Irritable Kind of Mania
November 28, 2014 12:09 PM Subscribe
I've posted plenty here about mental health stuff this year, and now I'm posting because I'm about two weeks into a manic episode which is the really irritable mania, not the euphoric kind. I have only been being treated for bipolar II starting this year, and it's possible my mania is actually a trauma response. I am hoping someone here can help me make do with the mania while it lasts, if not help me figure out how to get it to end early without totally crashing.
My current meds are lithium (1500 mg a day), Zoloft (150 mg a day), trazodone (100-200 mg a day) and now depakote (500 mg a day), which I just started a few days ago in the hopes it'd help my anger and anxiety. Also, I am aware that SSRI's can cause mania; I started the Zoloft in February after the lithium alone made me functional but totally anhedonic.
My manic symptoms started nearly 2 weeks ago, sometimes breaking for depression, which probably makes this a mixed episode. I am very irritable ,impatient and easily distracted. I just feel done with sleep after a few hours. (The lack of proper sleep part is troubling right now because I'm also dealing with some sort of chronic respiratory problem which hasn't yet been diagnosed. That sickness is making me exhausted, but the mania doesn't agree.) I am doing a pretty good job of impulse control, but I notice I've been spending money and not remembering how. Not a lot of money, just more than I'd like to spend.)
There is definitely some overlap with trauma symptoms, especially an exaggerated startle response and hypervigilance, two things which make sleep even more complicated. I kept thinking someone was coming into my room last night and woke up at every sound my cat made.
I posted earlier about the difficulties with the local mental health center where I see my psychiatrist. I left a message for her yesterday but haven't heard back anything. I suspect I will have to go to Urgent Care at my primary care clinic to discuss an atypical antipsychotic or other med. I will also email my therapist today (I see her again Monday). I have been doing a good job of impulse control so far and have abstained from sex, drugs, booze, etc.
I have not had much experience with hypomania/mania, and when I've experienced it this year, it mostly manifested in the form of heightened creativity, which was much more pleasant.Then, it was easy to fill my manic time because I could just make art for hours and hours or write a thousand poems. Right now my brain doesn't seem as wieldy with the kind of thinking and problem-solving that usually go into making art. Hard to explain, but I just don't feel like I can access the critical stuff that goes with the creative side.
Anyway, so one big thing I am asking is what activities are good when you are irritably manic and can't really concentrate but don't want to do anything self-destructive?
Right now I've mostly been binge-watching tv shows. I know some people clean, but I don't think I'd ever be manic enough for that. I'm not getting a lot of pleasure from things either, so a lot of things are not as fun as usual. Being physically sick with lung problems means it's harder to do anything physical; and it hurts to breathe cold air so I'm trying to minimize time I spend out of doors.
Thank you for reading this; I likely missed some things here and will be happy to answer questions.
My current meds are lithium (1500 mg a day), Zoloft (150 mg a day), trazodone (100-200 mg a day) and now depakote (500 mg a day), which I just started a few days ago in the hopes it'd help my anger and anxiety. Also, I am aware that SSRI's can cause mania; I started the Zoloft in February after the lithium alone made me functional but totally anhedonic.
My manic symptoms started nearly 2 weeks ago, sometimes breaking for depression, which probably makes this a mixed episode. I am very irritable ,impatient and easily distracted. I just feel done with sleep after a few hours. (The lack of proper sleep part is troubling right now because I'm also dealing with some sort of chronic respiratory problem which hasn't yet been diagnosed. That sickness is making me exhausted, but the mania doesn't agree.) I am doing a pretty good job of impulse control, but I notice I've been spending money and not remembering how. Not a lot of money, just more than I'd like to spend.)
There is definitely some overlap with trauma symptoms, especially an exaggerated startle response and hypervigilance, two things which make sleep even more complicated. I kept thinking someone was coming into my room last night and woke up at every sound my cat made.
