Cyclothymia

EDIT: I have posted an update on my experience with cyclothymia as of two years later here.

I have recently been diagnosed with Cyclothymia disorder. It’s a type of bipolar disorder. The main differences are more rapid cycling (abrupt shifts in mood or “polarities”) and less intense swings than those with bipolar disorder.

I’ll explain more as we go along, but first…

Why I’m Writing This:
One day a 19 year-old teenager comes home dazed from a meeting with his Psychiatrist. He has just learned that, according to the guy he’s seeing, he’s suffering from a subset of bipolar disorder called Cyclothymia. He is very confused.

Feverishly, he asks Google about it. Okay…so Cyclothymia is a type of bipolar disorder with less extreme polarity on both ends. You don’t get so depressed you want to kill yourself, but you aren’t so “manic” you think you can fly. Great, sounds like my life, he thinks.

But as he looks around for articles, blog entries, forum posts, written by young people that could shed some light on living with the disorder, he finds only the occasional YouTube clip and an old Yahoo group related to the illness.

While this wasn’t my experience, it very well could have been. I did my own research and self-diagnosed before ever seeing a professional, but it doesn’t usually work that way. There really is an incredible lack of awareness and content written about the disorder online, which is why I’ve decided to type this piece, possibly the longest I’ve ever written.

Now, full disclaimer: I could be a charlatan. I’m probably not, but Psychological diagnosis are anything but fool-proof, and the doctor relies heavily on the patient’s self-description of events and patterns in their lives.

This seems like a pretty decent segway into…

Diagnosis:
The web is full of stories from people who walked into a Psychologist’s office, talked about their grades in school, and walked out with ADHD (Attention Deficit Hyperactivity Disorder). The same stories exist about Cyclothymia and Bipolar I disorder.

A Psychiatrist can only see you for something like 45 minutes per week (if you’re lucky and insured), so they only thing they have in their toolbox is your perception of your behavior, and their tiny window of analysis. I don’t doubt that thousands of patients are misdiagnosed with mood disorder’s every year. But I also believe the same amount aren’t diagnosed when they should be.

I went through the same existential quest when I self-diagnosed myself with ADHD. Until someone gives you a prescription, it just feels like complaining.

But after meetings with Psychiatrist who made me more anxious than I was before to Psychologists who told me exactly what I wanted to hear, I think I have become to understand the value of self-diagnosis. Sure, hypochondria is a risk (wonder how often that’s self-diagnosed?), and sometimes when you’re looking for answers that fit it’s all too easy to ignore the symptoms that don’t, but if you’ve done the research and examined your life comprehensively, sometimes the safest thing is to recognize the illness within yourself.

Out of all of the posts about Cyclothymia I found on mental health forums, at least 75% were titled something like “How do I know I have it?”,or “Not sure if I have it…” The most asked question from those looking into the disorder is: What does it feel like?

It’s probably a good time to talk about that.

What Cyclothymia Feels Like:
Right now I’m riding in a Muni car. I’m on the K line to be exact. Riding toward City College San Francisco’s Ocean campus. Right now I feel pretty good. But unlike someone who wakes up, goes to work, and waits for their boss to piss them off, I have no such emotional guarantee. I’m constantly PMSing.

The result is some really fast typing. I write as rapidly as I can not because I’m worried there won’t be a tomorrow, but because there won’t be another hour. I don’t think I’m going to die, but my enthusiasm, productivity, and creativity very well could. Think I’m overreacting?

Let me show you a graph of my moods for an average week. It is on a scale from 1 to 10. A mood-score of 1 means I’m feeling pretty close to suicidal. A 10 means I’m out of control hypomanic (what’s that? I’ll tell ya later), buying expensive steak dinners, and climbing telephone poles (all things I’ve done).

Anybody can have a bad day, a bad moment, a bad couple of hours. Anyone can get a letter in the mail that makes them smile, get asked out on a date by their crush, get a sugar high. It’s when these moods shift without a trigger, in the middle of a benign activity like cooking dinner or brushing teeth, that it becomes a disorder. When you don’t feel safe making plans for longer than a few hours away because you don’t trust yourself to be in the mood to see anyone.

