Lithium Flatness (loss of creativity, not liking lithium)

A lot of people seem to not like being on lithium (or some other mood stabilizer).  They say that it ruins their creativity, makes them feel flat or emotionless.


I don't have this problem.  And I propose that there are two reasons for this, which need to work together -

1. Take the lowest dose of lithium or other mood stabilizer that is effective.

2. Make lifestyle changes.

If you think of mania or hypomania as being similar to alcoholism, except that the addiction is to "excessive involvement in pleasurable activities that have a high potential for painful consequences," whether it be sex or shopping or drugs or whatever your activity of choice is - then you can see how taking a mood stabilizer alone isn't the whole solution.

You have to change your lifestyle.  That is, your activities. If you are an alcoholic and love going to the bar but then start taking a medicine that makes you not able to drink, then you're not going to like that medicine because when you go to the bar you won't experience the same enjoyment as you used to.  The key of course, is to stop going to the bar.

I propose that you can have creativity and lots of emotions and be taking a mood stabilizer, IF you refocus your life on activities that aren't excessive and that don't have painful consequences.

If you can successfully change your lifestyle, then you may even be able to reduce the mood stabilizer.  Ideally, you want to be taking the mood stabilizer at the lowest amount so that you can still feel a wide dynamic of emotions.

Changing your lifestyle is not easy, and could involve major changes like changing a romantic relationship, changing your friends, changing where you live, changing careers, etc.  This is all stressful stuff that by itself could cause your moods to become worse, which is why you might need to see a therapist and a psychiatrist regularly so you can keep your meds adjusted as you go through these changes.

Also, some of your experiences might be rooted in not just brain chemicals gone awry, but they might be the result of environmental problems like trauma, lack of self confidence, difficult relationships, etc. Things that need to be worked through over time, perhaps in therapy.

So the mood stabilizer is just one part of the equation.  It's a big part, but if you aren't committed to making changes, then the mood stabilizer alone might not work.  The good news is that usually a mood stabilizer changes your thoughts enough that it makes it easier for you to slow down and do some self-examining to see what you want your life to look like.  You just have to embrace the opportunity to ask yourself big questions.

I'll leave it to you to come up with the questions that need to be asked.

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Footnotes:

1. I'm not a doctor, but from personal experience, I would suggest that you might need a higher dose of lithium or mood stabilizer at first, but that after you have made lifestyle changes and/or sought other treatment like therapy, then the mood stabilizer might be adjusted downward.  However, you have to always be watchful of a dangerous hypomania/mania episode coming on... Best to catch these episodes by watching your THOUGHTS and catching them before your actions take a turn for the worse.

2. Omitted from above, is this:

Going to the bar doesn't have painful consequences for everyone, but it does for alcoholics.

Similarly, whatever activity you became addicted to while hypomanic, you should try to avoid.

This statement might be a bit radical, but avoiding something at first might be a good idea. For example, don't go to the mall if you have trouble with spending too much money.

Hypomania and Jumping

My Dad built a deck onto my house, and for awhile, he had the steps all done, but not the railing.  One afternoon, after coming home from high school, I decided that a fun activity would be to see how far I could jump. I started on a lower step and worked my way to almost the very top of the deck.  I jumped until I got a little bit scared....

I was probably manic or hypomanic, as I suspect I was a lot during my teenage years. Looking back on it, mania explains a lot of my decisions...  Check out the following criteria for hypomania. I would say this jumping activity falls straight into #7.

Criteria for Hypomanic Episode  (from the DSM-IV TR)

A. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.

B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

   1. inflated self-esteem or grandiosity
   2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
   3. more talkative than usual or pressure to keep talking
   4. flight of ideas, or subjective experience that thoughts are racing
   5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
   6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
   7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

D. The disturbance in mood and the change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

F. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Giving up too easily?

Most often, the difference between success and no success, seems to be persistence.  Sure, chance plays a part, as does a slew of other things that you don't have much control over, but persistence is something you actually do have control over.

While playing chess a couple of weeks ago, I realized that I often give up too early in the game.  When I do play the game out, a disadvantageous situation often turns around, and some of the time I still win.  But, when the going gets tough, I was giving up too easily.  The most often excuse I gave myself is that I felt tired. But was I really tired of playing, or, was I just doubting myself?  Why do I quit when the going gets tough?

Translating chess psychology and strategy into real life is something I like to do, and so I thought about what I've given up on in the past, and the reason why.

About twelve years ago, back in high school, I gave up programming. Before I gave it up, I really liked it. I had a book that I was following, and I just got to one point and I got stuck. I couldn't go further.  So instead of seeking out a solution, I quit.  Today I can think of many solutions. Get a different book. Find a teacher or mentor. Try a different programming language. It could have just been a mistake in the book, or a gap in my knowledge. 

So now I am back, programming.  A little bit. I find it enjoyable once again.  I'd love to make a million dollars from something I program some day, but for now, I'm just picking up the path where I left it... Except for now I have twelve more years of maturity, wisdom, and confidence under my belt. It might just make the difference.  Plus, perhaps even more important: my moods are controlled. I'm no longer living in a prolonged stretch of irrational hypomania in a stressed out environment.

What have you quit, and why?  Is it time to revisit?

Seagull Takeoff Near Cannon Beach, Oregon

Picture taken by me :)