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Can hypomania be induced by just thinking quickly and variably?

Can hypomania be induced by just thinking quickly and variably?


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Emily Pronin and Daniel Wegner have shown that fast and variable thinking induces positive affect. This is independent of thought content. Sheri Johnson has noted that the key things that might start a hypomanic/manic episide are a night of no sleep, a positive life experience, and certain drugs.

Is it possible to clinically induce hypomania by just thinking quickly and variably?

Note that an easy exercise to implement this would be to think of a word and then a word beginning with the previous word's letter.

Added. In a sense, the above exercise is "anti-meditation." Mindfulness is essentially low thought speed combined with high variability. The ideal state would be high thought speed and high variability.

References

  • Pronin, E., & Wegner, D. M. (2006). Manic Thinking Independent Effects of Thought Speed and Thought Content on Mood. Psychological Science, 17(9), 807-813.

I had a read through the Pronin and Wegner study. The study had a sample size of 144. They manipulated thought speed by getting participants to read aloud one statement after another at either half normal reading speed (slow thinking) or double normal reading speed (fast thinking). They also manipulated the content of the text being read (depressing statements versus elated statements). They seemed to find that both the content and the speed of thought manipulation seemed to yield similar increases in positive emotion, energy, feelings of power, feelings of creativity, and grandiosity.

The first issue is whether their study is replicable. I don't know the literature regarding replications, but all the effects seem plausible, and the sample size is reasonable for this kind of study.

Another issue is how the manipulation of reading speed affected the reported emotions. Perhaps the slow reading led to frustration or being annoyed.

With regards to the nature of the effect, there are questions of how long this mood induction lasts. My guess is that the effect of the mood induction would be short lived.

There is also a difference wherein mania the speed of thought is presumably internally driven whereas on this task the "speed of thought" is externally driven. The study did not measure whether this "speed of thought" continued after the external stimuli was removed. For example, does speed of thought work with an inertial principle or not such that it can be started with external stimuli and will keep going on its own. My guess would be even if such a concept of inertia existed, people would quickly return to their own typical level. Thus, I don't think such a manipulation would induce clinical levels of mania, especially not in a sample of participants who do not suffer from bipolar disorder.


Substance Abuse and Bipolar Disorder

According to the most recent literature on substance abuse and bipolar disorder, these two problems occur together so frequently that all young people with a bipolar diagnosis should also be assessed for drug and alcohol problems. Those who experience mixed states or rapid cycling have the highest rate of danger from substance abuse &mdash the discomfort a person feels in these chaotic moods is so great that she may be willing to do or take almost anything to make it stop.

Some drugs, including marijuana, downers, alcohol, and opiates, seem to temporarily blunt the effects of mood swings, only to cause ill effects later. Others can actively exacerbate manic depression. Speed (methamphetamine, crank, crystal) and cocaine are two that have sent many abusers into mania, often followed quickly by deep depression and psychotic symptoms. Hallucinogens, including LSD and PCP, can set off psychotic symptoms as well. These drugs are not a good idea for any child or teenager, but their effects on young people with bipolar disorders can be even worse.

As with suicide, accidents, and SIB, the best approach to substance abuse is prevention. First, take a look at your own example: if you find that drugs or alcohol have become important coping strategies for you, seek immediate treatment. Talk to your child about responsible use of alcohol, for example, a glass of wine with a special meal, or a cold beer on a hot day at the ball game. Point out examples of inappropriate or excessive use, from street alcoholics to news stories about young people in trouble due to drug use or drunken driving. You really don&rsquot have to preach, just provide a good example and accurate information to counteract the messages your child will receive from ads, pop culture, and peers.

When a person first begins to try drugs or alcohol, there&rsquos still time to stop without involving a detox center or other strong measures. She needs to think about why she has chosen to try alcohol or drugs, such as feeling self-conscious in social situations or inability to handle peer pressure other activities that might have the same positive effects, such as improving her social skills and ways to avoid temptation, including choosing a different peer group or steering her friends toward something other than bong hits and beer bashes. These are issues that can be discussed with a parent or a counselor.

