This is a story about tailored medicine...

It's a subject I've written about at length before, but I was writing about my experiences with different mood stabilisers earlier today and I thought I would re-purpose that content for my blog, because I'm tired and I'm stressed, and it seems like a logical thing to do: To take something I wrote earlier and re-use it.

What I've written is in the style of advice given to somebody who's perhaps newly diagnosed as bipolar, or perhaps suspects that they have bipolar disorder. What I've written is from my own personal experiences. What I've written is not meant to be completely authoritative and factually correct, but I'm aware that it's my general writing style to present my opinions in a persuasive manner.

So, without further ado, let's get onto the list of bipolar mood stabilising medications I have known and loved (or hated, more like).

Quetiapine (Seroquel)

Horrible side effects, including weight gain, daytime sleepiness, dry mouth and constipation. When it takes effect, it's so strong that it's very hard to get to bed, or use the toilet in the middle of the night. Cannot be mixed with alcohol - the alcohol makes you feel very unwell.

Overall, this medication feels like being "heavily sedated" and it would be very difficult to carry on a normal life at dosages above 200mg. At dosages of 300mg or more, you'll be sleepy and dopey all the time. At dosages over 400mg, you'll be a shuffling zombie, good for nothing except dribbling in front of daytime TV.

Not compatible with having a job.

Aripiprazole (Abilify)

This medication had a strange side effect, where I lost fine motor control of my lips and seemed to produce excessive amounts of saliva. It was impossible to have a conversation with somebody without spraying them with spit, which was a horribly degrading experience for me.

Aripiprazole is very long-lived in the body, so it can take a week or more to wear off and get back to normal, even after taking this medication for only a couple of days (i.e. if you try it and you get bad side effects immediately, you'll have those side effects for a whole week at least).

Because of its very long half-life, I would have serious reservations about trying this one, except as a last resort.

Lamotrigine (Lamactil)

No side effects at first, but the dosage has to be increased very slowly with this one. Migrane headaches are a very common side effect, which I got, so I decided to stop taking it. The headaches are tolerable, I guess, because this is the medication with the fewest side effects.

Some psychiatrists might not consider lamotrigine to be a mood stabiliser, but in fact more of an antidepressant which is safe for bipolar people to take. It improves sleep quality so I think it's a good choice from amongst the fairly bleak options.

Also a good choice if you plan on attempting to have a normal job and work.

Olanzapine (Zyprexa)

Side effects include weight gain, daytime sleepiness and a general feeling of being drugged, but nowhere near as bad as quetiapine.

Very good at quickly stopping a manic episode, so it could arguably be used only when entering a manic phase, and then stopped a short while later, but this would require discipline.

Not recommended to take on a long-term basis.

Not compatible with having a normal job.

Sodium valproate (Depakote)

Dreadful side effects. Will turn you into a total shuffling, dribbling zombie and eventually you will get an irreversible kind of brain damage, which will cause you to make involuntary facial movements (a bit like a tic).

This is an awful drug, given to paranoid schizophrenics who are very severely sick (paranoia, hearing voices, hallucinations etc).

If you're on this, it's probably forcibly injected into you in a psychiatric institution. The injections last for 3 months. Don't ever let yourself get so unwell that this becomes necessary. Exhaust all the other options first.

Lithium

Very hard to get the dose right, and requires regular blood testing, which is annoying and inconvenient. Very effective and side effects are tolerable if you can get the dose perfect but it might take many years to find exactly the right dose, and it will be very destabilising if you start going too low with your dose - i.e. you might end up triggering manic episodes when you're simply trying to avoid side effects.

Lithium causes irreversible health damage when used long term, and is therefore "life limiting" in a way - it might reduce your lifespan by 5 years or more, which is obviously a high price to pay.

General Comments

Psychiatrists will tell you that you need to commit to a medication for at least 3 months, in order to feel the therapeutic effects and for the side effects to wear off. I have tried all the medications listed above for 3 months or more, and the side effects never wore off. The side effects were intolerable for all the medications, except lamotrigine.

If you take these medications for longer than a few weeks (with the exception of lamotrigine) then you cannot stop taking them abruptly. If you suddenly stop taking these medications, you will have horrible rebound mania and possibly psychosis too (hearing voices etc). However, I have successfully 'weaned' (i.e. tapered) myself off all these medications, without too many problems.

The worst manic episodes I've had have been when stopping quetiapine and olanzapine abruptly. When I've tapered off the medications slowly, my mood has been fine and I've not had any problems. In fact, every time I've stopped taking a medication, I've felt much better, because the side effects are so awful.

I would advise you to consider olanzapine as a treatment for acute episodes of mania... i.e. you should have some ready to take, and when you start to go manic then start taking it to make sure your mania doesn't spiral out of control.

I would also advise you to consider lamotrigine as first or second choice. I believe many busy working professionals with bipolar disorder find lamotrigine to be a good medication, because it has few side effects.

Psychiatrists will probably pressure you to be on a stronger medication, which is likely to be an atypical antipsychotic (quetiapine, aripiprazole, olanzapine, sodium valproate, risperidone, clozapine) but all of these will have very profound side effects, most notably making you feel tired and sleepy, lethargic, foggy-headed, confused, increasing your appetite and reducing your sex drive. It's personal choice, but I find those side effects unacceptable.

Alternatives to Medication

Alternatively, you can use good lifestyle choices to manage bipolar: no alcohol, no caffeine, strict bedtimes, strict work:life balance, exercise, good diet. You will probably need some trusted people around you who can let you know when your speech is becoming more pressured, you're getting irritable, perhaps you're getting a little obsessive about projects, becoming more impulsive and taking more risks... essentially, when you're heading into a manic episode, which could escalate. I find that getting 8 to 10 hours sleep each night, no more and no less, helps me to keep my mood stable. I also find that my manic episodes are much less of a problem since I quit caffeine. Recreational drugs are a terrible terrible idea, and completely incompatible with bipolar, unfortunately, especially the stimulants: legal high powders, speed, coke, crystal meth, meow meow, M-CAT, mephedrone, monkey dust etc. etc.

Stressful life events can be very triggering for mania, as well as the temptation to work hard because of a job change, promotion or exciting project. It takes a lot of careful planning to ensure that stress is kept to a minimum and work:life balance is preserved. If you want to get obsessed with anything, make it exercise and the great outdoors.

