The conventional view is that hypomania is part of an illness rather than our true personality, and so requires medical intervention.
But hold on, you’re Alexander Hamilton and you’ve just come up with a brilliant plan that will guarantee a new nation’s solvency for generations to come. But there’s also this insufferable prat named Aaron Burr who is bugging the hell out of you.
Now imagine you’re Hamilton’s psychiatrist. Do you reach for the Zyprexa?
Not so fast, says John Gartner, PhD, author of The Hypomanic Edge: The Link Between (a Little) Craziness) and (a Lot of) Success in America. Rather than part of an illness, Dr Gartner contends that in many individuals hypomania may be a true part of a person’s temperament – the good, the bad, and the ugly. Yes, it may be okay to reach for the prescription pad to tone down Hamilton just a tad – just enough to keep his hot head from getting hotter – but not enough to medicate the brilliance out of him.
That was the gist of an interview I had last year with Dr. Gartner. His remarks came to me as such a breath of fresh air that I could only think, “Man, the psychiatric establishment is going to hate this guy.”
I did my own research and what I found – or rather didn’t find – truly dismayed me: A PubMed search from May last year revealed only 652 article entries for hypomania vs 19,537 for mania and 176,667 for depression. There were no published clinical trials for treating patients with hypomania, and no information in any of the treatment guidelines on what to do for patients in this state of mind.
In short, psychiatry has no authority – zero, zip, nada – for treating patients with hypomania, an extremely frightening thought considering how common this phase of the illness is. Standard practice, instead, involves extrapolating from studies and clinical experience involving patients having manic episodes. These tend to be your 911 cases who generally require meds overkill to bring them out of danger.
But Alexander Hamilton was not a 911 case, though we know he was a slowly ticking time bomb. What do we do? Dr. Gartner likens the situation to the pitcher in Bull Durham with the 100 MPH fast-ball who keeps beaning the mascot. We want to slow him down a little bit so he has control, but not so he throws at 50 MPH. Dr. Gartner refers to this as “taking the edge off of the edge.”
This may involve careful micro-adjustments with small doses until you and your psychiatrist find the sweet spot. The sweet spot for you may be mildly hypomanic, with room to cycle down as well as shift sideways into occasional grumpy periods – in short, you. It feels right and you feel reasonably safe.
It’s a different story if you don’t feel reasonably safe. Many people only know hypomania as the prelude to something dreadful about to happen, either as the beginning of an ascent into mania or the start of a long drop into depression. If you’re one of these individuals, you already know that immediate and unequivocal meds intervention is a must.
Psychiatrists have good reason to be fearful of hypomania. But we often tend to fear most the things we know least. Oh, how little we know.
To be continued …
Part VI: Coping with Hypomania
Published On: March 16, 2006
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