Am I?

Thanks, that's very helpful indeed. I don't think I have any type 1 symptoms. My gp has mentioned a psychiatrist ,but I'm so scared of talking meds,it does worry me a little 

Are there typical lengths of time of up time vs down? Generally speaking I am anxious and up than I am down, recently though I have made a decision to do less of the creative things, I felt they were taking far too much out of me. As a consequence I'm suffering more extreme bouts of depression. So hard to know what's going on! 

That pretty much sums up bipolar - '[so hard to know] Whats going on!'  - one of the big myths is that Bipolar means up one minute down the next. That type is actually pretty rare ('rapid cycling'). There are no 'rules' - some people are mainly depressive, with a few minor highs - yet are still truly, genuinely Bipolar, others (myself for example) have Major highs followed by Major lows clearly alternating. 

Also, highs dont necessarily feel nice. Some people have Irritable hypomania, others have angry highs. You can even get something called a Mixed Episode or mixed state (i get these and they are truly horrible) - where you have the energy of a high, but the feelings of a low. Could that be something like what you describe as anxiety? The mixed moods make me feel like a cornered animal - just desperate, climbing the walls. 

Dont be scared of psychs and meds. Most psychs these days let you choose which drugs you want to try and wont force you to take anything you dont want to. It wsa a revelation to me - I avoided mental health professionals for 20-odd (very odd!) years cos I had images of Victorian cold-showers routines and forced medication and Bedlam type hospitals! Things genuinely have moved on and the psychs and nurses are all pretty human these days. 

PS you dont say what type of creative activity you have scaled down - generally creative activity is therapeutic, but you wont get much out of anything whilst you are actively ill - either depressed or severely manic. You know yourself best. If its a social type of creativity - eg music - it rather depends on the people around you. If it entails lots of drinking and wild behaviour - probably best to stay away for a bit. If its only occasional and calm and surrounded by sympathetic, sensible types, Id say its probably useful. Only you can decide. All the best!

My creative outlet was art,  I would spend hours non stop creating a piece, till I was exhausted, then it was all about the next,and the next etc. I was so constantly driven, it felt good at the time buy straight after it just wasn't enough. My anxiety I would describe as feeling really having the need to be creative, to please or excel at everything, and knowing that it isn't possible, so while I'm actually doing whatever it is I know at the same time it's pointless and wont give me what I need.  Do hard to put into words. I guess I've got some pretty dark artworks out of it, but I just don't think I can keep doing it anymore, I still have the drive, but just don't have the will or the energy anymore.  Work is usually a huge thing for me, I'm a programmer so it's a great canvas to be creative with, but I need to excel- if not then it's not worth it. And now I'm at the stage of my nightmare where I need to be off work- which I hate, but I know I can't keep going as I am 

Textbooker and textbooker (to paraphrase Alice!)... that trope of the 'tortured creative genius'aint a myth. Theres lots of evidence to show creative people are much more at risk from Bipolar. 

And the perfectionism you desribe is a prominent feature of a type of depression called Dominant Goal type depression. (Fellow sufferer - except my bipolar so bad i never got enough 'normal' to achieve anything. We all have our crosses to bear tho, i guess!)

Are you able to concentrate well enough to read a book? Cos Im gonna recommend two that really, really helped me:

They F@#k You Up - by Oliver James

Touched with Fire - by Kay Redfield Jamieson

James is a child psychologist - his book is about auditing your childhood and has a good chapter on Dominant Goal and perfectionism

Redfield Jamieson is a hugely eminent psychiatrist - who also suffers from Bipolar 1. Its about bipolar and the creative mind. Theres a list about 10 pages long and a very in-depth scientific appraisal of all the major artists, poets, composers etc who were definitely or probably bipolar - its also very humane and interesting and a good read. Both available on Amazon last time i recommended them (im a bit of an evangelist for these books cos i reckon they saved my life).

Know what you mean about a creative outlet becoming an inlet - for pressure intrusive thoughts obsession etc. i try to write as much as i can while i am well - but my writing only really flows when im hypomanic. So i keep getting tempted to stop my lithium. Only the cringey memories of all my nympho-psychotic manic embarassments is enough to make me keep taking the tablets! Its a poisoned chalice, for sure. A double-edged sword. 

 

Thanks Christine, thats all really interesting, and familiar . I do struggle with focusing long enough to read a book, but I'll see if I can get.my hands on those thanks! Its so difficult these days to get any kind of.diagnosis, many therapists say a label isn't important, but sometimes I think it's.needed 

too right diagnosis is vital - i only really started accepting my illness once i had the diagnosis. when you say therapist, do you mean a private counsellor that you have arranged yourself, or an NHS practitioner? Cos if its private then yes unfortunately you will have to go through your GP to get a referral to your Community Mental Health Team psychiatrist, and some GPs are more co-operative than others. I would definitely order Touched with fire (Kay Redfield Jamison) as it contains all the diagnostic criteria lists from the Diagnostic Manuals that the psychiatrists use (theyre american but our Royal college of psychiatry guidelines are based on them). So you could check off your symptoms against the actual scales a doctor will use - information is power! 

