TRIGGER WARNING: This story contains graphic language about substance abuse.
The morning alarm rings. You dismiss it, stay in bed, and stare at the ceiling.
Dread and melancholy begin to invade wakefulness with every passing moment (symptom #1: inexplicable sadness). Your body stays still as your mood tends to spiral into hopelessness (symptom # 2: feelings of hopelessness); the negative thoughts and anxiety (symptom #3: anxiety) about yourself, about your future and present and past, weigh so heavily on your conscience, your energy level already low and your body overtaken by inexplicable fatigue. Your brain is in a fog (symptom #4: trouble concentrating) or tuned in to an inner, repetitive soliloquy of negative thoughts and self-talk (symptom #5: a feedback loop of negative thoughts). You cannot find the strength or motivation to move beyond the promise of unconsciousness offered by staying in bed. Your instinct is to shut down, go back to sleep. You stop caring or even forget if you had work that day or an appointment with friends (symptom #9: apathy). You want to avoid human interaction (symptom # 6: social isolation). None of the prospects of the day, even if previously enjoyable or urgent, can muster enough willpower (symptom #6: anhedonia) to override the hypersomnia (symptom # 8: a tendency towards vegetative states or sleep) that dominates your impulses. You feel worthless and tired and your mind wants to become impervious to emotions if it is not already. Sometimes, you will feel like you are a passive, numb spectator of your life or feel like your experiences are not real, which are characteristics of a symptom called depersonalization (#8). The day would most likely end up lost, meetings or classes missed; phone calls or texts ignored. You succumb to slumber once more, but when you wake the mental fog still coats your experience, so you forget a lot of the things that happen when you are awake (symptom #10: memory loss); recollections while in this state tend to become a blur.
You may be experiencing an episode reminiscent of a pernicious and increasingly diagnosed illness: Major Depressive Disorder. But are you really experiencing clinical depression? *
My depressive symptoms first began to manifest around the age of 16, which was a solitary and profoundly introspective time in my life. But I somehow managed to survive and thrive academically, driven by my ambition to pursue a Ph.D. in Neuroscience, until I finished my undergraduate degree. The last year of my undergraduate was marked by the worst and most traumatic period in a relationship that had become toxic and co-dependent; the effects made more lasting and destructive by my gradually increasing alcohol abuse. On the day of my graduation, a day where I had much right to celebrate, I had a nervous breakdown in front of my mother. She asked me if I was excited and that made me start crying about how disappointed in myself I felt. I was overwhelmed with hopelessness, faithlessness, and sadness for myself. It was the first time I had shown either of my parents that I felt such despairing and negative emotions about myself.
On the day of my graduation, a day where I had much right to celebrate, I had a nervous breakdown in front of my mother. She asked me if I was excited and that made me start crying about how disappointed in myself I felt.
We concluded that, during my upcoming gap year, I would seek intensive therapy. At that point, I felt I would try anything to start climbing out of the melancholic hole I felt trapped in, so I agreed to begin an intensive outpatient treatment, which focused on treating my depression rather than the substance use disorder I had developed. Naturally, the psychiatrist and therapist assigned to me diagnosed me with Major Depressive Disorder at age 21. I was treated for this diagnosis with the standard regimen of exercise, therapy, and antidepressants until my third year of graduate school as a Neuroscience Ph.D. student when the first notion that we had overlooked a key symptom could mean I had possibly been misdiagnosed.
Graduate school introduced a significant number of unprecedented pressures in my life and I found myself cycling through moods in an erratic fashion and with such an intensity as I had never before experienced in my life, compounded by a return to increasing alcohol abuse. The first discussion I had about the possibility I had been misdiagnosed was with my mother (who fortunately has a Ph.D. in psychology and enough knowledge of my behavior across the years so as to substantiate a longitudinal case study of sorts). After consulting the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), she had begun to wonder if hypomania was a symptom we had not considered. I had always been a cheerful, energetic child until my teenagehood and after that my moods started to become inconsistent, oscillating between energetic bursts of creativity and impulsivity and periods of sadness and low energy. Given that I had only sought professional treatment due to the severity of my depressive episode, I had dismissed the periods of high-spirited creativity, restlessness, and impulsivity that I have experienced in the past as traits of a high-functioning depressive. She urged me to talk to my psychiatrist about the possibility that my mood disorder symptoms were indicative of a Bipolar Type II diagnosis. I was initially apprehensive of these ideas, given that I was so used to understanding myself as a patient of Major Depressive Disorder. I had come to understand myself through the lens of this diagnosis. But, after reading up on Bipolar disorder and, upon closer retrospection, I slowly started recognizing that perhaps I had experienced what could accurately be characterized as hypomanic episodes. Another realization was that the unstable epochs fit in with the description of rapid cycling, another symptom of Bipolar II: I would go from low to high moods over and over in the span of one day.