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.   

Is this really hypomania?

My mood's bounced back up in style since yesterday.

Once again I'm up good and early and being "productive" (i.e. trying to take on two many activities and getting distracted every ten minutes). The same thing happened three days ago. On that occasion I woke a couple of hours early, made a cup of coffee but forgot to drink it, started cleaning the fridge but couldn't be bothered to finish the job, went online to check out the news, look at pretty dresses, and checked out flights to various European cities. I almost bought a £300 return ticket to Austria on the spur of the moment, but thankfully had the insight to remember I'd have to check with my employer if I could take time off for this trip.

I never know whether to class these kind of episodes as hypomania or not. The only reason I have a diagnosis of bipolar disorder is because of the times I have been supposedly "high". I say supposedly because I still can't make up my mind whether my intermittent bouts of over-activity are pathological or not. My psychiatrists have thought they are - but then it's their business to spot these kind of things. Certainly when I've looked at information leaflets or online about bipolar disorder, I end up thinking Shit, that Sounds Like Me. But then a part of me questions whether perhaps I am just an intrinsically more intelligent, creative and energetic person when healthy and my diagnosis is all wrong. Or whether all of these psychiatric diagnoses are a product of the pharmaceutical industry wanting us to believe we're all sick and need pills to make us better.

DSM-IV states that true hypomanic episodes should last four days or more. I've had a couple of periods in my life when I have been symptomatic for well over four days (once in adolescence and once in my third year of medical school when I went fucking nuts). Each of these episodes were followed by acute crashes into the world of depression. But apart from that I tend to be symptomatic for less than 24 hours, and in all honesty I'm not sure how apparent these episodes are to other people, perhaps because no one tends to be around at 4am, but also because my sensation that my thoughts are racing aren't really visible to the outside world.

My current psychiatrist says that hypomania can last just a few hours at a time and that what I describe to her fits the bill. Which brings me around to the question - should I be concerned when I start to feel this way? Sometimes the sensation that my thoughts are rushing can be very distressing. But at other times I feel great. It's certainly nice to need less sleep. And booking last minute holidays or being extremely sociable and chatty is fun. Then again I don't really achieve much when I'm like this. Sure I can write, but I can't read or study because I get distracted. I don't finish cleaning whatever it is I've started cleaning. And so on.

So lets say I decide when I feel like this it is a bad thing, what am I meant to do about it? For a while I thought you couldn't do anything because I put it down to brain processes that could only be altered through medication (which clearly my medication ain't quite achieving). But then I found this website they other day that has some really sage advice about the importance of nipping hypomanic episodes in the bud and the best ways to do this. The author advises you to Stop, Isolate and Relax. I won't go into the details - check out the site if you want to know more.

That's about all I have to reflect on this morning. But before I stop writing, I just wanted to brag about the fact that my salary is 133% of the UK national average - check out this new BBC tool to see how you fare: http://www.bbc.co.uk/news/magazine-17543356