Good luck whatever you decide to do and keep in touch!

My therapists are NHS assigned yes, I would love to be able to go private. I don't always think the NHS have the very best to offer sometimes. My local community psychiatric nurses I must say are fairly useless, they don't seem to help at all. Brilliant thanks, I'll look for that!

know what you mean about nurses - they're not very proactive in my experience. Kind, sympathetic, well-meaning - but i) completely unaware of most research since they qualified ii) unimaginative about treatments, therapies etc. HOWEVER .... in terms of getting a proper diagnosis, emergency/crisis help, meds - I think you're better off with the NHS because its an unequivocally recognised diagnosis. So if you're already 'in the system' I would say - make an appointment with your psych ASAP to explore treatment options - the main reason I say that is because Bipolar is a progressive condition. Every manic or hypomanic actually permanently damages the brain, making another manic/hypomanic more likely. Also because anti-depressants are great and lifesaving in my case (remember, depression and bipolar are conditions with a mortality rate approaching heart disease) - but anti depressants have to be handled with care if youre bipolar because they can trigger manic episodes. And it sounds like your hypomanics arent so much fun, even if you enjoy the creativity? I mean, my full-blown manias are only fun while im in them ..... the aftermath is horrible. The last one cost me forty grand - despite the fact it also saw me join a pain-for-pay website!! work that one out haha. 

All the best - I think you'll be very pleasantly surprised at what the NHS offers - it seems to take Bipolar more seriously than 'common or garden' depression (thats not fair, but thems the breaks).

Thanks Christine, who generally would be the one to make a diagnosis? GP, psychotherapist or psychiatrist?  I ask because so many don't seem to want to commit themselves! No my up times are dreadful, very creative and productive but God I could live without them! At least with the depression I can sleep! 

Diagnosis (in the NHS) can only be made by a psychiatrist - if a GP suspects anything more serious or complex than mild-to-moderate depression or anxiety, they're supposed to refer you to the Community Mental Health Team, which are headed by consultant psychiatrists, who will diagnose you, then give you a care plan - which, realistically, will be meds and monitoring by a psychiatric nurse. If you live in a city, near a research uni/psych hospital, you might be lucky enough to get a referral there, where your care might be a bit more cutting edge, but I dont have first hand expereience of that, so cant advise. Most areas have various projects for therapeutic help - walk'n'talk groups, support groups, art therapy (might want to skip that!), music therapy - thankfully ive never been offered basket weaving, but maybe they hold that joy in reserve for the really interesting cases! I personally dont tend to join in with the therapeutic groups stuff, cos im a bit of a bookish loner. But some people really do find it very helpful indeed - mainly cos you dont have to explain anything, everybody there 'gets' your condition and are sympathetic. 

I would talk to your psychotherapist - if theyre in the NHS, they should be able to refer you back to the CMHT or your GP to make that referral. (You may have to hand-hold them through this process, dont get fobbed off or put on the back burner. But if your therapist was the one to raise the suggestion of bipolar in the first place, they should be pretty chuffed to be 'proved right' so will fight your corner to get diagnosis. HOWEVER - psychiatrists tend not to like being 'told' by other (lesser) professionals. So I wouldnt go into the psych appt saying :'my therapist says im bipolar' .....!

I think I'll ask my GP to refer me to a psychiatrist, she actually offered on Monday, so I think I'll take her up on it . Yeah that makes sense, I wouldn't think they would appreciate that! The previous diagnosis of anxiety and depression just doesn't sit any more, there's never a shift in my symptoms, they seem to cycle too regularly 

Sounds to me like you actually have some pretty decent people on your side. If your GP has offered referral - rip their hand off!! Lots of people have to battle to get that referral, so I think you're in reasonably good hands. I hope your psychiatrist is equally decent: a good sign is if they give you print-offs of different medications to choose from showing their side effects etc. That way you'll know what your options are rather than just being told what to take. Psychiatrists tend to try and include you in your care plan these days. 

Indeed yes, mostly the people around me are good, in all honesty I think it would be great to have a proper diagnosis, rather than a really generic one, maybe they won't see bipolar, but I think they are better placed to decide, rather than a GP who doesn't know, and a psychotherapist who doesn't think it matters

Absolutely. Go back to the GP and say you want that referral after all!

