Hi everybody,

I've had myself under quite the microscope recently since in August, I had an exhaustion/insomnia episode following a period of both stress and high inspiration & creative output and so my dx was given as BP "mixed, moderate" which I think is supposed to be BP2 even though BP2 isn't in their new diagnostic manual.

They said it was a hypomanic episode and I've never had one until 2016, at 36 years old. My story is this:

I had a happy childhood, loved music, video games, had great parents and friends and had a few migraines in my early teens that went away.

At 16, I had some deep thoughts one night that led down the rabbit hole and made me question everything in life, leading to about 6 months of what was definitely major depression with some panic/anxiety thrown in. It was mostly of the existential kind, not anything related to what was going on in life. More getting creeped out by the concepts of nothingness, meaninglessness, nihilism, what is reality, time, eternity, religion, and so forth. Not anything like "oh I'm so worried about what this person in my class thinks of me. if I'll fail a math test, or if I'll get a date to the prom." My safe Catholic upbringing and worldview were shattered, even though at first the feelings/thoughts were so awful I wondered if I had secretly gone to hell or offended God. It was persistent and once even made me vomit, from thinking too deeply about eternity. I'd wake up in the morning and briefly feel okay and then remember it all, and it would flood back and ruin everything again. My brain dissected anything that would make me happy. If I felt or acted normal or happy for a little bit I would question it over and over. This went on for 6 months. I had no idea what depression actually was so the experience was terrifying.

When school restarted, since so little would make me happy, instead of doing fun activities, I just focused on school work. One day I found I was somehow kind of enjoying it. I started losing weight and fell in love and was happy, productive, sociable, and confident for 18 months. I also began to drink more coffee and smoke cigarettes; friends and I would go to restaurants and have coffee, smoke, and have great conversations both on analyzing big topics and on fun gossip things. I felt that the earlier experience I had served a purpose, to make me stronger, wiser, and give more perspective.

At 18, I started talking about the experience late one night with some friends and had feelings of it coming back. I'd think of the person I'd fallen in love with or how much I could accomplish academically to get my mind off it, or music and it worked partially. But I'd be in and out of good and bad states throughout college. I started detecting a logic to it that sometimes things feel so bleak (again not for any external reasons) that I'd just get used to it and then later find myself feeling okay and enjoying things I ordinarily enjoy (music, video games, politics, socializing). I also noticed that there was usually a feeling of dread or unreality during the day to various degrees that I could never entirely get rid of (though morning coffee sometimes pushed them into the late morning or afternoon instead) and as the day went on, I'd gradually become more alive and "normal" feeling. I was definitely a night owl. This is still true today.

In mid-college, I started having some strange feelings in the right side of my head. A dull ache or feeling of discomfort, a feeling of pressure sort of like there was something not fitting, or like my eye was too big for its socket (it's not, but that's how it felt). It would come and go, and sleep, food, coffee often made it go away. I had a gazillion CAT scans and MRI's with nothing negative coming back, was told it could be TMJ, and Bayer would provide some occasional relief as well as Vioxx which my doctor prescribed one summer. I also noticed sometimes that right after getting home from work and having coffee, I would go to the bathroom and that would somehow help a lot of other symptoms, pressures in my head, and mood. For objective purposes (not to be graphic), I also noticed that if I pushed too hard I could get sparkles in my vision that were reminiscent of migraine visual auras. I had severe issues being able to go to the bathroom for a few days at age 21 so I took magnesium citrate and it reset everything perfectly. So ever since then, maybe once per month (and often after eating frozen DiGiorno pizza, what on earth is up with how bad that constipates the next day?) I would take it and it helped.

Grad school was great for 2 years, I was engaged, productive, energetic. I slept maybe 5-6 hours a night with a nap during the day. I started having insomnia during exam time but never had any lasting dark depression. I felt so far removed from where I'd been when I was 16. I had freedom in my sleep schedule to get things done on my own time and it worked greatly for me.

