Andrew Hamm: the Bipolar Express

Ruminations on theatre, music, and just about anything else that crosses my bipolar brain.

Friday, July 11, 2008

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.



  • At 7/11/2008 3:41 PM , Anonymous Phil Hamm said...

    Thanks for sharing. My Chumps friend Marci recently joined a Bipolar group on MySpace according to my updates. May be good conversation.

    Speaking of dreams....

    Two nights ago I had a dream that I went to a pro basketball game (I can only assume it was a Wizards game since that's who I've gone see play a few times in the last few years).

    Anyway, the seats that I was in were inverted, coming out of the ceiling. Yes, you got in your seat, then it spun around and seated you upside-down, directly above the court (impossibly high above the court I might add - in that dream-distance), looking up at the floor to see the game. The problem was you weren't very securely cinched in to the seat. The seat was kind of like an elementary shool desk, not like a roller-coaster (which is what Dream Phil expected). I was a bit scared of falling out. But I did enjoy the game.

    Translate that!

  • At 7/12/2008 12:40 AM , Anonymous Anonymous said...

    There is a great book called The Depression Advantage that is about spiritual growth and the role that depression can play in it. It talks about how facing and understanding depression can help you to find the advantages in it. The website is at and based on your spiritual interests you might really like it.

  • At 7/12/2008 12:48 AM , Blogger Robinitaface said...

    I'm so glad you're posting this. At the risk of seeming obtuse, I can relate. I was diagnosed with Epilepsy in 2005 - Complex Partial Seizures with Secondary Generalizations. I found the more I read about it, they may as well have called them Complex Robin Seizures! It was like they took symptoms I was having for years and never told anyone about and wrote them in every book and website about epilepsy! I was so relieved that these weird goings-on had a name. That meant I wasn't the only one.

    Next came the experimentation with antiepileptic medication to see which one (ones) worked for my wacky brain wiring. I got to deal with all sorts of fun side-effects (I'm still dealing with them today). Some of them were more fun than others. The first medication I was on stopped the seizures, but I found I was actually craving brains - I was that much of a zombie. Another allowed my soul to break though, but I also kept having breakthrough seizures. We couldn't have that.

    The medicine I'm on now - I had to tier up to the proper dose, but it's been over a year now since my last seizure. Some of the more annoying side effects include forgetting/switching words and the occasional focus/memory problem. The tingles in my fingers passed (shucks), and the weight loss I didn't mind either.

    What I have found works amazingly well is - SLEEPING. You are so right. While you are asleep, you body regenerates serotonin - that tricky chemical that plays a role in many mood and neurological disorders.

    I found it difficult - and still do - trying to weave the physiological aspect of my condition into my performance life. Professionally, I wrestled with who I tell - due to stigma that I'm discovering still exists. Our line of work has safety issues that I have to take into account. Plus, the side effects sometimes affect my performance when I have to be quick on the uptake. Try doing well at a dance call when you can't remember the word for "umbrella." But then, who wants to be seen as using their medical condition as a crutch? I know I don't. It's a tough balance.

    Many people have noticed my Medical ID bracelet and have asked about it. I'm SO happy to answer whatever questions they have. It puts a face on the condition for them, and sometimes puts a name on symptoms they've noticed on a loved one.

    Wow! So sorry to take up so much comment space!

  • At 7/12/2008 10:31 AM , Blogger Andrew Hamm said...

    The professional issue is a serious one, r-face, one I've also thought of. I still hope to work as a university acting and playwriting professor some day. Do I tell the people who are hiring me? I am under no obligation to do so. But if they have any brains they'll google me when I apply, and I'm not going to erase the now-and-future posts about being bipolar from this blog, which they are sure to find.

    Interestingly enough, I was told on two occasions by schools I applied for in '05 that despite my credentials I wouldn't be hired for their position because I'm a straight white male. They were looking for a minority. Now I wonder: does mental illness finally put me in that coveted position for affirmative action? ;-)

    The craving brains line was the funniest thing I've read in quite a while.

  • At 7/12/2008 10:44 AM , Blogger Andrew Hamm said...

    Oh! And the not-remembering-words thing is a symptom I experience with complex migraines. It's called dysphasia, and it's one of the most frustrating and hilarious things I have ever experienced.

    The bad part is that I will be unable to remember a word, usually of the two- or three-syllable variety. ("Umbrella" is a great example; that's exactly the right kind of word.) For example, I'll know the word starts with a "D," that it's three syllables, that it has an "L" and a "G" in it, that it ends with an e, that it means conversation, and maybe even almost know that it's spelled D-I-A-L-O-G-U-E, but I will be unable to remember that the word is "dialogue." And this quest for the word will consume my mind for as long as it takes to figure it out. Yeah, don't expect me to learn choreography while I'm struggling with this.

    The good part is that it's been happening occasionally for about six years, the newest of my lifetime of cycling migraine symptoms, so I've gotten used to it and started to recognize that it's frickin' funny.

    The bad part number two is that dysphasia invariably precedes a seismic-level migraine for me. But much like lithium and Ambien, my recent prescription of Maxalt has my migraines treated for the first time in my life. I love pharmacology.

  • At 7/12/2008 3:20 PM , Anonymous Phil Hamm said...

    Not-remembring-words, I can thank my migraines for that, huh? Sucks when I'm in a business meeting and am trying to explain that I want the database normalized but can't remember the word.....

  • At 7/16/2008 10:28 AM , Blogger Andrew Hamm said...

    You want the volume of the database maximized?

  • At 7/16/2008 12:30 PM , Anonymous Phil said...

    LOL!! No.


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