Hello insomnia, my old friend...

I know I am becoming unwell. Maybe “becoming” is an overstatement. It implies a kind of inevitability that I will descend into madness. That is not inevitable, but I have symptoms. Items on my carefully constructed “symptom list” have started to flag up.

The whole point of the list was to catch my mood disturbance before it spiralled out of control. To find a way to surf the waves rather than have them drag me under. So why am I not doing anything about it? I had a couple of weeks where anxious/low type symptoms were present. Nothing pathological, and nothing I couldn't do something about. In fact, I'd say my mood has pretty much been “normal” for a good month until now.

Now I am restless. Now I am avoiding sleep. There is so much to do with the day, oh how I wish a day had more hours than it did. I want to do everything: to learn, to teach, to sit exams, to practice medicine – oh, how I love being with patients! - to drive, to drink, to cook and eat, see friends, go to the beach, go to the gym, shop (especially for expensive dresses), to charm, to smile, to feel happy - why can I not be happy? Why do they (mental health professionals) want to curtail my excitement? I hate them. I loathe them, no, not just them, I loathe everyone. They're liars. This isn't a diagnosis, this is me and I am happy. I don't need to sleep – they're wrong.

Why am I so fixated about what they would think if they saw me now? Because in my heart I know something is wrong. I know they would worry about me sleeping less, about the times my thoughts rush, about me dropping almost £200 on a dress I really didn't need on Saturday because I felt like it (“I'm a doctor, I'm rich! I can have anything I want!”).

It's not all fun and games. A part of my heart is intermittently sinking. I am hearing those niggling voices say, “she hung herself”, “she hung herself”, “she locked herself in her room and hung herself”. Not one suicidal thought for two months and now they're back again. Damn those pesky voices...

What to do? My action plan involves stopping drinking and going to bed on time. Well, it's way past midnight already, and I resent trying to sleep when I don't want to. I didn't have a drink tonight, but it's a school night. Come the weekend I'll have forgotten this pledge to myself.

Who to tell? I've told my boyfriend, but he's gone abroad for a fortnight. I have a new GP I'm seeing on Friday. New. Can I trust him? Can I trust him to understand this, to understand me? I have one more session of CBT pending. Let's hope I can use it to turn myself around again. Because I am lost for ideas and lacking motivation.

It's hard to want to change when you're enjoying yourself.   

Coping with change... Again

It's been so long since I've written anything. Except drug charts and stuff.

Normally that's a good sign – the amount I write seems to be inversely correlated to my mood. The lower I go the more words pour out of me.

My mental stability is undergoing serious challenges this week: I'm moving house (which will involve negotiating my way through London during the Olympics); and I'm starting a new job. I'm having to say goodbye to all of my friends in London and, perhaps more importantly, people involved in my mental health care.

There is no way out of this chopping and changing as a junior doctor. I'll have another job in four months time and again four months after that. I will no doubt be having to move to a different part of the country next summer depending on the location of whatever training programme is mad enough to accept me.

I think it's hard enough for a healthy person, but when you have an underlying mental illness such as bipolar disorder moving so frequently can be very de-stabilising. I'm having to make sure I have a good GP to access and that Occupational Health at my new hospital are aware of my condition. I have to weigh up the pros and cons of letting my next supervisor know. And I guess in the short-term I need to be very vigilant about monitoring my mood and intervening early if things start to slip. So far there's no evidence of that that's happening. Not in a serious way. I felt really down this afternoon after a seagull shat on me (this isn't a joke), but come on... Isn't that a healthy emotional response?

I do wonder sometimes whether the UK medical training system couldn't be better at helping some doctors stay within a smaller geographical area. There are special circumstances that can allow a trainee to request to stay in a certain area, such as having children or requiring regular medical treatment that couldn't be accessed elsewhere. However I think it would be hard for me to make such a request on the grounds that moving house “may” destabilise my mood, especially as staying sane could well be seen as my responsibility, nor theirs. I don't begrudge them this particularly. I suspect such requests are rarely made on the grounds of embarrassment. But it's something to think about in future I suppose...   

Weight problems...

I've gained 2kg.

Okay, so that doesn't sound like that much. But in reality I've noticed my underwear is a little on the tight side. When I moan about my weight my boyfriend just roles his eyes and says he can't see any change in my appearance. We went on holiday last week, and looking back at the photos all I can see is how flabby my arms are starting to look (again, my boyfriend supposedly can't see this the way I can).

What bothers me isn't the weight gain itself, it's the question of why this has happened. Whatever it is has to be nipped in the bud or I'll risk gaining another 2kg next month. Deep down I know it's related to my mood. I'm not one of those depressives who draws attention to themselves by wasting away. I find myself slipping from a relatively active lifestyle to dividing time between my bed and my sofa. Pretty much all that gets me out of bed is food, as I suspect my writing has revealed. Is that such a bad thing though? When all is dark around you to hold on tight to any remaining source of pleasure in your life?

I've decided to avoid the temptation to respond to this with starvation. I've been through too many periods of self-starvation and subsequent overeating to entertain the notion that it would actually work. The plan is to gently increase my exercise levels and maybe ease off cake for a bit. I'm not an idiot, I know what my body needs to stay healthy. So why is it so damn difficult? I guess that long-term lifestyle changes require a degree of mental stability. I'm much better than I was a month ago, but in general I am an impulsive person. It's so tempting to hugely restrict my eating for a few days just to become giddy with excitement as the numbers on the scales drop slightly. Alas, the excitement never lasts. And when you enjoy food like I do starvation's a real mood killer.

Besides, I don't actually need to lose weight. I calculated my BMI and technically I'm still "healthy". I'd have to gain well over a stone before I'd be classed as overweight. But that doesn't take away my distress at the knowledge that I'm now (almost) the highest weight I've ever been. I've decided to bite the bullet and discuss the issue with my GP tomorrow, but I'm scared he'll just point out that I'm a healthy weight and leave it at that. We'll see.

I read a great blog post on the subject (here) the other day. Turns out it's not just me struggling with my body as well as my mind. If anyone has any other tips for managing to keep your body healthy in the face of a mood disorder I'd be glad to hear it.