On Bipolar-II and Psychopharmacology

Now two months after being diagnosed bipolar-II, I want to share a few thoughts on the condition and treatment thus far.

I've been reading an excellent book by pioneering psychopharmacologist Dr. Ronald R. Fieve called Bipolar II, the first book published that deals specifically with this variation of the disorder. The book could be subtitled "The User's Guide to Andrew Hamm." If you have ever wondered if your mood swings, your depression, your fatigue or sleeplessness, or your high-energy periods might be something other than normal, I highly recommend this book. It's not at all scary or hard to read, and it's exceptionally well-laid-out for people with questions about the behaviors of themselves or their loved ones.

It's interesting how researching this condition has made so many things about myself clear to me. It isn't that I have an "excuse" to misbehave or act out; it's that when I feel a certain way I don't judge or castigate myself for it any more. It's not really changing my actions so much as it's changing my perspective, and I don't at all feel a need to do something against my nature just for purposes of appearances or propriety.

Lately, I just can't stand large groups of my friends. I get overwhelmed easily and completely as I'm re-learning how to be, rewriting my personal narrative. I'd love to spend time with you one-on-one, or two or three at a time, but big groups just freak me out. The flipside of that is that when I do spend time with my friends one-on-one and they ask me how I'm doing, I end up answering honestly, truthfully, and completely. My biggest fear at the moment is that I'm the friend who complains all the time, and that when I finally get to a point where I'm ready to have some fun, I won't have any friends left to have fun with.

I'm going through a lot of personal upheaval right now that has nothing to do with bipolar disorder, but I can say this without reservation: without lithium carbonate and therapy I don't know if I would be alive right now. The lows are significantly flattened; I'm not sure about the highs at this point because I'm very much in a depressed phase of my life right now (my doctor actually upped my lithium this week). I'm not a big fan of America's compulsive need to medicate everything that doesn't fit in the cookie-cutter, but I certainly cannot argue with the results of lithium in my life these past nine weeks. It is nothing short of life-saving.

The other medicine I'm on is Ambien. It was initially prescribed as needed, but again my doctor has changed his prescription and I'm taking it nightly for a while. According to Dr. Fieve, there is a wealth of evidence linking mood disorders of all kinds with sleep disruptions. It's a circle: sleep disruption causes mood disorder which deepens sleep disruption which deepens mood disorder. And again, I look back at my life and see decades of insomnia alternating with hypersomnia, and repeated disruptions of my circadian rhythms in times of stress and success.

Ambien is a fantastic drug. Taken as indicated (one pill just as I'm going to bed), it pretty much guarantees a solid night's sleep. My history with sleep medications, or anything that "may cause drowsiness," is not good; they all tend to make me logy for the whole next morning. Ambien does not. It doesn't always keep me out all night, as it's supposed to; sometimes it's just four or five hours before I wake up, then go back to sleep again, but it's working nicely.

The thing I don't like about it is that it induces delta sleep, the deepest level of rest, at the expense of REM sleep. I've never had much of a dream life, and what dreams I've experienced have always been strange and fantastical. But since January I've been having lovely, realistic dreams involving real people from my life doing pleasant everyday activities. It's been the most enjoyable dream life I've ever had. But on Ambien I don't dream at all. I miss it, but I need the sleep more.

Three other issues merit serious mention. Bipolar-II people have astronomically high incidences of three extremely destructive behaviors:

1. Suicide.

2. Alcohol and drug abuse and addiction.

3. Compulsive behaviors (such as gambling, spending sprees, and sexual addiction).

I do not believe I am a risk for any of these things. I certainly am not right now, nor have I ever been much in the past. That does not mean I never will be. For those readers who are my friends and family, I just ask you to keep an eye out because I may not be able to see it.

A lot of people, artists in particular, have fear that medication for bipolar-II will take away their edge. They recognize what Dr. Fieve calls the "bipolar advantage" to a mild-to-moderate hypomanic state, and fear that medication will soothe the depression only at the expense of their highs. We feel like the highs are our real personality, and that the lows are just the price we pay for our intelligence, our energy, our creativity and gregariousness. And maybe that's true in some ways, whether you consider bipolar a disorder or a design element.

But when you're down, you know you're down, and you want it gone. Depressed people go to doctors; they want help. When you're too high, you don't know when it's too much, when it's too far, because it feels good. Manic or hypomanic bipolar patients don't refer themselves to psychiatrists; their friends and families do because they've exhibited some kind of frightening behaviors. This causes massively delayed diagnosis at a time when treatment options are most important. The average age of diagnosis for bipolar-II is 40. The divorce rate for bipolar-II is approximately 90%. I do not believe those facts are unconnected.

My experience is not universal. It may not even be typical. And it's just beginning. But perhaps the most important thing anyone has said to me in the past few weeks was, "You look much better. And medication hasn't taken away the essential Andrew-ness of you."

To quote DeNiro in Awakenings: "Learn from me!" If you think you have a mood disorder, talk to a doctor. Doctors are smart.