How "Stable" Are You Most Of The Time?

So, I have noticved over the past year or so that my illness is different than it used to be. I used to go through fairly defined mood episodes of a few months or whatever. But more recently, I have found myself going through all kinds of much briefer, weirder sort of mini-episodes. A few days of depression, then, better. I had a two-day period of florid mania last month, I mean, florid. Then, gone. Poof!

So, I am just wondering how many other people deal with more day-to-day shifts in mood that they have noticed. Or are you pretty much in whatever mood state you are in for a prolonged period?

Thanks!!!!!!

Short answer in green bold font (4 sentences total only). Longer answer in full in regular black font.

Last week I "dared to say" (that's what I wrote almost verbatim) that I was mildly depressed. Today my husband told me I'm "mildly hypomanic-like". I guess the signs are clear, when I tend to get very loud and repeat things over and over again, and become frustrated with slowness, and start ranting. Check, check, check, and check. Whether or not this will last until tomorrow, or longer, I don't know.

bpyclist, my worst bipolar episodes were at 14-16 years old, 20, 23, 31-38, and some brief really bad ones in my early 40s and one in April through early June 2018. I would say that almost all of the years not mentioned (after 14) I had either stable mood or mild-moderate episodes (short and long-term). Frankly, I believe I was symptomatic a lot of that time. The trouble is, I totally lacked insight into my moods back then. More often than I liked, my elevated moods got me in some mild trouble and/or turned off or actually attracted or thrilled people. Those reactions usually slid off my back like fried eggs on a Teflon pan. Those who were attracted by it were treated to my utter gratitude. It depended on the personalities of the observers. Males seemed a lot more tolerant or impressed than females, though of course there were exceptions both ways.

Since accepting my bipolar diagnosis and learning a lot about my illness, and myself, my insight has improved. These last couple of years, since June 2018, I have had more stable time than not. When I have had symptoms, they have been fairly short-lived and no worse than moderate. Between my husband's urging, my own eventual insight, and my therapist's and psychiatrist's urging, I would medicate away those comparatively minor "blips". Having PRN medication has been priceless for me. I also use various other methods to deescalate moods (laying low, trying to focus on "tamer" projects, etc.) It's likely that these past couple years have been more like those in between years of my youth. I must also admit that being on disability is extremely beneficial for me. I'm pretty darned sure that I would become quite ill quite quickly if I was pushed into a high stress situation without an exit door. My stress tolerance is far lower than it was when I was a younger woman.

I believe I have spent a much higher percentage of my life in elevated mood states than depressive ones. My posts in the polls I posted reflect that at bit. What I didn't include in those threads were likely "blips". That's why I suggested following the DSM-5 when counting episodes (whether you like the DSM or not). Plus, as many in those threads wrote, some episodes in our lives were likely not fully recognized. Or, how in the heck do you count something as an episode (or should you) if your mood is elevated 2 days, fine 7 days, depressed 6 days, and repeat, or some other wild combination?

Unlike you, bpcyclist, I don't believe I've had psychosis outside of bona fide episodes. However, I have had psychosis during "blips" of mood elevation that lasted fewer than the days indicated in DSM-5 criteria for episodes. They were always full blown mania, though.

I did have some strange arse times in between the years I mentioned with musical hallucinations or stuff that some believe could have been seizure activity of the psychic and sensory sorts. The latter was curious, though, because it had never occurred before my most severe bipolar episodes of my 30s. It has also pretty much completely disappeared since I reached a therapeutic dose of Tegretol XR (carbamazepine ER) about 8 years ago. My seizure dx was left not definitive. Part of that is my fault because I refused a 6-day in-hospital EEG suggested by an epileptologist. [I had had other EEGs, CT, PET scan and several MRIs, prior.]

Thanks so very much for this response, BirdDancer. It is really helpful to me to read about the details of your story over the many years. It does give me some reassurance that I am not maybe a huge outlier with some of these shorter, weird, blips or mini-episodes or whatever we should call them. Again, I know I sound like I am always bashing the DSM-V (sorry), but really, my point in all that is just that I just do not feel like it has captured the true heart and essence of what we contend with every day, and I find that disappointing for me and for us.

Oddly enough, as you may recall, I did have a series of tonic clonic seizres in the 1999-2000 time frame. Always wondered what that was all about, vis a vis the development of my bp 1 stuff.

