That’s what my first therapist said to me when I brought up my family history: that I might be “a little bipolar”, and that I needed to stop worrying. It wasn’t said as a comfort, to calm me down or to focus me on things I could do to help myself. She was telling me I was overreacting, that I didn’t have a problem that needed psychiatric help, that I should just learn her damn breathing exercises and control my thoughts a little better and solve my problem myself.
It turns out there is a “little bipolar”. It’s called Cyclothymic Disorder.
Articles on cyclothymia can be frustratingly vague. For a long time, the only concrete information I had was the DSM-IV’s diagnostic criteria.
- For at least two years, you’ve alternated between normal moods, hypomatic/elevated moods, and depression.
- You’ve never been symptom free for longer than two months.
- You haven’t had any Major Depressive Episodes. That means your depressions never last two weeks or longer, and you may have milder symptoms.
When every article is about Bipolar I or II, when every description about depression is about Major Depressive Episodes, when you can’t find an explanation for how you’re feeling when you know what you’re feeling is real…
After the depression, that confusion was the worst part. It was the terror that I might have asked for help for nothing, that I might just be weak, soft, a crybaby, an overreactor. Once a depression had passed, that pain seemed so alien, so unlike my real thoughts, that being told to doubt that I actually had a problem made me doubt my own perceptions.
The closest I found to a description of cyclothymic disorder was from an article that gave a glimpse of what other cyclothymics were feeling. The sudden shifts into anger, the brief but palpable depressions, and the fear that, since the shifts were so brief, those moods were just your fault. I wanted more, though. I wanted to know how it felt, not just what it was.
I doubt I’m alone in that fear. I’ve fought and researched for understanding and acceptance of my illness. Now that I have, I feel like it’s my responsibility to do my best to share that. When I was at my lowest, someone shared their experience with me, and I don’t know where I’d be if they hadn’t. How can I not do the same?
So: What does it feel like to be cyclothymic?
Imagine the ocean. There are always waves – some big, some small – but the ones you really worry about are the huge ones. The tidal surges raised by storms that hit the shore with force, flood buildings, drag those too close to shore out to sea. For people with Bipolar I or II, the tidal surges are a constant threat. Those waves – those shifts in mood – can leave severe damage in their wake. Major depressions can last weeks or months, and severe mania can lead to reckless, even dangerous behavior.
For a cyclothymic, tidal surges aren’t simply uncommon. They, by the very definition of the disease, never happen. Remember: If you get a major depressive episode, you’re now Bipolar II. If houses aren’t flooded, and no one’s been dragged out to sea, what’s the threat?
For a cyclothymic, the sea is never violent, but it’s never calm, either. The waves were just a bit larger than they should have been, and I was never free of them. I was rarely myself longer than a month at a time. No one episode was the problem. No one crash into depression critical. Four or five days of less-than-major depression isn’t so bad on its own. But, what about four or five days a month, every month, for years? Like a beach under assault by a relentless sea, one day I realized that all I had left was a narrowing strip of sand.
The depressions came in two flavors.
There were the anxious ones, where my mind worked unendingly at every worry, every concern it could find. I hated myself during those dips. I hated what I wrote, I hated how I never sold anything, I hated the stupid and annoying things I said to people, I hated what I was sure people felt about me in response. It didn’t matter what was going on in my life, because whatever was going was wrong. No matter how many lies about myself I put to rest, there was always another. Concentration was impossible. I couldn’t write. Even if I could force myself to focus, I didn’t have the faith in myself to trust what I was writing.
Then there were the empty depressions. When there wasn’t even energy for anxiety or self-loathing. I didn’t cry during the anxious depressions. I wasn’t even sad during them. What I wanted during the anxious depressions was to scream. Through the empty depressions, there was nothing. No anxiety, no made-up or out-of-proportion problems empowered by the depression. Just the hurt. Just the tears, always a word or thought away. Maintaining a facade of normal behavior was the best I could manage.
Before medication, I mostly suffered the anxious depressions. Since starting treatment, what dips I do experience are typically empty. They don’t have the force and fury of the anxious dips, so they just leave me hollowed out for a few days. They suck, but they aren’t too bad to ride out.
The hypomania wasn’t much fun, either. One of the other things that’s changed most significantly with the medication is the nature of my “ups”. Typical bipolar hypomania is referred to as euphoric. Tons of energy, less need for sleep, high confidence, and a tendency to make sudden, rash and reckless choices. Hypomania’s hard to notice until you’re in the midst of it, because you just feel really ok. The sign – for me – is that I can’t stop myself. You know how, when you’re drunk, you find yourself talking way too much? You know that maybe you’re going on and on, and you’re saying things you wish you weren’t, but your hands aren’t on the wheel. It’s like that. Not just with speech, but with thoughts. Everything is too much, too fast, to be entirely under your controls. These hit every once and a while, but not often, before medication.
For what it’s worth, I don’t like myself much during my “ups”. Some people enjoy them, but they always leave me feeling like an obnoxious ass.
I liked myself less during the other hypomanic episodes. The ugly ones. I was well into treatment before I learned some people get irritable hypomania; all the Up with none of the Happy.
Remember when I mentioned the sudden, overwhelming anger? That’s irritable hypomania. Most of the time it hit suddenly, when something that should have upset me made me furious. If I was stuck in traffic, I’d shout, scream, and slam the steering wheel with my hands. If I was at work and a coworker did something jacked, the urge to pick up my laptop and throw it against the wall would come on so strong that I’m surprised I still have my laptop. Minor family annoyances led to terrible, unwarranted screaming matches.
It wasn’t anger. It was rage. The kind of fury that grows exponentially, like a nuclear core in meltdown. There would be days on end when anything could set me off, where I hated just as much as I did in my depressions, but instead of wanting to lock myself in my room to scream, I wanted to do it in people’s faces. No matter how loud or how much I screamed, it was never enough to get that anger out. Any rage I let out was replaced by even more.
The irritable hypomania was the most obvious part of my disease. The depressions I hid and denied, but the anger I let fly. Even I knew something was wrong. I didn’t understand how I could be fine for weeks, then – without warning – be swamped with so much rage that I couldn’t let it out fast enough.
While cyclothymia is far less severe than other forms of bipolar, its rapid and constant assault makes it so, so difficult to understand where you end and the disease begins. Who was the real Eric? The self-loather? The raging screamer? Were the “normal” days just vacation from who I really was, or was that the Eric the disease was eroding?
It was the medication that gave me the space to figure it out. The first thing to go wasn’t the depression. It was the bottomless well of anxiety. That anxiety was the storm at the heart of every mood swing. It was the hatred I felt for myself when I was depressed, and the loathing I felt toward others when I was dysphoric. With the endless anxiety gone, who I was seemed so obvious.
Cyclothymia is a war of attrition. It’s milder than other forms of bipolar, but it isn’t “little”. It’s a chemical imbalance, and it’s one that can chip away at your life if left untreated.
If you’re searching for answers the way I was, know this: You aren’t at fault, and you aren’t alone. You deserve the help if you decide to ask for it. Don’t let anyone tell you otherwise.