times. Efexor is the drug that is the culprit here. I don’t mention this side-effect to pdocs anymore, I haven’t for years, because it comes down to “do I want to be depressed and have what little sexuality is left in me or do I want to be on the only med I have found in so many years of searching, that makes me feel better, but makes me asexual?” It’s been a hard price to pay and it continues to be so, whenever I’m reminded of it, like now - but that is just how it is. My depression is treatment-resistant and 27 years of the BP going undx'ed has worsened it over the years, so finding something that helps, is like finding gold – in this case in a box of Efexor. For the last 8 years Efexor has cost me my sexuality but has been/is the only med that lifts me out of depression.

So okay, my libido doesn't exist, which means I don’t think about it and I have accepted that. But when I get manic, the interest comes back, not a lot, but it’s notable because I start thinking of it, which I don’t do normally. This isn’t very often, and now I know it’s one of my early signs of mania. When I get manic the pdoc stops the Efexor - and a little libido, minus Efexor, means I actually get to experience it again, briefly. Just a little and just for a short while, until the next depression arrives hot on the heels of stopping Efexor.

When I’m mixed, like now, I start thinking about it and I’m still taking Efexor. And what has just made me sob this morning is that on the Efexor I can’t orgasm. No matter what I do – zip, nada. So I sit with this energy, desire … and no way to… and today it got too much. I wish I didn’t get any libido when manic, it would be less painful and less of a reminder of how this cruel illness has eaten its way into every corner of me.

When I’m manic proper, not mixed, and the pdoc stops the Efexor I get that brief window before I slump back in the depression I inevitably get when not on Efexor. The problem with Efexor is that it causes me to switch. It is amazing relief from depression when I switch (even as now, into mixed, which isn't that great but WAY better than depression) but it worsens the future course of my BP and has made me cycle faster, which makes it harder to treat, which makes me depressed more often. So the drug that helps my todays, makes my tomorrows worse. How cruel is that? I’m sitting here feeling such loss and feeling sorry for myself; it's such a basic human thing, but no, I can't have it.

How much more am I going to have to pay for this damn BP? I feel as if I do all the recommended stuff to manage it and I damn well work at it, because I am motivated to stay out of depression - heck anyone would be, severe depression is so awful. But it helps bugger all, I’m just banging my head against a brick wall. Why do I even keep it up? When next I see the pdoc he will stop the Efexor because it has once again made me switch. He was reluctant to give it to me this last time around. Then I will slide into the next depression which will get worse and worse until in desperation he puts me back on Efexor – hell, so I can stay alive and not want to kill myself every day, having to sign weekly no-suicide contracts (not have to, I want to). This nasty and fantastic medication... that gives, at a price, and then snatches away.

The cycling and the depressive cycles which are longer than anything else are bad enough, but this whole libido/ no orgasm thing has been going on for weeks and today it just feels like the last straw. Except my back is already broken and I know there will be more straws to come. I tried to have a Good Cry – you know, one that is cathartic and then leaves you feeling better for having got it all out there? But there’s no Good Cry today, because it won’t go away, it has to be accepted because it is what it is. And I get a little manic every day in a mixed episode, and everyday I’m reminded of what I would like, just a little, but I can’t have.

It feels so cruel and there is no getting away from it. I fear that soon (and that could be in two weeks when I have my next appointment) I will have to stop Efexor for the last time and go on the several-years-long hunt for something else, while the depression deepens and deepens, while I just try to stay alive, one day at a time. (I guess the upside is that the libido will disappear again, so at least that pain will go away... but it’s always a choice between two evils.)

I feel jumbled up and have probably repeated myself. I feel so bereft. I have thrown myself into my art (I think there is some sort of link between sexuality and creativity) and it helps, but… every so often everything tumbles down on me too hard and I wish I could break apart once and for all and get it over with, instead of the recurrent chipping away at me. Life is so long, day after day after day, so relentless. I hope the Grim Reaper comes for me soon.

So yeah, that’s what I wanted to say. I haven't told this to anyone before. If you made it this far – thanks…

Edited by Luna-
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