Author: Catalina Bellizzi-Itiola
Sometimes I look back at the timeline of my life’s volatile mood fluctuations, and it makes me worry about what on earth my future will look like. Will I hold a job? Will I have a child? Will I be able to survive more episodes? Even though it’s affected me my whole life, I’ve only technically been diagnosed with bipolar disorder for two years and in many ways am still learning the basics. Thinking about the endurance it takes to ride the pendulums of our brain chemistries over the course of decades is mind boggling. This past Fall, however, taught me about the actual meaning of the word endurance, and it might not be what you think.
Two years ago I was hospitalized for the first time with a devastating mixed episode triggered by a miscarriage. It was a slow and desperate recovery from that episode as I went through intensive therapy and the cautious titration up Lamictal (if you know, you know). After nine months it was Lamictal with the addition of Seroquel that lifted the majority of my symptoms. The feeling of normalcy was glorious and worth every second of the wait. In my mind, I was free for good.
Then, in September of last year, I got pregnant. A week later, another miscarriage sent me spiraling back down the depression hole. During that time, I woke up suddenly one day with the awful feeling that my medications weren’t working anymore. This was the beginning of four months in and out of the hospital while my psychiatrist and I experimented with different medication cocktails. I will insert some hope into this story right now and say that I’m currently back in euthymic bliss. I’ve been stable after adding lithium (God I love lithium) and have started to plan and dream again. I got into grad school, we’re trying for a baby, and I’m going on 3 different vacations. I’m confident, but not because I fully expect my meds to carry me through forever. I’m confident because I’ve learned how to manage the impossible parts of my bipolar disorder.
Everyone’s bipolar is different. Some people have soaring and destructive manic episodes with a little sprinkling of sleepy depression here and there. Some go just as low as they go high. As for me, my manic episodes are short and cute, tied up in a bow and surrounded by a ton of harmless abandoned projects. My depressive episodes, in contrast, are electric and armed with machetes. During my lows, my mind starts to dip its toe into the psychosis pond. I start to feel presences, like I’m walking through hell, and at its worst I look at my husband and get the overwhelming sensation that he’s not real. Excruciating panic attacks where my amygdala basically explodes in my head have lead to all my hospitalizations. I say all this to stress the point that my episodes have felt impossible.
I battled my mind throughout all of the fall, but finally had a revelation during my 3rd hospitalization when I realized that I had no choice but to “coping skills” my way out of my panic-stricken lows. It happened after I had a complete meltdown in the hospital where I laid on the ground screaming and considered throwing pens at the nurses so I could get the immediately sedating “booty juice” shot they save only for the most agitated and violent patients. I ended up not getting the shot, but crawled into my bed and visualized the raging fire in the center of my brain shrinking into embers and smoke like my life depended on it. To my surprise, it actually worked.
I spent the next few days in the hospital reflecting and it occurred to me that the reason I was having these horrendous brain cramps was because my brain was under-active and over-stimulated. I was pushing myself too hard after going on new medications with the expectation of a quick fix and not gently transitioning in harmony with the meds over time. I researched what goes on in the brain during depression and saw images of brain scans with very little lit-up areas. I read about how it takes the brain around six months to fully cognitively recover from an episode even after it ends. My rogue amygdala was in control because my pre-frontal cortex had gone offline. I was trying to make my brain figuratively walk on two broken ankles and it wasn’t working.
I spent the rest of my hospital stay in a state of meditation and gentleness, taking all of my PRNs to reinforce this idea of creating a spa-like nest for my weary brain to recover from the literal brain damage that depression was causing it. Meanwhile, I was titrating up Lithium, a medication known for the longevity of its efficacy. I started to feel it working while in the hospital, but I didn’t leave just because my meds were working. I left because my meditative brain care was also working. When I ran into mental roadblocks at home, I’d close my eyes and tell my brain “as long as it takes, I’ll give you a safe place” and it would de-escalate the “me vs. my brain” dynamic. I kept my house tidy with candles lit and soft music playing. Baths, dim lights, lavender diffusers, and low stimulation at all times. I stuck to a gentle routine centered on gardening and light-hearted Netflix shows. Certain kinds of meditations helped and others didn’t, I stuck to what worked. I noticed that the more I did this, the quicker my depression lifted.
The idea of rest and gentleness doesn’t seem to click with the concept of “endurance,” which brings up images of people running marathons and relying on strength and resilience. Us bipolarities are told to “be strong” and “push through” when what we really need is deep rest and radically gentle brain care. I also credit lithium for getting me most of the way, but this idea of radical brain care has given me the confidence that if my meds were to stop working again, I could endure until the next combination.
There’s also a philosophical side to the idea of endurance when you have Bipolar Disorder. Episodes are mostly inevitable and it’s hard to trust in the idea of longevity. Episodes can stop everything. Jobs, marriages, plans. The life re-building process after you’ve come back up to the surface/down to the earth is tedious. I’ve had to make goals that lend themselves to being put down and picked back up, goals which require belief in myself, my worth, and my story. I don’t know the key to believing in yourself, but I know it involves seeing other people’s stories of success and endurance and getting inspired.
So, I greet you from the land of euthymia, and reassure you that you getting here is not only possible, it’s probable. I hope that radical gentleness and perpetual spa-like brain care will help those meds kick in and build your endurance for the long haul.