Outside a cacophony of birds outside loudly pronounce that they have important work to do, nests to build, eggs to lay, offspring to bring into the world. Spring has sprung. The sun is bright. The season of rebirth is here. Hypomania is officially here, as well, folks. Yes, I have concurrent bipolar disorder and seasonal affective disorder. In spring, I ramp. Ramp I do indeed. Perhaps it’s a good time to visit my psychiatrist. Perhaps I do not need to take an antidepressant on top of my mood stabilizer now.
Near midnight, I resort to taking clonazepam to fall asleep. In fact, just one dose won’t do it at times like this. I lie in bed, then take a second pill, the bottle of which I keep bedside for just this purpose. I even chew the pills so that I don’t have to wait for my stomach to digest them. I want sleep. I need sleep. I beg the mucus membranes in my mouth to quickly absorb the medication into my bloodstream. Then, I lie in bed some more, mind hyper-alert, body fatigued, and finally go to the medicine cabinet to add melatonin and antihistamines to the mix, hoping that now I can somehow turn off that brain and rest. Past midnight, my mind is wide awake thirsting to get back online and work, which does not help, not at all.
To top things off, tomorrow – Tuesday morning – I have a Social Security Disability Mental Status Exam. Oh, joy. Yes, I am anxious. Crap. Very anxious.
Worst of all and perhaps what I should have led with, one of my brother-in-laws is fighting for his life and perhaps losing the battle against lung cancer. He is still in his 50s. He is one of my husband’s two older fraternal twin brothers, both once Marines. My husband has always looked up to his older brothers and turned to them for advice on how to fix things. They looked out for him when he was a kid. My heart goes out to my husband who is in great pain. Someone he loves dearly is dying, will be entering hospice care soon, and he can do nothing to fix it, to make his brother’s pain and cancer go away. I can do nothing to fix it. All we can do is love, pray, and reach out to share that love and those prayers.
September 2013, I started writing this blog when my father in law was hospitalized for sepsis. We almost lost him, but he is still with us today, thank God. Crisis, my inability to do anything to help with the crisis – aside from loving my husband and praying – triggered my hypomania then.
Now, a little technical know-how on the seasonal triggers of mood cycling:
Is seasonal affective disorder a bipolar variant?
Seasonal affective disorder (SAD) is an umbrella term for mood disorders that follow a seasonal pattern of recurrence. Bipolar I disorder (BD I) or bipolar II disorder (BD II) with seasonal pattern (BD SP) is the DSM-IV-TR diagnosis for persons with depressive episodes in the fall or winter and mania (BD I) or hypomania (BD II) in spring or summer.1
Table 1: DSM-IV-TR criteria for seasonal pattern specifier*
Table 2: Physiopathologic findings and clinical management for SAD vs BD
Proposed mechanisms for seasonal affective disorder
Etiologic hypotheses of seasonal affective disorder (SAD) include:
photoperiodic hypothesis (shorter winter days cause SAD,a perhaps mediated by a summer vs winter difference in duration of nightly melatonin release)b
phase shift hypothesis (less available light in winter may lead to an inability to synchronize circadian rhythms with sleep/wake rhythms).c
Some case studies of rapid-cycling bipolar disorder (BD) suggest that mood is correlated with daily hours of sunshine and light therapy is antidepressant. Rapid-cycling patients may be hypersensitive to day-to-day changes in photoperiod, analogous to mood changes in response to changes in photoperiod across the seasons in SAD.d
Circadian phase delays–in which internal rhythms lag behind the sleep cycle–are correlated with symptom severity in BDe and are implicated in the core pathology of BD.f Phase delays also are present in some individuals with SAD and are associated with severity and treatment response.g Preliminary evidence suggests that variation in circadian clock genes is related to both BDf,h and SAD.i
Source: For reference citations, see this article at CurrentPsychiatry.com
Etiologic hypotheses for both BD and SAD propose that an external event (life stress in BD; decreased photoperiod in SAD) leads to circadian dysregulation and, in turn, mood episodes. Circadian-related hypotheses for SAD and BD are supported by evidence showing efficacy of treatments that manipulate behavioral and circadian rhythms.
Source: Curr Psychiatr. Author manuscript; available in PMC 2010 May 21.
