Up? Down? How About Both At Once?

People who live with bipolar disorder grow used to – or at least familiar with – the cycle of manic highs and depressive lows. But what happens when the highs and lows come closer and closer together? What happens when they both occur at the same time?

There are various answers to that, depending on whom you ask.

Closely spaced highs and lows are known as rapid cycling. Technically, the Diagnostic and Statistical Manual (DSM) defines rapid cycling as four or more bipolar episodes within 12 months.

I don’t know about you, but that doesn’t feel rapid to me. I regularly experience four or more episodes a year. My mood swings can occur within weeks or sometimes even days of each other.

A new classification – Ultra Rapid Cycling (URC) – fits better with my experience and those of other people I know who have bipolar disorder. In URC, the person experiences “24 distinct affective episodes per year, each fulfilling duration criteria and separated by identifiable recovery periods.”

That works out to twice a month. Most months, unless I’m in a severe depressive episode, I usually manage to hit that mark.

The term – and the concept – are controversial, as it does not appear in the DSM. Some experts fear that is used too casually and without precision by those who aren’t qualified to diagnose it. Still, the term URC has become more popular since it appeared in the 1990s.

What’s even more in line with my experience is the mixed episode, also called an episode with mixed features, defined as “meeting the diagnostic criteria for both a manic episode as well as a major depressive episode nearly every day for at least a full week.”

Basically, that means experiencing depression and mania (or in cases of bipolar 2, hypomania) at the same time. What that is, is miserable, uncomfortable, confusing, frustrating, and exhausting.

My diagnosis is bipolar 2 and anxiety disorder, so I rarely get the exuberant flights of mania or even hypomania. Instead, my psychiatrist informed me, my hypomanic states “come out sideways,” as anxiety. And when I’m in a mixed state, I’m both depressed and anxious.

It seems like those two states of mind would be impossible to have simultaneously. Depression, after all, is characterized by, among other symptoms, not caring about much of anything. Anxiety involves caring too much about events that haven’t yet occurred. How can they coexist?

They don’t, exactly. Depression immobilizes me. Anxiety makes me feel like I’m going to jump out of my skin. I can accomplish both of these while lying in bed, and not wanting ever to get out.

It seems to me that the link between the states of depression and anxiety are intrusive thoughts. Before I was even diagnosed with bipolar, my depressive symptoms included that nasty little recorder in my brain that played back every stupid or embarrassing thing I’d ever done. This happened at random moments, apparently not triggered by anything like feeling stupid or embarrassed at the moment.

They were more than intrusive thoughts; they were intrusive memories – not extreme enough or distressing enough to be termed flashbacks, they seemed designed to make me more depressed by emphasizing how bad I was at the skills of living and socializing.

Nowadays my intrusive thoughts are more of the impending disaster kind – that we will be wiped out financially and end up living under the Third Street bridge and hoping to find discarded containers of cold french fries. If I wasn’t depressed already, that would surely do it.

Fortunately, among my prescriptions is an anti-anxiety medication. My psychiatrist allows me an extra pill if my anxiety disorder is unusually troublesome. I have also begun learning to use mindfulness/visualization-type techniques to banish the intrusive thoughts (I wrote about these recently in my blog).

Keeping my depression and anxiety separate seems to me a positive mini-goal along the path to my larger goal of eliminating both of them, or at least reducing the number and severity of such episodes. Any step I can take in that direction is a good one.

Read more of Janet’s posts here.

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