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?
What is Bipolar Hypomania?
Bipolar hypomania is a mood that is elevated beyond the average mood but it not as elevated as bipolar mania. Bipolar hypomania actually has the same symptoms as bipolar mania; the difference is simply the degree. Bipolar hypomania doesn’t typically put the person’s life at risk as a manic episode would, but it can easily put a lifestyle in jeopardy. And by lifestyle, I mean things like financial, personal and professional wellbeing. It’s not uncommon for hypomania to cause spending sprees, gambling, hypersexuality and other harmful behaviors accompanied with lack of judgment. While people sometimes think of this as “no big deal,” certainly anyone who is drowning in credit card debt or who has lost a marriage might disagree.
Hypomania Can Feel Good
And to complicate matters, some people feel really good while all of this is happening. This isn’t the case for everyone but many people actually find hypomania quite pleasurable and desirable. And if it comes after a depression? It’s like breathing oxygen for the first time after being violently strangled for months (or longer).
Are the Meds Working or Am I Hypomanic?
So, if the meds are working you feel better and if you’re hypomanic, you might be feeling better too, so how’s a person supposed to tell the difference?
I think it comes down to behavior. I always say that mental illness isn’t a problem unless mental illness is a problem. In other words, if your behaviors aren’t causing problems for you, then you probably don’t have a problem.
Of course, I said probably. There is also the worry that hypomania can just be the start of a manic episode so it’s important to take note of even unproblematic behaviors as they may be warning signs of the danger to come.
So then, it’s important to know your own prodromal symptoms (symptoms that happen before the episode). It’s important to pay attention to what the cycle is for you as symptoms are individual. Maybe the biggest sign for you is a lack of sleep. This is incredibly important to notice. This is incredibly important to pay attention to. This is incredibly important to act on and not to just sweep under the rug.
So my best advice is to:
- Watch for your personal prodromal symptoms
- Watch for behaviors that indicate a lack of judgment
And if you see either of these things, make sure and discuss your concerns with your doctor.
All that being said, hopefully, you aren’t seeing these things. Hopefully, you really are feeling better. Hopefully, the medication is working. Hopefully, you’re worried about nothing.
And remember, while watching for warning signs is important, it’s also important to carefully celebrate the wins. Don’t sabotage your wellness by looking for sickness. No one can live that way.
I’m lucky in that I have an incredibly honest berometer who has no problem with saying, “Mom, your manicy and you need a Xanax and a nap. You are doing…. ” It’s alot on an 11 year old, but its made him aware enough that when he started having some symptoms he could tell me how he was feeling. Hopefully, early treatment for him will help him have fewer and less severe episodes
I RETIRED AS A GP MANY YEARS AGO, DOING PUBLIC HEALTH AS WELL PUSHED MYSELF TO A POINT WHERE I WAS MANAGING ON 4 HOURS SLEEP A DAY IT LASTED A FEW MONTHS. THEN I HIT A BRICK WALL.
I WENT ON A LONG WEEKEND HOLIDAY IN MALTA AND STAYED FOR 1 YEAR. FULL OF CREATIVE ENERGY ETC BUT RARELY ORGANISED ENOUGH TO DO ANYTHING ABOUT IT . RECENTLY BY CHANCE, I WAS TRANSFERED TO THE BEST NHS PSYCHIATRIST I HAVE MET.
HE SEES ME 6 MONTHLY BUT I HAVE A CPN VISITING WEEKLY.
HE MACROMANAGES MY CONDITION THAT IS SETS THE MAXIMUM DOSE I CAN USE. I MICROMANAGE ADJUSTING MY DOSAGE WEEKLY IF NECESSARY
I AM A SLEEPWALKER WHO HAS WOKEN UP AFTER 15 YEARS.
IT IS DIFFICULT BECAUSE MY “NORMAL” SELF IS LIKE OTHER PEOPLES NORMAL BUT IN OVERDRIVE.
FOR ME A FLASH OF BAD TEMPER IS UNUSUAL. IF IT HAPPENS MORE THAN TWICE A MONTH I AM VERY WARY OF HYPOMANIA..MY THOUGHTS OFTEN RACE THAT IS OK, IF THEY KEEP ME AWAKE FOR HOURS THAT IS WORRYING. MY SLEEP PATTERN IS PROBABLY THE BEST INDICATOR OF MY STATE OF MIND SO I HAVE STARTED KEEPING A SLEEP DIARY.
