World Bipolar Day 2020

Today is World Bipolar Day. A year ago on this day, I broke my silence and told my Bipolar story. I was terrified to share it, to let myself be so vulnerable. I was afraid I would be judged, afraid I would be looked down upon, afraid I would be labeled. And sadly, while there were some that did respond that way, what I learned was that people have so much compassion and love inside them. Some people were brave and shared their own stories of mental health, some shared stories of other medical conditions. And then there were those who had never experienced it for themselves... they were supportive and kind. The outpouring of love and understanding was nothing shy of incredible. To see my world come together, to rise up like it did because I shared my story made it all worth it. It was empowering.

I've come to understand love a little differently since sharing my story. For years, I had kept my secret because I was ashamed, because I didn't love myself. But people showed me how gracious they are, they revealed their hearts, they shared their love. Today, because of so many of you, I stand a little taller, and I smile a little more at the reflection in the mirror. You all showed me I had nothing to hide, by loving me you gave me the courage to love myself for who I am.

What is Bipolar Disorder?

Bipolar Disorder is a complicated mental health disorder affecting 10 million Americans and is often very misunderstood. When I was diagnosed 5 1/2 years ago, I had a very limited understanding of BD (Bipolar Disorder), and much of what I thought I knew, I really didn't. What I thought was right, mostly wasn't. 

Bipolar Disorder is a mood disorder, characterized by unpredictable shifts in mood, energy, and activity levels. These shifts swing (or cycle), sometimes in rapid succession, between acute episodes of mania/hypomania and depression. BD is more of a blanket term as there are four types of the disorder, all varying to some degree from each other and each identified by their patterns of mania and depression.

Bipolar I Disorder: defined by severe manic episodes lasting 7 or more days, and depressive episodes last 2 weeks or more. Episodes of mixed features, mania and depression occurring simultaneously, are possible.

Bipolar II Disorder: defined by a pattern of severe depressive episodes lasting 2 or more weeks and hypomanic episodes lasting 4 days or more. Mixed episodes are also possible.

*It's important to note the major differences between types I and II: 

Mania is described as unusual euphoria and high energy. It can include racing thoughts, inflated self-esteem and grandiosity, abnormal exhilaration, impulsivity, hyperactivity, extreme irritability, and emotional dysregulation. Hypomania follows the same patterns of mania but to a less extreme degree, though still at potentially harmful levels. It is the difference of severity between full-mania and hypomania that distinguish the difference between types I and II. Type II is frequently characterized by longer, and more frequent depressive episodes. 

Cyclothymic Disorder: defined by low-level hypomania and depressive episodes lasting for at least 2 years. Symptoms do not meet the same diagnostic requirements for the manic/hypomanic and depressive episodes of types I & II.

Other specified or unspecified BD and related symptoms: defined by BD symptoms that do not match the other three types as they are induced by drugs, alcohol, or medical conditions such as Cushing's disease, MS, or a stroke.   

Episodes of psychosis can also occur and can sometimes lead to a misdiagnosis of schizophrenia.

My Bipolar Story

For most of my life, mental health has been a very real struggle, beginning around age twelve or thirteen. It seemed to surge in severity while I was in college, and during my sophomore year, I was treated for the first time with an anti-depressant. That medication launched me into my very first hypomanic episode, though I didn't understand at the time that that was what was happening. I learned many years later that anti-depressants can be dangerous to people with BD, often causing cycling. 

I went on struggling with my depression, my hypomania showing its ugly head from time-to-time for years. Though if I'm honest, those hypomanic episodes were a welcomed relief. Finally feeling good... and not just good, but incredible... was the most amazing thing - I didn't care about the risks and consequences that came along with feeling that good, I just loved feeling good!   

After college, I went on and off many anti-depressants. I seemed to live my life in a rowboat on the ocean, constantly rising and falling in the waves. As time passed, my symptoms only ever worsened, eventually becoming disabling, dramatically impacting my daily life. 