I spend most of my days like this:

• Wake up. Cheerful or miserable.
• Shower. Inspired or furious.
• Get to the Muni station. Happy-go-lucky or in tears.
• Get to class. Loving my classmates like siblings or wishing I had never enrolled.
• Midway through class: Violent shifts in mood, sometimes two to three times. Almost always extreme polar opposites.
• Get out of class: Sometimes I cry as I take the Muni home (no reason) and sometimes I am inspired and write, like now.
• Afternoon. Cook something and decide I hate cooking midway through. Purposely burn everything I spent an hour preparing. Get angry at myself for wasting my time and food. Start to cry. Put on a movie and lay motionless in bed until I have to leave for class.
• As I walk to class, you might see me scowling and muttering to myself, purposely bumping into people on the street, almost shoving them. Or, you might see me listening to an audiobook and smiling as the author makes a joke. I might get to class breathless, brimming with enthusiasm, or sullen and shriveled, refusing to make eye-contact.
• My teachers have begun checking in with me in the middle of class: “How are you feeling?” they’ll ask. And they’re right to.
• Then I walk home to Chanterelle, and she, in her graceful acceptance, searches my face as I walk through the door, trying to gauge who I am. Sometimes I hate her, I don’t want to talk to her, and I feel like emailing my friends to let them know I never want to see them again. Sometimes I tackle her and kiss her on the bed.
• Go to sleep and start the whole process again.

I’m not being over-dramatic. Some days really are better than others, but some are so bad I genuinely consider committing myself. No one knows this of course, because when I’m up I don’t really remember being down, and when I’m down, I don’t really remember anything rational.

I’m making it sound like multiple personality disorder – but really it’s not like that.

You see: none of the thoughts I had when I was in my alternate state make sense to me. I write down how I’m feeling when it’s really strong, just so I can remember later. But when I’m up, why should I read that depressing junk? And when I’m down, well, what’s the use?

Hypomania and Dysthymia:
Hypomania (our ups) is a type of mild mania. True mania usually involves running down the sidewalk with a gun, and very little sleep. I believe I have had a few genuinely manic times in my life (most people with mood disorders do, even if they’re not full-blown bipolar), and though it was suggested at these times that I might be bipolar, it wasn’t pursued.

“After all,” my parents would say to the doctors, “he seems to function fine most of the time.”

If you know me in real life, you may have experienced me in a state of hypomania. You know you’re hypomanic when:

• You’ve suddenly realized you have more money than you know what to do with, and that you need to spend it as quickly as you can.
• You finally realized how inconsequential due dates and pithy little errands are, and now you need to spend as much time having fun as you can to make up for lost time.
• You have just noticed how incredibly slow everyone is, and you feel the name to tell everyone in line at Walgreens about it.
• The thought: “Later is good, but now is better,” has become your single governing rule when it comes to buying things.
• Everything routine seems boring and useless, you must rearrange your life, now!

Additionally, people in a state of hypomania are often viewed as charming and confident. This is magnified by their momentary spontaneity. For this reason, Cyclothymia often goes diagnosed for years. Hypomania has a pretty face, and the depressive state doesn’t last long enough to keep an appointment with a Psychiatrist.

Dysthymia (our downs) just means depression. The difference, as far as I can tell, is that it goes farther than just “being sad.” While all of us can get sad, very said in the case of a breakup or death, dysthymia is chemical. When the brain is in a dysthymic state, we very well may be experiencing genuine, sad emotions, but the feeling is magnified with an imbalance of natural chemicals.

You know you’re dysthymic when:

• You can feel your muscles flexing as you restrain yourself from hitting the guy on the bus who doesn’t offer the old woman his seat.
• Musicians playing on the street cause you to sit in a corner and cry, even if you were feeling fine a moment before.
• You are angry at your girlfriend for “stealing” your headphones even though you offered them to her yourself just that morning.
• Smiling to someone who smiles at you on the street causes a shock of pain to your heart.

