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The Hypomania/Depression Roller Coaster with a Twist of Social Distancing

December 19, 2019. December 19, 2019. I could repeat this date over and over, yet it would not change the journey I have been on since that day. On that day, I started taking medication for a medical nerve problem. Within hours, I felt as if I were in a cloud, happy and very free. That feeling continued into the next day and by day 3, I was in a hypomanic state. I had never been hypomanic/manic in my life. I felt, literally, on top of the world: powerful, in control, happy as can be and unable to feel anything else. Even the rapid and numerous thoughts and inability to focus felt as if I had a super power that no one else had. I was grandiose and felt above everyone else. I could function on minimal sleep and also experienced de-personalization where I would see buildings or items on a shelf as “too” real where I could become lost in them and even lose time. This went on for a couple of weeks when my therapist and psychiatrist grew concerned as I also began having auditory and visual hallucinations (I had never experienced these before). My psychiatrist spoke with the doctor who prescribed the medication causing these symptoms and they decided to cut my dose in half. This did not change any of my symptoms, including the psychotic ones. I kept fighting both my therapist and psychiatrist as they thought it was time to taper off of the medication but I felt too good. I had never felt so good in my life. Why would I agree to get off of it?

I finally heard my therapist and tapered off of it at the end of January and within days crashed into a depressive episode. It was agreed upon by my therapist, psychiatrist and myself that an Intensive Outpatient Program (IOP) was warranted for more support as I could no longer work. I began IOP on 2/6/20 and remember sobbing through that first day. It was helpful and provided structure especially since my therapist was on vacation at the time. The surprising thing was that I became hypomanic again (without a medication cause) on 2/22/20, which, again, felt amazing. This only lasted until 2/27/20 when I crashed into a depression that lasted 24 hours. I then woke up on 3/29/20 to feeling on top of the world, grandiose, racing thoughts and powerful. Again, my goal in outpatient therapy and at the IOP was to convince the professionals how great I felt and that all was perfect. This would encompass each session. I was not myself: lying to my therapist hours before, canceling a session saying I didn’t feel well when all I felt was power and control. I had never done anything like this with any therapist before. That turned into a lie to my husband, as well. While my therapist didn’t understand why I felt I needed to lie, my husband was hurt, as we don’t lie to each other. While I felt bad about it and owned up to it, the moment when I decided to cancel that session in the way I did felt amazing. I felt as if I owned and controlled the world.

On 3/5/20, Lithium was added to my medication roster. It took 5 days to move up to the dose that the psychiatrist at the IOP wanted me at. On 3/11/20, I started to feel more even moods and even felt a sense of calm, which lasted until 3/13/20 when I felt low in the morning and flat or empty in the afternoon. But the very next day I woke to feel great, hypomanic, grandiose–all of the typical hypomania symptoms but it felt stronger, more than before. It came out that I had not added Ativan to my morning medication regime, as requested by the IOP psychiatrist as well as my outpatient psychiatrist weeks before. I was afraid it would dull my “happy” feeling. When I told them the truth, my therapist at IOP and my outpatient therapist tried to reach me saying things like, “how can we work together if you keep important pieces of information from me.” During my phone session with my outpatient therapist on 3/17/20, I was very confused about my thoughts. They were grandiose as they had been through this bout of hypomania. Telling my therapist that God gave me this gift of pure happiness resulted in her trying very hard to reel me in. She confronted me and told me that I was in charge of the hypomania, making choices, not like before. Over the next couple of days, I saw it for myself. This last episode of hypomania grabbed me and I grabbed back, held onto it and ran with it. I navigated it.

Luckily, I saw it. I saw it and I sobbed. Was I a terrible person? Lying, manipulating? Who was I? My husband was there for me, even with his pain over my lies about the missed appointment and the Ativan. My therapist was and is there for me, helping me now navigate what happened, piecing out the layers and talking about them.

The thing is, this world-wide pandemic began and reared its ugly head over the past weeks in the US. This past week I have had phone sessions with my outpatient therapist, which was helpful yet difficult to not sit in front of her. My last day of in-person groups at IOP was this past Friday, 3/20/20. I will have a check-in session with my IOP therapist on zoom and then the plan is to move to group therapy on zoom. My discharge date is not set due to my labile mood. Luckily, my therapist and I will transition to having sessions via zoom beginning tomorrow. I am so happy as I truly cannot wait to see her.