GOOD LUCK TO YOU ALL.
STEVE
If the appropriate person offered you money and some head, would you need to question how you
might feel and how… Assuming you possess an ounce of ethics and a gram of morality you’d probably decline. An internal personal conflict wouldn’t be a consideration.
Know thyself.
This is amazing advice. When I follow those precautions, hypomania is a huge bonus in my life. I study, I work better, I take much better care of my body. If I keep in check the silly impulses, the hypomaniac phase is a period to fix a lot of the bad I had during depression. I get in touch with friends I was avoiding; I lose the pounds I gained; I catch up on my reading and on my job.
All that productivity is really important to maintain my life. I would probably just change my medication if I felt it made my hypomaniac episodes much rarer. I am happy that the meds make it milder, though. The milder and more frequent, the better.
A very important thing you have to learn, however, is that IT PASSES. You just have to fight the illusion that you got better.
Just enjoy the ride and try to catch up on work you let pile up, clean up the house that was in shambles, get to see friends that you won’t be seeing much in the next months, do the important things you were putting off. When the next round of depression sets in, all the catching up will come in handy. As a metaphor, it is kind of having money on your savings account for when you are in between jobs. I am very happy I can be drawing from that account, because right now I can’t do shit.
If you screw up and misuse the hypomania, however, it will be the opposite, and you will have a lot of mess to clean up. It’s like getting in debt (sometimes literally!)
I know this is just my experience, though. I understand other people have a lot of problems when in hypomania, and feel bad. Just sharing.
Today is such a good productive day. A little bit on guard but enjoying it. Hope it lasts….
Prodromal symptoms: Other people seem stupid and slow. Their actions not only affect me, but the rest of the world too.
An incidence of tearfulness or emotional excess, every day.
More or less sleep, but not necessarily.
Signs of wellness: Relationships improve; involved in regular activities
Hard to tell: feeling more creative and productive.
I have a couple of simple tells. Hypomania and mania interfere with my ability to read anything longer than a blog post, so if I can read a book, I’m happy. If I can’t focus enough to get through a chapter, I’m starting to zoom.
What a fantastic topic of conversation and one that’s really applicable to us all. I’m sure we have all had that question at one point or another in life.
How do we find an accurate gauge to measure from. The all elusive question
Hi Chris,
Well, I did write this on self-diagnosing hypomania: https://natashatracy.com/bipolar-disorder/self-diagnosing-hypomania/
It’s just a personal opinion, not clinical.
– Natasha Tracy
Natasha, I wonder if you’ve written something on “being encouraged to be ‘crazy’?” Maybe having a friend who is untreated, or being in a profession (like art) where “crazy” is good? I mean, bad influences. I want to know because I’ve experienced both. It’s amazing how some people in this world encourage you to be mentally ill. I had a friend who didn’t want to get better and who didn’t want me to either. Even family is sometimes in denial like this. I think it’s part of the problem, kind of like enablers of drug addicts. I don’t even see how it’s necessary or possible to succeed as a mentally ill person, but…hey, I’ve heard the idea before.
Hi Anonymous. I think this is a good topic for a post and I’m going to write on it for HealthyPlace. It’ll probably get published tomorrow.
– Natasha Tracy
Hypomania has been a lifelong problem for me…and not just for me, but for those trying to help me. Since I didn’t understand it and others didn’t either, who could help? I told my family I was depressed, but then I’d act (what I now know is) hypomanic and they would think I was better. I thought I did too. Then again, I didn’t know I had this disorder, and only knew about depression. It was confusing to me. I couldn’t communicate that there was something else wrong. And now I realize, looking back, that they couldn’t know that because I never said it. I had bad habits and poor judgment when I was feeling “high,” but because I was so cheerful people enjoyed it. Then I’d be “down” again and others would think I was lazy – “you can’t be depressed, you felt so good yesterday?!” Ugh, I just want to be stable. I’m trying to avoid meds and discipline my behavior, including stopping my hypomania habits cold turkey, and not allowing myself to do any of those fun things. Hopefully I will NEVER have those moods again. I want to be a real person and not just…out of control. :/ I feel ready, with my current level of awareness. If only to be a success story, because I seem to others to be a hopeful case. Those thinking I enjoy how I am are totally misunderstanding it.
