TW: Suicide

One afternoon in the summer of 2008: Boom! I found myself flat on the grass after being tackled by a friend during an outdoor student party. For a couple of days, I hadn’t been myself, and this day I was going sky high! I barged into conversations expecting everyone to listen to me, made many inappropriate jokes and jumped on stage to claim the mic from an unsuspecting artist. “What the hell are you doing?!”, my friend said to me. He helped me by (physically) getting me back on the ground.

The Long Road to a First Diagnosis

I have been dealing with having bipolar disorder ever since. I experienced quite the mental crash that year and spent a few weeks at my parents’ house resting, seeing my first psychologists and preparing for a return to university. After changing university course, I was a physics student and besides pushing myself through the degree, I was enjoying the social part of being a student. I was a member of a student association and this typically meant lots of fun activities. As I already had friends from all these activities, I skipped all the social introduction activities when starting physics. Because of this I became a student who did most of my studying alone. This carried on into my personal life too. I don’t share my feelings much and almost never ask for help.

The many student activities came with a drinking culture that, in retrospect, was not healthy for people like me who generally aren’t good at setting limits. Alcohol had proven to be slightly dangerous for me when I was depressed, but much more so when I experienced hypomania (the high or “up” state). While most people I know can stop drinking and say “that’s is enough for me”, I always kept wanting more as the evening progressed. Later I saw in the excellent Stephen Fry documentary “The secret life of the manic depressive” that many of us use alcohol and/or other drugs as self-medication. I recognized in the stories of that documentary the urge to sedate oneself in fear of escalation.

I sought help right as soon as my symptoms emerged and went to a few psychologists. I never really clicked with them; simultaneously, I never felt the real urgency to fix me in the first years. Yes, I suffered low moods for weeks, sometimes for months, but I loved those the periods I called natural highs. In 2013 – five years after the first signs – it was suggested I let myself be examined in an academic setting. In a university medical center, I spent many hours talking to professionals. This led to the diagnosis of cyclothymia, or bipolar-light. They gave me some recommendations, e.g., engage in exercise a lot, limit alcohol intake, take rest etc., but they didn’t prescribe further treatment. My parents and I naively said how we were happy it wasn’t something worse.

When I was in an “up” or manic state, I attended lots of parties and had a great deal of energy. I would walk through town playing my air-drums or air-guitar, didn’t seem to need much rest, started many projects or tried to see if I could volunteer somewhere, and made heaps of jokes in conversation. All the promises I had made and projects I had started during my preceding high came crashing down; I usually had to force myself to do them or cancel. The latter I did very little as I was too proud for that. In the low moments, my calendar would become emptier and emptier and this was important as I really had no energy, inspiration or creativity to get anything done. I usually slept for 5-9 hours per night excluding the days that I could not even get out of bed. I tried to be healthy, do sport a little bit and kept away from social events – which involved drinks – hoping that the happier, funnier, better me would return soon.

Managing the Highs and Lows in Academia

Professionally, it was a similar story. When I was depressed, I tried to study or work but found myself cutting corners, just looking at other people’s work superficially – one can compare it only looking at the pictures in a book – or giving up and spending days reading news websites or YouTube. When I had more energy and a much better mood, my mind would be racing with ideas which I would advertise, often before doing the actual work. I would walk around my institute hoping to bump into someone as I was too restless to sit still. I took no notice of boundaries, sometimes making inappropriate jokes with people I had just met. For example, on a tour as part of a scientific conference, I took someone’s photograph and gave back the camera. I did so with the camera’s rope around my wrist and dropping it just as I gave it back. They were probably scared about the camera, and I was the only one laughing believing that it was funny.

A year or so into my PhD, I met the love of my life. She had seen me while mildly manic as well as in a depressed state in the past; despite knowing about my mental health issues, we became a couple shortly after. I am very lucky and I couldn’t have hoped for such a great support. Having her on my side throughout, I managed to complete my PhD. However, in the last year, with pressures increasing, my periods of depression became longer and, for the first time, I consulted a psychiatrist. They put me on Escitalopram, an anti-depressant, and this, in combination with several sessions with a psychologist, got me back on track enough to finish my thesis and do my defense. Months before that, in a well-timed (not too) elevated period, I had secured a postdoc on the other side of the world. My partner and I prepared for the big move and, together with my psychiatrist, we prepared all sorts of documents and months’ supply of medication.

On arrival, I was stable, and we arranged that my partner would come several weeks later. We had decided to wait to find a new psychiatrist until she would join me. However, in an elevated period, I had decided to already go for it and the new psychiatrist put me on something else: a mood stabilizer. I ended up depressed in bed by myself and quickly went back to Escitalopram. Not only was I experiencing highs and lows due to bipolar, but also due to the treatment I was receiving. 