I posted earlier about the difficulties with the local mental health center where I see my psychiatrist. I left a message for her yesterday but haven't heard back anything. I suspect I will have to go to Urgent Care at my primary care clinic to discuss an atypical antipsychotic or other med. I will also email my therapist today (I see her again Monday). I have been doing a good job of impulse control so far and have abstained from sex, drugs, booze, etc.
I have not had much experience with hypomania/mania, and when I've experienced it this year, it mostly manifested in the form of heightened creativity, which was much more pleasant.Then, it was easy to fill my manic time because I could just make art for hours and hours or write a thousand poems. Right now my brain doesn't seem as wieldy with the kind of thinking and problem-solving that usually go into making art. Hard to explain, but I just don't feel like I can access the critical stuff that goes with the creative side.
Anyway, so one big thing I am asking is what activities are good when you are irritably manic and can't really concentrate but don't want to do anything self-destructive?
Right now I've mostly been binge-watching tv shows. I know some people clean, but I don't think I'd ever be manic enough for that. I'm not getting a lot of pleasure from things either, so a lot of things are not as fun as usual. Being physically sick with lung problems means it's harder to do anything physical; and it hurts to breathe cold air so I'm trying to minimize time I spend out of doors.
Thank you for reading this; I likely missed some things here and will be happy to answer questions.
My dad's bipolar often manifests with the irritable type of mania and he handles it by going for long runs, a lot. He gets super fit during his irritable cycles, which I guess is a bonus.
I realise the physical illness you say you are dealing with might make cardio impossible, but perhaps there is still some sort of exercise you can do, like maybe weightlifting or something? (Actually my dad took up weightlifting when he was having an episode a couple of years ago because his ankle wasn't up for running right then. He must have found it helpful because he kept on with it, and just won some local title for over 60s!)
posted by lollusc at 2:13 PM on November 28, 2014 [1 favorite]
I realise the physical illness you say you are dealing with might make cardio impossible, but perhaps there is still some sort of exercise you can do, like maybe weightlifting or something? (Actually my dad took up weightlifting when he was having an episode a couple of years ago because his ankle wasn't up for running right then. He must have found it helpful because he kept on with it, and just won some local title for over 60s!)
posted by lollusc at 2:13 PM on November 28, 2014 [1 favorite]
Been there, so sorry. I use emergency benzos to get sleep -- not sleeping, as I'm sure you know, helps to keep the mania churning. Melatonin also helps me nightly.
I found really picky artwork to be helpful: get a grocery sack full of bolts and a pie plate of sand to make alien landscapes. I do seed bead jewelry -- hundreds of tiny glass beads to sort through. Once I purposefully mixed up beads and then separated them again, cursing a blue streak the whole time. You can find them at the thrift store, loose or as hideous jewelry to be reworked.
Research can be gratifying, tho' better IRL than down the net rabbit hole, where spending is too easy. I like typefaces; I research who made the typeface, where it was used, who designed that book, where did they learn design, etc.
Congrats on keeping the lid on sex, money, drugs -- it's not easy!
posted by Jesse the K at 3:05 PM on November 28, 2014 [5 favorites]
I found really picky artwork to be helpful: get a grocery sack full of bolts and a pie plate of sand to make alien landscapes. I do seed bead jewelry -- hundreds of tiny glass beads to sort through. Once I purposefully mixed up beads and then separated them again, cursing a blue streak the whole time. You can find them at the thrift store, loose or as hideous jewelry to be reworked.
Research can be gratifying, tho' better IRL than down the net rabbit hole, where spending is too easy. I like typefaces; I research who made the typeface, where it was used, who designed that book, where did they learn design, etc.
Congrats on keeping the lid on sex, money, drugs -- it's not easy!
posted by Jesse the K at 3:05 PM on November 28, 2014 [5 favorites]
I suffer from bipolar II, as well.
Would a puzzle book (crosswords, word searches, etc) require too much focus? As long as the crosswords aren't too difficult, then it would just be frustrating.
I have Tetris on my phone and that game sucks me in and relaxes me. I don't know why, but I find it mesmerizing. Maybe play simple games like that?
Talk to friends. Not about how you're feeling, just things that you both enjoy. I find my friends can help ground me when I'm feeling very anxious or depressed.
