The cyclothymia collective

Still in a very crappy state of mind. Came to work and have kept myself closely focused on my tasks. This helps.

I thought I could write a bit about the photo I posted of myself in the sidebar.It's a photo of me and my baby just a few days after she was born. Online, I call her Izzy. I was at my parent's house in the States. I had traveled there when I was eight months pregnant against my doctor's wishes because my father was having a bone marrow transplant. I thought it would be best to keep all of the stress in one place. It is one of the last photos of me before the hinges started to come loose.

Looking back, I wonder if I had post-partum depression. At the time I blamed it on my father's Non-Hodgkins Lymphoma that kept coming back like a villain in a bad horror movie. My father and I were very close. He was my friend, and my creative mentor. Two years after this was taken, he was dead. I did not take it well. OR, I guess looking back we could say I had some post-partum stuff going on, some intense worry about Dad's cancer and then his death and I went into mourning and just never came up.


I look so peaceful in the photo. And Izzy is so small and adorable. I don't like babies much. I am not one of those women who will rush over and ask to hold someone's else's baby. But I was a good mother to this baby; I breast fed her for 23 months.

It was after the weaning, which coincided with the death, that I crumbled. I limped along in a fog, struggling with mixed states, not knowing what they were. When Izzy was big enough for baby group meetings, I dutifully took her, but the gatherings were like fingernails of a chalk board for me. At 2.5 she was able to go to play mornings at a local day care, and that took care of that.

Parenting has always been a refuge for me.

This is why I hesitated for so long to turn the website into blog format, but maybe I can turn it around and give it some positive value. For the last few weeks I have been feeling great (but not too great) and then a couple of days ago I began to notice that I was losing my patience, losing my morale, and offhand comments people made to me were haunting me to a degree all to familiar. Perhaps because my high was not too high this time, maybe thank to the new anti-depressant I have started, the crash won't be so bad...

But still, I am sick of myself, sick of the world and aggressive to boot. Stay away from the car. Also I am horrified by everything I have said or written online. Even though I never divulge much about myself-- for precisely this reason. I think I developed an obsessive secrecy for this reason. I never want to say anything that might come back to haunt me...only in this state of mind, everything seems like crap.

I know I will feel better in a matter of time even though I have nothing but a vague memory of having been up and happy...sigh...I feel I am not explaining it adequately.

I write this to make a record of a Cyclothymic's experience.

My psychiatrist says I have no need for talk therapy as I don't have any issues. I put it that way so it has credibility :) I had no childhood traumas, no negative sexual experiences, nothing. So when I feel bad about the past, it is over stupid little things. I can't even begin to imagine what it would be like to be Bipolar on top of PTSD, for example, or to have been abused. It must be like being thrust down into one of the rings of Hell in Dante's Inferno,left to roast over a slow fire. I don't think I can exaggerate too much.

If anyone reading this would like to contribute with their own story or take on Cyclothymia, I would be very happy to post it. I believe the more stories we tell, the better. It can only help us as a population.

If you are feeling totally crappy and just want to whine on and on about it, in our forum we have a section called the Whine Yard, where you can get it out of your system by writing about it and no one can suggest a fix or tell you to snap out of it. Sometimes we all need to barf it all out down a very deep well. We also have an anonymous section, where you can log out and then log back in using the anonymous account set up just for this-- for people who want to get the really dark stuff out.

I always feel better after I post on the forum. I know my forum-mates understand me and will support me. It's good to know we are not alone.

A small study conducted in 2007 by Pasquini et al. reported on by Health Central.com looked at treatment of the mixed state (dysporia).

They began with the assumption, made decades ago, that the mixed state, while linked to depression, requires separate consideration during treatment. Pasquini et al. state that "depression plus anger or aggression is almost as common as depression with anxiety, the researchers point out.."

As far as I have found in the world of Internet sites on Bipolar, symptoms such as anxiety are put together in the category of mixed state. However, it is in agreement with a study from 2000 by Dayer et. al, saying "we describe in addition to the DSM IV mixed state (type I) two new subtypes of mixed states (type IIM and IID). This new typology can give the clinician a more accurate understanding of the complex and polymorphous reality of mixed states." (I was unable to find any more data online about IIM and ID).

