cyclothymia

Depression is here. It found me sometime last night. It was a busy night: I had therapy, and then my girlfriend and I went to dinner, and then we went to a bar afterward to see a friend of hers perform. Through it all I could feel the depression coming. I felt sluggish, lethargic, and uncaring. I remember thinking, I could be here, or I could be somewhere else. It doesn’t matter–I’ll still feel the same, while watching the band perform. Finally, when my head hit the pillow, there was no more doubt: I was depressed. I felt better in the morning, though. My girlfriend and I watched an episode of Star Trek and made waffles. We talked. We laughed. We joked. But then I left, and went to the library, and it’s back again. It must have been hiding. It wanted me to leave. It wanted me to be alone. And yet, I don’t feel that bad right now. I feel sad but not too sad. I feel tired but not too tired. I feel empty, irritable, and anxious–but not too empty, irritable, or anxious. I can still function, and that’s good, because I’m still behind on school. There’s no time this week to take days off; I can’t binge; I have to push through.

***

Yesterday was a busy day for me, mentally speaking. I had a session with my therapist, as well as my psychiatrist who diagnosed me with cyclothymia after reading over and discussing my blog post with me from September 11th. (Yes, I gave it to him! It’s still hard for me to believe.) Put simply, cyclothymia, or cyclothymic disorder, is a mild form of bipolar disorder, characterized by mood swings ranging from mild or moderate depression to euphoria and hypomania. From the minds at the Mayo Clinic:

With cyclothymia, you experience periods when your mood noticeably fluctuates from your baseline. You may feel on top of the world for a time, followed by a low period when you feel somewhat blue. Between these cyclothymic highs and lows, you may feel stable and fine.

Compared with bipolar disorder, the highs and lows of cyclothymia are less extreme. Still, it’s critical to seek help managing these symptoms because they increase your risk of bipolar disorder. Treatment options for cyclothymia include psychotherapy, medications, and–most important–close, ongoing follow-up with your doctor.

Honestly, it felt good to get the diagnosis. It was a big relief to find out that what I’ve been going through is something tangible, something real, something that other people experience as well. I’m not alone, and I don’t have to continue experiencing it alone. It’s treatable. There’s other options besides the short-term relief from binging. Now, there is some disagreement in the psychological community about whether cyclothymia is a mood disorder or a personality disorder. It seems like most medical professionals treat it as a mood disorder, though. It’s biological in nature. It’s a chemical imbalance. And thus, I should respond to medication.

My psychiatrist prescribed me Lamotrigine (or Lamictal). According to Wikipedia:

Lamotrigine is an anticonvulsant drug used in the treatment of epilepsy and bipolar disorder. … Like many other anticonvulsant medications, Lamotrigine also seems to act as an effective mood stabilizer, and in fact has been the only FDA approved drug for this purpose since lithium, a drug approved almost 30 years earlier. It is approved for the maintenance treatment of bipolar type I. Chemically unrelated to other anticonvulsants, lamotrigine has relatively few side-effects and does not require blood monitoring in monotherapy. The exact way lamotrigine works is unknown.

Interesting, although a little scary they don’t know how it actually works. The side effect to worry about is a rash–a life threatening rash. Sounds absurd. But I’ll be on the look out. (If I see it, maybe I’ll let it grow! SUICIDE BY RASH!) If this medication is effective it should help with the social anxiety too, because If I’m not quite as depressed when I enter a social situation, I should be able to handle the situation better because I’m not as negative. I’m not going to start the medication until I’m fully caught up with school work. My last depression put me behind, and I’m still trying to catch up. I guess I’m a little worried that the medication’s side effects are going to put me into a zombie-like state, much like Zoloft. I’m so skeptical toward medication in general. I’ve read too many dystopian novels.

Must. Stay. Positive. Or try to.

Even though cyclothymia is treated as a mood disorder, I think it’s important for me to address this in my psychotherapy sessions too. I’m already fairly aware of the mood swings I go through, and I can feel the warning signs when I’m about to become depressed. But I think therapy can help me become even more aware of how this disorder affects me, as well as providing rational coping techniques to help with my depressions. I really need to find something besides food to cope with. I want something positive that I can do to ease myself back to my “normal” states. Further, I think there’s always much more to mood disorders than what meets the eye. Pills alone are not the answer, in other words. I have a feeling that my fragile psychological state coupled with social anxiety brought on these extreme mood swings. I still believe the social anxiety is my primary concern, and I know that some of my depressive states come directly from my anxiety. Continuing to address the anxiety while being mindful of the mood swings is my new goal in therapy–and in life.

