Can degrees of mania increase over time?

[BeeKeeper]

I'm sure it is just the holidays, but I have seen an increase in the degree of my manic states.  I'm told by my wife I am more angry, i hear more voices/noises, i have more violent thoughts.  I do see a pdoc and am on all the medications perscribed (lithium, cymbalta, lamactol, seroquel).  the pdoc is a bit lost as to where to go next as I am on the upper limit of some of these drugs.

So, I'm just curious - can degrees of mania increase over time?  I know someone that has Schizophrenia and when his mind "splinters" the only way he can describe it is that it feels like razor blades.  I never knew what he meant until i had an intense episode last week and the only way I could explain it would be to say it felt like a snowflake - my mind going in a million directions and all of them jagged and incomplete around the edges.

I'm just afraid I am slowly starting to sink and no one understands it nor see's it but me.

[lindahand]

What you describe is mentioned in literature as the kindling effect. The gist of the theory is that each episode strengthens the pathways in the brain that affect mania or depression. With each episode those connections get more entrenched to the point that you need a lot less stimuli to create an episode of mania or depression so they become more frequent and often more severe. They also become more treatment resistant. That is part of the reason why preventing episodes is considered important.

I've noticed with myself that the older I get the harder it seems to be to treat this. I also hear theories that suggest psychiatrict medications can worsen the long term prognosis. It is so hard to know what is the proper course of action is.

[Athena_M]

Good point on the great ant story!

[paranoid_cataclysm]

lol I know, right.  I thought it was mindful too because we were supposed to be telling what we noticed about the thing and that's what I noticed but they said it had something to do with placing judgments on the object in question.  I'll still do that anyway even if it wasn't considered mindful because I think my free association has helped me get through life by augmenting my sense of humor and whatnot.

Bear with me here, but your story however further reminds me of how I theorized that if we traveled back in time and accidentally stepped on even an ant and changed that for example, that the future would still be altered irreparably because let's say that ant you killed if left alone would of been noticed by a kid who messed with it and ended up late to school or whatever but then they didn't notice it now because you killed the ant unknowingly and they never got the chance to notice it and thus didn't end up late for school.  They then didn't get detention or whatever and the principal ended up calling his wife or whatever instead of disciplining the kid and the principal and his wife got into an argument and ended up getting a divorce which resulted in the principal suffering from major depression and having to quit his job due to no longer being able to handle it and so on and so forth.  I got a little off topic with this but the moral of the (disorganized) story is how a small change can domino into a major change like how that guy changed your outlook of things by simply ripping a piece of paper in half.

Just imagine you might of never had this philosophy and then not of been able to tell us about it had he simply of forgotten the piece of paper that day or had no access to one.

[Xila31]

That reminds me of something that happened to me in high school. This guy walked up to me in class one day and said "Do you want to see me change the world forever in one second?" and I said, "Uhm, okay?" And he suddenly tore a piece of paper in half. That always stuck with me that tearing a piece of paper in half the world is changed in that one way. Even if you glue or tape it back together it's not the same as it was before.

Anyway, it just reminds me of that and I think it was mindful of you made that comparison even if it wasn't the one they wanted you to make.

[paranoid_cataclysm]

At DBT we did a mindfulness exercise where we ripped up a paper and then tried to put it back together and I noticed it was like your example of your life falling apart and then you're trying to put it back together from the pieces but they said that wasn't very mindful of me. lol

[BeeKeeper]

I appreciate all the thoughts.  It always helps to know you're not alone in these things and you're not just imagining it.  I liked Xila's thought of the tornado.  As I'm feeling "shattered" at the moment, the thought came to me this weekend that my world tends to be more of a sheet of glass.  At one time it appeared clear but then something happend that it slipped from my hand and shattered.  I glued the pieces back together the best I could with medication and therapy.  you could still see through the glass but not like before...and then I dropped it again...and glued it.  Each time this process happens the glass becomes weaker and you're less able to see through it...until one day i fear there will be no way to glue it back together and for it to hold.  