The researchers postulated that since serotonergic pathways seem to play a role in aggressive behaviors, perhaps patients would benefit from a selective serotonin reuptake inhibitor (SSRI). To that they added an anti-convulsant, on the theory that anticonvulsants affect GABAergic and glutamatergic pathways.

The subjects were treated with an SSRI plus an anticonvulsant (usually valproate) for 12 weeks.

Result: Treatment with the two-drug regimen was associated with a significant improvement in depressive symptoms. In addition, marked improvements in anger or irritability and anxiety were noted. Eighty-two percent of patients were rated as improved or much improved on the Clinical Global Improvement scale, the authors state.

Here are lists of SRRIs and anticonsants:

Common SSRI brands
citalopram (Celexa, Cipramil, Emocal, Sepram, Seropram)
escitalopram oxalate (Lexapro, Cipralex, Esertia)
fluoxetine (Prozac, Fontex, Seromex, Seronil, Sarafem, Fluctin (EUR), Fluox (NZ))
fluvoxamine maleate (Luvox, Faverin)
paroxetine (Paxil, Seroxat, Aropax, Deroxat, Rexetin, Xetanor, Paroxat)
sertraline (Zoloft, Lustral, Serlain)
dapoxetine (no known trade name)

Anticonvulsants
Carbamazepine (Epitol, Tegretol)
Clonazepam (Klonopin)
Valproic Acid (Depakene, Valprotate)

In the list of Bipolar meds at psyweb.com,these are only five of the standard 21 non-antidepressant medications approved for treatment in Bipolar Disorder, so be careful.

One thing that always gets me with a mixed episode is how shaken I feel afterwards. It's a life-altering event, no matter how mild the episode. For however short a time, I was questioning my sanity, my existence, my ability to go on. Now my "normal" life seems somewhat alien and will take some getting used to. It's like having been away on a very bad holiday...

Talking about suicide and even suicidal thoughts are taboo in our society, but the fact of the matter is that these things are part of the Bipolar experience. Citrome and Goldberg state that, “It is a myth that asking about suicide places the idea into a patient's mind,.” But just in case:

Save Awareness Voices of Education 1-800-273-TALK
American Fonudation for SUicide pRevention: http://www.afsp.org/
Suicudi Prevention Hotline
List of suicide hotlines by state

My aim in bringing it up here is to acknowledge that it exists and to show people that they are not alone.

First, a few statistics to illustrate how very common suicidal ideation is in Bipolar and how very profoundly it affects society. From this chart we see total suicides per population in the world and the breakdown between males and females. An interesting thing to remember is that while dysphoria (mixed state) occurs in 49% of patients, it is seen more frequently in women, in this table, men score higher than women in every country. is a chart that shows suicide rates among the states in the USA.

Suicide.org reports that in 2001 there were in the US 30,662 self-inflicted deaths.

Citrome and Goldsberg write that “ Suicide is among the top five causes of death in the United States for persons aged 5 to 44 years ...about half of all suicides can be attributed to bipolar disorder.” They say that “the lifetime rate of suicide attempts in persons with bipolar disorder was 29.2%, compared with 15.9% in persons with unipolar depression and 4.2% in those with other major psychiatric disorders (excluding personality disorders).

Among Bipolar patients, those with substance abuse issues are twice as likely as those who without (Citrome and Goldsberg). Put this next to the fact that Bipolar patients have 60% likelihood of substance abuse problems and you can see this involves a lot of us. 15-50% of Cyclothymics go on oh develop full blown BPII or BP.

I am just speculating, but it would seem to me that there is a lower rate of suicide among Cyclothymics. I havn’t been able to find any data on it. I suppose the reasoning is that if someone were to be as depressed/dysphoric as to develop suicidal ideation, the diagnosis would be changed to BPII.

