Depression is

If you haven't experienced clinical depression, you know someone who has. It is the most common psychiatric disorder, with approximately a 10% lifetime risk rate. You should know what depression is.

Depression is not just sadness. It is the lack of happiness. It is anger, frustration, fatigue, and enormous guilt. Depression wakes you up in the middle of the night, shows you you're standing in a hole, hands you a shovel, and commands you to dig.

When it isn't keeping you awake at night, depression makes you sleep during the day. It makes unconsciousness seem like an infinitely more palatable experience than anything in the waking world.

Depression blames you for everything. Depression is very convincing. It makes you second-guess, then third-guess and fourth-guess.

It takes your favorite things, smears excrement all over them, and buries them in rotting garbage, then dares you to find them beautiful. Depression laughs at you like that grade-school bully you're still angry at. It encourages you to wallow, then mocks you for wallowing.

Depression gives you piles of work to do, then takes away everything pleasurable about doing it. It is the thief of joy that tells you it's robbing you, robs you, then shows you the precious possession it has taken as it walks away.

It requires you to ask your friends for help, then makes it impossible for you to ask anyone for anything. Depression knows that boldness and company are its great weaknesses, so it keeps you meek and alone.

It makes you hard to love, and tells you just how hard you are to love. Then it makes you repeat "I am hard to love" hundreds of times as penance for being hard to love. It promises that there is an "off" switch to this feeling, but that you haven't yet earned the right to know the secret.

Depression is the abuser who beats you bloody, then holds you and strokes you, promising to never beat you again because it loves you. It convinces you that the way you feel is somehow your own fault, that your feelings must be the results of your actions, of your own terrible, terrible choices.

Depression takes the joy away from your music.

Depression cannot be argued with or convinced. It cannot be reasoned with. When it's there, it feels like a permanent fixture. And when you have it, it feels like the only thing you have.

I Am Bipolar.

I am bipolar. Specifically, I am bipolar-II.

I am built this way; I am designed this way.

It will not go away. There is no cure.

I do not want to be cured. (Well, most of the time.)

I have little control over it, but I bear the responsibility for my actions as a result of it.

I do not apologize for being the way I am, but I do wish to explain, to be understood.

I need help from my friends and family. I am too ashamed to ask for help from my friends and family. This makes me need help even more.

I speak before I can censor myself. I give too much information. My mind happens too fast for me to stop it.

I love being the center of attention, and it makes me uncomfortable. I want to congratulate myself for my work, but I become shy when someone else tries to congratulate me. I love finishing the show, but I hate the curtain call.

I worry, I worry, and then I worry about worrying. It sometimes feels as if my brain is a mass of hornets, angry that they can't get out of my skull.

I encounter the world violently and passionately. I love who I love with depth that saturates every cell of my body, with complete passion. I feel like I'm living poetry in a world of prose. How many actions most ridiculous have I been drawn to by my fantasy? In to a thousand, none of which I have forgotten.

I become impatient when the rest of the world doesn't move at my tempo. The rare moments when it does catch up feel like magic. When the people I am with move faster than I do, when they anticipate me, that's pure transportation.

I'm very big on ideas, not good with follow-through. I have hard drives and notebooks full of the beginnings of ideas, outlines and first chapters. I've been working on a musical for over a decade, and a new play for six years.

Sometimes my most extreme feelings come from nowhere. Sometimes they are triggered by something you say or do; this is not your fault. Sometimes they are triggered by getting a bad night's sleep. It's all a circle; worry will create a short night's sleep, which triggers a mood episode, which increases worry, which creates a short night's sleep, which deepens the mood episode, and on and on.

Sometimes you ask me if I want to do something and I say no, but I want to be convinced.

I make big mistakes, and no one can convince me it's a mistake until I learn it for myself. It isn't that I don't trust you, it's just that I don't trust you. I don't need to be told "I told you so," I need to be forgiven.

My brand of bipolar is not the same as everyone else's. In fact, mine is quite mild in comparison to many. I don't have problems with extreme addictions, substances, or suicidal thoughts; I don't gamble the company on delusional plans.

I can count the number of people in the world who "get me" on one hand and not need all the fingers. I'm not sure I'm on that hand yet. That is why I'm writing this.

I am bipolar. I am learning what it means.

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.

Lithium: It's Not Just for Teenagers Any More

There’s no clever way to come up with an intro here, so I’m just going to begin. I’ve been diagnosed with bipolar disorder and have begun medical treatment for it. Specifically, my doctor believes I’m bipolar-II. II is less severe than I in that the high state manifests as hypomania rather than the more severe mania, but the depressive state is largely the same.

Here’s a link to WebMD's page on bipolar disorder for anyone who’s interested in further reading. I plan to add links about bipolar disorder to this page soon.

I spent the first three months of the year in the highest manic state of my life and have since crashed into the lowest depression I have ever experienced. In the middle of some discussions with Karen last month, she suggested that I might be bipolar. I didn't think much of it at the time, but started to do some research the next week and found myself answering a vehement "yes" to almost every question on the diagnostic surveys. I started seeing a counselor who soon concurred that I should see a psychiatrist for an evaluation. It took two weeks to get in to see Dr. Sajid, and about 15 minutes for him to make a diagnosis.

There's no blood test or CT scan for bipolar disorder (though I am having blood work done to check other chemical levels). There's no "if it turns blue you're bipolar." The way it works is we try some medication, keep talking to medical practitioners, refine the doses, and see how it feels. I'm taking lithium right now (just started yesterday); it's the most commonly-prescribed medicine for my indications. It will be several days before I begin to feel any of its effects, and weeks before enough has built up in my system for a real gauge. Also, potential side-effects are myriad, and are worsened by too much caffeine intake (down to one cup of coffee per day) and use of anti-inflammatories, which means I have to hope aspirin will soothe my aching joints.

This comes in the middle (or as the result) of a host of massive personal questions and issues that may or may not have much of their foundations in a hypomanic or depressive phase of bipolar. In simple terms, I'm kind of a mess right now, and Karen and I could really use your kind thoughts and prayers. I'm not a lot of fun to be around right now.

I've posted this information on my blog first of all so my friends will know what's going on and second of all because part of the purpose of my blog is to make my artistic process transparent. Certainly a mood disorder like bipolar can't help but be a factor in your artistic process. The biggest question I have, and one no one can really answer for me is this: How much of my artistic identity is tied in with a mood disorder? I'm not afraid of lithium taking away my creativity per se, but the fact remains that the best work I've done, particularly recently, has definitely been heavily influenced by the boundless energy and running mind of an extended hypomanic episode. Intellectually, I believe this so-called "disorder" is in reality nothing of the kind; my bipolar design is part of what makes me Andrew and an artist. That, of course, doesn't make it any easier to figure out how to live with, but I'm not going to be ashamed of it or try to conceal it.

So where does that leave me? Well, I kind of have to put a lot of my personal questions and problems on the back burner while I figure out how much of them is purely a chemical imbalance in my brain. That's going to take a while. So forgive me if you're not getting the Andrew you saw in the catalog. In many ways, I'm re-learning how to be, and I'm doing it on the fly in the midst of a handful of personal crises that may or may not be the results of a disorder in the first place.

I'm not posting about this to get sympathy or pity or for anyone to feel like they have to treat me differently. But I want my friends to understand what's going on, and I want to take some steps toward advocacy for people (artists in particular) with mood disorders and mental illnesses.

Cheers,

Andrew