The first time Bipolar Disorder was suggested, I thought it was preposterous. My general physician acknowledged that it was not his specialty and referred me to a psychiatrist. It didn't take long after that and I received my diagnosis: Bipolar Disorder type II. It was like the worst sucker-punch and it knocked me to my knees. I was confused and so ashamed. For almost a year after my diagnosis, there were only six people who ever knew the truth (aside from my doctors). The thought of telling anyone else scared me because I didn't want people to see how broken I was. I didn't want to be called crazy. I didn't want to be judged. 

After my diagnosis, I set off on two journeys. The first was to learn as much as I could about my disorder. If I thought I knew little about Bipolar, I knew even less about BD type II. I read anything I could get my hands on. The second journey was the complicated search for the right medications that would stabilize me. That proved to be one of the most difficult things I've ever gone through. It was emotional, it was physically exhausting, and took a hard toll on my mind, body, and spirit. I didn't respond well to most medications, the side-effects wreaking major havoc. With some, I experienced severe drowsiness, and not just the I didn't sleep well kind but the drug-hazed I just drove my car in the ditch and remember none of it kind of drowsiness (yes, I really did that). I had meds that caused me to lose my vision, ones that made me chronically vomit, others that made me lactate. Some made me gain excessive amounts of weight, some caused neurological complications. Some made me panicky and anxious, some made me scratch excessively at my skin because I literally couldn't stand having skin on my body. Some made me pace incessantly. And one very horrible medication sent me into a state of psychosis. A time in my life I wish I could forget but I know I never will.   

I wanted to give up more times than I can count. But I had three people at home who were depending on me, who needed me to get better. And so I continued to fight - for them. Had it only been for myself, I wouldn't have kept going. My family, my husband and my kids, they are my entire reason for fighting. They are my whole world and I want to give them the strongest, healthiest version of myself that I can.   

During the years of medication trial and error (which were mostly error), I was also diagnosed with anxiety disorder, insomnia, and adult ADHD. So while we were trying to regulate my BD, we also had to regulate all of the other stuff. Bipolar and ADHD have a high comorbidity rate. Research suggests that as much as 70% of those with BD also suffer from ADHD. When they co-occur, one often masks the other and it can lead to treatment delays, inaccurate diagnoses, as well as having other dangerous implications. The treatment modalities for BD and ADHD are drastically different from each other and I was very worried one could make the other worse. After my episode of psychosis, I was very gun-shy about starting new meds. But my psychiatrist is very good at what he does. It wasn't until we started treating my ADHD that we started to make progress with my BD treatment, four years after my diagnosis.  

That was a year and a half ago. And while it isn't always smooth sailing, this is the longest period of relative regulation that I've had since my college years - 16 years ago.

      

It took almost 17 years of struggle and inaccurate mental health diagnoses before I finally got my Bipolar diagnosis at age 29. Add another four+ to find a good treatment regimen. And not because I didn't have good doctors. I've had amazing doctors, and they've all done their very best for me over the years. A lack of awareness surrounding BD isn't limited to the public, and healthcare professionals can easily miss the signs. By nature, the symptoms of BD I mania can be severe enough to often warrant hospitalization, making this easier to identify. But when the symptoms don't reach that level of severity, they can go unreported or overlooked, making it difficult for an accurate diagnosis. There were red flags throughout the years for me and it ultimately came down to one woman who had a daughter with BD II to recognize the patterns in me. And I'm so grateful for her, for her knowledge, and for the time she took to try to understand me.    

My Bipolar Today

While this has been my journey, I've not once done it on my own. When I was young, it was my mom who helped hold me together, and she was the first person to get me professional help. In college, I had a good group of girlfriends. And while there was no name yet for my struggle, they were always there for me, no matter how ugly things got. Then I married Tim and he has been by my side for all of it, every step I've taken. Between Tim, my best friends, my sister, and my mom, I've never been alone for even one day since my diagnosis. For years, it was Tim and my bf Kristin who saw the changes in me even before I did. And what an amazing thing, to have people that love you and know you well enough to see even the smallest shift in you. They were my guardian angels. I'm here today greatly in part because of them. 