I also love to put on some head phones, listen to music and read the lyrics online. Really absorb the song and its meaning. Songmeanings.com or Rapgenius can be fun.
posted by blackzinfandel at 6:48 PM on November 28, 2014 [2 favorites]
Would a puzzle book (crosswords, word searches, etc) require too much focus? As long as the crosswords aren't too difficult, then it would just be frustrating.
I have Tetris on my phone and that game sucks me in and relaxes me. I don't know why, but I find it mesmerizing. Maybe play simple games like that?
Talk to friends. Not about how you're feeling, just things that you both enjoy. I find my friends can help ground me when I'm feeling very anxious or depressed.
I also love to put on some head phones, listen to music and read the lyrics online. Really absorb the song and its meaning. Songmeanings.com or Rapgenius can be fun.
posted by blackzinfandel at 6:48 PM on November 28, 2014 [2 favorites]
Best answer: First of all, congratulations on holding it together and for the insight and impulse control you have been able to muster. That is very hard, especially when you are experiencing symptoms in a way you are not familiar with.
As far as sleeping goes, I would recommend trying ear plugs and a sleep mask and dedicated sleeping clothes (it is so easy to just wear the same clothes all the time, I am being hypocritical here a bit but this is advice I have been given) and try to make your bed when you are finished sleeping (I would say in the morning but sleep is going to happen when it is going to happen) so that you have a made bed to get into when you are ready to sleep. All of these are both ritualistic and will signal sleep to your brain. You are on a totally different cocktail of drugs than I am, but I think you would be safe taking a couple of benadryl before doing the bedtime ritual.
Sorting. Do you have a jar of coins? A collection of anything that you can move around? You said you usually make art but are not inclined; how about organizing your art supplies? Even kitchen items work. Take the stuff out of a drawer, put it in a box and take it somewhere comfy, look at it, get rid of a few things, put it back. Sort your socks, refold your shirts, take things out of your closet and put them back. Look at your books, CDs, DVDs, whatever, and move them around. Maybe have a box for stuff you do not want anymore, but do not get rid of it until you are well and look through it again.
Your brain wants order, it is rapid firing so fast that you cannot even make memories (well, you can but you will not be accessing them now, they will come back in flashbacks later). Force order on it. This is NOT cleaning. This is taking five items out of your closet, making them hang perfectly on the hanger, and putting them back. Or putting all the quarters in one jar and all the dimes in another. Etc.
None of this is fun. Think of it as sorting therapy, keeping your brain busy so it stays as stable as it can. It shouldn't be work or hard to do with respect to your medical conditions. It should just be busy but odd stuff to keep your brain busy until the neurochemicals stop firing.
Good luck with your efforts and your appointments. I hope you get good advice from your healthcare team.
Be well. I will be thinking of you.
posted by danabanana at 6:53 PM on November 28, 2014 [6 favorites]
As far as sleeping goes, I would recommend trying ear plugs and a sleep mask and dedicated sleeping clothes (it is so easy to just wear the same clothes all the time, I am being hypocritical here a bit but this is advice I have been given) and try to make your bed when you are finished sleeping (I would say in the morning but sleep is going to happen when it is going to happen) so that you have a made bed to get into when you are ready to sleep. All of these are both ritualistic and will signal sleep to your brain. You are on a totally different cocktail of drugs than I am, but I think you would be safe taking a couple of benadryl before doing the bedtime ritual.
Sorting. Do you have a jar of coins? A collection of anything that you can move around? You said you usually make art but are not inclined; how about organizing your art supplies? Even kitchen items work. Take the stuff out of a drawer, put it in a box and take it somewhere comfy, look at it, get rid of a few things, put it back. Sort your socks, refold your shirts, take things out of your closet and put them back. Look at your books, CDs, DVDs, whatever, and move them around. Maybe have a box for stuff you do not want anymore, but do not get rid of it until you are well and look through it again.
