The upshot is that we’re going to try doing what is to me a scary thing – changing my medication. I’ve been (I feel) pretty stable on Tegretol for a long time now but obviously with this recent change in my stability that belief needs to be reexamined.

So, over the next fortnight I am phasing out the Tegretol and phasing in Depakote aka Valproate semisodium (the posh name).

I’m having mixed feelings about this development. I’m pretty aghast that the tegretol is failing after this amount of time but I’m pleased that I’m not going to be put on Lithium which I have an unreasoning terror of. So – we’ll see what happens. Hopefully it’ll be a clean replacement. Fingers crossed.

When you are manic, it is too late. Everything seems like a brilliant idea and you feel like an unstoppable force put on the world to make XXX right (where XXX is whatever thing has popped into your head). Of course it never occurs to you that still being awake planning XXX in minute detail at 2:30 in the morning and that XXX is pretty much all you can think and talk about and that when others don’t share your enthusiasm they are slow witted idiots put deliberately in your way and that really the best thing to do is cut them out your life and hang about with the people who do see how your plan for XXX is brilliant and that oddly, you can’t seem to find anyone fitting that description and that is really fucking annoying…...etc etc etc.

That’s a bad place to be because the only way you can get back to normality from that point is through an enormous crash and maybe voluntary and involuntary committal (aka sectioning). Better to stop – or try – before that point is reached.

But it all comes back to insight into onesself. If I have a diminishing capacity for self insight which forms part of a build up to mania (which for me it does) then how can I recognise the truth about what’s going on with me?

The mood diaries help. No question. You can gauge your general direction fairly well and make an appointment with your doc or CPN to try and ‘head it off at the pass’ but what is even better than that is to look objectively at the reactions of the people you are speaking to. If they start to look cautiously at you, or are always changing the subject, take note – they’re trying to tell you something but without winding you up.

Best of all are people who know about your condition who will say, early on, ‘calm down and take a look at yourself. Something’s not right’. My wife has the phone numbers of my doctors just in case my insight has disappeared completely! Obviously this is something that should only be done with people that you trust inherently but for me, its a lifesaver.

Obviously the answer was ‘yes’ as I’m doing it right now!

I attended the MDF convention in London recently and heard some interesting stuff on the nature and science behind manic depression. Most interesting to me was the way manic depression, autism, tourettes and other things known to bless my family were described as spectrum conditions within one vast, overreaching spectrum of mental differences. This is something I whole heartedly agree with as it makes scientific sense as well as appeals to my own opinions on the humanity of mental illness.

Yesterday I was pleased to attend the first set-up and planning meeting for a local self-help group for manic depressives and their kin/spouses etc. This was a project I’d been toying with the idea of instigating for some time as although I work in a big city where a group exists, I live in a big town where no such group exists. It was heartening to see so many people turn up last night and I think we have the basis of a good group.

Its written by Jeremy Thomas who co-authored the fab ‘You Don’t Have To Be Famous To Have Manic Depression’.

To say that I enjoyed this book would not be the right word. It was excellent, don’t get me wrong, but enjoy is not the right adjective. It made me wince, laugh and brought me out in a cold sweat in equal measure. Thomas is – of course – a manic depressive and this book is about a young mans slow, unstoppable swing from minor mania to depression and back to full blown, florid mania again.

The truth is that despite the fact that I am not in the recording industry, the similarities in thought patterns, rationale and reasoning – as well as the inexorable escalating mood swings and their destructive uncontrolled scything through relationships – are just too close for any real comfort. As a study of manic depression Taking Leave is brilliant. As a nice comfy read to curl up with – for me – its too prickly. that is not the authors fault, he has done his job perfectly. However, its just too unsettling for me to say that I enjoyed it. I battled through it, enjoying the highs vicariously and remembering the damage I have personally caused as I read about Tim’s destructive path.

Highly recommended but if you are manic depressive, I would be prepared to suffer a bit.

This is referring to a study in the Archives of General Psychiatry. The conclusion of the study is:

There has been a recent rapid increase in the diagnosis of youth bipolar disorder in office-based medical settings. This increase highlights a need for clinical epidemiological reliability studies to determine the accuracy of clinical diagnoses of child and adolescent bipolar disorder in community practice.

Just like in another mental difference that touches my life, this increase in diagnosis has occurred during the early 90’s to early noughties. To what might we attribute that?

On a purely pragmatic level we can say that, these results were found because that’s where the study team looked. I know of a group of people who will fasten onto this as more ‘evidence’ to support their conspiracy theories about the evils of vaccinations.

However, the study team are taking a much more skeptical line here. They are essentially saying ‘well, lets go back and make sure that diagnosticians at the ‘coal face’ are giving the right diagnosis to these youngsters’. That seems an eminently sensible approach to me. Its not intended to cast aspersions on anyone’s diagnosis or on anyone’s skills as a diagnostician but merely to practice good science and make sure this very basic step is covered.

