Well, gosh. I’ve had quite the afternoon.
I had an appointment to see my psychiatrist in three weeks for a routine 12-week check-in, but I’ve been feeling so lousy that I asked to come in sooner, so I saw him today. I talked to him about how I’ve been feeling terrible, and in what ways, and how frustrated I am that I’m on two antidepressants and go to therapy every week and I’m not getting better in any kind of lasting way. I said I’m taking a lot of heat at work because I’m behind on deadlines due to my complete inability to focus on anything for more than a few minutes, and that just isn’t acceptable so something has to be done. We had talked in the past about adding Abilify to my medication regimen. Abilify is an atypical antipsychotic/mood stabilizer that often works well for depression patients when used in conjunction with whatever antidepressant they’re already taking. So, fine, sign me up for that shiz, because something has to change.
My psychiatrist is taciturn and a bit chilly. I’ve been seeing him for almost two years and I have never once seen him smile. He scares me a little, to be honest. So when he started silently flipping back through my file and scowling, I got nervous. After an impossibly long silence, he said, “Your moods don’t make sense to me.”
I didn’t say anything, because what does one say to that?
“Do you have mood swings?”
Shit, I thought.
“Do you find that you have periods when you feel really good, have lots of energy, your thoughts race, maybe you get easily distracted, or feel grandiose?”
SHIT, I thought.
“Not grandiose,” I said. “But I’ve always been a bit mood-swingy…and yeah, I guess I do have phases where I feel absolutely fantastic for a few days or weeks and then I come crashing down again and am as depressed as ever.” As the words were coming out of my mouth, I realized what he was getting at, and the cold buzzing wave of anxiety that I know so well washed over me and my heart started racing and I felt the blood draining out of my face.
“I think we need to consider the idea that you’re bipolar,” he said.
“Shit,” I said.
His reasoning is that my periods when I feel better and the ones when I feel awful don’t seem to correspond with much, and some of my depressive symptoms are atypical (example: I tend to feel my best in the morning and things go steadily downhill from there, whereas for most people with depression, mornings are the worst time). And attention/focus issues can be a feature of both the high and low episodes of bipolar disorder, along with irritability, which I definitely have. If he’s correct, I have bipolar II, which is different from the textbook manic-depressive illness that first comes to mind when you hear the word bipolar. With bipolar II, people have hypomania, which is nowhere near as intense and can often go unnoticed or be easily written off as “hooray, my depression decided to recede for a while.”
Unfortunately, the depressive episodes associated with bipolar II are not comparably mild. They can be very severe and can also last much longer than the episodes of hypomania. It’s very common to have the low-energy, can’t-get-out-of-bed type of depression symptoms, which I absolutely do. And suicidal thoughts occur in a lot of sufferers.
Again, sounds familiar.
Turns out that antidepressants can make bipolar disorder worse. (Which would explain why I haven’t gotten better after almost two years.) So we’re adding Abilify to my routine, and if that makes a big difference for me mood-wise, we’re going to get me off my two antidepressants and add another mood stabilizer called Lamictral, which has a great track record. Added bonus: he said this type of drug typically has very few side effects, especially compared to antidepressants. Sign me up for that.
I read tonight that 7 out of 10 people with bipolar disorder are initially misdiagnosed, and the average timespan between initial onset of symptoms and a correct diagnosis is 10-12 years. That makes me sad, but I get it, especially for bipolar II because the hypomania can be easy to miss.
I won’t lie – all this threw me for a major loop. “Bipolar” is a scary word, way scarier than “depression.” Also…depression can go into remission. Many people can recover and not need to be medicated forever, or can at least go off medication until they have another episode (if they have another episode). Bipolar is forever. I had pretty much gotten to a place where I accepted the idea that a significant part of my depression is caused by a chemical imbalance and therefore I might need medication for the rest of my life, but still, if I’ve been misdiagnosed and am bipolar instead…that’s a blow. The stigma and public miseducation about depression is bad enough; it’s even worse with bipolar disorder. That, to be blunt, fucking sucks. When I walked out of my psychiatrist’s office I was fighting like hell not to cry because I was so floored and overwhelmed, but then I talked to my closest friend and she brought me around to the idea that this is, after a fashion, good news. It sucks if I’m bipolar, but it’s great that maybe I’m getting an accurate diagnosis after all this time because that means I can get the right treatment and finally start feeling better. She’s 100% right…what matters most is feeling better and living a happier life and not ending up dead or back in the hospital. That perspective is calming me down significantly and also preventing me from having a pity party.
To be continued, I guess! I leave you with this, courtesy of the amazing Allie Brosh, whose blogging about her depression has been a light in the darkness for me many times.