Your brain wants order, it is rapid firing so fast that you cannot even make memories (well, you can but you will not be accessing them now, they will come back in flashbacks later). Force order on it. This is NOT cleaning. This is taking five items out of your closet, making them hang perfectly on the hanger, and putting them back. Or putting all the quarters in one jar and all the dimes in another. Etc.
None of this is fun. Think of it as sorting therapy, keeping your brain busy so it stays as stable as it can. It shouldn't be work or hard to do with respect to your medical conditions. It should just be busy but odd stuff to keep your brain busy until the neurochemicals stop firing.
Good luck with your efforts and your appointments. I hope you get good advice from your healthcare team.
Be well. I will be thinking of you.
posted by danabanana at 6:53 PM on November 28, 2014 [6 favorites]
I shall save us all (including, most importantly, myself) two hours' worth of typing-and-compulsively-editing background information; suffice it to say that I'm in a very similar state at the moment. Very similar indeed – although my exaggerated startle response and hypervigilance are more of a general anxiety thing and have thankfully settled a bit since Thursday when just UGH and also my aversion to exercise is more habitual than circumstantial but whatever.
TV shows, as you say - I'm currently binge-watching Castle, which can be wonderfully distracting for as much as three-and-a-half episodes swallowed whole until it pisses me off and I switch to a small but useful task that I'd rather avoid, thus inevitably returning me to Castle's warm embrace upon its completion. I know I'm likely to reach calmer waters by Monday, so I'm okay with this for now. And, as you so delicately avoid saying, cleaning is absolutely the worst.
I do have one little trick, though: if you enjoy low-to-medium proficiency in a language, and if you're happy hovering around that level without getting all caught up in sudden self-improvement, try watching plain-language shows (from a service you already pay for or are willing to steal) or listening to music (ditto) performed in your semi-competence of choice.
When nothing else quite fits, I find my truly miserable German offers a soothing combination of creating structure (from what I do understand), providing puzzles (what I don't understand, but can deduce from context) and distracting me with actual narrative plus a bit of confusion all at the same time. IMPORTANT TIP: don't look up missed vocab mid-song or mid-episode; hang onto a couple of key words and check them at the end. I generally set myself a hard limit of 3. Breaking between episodes/songs/albums/whatever for vocab keeps things moving forward with predictable boundaries; if you're watching a show, it provides an almost effortless check against any episode-after-episode-after-episode compulsions that might otherwise surface.
I totally suck at sleep and sleep routines at the best of times so, uh, I'll stop typing now I guess.
Best of luck. Honestly, it sounds like you're handling things pretty well. Keep doing that!
posted by not the fingers, not the fingers at 9:42 PM on November 28, 2014 [1 favorite]
TV shows, as you say - I'm currently binge-watching Castle, which can be wonderfully distracting for as much as three-and-a-half episodes swallowed whole until it pisses me off and I switch to a small but useful task that I'd rather avoid, thus inevitably returning me to Castle's warm embrace upon its completion. I know I'm likely to reach calmer waters by Monday, so I'm okay with this for now. And, as you so delicately avoid saying, cleaning is absolutely the worst.
I do have one little trick, though: if you enjoy low-to-medium proficiency in a language, and if you're happy hovering around that level without getting all caught up in sudden self-improvement, try watching plain-language shows (from a service you already pay for or are willing to steal) or listening to music (ditto) performed in your semi-competence of choice.
When nothing else quite fits, I find my truly miserable German offers a soothing combination of creating structure (from what I do understand), providing puzzles (what I don't understand, but can deduce from context) and distracting me with actual narrative plus a bit of confusion all at the same time. IMPORTANT TIP: don't look up missed vocab mid-song or mid-episode; hang onto a couple of key words and check them at the end. I generally set myself a hard limit of 3. Breaking between episodes/songs/albums/whatever for vocab keeps things moving forward with predictable boundaries; if you're watching a show, it provides an almost effortless check against any episode-after-episode-after-episode compulsions that might otherwise surface.
I totally suck at sleep and sleep routines at the best of times so, uh, I'll stop typing now I guess.