” Watch for behaviors that indicate a lack of judgement”
The funny thing about this advice is if you’ve already reached the point of lacking judgement, not sure you’re going to have good enough judgement at that moment to know what to watch out for. The word “habit” is kind of troublesome too. It implies that certain behaviors are chosen when they are really a result of symptoms. Probably just a matter of semantics, but this contradicts some of the other topics you’ve written about. I think you should definitely talk more about prodromal symptoms. There are certain behaviors that SEEM benign at first that are really indicative of something problematic to come. And this is so very helpful. The most useful time I’ve ever spent in therapy was spent discussing prodromal symptoms.
Hi Judy,
I’m not sure I agree. I think that even without a lack of judgement, you are still capable of some logic – which is what watching for behaviors involves.
Oh, and I just wrote about prodromal symptoms here: http://bipolar.answers.com/prevention/avoiding-bipolar-relapse-with-prodromal-detection-therapy
:)
– Natasha Tracy
I sort of agree? It sounds like you’re saying logic can be applied during the early prodromal stage? If this is the case, I agree. However, based on my experience, there seems to be a threshold where logic doesn’t even enter the picture and one can become pretty irrational. In my “well” periods, I’m a pretty logical and rational person – which is what makes bipolar episodes particularly disturbing.
BTW, the link to the prodromal article didn’t work for me. Nothing shows up on the page. Thanks.
Hi Judy,
I do agree with you that in any mood state, there is a point where logic no longer works. We definitely can pass that point and become quite irrational. I’m really less prone to this, personally, as I’m excessively rational but many people pass this point sooner than I do.
Sorry about the link. It’s coming up for me. Maybe try again?
– Natasha Tracy
OK. It looks like we agreed even though at first it didn’t :)
Certainly, if one did not know they were bipolar, crossing that threshold is more likely than not. I am pretty rational most of the time too. Even before I was diagnosed bipolar, subconciously I did a lot of the life management stuff to try and stay even keel. However, even with the best of efforts…well, bipolar can certainly knock you on your a**. And this is what makes some of these people’s “advice” so frustrating. They hand it out as if it’s new to me. I realize that some people have good intentions when they dole out advice and I appreciate it, but it really isn’t what I need. I think being knocked on your a** is even harder when you have put in sooooo much effort – and it still failed. The “advice” and “pearls of wisdom” really just adds to the sting. It’s really demoralising. Sometimes I think the need to hand out advice is really for the other person. It makes them feel good – and wise or something.
Thank you for the prodromal link. Its a good one for others to see.
Natasha, I know you’ve posted a few articles re: managing bipolar disorder. Pasted below is a concise of description of what appears to be prodromal detection in action. The subtleties are certainly important :)
“The study patients were adept at identifying their mood triggers, which needed to be picked up much earlier, they reported, than what their doctors recommended. By the time the sex, productivity, and spending of hypomania started to roll around, they said, it was already way too late. Instead, they were microscopically attuned to subtle changes in sleep, mood, thoughts, and energy levels.”
This is taken from an article that reinforces the importance of management skills suggested in some of your posts, as it examines the practices of those who successfully managed their symptoms.
http://www.mcmanweb.com/staying_well.html
The book looks interesting
Is hypomania or depression is something to be “kicked” cold turkey, or managed?
Judy,
I would say managed. It’s a symptom. Some people can suppress it with medication, many others have to manage it in other ways.
– Natasha Tracy
I would say managed as well.
I think this is a great topic of discussion, and one I certainly struggle with. I have to disagree with this point though –
“I think it comes down to behavior. I always say that mental illness isn’t a problem unless mental illness is a problem. In other words, if your behaviors aren’t causing problems for you, then you probably don’t have a problem.”
Hypomania is unique in the DSM, as it is the only ‘mental illness’ which is not required to cause any distress or impairment. The issue is that it may start to cause problems or lead to a manic episode, or be a sign that your bipolar isn’t under control and you may crash into depression.
