I Know I’m Hypomanic, Depressed or Mixed but I Can’t Help It

→ November 30, 2016 - 17 Comments

I Know I’m Hypomanic, Depressed or Mixed but I Can’t Help It

Many of us have the insight to know when we are manic, hypomanic or depressed or in another bipolar mood state but, unfortunately, even though I might know I’m hypomanic, depressed or mixed, I can’t necessarily help it. I wish I could. I wish that knowing what my bipolar disorder was doing would somehow alter it, but it typically doesn’t. I just can’t help it when I’m hypomanic, depressed or in a mixed mood – even when it’s clear to me.

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Win a Paperback Copy of “Lost Marbles” — GoodReads Giveaway

→ November 14, 2016 - 5 Comments

Win a Paperback Copy of “Lost Marbles” — GoodReads Giveaway

If you’re on my mailing list you head last week that a GoodReads giveaway was started. Right now I’m giving away three paperback copies of Lost Marbles: Insights into My Life with Depression & Bipolar

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Eight Ways to Calm Down a Hypomania – Self-Help for Hypomania

→ November 10, 2015 - 15 Comments

Eight Ways to Calm Down a Hypomania – Self-Help for Hypomania

After a stressful day, I’m hypomanic and it brings to mind my self-help tips for how to calm down a bipolar hypomania. These tricks might not be available or work for everyone, but here’s what I do to calm down my hypomania.

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Time It Takes to Recover from Depression after Hypomania

→ June 5, 2015 - 16 Comments

Time It Takes to Recover from Depression after Hypomania

As I wrote about on HealthyPlace this week, right now, I’m recovering from a depression after a hypomania. It’s been 11 days and I haven’t returned to my (admittedly, rather sucky) baseline. My point in that piece was that the depression after a hypomania is so much worse than an average depression. My point here, though, is that the time it takes to recover from a depression after a hypomania never passes quickly enough and I tend to beat myself up about it.

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Am I Feeling Better or am I Hypomanic?

→ May 30, 2013 - 27 Comments

Am I Feeling Better or am I Hypomanic?

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?

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Motivation and Bipolar Disorder

→ February 20, 2013 - 29 Comments

Motivation and Bipolar Disorder

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.

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What Does Bipolar Hypomania Feel Like?

→ November 2, 2012 - 72 Comments

What Does Bipolar Hypomania Feel Like?

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.

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How to Handle Bipolar Hypomania

→ March 12, 2012 - 51 Comments

How to Handle Bipolar Hypomania

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

Hyper HypomaniaSo, once you know you’re hypomanic, what’s next?

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?

Stress Leads to Bipolar Hypomania

→ February 28, 2012 - 22 Comments

Stress Leads to Bipolar 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.

I’m Stressed

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.

Stress Leads to Bipolar HypomaniaI’m Stressed. I’m Hypomanic.

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.

Bipolar Terminology: The Difference Between Bipolar I and Bipolar II

→ October 5, 2011 - 53 Comments

Bipolar Terminology: The Difference Between Bipolar I and Bipolar II

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.

Bipolar Terminology

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?

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Mixed Bipolar Disorder – How to Treat Mixed Mood Episodes

→ August 23, 2011 - 23 Comments

In the final installation of my mixed moods series, I talk about how to treat mixed moods in bipolar disorder. If you need a refresher on mixed moods in bipolar 1 or bipolar 2, see the first three articles in this series:

Treating Mixed Moods in Bipolar 1 – Mixed Mania

We know most about treating mixed moods in bipolar type 1 as that’s what has been classically defined as a mixed mood in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Because mixed moods in bipolar disorder type 1 are considered a type of mania, one could think of treating them in the same way bipolar mania is treated. Typical mania treatments include:

  • Lithium
  • Some anticonvulsants
  • Antipsychotics (normally atypical)
  • Benzodiazepines (for acute anxiety, commonly seen in mania and mixed moods)

Often a combination of an anticonvulsant and an antipsychotic is used.

