Bipolar disorder Pendulum: stories and information Women and bipolar Menopause may have triggered bipolar Janice Roberts says the menopause was probably the initial factor that triggered her first manic episode in 2001. Twenty years on, active management of her condition is helping her to live well Prior to 2001 I had no real difficulties though in my head I was aware of having to manage, to some degree, low and excited feelings but nothing troublesome. However looking back, now that I know I carry vulnerability to bipolar, there were two episodes in keeping with that. A vulnerability to bipolar In my third year at University there were very important exams that you needed to do well in to ensure an Honours degree. I worked hard rather excluding other activities other than table tennis with my friend. When the exams were all over, which I was successful in, I remember sitting having a summer picnic on my own feeling rather strange - my mind was fizzing and I just felt different from usual. I was a bit concerned. However after three days of end of term celebrations with much dancing I just came out of it and continued as usual. The second episode was in my mid-twenties. I attended a yoga class and we were encouraged to take on an almost three day fast. This made me high and I remember attending a business meeting and thinking how marvellous everyone was! Once I resumed normal meals the highness went. Even on medication now I still have to eat regularly to maintain equilibrium. This does have some implications for having medical procedures that require a period of fasting. My condition is clearly inherited. I have relatives with probably a similar condition one being in my grandmother’s generation. For her the condition developed at a similar age. Sadly she remained in hospital for the rest of her life, probably 30 years. I am thankful for effective medication. The effects of the menopause When I became menopausal at 45, as measured by FSH levels, I had severe symptoms of continuous low mood, lack of confidence, disturbed sleep, some memory problems and a degree of having difficulties with remembering some words, known as aphasia. HRT relieved all these symptoms and I felt well again. However something else was also going on as six years later I had my first manic and psychotic episode at a five day intensive meditation retreat; held in silence with eight hours meditation a day. During these six years I began to feel restless, our children were going to university and I began to feel isolated in my freelance yoga teaching that I had happily provided for 20 years. I had a drive to seek more and hence the interest in meditation which developed seriously in 1997. Further details of my experience are on the website I created in 2017. When I came home from the retreat in a psychotic and manic condition to some degree I was able to hide the condition. In a strange way you know your thoughts are odd, so you do hide them from others, but you still want to guide your actions by them. However my capacity to hide them lessened and I was seen by the medical services. As long as I took the anti-psychotic they prescribed I was allowed to stay at home. However after three to four months on this medication I developed severe depression. I was hospitalised and taken off the drug and the depression stopped. I was discharged three months later. The hope was that it was a one-off psychotic episode and I would recover. A fragile recovery However my recovery was fragile and with an emotionally challenging situation in my extended family I fell apart again. I felt desperate that I wouldn’t recover and was hospitalised again; in a different hospital. They prescribed me lithium and gave me the diagnosis of late-onset bipolar. However, over the coming months I started wanting to come off the lithium. When first prescribed the medication no one spent time with me explaining how important it is to stay on the medication. I am a reasonable and sensible person and would have responded well to this direction. It was almost as if they expected you not to keep taking it which is very common when people are first ill. I had moved to a new place and did ask the GP, who had never met me before, if it would be alright to come off the lithium. She agreed. She clearly had not consulted my notes. Her decision was incredible. Another hospitalisation Over the next two months, I gradually became manic and then psychotic again. I was sectioned and in a third hospital for six months this time. This was because I was slyly not taking any of my medication, lithium and anti-psychotics. However I eventually decided myself that the only way out of the prison was to conform. Once taking the medication regularly I recovered quite quickly and have not been hospitalised since and have had no further psychotic and manic episodes. I don’t seem to get depression. Coping with side-effects Over the next 12 years or so I had a productive life and worked part-time as an English Language teacher in spite of considerable difficulties with side-effects from medication. Good sleep was ensured with a strong sedative, 8 to 10 hours a night -perhaps too much! However it gave me a multitude of side-effects which at the time I didn’t realise were side-effects; weight gain, around two stone over the 12 years I took it, muscular scoliosis making me look down when I walked so not very safe crossing roads, mouth blood blisters daily and the day-time sedation making me socially not very sharp to mention a few. Distressingly, the sleeping tablet because of sedation affected my voice so I couldn’t sing properly anymore. I was asked to leave a choir I had joined, which was hard to bear. Eventually the sedative was giving me hypothyroidism, low thyroid activity, and the weight gain became unmanageable. Going private With these problems I sought out a private psychiatrist. He has turned my life round. He takes a collaborative approach and very much puts you in the driving seat. He really listens and is adventurous with treatment always seeing the wider picture. I feel very much better though we are still working on how to ensure more sleep. I do often feel quite tired but you manage, particularly using meditation and relaxation techniques, and I lead a productive life. At present we are investigating the possibility of hormonal imbalance having an effect on poor sleep. Learning more about bipolar I am training in CBT and went to a day about bipolar. The lecturer’s main thesis was at the heart of our problems are unmet emotional needs. I think this is absolutely right and it is good to recognise these needs and address them as best you can as well as having other treatments including medication. But I think the most important aspect is developing acceptance that you have to manage this condition for the rest of your life. It is tough and I feel I’ve taken rather a long time to get there. There is a lot to learn, but I now find developing genuine acceptance is an enormous help contributing to equanimity and making you a more compassionate person in helping others.