In Conclusion

I'm living a functional and complete life, with a full-time job, managing to have good relationships, managing my money, not engaging in risky behaviours or otherwise suffering many problems with my bipolar disorder. I have depressions, which are sometimes bad enough to cause me to take some time off work, but only a few days here and there. I have hypomanic episodes, where I can spend a lot of money and make impulsive decisions. However, considering that I don't take any mood stabilising medications for my bipolar disorder, my mood is remarkably stable and almost everybody would consider me to be successfully managing my condition, without having any particularly adverse effects on my quality of life.

I can highly recommend trying to go medication free, or spending a lot of time trying different medications and tweaking the dosage, because life is so much better when you're not drugged up to the eyeballs with powerful psychiatric chemicals, which radically alter you and your personality, with horrible side effects.

I'm not antipsychiatry per se, but I would advise people to make very well informed decisions and remind your clinicians that it's your body, so it's your rules, and like with every profession, there are people who are brilliant at their jobs and there are people who are not so great. You need to educate yourself so that you know whether you're getting good advice or not. You can't just trust everybody who calls themselves a doctor.

Mental health is complex. Bipolar disorder is complex. People are complex. We are all individuals and we have individual needs and individual unique circumstances. Tailor your solution to meet your needs.

Tags: #bipolar #medication #mentalhealth

This is a story about normalising...

There is some debate about what type of bipolar disorder I suffer from. I've always thought that I had the milder type 2 variety, because my 'high' periods had never caused me any problems at work or at home, but perhaps it's only because I've been fortunate enough to enjoy wealth and privilege that I've gotten away without suffering dire consequences. In fact, my 'high' periods have always produced far more wealth than my stable periods, reinforcing the idea that I don't have a very severe mental illness at all.

The world around us produces bipolarity.

Most of the time, there's nothing to do at our boring bullshit jobs. Most of the time we're in neutral gear coasting along. Most of the time our lives are filled with bland monotony.

We need to cram for exams. We need to shine in job interviews. We need to dazzle our new work colleagues. We need to work crazy hours to finish projects in time for deadlines. We need to dedicate ourselves to solving very hard problems, by thinking about them intensely without getting distracted. We need to pursue our love interests obsessively. We need to practice, practice, practice - to the exclusion of everything else - if we want to get good at a particular skill or sport.

We reward every bipolar aspect of somebody's personality. We celebrate bipolarity.

Who cares if you're depressed all summer, so long as you got through your final exams? Who cares if writing your dissertation or thesis nearly killed you, so long as you finished it on time? Who cares if your project burnt you out as long as the deadline was met? Who cares that nearly every aspect of modern life wrings more out of you than you can healthily give, so long as you're winning?

We are driven to use substances which confer a competitive advantage. Alcohol will tranquillise your jangled nerves. Caffeine and nicotine will pep you up. Who cares that there's a price to be paid for using these uppers and downers? Society will handsomely reward you for skipping sleep and using every substance available to you, at the expense of your health.

I'm a lifelong sufferer of social jetlag. To work 9 to 5 hours in an office is torturous because my body clock is not designed to run to that schedule. I'm genetically programmed differently from all those obedient little drones who find it easy to rise and shine. My DNA is completely different from that of an early bird. We're very different animals.

I'm a lifelong sufferer of interminable insufferable excruciatingly painful boredom. Waiting for something interesting to happen at work and for things to get exciting has consumed 95% of my wasted fucking time, spent looking busy at my desk.

Once all the waste-of-space dead-wood losers have finished having endless meetings and not making any decisions, when the project deadlines loom large, finally I have my moment to shine. I can't understand why anybody would have me - a miserable depressed cynic who turns up insultingly late every day - around in the office ruining morale, except that I'm pretty handy to have available when something actually needs fucking doing, which is surprisingly rarely. I guess the reason why my services are retained is because I can usually cobble something together that works, pretty damn quickly, although it always requires hypomanic levels of obsessive round-the-clock effort.

It appears that it's me who is aberrant, so I must comply and conform to the world around me. Because most people are wage-slave drones who do a whole lot of nothing most of the time, I am forced to pretend I'm just like them. I'm forced to act like I'm perfectly OK bumbling along doing sweet F.A. for most of the 40-hour week. I'm forced to act like I prefer be bored out of my tiny mind 95% of the time, just like them.

The problem is that I build up a lot of pent-up energy, like a compressed spring.

When eventually there's something to do, I race along at breakneck pace. When at long last I'm unleashed I tear along as fast as I can, because it's so damn wonderful to be free, having been held back for an eternity.

The system worked for a couple of decades. I managed to fit in for my whole career. I managed to get along just fine, even though I had a mental illness the whole time: bipolar disorder.

I discovered the unalloyed joy of telling people to fuck off. I discovered that it's not the end of the world if you quit your job and start your own company, because you were being exploited and unfairly discriminated against. I discovered that the whole capitalist society is rigged to make you paranoid about becoming unemployable, because of gaps on your CV or other less-than-ideal obedient slave behaviour.

What I later discovered is that there is a lot of very easy money to be made in the corporate world, if you're prepared to sell your soul and suffer the interminable boredom. It's easy money provided you're prepared to put up with an unfulfilling career doing things which are morally dubious. You can become a prostitute, getting fucked by the rich, or you can become a corporate whore and fuck the poor on behalf of the rich.

Only the rich have the luxury of being able to mess around doing so-called philanthropic things, with money they made from war, drugs, slavery, pimping and other forms of exploitation.

My working week consists of a whole lot of keeping my mouth shut because of my vested interests. The best thing I can do is sit quietly at my desk for 40 hours a week. Nobody cares whether I do any work or not, so long as I'm a willing participant in the conspiracy of silence. The more silent I am the better. There is an inversely proportionate relationship between how much I speak and how much I earn.

This time of year is always very difficult for me. I've had a helluva year to get to this point, but I'm in a good position to cement the gains I've made.

[I screwed up copy-pasting this text, which I'd put in the clipboard in the event that I accidentally lost my progress. I lost a few hundred words, but I'm not going to retype them now. This will have to do. I'm frustrated, but I've already written more than a thousand words, which is plenty]

Tags: #bipolar

This is a story about wakefulness promoting agents...

