National Bipolar Day

Once upon a time I would have reflected on past weeks as being the ‘well’ me. This judgement would stem from the incredible levels of productivity; my self worth being measured by the things I achieve each day. This ‘busy’ version of me has whispered a deadline to complete all our homemaking projects before the baby arrives in early October. It’s a deadline I’ve responded to well and the enormous list of unfinished projects is steadily toppling as I press on. Our home, inside and out, was a renovation project from the outset because this was all our pockets would allow. The episodes of depression year upon year have always stunted progress; that and the financial struggles that come with being unwell.

Since mid April I’ve advertised and sold 81 items on eBay, including some of our furniture and family car, raising the money needed to complete the projects. Seeing the progress has been truly rewarding. Working on these projects at home helped to give me back some of the confidence I lost to depression. Alongside our homemaking projects I have been working to revive the business. Again, with each episode of depression I lost projects and opportunities. The momentum is building again as bookings come in. I am relieved.

I suggested this was the ‘well’ me in action but an awareness of the mania phase of bipolar disorder suggests otherwise. I have more projects and commitments on the go than I can truly handle. I’m unable to sit and rest without feeling restless and driven to do something. My mind is busy all the time scanning for things that need my attention. I am never in the moment. When my body tires from all the doing I switch to planning and plotting future projects – unable to accept it is time to stop and rest. I get irritable with those around me especially when they are unable to keep up with my pace and see the need to hurry. And as rude as it may sound, when friends are talking to me I’m finding it really difficult to concentrate on what they are saying and hold my attention still.

During this period I have been a bad blogger, not publishing for more than 50 days. A few days ago the blog notched its first year, and I didn’t give it a thought. My busy mind has kept me from blogging – unable to tether myself to such an activity for any length of time. Even showering, shaving and cooking are filed under time wasting activities when so much more could be achieved in the same time. It is warped thinking, I know, but I feel a little out of control.

So why is it I have turned to the blog today? Well, just recently things have started to get a bit more difficult again. I put it down to tiredness at first, given that I’ve been pushing through when the body wants to quit. But there are a few things that together form something of a warning flag. I’ve had to talk myself into seeing other people, feeling an internal resistance to it, be they friends or customers. I’ve been getting really anxious, worrying about all sorts of things and feeling uneasy in myself. To manage this at work I’ve been rehearsing projects carefully and planning schedules and kit. It helps but I can still feel the internal, self made, stress. I’m eating a lot more chocolate and other sweet things and drinking coffee – using these types of foods when I feel the mental and physical inertia and need a boost. It’s a bad idea but the cravings are really overwhelming. I’m starting to feel the need to nap although I haven’t given into it yet. The fatigue is becoming heavier and it frightens me. Morning starts on Quetiapine have always been slow but increasingly I am unable to pick up my energy levels as the day goes on.

The dose of Quetiapine was clearly not sufficient to manage the manic phase – although I didn’t complain because I enjoyed the feeling of getting so much done. It may be that the dose isn’t quite right to manage the depressive episodes too. That said, I have a lot still to learn about this condition so that I can manage it in the future through other changes aside from medication.

Today is national bipolar day. Sounds like a good day to start learning.     

I Am Not Depressed

As we sat down to dinner this evening I noticed Xavier was wearing an apron. “Why are you wearing that?” I asked. He mumbled something which I didn’t catch and then replied, quite unlike a four year old, with a heavy heart and a flat tone “I don’t want to wear this bloody apron.” My first thought and in fact my reply was, that is the correct use of the adjective, and I held onto my laughter, although I’m sure some escaped through my eyes. Since dinner we’ve consulted a thesaurus to find some other words that can be substituted in, with all the feeling and minus the offence. He’s particularly tickled by ‘blasted’ and ‘darn’ and we’ve agreed to mutually remind each other of the alternatives should we ever forget.

I’ve been reflecting a little on whether things are working out between me and Quetiapine (Seroquel, Ketipinor). It’s a tranquilising psychiatric medication used to manage psychosis by blocking the receptors in the brain that dopamine acts on. My tablets are designed to be slow release, giving me relatively steady blood levels of the medicine throughout the day. This is why it’s important I take them on an empty stomach; food would speed up its absorption into my bloodstream.

So first I’m just going to take the symptoms I’ve been experiencing through depression and examine each one in turn – noting how things are now, compared with how they have been in the recent past.