Then when you have your appointment with the psychiatrist be sure to mention the creative bursts, especially how they take over your life. Talk about the lack of sleep, absence of appetite (especially if you lose weight because of it). Mention that your anxiety is chiefly around success and artistic perfection, and that as the energetic phase progresses it becomes increasingly fraught and intense and ends up in a terrible crash. If you overspend and get into debt, tell him that - dont be ashamed - same goes for drinking, drug use, sexual behaviour - they are all symptoms. If you ever have any unusual thoughts or see/hear things that arent real - im thinking when you are in the throes of creative obsession - again, dont be embarrassed, he's heard ten times worse even though all this stuff feels cringey, its very important to get everything out in the open. All the above symptoms are genuinely Bipolar symptoms so will contribute to him correctly identifying this as your problem. Very best of luck! Please let me know how it goes! 

thanks so much for the advice, thats really super helpful. overspending has been an issue, i ended up bankrupt just because i didnt think or care about what would happen once i spent. drinking - i dont at all, totally stopped, drug use - no never, sexual behaviour - jeez where to start! unusual thoughts - pretty much all the time, which lead to the anxiety i think, see/hear things- no to that one. after a creative episode the crash was mainly one of total worthlessness and anger at myself for spending so much time on effort for something which has no importance - then either another more intense period of it to try and better it - or totally giving up.

Well today I saw my therapist and my referral to psychiatry is done! I should get an appointment soon! Fingers crossed it's not too long. Many thanks for all your advice 

Brilliant - well done. Know its scary but think you'll be pleasantly surprised. When I went to my first psych appt,i paid the rent 3 months in advance and l left a note for my son with £500 cash and a list of phone numbers - thats  how convinced I was that they were going to haul me off to a locked ward! That just dont happen anymore I assure you!

You must tell the psych about the overspending and bankruptcy - they very much assess and diagnose on the effects of the moods on your day to day life, not just how bad the feelings are. its how badly it has disrupted your work, relationships,libido, eating, sleeping, etc. Thats just a good way to measure how severe it is. I know how utterly mortifying it is to share these embarrassing details with a perfect stranger - but remember, these are SYMPTOMS, not faux pas, however stupid you feel in hindsight, at the time your judgement was not under your control.

I think you'll find once the real problem has been tackled, a lot of other stuff will make sense. Any more advice - if you want to do a full post-match analysis after seeing the shrink! - dont hesitate to give us a shout again, any time.

take care x

 

Thanks so much, I am quite apprehensive but also very interested to see how the appointment works out.my psychotherapist said they think they know what the diagnosis will be, but they aren't allowed to give it. They said they thought I'd be prescribed prozac - I think they were trying to give me a hint but I'm clueless still lol

Thats pretty unprofessional of your therapist - after all, its a helluva jump from therapy to consultant psychiatry!! I reckon if you tell shrink everything you have told me on here, honestly openly and without minimizing/hiding anythng!! (know its hard to do, but you must) - then he'lleither diagnose Bipolar 2 straightaway, or bring you in for a few more appointments to do a more indepth assessment. I would very much doubt Prozac - it tends to be given for milder cases of uncomplicated depression. My guess would be a more sedating antidepressant like Mirtazipine (to take at night and help you sleep as well as tackling depression and anxious/mixed symptoms) - or maybe Escitalopram (wich doesnt help you sleep at night, but is very fast acting). If they feel you are at risk of another hypomanic phase soon, they might add something like Depakote which is a very gentle and very safe bipolar medication.

However, what they shouldnt do is just write out a script without discussing it with you first. Mine gave me pages of printouts of all the different meds and side-effects etc so I could choose which ones I would prefer to try. No guarantee that you'll be able to get exacctly what you want - depends on contra-indications/interactions etc - but at least you feel listened to.

All the best - let me know how it goes! x

Yeah I thought it was a strange thing for a therapist to say, even if they did have an idea- why tell me,  then not say what they think! I will defo be open and honest, there's far too much at stake and its been going on for far too long. About time for some proper answers, maybe those answers won't be what I think, but I just need to know now

Hi Christene, I have been offered a sooner psychiatrist appointment, but it's with a junior psychiatrist who will them liaise with the psychiatrist. .....do you think this would still be helpful? I like the idea of being seen sooner.....but a junior? Hmm not sure.....

Hello there - on balance, I would give it a go: you may find a younger/more recently trained psychiatrist just as helpful as an experienced/older person. Your symptoms as described in our conversation are pretty textbook,  - just as long as you are completely open and dont 'clam up' during the appointment! - If the junior appt is available significantly sooner than the consultant, I think that'l prob be better for you as you have been suffering real distress lately. Theres also the altruistic point that doctors have to get their training somehow.