This pandemic affects each and every one of us. I am trying to hold on while in this state of psychiatric flux. I am definitely feeling more even and I owe that to the Lithium and my own strength but I do need to continue with the Intensive Outpatient Program and, of course, my 4 sessions per week with my therapist. I need therapeutic support at this strange and very scary time. The past few days have actually, emotionally, hurt due to missing my friends. I miss seeing my therapist. The past 2 nights were filled with sobs, the sadness and fear of so many things hitting me. I worry for society and I worry for those close to me, my husband and my daughter, family and friends. I am simply scared. I do not do well with the unknown during “normal” times, but it is magnified right now. When can I see people, when will the financial markets recover, when will those who are ill recover? It’s too much for me right now. Today I decided I can no longer look at the news, either online or on TV. It’s terrifying. Add on a set of wounded neurotransmitters and it feels…it feels, maddening. I worry for my own recovery, not having access to my treatment providers in a conventional way. I want my in-person therapy sessions and I want my in-person therapy groups at IOP. People do need people…near them, next to them, in front of them. I know I need to be with my people and I need my people to help support me through too many things at once. All I can do is take it one day at a time, otherwise the burden is too much, too heavy. I am still regaining my strength and for the meantime will focus on the treatment I can, luckily, receive.

  • December 19, 2019: the beginning of an unfortunate journey.
  • March 22, 2020: the continuation of the journey in a unique way.

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My OCD Has Been Out of Control for Months, But You May Not Have Known That

Overall, I am doing pretty well. The thing that has been wreaking havoc on me is my OCD. I have had OCD since adolescence but didn’t disclose this until a couple of years ago to my therapist, detailing my obsessions and compulsions. They were “normal” to me but at the same time, extremely troubling.

Having OCD is, in one word, exhausting. I don’t mean this in terms of, “I didn’t sleep well last night and I just feel exhausted.” What I mean is, waking up to my brain already racing, never-ending tasking, conducting those tasks only to add more tasks as there is no relief. It’s ordering tasks, then re-ordering those tasks, planning out exactly how my day will run then starting over with another plan for the day. It’s noticing numbers on a clock, on a truck and adding those numbers together a few times. It’s ironing clothes to wear to work and then telling myself at least 10 times that the iron is unplugged and it’s safe for me to walk away. It’s planning dinners for the week and going over that plan too many times only to question and question again how the cooking will work with my schedule. It cycles constantly until I try to go to sleep at night. Sometimes my brain quiets with my night medication and allows sleep to settle in, sometimes not.

While my OCD is always there, lurking like the tyrant it is, it’s been worse the past couple of summers, which is now a time of year when my depressive symptoms also increase. Summer represents an anniversary for me of extreme illness, hospitalizations and last ditch treatments. While it hasn’t ruined the past 2 summers, it remains to be a harder time of year for me, symptomatically.

My current difficulty is that it hasn’t really quieted since it increased around June. The pressure I feel to complete an obsession is just as high:
Obsession > Compulsion > Obsession > Compulsion. There’s no actual cycle where relief follows the compulsive behavior to alleviate the obsessive thoughts. No circle is ever created.

I tested myself a couple of weeks ago while unloading the dishwasher. I have to unload it in the same order each time and would never think of changing it but on this day, I dared myself to. I put away the silverware, plates then the mugs before the glasses, when my must-do order is putting the glasses away before the mugs. When I finished the glasses, after the mugs, I almost started to cry, completely regretting that I changed the order. I knew I shouldn’t have done it and then I felt it. I felt hopeless and guilty, and actually terrified there’d be a consequence for my not following my own protocol. It’s a fucking dishwasher and I was nearly brought to tears. I know what this sounds like and how incredibly irrational this is but when I’m in it, it makes perfect sense to me as being reasonable. OCD is anything but reasonable. It taunts me whether I’m aware of the thoughts as they’re happening, after or when I have no awareness.

I don’t really have any more medication options to help alleviate my OCD symptoms as I tried 2 off-label medications last year with no luck and have tried too many others to count. I have been reading articles about Transcranial Magnetic Stimulation (TMS) being used in different parts of the brain for OCD, instead of the usual left frontal lobe targeted for depression. A few years ago I completed a full course of TMS, targeting the left frontal lobe for my severe depression with questionable results. I need to know more. Of course, I’m already worried that there aren’t local, reputable clinics/offices that offer this specific form of TMS targeting OCD. I don’t want to be back at square one.

Although I am constantly working on combatting my symptoms with my therapist and can notice more when I’m in an obsessive/compulsive state, I am having such a difficult time getting out of it and not feeling like it’s “pointless” or “impossible.” I need much more help with this than I care to admit which is what led me to research TMS as an option. I can’t keep going through each day like this.

The image I have is of an amoeba seen through a microscope, constantly moving, searching for food. My OCD is also unseen to the naked eye, and although it would not be seen in a microscope, it is also in constant motion, searching for ongoing sustenance to maintain itself. I wonder how exhausted that amoeba feels. Does it feel out of control in its quest for food? I feel out of control within my own brain, desperate for relief. My OCD has been well-fed for much too long and the end result for me is irritability, frustration and utter and complete exhaustion.

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The Summer of Growing and Learning

The summer can be a bit challenging for me. This phenomenon didn’t really begin until 2014. I was severely depressed and was hospitalized twice within 3 weeks and began ECT (electroconvulsive therapy) for the first time. It was traumatic to be so ill, it was traumatic to be in the hospital and it was traumatic to have ECT, without understanding the reality of it as a safe treatment.

