Tuesday, May 1, 2007

Ebbs and Flows

For me, there has always been a seasonal element to this illness. Last year, on May 1, I suddenly felt truly wonderful and it lasted until the end of October. This year, I've been okay for the last few months--not great--just okay.

Yesterday, I thought everything had changed and the depression was finally over. I awakened feeling really good. Given that the medication I take for depression is a stimulant, once I feel well I have to immediately stop taking it. Unlike other people who are supposed to titrate off medication, I have to abruptly stop because otherwise it will cause a hypomania.

From years of experience I know that once a depression ends, it's usually over. What's amazing--and disturbing about manic depression--is that whenever you feel like you've got it under control, it smacks you in the face.

While I felt fine in the morning and I was able to attend my biweekly photography class at a local community college, by late afternoon I was exhausted. And a few hours later, I was so tired I felt ill. Finally, I went to bed at 7:00 at night and slept until almost 9:00 this morning.

Upon awakening, I could tell that the depression wasn't over, and I needed medication but I wasn't sure how much. Because I take the lowest possible dosage, and because it takes an hour to kick in, I had to take 20 mg and wait an hour to see how it worked before taking 20 mg more. That seemed adequate, and I was able to drop my son off at school and help a friend edit a book. But once again, by 4:30, I was extraordinarily tired and it never lifted.

Compared to other years, this new pattern was just a slight glitch. It was disappointing but certainly tolerable. Years ago, it would have been very disturbing. Even though I try not to ruminate on past experiences, I couldn't help but think how bad I used to feel when my energy ebbed and flowed--and I couldn't be there for my son (the way I would have wanted to), had to cancel commitments, miss a few days of work, disappoint a relative or friend, or change plans.

(I don't know about you, but at some point I realized that I received so much grief if I had to cancel at the last minute, that it was easier not to accept invitations in advance.)

These days, I'm feeling much better and I have far greater flexibility. But I also have great empathy for those people--like me--who work so hard to achieve some level of "normalcy" and stability and yet continually have to adjust to bipolar ebbs and flows. It's just not easy, is it?


Anonymous said...

No, it's not easy. What a drag to have one's life defined by the seasons.I live in Maine and wished I lived in Hawaii.


marja said...

I find it interesting that you're taking an anti-depressant that can have an immediate effect. (the taking 20mg, seeing how it works, and then taking another 20mg) I don't usually like talking a lot about meds because I know they work differently for everyone. But can I ask you what you are taking?

I've been on prozac for the past 6 weeks to try and get my depression under control, but know it can push me into mania if I'm not careful. However, my doctor wants me to keep taking it, even when my depression is gone. Then I will stop a month or so later - just to ensure that I'm back to normal. I would rather do what you do - stop taking it as soon as I feel better.

But what are you taking that kick in so immediately?

Polly said...

No, it's not easy, and I've got empathy for you, too.

Speaking of "ebb and flow," I was unemployed until recently, and now I have two part time jobs. The schedules for both of them vary from week to week. I'm working different days and different hours every week. This is of course messing me up somewhat.

Syd said...

I had the same question Marja did about your medication (if you don't mind sharing, of course - I'm just curious as I've never heard of that type of immediate effect).

I have always hibernated in the winter, long before I'd ever heard of SAD. In fact, I was in a clinical trial at NIH in the early 90's for using a sun visor. The light therapy really did work, although it needs to be managed carefully.

In many ways, the happiest time of my life was the 6 months that I lived in St Pete, FL. I'm convinced that the sun, surf and warm weather were just what the doctor ordered. I suffered a major depression there, but it was very situational. What I wouldn't give to live in a warm, sunny climate again.

Meredith said...

I know this is belated, but I just stumbled upon your blog. I'm from Orlando but am going to school in DC and was recently diagnosed with bipolar II. My major depressive episodes have all happened between October and April, and living in DC makes them far worse. I plan to finish out school in DC, since the lithium is helping, but I am definitely going to try to live in Florida if at all possible. Both my parents have SAD, and I think I may have inherited those tendencies.

Bipolar Wellness Writer said...

I hope you will find my reply. I think that's a good idea. I've read enough about SAD to know that location makes a big difference. I'm sure you're familiar with Dr. Norman Rosenthal book, which I listed under the post on SAD. But best of luck with all this.