I used energy drinks to help me get through the aftermath of a screw-up back in May. I still had some left to help me get through a screw-up last week.

I forget how fragile my life is; how fragile my stability is.

I'm not aware how much I have recovered. I'm not aware how quickly I have destroyed that recovery.

It's only that I can remember key milestones, such as being hospitalised a year ago, or screwing up back in May - when I bought the energy drinks - that I can attempt to avoid repeating the same mistakes, which will hopefully break the cycle.

Unfortunately, uppers, downers, sleep deprivation and all those other things which are destabilising, seem to conspire and combine in ways that destroy my insight and render me dumb.

I often have no idea just how slow-witted and dumb I really am.

I've written and deleted thousands of words tonight.

I'm in Prague for the weekend. I have to go back to work on Monday; it's the start of another ordinary week. I have to carry on. I have to keep my 10-consecutive-month streak of uninterrupted work going for a bit longer. I have to pretend to be stable, even though I'm really not. I have to fix the things I've broken. I have to keep moving forwards, even though I sometimes take a backwards step.

Spending vast sums of money, international travel, seeing old friends after a long period of social isolation, caffeine, sudden changes in medication, sleep deprivation, drastic changes in alcohol consumption... it's bound to be very destabilising.

Work is relentless. Debt is relentless. Progress is imperceptible. Insight is hard.

I'm punch-drunk.

Tags: #caffeine

This is a story about delicate senses...

My preference for sweet or salty, my thirst and my sense of smell are all altered by alcohol, but I'm not able to perceive those alterations to my senses in any given moment. It's only when I carefully analyse my behaviour that I can see I drink more water and eat more sweet things when I've been sober for a few days, and I begin to see food as something worth spending time and effort on, instead of eating as a chore.

If alcohol can alter those senses so profoundly, I wonder what other subtle effects it has on me. The sleep I get seems to be of much lower quality when I go to bed drunk, although I don't perceive that at the time because I find it much easier to fall asleep when I've had lots to drink. When I have a break from drinking I notice that I have very vivid dreams, bordering on nightmares, which reveal a lot of things going on in my subconscious. Having used alcohol as a crutch for so long, it's amazing how much trauma I've repressed and not dealt with.

I made a prediction earlier in the week that I'd have increasingly better days, not because we're getting closer to the weekend, but because I'm sobering up. It's hard to quantify, but I found it much easier to get up this morning and although there were periods when I was bored and miserable at work, I found myself far less inclined to give up and walk out.

There was a leaving do at work and my colleagues invited me out drinking tonight. There's an open bottle of wine in my cupboard and I bought 4 more because there was an offer at the supermarket. The temptation to drink and the social pressure to get drunk is hard to escape. Alcohol is a social lubricant and can be especially welcome when making smalltalk and getting to know people. This week has felt long and difficult and it's hard not to reach for the bottle as a reward for putting myself through the misery.

Which came first? The misery or the alcohol?

I find it easy enough to stop drinking when I want to, but I wonder if I've simply become habituated into experiencing and putting up with awful feelings. Alcoholics can begin to enjoy the sensation of neat liquor burning their throat as they glug it down, and junkies can get needle fixations and enjoy injecting themselves. I wonder if my brain has become confused by my cycle of highs and lows; boom and bust. I wonder if I'm simply unable to tell when I'm half-drunk, hungover, withdrawing, completely intoxicated or stone cold sober, because there's nothing extreme enough to register on my scale. The highs and lows which I've experienced have ranged by such an exceptional amount that I've become used to never feeling very good at all. Earlier this year I didn't even notice that I had a bad chest infection, except that my ribs were so tender I couldn't sleep and it was agonising to sit up in bed in the morning, or to cough. Depression and anxiety are just things I live with, without medication.

I know that my brain is a homeostatic organ which will attempt to return itself to equilibrium. If I put stimulants into my body, I will make myself more tired. If I put depressants into my body, I will bounce back the other way. Everything has an effect for a short while before my brain readjusts and it becomes normal. It shocks me how functional I can be when full of drink and drugs, or under an incredible amount of stress and in very bad circumstances.

I'm attempting to control the variables. I'm attempting to clear my brain of drink and drugs. I'm creating a pharmacologically unpolluted state, where I'm free from nicotine, caffeine, uppers, downers, medications, hard drugs, soft drugs, legal highs and every other thing we normally use in our daily lives to tweak our moods hither and thither.

I stay in an identical hotel room and eat in the same place every night, normally choosing one of only a handful of my favourite dishes. I'm doing the same work I've done my whole 21+ year full-time career for an organisation which is ostensibly similar to all the others I've worked for, solving exactly the same problems I've solved a million times before. It's an almost perfect experiment. I can't imagine that it would be possible for almost anybody else to experiment on themselves in the same way, because so few of us are capable of giving up things like tea and coffee, or of sticking with a job which makes us excruciatingly bored and thoroughly miserable.

So far, my conclusion is that alcohol does not make the time pass any quicker, reduce anxiety or aid sleep. My conclusion is that alcohol makes it harder to concentrate and cope with the boredom. My conclusion is that alcohol is not very helpful, but I'll tell you what is helpful: money. Despite being almost continuously drunk for the past 9 consecutive months, undoubtedly the biggest changing variable has been my ever-increasing wealth. I can't say whether it would have been easier and more pleasant to reach today without alcohol, and whether I'd have been more inclined to improve areas of my life which are completely absent, such as a social life, but I can say that alcohol was ever-present. Is it possible that I might not have made it so far without alcohol? I really don't think it's likely that I would've made it through the roughest patches without alcohol as a relatively inexpensive coping mechanism, even if it's a very poor medicine for reducing anxiety, fighting depression, stabilising my mood and helping me sleep.

If we consider that a year ago I was suicidally depressed, manically high, abusing drugs, addicted to medications and generally in a dreadful state with little or no hope of escaping that situation, I don't see how it would be possible to resolve everything without something to use to self-medicate.