Thus, because Cyclothymia is a relatively milder form of Bipolar Disorder, major depressive episodes are not at issue. Our depressions are lighter, yet can be chronic. We are less likely to experience suicidal ideation (thinking about killing ourselves) than morbid ideation (fixating on the meaninglessness of life and our role in it, “how good it will be to pass out of this existence, how everyone in the past has died, how I will die too, how none of it is important because the worms will get us all in the end. Everybody thinks about death and existence, but not constantly, for weeks or months.”

While we may not be plotting our exit from this world, we suffer.

Suicidal ideation comes out of depression. My psychiatrist commented once that “depression has its own biology.” This mean depression is not only a feeling of sadness, meaninglessness, hopelessness, but can also be mixed with hypomania to create what is known as a mixed state (see page here for more on the mixed state).

For me, morbid ideation comes out of exhaustion. First I go through a period of hypomania, feeling really good and being very productive. It’s all very good for a while, until I get tired of being so “up” and I try to relax but my mind continues to race on without me. Slowly the spinning mind starts to descend, but not lose speed. The word loses its shimmer, I start to think negative things, to obsess about things that happened long ago. Then the mind descends into a more depressive state and the thoughts involve paranoia, insecurity, and on and on and on.and on and on. It is exhausting. And it is when it gets exhausting for me that I start thinking how I’d just like to shut my mind permanently. Just quiet. I never get so far as planning, or imagining a plan. All I know is I want escape. One of my forum mates wrote:

“I have truly had enough of this f**king shambolic roller coaster ride which is masquerading as 'life' - it feels more like a living hell.”

Another forum mate wrote about how he thinks of it:

“I wanted to make a post to talk about how thoughts of suicide let the pressure off being alive. That's what I'm telling myself when such things keep going through my mind without my asking them to, it's a way of holding back the stress of everything I feel I have to do. I have a choice, it isn't forced.”

What to do

First, go to a doctor, preferably someone who knows about Bipolar issues. Tell your doctor about it. It may be a difficult thing to bring up, especially if it has been months or years since your diagnosis, but please try. Perhaps you could write down a list of symptoms that you are experiencing and slip it in with the other items and have the doctor read them. Be sure to include the term “dysphoria.”

Second, know that you are not alone. You can come to the forumand talk about ideation and ask how people deal with it, or just make contact with others in the same situation. Talking about it can break the spell and make it more bearable.

Third, please know that it is not your fault if you are having these thoughts. You are not being irrational or attention-seeking, or any other such crap. These thoughts are being generated by your brain in the depths of a depressive trough filled with dysphoria. This makes your brain lock onto an idea and chew on it like a hungry dog with a bone. Don't pile on feelings of guilt or remorse on top of this. Get in to see a doctor and get help. Medications can help.

Fourth, choose life. One of our forum members wrote this:

“Choose Living .
Sometimes an almost impossible choice but I find the more of it you do the less difficult it is to make the choice to choose life. It is the difference between thriving and just surviving.

The choice is not just black and white but a thousand shades of gray.”

I was surfing around Bipolar blogs last night. I found a writer that seemed interesting (here ) and saw a post that discussed Lithium. I have been taking Lithium for 8 years, so seeing an article about it written by another blogger caught my attention. The post is titled "Lithium: Bipolar Remedy or Exacerbation," which piqued my interest as 1)Lithium is not a remedy, but a treatment; and 2)Lithium is not known to exacerbate Bipolar Disorder. Quite the opposite, in fact. It is an example of the misinformation about and fear surrounding this widely-used medication. The entry starts with:

In the late 1800s it was discovered as having mood stabilizing effects but bipolar patients have different viewpoints towards this drug: Lithium. Sting, Evanescence and Kurt Cobain all wrote songs about it and their interpretations highlighted ambivalence around this drug. No one can say for sure whether this drug is the essential choice to treat bipolar disorder but it most certainly is a primary one.

There are a few things I find troublesome in this excerpt. First, BipolarLives.com tells us that Lithium was in use in the second century AD in the southwest of what is today Turkey:

From the ancients up until today, bathing in mineral pools and drinking mineral waters, have been popular treatments to promote mental as well as physical health...Who discovered lithium is a hard question to answer because so many early advocates of spas containing lithium knew the water to be beneficial, but had not isolated lithium or identified its specific link to manic depression.

