Keeping It Together: Dealing with Hypomania

John, What a great article. I don't see how we survive without loved ones that help us with our illness. I so understand not "seeing" hypomania. What did you do after you realized (with your wife's help) you were hypomanic? Do you adjust your meds? What non-medical things do you do? Thanks for sharing. Michele *************************************************************** Hi, Michele. Glad you enjoyed the article. It really was as simple as getting a good night's sleep, and then making sure I did not go like a bat out of hell the next morning. I can't overstate the value of a good night's sleep. Lack of sleep has been cited by the experts as the quickest road to mania. Therefore, it's no surprise when manic patients are admitted to the emergency room they are given a strong sedative to induce sleep. It was the same principle with me, only I didn't need the sedative to sleep. Once I was mindful to the situation, all I had to do was let nature take her course. Had I not been able to sleep I had some sleeping meds handy and would have used them in a second. Once I slept through the night I was okay. But I didn't want to press my luck. I made sure I had a quiet morning. So I guess there's two lessons: 1) Hypomania can sneak up on even the best of us. 2) If you are mindful and can catch it early it is fairly easy to control. Or to put it another way: Depressions are virtually impossible to "snap" out of, but hypomanias - if you are prepared to listen to your friends and loved ones - are possible to "chill" out of. John

I have the utmost respect for all mental illness - and have been told by some (but not most) that I have hypomania - but frankly I think that this is so broad, so unclear, so confusing and such a huge label that people have to be careful. What is hypo depends on the region (90% of the people in NY are hypomanic if you ask me), hormones, stresses etc. - to say nothing of the fact that everyone has a different temperment. Not to say it doesn't exist but there's almost no research on this, no real med to address and frankly I am not sure that most of the time there is something to address. ********************************************************* Hi. Bingo on all counts. NYC is definitely hypomania city. There is absolutely no research on it, which includes no research into treating it, which means psychiatry is flying blind. From my personal experience, cycles into mild hypomania is part of my "normal" personality, but my hypomania can sometimes fly out of control, which is why I need to be extremely vigilant. Please check out my five-or-six-part blog series on this important subject. Take my word for it, there is more on hypomania in this blog series than most psychiatry texts - which is an indictment on psychiatry rather than an advertisement for me. John

When you talk to your Pdoc and mention depression, they don't seem particularly concerned. But mention that you're becoming elevated, and they're all over it. For me hypomania, and of course mania, seem to be more of a risk than depression. Great post. *********************************************************** Hi, GJ. You just hit the bull's-eye to my biggest soap box issue of all time. Psychiatrists are so afraid of mania that many of them, I'm convinced, tend to err on the side of over-medicating and over-sedating us. Show up at their office looking happy and they'll double your doses - just kidding but not quite. At present, psychiatry does not know how to distinguish between a legitimate baseline state and what could be the beginnings of a cycle into a very dangerous mania. They are trained to treat hypomania exactly as if it were severe mania. There are no clinical trials involving treating hypomania. And here's where the depression side comes in. Of course we're going to be depressed if they medicate our true personality out of us. I have a strong belief that it's okay to be way more lively and productive and creative and sociable than the rest of the population if this is really our true "normal" and not just some artificial high. Take that away from us - well, that violates the Hippocratic Oath. But for some perverse reason, depression doesn't seem to scare psychiatrists even though - ironically - this phase of the illness is far more pervasive and dangerous and disabling by a country mile and far more difficult to treat than mania. I could talk for hours on this ... John

excellent post--thank you. For those of us who don't quite fit the diagnostic profile, just figuring out what is normal is tough. I would like to live life in hypomania, or at least a bit of it. I have never been manic, just hypomanic and then down through "normal" to deep depression. I agree that sleep is the key, but never have been a good sleeper--even depressed I don't sleep well. Exercise, and lots of it seems to reset the brain to where I can sleep. My brother is and my dad (now deceased) are the more classic bipolar, mine is not. Again, thanks. First time I have been on this site. ***************************************************** Thanks. Claire. Be sure to check out my other blog entries, where I raise a lot of the issues you discuss. And this will be an ongoing discussion, so keep checking back and keep posting. John

I'm new to the world of Bipolar Disorder. My partner was recently diagnosed with Depression, but I believe there is definitely some Hypomania at work. He is on medication for Depression, if he is indeed Bipolar could his anti-depressants be making the mania worse? I've tried to talk to him about this, because he's very open to discussing his depression, but his response is that he feels like I want him to be sad. He feels that by asking him about his behaviour when he's "happy" then that means I'd obviously prefer him to be sad. I understand that this is his illness speaking, but I'm at wits end. I want to get some help in dealing with this. I'm a little lost. The depression I can deal with because we recognize it, we talk about it, he's using medication for it. We're even dealing well with the side effects. But the problem is that he's confusing happiness for manic behaviour, and therefore will not mention it to his MD. He will not see a therapist. I've read up a fair bit about depression and hypomania and he fits in almost every symptom: erratic speech, erratic spending, fidgety, hyper-sexual, disorganized, grandiose actions/comments, and then the opposite. Anyway, I'm sorry, I'm getting a little erratic here myself! I was just wondering about medication and how to approach the topic with him. Thanks...your blog has been most helpful! *************************************************************************************** Hi, Leslie. You definitely don't want to have this discussion when your partner is hypomanic. When he's more down to earth, though, you need to have "the talk" and establish some clear ground rules. Yes, you will have to exercise extreme patience and understanding, but you should also feel entitled to be all over him like a bad cop. After all, everything he does (or doesn't do) profoundly affects you. You might want to share with him my seven-part blog series on hypomania starting here. Don't allow him to misinterpret anything in the series to mean he is entitled to indulge in irresponsible hypomania. For some people mild hypomania is a legitimate baseline, but maintaining that baseline requires rigorous illness management - strict lifestyle routines, meds adherence, extreme mindfulness. This also means that you get to be his watchdog - if he steps out of line you can chew his leg off. But get his support and permission first, while things are okay. Establish what kind of words from you will work for him and what is likely to make the situation worse. My wife and I have developed a lot of understandings between us in the two-and-a-half years since we've been together, but we need to do a lot more. I recently came back from a NAMI convention, where I had a good conversation with a woman who lost her husband to a manic episode. Our conversation made me realize my wife and I need to put things on paper. This is a critically important topic - hardly anything is written about it - so please get back to me and let us know how things are going between you and your partner. We all stand to learn from your experience.