It's impossibly unlikely that anybody's going to gift you £100,000 and a year off work to get your life sorted out, which is what it would take to rescue somebody whose entire world has imploded spectacularly, leaving them crippled with mountainous debts, homeless, jobless, single, estranged from their family, mentally ill, alcoholic, addicted to drugs and dependent on medications.

As my head clears, I realise I've pulled of an impossible feat. I've come back from a clusterfuck of issues which should have buried me a million times over.

It's hard to avoid the pitfall of marvelling at the miraculousness of my recovery, such that I start to believe I'm special, different and perhaps even immortal. It's hard to see the evidence and to not draw the conclusion that the clearly exceptional achievement must mean I'm destined for greatness. At least I have a clear enough head to see that I've fallen foul of that before, and that it's important to keep my brain intoxicated just the right amount to stop it from overheating. Going teetotal in 2015 caused me to swing into mania, so I'm not going to make that mistake again.

I'm also aware that I'm no longer a young man and that the past few years have been very hard on my brain and body. Ultimately I can't keep pushing myself as hard as I have been and taking extreme risks. Sooner or later my luck is going to run out, even though all the evidence seems to indicate that I'm immortal.

As my thoughts start to wander towards topics which have always been a little too hot to handle - such as quantum mechanics - I now start to realise that there's a lot to be said for being a bit of a drunk, at least until I'm filthy rich again.

I've managed to avoid drinking again tonight. I'm going to see how I feel tomorrow, but I must be careful to preserve the good progress I've made this year, even if that means continuing to drink because it's my tried-and-trusted means of keeping my mania at bay. Better the devil you know.

Physically, I have a runny nose, a sore throat and a headache. I feel terrible, which I imagine is because I'm at the 3 or 4 day sober mark and my body is seriously protesting about the lack of alcohol. If I continue my sober streak I'll feel physically better, but there's always the risk that mania will rear its ugly head and I'll screw up everything I've worked for 9 consecutive months without a holiday to rebuild.

September is coming. September is my nemesis. If I can get through September smoothly, that will be a huge milestone.

Tags: #bipolar #alcohol #anxiety #depression

This is a story about a calorie controlled diet...

If there's one thing I like to do other than drink alcohol, it's to eat unhealthy food. In fact, I find the combination of both to be most agreeable.

Here's what I've eaten (and some of what I've drunk) in the last week:

Sunday

1. Tin of Heinz beans & sausages

Monday

1. Vegetable samosa
2. Chicken, bacon & mayonaise pre-prepared sandwich
3. Large bag of Skips crisps
4. Large bag of beef flavour crisps
5. 3 cheese strings
6. 1 bottle of white wine
7. 1 bottle of red wine
8. Peanut butter eaten straight from the tub

Tuesday

1. Nothing

Wednesday

1. Nothing

Thursday

1. 4x slices of toast with marmite on

Friday

1. 3x chicken drumsticks
2. 2x smoked mackerel fillets
3. 4x cheese strings
4. Tiny amount of Ben & Jerry's Karamel Sutra ice cream
5. 1 bottle of red wine
6. 1 bottle of white wine

Saturday

1. Nothing

In terms of drinking that I omitted, because it's been a bit more chaotic/unpredictable, and it's also fairly boring information, I have drunk a lot of apple & black-current, orange and lime flavour squash. It's 24 degrees celcius in my apartment and staying cool is a problem. I pre-mix the squash, speed chill it in the freezer and then transfer it to the fridge. In theory, there's always a cold drink I can grab, provided I'm not cornered in some part of my apartment.

Monday is representative of what I ate and drank most days while I was working full-time, although I'd try to keep to one bottle of wine only.

Friday I managed to stock my cupboards from a proper big supermarket on Friday. Not well communicated by this food diary, is the fact that my cupboards and fridge are now brimming with easy-to-make meals, which are far healthier than big bags of crisps, samosas, more crisps and other crap you can buy from a corner shop, along with 2 bottles of wine for just over a tenner.

I have a cornucopia of delicious foods to choose from right now, yet my life is still chaotic.

The vicious cycle goes like this: I start to feel stressed and anxious, which triggers an alcohol craving. I then buy 2 bottles of wine, 'planning' on only drinking one. I drink both bottles and wake up feeling awful, of course. The hangover triggers a stimulant craving, which can be temporarily alleviated with Red Bull, but that then causes me to feel anxious and jittery and crave alcohol. Allegedly, somebody identical to me but not me, tried taking Concerta (an ADHD medication) for a couple of weeks: it's often sold as Concerta, but that's because the previous brand - Ritalin - has negative connotations in patient's minds, like Prozac (tell the patient it's fluoxetine and they'll be much more likely to take it).

I think my health would benefit from:

• Not drinking 1 or 2 bottles of wine every day
• Not binging on unhealthy snacks while getting drunk
• Going to a proper supermarket once a week, so I have food that I want to eat in stock, as opposed to going to the corner shop every day because I'm "hungry" but really it's to buy 1 or 2 bottles of wine too.
• Not relapsing back into being a regular caffeine user
• Finding some kind of Concerta/Adderall slow-release formula type medication that can help me face the next 27+ years of soul destroying office job bullshit, which only keeps me busy & concentrating for 5% of the time and the rest is like torture
• Finding some kind of tolerable antidepressant, to help me through what I anticipate will be at least a year of feeling lifeless, joyless, demotivated and deriving almost no pleasure from the things I used to enjoy.
• Maybe if that pile of pills is making me a bit too enthusiastic and excitable, bordering on the manic, I might have to consider a light mood stabiliser too - perhaps a low dose of Olanzapine, although I'm loathe to suffer the weight gain.