Being far away from my circles of friends and family, I had much fewer social obligations and because of this my mental health was more stable. Based on this, I felt I did not want to take a pill each day for the rest of my life and I decided by myself to stop medication at the end of that year. This went well for almost a year, until setting up new projects and saying yes too many times had resulted in two intercontinental returns and three continental flights in three weeks. After this intense period of travel, I went into a depression I would not recover from for months.

Darkness and Light

One of those intercontinental trips was actually an interview for a permanent position close to where we were from, and I was offered the position. The job did mean some periods of time away from my partner, but I accepted it. This was all pre-pandemic so we believed that things would be fine and we let our employers know we would be leaving. Then the pandemic hit and in the last two months of our contracts we were very worried about our families and friends back home. At the same time, we were trying to finish our jobs while trying to organize a move halfway across the world. Our employers had already found new people for our positions, so there was no way back. 

With both of us struggling with our mental health, our return just at the end of the first wave of COVID-19 was surreal compared to the welcome we had looked forward to. Additionally, personal festivities we had been planning for a while had to be put on hold. Couldn’t we have stayed there where we were safe, settled and both had jobs? How could I have put my partner in unemployment? How would I travel for work once things opened up a little? I didn’t have answers to any of these questions, was increasingly anxious and depressed and felt crushingly guilty. In my first week on the new job, meeting my new colleagues on Zoom did not feel good and I started to doubt my decision to take the position. At some point I just stopped responding to anything. One morning, my lights went out and I attempted suicide. 

I ended up in a hospital and spent the next week there to recover, both physically and mentally. I was diagnosed with bipolar type II and was put on Lithium and Escitalopram. I was told to not try and analyze my situation, “just feel” my emotions instead and certainly not work the coming month. The week after I started feeling much better, so much so that I started to experience a “high” and started working again. In particular, I really wanted to work on grant applications that would help me start up my research. That weekend, things fell apart again and that Monday I was completely stuck, mentally and physically. I experienced a catatonic reaction and first needed large doses of Lorazepam to recover. This tranquilized me enough that I came out of this locked state and could start my recovery again. This time, I stuck to the advice to not work for at least a month.

Recovery

I have been recovering ever since with the help of my partner, my psychologist and my psychiatrist. Overall, we are trying to find out how to help me remain stable, but also where it went wrong and what my risk factors are. Up until now, I have learned (or am still learning) the following lessons. These are personal thoughts that I hope can be helpful to others.

• Early diagnosis is vital and people should be actively discouraged to self-medicate with alcohol and/or drugs. In my experience, self-medicating can be destructive and worsen your condition, both in the short as well as in the long run;
  
• Bipolar disorder can worsen if left undiagnosed and untreated [e.g. 1,2]. Your illness can get worse by not actively working against its symptoms, but it can improve with many things such as the right treatment, medication and self-care. For instance, I found that it’s important to get out of the house when you’re depressed, don’t self-medicate when experiencing a manic high, and exercise as much as you can. Unfortunately, it is a constant battle;
  
• Be aware of your mental state and how it affects you. If you have bipolar disorder, although you might enjoy the hypomania and the associated “highs”, you probably aren’t very effective when you’re feeling like this. I went from a love-hate relationship with my ups and downs to a hate-hate one, as both ultimately do not benefit you;
  
• Find ways to share your feelings and get feedback from people you trust. Sometimes I had been very ashamed for something that was not that bad, but other times I was unaware of any wrongdoing and someone had to tell me; For instance, when depressed I would meet groups of friends and have nothing to say and my conversations did not feel great. Afterwards I would tell this to my partner and she would have to tell me I sounded fine and I was just wearing very negative glasses. Or when I was “high” in a student panel asking question to the university board, I always shot from the hip and posed the first question at each new topic. Afterwards, I needed someone to make me understand how disruptive and annoying this had been;
  
• Don’t avoid seeking help just because you have one bad experience with a psychologist or psychiatrist. It can be frustrating to tell your story a few times, but have patience and wait to “click” with someone;
  
• It goes without saying, but never make your own decisions when it comes to medication. You may feel you don’t need it in certain phases of your life. However, you can be very vulnerable to sudden change and, in my case, this almost cost me my life.

Things are manageable at the moment which is great. I feel lithium is giving me a stable basis from which I can work with my psychologist on my pitfalls that could trigger unwanted mood swings. Sometimes I feel frustrated that I needed more than 10 years to find stability. Finding out what works for you can take a long time. I believe there is a specific treatment that works for every specific bipolar person. Help is out there!

[1] Altamura, A.C., Dell’Osso, B., Berlin, H.A. et al., Duration of untreated illness and suicide in bipolar disorder: a naturalistic study. Eur Arch Psychiatry Clin Neurosci 260, 385–391 (2010)

[2] Drancourt N., Etain B., Lajnef M. et al., Duration of untreated bipolar disorder: missed opportunities on the long road to optimal treatment, Acta Psychiatr Scand. 127, 136–144 (2013)