At 24, I was on an early schedule all year. Instead of gradually adapting to it and getting better, I started to get worse and worse. Not only would I feel pressure in the right side of my head but often right after having coffee, the skin above my left eye would start twitching rapidly and involuntarily. I was having more trouble going to the bathroom and issues sleeping. I went to a neurologist who diagnosed me with "transformed migraine," (which I believe is now called mixed headache syndrome). The idea is that some migraineurs over time can have features of migraine present without the full blown attack. So it's like a protracted constant migraine of much less severity. I was so relieved to have a diagnosis that made sense.

He prescribed Nortriptyline and it seemed okay at first though I became very fixed on watching my weight as I'd been chubby in middle school and then very skinny during and after high school, which I took pride in. Things started to feel a bit bizarre though on it and after a few weeks I found that during my typical lulls during the late morning/early afternoon, they instead had intensified to a very deep palpable dread. Around 4-5 pm, I would have my meal, coffee, and cigarette and it'd be like they never happened. All would be close to fine. Additionally, I had strange impulses in class. It reminded me of being in church and imagining yourself standing up and saying something silly. Normally, I could laugh privately at those and knew they'd never be acted on. But I got this recurring compulsion of standing up and throwing my pen at one of my favorite professors. It's hard to describe it, but things felt more "fleshy" and less "airy" on Nortriptyline so the compulsions were in a sense more vivid and almost tangible. I began to get scared that I would actually do it (I never did) and then because I was privately fretting over that so often, I started to think I was turning into a freak. When I saw my mom over Christmas, as soon as I gave her a hug, I had a terrible vision/fear of her perishing violently in front of me.

I stopped taking Nortriptyline gradually with the doctor's knowledge and felt not quite right or real for several months. I still remember a few times taking a nap in the early afternoon and waking up so different and refreshed that it felt like a miracle had occurred. I remember once having horrible feelings and thoughts around 8 PM and laying down for an hour, waking up and everything was okay to go out for the evening. I experimented with very low doses of 5HTP (a precursor to serotonin) at bedtime which would make everything so calm and sleep so inviting. I'd wake up and feel "real" and be like "OOOOOOooohhhh, right, that's what life is supposed to feel like when things are normal." I didn't take it too often or even regularly, but knowing it was there helped.

Interestingly, because migraine overlaps with other conditions so much, I first came across information about bipolar disorders that weren't bipolar I in this time. My cousin died of an overdose and my younger sister started to have serious psych issues and treatments that initially didn't go well (she's since been mostly stable for 12 years on Seroquel). I connected the dots between that, my grandmother having been "crazy," cousins with epilepsy, bipolar disorder, migraine on BOTH sides and one with schizophrenia on another, as well as restless leg syndrome, some alcoholism, and around 95% of my cousins smoke or are former smokers. It became clear to me that my migraines related to genetics and for a while I started to view myself as "defective." Despite that, the depression I had still wasn't as deep as when I was 16 and I'd learned so much since then, I was able to ride out this time knowing that since life had been soooo good for so many extended periods of time DESPITE having had a bad depressive experience that I'd worried would have "changed me forever," I knew life would eventually be okay again. And surely enough, it was.

Months after school, things started to have a better rhythm and I took Prevacid for stomach acid which somehow made my going to the bathroom issues flow very predictably and easily. I got interested in games again, deeply and with much excitement. A few months later, I woke up a couple times with actual migraines, which I hadn't had since I was 14-15 (so it had been a decade). A little coffee and things started to feel normal again. But I'd have trouble sleeping (and I'd be up super late so trying to sleep at 7 AM, 8 AM, 9 AM and wake around 4 was not unusual) and could still wake with the migraine. However, I had pretty much no depression. It got to a point where the actual migraines became so frequent that they were getting debilitating so my partner at the time finally convinced me to try medication again (I'd been opposed due to my bad time with Nortriptyline and was worried about memory & word loss I'd heard about for Topamax). I was prescribed Lexapro, 10 mg, and started taking it at bedtime (often 4-6 AM). It helped sleep and I didn't have migraines. After a few weeks, I noticed music was sounding more enjoyable. Things were pretty okay. I didn't have to work early since my dad owned a business and was very accommodating.
It helped with migraine, it helped with my stomach, it helped with insomnia, it helped with mood (I could feel things more, previously I could at times be more robotic and even was once called vacant), it had basically none of the terrible stuff that had happened with Nortriptyline. At one point, we went up to 15 or 20 mg but my parents though it was making me a bit too lazy and I agreed so we went back to 10. I had samples of Cymbalta a few times but didn't need them and also at age 30 was on Pristiq additionally for some months and a little bit of Topamax at age 32.

