It is not lost on me that next week is the holidays. Whether you’re religious, or, like me, just like a finely-dressed tree, there tends to be a lot going on.
So here is a bipolar holiday guide on maintaining bipolar stability over the holidays, which, as we all know, can be tough.
This is an interesting question that was recently posed to me by a reader: Am I feeling better, or am I feeling hypomanic? Feeling better, of course, is the goal. Feeling hypomanic, of course, is not. One can be something to celebrate while the other can be something to be afraid of. So how does one tell the difference between plain wellness (or happiness) and hypomania?
The way I see it, bipolar disorder presents a problem with motivation (you know, among all the other bipolar problems). Many people in acute bipolar moods suffer from too much, unrestrained motivation or no motivation at all. Either way you slice it, it’s a bitch.
Hypomania. People haven’t generally heard of that word, but once they have, they want to know, what does bipolar hypomania feel like? This is a reasonable question with a completely unreasonable answer.
After my recent post about stress leading to hypomania in bipolar, I’ve had a couple of questions about what tools I use to handle hypomania. I’m happy to share my experience with hypomania but I can’t promise it will agree with your own. (Remember, hypomania is not the same as mania. In bipolar I, mania can easily be life-threatening.)
Are You Hypomanic?
I know it’s tough to admit you’re hypomanic, which is a mood, which is a symptom of bipolar, because many of us enjoy parts of hypomania and we don’t want it to go away, especially considering some of the alternatives. We just want to believe we’re feeling “good.” Really good. Which would be nice.
Nevertheless, the first step in dealing with bipolar hypomania is realizing that you’re hypomanic. And, of course, there are various degrees of hypomania – the more hypomanic you are the more worried you probably should become. The more hypomanic you are the more you need to focus on dealing with it properly because the chances are greater are there’s a nasty depression waiting for you at the end. (See, Self-Diagnosing Hypomania.)
How to Handle Bipolar Hypomania – Self-Talk
The first step in dealing with hypomania is self-talk. If you know you are hypomanic then hopefully you can create the presence of mind to not make decisions based on your mood. Yes, I understand you feel like you’re the most brilliant person on Earth but the President probably doesn’t want to hear about it, k?
Self-talk is about your own awareness. Yes, I’m hypomanic, that’s why I’m feeling this way. Yes, I’m hypomanic, that’s why I want to act this way.
If you know that, and you can (probably) repeatedly tell yourself that, then you can start to correct some of the problems that are likely to happen when you’re hypomanic.
Dealing with Bipolar Hypomania
So to deal with bipolar hypomania:
- TAKE YOUR MEDS and see your doctor if the hypomania puts you or your life in jeopardy
- Don’t make any big decisions; don’t make any major purchases
- Don’t eat sugar or caffeine; don’t take drugs or drink alcohol
- Don’t skip meals – force yourself to eat good food
- Breathe – your hypomania is going to want to speed you up but purposeful, deep breathing will slow you down – but you have to do it for it to work
- Try meditation or yoga (if that’s your thing)
- Exercise to wear off the excess energy in a positive way (One commenter mentioned this can be activating for them so be careful about that.)
- Force yourself to sleep on schedule (I admit to using sleeping pills for this. I believe it’s much better to take pills and sleep than to not take pills and not sleep. I believe it is much better for mood and this one step can often right hypomania immediately.)
- Check in with yourself on your actions – before you go and sleep with that handsome stranger, check in with yourself and really see if it’s you that wants a one night stand or the illness. Are you really angry with your friend or is it the illness?
In short, whatever the hypomania wants you to do, do the opposite. That’s not a very fun rule but it is a generally true rule of thumb. Hypomania feeds on itself so the more you give into its behavior the stronger it will get (just like depression).
Self-Awareness and Bipolar Hypomania
Dealing with hypomania is like dealing with any other mood – you need to see the mood, analyze the mood and outthink the mood. It’s hard but that’s what self-awareness is about. And self-awareness is what’s going to get you out of the jams that hypomania has a tendency to put you into.