A year and a half ago, I met Kim who was very open about her BD I. She was unlike anyone I'd known until that point. Meeting her made me feel less alone in a way I didn't understand until she was in my life. Yes, I have the world's greatest support system, my miracle tribe. But while they are all empathetic, they have never experienced my disorder. She made me feel understood in a way I never had been before. She's been another kind of blessing in my life. It was these people, Tim, Kristin, Kim, my mom, and too many others to name, who gave me the courage to step out from the shadows, to be brave, and to share my story. They taught me I have nothing to be ashamed of. I am not broken. That we're all a little crazy in our own way. That in the eyes of my Father, I have been made exactly how He wanted me.

Today, I'm more knowledgeable. Though I still rely heavily on those closest to me. I'm better at picking up the small signs, seeing them earlier and earlier, catching my cycling in its early(ish) stages. I recognize that I can't fully prevent myself from cycling, that it is the nature of my disorder, no matter how hard I try. But I now understand that I'm not helpless, either. Through diet, sleep, exercise, strict routine, and medication, I can help minimize my episodes, their frequency and their severity. 

"Stay Wild" - mental health awareness

In the beginning, the facts and the data surrounding Bipolar Disorder both overwhelmed me and scared me. Suicide, addiction and substance abuse, unemployment, divorce and broken families... it was all too much. It still is. In the beginning, it scared me because I didn't know who I was, I didn't know how my illness and I cohabitated with each other. I know the data, the statistics, and while the risk never goes away, I feel more confident in who I am. I better understand my stressors and triggers, I better understand how I fall apart and how I fly. I still get terrified of my mind. I know the monsters that lurk in the darkness. But I'm stronger today than I ever have been, and I let that fortify me for what tomorrow may bring. I'm still trying to fully accept my Bipolar, and I'm learning that to love myself, I can't hate what makes me who I am. More than anything else, my journey has taught me this: that I am loved, and that I am supported. I have a whole team behind me, and while this is my journey, they will never let me go it alone.

So on this day, World Bipolar Day, I share my story to help bring awareness and to educate, to stop the stigma that surrounds Bipolar Disorder. Love and compassion can mean all the difference for someone who is fighting an invisible war. That's what mental health is... an invisible war. Remember, just because someone carries it well, doesn't mean it's not heavy.

Together, we can make a difference.   

World Bipolar Day

Today, March 30th, is World Bipolar Day- strength for today, hope for tomorrow. The vision for WBD is to bring awareness to the world and to help stop the stigma associated with bipolar disorder.

This is an important day for me, and an important post, as I share with you all that I am bipolar. My diagnosis has been a part of my life that I have kept very private. Until now, it is only my immediate family and closest friends that I have shared this with. But today I step out of the metaphorical closet. I decided that in keeping this a secret I am perpetuating the stigma that surrounds this disorder, and any mental health disorder for that matter. By standing up and owning this part of myself, I take the power away from it, and away from the often negative opinions and understanding people have of the disorder. So, on this global awareness day, I have decided to share my story.

First, let me explain clinically what BD (bipolar disorder) is:
Also known as manic-depressive disorder, BD is a brain disorder that causes unusual, extreme, and unpredictable shifts in mood, energy, and activity levels. These shifts swing (or cycle), sometimes in rapid succession, between acute and severe episodes of highs (mania or hypomania) and lows (depression). BD is a lifelong disorder with no cure, and although it can often be managed through medication and psychotherapy, those with the disorder will always and inevitably cycle.

Approximately 10 million Americans suffer from bipolar disorder.

I was diagnosed with bipolar II over 4 years ago.

There are four known types of BD:
-Bipolar I disorder: defined by severe manic episodes lasting 7 or more days, and severe depressive episodes lasting 2 or more weeks. Episodes of mixed features (both extreme high and extreme low episodes occurring simultaneously) are possible.
-Bipolar II disorder: defined by a pattern of extreme depressive episodes and hypomania (unusual euphoria, but typically never reaching the full height of BD I mania). One major episode of depression and hypomania is required for diagnosis. Episodes with mixed features are possible.
-Cyclothymic disorder: defined by low-level hypomania and depressive episodes lasting for at least 2 years. Symptoms do not meet the same diagnostic requirements for hypomanic and depressive episodes as BD I & II.
-Other specified or unspecified bipolar disorder and related symptoms: defined by BD symptoms that do not match the other three types as they are induced by drugs, alcohol, or medical conditions, such as Cushing's disease, MS, or stroke.