FDA-Approved Drugs for Treating Mixed Moods in Bipolar 1

Since mixed moods are defined in the DSM, there are specific medications approved by the Food and Drug Administration (FDA) to treat mixed mania. FDA-approved drugs for treating mixed moods in bipolar disorder type 1:

  • Carbamazepine extended release (Equetro)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Risperidone (Risperdal)
  • Asenapine (Saphris)
  • Olanzapine (Zyprexa)

Bipolar Type 1 and Mixed Mood TreatmentWhy lithium didn’t make the list I’m not entirely sure;* because, as I’ve mentioned, mixed moods and acute anxiety carry a significant risk of suicide and lithium seems to have a particularly strong anti-suicide effect.

Electroconvulsive therapy (ECT) is also indicated for the treatment of bipolar disorder mixed moods.

Treating Mixed Moods in Bipolar 2

As I mentioned in the article on mixed moods in bipolar disorder type 2, mixed moods can either have hypomania or depression as the primary mood. This primary mood then, dictates the type of treatment chosen.

Treating Mixed Hypomania

According to this two-part Psychiatric Times article by Steven C. Dilsaver, MD, mixed hypomania in bipolar type 2 can be treated similarly to treating a mixed mood in bipolar type 1.

Specifically noted is the concern of acute anxiety during mixed hypomania and the fact not all patients readily admit to psychological and physical symptoms of anxiety. However, this is critical information to your doctor and should always be offered, even if not specifically asked.

Other mixed hypomania treatment tips include:

  • Comorbid (co-occurring) anxiety may decrease the effectiveness of mood-stabilizing agents, so benzodiazepines may be a better choice.
  • Not treating anxiety aggressively can reduce overall long-term treatment outcomes.

Treating Mixed Depression

Mixed depression is particularly hard to treat as mixed moods often predict a lack of response to antidepressants, not to mention the fact that antidepressants can make hypomanic or manic symptoms worse.

A suggested treatment strategy for mixed moods in bipolar 2 with the primary mood of depression is the following:

  • Begin by suppressing hypomanic symptoms by using an mood stabilizer or antipsychotic (antipsychotics may work in 1-2 weeks)
  • Start medication at low doses and titrate (raise the dose) quickly – this is generally necessary due to the severity of mood symptoms
  • If depressive symptoms persist after response to the above medication, add a selective serotonin reuptake inhibitor (SSRI) antidepressant very slowly while watching for signs of hypomania – this requires very close monitoring and likely weekly doctor visits (impossible for some, obviously)

This is very similar to what many doctors are now recommending for bipolar disorder type 2 in general. First, stop the cycling (or hypomania) and see if that also corrects the depression. Avoid the use of antidepressants whenever possible.

Preventing Mixed Depression in Bipolar Type 2

How To Prevent Bipolar Disorder Mixed Moods

Obviously, no one can guarantee prevention of any mood, but there are some recommendations given in the article, as people with mixed depression are known to be at high risk for reoccurrence.

Tips on preventing mixed depression in bipolar 2 include:

  • Lamotrigine is the favorite prophylactic medication as it seems to prevent depression without being an antidepressant
  • Ongoing scheduled benzodiazepine doses can help prevent panic attacks^
  • A combination of an antipsychotic, plus lamotrigine, plus a benzodiazepine is often “highly effective” (words Dr. Dilsaver’s)
  • Lithium is known to be a highly preventative agent; however, in many cases divalproex (Depakote) is superior and has fewer side effects

Series on Mixed Moods in Bipolar Disorder

Whew. OK, there turned out to be a lot to know about mixed moods in bipolar disorder. I hope you learned something reading it as I certainly did writing it.

For your convenience, here are the links to the other three parts in the series:



* I suspect there wasn’t enough money to be made on a generic drug to fund the studies, especially when doctors are going to use it anyways.
^ Yes, I know, long-term (sometimes any term) benzodiazepine use is controversial. Personally, I’m not against them and neither are many doctors – when used responsibly.


Psychiatric Times, Mixed States in Their Manifold Forms. Part one and part two.

Mixed Moods in Bipolar Disorder and Depression in the DSM-V

→ August 16, 2011 - 2 Comments

Mixed Moods in Bipolar Disorder and Depression in the DSM-V

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.

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