Anhedonia, an inability to experience pleasure from activities usually found to be pleasurable, is what characterises depression the most. The numbness severs through everything, even my relationship with my wife and son, the two greatest joys in my life. The magical morning sunlight, my eager dogs, the sound of music on the radio; everything disappears into a blind spot. Now things are different, I can project the love and affection I have for my family, colours have come back into the world and everything around me is buzzing with life. I have a grasp on happiness again, although it is different to before – sort of a tethered happiness, not the vivid winged happiness I’ve known in the past. It is practical.

Feelings of grief and guilt, my two close companions during depression, keep me ruminating irrationally on past failures, conflicts and inadequacies leading me to a place of hopelessness and intense stress. This is when, combined with the anhedonia, life stops making sense and becomes something I stop fighting for – something I’m actually desperate to be relieved of. I’m grateful that these dark feelings have lifted and it has become easier to rationalise my thoughts and memories, and manage the internal stresses. Horrid thoughts still pop into my head and I get quite anxious, but they don’t imprison me as they did before; I am not the scratched record.

Psychomotor retardation is a slowing of thought and movement so that both can feel desperately heavy and cumbersome. Making simple decisions became difficult, as did other tasks that required a degree of concentration. I shuffled about, sloth like in darkened rooms, or more often than not – remained in my bed pinned down by my heavy limbs and the stress of my own debilitating thoughts. I slowed to the point of sleep – if fortune was kind enough to afford me the peace of sleep. I have to distinguish now between that feeling, which I’m glad to say has passed, and the sluggish feeling I experience because of the Quetiapine. Sure, I feel sleepy and physically tired a lot of the time and have brief bursts of activity and energy – but it isn’t the same as the depression.

So on balance my relationship with Quetiapine seems to be working out, except for the way it makes me feel physically. Now that my mind has returned to me I find it is keen to make plans and push on with work, but my body feels like it’s holding me back. This is a deep furrow for negative thinking to prosper and therefore something I continually need to keep in perspective. I must not let this physical slowness dishearten me – and I do have a knack for seeing the negatives. It has been interesting for me to get this all down on paper – things are more positive than I had realised. If Quetiapine is prepared to give me something of my energy back, then this relationship could well work out.

'Dad' Fit

A typical game of ‘Guess the Animal’ with Xavier goes a little something like this:

Me:                  Does it have four legs?

Xavier:             Yes.

Me:                  Is it a mammal?

Xavier:             (in a hushed voice) Are tigers mammals?

Me:                  (in a hushed voice)Yes.

Xavier:             Yes, it’s a mammal.

Me:                  Is it a predator?

Xavier:             (in a hushed voice) Are predators the ones that get eaten by carnivores?

Me:                  (in a hushed voice) No. Predators eat other animals.

Xavier:             Yes, it’s a predator.

It is endlessly fascinating understanding the world through the eyes of a four year old. For instance, Xavier thinks that when we get older we’ll need to move into a bigger house, and by bigger, he means taller. From his perspective he gets taller ever year and he doesn’t see that ever stopping, so at some point well need a really tall house.

Only recently he appreciated for the first time that he wouldn’t actually catch up with his older cousin in age. He was looking forward to the day that they would both be six together, but hadn’t considered that with each year his cousin would grow older too. Time, generally, is a bit of a strange concept when you are four. The other day he was really caught out when I was talking to him about a time before I knew Alicia. This was a real surprise to him; the idea that Alicia and I met, and before then we were not together, or more to the point, didn’t live in the same house.

Xavier loves winning and takes losing quite badly (much as I did when I was a child - but I’ve found it’s something you can get used to). He has just started to cheat at snakes and ladders, which is brilliant. I give him plenty of opportunity by looking away and getting distracted when he’s rolling or moving his counter. Alicia says when children start cheating at a game, that’s when you know they really get it and you can start to raise the bar a bit. He cheated at table football yesterday too, and then looked at me squarely to see if I’d noticed. I hadn’t of course.

He doesn’t play with toys that much. At first we both thought this was a bit strange. He doesn’t want for new toys; he has a stash in baskets and cupboards all over the house in almost every room, but it’s as though it rarely crosses his mind to take them out and play with them. But I think the truth is, he is really a social creature and what he prefers is to play with others. So he will play with anything, even if it is just a cardboard box, if we are playing together. Toys, by themselves, do not occupy Xavier for very long.

