A few months ago I was diagnosed with type II bipolar, and while some of you who know me might feel that was obvious, it was not obvious to me. I want to talk about what the diagnosis means, what it’s like to have Bipolar II, and the effect my medications are having.

What it’s like to have bipolar

I think it’s a common belief that people with bipolar have two mood poles that they swing between. They’re either up or down. They’re either manic or depressed. And you’d be forgiven for thinking that, because it’s absolutely what I thought up until the point of my diagnosis. However I can tell you from first-hand experience that this is not the case.

Having bipolar means having has two axes. There’s the manic axis, and the depression axis, and it’s possible to be on both of them at the same time.

As someone with bipolar, being depressed is the big thing which most feels like a mental illness. My depressive moods would come on very suddenly; it would feel like I’d have a normal response to sadness,but then there’d be a cliff that I would just tumble off and into despair. I’d actually describe these periods as being in a “pit of despair”, and I really did feel like I was in some sort of pit. Everything would be hard, nothing seemed to be worth it, and not only could I not feel joy, I couldn’t even imagine feeling joy in the future. My pits would often come with psychomotor retardation, where I would lay still and my thoughts would slow to a crawl. Oddly enough, that was the only thing I liked about my pits. Everything felt awful, but if I got far enough down I didn’t have to experience the full weight of consciousness. It was oddly comforting in a way.

Sometimes my brain would be sad for no reason. I’d feel awful, everything would seem grey, but there’d be no reason for this. Sometimes I would think something was making me feel bad, like the current state of information security, or how we’re screwing up with climate change, but honestly my brain was just not being kind to me. These would be the days when I’d struggle to get out of bed. Oddly enough, these were also some of the days when I did my best writing, but that writing was never about joyous things.

My manic episodes, on the other hand, didn’t feel like part of an illness. Bipolar II means my manic episodes are “hypomanic”, they’re not full-blown mania. I don’t lose touch with reality or purchase cryptocurrencies, but I do become very outgoing and very productive. A lot of you have probably met me or interacted with me in my hypomanic states. I’m filled with ideas, conversation comes to me easily, and I can absolutely throw myself at whatever project I currently have on hand.

If you’re thinking that my manic episodes sound enjoyable, they are. Most of my large accomplishments were done in a manic state. Writing the KSP-CKAN was definitely done during a bout of mania. I’d joke that “I thought we needed a mod manager, so five weeks and 300 hours later, I had written one”.

It’s also possible to have mixed episodes, where one is both manic and depressed at the same time. For me these would present as irritability, and I would be productive but with no sense of accomplishment. I would even joke about these as well, saying that “annoyance driven development is my standard workflow”. In recent years these mixed episodes were extremely common for me. What’s more, being anywhere on the manic access would also come with less sleep, and being irritable and tired was not at all an enjoyable state to be in.

Whenever I was anywhere on the depressive axis (including during mixed episodes) I would regularly isolate myself. I spent a lot of time absent from conferences and events because of this. The isolation wasn’t pleasant, but I would feel so socially inept during my episodes that it felt necessary. My depression and irritability would make me feel like I had very little chance of navigating any meaningful human contact without screwing things up. It’s been a barrier to forming closer friends. It’s been a source of strife in my relationships. Isolation is almost certainly not the best coping strategy, but it was still my go-to when my brain was not being kind to me.

As I’ve grown older, my number of hypomanic episodes have reduced, and my mixed and depressive episodes have increased. Bipolar was almost a minor superpower in my 20s, allowing me to be incredibly productive and outgoing. It doesn’t feel like a superpower now.

If you asked me last year about what sort of mood disorder I might have, I would have absolutely replied some sort of depression, because the manic and mixed episodes didn’t feel like part of a mood disorder, they just felt like me being productive. A huge number of people with bipolar get misdiagnosed with depression for exactly this reason, and the wrong treatment comes with the risk of entering a full manic state.

It was only reading up on the diagnostic criteria—and especially about mixed episodes—that I realised how much of this seemed familiar. It was also essential that I got a new doctor, as my old doctor was great with physical health, but not with mental health.

Treatment

One of my fears in getting treatment was that the manic episodes are so productive and so enjoyable that I had fear they would go away. I’m relieved to say that my treatment has been an entirely positive experience and I am amazed at how effective it has been.

Before treatment I was used to having multiple competing trains of thought running through my head at any one time. I’d be thinking about whatever I was doing at the time, but I’d also be thinking about whatever project I was working on, and I would also be wondering how do birds work, and I would also be remembering not to forget that thing I need to do later. This made me good at juggling lots of tasks, but not necessarily that good at focusing on individual ones.

For those familiar with computers, it felt like I had multiple threads running on a single-core CPU. They’d all compete to be running in my consciousness, and I’d context switch between them.

My mood stabilisers reduce my thread-count. Rather than having multiple competing trains of thought, I instead have mostly one single stream of consciousness. That makes me less good at multi-tasking, but it means my head feels much less busy, and my anxiety levels are much, much lower, as I’m not worrying about multiple things at the same time. The tension in my back is gone, I’m sleeping a lot better, and for much of the time I’m better able to focus. I still feel very much like me; indeed, I feel a lot more like me with the mood stabilisers.

My anti-depressants have filled in my despair-pits, which means I can still feel sad, but I don’t fall into full-blown despair. I’ve had to do a lot of adjusting to that, because there’s a whole range of uncomfortable emotions I wasn’t feeling previously, because I’d hit despair before I reached them. There was a short period where it felt like the blunted my emotional response, but it feels like now I’ve adjusted to them my emotions are at a much more normal and sustainable level.

One of the most unexpected results of my treatment is that my sense of smell has improved, and consequently food is tasting better than before. Some of you will know that one of my experiences with depression was that even great food would taste bland, and I’m glad to say that seems to be lifting.

The side-effects of my medication have been almost non-existent; sometimes I feel a touch of nasal congestion, and sometimes I need to visit the bathroom more often, but neither of these have any significant impact on my life.

I know that not everyone has as good an experience with medication as I do, and so I feel incredibly fortunate that my treatment is so effective.

What now?

In the past it was very common for me to be either extremely “on”, or completely absent. With medication I’m a lot more mellow, so I’m hoping that I can find some kind of a routine.

I’ve done a lot of shitty things during my depressive and mixed episodes. One of the reasons I isolated myself so frequently is that it felt that I couldn’t trust myself, because I kept hurting others or myself when I absolutely didn’t want to, and isolation was one of the only ways how I knew how to deal with that. I’ve got a lot to work through here, and while I’ve finally found a therapist I feel comfortable with, I imagine it’s going to be something I’m dealing with for quite some time.

At some point I’ll feel more comfortable talking about the specifics of my medication, but not yet. I’m dealing with a lot right now, and even though it feels like the right time to talk about my mental health, I don’t want to get too far into it at this stage.

Thank you so much for your time.

~ Paul