No one wants to be depressed. Everyone, on the other hand, wants to be hypomanic. Think of hypomania as "mania lite," for the time being, an elevated mood state that is better than any recreational drug high. Energies bop, inhibitions drop, ideas pop. This is the kind of personality makeover we all pray will happen to us - salesperson of the month productivity combined with life-of-party sociability.
So "right" does hypomania feel to most of us that we are inclined to mistake this state of well-being for our normal selves, Life is a cabaret. Who wants the party to stop? Not surprisingly, psychiatrists never encounter individuals walking into their office for the first time complaining of hypomania.
Psychiatrists and therapists inevitably wag their finger at the mention of hypomania. They've seen the consequences in far too many of their patients and clients. Sure, mild hypomania may make us the envy of the human race, but ratchet up the mood a degree or two and we start doing stupid things, make stupid decisions. This may range from spending way too much money to sleeping around to dancing on tables.
Now trouble is brewing. Overly hypomanic individuals are well on the way to destroying their finances, their relationships, their careers, and more, with no insight into the risks they are exposing themselves to. The cabaret is out of control. Life is a parody rather than a party. Events and conversations become out of sync and decidedly unpleasant. No one understands. Everyone is stupid. It's all their fault. Anger erupts. Voices are raised "
The roller coaster ride is about to begin in earnest. For some, the crash into depression may happen. For others, the terror of full-blown mania is about to take hold.
And there is the psychiatrist or therapist, with knowing looks, saying, "I told you so."
But how much does psychiatry truly know about hypomania? The answer is surprisingly - and inexcusably - precious little. The pioneering clinician Emil Kraepelin indentified hypomania in his classic 1920 opus, but until last year no book appeared with the term in the title.
Studies on hypomania are virtually nonexistent, absolutely ZERO clinical trials have been done on treating patients with hypomania, treatment guidelines are entirely silent on this critical phase of the illness, and the DSM provides precious little guidance.
One result is some overly-cautious psychiatrists who err on the side of overmedicating us. Patients then complain to their clinically deaf psychiatrists about feeling like zombies and having to put up with other burdensome side effects. Frustrated, these patients may quit on their meds, with predictable results.
And there's the knowing psychiatrist,
wagging his finger, blaming the poor patient.
In the next several blogs, we will discuss how some experts are challenging commonly-held assumptions, and what they are recommending to patients. Yes, hypomania poses a real danger, but for some of us it may be close to our true baseline, part of our true temperament. Are the people who treat you aware of this? Are they doing anything about it?
To be continued "
Part II: What Hypomania Means for Depression Treatment