Specifically my mental health would benefit from:

• Detoxing again from the sleeping pills, tranquillisers, sedatives and stimulants, which I've only used sporadically over the last 6 weeks - I have no benzodiazepine dependency, thankfully - but I need to 100% cease that ruinous vicious circle.
• Getting a hair cut and washing my favourite clothes; maybe even buying a couple of new things I like... I seriously only buy new clothes every 3 years
• Getting my apartment in a state where I'm not paranoid that the landlord might see a couple of bits of damaged decoration and freak out.
• Securing a new contract, but with enough time to physically rest & recuperate before starting
• Spending some time with my friends in Ireland, or going to a hostel where I can be around people, and socialise a bit, as well as sleeping lots, getting fresh air and generally having a long-overdue restorative holiday.
• Being realistic about where I'm really going to thrive, or where I'm going to be isolated and lonely. Swindon is a big no, I think. Newport, I have one friend, but he's super busy with his kids. So, it's got to be London really.
• Friends first - get a regular meetup sorted... a guaranteed one day of the week (minimum) where I'll see friend(s). The more friends the better. Concentrate on friends.
• Being more aware of how easily I fall in love and become relaxed and comfortable in domestic life. I'm quite content deciding on dinner, cooking, eating, watching TV or a film, kissing and cuddling, sex, spooning, then a kiss goodbye in the morning with a nice hug... and repeat, and repeat, and repeat. I've been so isolated and lonely for so long that FOMO and jealousy of my partner's social life isn't a problem, and I just spend the time on my own... drinking. It doesn't leave me in a very secure place though, if I don't have my own friends and events.
• Exercise. I put this on just because it's such an obvious suggestion, and one that I get all the time. It's not a bad suggestion. It's an impossible suggestion when all the other stuff listed above is broken. "You won't feel like doing it, but afterwards you'll feel more energised; it'll give you energy" - OK, what you're talking about are chemicals released to ease your muscle pain, which are actually opioids, so you get a literal 'high' after exercise, AND the fact that you're getting fitter. Energy cannot be created or destroyed, so to use energy does not give you energy. You're right, I don't feel like doing it, and I would benefit from being fitter, but as the Millennials are wont to say: "I literally can't even".
• Speaking to friends on the phone or Facetime etc - I live my life in text, through a browser or an app. I'm in contact with sometimes hundreds of people a day (19.5k Twitter followers presently, for example) and some friends are good enough to regularly message me, but it's not the same as a live conversation where you can hear somebody's voice.

Well, and just because I'm making lists, here's the practical stuff I've got to sort urgently:

• Car MOT on Monday morning
• Answer phone/emails from agents RE: contracts
• The world's biggest pile of stinky washing
• Making sure my back bedrooms are at least passable and not likely to cause alarm to uninvited visitors

Less urgent is the redecorating, just because it's going to be a pain to organise.

nAlso, I did an epic job of cleaning the bathroom(s) spotlessly and mopping the floors and otherwise making my apartment pretty presentable, A lot of my TODO list has been tamed.

So, a bit more than just my food diary, but it hints at why for 5 out of 7 days I ate virtually nothing. It also hints at the three ways things could go: 1) no more food diary cos I'm dead, 2) food diary of junk which is making me fat, and alcohol which is making me unwell, 3) food diary that might be a bit more interesting (although it'll probably start with sandwiches and soups and pre-cooked meats).

Also, related content if it's going to be the "no more food diary": The Supercrack Diet

NOTE: I think the muscle damage/breakdown causes weight loss (at the expense of your kidneys) and sweating and dehydration cause further weight loss, but your body goes into shock and you just end up weak and more or less the same weight once you've rehydrated... although my tummy is half the size of what it was 6 weeks ago. Any sport scientist will tell you not to run out of glucose or water when exercising, or else you'll lose muscle mass, while any doctor will tell you that artificially raising your metabolic rate and putting strain on your heart (such as using fat-burners like DNP) is quite likely to kill you or permanently f**k you up.

You can lose weight by 'fasting' but it's for people with sedentary jobs, and also there's no point if you're going to undo your good work by binging on junk and alcohol on the 'normal' days.

Anyway, there's a little glimpse into my unhealthy lifestyle.

Tags: #food #diet #fat #slimming #mentalhealth #depression #adhd #exercise #friends

This is a story about shelf life...

Objectively comparing feelings at different times in your life is a virtually impossible task. What you would have described as 'low' mood a few years ago might have now become your new standard for a 'good' day. All I can tell you is that I don't remember ever feeling as tired as I have felt today.

I spent 5 hours driving, 7 hours waiting around in airports and 5 hours flying, which was all exhausting. However, in the last week or so there's something else that's been quite different about my behaviour - I've been drinking coffee and energy drinks.

A couple of weeks I desperately needed an extra bit of 'get up and go' to get me through a tough couple of weeks. I reached for caffeine as a crutch. I gave up - although perhaps only temporarily - my many years of caffeine-free existence.

When I was away with my friend over the weekend, it was tempting to just move from bar to bar, restaurant to restaurant, café to café. We drank fizzy drinks, strong European coffee, had ice-creams and I drank quite a lot of beer. We guzzled sugar, caffeine, and I had plenty of alcohol.

Yesterday, because I had to drive home from the airport, I had to stay sober all day. I also didn't want to be wired and jittery from having loads of coffee. I was exhausted, so I wanted to sleep on the plane ride, so that I wouldn't fall asleep at the wheel while driving home.

I think to say "alcohol dependent" is an over-exaggeration, but having slept most of the day, and generally felt like everything was far too much effort, it was the lure of alcohol that finally managed to get me off the sofa and out of the house.

If you look at most of my behaviour, it's motivated by the tiny dopamine hits from sugar, caffeine and the mellowing effect of alcohol. I used to ride a dreadful chemical carousel when I was a lot younger, working in London: I would have 8 or more espresso shots a day, and then had to have a bottle of red wine at night in order to be able to sleep. It was a vicious see-saw of uppers and downers, that were quite legal and indeed the consumption of coffee and alcohol was quite ubiquitous amongst my friends and work colleagues.

I've felt like my sleep quality has improved and I find it a lot easier to get up in the mornings, since going caffeine-free.

I've never really managed to get rid of alcohol completely. I find that I suffer terrible anxiety and depression whenever I try to stop drinking.

Sugar is something I have a mixed relationship with. I crave it like crazy when I'm tired. When I'm well rested I don't have a very sweet tooth at all. I think I associate sugar with getting an energy boost, which in fact never happens. If I'm craving sugar I should probably take a nap.

There's nothing to say that caffeine is particularly bad for you, and in fact there's good evidence that it has a neuro-protective effect against dementia in older people, but anecdotally I can definitely report feeling improved mood, energy and sleep, since cutting my caffeine intake to zero.

Sugar is obviously fattening, and is very unhealthy, although an essential part of our diet - every cell in our body is powered by glucose, so any faddy sugar-free low-carb diets are pure idiocy.