What bothers me on a deeper level is that I'm starting to accept it.  Like last night, sitting on the couch at hom relaxing and i hear a "jumbled" male voice to my right.  I ask my wife if she heard it and she says no.  I shrug it off as to just another crazy episode.  One of the frustrating things is that no one really believes you and how do you explain it to your spouse or loved ones?  Just can't...which just makes you feel more isolated.

[paranoid_cataclysm]

Yes bipolar disorder can potentially get worse as you grow older but this isn't always the case.  Sometimes it just flares out of control for no apparent reason like schizophrenia where I was reading this guy's blog and he said he'd been taking a medication that worked great for forty years for his schizophrenia and then one day it just stopped working for no apparent reason without warning.  I'm on the verge of relapsing from stress myself, I find the only way to cope with this stress in my life is living in my fantasy world and voluntarily fleshing it out even more because I have too much stress to deal with and I can't make it go away.

[run4you]

My neurologist/psychiatrist (she's a dual medical degree holder) has explained this to me...

Bipolar is a progressive illness. It gets worse over time. Also, the more 'episodes' you have, the more it progresses and becomes harder to treat. So, every time you become manic or depressed, it's harder to stop the next fluctuation.

I had a mixed episode about 6 months ago... like you, I was taking my meds, nothing had changed for a long time... it just happened. We never did figure out *why*, there was no trigger. I hate that I can do everything right, and still get smacked around by my moods.

As a random side note, I've read that bipolar physically shrinks your brain (in size, not cognition, not sure about that) over time because of the damage it does. Sort of scary to me.

[adel_ezz]

SURE, mania degree increases over time at least to me.
my 1st mania was for a month, my 2nd and 3rd aborted in a week, my 4th lasted for almost a year. Watch out for your cymbalta, Antidepressants worsen the mania.

My view is that people tend to confound lethargy with depression. Bipolarity is mainly a deficiency in Gaba and a fluctuation in the dopamin, and the meds (seroquel especially) tend to make you lethargy so you feel helpless and need an AD and this is the beginning of all the troubles.

Of course taking an AD makes life more fun, you are courageous enjoy your meals, etc..etc.. but then this pleasure send you to mania in which its 1st phase is euphoria then soon becomes dysphoria and the vicious circle you increase your dose of seroquel to stop it but then if you continue like this each time your mania worsens (kindling effect). The same story occurs to each of us.

I happened to have posted once saying that if you can beat depression then you can beat bipolarity, some rejected this view others agreed, but this is my idea of this bloody illness. If you can live with depression (not the worse of course i.e. not suicidal etc...) then try to proceed with it and don't ask me how, a love affair, motivation, gymnastics i don't know myself then you will not need an AD and you will feel that life becomes "very stable" almost. I was there many times, believe me

good luck    

[Xila31]

When you say snowflake I know what you are talking about, like the millions of branched ideas happening all at once. I tend to think of it more like a blender on high speed. >.< Because I generally can't make sense of my own thoughts. Or a tornado, with all the bits of farm equipment, houses, and trees flying aroun in my head. :(

I'm not a doctor but from my experience I feel worse now than I remember feeling before, not more depressed or manic, but, and I hate to use this word, but I feel more "crazy." I feel worse now than when I was having my big psychotic episode when I was a young adult, and I thought people were out to get me. In my mind that was real, it was really happening, and I felt powerful and alive. But now, I just feel like I'm losing my mind all the time. I have two theories on this.

First: when I was a teen / young adult, I had 0 responsability on me. I just had to get up and go to school, and if I felt overloaded I would drop a class. But now, I have a ton of responsability. I have to keep my job or my whole family will face the consequences. I have to think of my kids first, not me.

Second: I feel that I've been ill for a very long time, at least since I was 11 or 12 years old. In all this time I've never had any solid treatment, very little to no support, and I fear that over time I'm slipping away and it becomes harder and harder to get back. Also, I feel it has changed inside of me. It's not the same as it was when I was 11, 19, or even 25. I wonder if things slowly break inside of you, and although you patch them up, they still have cracks, so next time it isn't as strong.

Now, those are only theories. They have no basis in anything other than my own observation. :(