Reading nineteenth century European literature it is not unusual to come upon mention of characters being sent to a spa for the waters (Tolstoy and James come to mind).

"[B]ipolar patients have different viewpoints towards this drug." This is a statement that can be accepted by everyone. But then the examples given are lyrics of songs written by people who have never been confirmed as being Bipolar. Neither Sting nor Amy Lee (of Evanescence) has made a confirming statement about it and Cobain was never formally diagnosed. Lee is quoted all over the Internet ((here, for example) as saying "It's not literal, it's not literal about the drug for me, I've never taken lithium before." She says she uses it as a metaphor for happiness. This means none can be cited as an "expert" about Bipolar or Lithium use, or Lithium use in the treatment of Bipolar.

The rest of the post quotes respectable websites and articles about Lithium, but focuses on the drug's negative side-effects. This gives the impression that this is a dangerous medication. While Lithium does have a list of side-effects, it is not longer than those for other psychotropic medications. For example, I am taking Wellbutrin, which can cause seizures if taken with alcohol. Lamictal can give you a lethal rash. Some anti-depressants come with suicide warnings.Crazymeds is a good place to go for extensive information about the medications used to treat Bipolar Disorder and their side-effects.

I think the fear surrounding Lithium is actually a projection onto the drug of the feelings people have about being diagnosed with a neurological condition. Lithium is closely associated in the popular mind with people being carted off to psych wards or stumbling around in a heavy stupor. I think for a lot of people it translates (however subconsciously) into a kind of "Lithium takers are REALLY CRAZY; I can't take that. If I take another drug, like Neurotonin or Abilify, then I'm not REALLY CRAZY." If they slapped a different name on it, people probably wouldn't balk when told they needed it.

Lithium is the med with the longest track record. Another thing that sets it apart from all of the other mood stabilizers is that it has been shown in extensive testing to reduce the risk of suicide, which is considerable because as many as 25 percent of severely depressed or manic-depressive patients take their own lives. Some people may have a negative reaction to it, but some people have reactions to any medications. My feeling is that Lithium has a bad rap because it was the only med for many years-- it carries the stigma of serious manic-depression-- whereas the others don't. The fact remains, however, that Lithium remains among the leading treatments. And don't forget that anti-suicide effect.

A study in seratonin production levels in men and women conducted in Sweden has found that "the brain’s serotonin system differs between men and women. The scientists who conducted the study think that they have found one of the reasons why depression and chronic anxiety are more common in women than in men."

women have a greater number of the most common serotonin receptors than men. They also show that women have lower levels of the protein that transports serotonin back into the nerve cells that secrete it. It is this protein that the most common antidepressants block

What I get from this (feel free to correct me): Seratonin is a neurotransmitter that is secreted by the brain and has a great influence on mood . The substance is secreted by the brain and then reabsorbed (which is called reuptake). The slower the reuptake, the more time the serotonin is allowed to do its job-- which is why most antidepressants are designed to inhibit the reuptake of this neurotransmitter (they are called SSRI-- Selective serotonin reuptake inhibitors). If women have a difference from men (the usual subjects of med trials) then there is a difference in how the anti-depressants interact with the flow of serotonin. Anti-depressants could be modified to better deal with depression and anxiety in women.

In the brain, messages are passed between two nerve cells via a synapse, a small gap between the cells. The cell that sends the information releases neurotransmitters (of which serotonin is one) into that gap. The neurotransmitters are then recognized by receptors on the surface of the recipient (postsynaptic) cell, which upon this stimulation, in turn, relays the signal. About 10% of the neurotransmitters are lost in this process; the other 90% are released from the receptors and taken up again by monoamine transporters into the sending (presynaptic) cell (a process called reuptake).