Alcohol is fattening and seems to have a firm grip on me, even if I'm not physically dependent on it. The strength of the cravings I have for alcohol are quite shocking, and the regularity and quantity I consume is definitely unhealthy. I would like to cut down, or even quit for a while, but I'm never quite able to.

In short, I'm feeling really tired, old and unhealthy. My mood is dreadfully low, I'm lacking motivation and I seem to have lost all enjoyment of life.

I wonder if I'm past my sell-by date.

Tags: #alcohol #caffeine #health #diet #sugar #mood #depression #exhaustion #fatigue

This is a story about paying the penalty...

I thought this week was going to be impossible - I'd lost a lot of sleep over the weekend and I was freaking out that I'd never catch up. However, I seemed to get through 3 normalish days in the office somehow.

Something's screwy with my mood and body clock. All of my rules about early bedtimes and no caffeine have gone out of the window.

The net result has been 3 late nights, and 3 days when I've been quite manic, which is exhausting in and of itself.

It all caught up with me today, and all the exhaustion has seemed to hit me at once.

Frustrating, because it's my last chance to make a good impression at the old place, and possibly find a way so that I can carry on working locally. Also frustrating because I need to be sharp and at the top of my game tomorrow, first thing in the morning.

I've got so much to do tomorrow. It's going to be a horribly busy day.

Then, I'm seeing an old friend over the weekend, which I'm really looking forward to, but I'd hate to ruin it by being half-dead from exhaustion.

Things should be alright, but I really need that early night I keep talking about but never actually managing to get. Also, less wine. I've been drinking far too much.

Not been looking after my physical or mental health at all well.

Tags: #bipolar #mania #insomnia #alcohol

This is a story about predictable unpredictability...

I messaged a trusted friend at work: I'm sleep deprived and manic... can you sneak my laptop out of the building, should I make up an excuse to bunk off work, or should I just come in and pretend like everything's fine? He told me to message him in the morning.

I woke up at 4am, when presumably the deadly cocktail of sleeping pills, tranquillisers, sedatives and alcohol wore off enough that my mania re-asserted itself. Even my dreams hadn't been sweet dreams about nothing... my mind had been working overtime to find elegant solutions to hard problems.

By 7am - when I usually get up - I realised I could force myself out of bed and face the day if I wanted. However, the only restful part of any 24 hours for me, is the period when my intense dreams are done and I can have a second period of sleep, which is pure bliss. The alarm clock is perhaps responsible for more human misery than any other human invention, including bombs and guns and instruments of torture.

There were no small cans of Red Bull for sale at the office canteen, so I guzzled half a litre of high-glucose high-caffeine energy drink. As I feared, I spoke far too much; too loudly... I lost all subtlety, tact and ability to hold my tongue. In short: I was everything you don't want from a work colleague who you have to spend 40 hours a week in a small room with.

As with many engineers - or those with a tendency towards the technical - I started pulling things to bits. Something had been broken for a week or two and nobody knew how to fix it. People were losing sleep and the shiny shiny new system was starting to look like an unreliable heap of junk, not the perfect thing that everyone imagined they would create, given a blank canvas.

I skipped my lunch. I said "just give me 5 minutes" to so many people, while I continued to pursue my new obsession: I was going to be the hero who solved this problem which had defeated so many others.

Before I knew it, the cleaners were hoovering under my feet and the building was looking pretty dark and empty. I went out to the car park, where luckily my car wasn't parked, because the compound was fully secured - I was locked in.

In my mind, I achieved something noteworthy. I found and fixed the problem they said that nobody would ever be able to do - it was too hard; everything that could be thought of had already been tried.

I shared the news with my colleagues, all long-since departed home to their families. Most people write 1-liners "fixed the bug". I struggled to not write an entire essay on why the shiny shiny new system is actually a piece of shit that should be rebuilt; repainted on that blank canvas. Of course, nobody really wants to read a message with 6 paragraphs. Nobody really wants to be told that a fundamentally shit decision at the start of the project has flawed the whole damn thing. Nobody really cares that much, except me.

Actually, I'm being unfair. Some of my colleagues have been seized by manic moments and decided to embark upon one-man missions to reach that engineer's nirvana: the most elegant system imaginable. My colleagues kindly indulge me when I say "errr.... why hasn't this been done properly?" and they tell me the age-old tale of the decision to cut corners, because it's "tactical". We roll our eyes, and dream of the day when we're really given that elusive blank canvas.

A few years ago, I single-handedly rewrote an entire system - belonging to one of the UK's big 4 high street banks - over the course of about 4 days, mostly without sleep. I learned nothing. What I ended up with was elegant and beautiful, but it'd be like hanging a Monet in your 3-year-old's bedroom - it'll soon end up with crayon and felt tip pen scrawled all over it. It was an arrogant and stupid waste of time.

Today, I rebuilt what my colleagues had built, so that I could learn why they made the decisions they made. I put myself in their shoes, and I walked the same path that they must've walked, when they built the shiny shiny new system.

There's a short answer and a long answer. Tomorrow I can say: "I know where the bug is and I know how to fix it". That's the short answer, and that's the only one anyone cares about. Tomorrow I want to say: "I know where you took a wrong turn, and I know how we can make things perfect; elegant" but nobody cares... just get the damn thing running, no matter how flawed and unreliable; no matter how ugly it is when you peek behind the scenes.

It wasn't that long ago I was given a blank canvas for the first time in my career. You know what I opted for? Ugly simplicity. I built something that was the complete opposite of elegance. I built something where just about anybody could see what every nut, bolt and widget was there to do. You know what else I learned? When you've actually got to make a whole entire system from the ground up, you never ever anticipate the things that are going to ruin the perfection - the decisions that seem great at the time, but eventually mean you'll never achieve a completely elegant solution.

All I can say is, at least my mind is occupied on days like today. There hasn't been a moment to consider just how terrible I feel. There hasn't been a moment of boredom.

I'm glad I got up and went to the office, even if I've made it abundantly clear to my colleagues that I'm an unstable nutcase.

The world needs unstable nutcases.

Tags: #bipolar

This is a story about non-pharmacological interventions...