Published in final edited form as: Curr Psychiatr. 2010 Feb; 9(2): 42–54.
[…] those with depression and bipolar disorder. For those of us with bipolar disorder, SAD can trigger mania and hypomania. The stressors of these changes contributed to my psychiatric hospitalization a decade […]
Thank you, Ellen.
I certainly seemed agitated during the interview.
Thank you, Sheri.
Now I wait and see if I maintain my disabiiity benefits. i think my hypomania was evident.
First off, good luck with your SSI meeting! Secondly, I get depressed when Spring comes. I love Winter. Winter is like MY season. Nobody else seems to like it so it feels like my little secret. When the weather is bad and everyone is begrudgingly cursing it, I’m over here smiling because it’s snowing yet again. I don’t know what that’s about. Internally when Spring comes I’m depressed for a long while. Into summer. My body loves it though. The warmth and the sunshine. No more driving to and from work in the dark. I secretly don’t like Spring though.
I’m weird probably. I wonder if there is anyone else like me?
Very good information 🙂
[…] Fellow blogger-friend, Kitt O’Malley (and what a foin Irish name, that is) just posted a clinical piece about the relationship between BP and Seasonal Affective Disorder (SAD). It was the first thing […]
Good luck tomorrow, Kitt!! I didn’t do your recent survey because I couldn’t think of anything to say but these are the kind of pieces of yours I love– the personal ones.
So it is 3AM and I have gulped down many pills and am wide awake, posting and ruminating and worrying and trying to just “be” and freezing my ass off because it is 12 degrees and snowing and the heat is off. So your post is timely.
I lost my brother to lung cancer 3 years ago and it was very,very tough. One deso feel so helpless. I wish you strength and courage and the same with the father-in-law situation. I learned Reiki to be able to do something in these situations and my brother said it helped him some– this was huge coming from him– but prayer is the best bet, I think. Sending you a hug, Ellen
Wow. So timely. I’m up at 1:30 am after 4 hours of sleep and much of the pill-crunching you described. My therapist and I are actively addressing the SAD part this year (after finally recognizing that piece). It’s very mixed-state for me–insomnia and agitation with the deep depression.
I sympathize with you and your husband. There’s no fixing this. All you can do is be available, if you can, and if Brother and his family are nearby. Otherwise, it’s all about coming to terms.
In your present state, I can’t imagine that your SSDI interview will be questioned at all. Take heart in that, at least.
Wow, you’ve.provided a lot of information, Kitt. So sorry to learn of your brother-in-law’s illness. I also know of the whirling thoughts at night. I’ve had insomnia for years and you are so right, it sucks. Please remember to be kind to yourself.
Wow, light therapy can cause switching?
You learn something every day.
I feel compelled to write something about your brother-in-law, but what can you say?
In the face of death words reveal themselves as banal. Well, my words do at least.
It might not be the end of the universe but it’s the end of a universe.
My dad went out the same way. Another Marlboro man riding off into the sunset.
Best of luck with your crazy test. I guess you’ll be up all night swotting with Kafka and Catch-22.
Oh, that’s right. Bureaucrats think that kind of stuff is perfectly normal.
Maybe Jung’s Red Book is a better study guide.
Thank you, Dyane.
Good luck with the disability status exam tomorrow! I’d be anxious too! You know how freaked out I got simply with my disability paperwork. I agree with you that a check-in with your psychiatrist is wise. You absolutely need to get your sleep, as do I and it sounds like the medication needs to be tweaked. After an email exchange with my psychiatrist last week, I raised my Seroquel to help with sleep. It’s helping, but then I am more groggy during the morning, but it’s worth it if I can sleep more. I’m glad you’re aware of your seasonal patterns; many people are so out of touch. Finally, my prayers are going out to your husband and your brother-in-law and always, always to you.
Thank you, Terri. Bless you.
Great information, Kitt. I can’t imagine what you have to endure with Bipolar Disorder. I’ve had bouts of SAD over the years but they are predictable. With all the sun we’re having in Northern Cal, I’m way over any SAD symptoms. My daughter suffers from anxiety and some depression (she’s 27 and finishing college), so I get a glimpse of her state of mind. Keep praying!