Some theories link depression to a lack of stimulation of the recipient neuron at a synapse[citation needed]. To stimulate the recipient cell, SSRIs inhibit the reuptake of serotonin. As a result, the serotonin stays in the synaptic gap longer than it normally would, and may be recognized again (and again) by the receptors of the recipient cell, stimulating it."(see SSRIs.

Bruxism is a term used to describe grinding of the teeth accompanied by clenched jaw. I was reading up on Bipolar and dental care because of my dry mouth syndrome and saw mention of this along with a note that it is common among people who are Bipolar. It involves teeth clenching and grinding during the day or night, which according to one site can cause

1. cracks in the teeth, necessitating root canals and crowns
2. jaw pain
3. headaches

I did this when I was going through grad school. My husband said the noise was frightening. I haven't had it as a result of meds, but I think with an estimated 5.7 million people under treatment for BP in the US alone, it's worth mentioning.

Medications frequently prescribed for Bipolar can also cause Bruxism. The following list is given at Contemporary Oral Hygiene.com:

venlafaxine hydrochloride (Effexor, Wyeth Pharmaceuticals),
Haldol (Ortho-McNeil Pharmaceutical),
Fluvoxamine (Luvox, Solvay Pharmaceuticals),
paxoxetine hydrochloride (Paxil, GlaxoSmithKline),
fluoxetine hydrochloride (Prozac, Eli Lilly), and
sertraline hydrochloride (Zoloft, Pfizer Inc).

Patients experiencing this condition may need dental interventions such as nightguards to alleviate the discomfort associated with bruxism

The mayoclinic.com site says

In adults, psychological factors seem to be associated with bruxism, including:

* Anxiety, stress or tension
* Suppressed anger or frustration
* Aggressive, competitive or hyperactive personality type

I should think that bruxism would be an outcome of dysphoria (mixed state, agitated depression), the main symptoms of which are "agitation, anxiety, fatigue, guilt, impulsiveness, irritability, morbid and/or suicidal ideation, panic, paranoia, pressured speech and rage" (source.

Treatment.
Most dental care websites first recommend that the patient relax. (Web page writers have obviously never been in a dysphoric state). Next is the fitting of a plastic mouth guard to be worn at night. In extreme cases an experimental approach is injecting Botulinum toxin. Autohypnosis in conjunction with counseling is also recommended.

If you grind your teeth at night (and how would you know unless someone told you?), seek help immediately as it can cause permanent and catastrophic damage to your teeth and jaw.

I just got back from five days in London with my daughter (she's 15). We had a great time. Mostly we shopped and walked and walked. Loved the street culture and listening to people talk. I was surprised during our time on the Underground, sometimes at packed rush hour, how calm I was. Most of my life I have had a difficult time in crowds. I became overwhelmed quickly and withdrawn, had to take Xanax for plane flights- not because I am afraid of flying but because of the crowdedness-- and didn't like sightseeing because I could not count on being in the mood to do the things I had planned while excited (hypomanic).

But this time everything was fine. No, it was GREAT!

THIS is the goal of treatment with meds: a full range of feelings, enough energy to walk seven hours a day, an optimistic attitude, curiosity about things and people, not getting bothered by the little stuff...and not getting too wound up about it. It was a triumph, in medical terms.
I am home now. Not manic, not crashed. Just fine. Physically exhausted-- my feet are killing me.
The funny part of our trip was that we stayed with a friend who is a doctor specializing in psychiatry. I have never mentioned my Cyclothymia, just because I don't know her that well. She is engaged to my nephew. She had to complete an application to qualify for a program she desperately wants to make her career (psychoanalysis) and was paralyzed with doubt-- so I talked her through the whole process (I don't know if I mentioned that I am an academic editor and do just this kind of coaching all the time), read and edited her essays and she submitted it the morning we left. It just goes to show you that psychiatrists are people too and need support and understanding. :)

During the trip I found myself wanting to be alone-- don't get me wrong, I adore daughter and we get along great-- but I imagined how nice it would be to wander alone and just do what I wanted to do for several days. The critical idea here is that I was imagining. Before I was diagnosed and started treatment, and even for some years after that, I was unable to state anything I would want to do. I just could not fantasize, get out of my moment, rise above the tremendous BLAH that is chronic depression. This was a big moment for me, realizing that I wanted to do things by myself, for myself.