(This is not to suggest you can always do this on your own. Sometimes other people can be your saving grace as they can see your behavior and moods much more clearly than you can. It’s OK to lean on them for their insight too.)
How do you like to handle hypomania?
I’m not sure how your average person deals with stress. Bingeing? Talking? Ranting? Raging? Running? I just don’t know. As far as I can see, people do all those things when they’re stressed.
But for a person with bipolar disorder, stress can lead to hypomania. And one has to deal with the stress and deal with the hypomania combined – which is kind of stressful in and of itself.
Tomorrow I’m being filmed for a documentary by Andy Fiore of Fiore Films. It is for a documentary about people who have learned to successfully live with bipolar disorder. As many of us do, I successfully live with bipolar disorder type 2 even if it’s a rocky path much of the time. And one might argue, I have turned my bipolar disorder into a positive by becoming a mental health writer and helping create a positive path for others living with bipolar disorder.
OK. Fine. But I kind of can’t breathe.
But I admit, I’m nervous. Stressed. I’m stressed about appearing on camera. Even though I do a video spot for HealthyPlace once a month, I still don’t feel particularly comfortable looking into the black abyss of a camera lens.
What do I wear? What do I say? What do I not say? How do I not sound like a shmuck? I just don’t know these things. These are unanswered questions for me.
And they sure the heck are eating away at the back of my brain. And maybe the middle of my brain. And maybe the front. So sayeth the fragments of brain I can scrape together for a consensus anyway. Many other fragments are off doing random bits of flittery that keep distracting me from writing.
My brain is taking the stress, that would make an average person feel, well, stressed, and turning it into hypomania. A fast-thinking, fragmented-moving, cluttered, shaky world view.
Bipolar Hypomania is Useful?
And all this hypomania is kind of useful in that it’s helping me get a lot done before I’m off to do the filming (it’s going to eat a whole day). I appreciate that. But hypomania also seems to turn the stress volume up to 11, makes sleeping impossible and makes following through on a task extremely challenging. It’s like pumping 110 volts into a 100 volt socket. It’s powerful but one could argue the usefulness of lighting your wiring on fire.
Using and Not Abusing Hypomania
Hypomania then, is pretty dangerous. It’s a sharp knife, good for slicing carrots but deadly on the fingers. So I try to use it for what it’s good for – producing energy and getting things done – and yet try not to let it get out of control. I won’t drink coffee or eat a tonne of sugar and I’ll force sleep on myself through whatever means necessary tonight. I won’t encourage the hypomania, I’ll try to work with it accepting that I’m not going to be able to make it go away completely.
Hypomania Passes, and Not Usually in a Friendly Way
And if there’s one thing I think it’s quintessential to remember it’s that the higher you fly in hypomania the farther there is to fall when you’re done. A hypomanic Wednesday, due to excessive stressors will probably lead to one heck of a Thursday coming back from an impact crater.
So, wish me luck, deep breaths and good hair. I’ll let you know how it goes.
Cyclothymia is neither bipolar depression nor unipolar depression but instead it is an illness that lies somewhere in the middle.
When psychiatric illnesses first started being recognized, some doctors felt that unipolar and bipolar depressions weren’t really the binary options for an illness but really just opposite ends of a spectrum. So then, one would have a spectrum where one could be a 100% bipolar depressive, or 100% unipolar depressive or they could lay somewhere in the middle. However, as illnesses need names and diagnostic criteria and not really vague percentages, bipolar and unipolar depression were defined separately.
Bipolar II – Within the Bipolar Spectrum
Bipolar 2 though, is recognition of this false dichotomy. Bipolar 2 really sits in between unipolar and bipolar depression as more depressed than bipolar 1 but more hypomanic (emotionally dysregulatory) than unipolar depression. (See the difference between bipolar 1 and bipolar 2 disorders.)
