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This Bi-Polar Story(part 2) Is A Little Long, But...

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  • Posted By: RonPrice
  • April 24, 2007
  • 00:24 AM

3. Manic-Depression: Long-term 1947-2001

There seems to be a process, one of immense variability, that I have experienced on a daily basis for some 60 years. The details, the symptoms, the behaviour, varies from year to year, with the decades, with the days. I cross from some normal behavioural constellation to an abnormal, intense one. The abnormal extreme position varies, as I say, from year to year in content, texture, tone and intensity. In 1946 it was characterized by uncontrollable early childhood behaviour. My mother had to deal with these aberrations. I think the diagnosis of bi-polarism at that early stage of my life is a remote possibility given a statistical average of 1% of manic-depressives having the disorder in childhood. Looking back to my childhood I did have some behavioural abnormalities, but their association with bi-polarism is, I think, unlikely in retrospect.

At the moment my bi-polarism is characterized by a mild tedium vitae attitude and behaviour as I have come to call it--late at night. Due to the above "process" over the last sixty years, due to the part of the process which occurs in varying degrees in various accentuated forms, it has often been difficult to define just where I was at any one time along that 'normal-abnormal' continuum. This was true at both the depressive end and the hypomanic end of the spectrum. It is difficult, therefore, to actually name the number of times when I have had major manic-depressive episodes, perhaps as many as eight, certainly as few as four, in my whole life, from the first episode--which was probably not an episode--in 1946 to the last brief episode in 1990 when I went off my lithium for between one and three months. Defining an episode is not easy for me to do; indeed, the concept of episode is only useful in some respects. In other ways it over-simplifies a complex set of behaviours and has value when trying to describe the experience in writing.

Since 1990 I have generally had little difficulty knowing where I was in this process, this swing of mood and feelings. The great intensities had gone by 1990. Total acceptance of the necessity of taking lithium was a critical variable in this process and it took a decade to achieve(1980-1990). At the hypomanic end of the continuum over the years there were experiences like the following: violent emotional instability and oscillation, abrupt changes and a sudden change in a large number of intellectual assumptions, elation, high energy. Mental balance, a psychological coherence between intellect and emotion and a rational reaction to the outside world all seemed to blow away, over a few hours to a few days, as I was plunged in a sea of what could be variously described as: emotional heat, intense awareness, sensitivity, sleeplessness, voluble talking, racing mental activity, fear, excessive and clearly irrational paranoia--and in 1968 virtually total incoherence at times--at one end of the spectrum; or intense depression, melancholia, an inner sense of despair and a desire to commit suicide at the other end. The latter I experienced from 1963 to 1965, off and on; the former from 1964 to 1990, on several occasions.

The longest depression I had was in 1963 and 1964 with perhaps two six month periods from June to November and July to December, respectively. The longest episode of hypomania was from June to November 1968. This episode was also given the name of schizo-affective disorder with the adjective mild placed at the front of the term. The episodes of hypomania in 1978, 1979, 1980 and 1990 were treated quickly with medication, although the 1978 episode, beginning in January, seemed to last for at least three or four months and had a mostly depressive component. It was treated with stelazine and the side effects were horrific. I wanted to get under the bedclothes every night after getting home from work due to paranoia and depressive symptoms. Only the 1980 episode required hospitalization in this case for one month.

I had some experience of this variously characterized illness in childhood as far back as about 1947 at the age of 2 and then onward through early, middle and late childhood into the puberty cusp of 12 or 13 I manifested symptoms which, in retrospect, seem to me examples of a lack of control of my emotions, a far too intense activity threshold and activity with what could be called mild bi-polar symptoms. It was not until much later in life, though, that I began to see these behavioural aberrations in childhood, at puberty and during adolescence as possibly having a link with my future mental illness. It was not until I was 19 in 1963 that any characteristics of this illness became quite clearly apparent in my day-to-day life. They did not receive the required medical attention and the diagnosis of schizo-affective disorder, bi-polarism and/or depression did not take place—medically. I was just given lots of advice from religious to common-sensical varying from diet to exercise. And after several months or several years the emotional aberrations disappeared, at least for a time.

