cleaning out the medicine cabinet

okay, so i haven't literally cleaned out the medicine cabinet. i don't even have one and i still have bottles containing plenty of psych meds sitting in a drawer and in a cabinet in a bathroom. but i use that phrase metaphorically to label the process i've been going through over the past few months of clarifying my diagnoses and what they mean for my life.

in just over a decade i've been labeled with nearly a dozen psychiatric diagnoses, some of those have been obvious and correct, some have been confusing and indistinct because of their similarities to others, and some have been wrong.

in 1996 i was diagnosed with depression and panic disorder. in 2004 i was diagnosed as bipolar ii and nearly half a dozen anxiety disorders were clear by then as well (many existed previously but had gone undiagnosed).

the diagnosis of depression while i was in college (my first time around) threw me into an all out identity crisis. though most adolescents go through one of these crises at some point, i hated that mine had to do with the acceptance of a mental illness. i had considered myself strong, funny, outgoing, lighthearted, and easygoing. accepting that i was depressed caused me to wonder who i really was if i were truly (in my mind) weak enough to be depressed and too depressed to be funny, outgoing, lighthearted and easygoing.

i fought the diagnosis and then battled through the concurrent identity crisis for quite some time. though i eventually came to accept it, and move through many aspects of that crisis, i still have always negated any view of myself as an anxious or depressed person (even though i spend the vast majority of my time in states of anxiety and depression).

the shift in diagnosis from depression to bipolar ii while i was in my third round of college, brought on a brand new identity crisis. nearing thirty, i certainly didn't want to go through another one of these at that point in my life. but i found myself once again questioning virtually everything i knew about myself.

the first time around, i felt like many things i thought were true about myself couldn't be true if i suffered from depression. at that time, i wasn't yet seeing depression as a daily struggle i'd live with continuously, but simply a phase i was going through. but even as that, it seemed to contradict anything positive i could have thought to be true about who i was. i eventually saw that i had strength (or i wouldn't have made it this far) and that those other qualities were true even if hidden during an episode of major depression.

in general, i lived for years with two selves: me/depressed who i detested deeply and me/not-depressed who i liked well enough.

the second time around, my diagnosis caused me to wonder about myself all over again. suddenly it seemed as if the me i knew myself as when i wasn't depressed and all those qualities that self contained might not actually be personality traits but simply symptoms. being outgoing, funny, lighthearted, a leader, strong-willed, friendly - in short, the things i liked - to some extent each fell under the category of hypomania, a symptom of bipolar disorder. things i'd seen as positive characteristics were now simply aspects of a particular mood state, not part of who i was as a person, and they were things to be medicated away.

i found myself constantly watching and judging and questioning my feelings and behavior, searching for signals that my mood was switching from one extreme to another. things that had been a normal part of the way i acted on a day-to-day basis now served as warning signs of a disorder.

now that i look at how i've been dealing with this for the past few years, i see that i let myself become no more than a cluster of symptoms to watch, judge, question, and fear.

by the time i was diagnosed, i was rapid-cycling, shifting between moods within days or even hours. rapid-cycling is seen as a sign of deterioration in bipolar disorder, and bipolar is a disorder that continuously gets worse (aside from the abatement of symptoms that medication can bring). thus, getting treatment for bipolar with a mood-stabilizer seemed crucial. so i faithfully took a mood-stabilizer (and attempted two others) for two and a half years.

during that time, i remained depressed the majority of the time, and my mood still shifted quite a lot. with certain combinations of medications, my mood shifted more drastically than ever.

for over two months, i've been off of all of my meds. i've still been somewhat depressed (mild to moderate), but within that, my mood has been stable.

with what's known about bipolar disorder, since i have a history of rapid-cycling, i should not be so stable. my mood should be fluctuating all over the place, and it's not.

with everything else, i carry around a diagnosis of adhd. the main differences between bipolar disorder and adhd are that bipolar is cyclical while adhd is constant, and bipolar is primarily a mood problem (that causes problems with attention, etc.) while adhd is primarily an attention disorder that causes mood problems. lovely distinctions, right? so if i had both, as has been assumed, then you could say i have constant mood and attention problems that are sometimes worse.

for several months i've thought through the diagnoses i've been given. i've been watching my symptoms, and rethinking what i've been told, working through what i know, and trying to sort out this puzzle.

the vast majority of the times in my life that could qualify as hypomania or as mixed-episodes (symptoms of depression and hypomania together) have been while i've been taking antidepressants or stimulants. this seems to point to a condition some doctors are referring to as bipolar iii, which is simply depression that reacts like bipolar disorder in response to antidepressants or stimulants.

the more i watch my current mood and symptoms, the more thoroughly i think through my history, and the longer i go in a stable mood state while off of medications, the more convinced i am that i do not suffer from bipolar ii, but simply from medication resistant depression (specifically bipolar iii), and that what has appeared as hypomania when i have not been medicated is easily explained by seeing my adhd as more severe than previously thought (particularly the hyperactivity aspect).

what does this difference in diagnosis mean to me? it tells me that i should avoid antidepressants and seek solutions to my depression and anxiety through other means. it lets me see how much my problems with attention, concentration, and distractability contribute to my depression and anxiety (and vice versa), and forces me to look at different solutions than what i've tried in the past. it makes me rethink my priorities in my attempts to live with as much mental health as i can (more emphasis on structure and organization, less concern about when i go to sleep and keeping a perfectly regular schedule). it lets me start to find an end to this ridiculous identity crisis by being able to stop looking at my personality traits and behaviors as all symptoms of a mood disorder to be medicated away or to watch out for as they could be signs of bad times ahead.

it's easier for me to embrace adhd as part of the way i am built, simply as part of the way my mind works, than it is for me to accept fleeting mood states as creators of my personality. with bipolar ii as my diagnosis, i felt as if what i thought of as my personality (both things i liked and things i didn't) were simply moods that came and went, not truly integral parts of my being, and that many were symptoms that were seen negatively by the medical establishment. but adhd is a constant, not something that fluctuates in the same way that bipolar does, and is therefore something that doesn't cause me to believe that all that i thought about myself is not really true.

though it's easier to accept adhd than bipolar, i don't make the claim that my diagnosis of bipolar ii was wrong easily. i have thought through every aspect of this disorder and my history that i can. but where i am right now in my process of sorting through my diagnoses, this is what makes sense.