Circadian rhythm disruptions and sleep deprivation can wreak havoc in bipolar disorder. Tribune press service
Devika Bhushan, Tribune press service
In 2011, I was a third-year medical student at Harvard Medical School. I was on a rotation in psychiatry – and I had a secret.
My primary care physicians remarked on how supportive I was of our patients. I was grateful, but felt like my familiarity and deep empathy for their symptoms and medication side effects was like a neon sign that could overtake me at any moment.
Using the words “bipolar disorder” in reference to myself was all new to me then. The images I had of people with bipolar disorder just didn’t match my perception of who I was.
And I felt a strong internalized shame around my diagnosis and the mood-stabilizing medications I had started taking.
This stigma was also pervasive around me. In other rotations, I had heard colleagues speak with unfounded prejudices about patients with bipolar disorder. “You can’t trust anything she says. She’s probably lying – she’s bipolar.
I never wanted anyone to diminish the doctor and colleague I could be with stereotypes like these. So I went to great lengths to keep my diagnosis to myself.
I first noticed mood symptoms in 2009, before I started my second year of medical school. That summer, I had worked in a health center in a Nicaraguan village, far from my relatives.
When I returned to Boston, I remember standing frozen in the grocery store, completely overwhelmed by the vegetable choices in front of me. My mind kept going through the options not knowing what to put in my cart.
My thoughts were slow. I was absent from the conversations. It felt like I was living my life from a distant place, muted and colorless. It took all my effort to find the right thing to say to sound “normal”.
I read the same passage over and over again – and I didn’t recognize any of it. For the first time, I felt overwhelmed by my university studies and thought that maybe I didn’t have the strength to continue my medical studies.
The hardest times were the sleepless nights. I tossed and turned, feeling alone and anxious. Nothing relieved my fatigue. I dreaded sunrise because it meant having to go through another day.
I alternated between feeling numb and erratic panic attacks: what’s wrong with me? Could this really be the new me? It was terrifying to lose such fundamental parts of myself – my way of thinking, my relationships with others, even my basic disposition.
I knew something was seriously wrong. But despite having studied depression, I did not recognize it in myself.
After two weeks of feeling this, at the request of my partner and my parents, I saw a psychiatrist. Since I had no family history of bipolar disorder, she had no idea. I started taking antidepressants and routine therapy.
For over two years I tried drug after drug with no significant relief. The drugs also superimposed what looked like miserable, activated energy on top of my depression. Eventually they drove me crazy.
But this first – and so far only – manic episode saved me. This allowed me to receive the correct diagnosis of bipolar disorder, two and a half years after the onset of my symptoms. I was losing hope of feeling like myself again, but this diagnosis led me to treatments that eventually worked.
It took a few months of medication adjustments and coming out of my lowest depression yet – when I struggled with suicide – but I finally found my full self.
With experience, therapy, and support from those close to me, I became an expert on the variations in my moods – those that were “normal” and those that were part of my bipolar disorder. I learned to ask for and receive help when I needed it.
I learned that circadian rhythm disruptions and sleep deprivation were wreaking havoc on my brain. Rapid day-to-evening schedule changes and 30-hour medical residency shifts—which isn’t healthy for anyone—could specifically trigger major mood swings for me. I learned to minimize triggers, recognize my alarm symptoms, and double down on behavior management and medication when I needed it.
In 2021, I had had six years of well-being. I worked at a public health station that I loved and was pregnant with my first child. Hormonal changes, sleep deprivation, and new roles at work and home meant I was entering a particularly high-risk period for a mood swing. I was afraid of getting lost again.
But with the help of my partner and family, and concerted strategies to protect sleep after the birth of my son, surprisingly, I was able to stay healthy. There were definitely ups and downs that first year, but I was grateful to start parenthood as myself.
Today I live with bipolar disorder as a chronic and manageable condition. Having hit rock bottom and survived, I am motivated to protect myself at all costs, to fiercely guard the boundaries and care strategies I need to stay healthy. With the right treatments and therapy in place, I hope to be healthy for most of my life.
I am now more and more open about my diagnosis with my colleagues and friends. I am more authentically myself than ever, having worked to accept all parts of me, flaws included. I would never have predicted this in the lower moments of my illness.
I believe that our struggles can be the source of our superpowers. They show us our capacity for vulnerability and strength – that we can endure and overcome difficult things.
They also give us empathy for the full spectrum of human experience, allowing us to better support others in their most vulnerable times.
I am not who I am today despite bipolar disorder, but because of it. Bipolar disorder has made me a better doctor, colleague, parent, family member and friend.
I wish, during my darkest times, I had known someone who had survived the worst of bipolar disorder. Someone who could tell me that not only would I find who I really was, but that I would continue to thrive. I wish I had known that bipolar disorder wouldn’t stop me from becoming who I wanted to be – in many ways it would.
By sharing my story, I hope to dispel stigma and internalized shame and help anyone struggling to know that they are not alone. If you feel comfortable, consider spotlighting your story – stigma festers in the dark and scatters in the light.
Above all, I want people to know that with effective treatment, a full life and our dreams are all within reach.