I would ring the clinic and ask if you can keep both appointments - see the junior doctor sooner, but stil have an appt with the consultant in due course. If they are agreeable to that,  i would say its the best compromise. Is it a hospital setting, or is it through your local CMHT?

Thanks Christine, yes it's at the hospital. I just figured I would call and see if they could bring my appointment forward, as you correctly say, now is not a good time for me at all. The secretary was very nice indeed and spoke to the psychiatrist straight away. The revised appointment is 9 days sooner, so it's the 9th June instead of 18th June which is a good thing I think. Indeed a more recently trained person might be more eager and I shouldn't judge. I do though lol many thanks, super helpful as always! 

No worries - always good to be able to give advice when you've been thru it yourself! have no doubt you'll be helping others with advice yrself in a couple of years time!!

9 June is still quite a long way away, to my mind - though beter than 18th! - You might try ringing them and askig if you could see a psychiatric nurse at home meanwhile? - tell them you are in a real state and feel worried to wait for yr appt - and while yr on the phone, ask them for the phone number for the Emergency Duty Team (the mental health out-of-hours service) - be good to have it to hand - hopefully you will never need it , but a very good idea to have it in your mobile phone 'just in case' -n they send a nurse round any hour to your home to reassure you or assess you and help you however they can. 

 

It does still seem a long time I agree.  Well I did deal briefly with the community psychiatric nurses, but really found them quite irritating if I'm honest, had very little advice. When they started going on about writing my emergency plan etc I could have slapped them lol quite patronising. I did ask them about out of hours, they said to call breathing space or nhs24. An out of hours nurse does sound brilliant 

PS..... y'know, re-reading your original question and posts on here, it crosses my mind the diagnosis may be bipolar 1. (cos of the uncontrolled spending, bankruptcy, unusual thoughts, driven behaviour, and sleep problems.) If you have significant weight gain/loss during phases, tell them that too - I go up to a size 22 during lows, then down to a size 12 during highs! - the diagnostic criteria is +/- 5% body weight during a phase. Also social stuff like withdrawing completely or mad socialising behaviour - compulsively reaching out to people, texting at 4am or huge phone bills, indiscriminate freindliness (telling your life story to strangers at the bus stop, that sort of thing!) It all adds to the picutre of how your moods impact on your life - they cant judge just by the feelings, but by how the feelings affect your behaviour and judgement.

Well, the spending was....stupid, I knew I shouldn't but I also didn't care one bit. Even buying something small was a huge buzz.  Yes lots of weird obsrssions, my old traits- worrying about health- tends to rear it's head in bad times. Weight- my weights often up and down, recently I've lost 5 belt holes worth in about 3 weeks. I don't know weight, I have had eating disorder issues since I was 16, so I never weigh now. Withdrawing completely- absolutely, then desperation to reach out to anyone, often late at night yes. Its easier online now. I can't say I've ever taken to talking to strangers though, not for many years. I guess I have in the past. Ruined friendships though, encouraging people to be reliant on me emotionally, then suddenly I'll realise I don't want that- total mess! I've never considered type 1 though I must say, cause I never though I was classically manic 

I think yr prob within bipolar1 criteria myself - it doesnt make much odds except that you may find better emergency help/easier to get psych appts earlier with a bipolar 1 diagnosis (cos the mania is so much more dangerous/destructive than the hypomania of bipolar2)...

Know what you mean abt care plans - my bete noire is the Risk assessment review every 6 months.As if im an escaped murderer or summat!!

Be careful abt explaining eating disorder - you dont want them writing you off as a depressed anorexic. (they flock to cliche and labels as readily as do politicians!) Theyll ask you about weight so would described the gains/losses without using the loaded phrase 'eating disorder' - better safe than sorry. I lost out on proper diagnosis for ages because I was a drug user - they saw the drugs first and didnt look any deeper. I now know the drug abuse was  a symptom (self-medicating) of bipolar. Just tread carefully - esp with a junior psych.

everything else you describe is textbook bipolar, so 'share' with impunity!!! 

 

Thanks Christine, it's great to talk to you,your advice and insight is really exactly what I need just now. Roll on the 9th! Can't wait strangely! 

Hi, do you  specific IBSN ... It seems there may be several books written by this author and I wanted to ensure I am looking at the right copy ...My creative side is interior/ exterior design ...does this count ? 

Well I finally met with the psychiatrist!  My diagnosis was, some bipolar 2 traits, depressive personality disorder, mood disorder an obsessive personality disorder.  She seemed to only have time for bipolar type 1, type 2 she thinks is a diagnosis for drug companies to profit from. So......not sure where that all leaves me to be honest