Since then, my mood usually begins to dip toward the end of May. My last psychiatric hospitalization was the summer of 2017. It’s simply a triggering anniversary. This year was no different. While I have had some medical issues leading into the summer (I fell down some stairs at the beginning of April thus causing a bulging disc pinching a nerve in my lower spine: out of work for 6 weeks, physical therapy, steroid injection = lack of normal routine). When I do not have a “normal” routine, my mood does not respond kindly so this added to the now usual increase in my depressive symptoms.

June was very busy buying, buying and buying everything my daughter would need for 2 weeks at overnight camp. This took thorough organization, planning, seeking out sales and crossing off items on a lengthy list. People who send their kids to overnight camp joke about the tedious and stressful preparation, but, while I laughed on the outside, I was beyond stressed on the inside. I am the ultimate organized person. I thrive on it. I also thrive on being busy, having things to check off of a list. But dealing with my back and not only making sure my daughter’s concrete needs for camp were taken care of, but also making sure I could help her be as ready, emotionally, to be away from home for 2 weeks, it was a lot.

She seemed prepared and we talked a lot about being homesick and that it is normal, expected and that the counselors would help her through it. She talked about her excitement about doing so many fun activities and making new friends. We were all excited and Ken and I held our breaths as we said our goodbyes at drop-off, not because she seemed nervous, but because we were already missing her.

Those first days were quiet, nice. Ken and I commented on the strangeness of the quiet in our house, of the dark bedroom we would peek in at night, door open with no little girl sleeping diagonally in her bed. Then there was the first phone call from the girls head counselor. A little homesickness which led to her not eating much due to fear of “cross-contamination” because of her allergies to dairy, egg and tree nuts. While she has used those words before, it has only been a few times. The camp provides a completely safe environment for kids with allergies and prepares those foods separately to the point of having plates of food for each camper with an allergy separate and labeled. While the food issues continued, the camp provided over-the-top support for her and we were repeatedly told that she made friends and enjoyed her activities and being there.

It was clear that the issue was not really about food but about control. She is a 9 year old only child and therefore, at home, it is mostly all about her. She was away from home for the first time for a long period of time. She was in a bunk of girls her age which totaled 27 with 4 counselors and the female head of her age unit. She ate meals with hundreds of other children where it is loud and sensory stimulating. She does not respond well when it is too loud and has had some sensory issues since toddlerhood. Her mommy and daddy were not there and she was making decisions on her own, which she did well, at times. Unconsciously, the food was a way to control what felt like an out of control situation. When I say that the camp staff went above and beyond, that is a complete understatement, as she took up much of their time while they had to also attend to those other few hundred campers.

While she made it to the last day and said she did have fun (which was repeatedly verified by staff), she is still acclimating to being at home a week later. She is talking about her allergies in a way she hadn’t before, will not eat certain foods she used to before camp. But, she is also actually talking to us. She sobbed the first night home talking about her homesickness and that she was afraid of the food not being safe. While this was so painful to see, we began the conversation that will continue for months in order to process her experience of what happened. At the same time, she is different in a mature way. She brought up the issue herself. She has rarely done that in the past. She was able to talk about it a bit with her therapist last week and as I heard her sobs through the door, I was so proud of her for sticking it out in that office and not running out to me. What a positive example of control!

While Ken and I look at our role in what occurred, regarding the food, we are also maturing. Our daughter is a capable and smart 9 year old. We are changing things regarding how we go about managing her allergies and foods. She will make her own lunch for day camp (and then school) each night. There is no reason that Ken has to do it and continue to ask her what snacks she wants when she says she doesn’t care and then doesn’t end up eating them. She needs to take responsibility but also will gain control over her own decisions.

My brilliant sister-in-law had another idea that we will use, of having one dinner a week where I make something that is “safe” for her, one meal for the 3 of us, and she can decide what she eats: If I choose to make roasted vegetables, salmon and roasted potatoes and she serves herself and eats 3 pieces of cauliflower and a small piece of salmon then says she is full, so be it. If she eats one bite of a potato though, that will not be acceptable and that will also be her decision but there won’t be a cookie waiting at the end of the meal. She takes control and can learn what works for her and what doesn’t. She won’t go hungry, that I know.

It’s time for the three of us to move forward. We will work out the emotional part of what happened at overnight camp and she has said she may want to go back next summer, but for right now, we don’t have to think about that. Right now, Ken and I will grow up with her, leading her on a path of maturity, with expectations that match who she is and remember that she is only 9 years old. Right now, it’s about our health, physically and emotionally.

Summers continue to be a bit more difficult for me but I get through them and I do so with the aide of others. I ask for help when I am able. I speak up. I hope Ken and I can teach our daughter that she has the power to get through difficult times, with the help of others, by asking for help, speaking up for herself and, most importantly, for her needs: to use her voice in order to help herself. I hope she will learn to understand the connection between physical health and mental health and understand more about her allergies and trusting others and, most importantly, trusting herself in that regard.

We have some work ahead of us, individually, and as a team, but I think we are on the right track.

 

 

 

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