There’s also a part of me that thinks cyclothymia isn’t a real disorder. Everybody goes through ups and downs. Everybody gets depressed and goes through periods of excitement and euphoria every now and then. Why do I need medication for something that everybody goes through? It’s different in my case because the swings don’t seem to be triggered by anything–they just happen. For most people, their swings are the result of something that happens in their lives, like getting married or getting fired from a job, etc.. When the ups and downs come from nowhere, it causes anxiety and frustration because I don’t feel like I have control. It’s okay for someone to feel down because something negative or bad happens, but it’s not okay to feel down for no reason, especially when it happens over and over and over again. Severity and frequency are factors as well. When I’m depressed I sometimes get so low I can’t function. I can’t see anyone. I can’t talk, smile, or laugh. I can’t work on schoolwork. My life gets put on hold, and sometimes I feel suicidal. The lows are becoming more and more frequent too. It’s not okay for me to be knocked on my ass two days a week, every week. I’ve really only been aware of these cycles or swings for the past few months, but I know they’ve been going on longer. I remember telling my therapist like six months ago I binge at least twice a month to get out of depressions. The swings are happening more and more. Twice a month is something I can handle; five or six times, I can’t. I need help, and I’m finally getting it.

***

I gave a copy of the blog post to both my psychiatrist and therapist. I left the writing in its original format, so they know it comes from my blog and they know its name as well so they could find it pretty easily. They could also find my previous blog too where I went into great detail about what happens during some of my sessions with them. They may not like that I’ve been so candid about it. I’m not sure how I feel about this. I care, but then again, I don’t care. I probably should have removed the information about my blog, but I didn’t, and to be honest, I really didn’t event think about it. I guess I really don’t care. I am going to continue talking in great detail about my sessions because it’s important to me, and it helps me integrate and process everything–which helps me heal.

With that said, I do care about the journey I’ve been going through with both my psychiatrist and therapist. Therapy, especially, is a sacred, intimate experience. I don’t take it lightly. I respect my therapist and everything that’s happened between us. He’s letting me take him somewhere within me. I do not think writing about the process diminishes any of that. In fact, I think it strengthens it because writing has made it easier for me to go deeper in sessions. It’s brought understanding and clarity. Sharing my process with others is intimate, as well. The healing process shouldn’t, and isn’t, just about two people, my therapist and I. It’s about everyone. Keeping the process hidden doesn’t do any good. There are too many books out there that deal with social anxiety and depression after the fact–after the person has been through the healing process. This skips the journey altogether and shows us the destination, which doesn’t help, because the journey is the destination. By providing insight into my journey, I believe that I’m giving others the chance to see themselves in me and to pick out the parts of my process that may work for them. And that’s worth sharing.

On that note, last night when I told my therapist that my psychiatrist diagnosed me with cyclothymia, he didn’t have much of a response. We talked a bit about me attaching onto labels, but we moved on to something else afterward. I asked him about whether we need to specifically address cyclothymia in our sessions or if it’s unnecessary because it’s more biological in nature. He gave no response. I realize now that his none response was really a response. By not giving an answer, he was saying that it’s something we address by not addressing it. We just continue doing what we’ve been doing, and by doing that, it will be addressed.

***

Finally, I want to talk about labels. Yesterday I was given another label to add to the mix. What does that mean? Put simple, I have Social Anxiety Disorder and Cyclothymia. And I mean that subjectively. If I opened up the DSM right now and looked up both those disorders, I could probably read a little about myself–but in a detached, objective sense. I am much, much more than the words in the DSM, and I try my best not to limit myself to the judgments and feelings behind those words. My therapist is right: By constantly telling myself I have Social Anxiety Disorder, I’m also constantly saying that I’m a loser, I’m not good enough, and I’m a failure. Those labels are powerful, in other words. They’re weighed down by emotions and judgments. For me labels are still important, though, because they allow me to get the treatment I need and sometimes they are just easier to deal with.

We use labels or names everyday to define our world. When you go out for a walk you may see trees, birds, houses, people, stores, cars–all labels. How often do you go deeper and ask yourself what’s behind those labels? What really is a bird? What’s at its essence? Have you really looked at one before, seeing it for what it really is? How is it connected to you? How do the decisions you make affect that bird, and how does that bird affect you? I think it’s important to address those questions from time to time. It keeps me grounded. It keeps me connected. But I don’t think it’s necessary to see the world like that all the time. If I did, I wouldn’t have time for anything else. That’s why we create labels. When I see a bird, I think, That’s a bird, and then I move on with my day. The same can be applied to the labels I’ve put on myself. Sometimes it’s okay to just say, “Yes, I have Social Anxiety Disorder and Cyclothymia.” It’s okay to say it like that, as long as I understand there’s much more to it than that. (I alluded to this in my last post.) These disorders are subjective; they affect us differently. As long as I’m aware of that, I think it’s okay to just say sometimes that I have Social Anxiety Disorder and leave it at that. If I went into great detail all the time, I would never get anywhere.