The manic episode I wrote about last week turned into a mixed-episode on Saturday.
I actually slept well the night before, but when I woke up I felt jumpy and agitated. Everything about everybody seemed to get on my nerves, and coffee, which oddly often calms me down, only made things worse.
Walking the dogs helped a little, and I left a bubbling anger on the doorstep when I returned. A panic at what the day might bring passed, and my wife, daughter and I left the city for a farm to pick apples.
To be outside on a brilliant fall day is curative, and I sat on a bench and gazed at the billowing clouds painted onto a royal blue sky as the others foraged for gourds. We had lunch with my in-laws, and it seemed the mixed-state, in fact the entire episode, had passed.
When we got home we sat on the patio and played school – our daughter taught us the properties of multiplication. We shared a moment of laughter that is all too rare in the press of passing days.
Then the agitated mess came roaring back and punched me like a heavyweight.
I told my wife what was happening so she’d know why I had to disappear. In that state I can be brutal on those closest to me, furious without provocation, so I removed myself to a bedroom and shut the door.
I crawled under the covers; I got up and meditated; I paced around and punched a pillow. Like a beast caged I didn’t dare open the door. When I touch on depression coupled with mania violence is a possibility. No one deserves what I might dish out.
Suicide crossed my mind. I crossed it out.
I collapsed onto the bed and slept for about an hour. Enough of the uneasiness slipped away that I could come down for dinner, although I didn’t eat a thing. Then I collapsed again.
I woke about 10:30p as my wife was going to bed. Of course, I didn’t sleep at all the rest of the night.
Sunday was better. I planted a couple of trees and swept the walk clean, watered all the plants, and by dinner I was fine. Evening saw the return of uncomfortable agitation, and I had to withdraw again. But it didn’t last long. The night served up was great.
I rapid cycle. Monday started off well enough. It seemed I fell back to a state of hypomania. Today is not bad. I’m burning with much more energy than I usually have, and I’m a tad grandiose, but my mood is level. Who knows if this episode is over or if bipolar disorder has more to dish out?
Mixed states are characterized by the appearance of depressive symptoms and suicidal ideation simultaneous with the racing thoughts and elevated mood common in mania. Speech is often pressured, and psycho-social functioning is severely limited.
40% of people with Bipolar Disorder 1 experience mixed-sates. The switch from mania to depression (or vice versa) can occur over days or weeks, or can ratchet disruptively over hours or less.
Rates of anxiety and substance abuse are higher in mixed-episode, bipolar patients. Psychotic episodes are not unusual in those who swing suddenly from one pole to the other. Suicide attempts are more common in this group, and people with mixed-states who attempt suicide succeed in killing themselves at a much higher rate than any other mental illness.
I’ve seen the worst of it. This one, so far, has paled in comparison to the mixed-episodes that drove me to attempt suicide.
So far I’m holding on. I continue to meditate, exercise and work. I cling to a routine and skip none of it. My wife is off to work and my daughter is at school, so there are fewer distractions to cling to and I’m left to confront myself, alone.
Years of this have taught me how to cope, but it’s always difficult.
I do cope. I have a lot to do, but it’s not overwhelming. It’s all a matter of exercising the self-discipline that keeps me taking my meds and taking care of myself, and reaching out to others who can lend a hand, or an ear.
The episodes always exit as quickly as they come. I don’t know what brings them on, but I do know there’s a way through them.
That’s where I am today.