My episodes over the years seemed to exhibit quite separate and distinct tendencies and patterns; hypomania was always characterized by elation and depression was always characterized by varying degrees of very low moods. In the 1978 episode, elation and depression followed each other alternatively within a two to three month period. Clearly, in the episodes in the late '70s, fear, paranoia and the extremes of depression seemed to be much less than those of the 1960s.

This account above has none of the fine detail that I could include like: (a) mental and mostly auditory hallucinations, (b) specific fears and paranoias, (c) electroconvulsive therapy, (d) psychiatric analysis and diagnosis, (e) the many years of dealing with suicidal thoughts and the death wish, (f) experiences in and out of half a dozen hospitals, unnumbered doctors’ clinics and the advice from more people than I care to think of, (g) adjusting to medications that varied from ones which put me to sleep to ones which made me high; (h) the affects of these swings on my employment, my relationships and my attitude to life; and (i) the periods in my life when the manifestations of the disorder were few and far between. Many of the situations, looking back, were humorous and the contexts absurd. And there was much else but, as I indicate, I hesitate to go into more detail. My aim here is to make a short, clinical statement, to put the facts on paper. Perhaps later I will go into the kind of detail some readers have already asked for. And so--I want to make this statement as short as possible but as detailed as I can to give a longitudinal perspective.

There are a variety of manic-depressive profiles, different typicalities, from person to person. It is bipolar because both ends of the spectrum, the moods, were experienced over the period 1947 to 2007, 60 years. Thanks to lithium most of the extremes were treated at the age of 35 in 1980. It took another ten years, until 1990 as I say above, for me to fully accept the lithium treatment. From time to time in the 1980s I tried to live without the lithium, to ‘go it alone’, as they say colloquially. Such, in as brief a way as possible, is the summary of my experience over the years. I have written more extensively of this in my autobiography which is readily available on the internet if anyone is interested. I would like, now, to focus on my more recent experience of the last decade and a half, 1991-2007, and especially the last half dozen years, 2001-2007.

4. Manic-Depression: Short-term 1991-2007

In the eight years 1991 to 1999 I finished my life of full-time employment, began my obsession with writing and experienced, at last after a decade a full-acceptance of my lithium treatment. In 2001, after two years of early retirement, my supervising psychiatrist in Tasmania suggested I go onto fluvoxamine in addition to the lithium treatment. Fluvoxamine is an anti-depressant. The fluvoxamine removed the blacknesses I had continued to experience at night, from late in the evening until early morning when I was awake or partially awake. The death-wish has always been associated with these blacknesses. With the fluvoxamine, gradually the blacknesses, the nightly depressions, disappeared or virtually so with only residues of a lower mood remained. The death wish remained as did sleeping problems, but in a much milder form. Like so many things in life, the death wish and mood swings have varying degrees of intensity and coping is the key question—and one not easily described and/or answered.

Frequent urination, periodic nausea and memory problems related, in part and perhaps, to the shock treatments I had back in the 1960s, were new problems by the year 2001. But the dark and debilitating feelings, I had experienced for so many years, were at last removed, if not totally at least virtually. After sixty years of bi-polar disorder and/or manifestations of bi-polar disorder in varying degrees of intensity, with periodic totally-debilitating episodes, most of the worst symptoms seem at last, at least in the last six years, to have been treated and removed. The anger seemed, at last, to have disappeared, little by little, year after year, the anger episodes had finally gone by the time I was in my early sixties. Irritability, it seems to me looking back over nearly 45 years of periodic outbursts of anger or what some call ‘intermittent explosive disorder,’ triggered my anger. Irritability in people who have bipolar disorder is a biologically driven symptom of hypomania or mania. The sexual urges still remained.

