writing and hypomania

Back to thinking about my week of frenetic writing. I think I definitely had enough of the criteria for a hypomanic episode. Elated mood, decreased need for sleep, increased involvement in goal directed activity (writing to get read and published online and to make money), irritable (especially when my boyfriend tried to get me away from my computer), subjective experience of thoughts racing (flight of ideas), pressured writing (pressured speech), overconfidence (inflated self esteem).

I was staying up most of the night writing, and writing most of the day. I normally don't write much and it takes a lot of effort. This didn't. I had so many ideas, and I had to write them all down. And other people had to read them! I thought that my ideas were very important. I thought I was great for writing this stuff. I thought I could make lots of money. I just had to keep writing. I didn't miss sleeping, I felt energised. I didn't think it was weird or unusual at the time, but it is looking back on it.

It could have just been me getting an idea in my head and getting excited about it. But it's the lack of a need for sleep, and the fact that it was so unlike me, that makes it stand out.

After I stopped writing my thoughts were still racing a bit, then I went on abilify. I thought it was great at first, my mood was great and I had so much energy. Then it just made me so anxious and agitated.

Risperidone calmed me down a bit. I didn't take it yesterday, and last night I was so agitated. Today I feel like I really could just lie in bed. The agitation might come later, though.

It was weird not waking up at 3am. I woke up at 7. I think 6 or 7 is a good time for me. The early waking was obviously just caused by abilify and has stopped now.

My normal pattern is staying up late. If, like in the week I was describing, I don't feel like I need much sleep, I can still get up in the morning and have energy. Otherwise, I just want to sleep all day.

I had such a good time just having coffee with friends last night. It's good to know that I have such good friends who will really support me.

ICD-10 criteria

http://www.fortunecity.com/campus/psychology/781/icd.htm
"F30.0 Hypomania

Hypomania is a lesser degree of mania, in which abnormalities of mood and behaviour are too persistent and marked to be included under cyclothymia but are not accompanied by hallucinations or delusions. There is a persistent mild elevation of mood (for at least several days on end), increased energy and activity, and usually marked feelings of well-being and both physical and mental efficiency. Increased sociability, talkativeness, overfamiliarity, increased sexual energy, and a decreased need for sleep are often present but not to the extent that they lead to severe disruption of work or result in social rejection. Irritability, conceit, and boorish behaviour may take the place of the more usual euphoric sociability.

Concentration and attention may be impaired, thus diminishing the ability to settle down to work or to relaxation and leisure, but this may not prevent the appearance of interests in quite new ventures and activities, or mild over-spending.

Diagnostic Guidelines

Several of the features mentioned above, consistent with elevated or changed mood and increased activity, should be present for at least several days on end, to a degree and with a persistence greater than described for cyclothymia. Considerable interference with work or social activity is consistent with a diagnosis of hypomania, but if disruption of these is severe or complete, mania should be diagnosed."

http://www.fortunecity.com/campus/psychology/781/cycloicd.htm

"F34.0 Cyclothymia

A persistent instability of mood, involving numerous periods of mild depression and mild elation. This instability usually develops early in adult life and pursues a chronic course, although at times the mood may be normal and stable for months at a time. The mood swings are usually perceived by the individual as being unrelated to life events. The diagnosis is difficult to establish without a prolonged period of observation or an unusually good account of the individual's past behaviour. Because the mood swings are relatively mild and the periods of mood elevation may be enjoyable, cyclothymia frequently fails to come to medical attention. In some cases this may be because the mood change, although present, is less prominent than cyclical changes in activity, self-confidence, sociability, or appetitive behaviour. If required, age of onset may be specified as early (in late teenage or the twenties) or late.

Diagnostic Guidelines

The essential feature is a persistent instability of mood, involving numerous periods of mild depression and mild elation, none of which has been sufficiently severe or prolonged to fulfil the criteria for bipolar affective disorder or recurrent depressive disorder. This implies that individual episodes of mood swings do not fulfil the criteria for any of the categories described under manic episode or depressive episode."

My current state

I'm back to feeling as agitated as I was before abilify. I feel kind of elated, though. I wish I could work on my assignment, but I can't focus. My mind is too crowded. I feel like doing things, not sitting here in the library. I have what they call psychomotor agitation, I think. Leg jiggling. Writing calms me down. I feel disjointed. I don't quite feel safe with so many people around me.

I experienced such a rush of euphoria while I was exercising this morning. I embraced it. I woke up at 3am but I feel energised. Part of it must be a lack of sleep, and because I went to the gym this morning. I think sleep deprivation and exercise can make me more energised or agitated.