And that’s fine as far as it goes. But there is also recognition from a lot of doctors that other states lie even more in the middle, and cyclothymia is one such disorder.
What is Cyclothymia?
Cyclothymia can be thought of as bipolar light. Cyclothymia contains hypomanic moods and moods that are depressive but do not meet the criteria for major depressive disorder. Cyclothymia is more common in women than men (as with rapid cycling bipolar disorder).
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), cyclothymia is:
- For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode. Note: In children and adolescents, the duration must be at least 1 year.
- During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.
- No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance
- The symptoms in Criterion are not better accounted for by Schizoaffective Disorder and is not superimposed on a psychotic disorder (like Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.)
- The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- Note: After the initial 2 years (1 year in children and adolescents) of Cyclothymic Disorder, there may be superimposed Manic or Mixed Episodes (in which case both Bipolar I disorder and Cyclothymic Disorder may be diagnosed) or Major Depressive Episodes (in which case both Bipolar II Disorder and Cyclothymic Disorder may be diagnosed)
Cyclothymia may also appear with other mental illnesses like anxiety disorder.
Treatment of Cyclothymia
Like with bipolar disorder or major depression cyclothymia can be treated with medications and other therapies. Typical medication treatments for cyclothymia include:
- Lithium (a mood-stabilizer)
- Anticonvulsants (anti-seizure medication) like divalproex (Depakote) and lamotrigine (Lamictal)
- Atypical antipsychotics like aripiprazole (Abilify) and quetiapine (Seroquel)
- Antidepressants (only recommended in combination with other, mood-stabilizing, medication)
Therapies for cyclothymia include:
- Cognitive behavioral therapy (CBT)
- Family therapy
- Group therapy
- Social rhythm therapy
Just because the symptoms of cyclothymia are not as severe as bipolar disorder or major depression does not mean it shouldn’t be taken seriously.
There is a concern that cyclothymia can turn into full-blown bipolar disorder if left untreated and it may increase the risk of suicide.
Sometimes I get so wrapped up in research, I forget some people are looking for some introductory information like the different between the types of bipolar disorder. Thanks to commenter on my GooglePlus feed, I was reminded of this fact and I decided to answer her question here so I could give her more detail.
Unfortunately, within bipolar terminology resides more bipolar terminology. But don’t be scared, I have information on most terms on my site and I shall try to walk gently into that good encyclopedia.
But let’s try to get rid of the terminology confusion: What is the difference between bipolar type I and bipolar type II?
The Diagnostic and Statistical Manual of Mental Disorders (DSM), the manual that defines all mental illness in the US, is being revised and a new version is due out in 2013. One of the proposed changes to the DSM is to the diagnosis of mixed moods. This change is being proposed by a mood disorders workgroup. It aims to reflect clinical practice where doctors already refer to a “mixed” mood that doesn’t officially meet the DSM criteria. (As I noted, mixed moods are only technically recognized in bipolar type 1.)
Changes to the mixed mood diagnosis will help people with bipolar 1, bipolar 2 and unipolar depression get better treatment.
As I mentioned, mixed moods are technically considered part of the manic phase of bipolar disorder and thus, by definition, are only a part of bipolar disorder type 1. However, those of us with bipolar type 2 can tell you we mix it up with the best of them.
So, in part II of this series on mixed moods in bipolar disorder, I look at mixed moods in bipolar type II.
I can feel the post-depression-bounce-back hypomania beginning in my brain; not in my body, only in my brain. Hypomanic symptoms started yesterday evening. Things started seeming clear, perhaps just a little too clear, and certainly a little too fast. Bipolar fast. Gospel music (yes, oddly) played in my head intermittently while I guided an old tourist couple to the park, I drafted my upcoming novel, planned a conversation, and I investigated the fallen tree branch in the middle of the baseball field. Rapid fire thoughts, hypomanic thoughts, took over.