I think everyone has their own ways of dealing with dysthymia (hereafter referred to as depression, typing “d-y-s-t-h-y-m-i-a” every few seconds is a pain).

The problem I have when I’m chemically depressed is that as soon as I realize I’m upset, I try to think of a reason. If there isn’t a reason, I make one up. I cling to things that have never bothered me, and before you know it, I find myself tangled in the web. Then, like a fly, I try to struggle free and think my way out. Turns out this is a waste of time when you’re being held-down and injected with downers.

So much of my days over the past few months have been spent tracking and monitoring myself, trying in vein to think my way to balance, there hasn’t been much time left for anything else. Did you wonder why I haven’t been blogging?

Let me tell you how it affects my work.

Productivity:
Hypomania has an excellent reputation for productivity. You’re supposed to feel inspired, obsessed with getting stuff done, and completely free of the need for sleep. Most of the time, however, this isn’t the reality. As I alluded to above, when I am feeling hypomanic (hereafter referred to as high, apparently it feels very much like a mild hit of heroin) I “forget” about due-dates. I’m above them. The stuff will get done. There’s plenty of time. So I do something else.

When I’m depressed, I have no motivation to live life as I have. In fact, I hate life as it is, and if not getting my homework done is what it takes to escape the oppressive walls of the classroom, I’m going to make that sacrifice. After all, I think at the time, I don’t have much else to sacrifice. Everything I have is rented-to-own from hell anyways. So I do something else. Or nothing.

Do you see the problem?

Most of my time is spent oscillating between these two states. Every once in a while (once a week, maybe) I get a day like today. A day when I maintain enough stability and balance to keep my head out of the clouds and free of aches long enough to get something done.

These days, while not “fun” like my highs, make me feel good. They’re like gold, and just as rare. On these days, I have a sense of self-control. It may not be reliable, but it’s there, and I hold on with both hands.

Assuming these mood-swings don’t go away, and my days continue to go the way they were, what will I do? How will I function as I go on? In school, a missed homework assignment takes you down a grade. In the world, a missed deadline takes you down a client.

No, those standard desk jobs aren’t going to work. Anything that requires consistency everyday is out. As is a job where I am required to interact with people predictably at preset times. What does this leave?

I need a career that allows three hyper-productive hours to support myself and a family for a week. Anyone know of any openings?

Didn’t think so.

So, if I have to seek some treatment, what can I do?

Treatment:
First off, I want to say that I have no idea how to treat Cyclothymia. Everything I have to say is based on a week or two of data, it’s hardly conclusive.

But, the past couple of weeks have been full of self-examination. I have done just enough research and experimentation to have something to say on the subject.

First: medication isn’t enough by itself. Pills can take the edge off of our emotions, but they will never be the final answer. Call me a hippy who had a naturopathic doctor for a mother, but it is my opinion that pills are made to suppress symptoms, not the illness itself.

I have been taking an antidepressant called Welbutrin since December. The first week I was on them was wonderful. I felt like a superhero. I lifted more weights than the athletes at the gym. I did my homework in minutes, then did everyone else’s. I bet speed feels the same way.

Then I crashed. Since then, the antidepressants have only seemed to make the mood-swings worse. I’ve been continuing to take them because I wanted to give them a chance, but my Psychiatrist and I agreed yesterday that we would phase them out pretty soon.

Just so you know: Anti-depressants are almost never prescribed for bipolar disorder or cyclothymia. They’re often reported to make manic episodes more frequent (and worse), and can knock someone with a mood disorder even farther off-balance. My doctor didn’t know I had Cyclothymia when he prescribed them. All he had to go on was my report of an extended depressive phase. “Why tell him about my highs?” I thought.

So yesterday, my Psychiatrist prescribed lithium carbonate. I took his little blue slip (I love these things for some reason) and gave it to the nice woman at Walgreens. In a half-hour, I came back and picked up a little bottle of pills. I took my first one yesterday as I was walking home.