And wanting to shop. I haven't shopped for myself-- really shopped, as in "try everything on and experiment", and have FUN with clothes, in the longest time. Once upon a time, a long time ago, I was tall and slim and loved clothes. I've been apathetic about my appearance for years. I was twenty pounds over weight when I was dx'd at the end of 1999 and have gained another 30 over the last 9 years. While in London I suddenly felt like enough is enough, I want to participate in fashion again. I saw women my age with great hair in fitted tweed jackets and there I was in my baggy old sweater and jeans and my self-cut hair and, well, an enormous BELL went off in my head. Sounds stupid maybe, but it was profound for me.

When I came home and told my husband about this, he encouraged me to go back on my own soon and spend time alone doing whatever I wanted. I love that about him. He has been very supportive through all of this.

I had this website on a free server for seven years. This is directly related to Cyclothymia. I worried that if I had to pay for a web domain and hosting, that given my mood swings, one day I would think "What the hell am I doing?" and delete it all. Such is the wonder that is Cyclothymia. My mood swings go in weeks, so one week I'll be feeling social and creative and I'll get all kinds of things done, and then POOF! the next week I'll no longer be interested in a project in which I was completely immersed for days, and even wonder what I saw in it.

This has serious implications. For example, I run two websites at work. Both need to redesigning and updating. I started working on one and was busy with it for days and made a lot of progress. I told people it would be up by such and such a date...but then POOF! The date passed a week ago-- thankfully the old sites are up and functioning or this would be embarrassing.

Or a good friend, the one who lent me her horse yesterday, asked me if I had time for a coffee after my ride. I was horrified by the idea-- actually I couldn't do it because I had to do some things with my daughter--but at other times I have really enjoyed this woman. I felt bad. Guilty. Emotionally stunted. I have few "real" friends. Usually I don't notice this very much, but when I hit a downswing, all of a sudden it is very noticeable. I always think "what the hell is wrong with me?" Fortunately I have online friends from whom I can hide my reality better (ha!) and the the forum, where all mood sins are forgiven. I have a great many warm acquaintanceships, but let few people in farther than that...because I forget that they to have a friend you have to be a friend. I forget to call. maybe don't see a friend for six months-- because it just didn't occur to me to keep in contact.

When I was in my teens and twenties I used to put a lot of effort into socializing. I didn't always choose the most appropriate friends because I was caught up in my own struggle just to be there, and could not assess them as they should have been. I sat for two years with an incredibly self-centered, highly talkative woman just because our girls were little and they were friends and had play dates. I would sit and listen to her go on an on, whingeing about life-- but I mostly was hanging on by my fingernails then and just relieved I was actually socializing. Two years into this relationship she stopped and noted I was sometimes talkative, sometimes not, and I said I was manic-depressive and glad she had noticed after two years...not long after that her husband asked for a divorce and she moved away, and I resolved to only make friends if they were actually friends. No more hanging out and torturing myself just to be social because I thought I should.

I now have a few friends. One is a colleague at work who also studied history and is dark and funny. Another is this horse friend, who is sunny and loud. That we have passions in common makes it easier to be with them, but still the relationships are tenuous.

I am very close with my husband and daughter. I was very close with my father (he died). I have a ten-year relationship with a group of women I met online 10 years ago. I actually run that group's forum and take care of the tech stuff, by which I mean I am an active, central member. I also have the Cyclothymia forum here, and enjoy that tremendously. So it is not that I do not like to socialize, just that I like it in small doses and on topics to which I can relate. I like the Cyclothymia forum best because I can go there no matter what my mood and it really does not matter. I can just be me, by which I mean I can talk about my neurology and meds all I want.

We have nearly 7000 posts on the forum. This is what made me decide to commit to a domain name. I felt it was time to honor the group and try to reach out to more people through a blog format. I hope other people will beas helped by the site and forum as I have been.