Marriage, Mood Disorders and Managing a Chronic Condition
The reality of living with cyclothymia and GAD is far from alluring but I'm married to it..for better, for worse.
I recently remarried and amidst lots of romantic tales during the wedding speeches, the Best Man humorously took our guests through the various girlfriends of my husband’s past and their differing mood disorders as part of the story of why he would be well-equipped to deal with the rollercoaster of marriage in the years to come.
Marriage, it was argued, is a long term medical condition with symptoms, patches of ill health and good health! I disclosed very early on in our relationship that I have cyclothymia (sometimes described as ‘bipolar-lite’ much to my disappointment) and General Anxiety Disorder. I’ve lived with these conditions since they were diagnosed more than twenty years ago. And for the most part I’ve achieved success in managing my mental health. There have been three serious depressive episodes during that time that necessitated drug intervention, but I’ve worked hard with a great support team of HCPs including psychiatrists, GPs, therapists and lifestyle coaches to achieve and sustain the best equilibrium that I can. The relationship I’ve had with these mood disorders has been the most enduring; what is daily life like as a patient with a chronic condition?
In sickness and in health
When I first described these illnesses to my partner, I listed the everyday symptoms of the ‘cluster C mood disorders’ under which cyclothymia and GAD are categorized; the worst of which for me include hyper-vigilance, a persistent and omnipotent state of dread, difficulty concentrating for more than 15 minutes at a time and, peculiarly, excessive oscillations in temperature. Expecting that he would consider retracting his proposal, instead his response was interesting; he shrugged off my worrying (about worrying) and reassured me that “those are hugely endearing qualities that make you super fast at getting stuff done, mean that you pay great attention to the people you care about and you are hugely empathic to how others might feel.” These compliments alone triggered a rethink of how I do a decent job of living with a chronic condition that I’m actually embarrassed about because I’ve always thought they rendered me ‘too difficult’ to employ, to trust, to love. But his sign-off was particularly insightful – “I’ve had several relationships with women who had mood disorders; I just needed to find a woman with the right kind!”
The reality of living with cyclothymia and GAD is far from alluring. Needy may be attractive in a romance; needy is toxic when it comes to your profession. Accepting that these conditions are life-long and manifest with daily impairments is the most difficult of the symptoms. There are periods of great uncertainty when I simply don’t know if I can commit myself to large-scale projects or to a full-time employment contract. Anxiety is an all-pervading disability. When I’m having a clinical episode, I literally don’t have the capacity to focus for than 15 minutes at a time on a task. Ironically, this has driven me to run a self-employed consultancy for almost a decade and has forced me into being extremely fast to assimilate data and find solutions. As a medical writer, my adherence to deadlines is outstanding; because I’m on a perpetual mental deadline – I have perhaps a 30 minute concentration at best so I really have to dive deep into research, processing data, being able to draw meaningful conclusions and prepare accurate pieces of work. I’m also then very thorough because I worry about being wrong; so I triple check anything before it goes out.
As patients have become more adept at managing conditions and seeking more involvement in medical decisions, has society also become more accepting that mental health is as important as physical health?
The outcome of such ‘disease adaptation’ is that my pharmaceutical, medical and patient colleagues trust me. I’m a safe pair of hands because I will worry so much that I work my way through all the possible gaps. And I’m often called in last-minute when other people have let down conference organizers or when a drug-rejection response has to be rapidly addressed. Super anxious makes for super fast. I was recently awarded second place for ‘Best paper’ presenting at a prestigious medical presentation having made a last minute submission - the first time I’d ever submitted anything to this particular organization. This was a really invigorating achievement and I was delighted to receive the award. What wasn’t surprising was the feedback I got from the judges – being told that I’m a passionate speaker, direct, candid and ‘refreshing’ for an audience is praise I often receive. Underlying that is the mood disorders. I’m usually so anxious that I’ll get something wrong that I will have been on full alert from start to finish – I don’t want to overrun, miss anything out, misunderstand the audience. I’m an engaging presenter because I’m having to biologically strait-jacket my racing mind before it collapses in an exhausted heap!
When did it become ‘normal’ to have a mood disorder?
I don’t ask this in despair; more in fascination. As patients have become more adept at managing conditions and seeking more involvement in medical decisions, has society also become more accepting that mental health is as important as physical health? The corollary that mental illness is as vulnerable and unavoidable a part of the human condition as is infection, inflammation, injury now seems engrained in how we routinely assess our general well being. Social media sharing has helped ‘normalize’ mood disorders as part of the ‘expected’ conditions we are likely to encounter. For example, Seasonal Adjustment Disorder is talked about with the same level of anticipation as getting a ‘winter cold’. The Sunday Supplements regularly run articles about whether a level of narcissism helps you to achieve professional success. And increasingly, books touting titles such as ‘The sociopath next door’ top best-seller lists and are transformed into lists of how to apply skills of mood disorders into business or recipes for commercial achievement. Steve Jobs is almost admired for having demonstrated NPD rages. Sometimes it can seem that mood disorders are gathered as tokens of intellect or as excuses for just being difficult. Does everyone have to have a mood disorder these days?
As self-aggrandizing as my declarations of a new personal best on my daily 5k beach run may appear to be, they’re essential to keep my anxiety at bay. That’s where the tools, trackers, techniques that patients create and share to be more public about mood disorders is key.
Mental illnesses such as anxiety and depression – there is comorbidity between the two – cost the UK economy some £80m annually. This is truly a disease state where the pharmaceutical industry can align with physicians and patients to make great differences in how to approach things from a patient-centric perspective. Pharmacotherapies such as the benzodiazepines and antidepressants along with psychotherapy and CBT are the mainstay of treatment paradigms. The problem with anxiety however, is that the inevitable relapses exacerbate the omnipotent dread. When I’m in a hyper-vigilant state much gets done but with a wake of physical pain once the anxiety work-through, the acute incident, has passed.
Lifestyle changes such as remaining physically active, avoiding alcohol and stimulants, making sleep a priority and diarising triggers to anxious thoughts are also key. I’ve heard this described as being a ‘biological warrior’ – it is empowering to know that I’m not just letting my worries overpower me but I’m going to run them off and sharing socially around that is a great treatment. As self-aggrandizing as my declarations of a new personal best on my daily 5k beach run may appear to be, they’re essential to keep my anxiety at bay. That’s where the tools, trackers, techniques that patients create and share to be more public about mood disorders is key. Fairweather friends may get frustrated about how ‘needy’ my declarations or achievements appear to be – but scrape the superficiality away and there’s a patient struggling every day with a mood disorder.
I’m married to my GAD – it is a lifelong partner – sometimes I treasure it for what it drives me to accomplish, sometimes its disruptive force infuriates me to a state of desperation. But I accept it, for better for worse … in sickness and in health. I do.
Emma D'Arcy has been a leader, lobbyist and innovator in healthcare and proponent of the value insights gained from socialized health and patient centricity for 20 years. A medical biochemist who is completing Phd research about the impact of social media on medicine, Emma helps the pharma industry upskill and adapt to the era of participatory medicine where everyone is a consumer and a contributor. When she isn't writing articles, chairing events or educating industry, Emma is writing poetry - or failing to parent 2 children, a large dog and an irascible cat.
Patient Summit USA 2015
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