The word "choice" is a little unfair. To suggest that people could help themselves by making better lifestyle choices assumes that our choices are unbiased. It seems obvious that we'd choose low-fat, low-carb, low-salt options because they're better for our heath, but we're biased towards things that taste nice. It seems obvious that we'd cut alcohol, caffeine, drugs and medications out of our life, because they all have nasty side effects, but we're biased towards things which make us feel good. It seems obvious that we should work less, spend more time with our families and not commute so far, but sadly it's not easy to up sticks and move closer to our jobs and often we have to do jobs we hate because we need the money.

At my meeting with a psychiatrist today we essentially agreed that I can manage my disposition towards mood disorder using lifestyle choices, but it's going to take a lot of hard work. I need to exercise more, I need to change my job and I need to cut down or even quit my alcohol consumption. As well, I need to continue to have strict bedtimes, avoid caffeine, dim the lights after dusk, use a light box in the mornings and eat a balanced diet. I also need to resist the urge to spend money, take risks, be promiscuous and dabble with drugs. All fairly obvious stuff, but none of it is much fun.

Aside from some disagreement over whether I'm type 1 or type 2 bipolar, and the severity of my illness, I actually got on pretty well with the psychiatrist. To hear the words "you have a chronic condition that cannot be cured" is not very nice and my instinct was to argue that I don't have a condition at all - my symptoms have been a product of my environment; caused by the stress of my situations I've been in. In actual fact, I concede that I've had symptoms of bipolar for as long as I can remember... it's just that my bosses and work colleagues have always been very understanding of my highs and lows. A lot of people would get sacked for coming in to work two hours late every day, or shooting their mouth off and throwing a tantrum in the middle of the office, but there's a place in the workplace for somebody who can work for weeks without any sleep when there's a crazy deadline to meet. I agreed with the psychiatrist that I've got a lifelong condition, which will need careful management. It doesn't scare or upset me, because I managed my condition effectively for years before things got dangerously erratic.

To hear lithium and sodium valproate banded around as potential treatments is not what I wanted. I prefer to think that I've got a mild form of bipolar which can be managed with a medication like lamotrigine, or no medication at all. I consider that my 'high' periods have been hypomanic because I had no grandiosity, psychosis or paranoia. The psychiatrist considers me to be a fully blown manic depressive, because my manic phases have lasted more than a week. I think we'll have to agree to disagree, because my mania does not seem at all severe, except when exacerbated by drugs and sleep deprivation.

I asked about talk therapy. There's an 18 month waiting list. I'm being referred, but 18 months is a heck of a long time to wait for psychological therapy. Getting some kind of talk therapy has become a crusade to me, because I first sought treatment in 2008, so it's been 10 years since I asked and I still haven't received any therapy.

In short, I think I agree that I have a certain amount of risk towards becoming really unwell, but it's not destiny. I have a lot of hard work to do, and I have to continue to make so-called smart choices, when really my life's not a lot of fun and I still have to figure out how to pay the bills somehow. I do agree that there's something about me - call it an illness if you like - that means I have to pay a bit more attention to my lifestyle than others might, who don't share the same predisposition towards mood instability.

I went into the psych consultation feeling quite unique and special. I was feeling pretty proud of myself for being unmedicated and having dealt with a lot of things that were definitely wrecking my life. Then the psych helped me see that a lot of people who are bipolar have a similar story of reckless risk taking, money spending, hyper-sexuality, drug taking, getting into conflict with bosses, drinking too much and all the other things that lead to a point where lives get utterly screwed up. I suppose there comes a certain point where a person just can't continue to live their life a certain way - the end of the road. Where my inclination was previously to commit suicide, I'm perhaps slightly erring on the side of trying to mend my ways and crawl back into normal society over broken glass.

I can see the temptation of a chemical crutch to aid my 'recovery' but I'm still pretty adamant that I'm going to go medication free. Actually, the psychiatrist agreed with me that something like sertraline, or even lamotrigine, could push me into hypomania. Antidepressants have always had a mood destabilising effect on me in the past. There's something to be said for feeling miserable: it does somehow make you appreciate the better times, when they eventually arrive.

So, it seems like a rather well-behaved life beckons for me. I don't relish the prospect of having to always make sensible choices, but I guess I'm not a young man who can bounce back from anything anymore.

Hardly thrilling, but the saga continues. I'll keep you posted on how it goes, doing the boring mundane stuff.

Tags: #bipolar

This is a story about doing no harm...

Imagine that somebody says to you "you're so argumentative". What could you possibly say in return? You can't say "no I'm not" because then they'll say "yes you are and the fact that you're arguing proves it". There are lots of other quirks of the English language that allow you to box people in, such as asking questions like "so when did you stop raping children?" or some other kind of fallacy.

I'm not actually against psychiatrists and psychiatric medications. Every psychiatrist is different. Most psychiatrists who work in the NHS have to deal with society's very sickest and most dysfunctional cases. Every psychiatric bed in England is filled with somebody who is being detained against their will for 28 days, or more likely for 6 months. There aren't any spare psychiatric beds for people who are merely having a crisis and who are in danger of committing suicide - the NHS will call your bluff and leave you to die, as so many do, because mental health services are overstretched and underfunded.

The kinds of treatment on offer vary from snake-oil bullshit, such as CBT and other behavioural therapies, to chemical coshes that will put you into the drugged equivalent of a straightjacket. For sure, there are some very sick people who are psychotically disturbed, but powerful antipsychotics are not a panacea for all problems of the mind. In some countries, physical restraints are more commonplace. In the UK, we dope people up to the eyeballs.

If you've never lost your liberty you won't quite be able to comprehend how terrible it is. We're free-thinking individuals who move through the world according to our whims - the illusion of free will. When locked into an overcrowded psych ward, even if you asked to be hospitalised because you feared for your own safety, you might suddenly panic that you won't be able to get back out.

Ironically, you can't say "I'm not argumentative" when somebody wrongly accuses you of being argumentative, and it's equally impossible to say "I'm not mad" when you're trapped by psychiatry. The only strategy you can play is to be calm and patient and ignore the provocation, which is easier said than done. It's a very natural reaction to want to defend ourselves against unfounded allegations. To have our character criticised by somebody who doesn't know a damn thing about us, is incredibly insulting. When somebody who hardly knows us has the ability to detain us against our will, and even to have us forcibly medicated, then the situation is unbearable.