But straight up 10 mg of Lexapro pretty much worked for me for a decade. I didn't have to work full time and had near total freedom to control my sleep schedule. If I had to do something early in the morning, I could do it once or twice, sometimes with an elevated mood. When stuff went wrong, I knew things would be okay in time, that I just needed exercise, a nap, food, or coffee. I met someone and cultivated a healthy relationship for 7 years (still ongoing). During these 10 years, the worst things that happened to me were a best friend's suicide and 3 recurrences of migraine that lasted for some weeks each time. But they went away and then were gone. Once, it was after coming back from Ireland where I'd been jetlagged and on a totally different schedule (I didn't feel great there but I knew I'd be fine once we'd returned home and I could sleep better), another time when I stayed up through a whole day without much sleep (this was the shortest one), and the worst were after my best friend committed suicide. I experienced the grief head on, I knew I had to grieve then and after a month and a half, I must have been exhausted emotionally cause that's when they came. These were the most puzzling and difficult to get rid of cause when I got back from Ireland, I found from experimenting that a slight amount (1 mg) of Lexapro somehow eased the pain and let me wade into sleep after which it'd be gone. For a little bit, I'd take a slight amount of Lexapro a little bit after waking up and it would stave off the migraine until finally they were just gone.

After my friend died, that wasn't helping but one morning, I took a slight slight amount of Topamax I still had and it just made this sense of total calm where all the pain was. Just like that, the migraine was gone and the entire migraine phase ended.

About 6 months after my friend passed away, I was driving somewhere and realized I wasn't just going through the motions of living, I was actually enjoying being alive and looking forward to the day. I had another relatively good three years. So in total, despite some obstacles and tragedies with migraine and a friend's suicide, I never fell into the abyss or endless pit. I had a fundamental sense that life was okay and that I'd just been serotonin deficient which Lexapro had addressed pretty well.

Until last August.

I finally got around to working on some music projects I'd had on the backburner and the energy as well as physical exertion made me feel so alive and excited. I also noticed I was off of the internet for quite a while and able to think clearly without the constant stimulations & distractions we all know so well. I recorded vigorously and with excitement for about a week while needing less sleep, accidentally doubled my dose of Lexapro (by overestimating how much I'd slept one night), lost track of time, and when I knew I should go lay down, I instead pushed myself to work more and afterwards could not sleep. I had some awful feelings and then was insomniac for 36 hours or so when I went to my parents' place and tried to lay down. I went to my sister's room and started meditating, praying, and crying. I cried out for divine help cause I had nowhere else to turn to. After that, something happened. I think I fell asleep while awake or something because there was this sudden feeling of calm and an overwhelming presence of a higher power or God (I say this as someone who'd been agnostic for quite a while, but with a tendency to believe there was -something-). All of the thoughts in my head were extremely positive. They were like "you should speak less and listen more / worry less about yourself and think of what you can do to help others." I started to see myself as just on one point on a timeline of my whole life and imagined or dreamed there were higher powers watching, and something like a peanut gallery audience where a couple of older folks were giggling that it's so typical of me to get so worked up over things but that I'll be okay. I fiercely wanted to sleep so that I could continue working on my projects and start doing things to become a better person.

