Long-term uniform mild mood disruption is not good enough. Or is it?

moodchart

People who experience mood disorders, like unipolar depression and bipolar disorder, are most intensely monitored when severe mood disruptions are occurring, such as moderate-severe depression, moderate to severe mania, or episodes with mixed features. Also of deep concern are labile moods where the afflicted quickly cycle between various mood states. In the case of bipolar disorder, this would mean mood fluctuations between depression, hypomania/mania or mixed states within short periods of time (i.e. hours, days or weeks). But what happens in many of these peoples’ treatments when the mood state is uniform/level, but not severe, and yet not completely considered stable either, like in dysthymia or mild hypomania.

I can’t speak for all patients with unipolar depression or bipolar disorder, but many of my psychiatrists have stopped making medication changes at times when I reached long-term uniform mild moods, like mild depression or even mild hypomania. My current psychiatrist stated once that it was time to wait for slow changes to happen on their own over time, hopefully for the better, and not risk further mood disruption. The suggestion was to use therapy to “finish the job” and help ensure long-lasting stability. His argument was also that adding more of a certain medication could have the result of pushing me too far in the wrong direction. I’ll admit that similar trials in the past did have that effect, but at the same time being stuck in mild depression is not where you want to rest for too long. Mild hypomania (for bipolar patients) perhaps isn’t too bad, as long as the mood state does not progress upwards over time, or cause an eventual crash into depressive mood states.

One never knows if mild depression or hypomania will be long-term, but I can say that I personally have experienced these states lasting months on end. In mild depression, I have employed therapeutic steps to raise my mood more naturally. Challenging dysfunctional thoughts, pushing myself physically (they say that can help), struggling to improve my lifestyle, and making efforts to include simple or larger pleasures into my days to lift my moods. Have these things worked at times? For me, they have sometimes, but not always. Also, sometimes I found it easy for my mood to fall back to the mild depression, and through frustration became resigned to the state.

irritabilityMild hypomania can yield pleasurable experiences. Feeling more energy and motivation than usual, mild elation, having endorphins flowing. As long as this state doesn’t include too much irritability or agitation, it may be considered a most ideal mood state to live with. In fact, I have known a few people with bipolar disorder that strive to maintain this state. I, myself, have had a long history of long-term mild hypomania, so much so that my psychiatrist once said it was my “baseline” mood. But as I mentioned, this state is not always a bowl of cherries. Irritability with outbursts and agitation can become present. Such characteristics can get you in trouble in many ways (impulsivity, outbursts), even at this mild level. Sometimes the prolonged state eventually causes some people to self-medicate with substances like alcohol or sedatives to improve sleep or wind down. That’s what I did in the past. I never found therapy that helpful in these states, though grounding techniques have been said to be helpful at times. My psychiatrist has given me prn “as needed” medication supplies that can help calm hypomania…if I take them.

seesawIt can be a great struggle for many people with mood disorders to find that happy medium. Perfect stability with the mood “seesaw” parallel to the ground takes a lot of work, and some luck, too. Of course that is the goal for most doctors and most patients, but for many it is almost a utopian place to be. Maintaining that position long-term is even harder. Regardless of the challenges, complete long-term stability is what needs to be reached for in mood disorders. I do think we have the right to expect it.

Save

15 thoughts on “Long-term uniform mild mood disruption is not good enough. Or is it?

  1. Kerrie June 6, 2017 / 8:43 am

    Hi updownflight! I have the good fortune of a psychiatrist who was adament about getting rid of all symptoms, and I’m glad she persisted! I have a friend with MDD, though, whose doctor believes it’s good enough that he’s back to work and won’t change his meds even though he is still depressed and suffers angry outbursts as a side effect of what he is on. His doctor clearly doesn’t care for his quality of life, just that he can work. I think that’s very sad, so I agree with you that it’s not good enough!

    Liked by 2 people

    • updownflight June 6, 2017 / 1:02 pm

      Thank you, for sharing about your friend, Kerrie. It must be very hard for him to work with continuing symptoms. I hope he gets more and better treatment soon.

      Liked by 1 person

    • bipolarsojourner June 6, 2017 / 7:01 pm

      that’s a crime. i spent a year and a half not deeply depressed but not anywhere close to where i wanted to be before i realized i wanted so much more. moderate depressive is still a jail. the jail door is open a little, but it’s hard to open the door enough to escape. sadly, i haven’t got out yet.

      Liked by 2 people

      • updownflight June 6, 2017 / 7:44 pm

        I’m sorry to read that you’re still struggling to get where you want to be mood-wise. I struggle more often than I’d like, too, which is why I wrote this post. I do have plenty of stable days, but I get occasional mood lability. Enough to the point where I’m not confident to get back to a “normal” life working outside of my home. It’s hard for me to know if I should be cursing my bipolar disorder, or if I should be pressuring my psychiatrist more. I have had conversations with my doctor about this. He emphasizes that I should really get a full year stable before making major triggering moves. I wonder if I’ll ever manage to clock enough hours to reach his goal for me.

        I plan to keep making baby steps forward whenever I can. I suspect that that may very well be helpful in the end. I do think that therapy does/should play an important role in finding long-term stability. I don’t think chemical treatment alone is often perfect at doing this. Just my view, but it doesn’t make my frustration any less. It’s really hard work!