Best of luck. Honestly, it sounds like you're handling things pretty well. Keep doing that!
posted by not the fingers, not the fingers at 9:42 PM on November 28, 2014 [1 favorite]
Best answer: People ask why I'm flying this time of year, why am I veering this way and that, careening about, careering about, banging into walls, my life like driving a bumper car, or sometimes more like those demolition derby races they used to have at intermission at stock car races, just smashing the fuck out of everything until the car doesn't move anymore, a big pile of dents leaking fluids, pouring smoke, maybe aflame.
I try to explain, hey, I didn't set this thing up, it is what it is; I didn't choose it but the fact is that autumn and through mid-winter the most dangerous time of year for me. I careen throughout the year but this time of year -- red flags.
And just like you, too -- Mixed States. Mixed States sounds so friendly, like maybe North and South Dakota doing a quilting bee, or raising a barn together; or maybe north California and southern Oregon getting together, working out a friendly initiative on litter clean-up or some such. Doesn't that just sound swell?
But mixed states, it's not swell at all -- it's a fucker. Hmmmm, let's see -- supposing I take the mood (black) and the thoughts (negative, hopeless) of depression, supposing I take that and then power it with high-voltage mania -- sweet. I'm sure happy now! Oh boy! It's swell!
Fuck.
So what do I do when it's clawing on me?
Sleep. Numero uno -- sleep. I take all kinds of shit every night anyways, for sleep, and mostly it works but this time of year, not so much. When flying manic, whether gritty mania or fun, festive mania, sleep is imperative, and I've got a hat-full of shit over here to shove into my mouth until sleep falls upon me. Cuz if I don't sleep, it just cranks everything up higher, and then higher
I keep close to people who know me, and I keep the cards face up on the table with my shrink, my therapist (if I'm in therapy), my friends (the ones I trust not to get flipped out about this -- some people get all antsy, or, worse, they try to fix it, when the only sensible thing for those who don't get this is buzz off, go be with regular people till I get back.) So I tell anyone who needs to know, anyone who I trust to tell me what they see w/r/t this stuff. Take whatever meds you need to knock you down for at least some rest, some restoration -- it's just imperative you get enough
Good luck.
posted by dancestoblue at 1:45 AM on November 29, 2014 [4 favorites]
I try to explain, hey, I didn't set this thing up, it is what it is; I didn't choose it but the fact is that autumn and through mid-winter the most dangerous time of year for me. I careen throughout the year but this time of year -- red flags.
And just like you, too -- Mixed States. Mixed States sounds so friendly, like maybe North and South Dakota doing a quilting bee, or raising a barn together; or maybe north California and southern Oregon getting together, working out a friendly initiative on litter clean-up or some such. Doesn't that just sound swell?
But mixed states, it's not swell at all -- it's a fucker. Hmmmm, let's see -- supposing I take the mood (black) and the thoughts (negative, hopeless) of depression, supposing I take that and then power it with high-voltage mania -- sweet. I'm sure happy now! Oh boy! It's swell!
Fuck.
So what do I do when it's clawing on me?
Sleep. Numero uno -- sleep. I take all kinds of shit every night anyways, for sleep, and mostly it works but this time of year, not so much. When flying manic, whether gritty mania or fun, festive mania, sleep is imperative, and I've got a hat-full of shit over here to shove into my mouth until sleep falls upon me. Cuz if I don't sleep, it just cranks everything up higher, and then higher
I keep close to people who know me, and I keep the cards face up on the table with my shrink, my therapist (if I'm in therapy), my friends (the ones I trust not to get flipped out about this -- some people get all antsy, or, worse, they try to fix it, when the only sensible thing for those who don't get this is buzz off, go be with regular people till I get back.) So I tell anyone who needs to know, anyone who I trust to tell me what they see w/r/t this stuff. Take whatever meds you need to knock you down for at least some rest, some restoration -- it's just imperative you get enough
Good luck.
posted by dancestoblue at 1:45 AM on November 29, 2014 [4 favorites]
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Goes well with tea and possibly radio.
posted by feral_goldfish at 1:09 PM on November 28, 2014 [2 favorites]