Did you know there were that many types? I didn't until my diagnosis.

Episodes of psychosis can sometimes lead to the misdiagnosis of schizophrenia.

Research shows that as many as 70% of BD patients also suffer from ADHD. Anxiety and insomnia disorders also have a high prevalence with BD. Successful treatment for BD can be difficult when these disorders co-occur with one another, often masking each other.

Due to the less extreme levels of hypomania, BD II often goes misdiagnosed as unipolar depression (depression unrelated to BD). My bipolar went misdiagnosed for nearly 17 years. I was diagnosed in 2014, and approximately two months later I was diagnosed with anxiety disorder. A year following that I was diagnosed with clinical insomnia, and almost 4 years after my initial diagnosis I was also diagnosed with ADHD. I know, I sound like a hot mess.

For many years I was treated for depression, and it wasn't until my BD diagnosis that I learned that some of my extreme episodes were likely induced or exacerbated by the antidepressants that I was taking at the time. Treating a patient with BD with antidepressants can often have an opposite response, causing dangerous cycling. Treating BD is finding a tricky balance, often through mood-stabilizers, anticonvulsants, lithium, and other medication mediums along with psychotherapy because there are essentially two disorders being treated- and they are on opposite sides of the spectrum (high & low). Although my depressive episodes appeared as early as twelve or thirteen years old, it wasn't until my college years that I suffered my first identified hypomanic episode. I just didn't know that that is what it was until years later. Looking back, there were glaring red flags all over my medical history, but my doctors (and they were good doctors) missed it- for nearly 2 decades.

A lack of awareness isn't limited to the general public- doctors often miss the signs, especially outside bipolar I disorder, because of the less extreme highs, which tend to go unreported. Hospitalization and psychosis are less prevalent with the other types of BD, although still possible.

The very first time the idea of BD was floated for me I thought it was completely preposterous. I mean, I was absolutely nothing like Charlie Sheen! I was referred to a psychiatrist and after extensive evaluation, I got my BD II diagnosis. I was crushed. The name alone instilled fear inside of me. I was overwhelmed with shame. I didn't want anyone to know because I thought it meant that I was broken. I thought no one would want anything to do with me. I thought I would lose all credibility and just be another label... she's crazy. I thought that something was wrong with me. After I began to learn more and more about my disorder, the more the lightbulbs turned on. I remember having these Ah-Ha moments when I realized that certain thoughts and behaviors of mine weren't normal for most, and yet they could suddenly be explained.

After my diagnosis, I naively believed that I would start treatment and that I would instantly level-out and stabilize. And oh boy was I wrong. I had read stories of people taking 10 years to find the right medication combination for effective treatment. 10 years? I had already been suffering for 17! My doctor and I began my search for the "perfect" cocktail for my treatment. In four years, I have gone through over a dozen medications, and at least 3x more than that of dosage changes. The side-effects were often as extreme, and sometimes as dangerous, as my episodes and took a very real toll on my body. I've had many, many frustrated and emotional moments just trying to get through... more than once I wanted to give up, but I also wanted, so desperately wanted, to find something that worked for me. Every time I tried something new I was filled with both fear and hope... how terrible would I feel, how would my body tolerate and respond... could this, just maybe, be the one that would change it all? As I sit here now, writing my story, I can say proudly that the regimen I am on is the same one I've been on for 6 months now. I can't emphasize enough what a victory this is for me.

More times than I can count I have cried, completely broken down with frustration and resentment... why me? I felt I was dealt a bad hand. But at the end of the day, I put my head down and forged ahead, even when I felt like there would never be a light at the end of the tunnel. And as much as I wanted to get better for myself, I was that much more determined to get better for my family.

This journey, both before and after my diagnosis, has been a rough one for my family. Nothing about it has been easy. But my amazing husband has stuck by my side every inch of the way. He doesn't look at me and think this is a road I take alone because I'm the one with BD; he looks at the road as something we take together because we're a team. And I never want to be a mom who can't be there for my kids. Everything I do to get better I do for them.