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  • Here is my final post here until some feedback results indicating some readers find this post is useful to them.-Ron:cool:-------------------3. Enter Lithium in 1980 and Then Fluvoxamine in 2001: 3.1 Lithium was and is, arguably, the central pivot in this whole story, at least to this point in my life at the age of 63 as I live through these early years, 60 to 65, of late adulthood, a period some developmental psychologists characterize as the years from the age of 60 to 80. I was on lithium for twenty-seven years: from May 1980 to April 2007 a little more than 40% of my total lifespan to this point, to 2008. I have experienced the symptoms of this disorder, this partially genetic disorder, with the label MD and then BPD for 27 years. I would now add at least an additional 17 years during which I was not diagnosed with BPD, but had a range of symptoms and experiences I have described above and which were diagnosed in 1968 as a mild SAD.3.2 By 1969 I had been treated and I was ready to re-enter society which I did as a security guard on what was then Canada’s tallest building in Toronto. And so, this made 70% of my life, 44 out of 64 years during which I manifested some obvious features of a disorder of some kind: SAD, D, MD or BPD—not every month or every year but at various times in these 44 years.3.3 My mood swings came to have an entirely different typically in 2001. And again in 2007, after eight months on this new package of medication, on yet another medication, sodium valproate, my emotions, my feelings, are of quite a different order. The death wish, for example, which I have lived with periodically and in various degrees of intensity since at least 1963 has diminished even more and is now only a faint trace of its past. It has not blown away entirely, but its heat has gone. If it exists at all, it is as a trace element, so to speak. My mood swings have moved into new territory yet again. The luvox in 2001 took my nighttime blackness away and the colouration of my emotions late at night became grey; luvox(fluvoxamine) was added to my medication package that year.3.4 There is very little high-quality evidence to guide prescribing for older people, particularly those with multiple medical conditions for which multiple medications may be indicated for those with various disabilities. Current best practice in prescribing drugs for late adulthood and geriatric patients relies on regular evaluation of the safety and efficacy of each medication and of the combination of medications for each patient. Functional and cognitive impairment are strong independent predictors. The inappropriateness of a drug and the inappropriateness of a treatment, the inappropriate quality of a drug are not concerns I take on board. I leave these concerns to my psychiatrist. An inappropriate treatment would include the use of medicines at too high a dose or for too long a period or the addition of a new drug that induces harmful adverse effects through drug–drug or drug–disease interactions. Another inappropriate way of prescribing occurs when a patient is denied the beneficial effect of a known drug on the grounds of advanced age. In such a complex milieux and after many years of dealing with this disorder, I prefer to just leave the treatment regime to my doctor after brief consultations.3.5 The symptoms that affected my daily working capacity, even now, are fatigue and psychological weariness especially after (i) a night of light sleeping, tossing and turning or what some call agitation insomnia and/or (ii) after many hours of intellectual activity. One can hardly complain, though, given that this fatigue, these experiences, psychological and/or physical weariness, are the lot of Everyman to some degree and in a myriad of different patterns. My story, my experience with sodium valproate, my lithium substitute, began just nineteen months ago in April of 2007 and effexor was introduced into the medication package about a month later to replace luvox. Sodium valproate is an anti-psychotic or mood stabilizer & effexor an anti-depressant medication, but more on these drugs later in section 4 below.3.6 Since 1980 and more so since 1990 I have had little difficulty knowing where I was in the process of mood swing, psychological orientation and general understanding. The chemistry and the relationship with brain functioning which is involved with BPD is very complex and I make no attempt to describe the chemistry, the anatomy and the physiology here in this document. Over the years I had grown used to the various plays on my emotions, my sleep patterns and my mental activity during the pre-medication phases and the post-medication periods of the medications prescribed. During this mood transition, though, the swing to a mild elation or euphoria was new, refreshing and quite pleasurable, after an initial period of a few weeks of instability and highly variable sleeping patterns and problems. During this transition there were a variety of symptoms, but I feel no need to outline them here.3.7 The transition to the medication package in 2007 was very different than the one in 1980 or the second major shift in 2001—with the addition of luvox. The great intensities of swing had virtually gone by 1980, although the blacknesses late at night remained. After the introduction of luvox, though, as I said above, these blacknesses disappeared. Total acceptance of the necessity of taking lithium was a critical variable in this process and it took the decade of 1980 to 1990 to achieve. At the hypomanic end of the continuum over the years there were experiences like the following: violent emotional instability and oscillation; abrupt behavioural changes and a sudden change in a large number of intellectual assumptions; elation, high energy and various forms of excess. Mental balance, a psychological coherence between intellect and emotion and a rational reaction to the outside world all seemed to blow away, over a few hours to a few days, as I was plunged in a sea of what could be variously characterized as: emotional heat, intense awareness, sensitivity, sleeplessness, voluble talking, racing mental activity. :cool:--Ron Price, Australia--I trust this post is useful to some readers at this site.
    RonPrice 3 Replies
    • January 8, 2009
    • 03:38 AM
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