Although the spectrum for bipolar disorder is rather wide, there are actually two major classifications for the disease—bipolar I and bipolar II. Bipolar I is considered much more serious, and most people with this classification are usually hospitalized when they go into mania or severe depression. People with bipolar II go into what is known as hypo-mania, a less severe form of mania.
What differentiates the two classifications is the severity of your manic episodes. I am bipolar I, although I have never once been hospitalized because of my disease. As my good friend Joey always tells me, my greatest gift is to accurately assess my own mental well-being, and get help when I need it, or talk myself out of some pretty hairy trees.
People with bipolar I usually hover on the manic side, and don’t take antidepressants unless they swing deeply in that direction. I rapid cycle, meaning my moods go up and down rather quickly, but generally stay pretty close to my baseline. We rate our moods from a -5 to a +5. The scale looks something like this: -5 -4 -3 -2 -1 0 +1 +2 +3 +4 +5.
Zero is our baseline, and we are completely stable at that level. A +1 is a slightly elevated mood. A +2 is a comfortable, happy high with lots of energy. At this level I can produce enormous amounts of work very quickly. I have astounded my boss on many occasions when I hit this zone and stay there for an extended amount of time. A +3 means you are probably not getting enough sleep, and need to stick to your sleep pattern. A +4 means get help immediately, and adjustments to your medication may be necessary. A +5 is when you are completely off the rails, and here you experience incredible highs with lots of energy, little or no need for sleep, a huge increase in your sex drive and often delusions of grandeur. This is a very dangerous place to be if you don’t get help because you are apt to be very self-destructive and can spend reckless amounts of money or take huge risks.
On the other end of the spectrum, there are rare occasions when I go into a deep depression, and thoughts of suicide are pervasive and overwhelming. My last depression lasted several months, and my doctor was thinking seriously about hospitalizing me, but I convinced him that these thoughts of suicide are just thoughts that come with the disease, and that I had never acted upon them in the past and had no intentions of acting upon them in the future. But I will tell you I was miserable beyond all belief, but still managed to go to my job everyday and produce. I just put it out of my head and concentrated on my work. Self-discipline is a very powerful thing.
My doctor does not worry about me. He knows how responsible I am and how seriously I take my mental health. My therapist, on the other hand, worries about me quite a bit because of all my anger issues and unhealthy situations and relationships I get involved in. We work well together because all my years of introspection have taught me to be brutally honest about what I feel and think, and I express it so succinctly in our sessions, although I have a tendency to go off on tangents, which drives him crazy. Anger, without a doubt, as I have made clear in so many earlier posts, is my biggest demon. But together we are wrestling with it, digging deep within my psyche to find the source, deal with it, and let it go. There are other issues that we deal with, but my anger is on the front burner for now.
My regimen consists of 2,000mg of Depakote, a powerful mood stabilizer; 500mg of Seroquel, an antipsychotic; 3mg of Clonazepam, an anti-anxiety; and 10mg of Ambien, a sleep aid. These are hefty doses of medication. There are other regimens, and I have tried a variety of them. Lithium is considered a leading standard for treating bipolar disorder, but my system can’t tolerate it, so we changed up my medication until we found a combination that works.
Sleep is the most important thing you can do for bipolar disorder, and without a regular sleep pattern you are asking for trouble. Ironically, the first thing that happens to you when you go into mania is sleep deprivation. It feeds upon itself until you completely wipe out your system. For some, their manic episodes are so severe that hospitalization is their only option. For me, writing a full-length novel in a matter of weeks does the trick, and keeps me out of the hospital, but I do pay a heavy toll afterwards in that I am incapable of functioning for about a week.
I hope this discourse has provided an education and some insight into what many people with bipolar disorder suffer through. This is not an easy disease to live with, but it can be managed with the right regimens and behavioral training. Beyond doing individual therapy, I am also in a support group for people with bipolar disorder. Some of us are more high-functioning than others. There are a few guys in my group who are so debilitated by their disease they are on disability. I find that heartbreaking, and wish I could do or say something to help them cope with their disease more effectively. Several men in my group are going through divorces or have been recently divorced because their spouses can’t deal with their diseases. I have to admit this disease is hard to live with, but I am lucky in that I am very high-functioning, and hold an important job with the State of New York. I get along very well with my coworkers, and adore my boss. For the last four years I have gotten glowing annual reviews that are beyond spectacular.
This year has been tough, however, because the publication of my debut novel has had ramifications I wasn’t expecting, and I have had trouble concentrating on my job. I need to turn that around and really focus on what’s important. My job is paramount, and I need to keep it. I have many responsibilities to my family, and provide my ex-wife with enough child support to make sure my kids have all that they need. This is important to me, and I take the well-being of my children seriously. My lawyer and I are in the process of nailing down the details of my visitation rights much more concretely, and the matter of the house was never decided because I was given a Default Judgment. That will be decided as well.
Love to you all!
James M. Weil
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