Where there is no spring and no autumn: the world of rapid cycling

Seasons are funny things. If you live in a equatorial region, you may barely experience them at all; if you live in a polar region you probably live part of the year in unremitting darkness which eventually gives way to “white nights”. Living through a heat wave that has gone on for weeks, it can seem impossible that our streets and parks and fields were once covered in snow. Bizarre, even. Yet as we crunch over layers of ice, in that strange silence that comes only after snowfall, it is the sensation of heat and light, of long days and high pressure, that we cannot recapture. No wonder that so many films and novels play with the idea of perpetually cold environments, or create desert planets, or dream up worlds in which the seasons are very different to our own.

I think I’m on pretty safe ground in assuming many readers will have heard of Westeros. It is the continent upon which most of fantasy novel A Game of Thrones, the subsequent books in the A Song of Ice and Fire, and the TV series adaptation is based (even people I know who Don’t Do science fiction or fantasy seem hooked on AGoT, which pleases me). Just in case you are as yet unconverted, Weteros, as in our own northern hemisphere, is permanently frosty at the top of the map, and gets warmer the further south you go. The difference – and oh, what a difference it is! – is that on Westeros, seasons last not months, but years. When the series opens, a whole generation has grown up not really knowing what it means to experience winter. Autumn, however, is in the air, giving rise to repeated warnings (now become a full-on internet meme!) that “Winter is coming.” And winter on Westeros has the potential to bring very bad things indeed.

Right now, I feel like I live in my own alternative world – I haven’t made it up, I didn’t ask for it, but here I am. It’s pretty much the opposite of Westeros, because in my world the seasons change frequently, and without much warning, often with none at all. It is the world of rapid cycling, where there is no spring and there is no autumn, just a switch between extremes. Hypomania brings the summer. It is a period of light, of joy, of optimism about the future. It is a time for dancing, for working, for making hay (pitching for work, buying Christmas presents, cooking interesting food) while the sun still shines. Because I know that winter is coming. It is always coming; it is just a question of when. The sun will shine for no more than five or six days, and often much less than that, indeed sometimes it shines for just a few hours before the psychiatric storms brew and joy turns to irritation, to feeling overwhelmed, to craving rest. Then there is a point when I wake and my initial understanding of the world – just seconds into the new day – is that the first frost has set in. From there the psychological cold creeps over me, settling into my bones until I feel I can hardly drag myself around. My mind too is cold and can only hold chill, dark thoughts, thoughts like: I cannot survive another winter, no matter how brief. Like: maybe this time winter has set in forever and I will never escape. Like: I cannot cope, I need to not be here, not live on this constantly changing world. Once summer returns I will struggle to remember how this felt, how powerlessness against the cold. Yet once I’m again in the grip of winter, there is no imagining summer.

Rapid cycling is no way to live. When I finally had my appointment with National Affective Disorder Service last week, this is what I told the two doctors who assessed me. They fully understood; being specialists in mood disorders my ever-shifting world is something they have seen before. They were incredibly reassuring on several counts. Firstly, that people with bipolar sometimes just develop rapid cycling. It’s not something they’ve done, or failed to do. Sometimes there is an obvious trigger. Sometimes there isn’t. Sometimes it just happens. Secondly they were reassuring in their belief that a treatment plan could be developed which would better target rapid cycling than my current regimen of quetiapine and lithium. Furthermore, they were confident that there were options. They could suggest a first line in a new treatment plan, but if that didn’t do the trick it could be augmented, or replaced with another option. (The issue of specific therapy for bipolar was also raised, although unfortunately the post for the therapist that would provide this is currently vacant.)

I felt validated and much more optimistic than I had in a very long time, and that the appointment had definitely been worth the wait (although they apologised for all the bureaucratic problems). I was given the opportunity to choose my preferred option, and the doctors agreed to fax that over the Home Treatment Team consultant. The nurses and junior doctors at HTT were really pleased that I had finally been seen and had a new plan to work to (“We are all almost as excited as you are, we are so happy for you!” said one of the nurses, which I found very endearing).

I started my new plan today. It involves very, very slowly building up a new drug, the antiepileptic lamotrigine, in my system over many weeks, and not even attempting to reduce any of the quetiapine dose until the lamotrigine is at a good therapeutic dose. Even then the reduction will be done very slowly to avoid breakthrough of symptoms and/or physical withdrawal. I’ll be staying on the lithium indefinitely. I’m positive about this plan, because, well, quite frankly doing anything feels better than just staying as I was. But it is a fairly long-term strategy, and that requires patience, and patience is hard to come by when you dwell in the land of ever-changing seasons. For now I remain under HTT for support, I continue to use diazepam, I continue to tweet and I continue to blog. That’s all I have to keep out the worst of the cold.

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