On madness: a personal account of rapid cycling bipolar disorder.

I became unwell suddenly, unexpectedly and severely 5 years ago. I was working as a full-time GP at the time with a growing list and four small children. Initially, I had days when I was intensely irritable with my family and suffered from episodes of anxiety and tension headaches. I put these down to the long hours I was working and a full social life at the time. Then driving down the motorway one day I decided it would be appropriate for me to crash the car and end my life. This was the start of very strong suicidal thoughts and impulses that would pop into my head unbidden and needed real mental energy to resist acting them out. In the meantime I was also having difficulty working, at times literally dragging a deeply fatigued body and an equally befuddled brain into the consultation, managing by treating one person at a time, rather than look at a whole fully-booked surgery. On other days I found work a useful distractor from the milder symptoms of my depression. Then again, at other times I was full of energy, enjoyed patient contact and was continually looking round for extra things for myself and the family to do. Gradually, I noticed that working long nights and weekends became intolerable, which I initially put down to having young children rather than believing that I might be ill. As my mood fluctuated so widely and on a day-to-day basis it was difficult for me to see that I needed help. In the end my husband encouraged me to make an appointment with my GP. My GP wisely referred me straight on to a psychiatrist, unwisely she started me on an antidepressant not having asked about symptoms of elevated mood as I was clinically so depressed at the time. My psychiatrist signed me off work initially with depression, but eventually with bipolar disorder, and thus began several years of treatment. Antidepressants, mood stabilisers, ECT, antipsychotics, thyroid hormones, lithium, psychotherapy and hospital admissions made no difference to the unstable pattern of abrupt mood swings, rapid cycling, bipolar depressions, and mixed mood states with psychotic features woven throughout.