After this happened though, I left the room and realized something was not right. I'd had an experience after very little sleep that was either religious inspiration or a dreamlike experience that typifies mental illness. Either way, it was VERY convincing in the first person this sense and knowledge that we're not alone, and perhaps we do "go" to a higher plane when we sleep that is in ways connected to a greater beyond or afterlife. But I knew I needed rest and couldn't get it, so I went to the ER where they gave me Ativan which I'd only taken twice in my life before an exam cause it was the only thing that ever made me sleep (OTC and prescription pills generally do not work on me). I was a mess in the ER. One second I'd feel alright and then it would be a total crash, I even said "I'm rapid cycling" which might not be the proper use for the term cause I was back and forth in a course of seconds. This is embarrassing but I was so exhausted and out of it that when they told me to pee in a cup and get a glass of water, I drank the urine cup thinking it had been my water. I had Ativan at the hospital, went home calm, fell fast asleep.

The next day I was anxious in the afternoon and wanted to make sure I had Ativan that following night and an emergency appointment with my PDoc the next Monday. Prior to this I was only referred there for adjustment disorder dealing with chronic migraines.

They said I'd had a hypomanic episode, so they lowered my 10 mg of Lexapro to 5 mg and added Abilify, with Ativan to sleep at night.

I gradually calmed down, was able to rest, and was so much better after some sleep, still keeping to the resolutions I had to accomplish things I'd procrastinated, reach out more to friends, and be a more active listener. I stopped taking the Ativan after only 2 weeks and it was ok. Things were great for 2 months, they moved me up to 7.5 mg of Lexapro cause my goal was to reestablish the relative health/normalcy I'd had on just 10 years of Lexapro. But I noticed I gained 13 pounds in 2 months and knew from seeing my sister gain 80 pounds in a few months in 2005 (most but not all of which she's finally lost just now), that this likely could quickly spiral out of control. So I cut the Abilify in half the next day or two and then stopped. My dose was pretty low to begin with. But a few days afterwards, I had some odd depressed feelings. I chalked it up to the reputed Abilify "withdrawal." For 2 months I had occasional crying spells but also some alternating long periods of normalcy. Things felt off again in mid November so at my appointment, we decided to try Rexulti along with Lexapro going back down to 5 mg. The first week was tough and I assumed that was just due to the lowering of Lexapro but Weeks 2 and 3 were pretty good.

I had a tooth extraction though that went fine but the painkillers I took afterwards had some withdrawal and messed my stomach up, so I took magnesium citrate which made me really anxious so I took an Ativan and then I had to sleep for another obligation in the morning, so I took Temazepam (Restoril), my prescribed sleeping pill that I'd only taken a couple of times in the decade and I always knew it made me feel a bit elevated the next day, had some stomach issues, and then had some rebound insomnia and mood issues for about 4-6 days before total normalcy returned. During this time, my sleep schedule was flipped upside down. I would take my Lexapro and Rexulti at 2 AM as normal (I'd been taking it around then and falling asleep at 4 or 5, waking at 2-4 PM and being great for most of my day) but couldn't fall asleep and went through total hell in the night. The Rexulti in this circumstance became 100% intolerable. While previously, it would make me go into a somewhat eerie twilight zone that turned dreamlike and gave me good solid 8-9 hours of refreshing sleep, when I couldn't sleep on it, it filled my head with terrible thoughts of life's pointlessness coupled with a restless energy to just "do things" even though they brought no joy and had no purpose. And Lexapro is kind of an intensifier so it was awful. I called the doc and they said to try splitting them (meaning one at one time of the day, another at another) but the Rexulti was still intolerable, bringing back the worst of the worst feelings I'd ever had and vivid memories of being in bad moments while severely depressed, many of which I'd totally forgotten. The doc said to try taking half but if it couldn't be tolerated, I could stop it since I was on a low dose and hadn't been taking it long. I did half for two days, then none, then tried half once more and the experience was the same --- absolutely horrible after taking it and gradually feeling better with every hour past taking it. It was something I just wanted to get away from.

So I was on just 5 mg of Lexapro for 2 weeks and taking either an Ativan or half an Ativan to sleep. This is very low since 5 mg isn't even a therapeutic dose for depression and I'd been on 10 for 10 years, so it felt like it did while I was coming off of Nortriptyline. Going back up didn't seem to help that much because if I didn't fall asleep, it felt really bad for a few hours, though it would improve afterwards.