I don't doubt that psychiatrists believe they have their patients' best interests at heart, but there's no acknowledgement of the antagonisation, frustration, anger and upset that they provoke. Nobody should have godlike powers over any other human being. The line between sane and insane, sick and healthy, right and wrong thoughts... these are completely arbitrary. There can be no ultimate arbiter who decides who's normal and who's not - it's not right that anybody should sit in judgement.

Am I arguing that we should fling open the doors to our asylums and let the mental patients roam free? It's more complicated than that. A survey of the general public revealed that the vast majority of people wouldn't want to live next door to, work with or have their children play with a schizophrenic. It seems that those paranoid delusions are not so paranoid after all - no smoke without fire. Having had my case reviewed at mental health tribunal to decide whether to give me back my freedom or not, it appalled me how six people could sit and have a discussion about me as if I wasn't even present in the room. To button my lip and remain silent through proceedings; to maintain my polite and courteous façade - this was virtually impossible when my liberty was at stake.

Another thing that's deeply upsetting is the way that the patient is often mobbed. Ward rounds consist of sitting with a whole room full of people - usually a couple of psychiatrists and a couple of nurses - who sit stroking their chins while the patient explains the same thing for the millionth time: please stop ganging up on me and let me go. Of course, there are mental heath problems present, but the set-up is antagonising. Should we just let anorexics stop eating and die? Should we just let the psychotic do what the voices tell them to do? This isn't what I'm arguing for. I'm just pointing out that even the most sane amongst us would be driven mad by a jeering crowd, licensed to torment and keep their victims in captivity.

If you imagine that you might get to spend 10 minutes with the psychiatrist who has the power to set you free, once every week or every fortnight, all the decisions are more important than I can possibly express in words. If you're on a medication which is causing you intolerable side effects, in a psych ward setting which is causing you intolerable distress, you're going to have to wait a couple of weeks before you can have another go at trying to communicate your needs to the doctor... which you'll have to do through the foggy haze of powerful antipsychotic medication. "This man is making no sense" they'll say, because you've been drugged into a dribbling mess. What further proof could be necessary to show that you're an imbecile who could never survive outside the protective walls of an institution?

Experiments were conducted by investigative journalists, who deliberately got themselves committed to institutions, only to find they couldn't get out again - the system grabbed them. The harder you fight the system, the more you're giving the system the 'proof' that you really are mad. It's maddeningly self-perpetuating.

Very few of us have the ability to bring our racing pulse back under control, to lower our respiration rate, to relax our muscles. Very few of us possess the ability to react to incredible stress, by calming ourselves and being patient. The most antagonisingly provocative situation will elicit the most predictable response: people don't like having their freedom taken away, told what to do and being judged by strangers who pry into every aspect of their private life.

To have captive creatures to toy with as we please must make those men and women who wield godlike powers feel very full of themselves. "It's for your own good" is the well-worn defence for the indefensible. The very nature of the relationship is toxic to mental health. Mental health treatment cannot be imposed by those who know best, because they don't know best - psychiatry is such a young branch of medicine. Nobody really has a clue what they're doing. Long-term outcomes are abysmal and the mental health epidemic continues to grow apace. Clearly, evidence-based medicine is not being practiced.

Of course I don't think that psychiatrists and mental health nurses and all the other people who offer medical and complementary treatments for ailments of the mind, are bad people. Of course they're not bad people. I don't believe there's a Big Pharma conspiracy. The truth is though, people are sicker than ever before and the treatments aren't working. My objection is with those who talk authoritatively as if there are useful diagnoses and accompanying medications and therapies which are making a profound impact... it's just not the case at all. What's happening is abysmal, and nobody is admitting they've got it wrong - a lot of people aren't sick, they just hate capitalism and modern society.

Good science means controlling the variables. I've aggressively cut out all psychoactive substances. Tomorrow I shall tell my psychiatrist that I'm debt-laden and forced to work a job that conflicts with my values and needs. My malaise is a function of the conflict in my heart, knowing that banking is a morally bankrupt profession, loan-sharking and taking advantage of the most vulnerable. My prescription? The end of capitalism and the return to a society where we're intimately connected to our local communities... do you think they'll stock that in the chemist?

Getting my happiness and contentment back in the current economic climate looks to be an impossible task. However, to medicate myself because I'm having a sane reaction to an insane world is not a good course of action.

Of course, my psychiatrist doesn't have the ability to cure me of my intolerable situation. I've got to work. I've got to travel to where the jobs are. I've got to pay my bills and service my debts. But, I don't need medical solutions to a non-medical problem.

Why even go to see my psychiatrist, when I don't think they can help me? Well, it's obvious isn't it? If we keep sending people away with pills, then we keep proceeding with our delusion that they're working and things are going to improve one day. How many times a year do you suppose a psychiatrist meets somebody who's foresworn ALL psychoactive substances, including caffeine and nicotine, and is a functional high-achieving member of society, to all outward appearances? To say that a medical problem - suicidal depression and debilitating anxiety - doesn't have a medical solution is heresy, but somebody has to stand up to those who dogmatically decree that they have the solutions, when they demonstrably do not.

Being unmedicated is really horrible and I feel terrible, but I'm being a bit of a martyr because I've got a point to prove. One day I will escape from the burden of debt, the soul-destruction of bullshit jobs and the need to commute long distances, preventing me from forming social bonds and having a work:life balance. One day I'll get a girlfriend and a cat and a home of my own and all the other things that humans need to feel complete, and then we can re-examine the situation and ask if I need medication. Until such time as the major problems in my life still exist, then medication looks like a dangerous option, because medication is allowing our society to develop into a grotesquely unhealthy form. Just because medication allows you to do awful things, it doen't mean you should do awful things. If it feels wrong, it probably is wrong.

A certain proportion of society will always struggle to abide by its rules, its laws and its social contract. A certain proportion of society will be criminals and parasites - anti-social. However, when the vast majority of us are struggling and unhappy, then we've made a wrong turn somewhere; we've made a mistake and we need to retrace our steps.

I refuse to be labelled and drugged.

Tags: #mentalhealth #medication