Thread by @pjf, Okay folks, let's talk about bipolar. It's something that's stigmatised, and doesn't [...]

Okay folks, let's talk about bipolar. It's something that's stigmatised, and doesn't get anywhere near as much visibility as some other forms of neurodiversity.

I have Bipolar II, and I've all the signs that I'm experiencing a hypomanic episode right now.

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So first up, Bipolar I vs II.

Bipolar I has "manic episodes", with "functional impairment".

Bipolar II comes with "hypomanic episodes", which are similar, but don't have "functional impairment".

How one gets classified depends somewhat on how acceptable society finds you.

Wikipedia has a good description of hypomanic episodes:

"Notable decrease in the need for sleep, an overall increase in energy, unusual behaviors and actions, a markedly distinctive increase in talkativeness and confidence, commonly exhibited with a flight of creative ideas."

Sounds great, right? There's more:

"Other symptoms related to this may include feelings of grandiosity, distractibility, and hypersexuality."

Often manic episodes come with a lot of irritability, and can have "racing thoughts" where one just can't stop thinking about a thing.

If you've seen me present at a conference, especially one of my earlier OSCON talks, there's a good chance you've seen me in a hypomanic state.

Those times I gave multiple talks a day, and still had time for lighting talks? Heckin' pure hypomania.

For the longest time, before I was diagnosed, I used to think there was something wrong with me wherever I wasn't having an episode.

I thought being inspired and engaged and full of energy was my baseline. I honestly felt broken when I wasn't experiencing that.

So, you'd think that manic episodes are great, and honestly they can be. Lots of folks with bipolar are extremely cautious about treatments, because they don't want to lose that creativity and energy that comes with the highs.

But there's more to it than that.

Manic episodes aren't always nice to bipolar folks, and often are extremely hard on those around them.

If you're in a relationship with someone who's extremely irritable, who's obsessing about their thing, and doesn't act like you or your goals are important? It's not great.

I keep mentioning the irritability, because for me it's one of the most noticeable things. If I've got racing thoughts, and I'm building a thing, *anything* that takes me away from that is like having forks stabbed into my brain.

Even if I'm not interrupted, there can be forks.

This also manifests itself as what can look like extreme mood instability. Your manic friend is super happy and charming and full of great ideas, and then something doesn't go their way and *very suddenly* they're angry or sad or super fuckin grumpy.

For much of my life I tried to direct my irritability towards productive ends. I would joke about "annoyance driven development", or I would pick fights with injustices, or I would write talks or essays.

I was also very bad at backing down, and would escalate unnecessarily.

It's also very common to have "mixed episodes", where one has signs of both mania *and* depression at the same time.

Being an irritable person who can't sleep, who has racing thoughts, and who is incapable of experiencing anything more than fleeting happiness absolutely sucks.

I've caused a lot of harm during my episodes, especially to those closest to me.

Coming to terms with that is still something I'm working through, and one of the reasons I'm so cautious of my actions now. My episodes contribute to, but are not an excuse for, the harm I've caused

Which brings us to treatment. There's a lot of treatment options for folks with bipolar, and this is something you should absolutely be discussing with your doctor.

I'm on two medications for my bipolar. The first is sertraline, a common SSRI antidepressant. I take it every day, and it means I roll 3d6 rather than 1d20 for my mood.

Antidepressants can trigger manic episodes, so they're used with care, especially at the start.

My experience with the sertraline has been mostly positive. I miss having some of the emotional range that I used to have, but I no longer experience despair so great I'll just roll into a ball and cease to exist for a while. I've had very few side effects.

The other medication is olanzapine, an antipsychotic. It's an extraordinarily effective "chill pill", and rapidly halts most of my manic symptoms. If I notice I'm getting especially irritable or argumentative, then a moment of reflection and a low dose of olanzapine may be needed

CN: Weight, food

Olanzapine absolutely comes with side-effects. Aside from the sedation, it increases weight gain, the risks of a number of metabolic disorders, and (at least for me) makes carbs taste *amazing*.

Olanzapine can be used as a baseline treatment, and as needed.

One of the biggest impacts in my bipolar treatment has been positive experiences with psychiatrists, who have been supportive in developing plans and strategies *with* me.

This is very much a form of privilege, and is absolutely influenced by me being a white dude in tech.

As for my current episode? Currently it's treating me kindly.

I've been learning a lot of new tech skills, the elevated mood is a much-needed reprieve from 2020, and there's been thankfully little irritation. I'm keeping an eye on it with meds ready if needed.

Thanks for reading along, and feel free to retweet or send this to others you feel it might help.

DMs are open, but my sleep schedule is munted right now (thanks hypomania!) so I might be slow in being able to respond.

Stay safe, look after each other, and defund the police.

PS: I *also* have ADHD. For this thread I've tried to tease apart just bipolar, but I don't know what it's like to have one without the other.

ADHD: I'll hyperfocus and stay up late because time isn't real.

Hypomania: Way more energy. I'll stay up because I don't need to sleep.

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