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Wednesday, March 10, 2010 John asks

Q: Maybe I am bipolar... I'm not sure?

I'm having a good day today. Elated, an almost Zen-like quality about everything I have done. When I'm on, I'm really on. Joking, making people laugh, focusing intensely on the things people say, really connecting with them, etc. The world practically glows, and I feel so much warmth for people, even total strangers.

Days like this are somewhat rare, but enjoyable.

 

The rest of the time, I feel horrible. So unmotivated, I miss classes which I normally really enjoy. I think about killing myself. I don't shower for days. I can't make myself care about anything. I fixate on ideas (often) like cheating on my wife or figuring out how to get some hydrocodone (it makes me feel sooo incredible; euphoric, but functional).

 

A seemingly harmless comment, even one made by a friend, can shatter my overinflated mood and reduce me to steaming rubble. I once quit a great graphic design job right in the middle of the day, right after I found myself cutting my arms with an x-acto knife, and having told my (female) boss that I had feelings for her (we were both married, yet I was convinced there was "something between us") It was a miracle I didn't kill myself that day, sitting in the back of my car out in the woods with a razorblade and all of that having just happened. In hindsight, I couldn't believe myself capable of thinking this way or simply walking out. I had walked out on another great job of 3 years before this happened, very suddenly, no notice, because of a relatively minor remark. Most of the time, I just feel like shit, though. No self esteem, self-destructive. I'll never be able to quit smoking. I am less than a year away from finishing my degree in Biotechnology, and some days, despite riding an A-B average and being fascinated by this field, I get the urge to just withdraw from school. Sometimes I get so irritable, pissy, and lash out at those around me, even though I can't really figure out what I'm pissed about. I almost gave it all up a few months ago to become a Fransiscan monk (of all things).

 

This erratic behavior has been going on for years. I have 170+ college hours, mostly in science, but no degree because I change majors so often. My poor wife has been living with it for 12 years now. I can't tell one day to the next how it's going to be. Nothing is stable. I get by by maintaining a mindset that it could all just wash away at any moment... my life, my house, my marriage, my career. I usually have to keep myself distracted with escapes, mainly in computer games, sometimes reading, sometimes the occult.

 

To my benefit, I seem to be very gifted, especially in languages, math and science, as well as having high creativity (formerly an artist/graphic designer). I can get a B or an A in a tough science class without studying, which has actually done me more harm than good, as I never learned good study habits. I was lucky enough to serve as a crypto-linguist in the military (another of my many previous "careers"). I'm reasonably sure my IQ is in the 135-140+ range (not really sure). Despite all of this, I am still a terribly unstable person.

Some days I would sacrifice anything of myself for anyone else who needed it. Other days, I feel like I could perpetuate genocide. I have prayed for death on numerous occasions. I feel like I am an affliction to my family, my friends, the world at large. I have researched a quick, painless method to end it all, but luckily haven't gone that far (not recently at least).

 

I have been on a battery of antidepressants, with marginal success. I am on Effexor now, and have had as much as 350mg/day, but am now on 150mg/day. When I don't take it, I really really feel like shit. But even on it, regularly, I exhibit all the behavior I described above, including suicidal thoughts and the highs and lows.

 

So is there anything wrong with me, or am I being a whiny, poorly-adjusted hypochondriac?

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Answers (1)
Jerry Kennard, Health Guide
3/16/10 9:45am

Hi John

 

It certainly sounds like you have a number of conflicting emotions. Your mood sounds relatively labile but whether this is bipolar is a moot point. You clearly do have emotional swings but you aren't alone in this. I suspect you are wondering whether these 'high' emotions are hypomania? Well, they may be but one or two things you say make me wonder. If you spend a great deal of time feeling low, or depressed, it may simply be a relative thing - normality feeling great!

 

At the clinical level you need at least one episode of hypomania or mania to be diagnosed with bipolar disorder. Hypomania involves a persistent mild elevation of mood, alternating with irritability, increased activity and energy, inability to concentrate, flight of ideas, and insomnia; without hallucinations or delusions.

 

You describe a level of connectedness and 'intense focus' that makes me wonder whether you really fit with such a definition. This takes me back to emotional conflict. Given your history and the way your life is being affected I wonder if analytic psychotherapy might help?

 

In summary. A diagnosis of bipolar may be on the cards and it's not for me to rule this in or out. The rule of thumb is to take things a step at a time and that includes first ruling out physical causes such as hyperthyroidism that may mimic some of the symptoms you describe.

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3/16/10 10:46am

Thanks so much for taking the time to provide your insight. In the interim since posting the question I have consulted with my family and we have agreed that I should visit a skilled psychiatrist and get a full work-up. In fact, my appointment is today, so I may post my initial findings afterwards as a response to this. I think everyone I know agrees that there's "something wrong", but exactly what, who can say?

 

I know for a fact that I'm depressed, so often it's the norm. Lack of purpose in life, lack of a zeal for living, mood swings, yes, but perhaps not to the degree of mania, per se. Frequent suicide ideation, withdrawal, low energy, constant need for escapes (such as video games, drugs, etc.) and inability to cope with day-to-day stress and less-than-ideal social circumstances. I also have a pattern of obsessing about one concept or another... which shifts somewhat cyclically (sp?).

 

Anyway, enough babbling. Again, I thank you for your time and wisdom. I hope this doctor visit can get me going in the right direction for once.

Reply
3/16/10 3:28pm

After visiting the psychiatrist's office (they were very nice), I have been diagnosed with some type of bipolar disorder and possibly schizoid personality disorder. I am starting Trileptal today and Abilify in about a week, after I get some blood work done.

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By John— Last Modified: 12/24/10, First Published: 03/10/10