One of the fascinating things the New York Times article highlights is the differences between the US and UK experience of epidemiology. The New York Times states for example:

Until relatively recently, it was thought to emerge almost exclusively in adulthood.

Whereas in the UK, it has been accepted for some years that:

....the average age of onset is early adolescent to early twenties.

I received my initial diagnosis in my early adolescence.

The NYT goes on to say:

Other experts say bipolar disorder is overdiagnosed. The term, the critics say, has become a catchall applied to almost any explosive, aggressive child.

This is an odd statement. Explosive aggression on its own cannot be used to diagnose manic depression. If it really is the case that US kids are being diagnosed with Bipolar I or II based solely on ‘explosive aggression’ then it is indeed recommended that their cases are re-examined.

Most children who qualify for the diagnosis do not proceed to develop the classic features of adult bipolar disorder like mania, researchers have found. They are far more likely to become depressed.

This is troubling. That these kids need help is beyond question. That they are getting the right help if they’re being treated for manic depression if what they really have is clinical depression is an open question. People being given mood stabilisers know the effect they can have on ‘uppers’ such as Prozac. Its not a good effect. These kids need to be accurately assessed, not just shotgunned into bipolarity.

So, I am never fond of this time of year. I love the summer. Not the heat. That is uncomfortable. But the sunshine, late nights and open-window-being-outside-all-dayness of it all. Its a time that I can usually not worry at all about the encroach of severe depression.

But now, already, I am aware that the nights are drawing in. The curtains stay drawn for longer in the mornings and there is already something of a chill in the air as I walk to the train station. This means I have to start being vigilant. I need to make sure that anti-depressants I take are all present and accounted for and are still doing the job. I need to have a round of blood tests to make sure that the Tegretol isn’t playing havoc with my blood cells.

In other words, its time to take stock and, not batten down the hatches exactly, but make sure the storm cellar is well equipped and that the latches on the door is well oiled. Its also time to make sure that this bad boy is still working.

The sun season is over for another year. Such is life, but its been a short, short summer this year.

Looking back on those times now is painful. It takes an effort to think about them, never mind write about them and for now, that pretty vague paragraph is about the best I can manage.

However, where I am right now – and have been for over a decade – is much better. I am not ‘cured’. I still have to be careful. I have to watch my moods. I have to be realistic. There are three things that help me.

Medication. Its not a cure, its a way of stabilising moods. The actor Richard Dreyfuss talks about his medication in a similar way to how I feel about it – with relief. I am lucky enough to be settled into a particular medication that a) I tolerate pretty well and b) does what it should. I know I am lucky in that respect. Lots of manic depressives are still struggling to find the right medication for them.

My kids. Having children is a gift. If I was ever to believe in a god then I would think that having the three kids I have would be proof that I was in their favour. Each of them has something that reminds me that it is a good idea to be stable. They need me to be there in every way and so any temptation I might ever have to stop taking medication (and sometimes it does get very trying) disappears when I think of them.

My wife. In a fortnights time we will have been married for 10 years. During that period my wife has been like a port in a storm at times. Whenever I have a situation that exacerbates my condition she is there to help me keep grounded. If she thinks my moods are beginning to cycle in that ominous way that heralds the start of a true cycle of mixed state/mania/depression then she makes sure I know about it. She’s there to give me insight into my condition when I lack it. The words ‘thank you’ and ‘I love you’ have become trite lines in crap pop songs but they are the least my wife deserves to hear. I owe her a debt of gratitude for literally everything good in my life.

As well as the anger, my sleep has been affected. I am sleeping poorly. I want to sleep well but I frequently find myself awake way past 1am. These two things in conjunction with each other are a dangerous combination for a manic depressive. They can quickly escalate and the next thing you know you’re trying to scale Nelson’s Column in the middle of the day whilst dressed in a tutu and wellies. No, I haven’t actually done that but you catch my drift.

So, for the next few weeks I am back to tracking and recording my moods and sleep. No big deal but always there is that niggling fear at the back of your thoughts and you find yourself checking your wallet for the presence of the correct phone numbers you may need. Or your wife might.

Handled in the right way this simmering fire can be harnessed and yield great results. This is the double edged sword of mania. The feeling of ‘hold on now young feller me lad’ as your mind revs up like a Indy 500 car seeing the safety car drive off the track for the last time and the knowledge that you could be very, very creative and productive right now.

Luckily for me, the medication that I take I am stable with, both in terms of its stabilising effect on my moods and that I tolerate it well. This is a non-issue for me. Stable is good. Mood swings are not therefore medication (for me) is good. Creative fire is good, no doubt about it but fire can burn and so I elect to strive for a damped down fire that offers plenty of heat but not enough heat to engulf and kill.