Hi @SJT63 thank you for your question and I can definitely identify with much of it so hopefully I can help shed some light.
First of all obviously everyone is different, bipolar disorder is on a spectrum so my experience & symptoms may be different to Mr S's.
But what I can tell you is I get the irritable highs and aggressive depressions as well. It seems to be a general "theme" on a lot of informational sites, that being bipolar means you experience happy highs (Mania) and very sad lows (Depression) but that is a gross misrepresentation of the illness.
Mania can be euphoric, dysphoric or both. It sounds like Mr S experiences dysphoric mania, which is what I also experience. When I am "high" I am very rarely happy. I am generally angry, frustrated, anxious, very irritable and have a quick fuse. The smallest things can set me off. I have learned over the years to hold back or internalise that anger and frustration, but sometimes to the point where it can make me physically sick. But it can still bubble out and quite often will do so, because it is not always possible to control the energy behind it.
And essentially that is a typical sign of mania an over abundance of energy and if the mania is dysphoric and there’s nowhere for that energy to go, it will manifest as angry outbursts, rage over the most stupid or innocent of things and some people can physically lash out. If I feel this outburst I isolate myself to keep myself and everyone else safe. I have never physically lashed out at anyone, nor would I ever, but in the past behind closed doors when I’m on my own and my frustration has boiled over to rage, I’ve been known to punch door frames and break my knuckles or hit myself repeatedly in the head. These behaviours have been spontaneous and yes there is a small part of me sitting in my head watching all this going on telling myself to stop acting like a lunatic, but that part of me is a witness and has no control whatsoever over my rage. I will talk more about that part in a second.
I have learned over time to channel that energy when I feel it coming on into a more productive means and that has substantially changed my distress and trust me it is extremely distressing to go through. I can only imagine how upsetting it is to see Mr S go through that from your perspective. But I guarantee it is very distressing for him as well. When mania is that way for me I feel like a monster. I feel like no one could possibly love me and I feel helpless to stop it from occurring. I don’t blame anyone for not wanting to be around me, because I don’t want to be around me either.
I have learned with a lot of trial and error what helps me get through those episodes. For me it’s physical exercise or what I like to call “Exorcise Exercise”. Because essentially that’s what I’m doing, exorcising the rage and hostile energy from my system. I run, I ride my bike, I punch my punching bag (might be a good one for Mr S), I lift weights. I do something physical to burn out those horrendous feelings.
Another thing I do is I have worked hard to identify my triggers. There is definitely a point where manic irritation that you can control gives way to rage where you lose all control. So if you can burn away that energy before it reaches that point, more often than not the mania will not turn to rage.
From your perspective as a carer when Mr S becomes infuriated the best thing you can do is walk away and keep yourself safe. Words thrown during a manic outburst may not be intentional, but they still have the power to hurt and you must protect yourself from that and if you have kids you definitely need to protect them from that. Think of someone in a manic rant as a 3 year old child having a tantrum. You cannot reason with them, or calm them down. The best thing you can do is remove yourself from that situation until the storm blows over, and it will blow over and then talk to him about it when he is calm.
Try not to judge and I know that can be a tough one. But perhaps ask him about what upset him, what does he think triggered the outburst. But only do this if you feel it won’t set him off again.
Aggressive depression is often a sign of a mixed episode, at least it is with me. A mixed episode is when you show signs of both depression and mania combined in one episode. It is not dissimilar to a dysphoric mania, but the major difference with depression is there is no energy whatsoever. If it’s a mixed episode there could be the despair of depression mixed with the energy of mania.
When I get depression there is no other way to put it other than say, I am pissed off with the entire world. I become extra paranoid. The whole world is out to screw me over. I have a complete misanthropic view of the world. I become anhedonic, which means I lose interest in everything I normally love to do. Some days I cannot get out of bed. Sometimes I won’t shower for days because I just can’t see the point. I become self destructive and sabotage goals and dreams I’ve spent months or years working towards. I cannot look people in the eye, even my therapist, cause I feel as if they will look straight into my soul and discover the fake and worthless piece of sh*t that I am. And being like that, feeling those intense emotions makes me bitter and angry.
If it’s pure depression I don’t have the energy to care that I’m worthless or thinking about suicide, but if there’s manic energy involved, I’m just pissed off enough and energetic enough to do something stupid. This is a very dangerous place to be mentally. If this sounds like Mr S and he becomes aggressive and makes threats to self harm take them very seriously. Take him to hospital if he will agree to go with you, if not call a mental health team to come and assess him. If he makes threats to harm you or lashes out physically, get yourself and your kids somewhere safe pronto. As with mania you cannot reason with someone in a state of depression.
As with the dysphoric mania, this type of depression causes so much distress mentally to all parties concerned and I cannot emphasis enough how you must protect yourself. I honestly think anyone who cares for someone with bipolar is incredibly brave, incredibly strong, incredibly loving and incredibly selfless. I couldn't do it.
I know it sounds all doom and gloom, but there is hope. Medication is a big help to level off the extreme highs and extreme lows, but not all meds work for all people. It’s that spectrum again.
For me antipsychotics help enormously with the pointy ends of my mania and depression. They help keep me in a zone where I can learn to identify my triggers, where I can recognise an episode coming on and take steps to lessen its impact. They also keep me safe. My antipsychotics have taken away my suicidal ideation completely. But they do not stop the mood swings altogether.
Therapy for me has been a game changer. I have learned so much about myself, my illness and I have learned to own my bullsh*t. I have learned to forgive myself for things beyond my control and I’ve learned to kick myself in the pants when I’ve needed it. I’ve learned that introspection is a powerful ally when living with bipolar.
Sorry I've written a novel already, I'll answer the rest of your question in a second post.
BB 🐰💙
@Shaz51 tagging you in Shazzy, you might find some of this info helpful.