I guess I also feel anxious in this agitated state. Maybe it's still the after-effects of abilify, but it's different somehow. I feel clear. My mind is clear yet it is crowded. It doesn't really make much sense. I feel like I'm slipping into insanity.

For hypomania, "the change in functioning for some individuals may take the form of a marked increase in efficiency, accomplishments, or creativity. However, for others, hypomania can cause some social or occupational impairment."

Occupational impairment... does that include not being able to study?

I'm a lot more efficient at some things in this state, like exercising and writing. I can't write anything to do with my assignment, though. I don't feel that worried about uni at the moment. I feel that all will be well, unless of course I can't calm down.

Sometimes I feel this rush that reminds me of the effects of ecstasy.

Anyway, I feel like I can't calm down or slow down at the moment. I feel sort of like I've taken stimulants.

I have intrusive and vivid thoughts. I've always had those. I sometimes feel paranoid in public. My extreme fears/phobias seem to come from intrusive, vivid thoughts. They're not so much phobias, because they are fears about situations I don't actually find myself in. Situations that will probably never happen to me. They are more like obsessions. I can imagine such horrible things happening. The first thing was just death in general, when I was very young. I felt I could imagine what death would be like. I guess this what at an age when I didn't really understand death. I thought of it as unconsciousness, and then I associated sleep with death and sleep seemed scary sometimes. I also pictured the end of the world. That was an obsession for me, for a long time I think. It started when I was around ten. It may have been related to the religious ideas I'd been exposed to. I thought about it all the time, and it scared the crap out of me. Then, in 2008 I became obsessed with my fears of flying and surgery. I knew I didn't have any plane trips or surgery coming up (I've never even had surgery), but I thought about it a lot. I pictured these bad things happening.

agitation

Agitation and depression. The two most horrible things. When they occur together, it's most horrible. Agitation is like having a lot of energy, but in a bad way. It's the reason I'm writing and not reading or watching tv or doing something else relaxing. Maybe having energy is good when it's energy that can be put to good use (because you can still focus on things) and when it's energy that can be exhausted. It's also not just having the energy to do things, it's a constant pressure to do things. It comes from inside. I don't necessarily want to do anything but I have to. I have energy in my head but I can't so much with it because I can't focus. I can't sit down and focus on one thing for too long. It makes it hard to read a book or work on assignments.

In this state I think that I would rather be depressed, but of course I would think that now.

I thought the agitation was caused by medication, but obviously not.

In the past I've had a lot of energy, but it felt good. I felt driven to do things, but I also wanted to do things. I think "yeah, I was doing so well in 2007". It was the year before I became severely depressed. I was so HAPPY. I had so many friends, and oh how I loved my friends. I worked, I partied all the time, I exercised so much at the gym. I was just so freakin happy. I thought everyone loved me. I didn't bother with things like studying. I didn't get depressed after a night of heavy drinking. Having a hangover was just a relaxing day. Drinking was an ecstatic experience. So was dancing. When I went out dancing I could picture myself doing it forever. It seemed like the most important thing in the world. I felt attractive, alive, charismatic. All this is actually very unlike me. I change a lot, I guess. I miss that person, though. I miss being like that. I thought things would be that way again. I just miss feeling that way. I was on top of the world.

Was this some sort of pathology? Was I actually hypomanic, instead of being a normal, outgoing woman in her early 20s? Normal... no. Not normal for me. Maybe normal in that I've experienced these shifts in my social functioning before. Am I shy or am I that outgoing, confident, social, talkative person?

I remember feeling high sometimes, as if I had taken ecstasy. I didn't need drugs to get high. I just needed some music, some people and some booze. I've been chasing that high. I still go out dancing sometimes, and I wonder what happened to my high. It's not that I'm depressed, I just can't believe the huge shift in my experience. Of course, I'm older now. These things get less fun.

So maybe agitation is just energy without the high. Anyway, it sucks. But everything shifts, nothing stays the same. Maybe tomorrow I'll feel normal and subdued. Or maybe I'll have positive energy and try to write a book. I'm just so glad I'm off the abilify and I don't have to put up with that level of agitation and anxiety. I feel so much better now. No drugs. I'm supposed to take risperidone tonight.

Why am I being prescribed these drugs? I really don't understand. Maybe the doctor has some theories he's not telling me about, or maybe he just likes these drugs a lot. I certainly don't think that people are usually prescribed antipsychotics because they have anxiety. At least he didn't put me on another antidepressant. Well, which is worse? I don't know. I don't want to take anything, I don't want side effects on top of symptoms. It's too hard to know what the drug is doing to me. I feel so much clearer without any drugs.

Hmmm... risperidone. Should I try it? Just so I can say I did? It will just knock me out and make me feel weird. How can I possibly believe that it could be any different?