        Liked by 1 person

      • bipolarsojourner June 6, 2017 / 8:24 pm

        getting back to normal is only a distant dream, right now. it’s been 6 1/2 years since i’ve dipped my toe in the pool of normalcy. to think back to how horrid i thought my 6 month cycles were.

        Liked by 1 person

      • updownflight June 6, 2017 / 8:28 pm

        My past is pretty horrid, too. I’m happy with how much I’ve improved, but “normal” is not where I think I am yet. I’m still on disability. The thought of working outside my house is still frightening. It used not be like that at times of my life. Although I’ve had bipolar episodes since age 14, I had plenty of time up until 30/32 that I felt “normal”. I wonder, though, am I ever going to obtain THAT “normal” again? Or do I have to accept the new normal people sometimes write/talk about?

        Liked by 1 person

      • bipolarsojourner June 6, 2017 / 8:43 pm

        expect for adding a decade or so to your numbers: ditto.

        i used ditto with a younger person recently and their reply was, “what?” maybe i could make him watch ghost. lol

        Liked by 1 person

      • Kerrie June 6, 2017 / 11:42 pm

        I think it’s sometimes difficult for us when we’re trapped in that mild to moderate state because it can feel like a vast improvement from severe and when it goes on for so long we forget what normal (or should I say lack of symptoms) feels like too. It’s only once the mood episode is completely gone that we can truly appreciate what we’ve missed out on by not pushing for more recovery. I think doctors have an important role here because while we’re in a mood state we can’t always judge correctly what is best for us or what we want.

        I can definitely see how doctors want to be cautious because our moods are fickle things, but I think a whole year (as you describe here in your post updownflight) is far too long to wait. I agree with you bipolarsojourner, moderate depressive is definitely a jail and I’m sorry you’re still held there right there. ❤

        Liked by 2 people

      • updownflight June 7, 2017 / 12:07 am

        I know that I’ve never made it a full year without at least a short significant episode, but yes, if I always try to wait for a year of stability before making next steps I’ll perhaps never go anywhere.

        Liked by 1 person

      • bipolarsojourner June 7, 2017 / 1:56 pm

        thank you much for you empathy. it is nice to converse with someone who “gets it”.

        sometimes my depression is a blessing and sometimes sometimes it a curse. it is a blessing for what depression teaches me, for what i learn, and hopefully share with others to ease their pain. it’s a curse when i see no way to loss the shackles that bind me, feeling like there is no escape. i’m mostly in curse state right now pissed off by 6 1/2 years of depression. that’s about 12 times longer than any of my previous cycles.

        I just want to be free, again. i tire of being part of the “in” crowd.

        why the hell did i get this sentence. i don’t deserve it. no one does. if clearly qualifies as cruel and unusual punishment when some malady can take someone so close to the razors edge, to taking one’s own life. that ultimate act robs the world of gifts that will never be seen, again.

        Liked by 1 person

      • updownflight June 7, 2017 / 2:28 pm

        I don’t know why depression has to last so long despite medications. I guess the medications just don’t completely cut the mustard.

        I’m not always depressed. Sometimes I’m a little manic, and a lot of times I’m stable, but I’ve not been stable for a full year or more in more than 13 years.

        Let’s hope we finally get a break!

        Like

      • bipolarsojourner June 7, 2017 / 5:32 pm

        on medications, there effectiveness is ruled by our genes. there 19000-20000 genes in your body. think of them as light switches. these light switches control how body reacts and acts. have the right switches on, you have a drop dead gorgeous body, even after babies. have the wrong on switches on and your changes of certain cancers shots to nearly 100%.

        let’s do a simple drug study that effects the processing of a single gene. if that switch is on, the drug is 80% effective. with that switch off, the effectiveness of the med drops to less 10%. this drug would be a miracle drug if your switch was on, and basically useless if your switch is off.

        most drugs interact with at least 10 gene switches. for simplicity, let’s do a drug test with 4 genes. perhaps the drug is pretty effective if gene 3 and 4 are on, but if gene 1 is on, the effectiveness jumps. if gene 2 is on, the drug becomes completely ineffective. this is overly simplified but i hope explains genes effectiveness of drugs and why a drug may work for one person and not another.

        there is also environment to consider. i’m taking a drug that is suppose to increase the production of cells. one of the b vitamins is also important to cell production. if i’m deficient in that vitamin, it would be like a auto plant with plenty of bodies but no dashboards. not many cars will make it out of the plant.

        consider drug interactions. maybe one drug would be completely ineffective on its own. a second drug gets introduced that works with different switches and the two drugs together are very effective or create lousy side effects.

        sometimes drug get “repurposed”. viagra, under a different name failed miserably as a heart med. in the testing, they noticed it worked pretty wonderfully with ed. they slapped a new name on it, put heart condition warnings on the boxes and they were good to go.

        i wish that it would be as simple as >>poof!<< make a new drug and it will work for everyone. it isn't. i hear your frustration with meds as i have the same frustration. I wish there was a silver bullet and all would be cured, well, and least you and me :-). Unfortunately, the silver bullet doesn't exist.

        Liked by 1 person

      • updownflight June 7, 2017 / 5:46 pm

        Your comment here was very interesting and informative. Thank you for sharing this. I definitely experienced some medications that worked well and others that did nothing. I also experienced how some medications in combination can do very well, but in other combinations or alone not.

        Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s