One of the more disabling aspects of bipolar disorder, for me, is fluctuating energy levels. I’ve learned that this is a key aspect of my disorder and is often (not always) at the root of many of my symptoms. However, I don’t believe it is as simple as that for many of us, unless one has an extremely “classic” form of bipolar disorder, which seems less common that once thought.
In an article on MentalHelp.net, energy levels in bipolar disorder are emphasized. It’s a fairly simple explanation, in terms of causation of various mood symptoms, though I see it as a starting point in understanding the complexity of how bipolar disorder affects many sufferers. It reads:
“Although popular culture tends to equate mania with happiness and depression with sadness this isn’t really the best way to think about what is happening in bipolar disorder. Bipolar Disorder involves not so much a swing between happy and sad states, as it does a swing between high and low energy states. When in a high-energy state, people appear happy because they are motivated and excitable, whereas in a low energy state, people feel sad, and lack motivation and enthusiasm. As the energy level of a manic episode increases, the early happy mood tends to degenerate into a more agitated and psychotic state which may be experienced more as terrifying than happy, but which is nevertheless very energizing. Similarly, as a depressive mood state increases, people may go from merely feeling badly about themselves to literally not being able to leave their bed. Thus, the happy and sad moods that are thought to characterize mania and depression respectively are results of different energy states and not necessarily primary features of the disorder.”
The above explanation neglects to mention the irritability, agitation, and/or anxiety often experienced in high energy levels. I mean, if I’m charged up, yes I am often elated, but of course also sometimes have aspects of fight or flight, and/or mental breakdown of some sort (i.e. psychosis, confusion, and even catatonia). The relationship between low energy and depression is also not so straight forward, in my view. And what about symptoms when energy is otherwise seemingly normal?
Not all of the symptoms?
Has anyone else out there with bipolar disorder had extremely low energy and motivation, but not really felt depressed in the sense of feeling hopeless, sad, low self-esteem, or the like? And didn’t have any other medical condition or explanation for that state? I can say that I definitely have. I sometimes have extremely low motivation, stay in bed all day (can’t or barely work/study), want to sleep too much, don’t do sufficient self-care, perhaps yearn to self-medicate the low energy, and yet my mood is…pretty good otherwise. Am I stable in these cases? If so, why am I otherwise feeling disabled to a partial or full degree?
Symptoms don’t seem to match?
Then there are mixed states where energy levels and moods don’t match what that MentalHelp.net paragraph describes. I can also have major league energy, but feel hopeless, desperate, frustrated, low self-esteem. Or have zero energy, but my mind is racing, I might be anxious, or even elated or charged up angry. In this latter case, I’m in bed all day with my laptop on my lap typing at 100 mph, sometimes impulsively, with disinhibition. And yet, I definitely don’t want to do chores or errands and would become tired or even winded, physically (not mentally), if I walked even one mile, or up and down my stairs, for that matter. Oddly, still disabling to various degrees.
Not just mood issues and energy levels. Maybe no mood or energy issues at all?
A while back, I discovered an online article by Dr. Jim Phelps about this type of curious chaos of mood-energy continuum. See Rapid Cycling And Mixed States As “Waves” – PsychEducation Actually, Dr. Phelps himself referred me to it. It included a graph that showed an example of how moods and energy levels may not always fit the model that MentalHelp.net described as more “classic”. The very interesting thing was that in addition to curves labeled “energy” and “mood”, the graph also included a curve labeled “intellect” (speed of thought, creativity, ability to connect ideas). Basically cognitive issues. Hmm? That can sometimes be so true for me, too! I can have low or high energy with either low, high, or even normal mood, OR even normal energy and normal mood, and yet NOT feel creative and/or feel cognitively impaired. I think this goes beyond the mixed states and rapid cycling emphasized in the Dr. Phelps article. See the graph in his article linked above to see what I mean. It’s interesting! Can you relate to any of this?
Yes, I know there may be other factors…
Medication side effects (i.e. sedation, or ones that make you otherwise miserable), co-occurring anxiety issues, and/or other mental health issues can contribute to disability or psychological struggles. I’m not debating that. However, I am saying that I think bipolar disorder itself is currently the biggest culprit, for me. I don’t see my situation as hopeless at all, though. Time/healing, the right medications, therapy, and other factors have managed to “tame” the waves on my “graph” to varying degrees.
How to level out all of the curves on the graph?
My psychiatrist and I strive to find the best medication (or medication cocktail) and the right doses to handle my bipolar disorder issues. At one point, years ago, I even had ECT. Medications and doses change as my symptoms are triggered, or show up seemingly out of nowhere. I also know that coping skills/tools and other therapy contributions help. One brilliant psychologist I once had, briefly, said we can even make changes to our brains using various psychological exercises. These non-medication options can be the figurative “icing on the cake” for improved mental wellness, for some. But they are difficult to master sometimes, and they don’t all work for everyone! If it was as easy as a simple “up” and “down”, I’d use a seesaw as an analogy for leveling the curves on this complex graph. Instead, it can feel more like juggling multiple balls. But people can learn to juggle, and things can help with the task.