Lithium carbonate is, from what I can gather, a sort of non-organic salt. Maybe if I had gone to high-school past freshman year I would know more about the stuff than the fact that it’s used in batteries. Whatever it is, it has been around for a long time. One of the things I that attracted me to it was it’s long lifespan. “Old-fashioned” has become the search phrase I use in Google when I want pie recipes that don’t include instant jello puddings. Old-fashioned means quality.

Last year a study in Japan showed reported that communities whose water contained large amounts of lithium had significantly less suicide rates, and psychiatrists have been using the stuff for over 100 years.

A tid-bit: apparently lithium used to be in the majority of sodas until around 1950. In fact, 7up is named after the number “daltons” (what the hell are those?) that make up lithium’s atomic mass.

So there’s always lithium. Jeremy Brett, a hero of mine who played Sherlock Holmes in the 1984 Granada television series took it after he was diagnosed as bipolar midway through taping a season of the show. Apparently it helped with his mood swings, but his liver was so weakened by it that he began to take on large amounts of water. He gained an incredible amount of weight as the Sherlock Holmes series went on. That scares me a little.

I can’t say much on the effects of these little pills, because I’ve just started taking them. If they don’t work, I’ll likely move on and try something else. The other common drugs used are anti-seizure medications.

What I really want to talk about, though, is therapeutic treatment. My Psychologist (different from my Psychiatrist) is excellent at what he does. He is holistic, and realizes that treating people isn’t just about listening to them whine, and giving them advice. He works to help me pry the right answers out of myself. And that works.

The most helpful thing he has worked with me on so far, is the acceptance of my states. What I mean by this, is the willingness to acknowledge and stop fighting the moods as they come and go, whatever they may be. As I mentioned earlier when talking about what chemical depression feels like, the default tendency is to try to invent reasons to justify your mood.

The trick is to change this pattern. The reward? The mood swing will last only as long as it needs to. If you let yourself get tangled, you’ll stay angry, depressed, whatever, for longer than you need to. For the past week, I’ve been focusing on remaining centered, recognizing the early warning signs, and changing my default responses to unexpected chemically-induced emotions.

And, of course, I’m still terrible at it. But I’ve already noticed a difference in the length of my swings.

Relationships:
Much of the time, I am reliant of Chanterelle to keep an eye on me and try to supervise my actions. The common script when we’re out:

Me: Hey, let’s try out that new Indian place!
Chanterelle: (Looking hungry, but retaining self-control) We don’t have any money. It’s too expensive.
Me: Oh come on, we’ll just do one less load of laundry. Don’t worry about that.
Chanterelle: Christian, no.

Thankfully, I respect her “no” enough to let it be the final word on the subject. If I didn’t, we’d be in trouble.

My closer friends who I see in person have started asking Chanterelle what sort of mood I’m in when we get together. Sometimes (like just the other day, when Samantha brought her cousin to meet us) I’m in a crappy, I-hate-you-and-everything mood. But they know that within as little as 5 minutes I could be talking like an auctioneer and dancing down the sidewalk.

The only one who does not respect my boundaries and leave me alone when necessary is our cat, Maya. She finds my worst moods convenient times to take a seat on my lap, and funny enough, she never gets mad at me for being such a jerk.

The future:
Who knows how this will all turn out. In the end, I think it’s better to know about a disorder like Cyclothymia, even if you don’t know quite what to do about it.

If you’re interested in learning more about bipolar disorder and Cyclothymia, the actor Stephen Fry (who played Oscar Wilde in the movie) created a documentary after receiving his own diagnosis. In the film, he goes to various friend’s houses (including Robbie Williams and the woman who played Princess Leah in Star Wars) and interviews them about their bipolar disorders. I have seen it, and really enjoyed it. It’s called: “The Secret Life of the Manic Depressive.”

Thanks for sticking with me through this post. It may be the longest post I’ve ever written. As I mentioned before, it is my hope that my words will serve as support and comfort for someone who might be trying to understand why and how this illness has slipped into their lives.

The most important thing to remember: accept your moods for what they are, and don’t get caught in the web.

Cyclothymia, 4.7 out of 5 based on 50 ratings If you liked this post, you might like these:

1. Update on my mind…
2. Almost clinical
3. Superhuman update