Hypomania Part II: What It Means for Depression Treatment

By John McManamy, Health Guide Monday, February 27, 2006

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Conventional wisdom states that hypomania (see my Feb 23 blog) is a psychopathology that needs to be avoided at all costs. Surprisingly, a literal reading of the DSM does not give that impression.You could have knocked me over with a feather when, a few years back, I carefully read what the DSM h...

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Glen

3/ 3/06 12:57am

If hypomania is a result of an acute episode, it should be treated. So long as it can be ascertained that it is above a baseline mood for the patient. ******************************* Hi, Glen. No question about it. The question isn’t really to treat or not to treat. It’s more like how much treatment and in what circumstances. And this is where the psychiatric profession is shockingly ignorant. You mentioned hypomania in an acute episode, yet I am not aware of any studies at all for treating hypomania in an acute episode. We have plenty of studies for treating mania in an acute episode. Meds doses are all based on trials for treating acute mania. Are psychiatrists dosing us wrong for hypomania? Or does hypomania justify meds overkill to head off a manic episode. Or should we be treating hypomania BEFORE it happens, when the early warning signs start manifesting. We don’t really know the answers, but my next blogs will be asking these hard questions and more. Thankfully, there are things we can do to head off out-of-control hypomanic episodes, which I will also be exploring. I appreciate your comments, so stay tuned for more blogs and keep posting, John

Christine

3/ 4/06 5:32am

It's been my experience that psychiatrists don't treat hypomania. It doesn't warrant hospitalization, and my doctors have never been concerned about my manic/hypomanic symptoms until *after* I do out-of-control things. I definitely think there should be emphasis placed on preventing escalation of symptoms and treating hypomania instead of demanding the worst happen before there's intervention. **************************** Hi Christine, Thanks for your comment. I tend to agree. Psychiatrists are trained to treat mania in 911-type situations. Hypomania is subtle and elusive. The onus is on us to pick up the warning signs before the hypomania occurs. Stay tuned, as I will be getting into this in future blogs. Thanks for reading, John

Donald Kahn

3/ 5/06 1:05pm

I have had occasion to consult Dr. Florian Holsboer, of the Max Planck Institute of Psychiatry, Munich, which was founded by Dr. Kraepelin. He treated me successfully (thus far) for a dismal depression. I had had a few hypomania episodes in my (80 years) life and would produce another one if I could. Thanks for your splendid writings. DK **************************************** Hi DK, If we could only put hypomania in a bottle and sell it. The mild more stable variety, mind you. Not the kind that is a prelude for bad things to come. Hypomania goes great to swing band music, and you're of the age to really appreciate that. Thanks for reading, John

kay

3/12/06 1:37am

john, your site is a real help. having bipolar is like wearing a nazi star of david sign but you make me feel like i'm wearing a sign: winner ***************************************** Hi, Kay. Many thanks, Karen. You just made my day. John

barry

3/15/06 6:20pm

hello- i was diagnosed today with hypomania.....My Dr said to not take meds and to work it outr does this make sense? ********************************** Hi, Barry. I'm in no position to second-guess your doctor, particularly when I have no knowledge of your situation. In another day or two, a new blog will go up that should give you a much better take on the situation. In the blog, I discuss the different issues involving the choices in whether to treat hypomania with standard meds doses or little or no meds doses. In a future blog I will discuss the various coping techniques you can use whether you are on meds or not. Your wellness is important to us, so please hang in there, read my next blog, and feel free to post. John

lee

3/20/06 6:34am

I have been just dx with hypomania, and have been put on lamictal. there seems to be little info on treatment for this illness. And of course finding out I have this has made me more depressed and feelings of being alone even more. How do i include my family and boyfriend who is a counsler who does not want to help me as i am not his patient, but he knows more than i and i feel that i should be able to have some guidance from him, all he says is asks your drs. help! This illness does involve him. ******************************** Hi, Lee. "Little info" is an understatement. The Lamictal is mainly for the depression side of your illness. I suggest that you read John Gartner's The Hypomanic Edge, which will give you a good education in hypomania, and which provides a positive view of this aspect of the illness. Based on what you read in the book, it should be much easier to approach family and boyfriend. As for your counselor, ask if there are specific therapies to manage mood swings (cognitive-behavioral therapy is effective). If your counselor isn't able to help with this, then feel free to seek out a therapist who can help you (your psychiatrist should be able to recommend a cognitive-behavioral therapist). Hope this helps ... John

joe fitzpatrick

8/26/06 4:27am

my psychiatrist was not listening to me. I said F-U to him. He called the police on me and told them that I had just said I was going to go kill people. An out-right lie. Now I suffer from more than just anxiety, depression, mood swings, bipolar 1 or bipolar 11, manic episodes, manic depressive episodes, etc. but medications are helpful for sleep & stability - seroquel 50 mg, gabapentin 1800mg, effexor xr 300mg, requip RLS 1mg, klonopin 1mg, melatonin 3mg. Thx for all the info.

Suzanne

9/19/07 6:32am

John, I'm not sure I understood your comment that for a dx of bipolar 1 mania alone will do. Do you think that you can't have a dx of bp 1 if you've only had hypomania, but severe depressions?

I was dxed as bp1 because I had delusions. When I first saw the doc I was in a mixed episode. I take anti-psychotics, as well as Lamictal, sleeping aids, etc.--6 different drugs. I've never had a "full blown" mania.

Right now I'm hypomanic (which I love--the not sleeping, the energy, the enthusiam--but I did spent $600.00 in 4 hours the other day). Last time I was hypomanic for about 5 mos. & I didn't tell doc, because I didn't realize how dangerous it was to not sleep.

After 5 mos. my brain "misfired " & I fell into a sudden & deep depression & overdosed.

I see my doc today & she will not be happy about my sleeping only 3 hours a night, but I already take sleeping aids & anti-anxiety drugs at night so I don't know what she'll do--increase my Abilify?

Stardust

1/19/08 8:17pm

I always learn so much from you. I really appreciate all you do. I want to learn the precusors to hypomania. Maybe an idea for a new post? I'm definately going to check out the Hypo. Edge book. Thanks. I had no idea the status of hypomania with the professionals. And it was discovered in 1920, then little if any to date. I'm getting broke on my sprees, I really can't help myself. Then that adds to my depression cycle. That's my life till I get some tools I can work with. And I will!

Nancy Nielsen

5/31/08 12:26pm

Thank you for your insightful research information. Looking back, even recently, I have so many regrets and self-resentful thoughts, that these feelings add to the depression that follows. Now, I have STOPPED dating, because I do not trust myself. I avoid important decisions, as I fear they may be irrational. Thank you for pointing out the importance of this rarely treated and 'disguised' disorder.

Stopping off Effexor, and staying on Lamictal, seroquil, and oxezapam seems to have helped.

Thank you again.

Jan

1/ 1/10 6:04am

My daughter (17) seems hypomanic right now. I am wondering what's coming. Watching and waiting and holding my breath. But, I confess to enjoying her in this state.

Hypomania Part II: What It Means for Depression Treatment

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