He totally adores his magic drawers. I have this small old chest with about twelve tiny little drawers in it. They are magic because whenever Xavier does something wonderful, he can open any drawer and he will find something inside. On all other occasions the drawers are magically empty. He chooses the drawer to open and he is always excited to discover what’s inside. He has found sparklers, popping candy, tiny wind-up toys, finger puppets, magnets, a parachute and lots of other fascinating objects that take him off on a curious tangent. The magic drawers came about when I was tidying and found that smaller things, no matter how wonderful, could just get overlooked and lost as they jostled with large, colourful toys, just like plants, competing for space, light and attention.

The world is so different for Xavier to the place I grew up in. His curiosity can drive every moment of his day. You Tube means that all his questions about the baby growing inside Alicia can be answered vividly and on demand. He dives into the ocean to see blue whales giving birth, then travels through time to see dinosaurs fighting over carcasses, then up into the sky to be with astronauts moving about in a weightless space station. There are so many wonderful events to witness from across all of time and space.

He is an active boy too. Only the other day he had been penned in somewhat by the rain and as I tried to talk to him I could see every limb in his body twitch and his eyes darting about - and I stopped myself and realised he is bursting with energy and that now was not the time for talking. When I am in better shape we walk the dogs together and chat along the way. There is always something he's trying to figure out, like what happened to all the even numbered houses on the street or what made that hole in the gound.

With Xavier devouring the world at an incredible pace and finding his place in it, and with another member of our pack on the way, I really want my energy and ‘me-ness’ restored so that I can be everything I want to be to my wonderful family. So that I can be that 'giant' that Xavier thinks I am, still growing skyward. But even when I'm not my best, he understands like a best friend would.

Tiny Little Goals

I’ve been taking Quetiapine for 26 days. For 14 days I have been on a dose of 100mg. I passed through a dark place where suicide held my hand for a little while and I achieved little outside my own thoughts. I’ve got two good reasons why it would never come to that so there is no call for alarm – it was just that my mind wondered onto suicidal thoughts in much the same way as anybody’s can become fixated and preoccupied.

The pace of mornings continued to be dictated by the medication’s side effects until very recently, when I became disciplined about not eating for two hours before taking the tablets, and for one hour afterwards. This places my evening meal at around 5.30pm and I take the Quetiapine spot on 8pm. Not the most sociable of habits but necessary, if I am to wake the next day alongside everybody else.

A month ago I was walking my dogs regularly and trying to be mindful, and then I found myself trapped inside a cumbersome, sedated and tired body again. I was tired too of having to start again, I had started again so many times. Each time it was hope that helped me make the first move - but now I was starting to feel a little cheated by hope. There seemed to be more snakes than ladders on my board.

About a week ago a flurry of articles about exercise and mental health were widely publicised by campaigns like Time to Change, which coincided with my own wishes to be more active. I accept that being active sometimes helps me fight the depression, but I recognise too (as more articles ought too) that sports men and women are not immune to depression. With the encouragement of others I took the first steps again, walking with the dogs around the block that encompasses the red brick church with its high walls. A short walk by any measure, and exhausting too – but it was a walk all the same. The tiniest of goals achieved. Yes, a month ago I could walk much further but this is where I am now. This is what I have to deal with – there is no good that can come from drawing that comparison.

As my mornings were returned to me and those short walks became once again a part of some kind of routine, I became useful again. My body was responding better to what I wanted to do, and my mind more able to focus. I was still astonished at the frequency with which needed to stop and rest, but I accepted it and tried to think of it all as exercise on the way to somewhere healthier.

My mood has been improving and the facial expressions that Alicia recognises as me are, at times, evident again. There is a component missing though – emotion feels muted somehow. Alicia has noticed it too. But I have been busy and can look back across a day and claim to have done something worthwhile.

Today has been a difficult so far but that means nothing at all. It says nothing of yesterday and of course can say nothing about tomorrow. It does bother me though, because I do want to be reliable. I want to have up and down days like other people who don’t find themselves completely derailed by the downs. I want an employer or client to look at me and be confident that my downs won’t keep me off work or critically alter my functioning – but they do. This is something I’d like to consider more another day in another post, when my energy and mood permits it. But for today I’ll just accept that this is what I can manage for now, just like my little walks.