I do agree with what you wrote about the DSM-5, bpcyclist. As I wrote (yesterday?) I agree with my psychiatrist that we don't all fit neatly into any "category" and that we have our own flavors of the disorder, if it's even the same disorder, which the DSM-5 defines mostly for some shape and form of a guide and....insurance codes. $$$$ Which I'm sure you know a lot about!

I'm so sorry to read that you had tonic clonic seizures. They are dangerous and scary. I know about them well, since my mother had them, regularly, most of her life. If I have had seizures, mine would seem to fit into the focal seizure category (psychic or sensory simple partials). I have read that some medications that people with bipolar disorder take can cause tonic clonic seizures, but surely rarely. I even wonder if the trauma some of us experience can bring them on. If I have had the focal partial seizures, I haven't a clue why. All I know is that my carbamazepine ER (Tegretol XR) seems to have stopped them long-term, and is also beneficial, to a degree, for my bipolar disorder.

Once I went to a consulting psychiatrist that also focuses on neurology. She flat out told me that bipolar episodes could very well be unique types of seizures. It's actually quite uncanny the similarities there can be between the two disorders. Way beyond just the common use of anticonvulsants. I could go on and on about them.

When I was younger I had more clearly defined episodes of depression and hypomania. The year I was 48 my disorder changed. Depressive episodes seem to fall away. Hypomania turned to full-on mania. What I call "dysphoric mania" hit me hard...monumental anxiety, irritability/anger/rage. At the same time, euphoric manias were far more common.

In my mid-fifties (I'm 57) mixed states seem to become common for me. But the mixed states are more of a dysphoric mania/mild depression/euphoric mania.

Very fortunately, I am now on medications and in therapy and (for the first time in my entire life) they are keeping me decently stable. Some days are more stable than others, but overall I'm pretty much in the middle. The stability began in, I think, February.

btw, I am convinced that bipolar disorder is some type of seizure activity. I feel that very strongly when I'm hit with an episode.

I am so glad you have not had any more seizures, BD!!! That is fantastic.

I often find myself wondering about the relationship between what we have and seizure disorders and autism and unusual artistic and scientific abilities some people have. I have not said this here before, but it is in my book. Truhtfully, in my opinion, psychiatry, psychology, neurology, and neurosurgery? They are all the same specialty. They just haven't quite realized it yet...

Very glad you are so stable at the moment, Beth. That is fantastic. Why do you think that is happening now for you?

Interesting comment about the seizure disorders...

I have for sure gotten less stable as a result of the shots I’m on and also as a result of the pandemic. I’ll have a few days of depression and irritability, and then a couple days of being ok. And then maybe a day or so of almost feeling like I’m on top of the world.

Before that I was pretty stable. I am very worried about returning to work next for many reasons including the unstable mood swings I’ve been having.

I am certain, bpcyclist, that your book is highly interesting and thought-provoking!

You know, it used to be the case that many psychiatrists were also neurologists. My father-in-law (from modern day Czech Republic) was a common example of this. He was from a very different era. He would be 115 years old now. [He passed away before I came into the picture.] My husband is 13 years older than me, and his father was 54 when he was born. The country was Austria-Hungary when he was in med school. It is a bit of a shame, in various ways, that there is now such a specialization tendency that many doctors can't always see the big picture of things. Though I know that younger psychiatrists offer a special perspective on their cases, I am happy that my long-time psychiatrist is older at 73. He's not also a neurologist, but he has offered me a lot that many younger docs likely do not. Some day I'll obviously have a younger doc, but at least I know now what I know.

It sure would be nice for more research to be done on the relationship between bipolar and seizures. That seems to all be related to money, as well.

I am with you all on the link between the episodes we experience and seizures. I looked into it heavily when researching a possible cause for my experience. My brain was on fire and it felt like I was short circuiting. There was also a popping sensation in my head and pressure near my brainstem in the days before everything went nuts.

When my mother got sick I remember telling my brother I thought her brain might be having a seizure. I had no idea what psychotic mania was at the time. Her doctor told me if we were to scan her brain it would look like someone who suffered from epilepsy.

The agression and psychosis described in this article pretty much sums it up. My onset of symptoms was acute. I went from zero to 100 in a day. I had been researching some very disturbing material for some volunteer work I was involved in and some childhood repressed trauma all came up at the same time. After that I had the weird sensations in my head and then bam. Insanity.

Postictal Psychosis: Common, Dangerous, and Treatable

As for stability, I am stable and have been for quite sometime. After I was brought out of my episode at the hospital I returned to 'normal' and none of the symptoms have returned. That all happened in the fall of 2018. I'm not on any meds at the moment and life is good. I'm processing the trauma of the episode as well as the trauma that came up just before it. That is tough sometimes, but nothing destabilizing.