I started Lamictal last week, very low (I think 20 mg?) for two weeks, and then they'll titrate upwards. Still on 5 mg Lexapro. Falling asleep around 12:30 or 1:30 AM and waking around 8:30 to 9:30 which is very early for me.

And what I experience is that the first half of the day has an illogical dread, an anxiety, an unreality to it while in the second half of the day I feel more normal and like myself. It feels biological. I'm used to coming alive around 3-4 PM and when my sleep schedule was such that I'd away at 3-4 PM, the day seemed to flow near perfectly.

I have no idea how bipolar I am or what to do about it. There are some similarities but some differences also. I have the family history, migraine, and the key personality traits, ebullience, high creativity, sensitivity, inspiration, empathy. But aside from the insomnia episode I had this summer (which may not have happened if I had simply gotten more sleep instead of pushing myself too far), I had no episodes for 10 years on an SSRI, which are usually supposed to aggravate bipolar. And the during the depressions I've had, I've always been able to go through the motions of functioning. I always shower and never had a time where I was in bed for 3-4 days aside from the flu & chicken pox. Fortunately, no hallucinations, delusions, paranoia, or persecutory fears.

And my elevated modes are ordinarily something I go through almost every day at the right times (evening, night). If my sleep matches my cycle well, I'll be in a good to moderate mood almost all day. I'll have inspiration and excitement when I have coffee, which is sort of exactly what caffeine does to everybody. I'll also have my mind off of myself and focused on whatever show we're watching, the news, a game, music, and so forth. Having one's self under the microscope while going through med changes is really excruciating.

So I find myself wondering whether caffeine addiction, migraine cycles, and a delayed sleep onset cycle can either explain or masquerade as symptoms of bipolar disorder. And if so, how to treat them to have as fulfilling a life as possible.

I wonder if taking half an Ativan at night could lead to a malaise in the early part of the day. Cause until the past few months I don't remember having random attacks of anxiety.

I keep thinking if I just had a bit more Lexapro built up in me and was back on my more late sleep schedule, that things would fall into place as they did for ten years but I dunno. Week 1 on Lamictal hasn't been much different than the 2 weeks before it. I'm still irrationally creeped out, miserable, tentative, vacant, anxious and unhappy in the morning and then as the day goes on I feel normal and alive. Not bouncing off the walls just good and like things are okay.

So I wanted to share my story and where I'm at in my journey. Maybe it will connect with someone else out there who has a similar day/night cycle thing going on and traits of bipolar disorder that generally do not manifest into episodes.

I'm having a very tough time looking at all the positive things I've felt, experienced, and accomplished and attributing them to pathology. That really hurts, you know? People like my optimism, enthusiasm, and zest for things I'm passionate about and that's important to me. It's such a blow to think of these traits as the upside of a package that ill, freakish, and wrong. How can that possibly be the case? :-(

I'm also scared of changes and treatment for bipolar and how they interact with migraine. Generally, they help but how it will all come together is confusing without knowing what it will feel like over time. I was never put on Lexapro for depression but only for migraine.

I'm scared of the long term. It bothers me deeply to think of kindling, of things getting worse over time (whereas with migraine they often improve with age), and to think of how high the suicide rate is. My best friend was diagnosed with bipolar disorder a few months before she took her own life. I feel an empathy for the sort of zones and places of hopelessness she must have been in cause I've experienced them without self-harm. I've had the thoughts of "oh it will all be easier cause one day I'll die and then it'll all stop hurting and be calm" but never a passive or active plan to commit suicide.

I hate to hear of sufferers overdosing or taking their own lives. The highly gifted creative types, George Michael, Whitney Houston, Michael Jackson, and so forth. I'm inspired by people like Stevie Nicks, Tori Amos, and Kate Bush who show very positive healthy futures for gifted persons.

And finally I wonder if a mood stabilizer isn't really impacting the fact that I have dread/unreality in the mornings that gradually turns into normal, healthy and alive feelings as the day goes on and I get more food in me, perhaps something else sleep or biologically/migraine related is going on here than bipolar disorder.

That's all for now. Thank you for reading.