One day, a couple years ago, my C came to me very upset as the realities of his dyslexia were dawning on him- specifically the awareness that there was no cure. So I got brave, and I sat him down and told him about my BD. I didn't give many details, of course. I didn't want to scare him. But I so clearly remember seeing a wave of calm wash over him. Yes, he would be dyslexic forever, but I would be bipolar forever. I took medication to keep me stable, and he got extra help at school and went to a learning center... we both did things to help us manage... we would overcome. It was the first time I looked at my disorder as a gift- I had something to offer because I gave C a confidence that day that he never had before. And he still carries it with him.

A gift... maybe, despite the extreme struggle and the constant fight... maybe my BD was a gift, too. I told Tim when I was working on my latest novel that I had to have a little madness in me to write 130,000+ words in 2 months. There is a high prevalence of artistic qualities linked to bipolar. And I think that I am no exception to this. I really believe that I can do what I do, that I can write what and how I write because of this.

Cycling is hard. Not just on me, but on those closest to me. And despite how stable I can be, I will always cycle. It's the nature of BD. And sometimes I really hate that I'm not allowed to just have a really bad or a really good day without the panic at the idea that I'm going to start cycling. But today, over 4 years later, I'm more aware. I have a better idea of what to watch for. I know some of my biggest triggers. And, most importantly, I have people in my life who know me so well that they pick up on the smallest changes in me. I'm typically the last person to the realization-party when it comes to recognizing my cycling patterns, but I feel so incredibly blessed and fortunate that I have people who have my back.

I get up every day and have to make the conscious decision to be a fighter. The moment I get complacent or begin to think that I can take a mental vacation, that's when I tend to slip. I will share in good humor a little of what hypomania has been like for me... it's reading Jane Eyre, Pride and Prejudice, Sense and Sensibility, The 100, and A Fine Balance in exactly 7 days. It's not sleeping more than a collective 10 hours in an entire week. It's every crafting project for two years completed in two days. It's making so many holiday decorations that I give them away in droves because I can't fit any more in my house. I won't share the dark depressive side of things. It's... well... depressing. It has been crippling at times and is a painful place for me to go to. But even in the lowest, darkest places, I try to hang on to the knowledge that I will eventually come back up... up... up... and up. It's the nature of manic-depression.

It is important to note, however, that most individuals who have manic-depressive illness are normal most of the time; that is, they maintain their reason and their ability to function personally and professionally. - Kay Redfield Jamison, Ph.D. Touched with Fire 

Over 43 million Americans suffer from some form of mental health - or 1 in 5 adults. I am telling this story today to STOP THE STIGMA. I'm not broken. In fact, my BD allows me to truly rock at certain things because my mind thinks in so many different ways. Having bipolar doesn't mean I'm a bad mom, a bad wife, a bad friend. It doesn't mean I'm not good at my job. It doesn't mean I'm lesser. It's how God created me.

Though my soul may set in darkness, it will rise in perfect light; 

I have loved the stars too fondly to be fearful of the night. - Sarah Williams

A huge shout-out to one of my closest, dearest friends. She, too, lives with the curse and gift of bipolar disorder, and she wears it proudly. I've had an amazing support system since day one, but I never realized that I had been an island until someone else showed up in my life with BD. She sings the same tune to her soul, and only we can understand each other the way we do. She is the one who gave me the courage to step out of the shadows and share this with all of you today, not because I'm some epic failure, but because I go out there every day determined to be better than the day before.

Thank you to the many who love and support me, especially my very best friend, Kristin. She and Tim are my tribe. She has stuck by me through absolute thick and thin. Her love for me is truly one of my greatest blessings. I wouldn't be where or who I am without her in my life. She and Tim are everything to me. There are so many others out there who have been there with me through my struggles, and they are too many to name, which makes me all the more blessed. This post is dedicated to you, for all you do for me, in good times and bad. I am grateful beyond words.


Sources:
WebMD
AdditudeMag
Psycom
nimh.nih (national institute of mental health)
Nami (national alliance on mental illness)

*This article has been updated