My therapist thinks my bipolar diagnosis is incorrect. My pdoc agrees. My other pdoc said I had reactive psychosis. Nobody really knows for sure. My therapist also said last week I have OCD tendencies. She said I do not fit the classic mold, but I hyperfocus and she thinks maybe my obsession with my volunteer work set off a chain reaction that led to everything falling apart.

I'm not sure what to think. I do have some OCD like behaviors. I also have some behaviors that come up in Aspergers. I'm a mixed bag and every professional basically tells me I'm atypical.

So.... I'm just doing me. I am striving for holistic balance and I am trying my best to integrate my repressed trauma. I could have freaked out each time it came back up since my episode or ran from it but I think I would end back up in IP. For the sake of myself and my family, I'm facing it. With love.

As long as I take my medication, I am stable. I hope to remain compliant. Each time I get off medication, I have become psychotic. I have been off 7 times and had enough of psychosis and set backs. I am ready to remain stable until I die.

I struggle with this question lately more than ever. I've been really grappling with trying to understand my role in my BP2. I have a long history with it, diagnosed or not. Like bpforever1, my dance revolves around 1 or 2 things related to medication. Am I compliant, and is it working? In the past, compliance has been an issue. As has proper diagnosing/dosing. This past March, it was more related to me sensing that the meds were failing and self-admitting to the hospital.

I'd say with the exception of four to five large incidents and one to three smaller incidents in 43 years, I'm mostly stable. It's hard to self-judge though. I used to be married to someone that could provoke me into an episode quickly, and would enjoy doing so. Abusive much, you think? I would have to lose count to capture those incidents.

I'm at a point where I want to know all the warning signs, avoid the living hell that is me uncontrolled, or be able to minimize the damage to my life that I have been known to do. I'm still paying money out from my last big batch of bad decisions five years ago.

Great post. I have to run so I can’t answer in the depth I would like to.

I’m feeling quite confused and wish I could go back to bed..... and have some good sleep. (not gonna happen)

Thank you. It is fantastic...I honestly never thought I'd be stable. So there is hope for all of us!

The medication combination I'm on is causing me to be stable enough to work on trauma in therapy - which results in increased stability.

It has taken me 49 years and at least 35 meds, in countless combinations, to become as stable as I am at this time. The medications I'm taking now are:
Lamictal (mood stabilizer)
Pristiq (anti-depressant)
Klonopin (anti-anxiety)
Trilafon (perphenazine. Typical (as opposed to atypical) AP. Treats agitated depression/mixed state bipolar, and mania...decreases that horrible bipolar anxiety)

The most successful med I've ever taken is Trilafon. It has given me a life. I had never even heard of it before my pdoc prescribed it some months ago. I don't know why it's not used more often.

For me, especially when rages have happened to me, I have felt like I was having a seizure of some sort. The rage would come on extremely rapidly, felt uncontrollable (without meds, that is), and would last for a short time before it would "burn out." Afterwards I would feel fatigued, like I could sleep for many hours.

Trilafon has been really good for me, too.

Great thread

Every day I say to myself: "I just can't do this anymore." And then, every day, I do.

Good for you Skeezyks, for suiting up and doing it and inspring other people to do the same.

Hugs to all

On clozapine fairly stable and my episodes are shorter and MUCH less severe or frequent. Off clozapine not at all stable.

Antidepressants kept me unstable for years. I'd go off meds and be temporarily better then I'd have an episode, usually mania which I thought was fine but usually resulted in my moving, uprooting my life or at the very least in broken relationships. Then the depression would hit and I'd seek help for that which was antidepressants and then mixed episodes resulting in many hospitals. Finally during one of my off med times I had a very good T who help stabilize me and when I become manic she pointed it out. When I sought a pdoc tho I put lots of restrictions on what meds I'd take and it didn't work. I got very depressed and went to an emergency psych department and told the pdoc everything and he put me on a AP and told me no more antidepressants. I've been stable since. But also I have a very low stress life. Some would say boring but it works.

I have heard so many good things about Clozaril. Very glad it is working for you!

Very happy for you, Nammu. I have had many, many years, decades, really, of incredible struggle to find a med combo that workse for me. In my case, if I am not on an antidepressant, I will definitely die. My depression becomes so all-consuming that it takes control of my life and I become suicidal and make very serious attempts...

Very happy for you.