I've been flat-out exhausted for the past nine months. Not just tired – running on fumes. My new memoir, The Dark Side of Innocence: Growing Up Bipolar, was just released, and as any author knows, giving birth to a book can be grueling work. Not ditch digging by any means, but mentally taxing. Maybe that's why I felt so fatigued, I kept telling myself.
But then the book came out, and after the initial flurry of attention subsided a bit, I found that I was still dragging. Worse yet, my mood was suffering – and when you're bipolar, that's a very big deal. After years of being relatively stable, I was ping-ponging between periods of irritability and depression. Everything and nothing upset me.
I stopped going to my usual cafe to write, because I couldn't stand the sound of a certain waiter's voice. I lost all track of what was going on in the world, because just the sight of the CNN logo was enough to make me cry. I even screamed an obscenity at my poor mother when she told me to cheer up. Cheer up! I could barely smile. I tried – I actually placed my fingers on the corners of my mouth and tugged. But the muscles were too tired to cooperate, and my face drooped ever more downwards in that unmistakable rictus of depression.
I couldn't believe I was going through this again. Every time it happens to me, it happens fresh, as if it were the very first time ever. In between episodes, I can never seem to remember the aching lethargy, the paralysis, the crushing weariness in my bones. Maybe it's like the amnesia of childbirth: we're hard-wired to forget the physical pain, in order to go on.
Therapy once a week didn't help; twice a week made me feel even more hopeless, mired in my own inertia. It was time to call in the big gun: my psychopharmacologist, the man who administers my medications and has the power to send me skyrocketing or plummeting, depending on the prescription. I simultaneously admire and fear him. I sometimes feel he holds my life in his hands.
So it was with some trepidation that I left a message on his machine, telling him I was depressed again. Acknowledging this made me feel like I was a bad patient, like I had failed him somehow. A better patient would just swallow her pills and be magically cured, to compliment the magician. But he called me back immediately, and we started on the old familiar routine: a slow titration of my existing meds, followed by a seemingly endless waiting period, then the inevitable side effects, then new drugs to counteract the old ones, and so on. It's a frustrating, maddening, humbling process, as anyone who's ever gone through it can attest.
I was on such high doses of so many pills that my doctor insisted I get some blood work done, to make sure I wasn't damaging my kidneys or doing other nefarious things to my body. I reluctantly complied, although needles scare me, the sight of blood makes me dizzy, and I was certain the tests would reveal one of the gruesome possibilities I'd read about on Google. A lesson: fear is a lousy predictor of miracles.
My doctor called a few days later. "Bad news. Your thyroid is completely out of whack," he said. "It's three times below what it ought to be." He went on to explain that hypothyroidism can cause intense fatigue and depression.
Hypothyroidism! I wanted to kiss him. Only someone with mental illness will understand my ecstatic reaction: it wasn't all in my head! What was happening to me was quantifiable – you could chart it and measure it and predict its response. You didn't have to resort to voodoo magic to make it go away. And the stigma was practically non-existent. I told everyone who'd been concerned about me, "I've got hypothyroidism," and nobody blinked an eye.
I'm blown away by my own hypocrisy. In my role as a mental health advocate, I constantly espouse that depression is a physical disease, as physical as diabetes. I firmly believe this; I can feel its profound effects on my body. And yet, I was immensely relieved to learn that I wasn't just depressed – that I had a "real,” objectively verifiable illness. Shame on you, I admonished myself. But my heart was almost instantly lighter. Despite the fact that the thyroid meds often take up to six weeks to work, within a week I started feeling better. Not wildly so, but enough to realize how heavy the burden has been these past nine months. And to understand that I still have a long way to go in accepting my own disease.