Personally I obviously wish to avoid heading to problematic territory, but I don’t want to squash any happy feelings lest it lead to mania. I think being afraid of happiness is one of the (many) horrible parts of bipolar disorder.
Great discussion!!!!!!
Thanks for the heads up ! Had a very bad episode when a not so intelligent psychiatrist took me off of my Klonipin, and I experienced exactly what he said. I went through withdrawal in a way that kept me in the emergency room for a good eighteen hours. Sadly enough, this would have been my fifth year without the slightest of panic attacks, and so let it be noted that I have never returned to the $*^&@#@! !!! I am now going to a private psychologist who is very good at his job, and although it is slow going, he is helping me get my grip back. He is extremely good, always seeming to ask the right questions during every visit. The reason I’m glad I read this post, is because he raised my Lamictal to a total of 400 MG,s. This post is a reminder to keep an eye on myself, so thanks again !
It really is amazing that you just wrote this article. Without being conspiratorial or ‘ new agey ‘, I just had an episode 2 night ago when I ran out of Seroquel. Well, as you know because you have written about it that bathing and personal hygiene not only is a chore that can and must be avoided at times, it is also a trigger for me.
Being in Florida and on SSI Mental Disability, I have to watch the money carefully.
This means that I lived with the air conditioner off and the windows open for as long as possible.
The day I cleaned up really well, because the 6 month A/C check-up people were coming, was the night I ran out of Seroquel.
The A/C check-up found and wiring problem which was quoted as being $400 to fix.
Connie and I were determined to save that money, so we broke out the soldering iron, wire nuts and that really high quality rubber electrical tape.
We had the Victory, and it added to my good feelings.
Well, normally I sleep 12 hours with Seroquel and Restoril – Normally they are NOT Prescribed together, because they are both sleep aids in effect, so Please Do Not Take Both – You can get your doctor into trouble unless it is absolutely necessary as in my case.
I shot out of bed @ 3am and I was fearful all day.
I went to the doctor to get additional Seroquel until the June 3rd date that the insurance will fill it once more.
Being clean, getting the medicine and getting the car cleaned all made me very happy, yet my underlying fear was not comprehended until the end of the day.
I was afraid of being ‘ too happy ‘ and entering into the Prodromal symptoms.
My conscious mind did not know this until the end of the day.
My sub-conscious did know this, therefore the unreasoning trepidation and fear.
I got the Seroquel, and slept my full 12 hours, and now it is resolved that I can actually be happy without fearing the entering into mania, hypomania or psychosis.
It is a good, solid feeling of progress.
I normally strive to stay blunted and flat affect in my emotions because it does not require that much energy to stay there.
Your writing this article on afraid of being ‘too happy’, along with the 12-hour dark therapy which I use every night has an element of serendipity.
I feel that we are evolving with the collective unconscious as bipolar patients, although I have not studied Jung in depth.
It really is a heart-felt Joy to me that we are all moving forward.
And that Natasha is able to dive into the milieu of our collective thoughts, emotions, and feelings to pull out the nuggets of gold that she is then able to translate into human language.
This is not ‘ magical thinking ‘ on my part.
Because, there have been well over 7 or more synchronistic articles written at the proper time for me to be able to key into them.
Together, we are moving forward.
And, I was able to enjoy progress without sabotaging my happiness !!
— Burt B.
I love hypomania! But it has always been a problem for me. Luckily I haven’t experienced it in a couple of years.
I just came out of a depression a couple days ago, feeling good, medication working, and I go upstairs to get my coffee. My sister is up, and she wants to go to Molbak’s to get some more landscaping supplies. We get ready, next thing ya know we’ve spent $350. I want to plant some, taking my time, but all those bare and “unsafe” places called out, and our family has given us a roof over our heads………I did plant all but one, thankfully rain came before I got started on the rocks.
This time the rain was my clue, and it’s the kind of clue I love, nature, the smell of bruised pine. The hint of smell that someone in the neighborhood has a fire in their fireplace. It’s one of my coping skills that I learned as a child. When I feel closed in, and my moods are making my partner and cats twitch I go outside and stand under our cedar tree. That is my meditation; having this article in my email this am was just what I needed.