Most teens will attend a wild party or two, out of curiosity or boredom if nothing else. You may be able to prevent them from coming to harm even when they&rsquove made a bad choice. Many families have drawn up a contract with their children, promising that they will retrieve them from a dangerous situation at any hour, with no lecture to follow. Let them know that while they may make some poor judgment calls, you&rsquore available to come to their rescue.

You may also need to actively help kids whose peers are fixated on drinking and drugs to find other ways to spend their time. This negative aspect of youth culture isn&rsquot just a big-city phenomenon by the way&ndashsmall towns and rural areas, with their lack of activities and places to go, can have extraordinarily high rates of drinking and drug use among teens. The drug and alcohol problems of suburban youth are often covered up, but they&rsquore there in force, spurred by lack of supervision after school, access to cash, and easy mobility.

When substance abuse progresses in frequency or seriousness, or when highly dangerous drugs are involved, early intervention is essential. Experts in treating children and teenagers with a dual diagnosis of bipolar disorder and substance abuse or bipolar disorder and substance dependency say success depends on appropriate medication education about their psychiatric condition, psychiatric medications, and the dangers of drug and alcohol abuse and close monitoring. Lithium has proven to greatly reduce or eliminate substance abuse in as many as 75 percent of dual-diagnosis youth with a bipolar disorder. It can be assumed that when other types of mood stabilizers are tested, they will show at least some positive effect on substance abuse as well. Twelve-step programs such as AA are important for reaching and maintaining recovery.

Although some sources recommend treating the substance abuse first, mostly because drugs and alcohol can have severe interactions with the medication used to treat manic depression, both really need to be addressed at once. Obviously, a person who is not sober is unable to adhere to the lifestyle changes, medication regime, and therapy appointments needed to hold back mood swings. At the same time, most bipolar substance abusers drink or use drugs partly to self-medicate their symptoms, and they may misuse their prescription medications as well.

Drug treatment programs, including inpatient detox centers, are beginning to be more knowledgeable about working with bipolar patients. If your child will be going to a drug treatment program, make sure that its clinical staff is fully aware of the implications of his illness, and that appropriate medication management and psychiatric expertise will be available.

Most detox centers say that about a month is needed to break a true addiction&rsquos physical grasp, and it takes a year of sobriety before an addict can honestly feel mentally comfortable without his substance of abuse. Relapses are common until several years of sobriety have been achieved, and can present severe dangers, including suicide. The earlier a drug or alcohol user seeks effective treatment, however, the more likely he is to achieve complete freedom from substance abuse without progressing to substance dependency.

Many addicts use self-help resources like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or Rational Recovery to get and stay sober. In these programs, people attend regular meetings to talk about their addiction problems and offer each other support. Former substance abusers who have gotten clean act as mentors to newcomers. Generally speaking, these 12-step programs are an excellent resource for drug and alcohol users in recovery. There are special groups for teens, although many experts recommend teens attend mixed-age groups. Participants in 12-step programs are paired with sponsors who can help them deal with temptation, social pressure, old behavior patterns, and the stress of meeting new expectations.

There are also adjunct groups for the families of addicts. Family support groups can really help you make it through this difficult period. You&rsquoll learn many strategies for helping your child on the road to recovery. Families Anonymous is one with many local chapters.

The only down side of 12-step programs is that a few former addicts are against using prescription medications for brain disorders, seeing them as simply a legal substitute for street drugs or alcohol. This is not an official policy of AA or NA, by the way. To make sure a particular 12-step group doesn&rsquot have this orientation, talk to one of the group&rsquos long-term members or to its institutional sponsor, if any.


Abstract

Objective

Evolutionary perspectives on bipolar disorders can further our understanding of the origins of these conditions, and assist clinicians in distinguishing normal from abnormal states. Hypomania is unique amongst bipolar conditions in that it seems to have beneficial aspects and can be difficult to diagnose, in contrast to full-blown mania and depression. A theoretical perspective regarding the evolution of hypomania as a defense mechanism is presented.

Method

Literature review focused on the fitness reducing aspects of depression and the fitness enhancing aspects of hypomania/mania.

Results

Of all the adversity inherent in depression, inhibition of physical and mental activity—depressive inhibition—has the most detrimental consequences, and throughout our evolution would have significantly reduced fitness. It is proposed that hypomania evolved as a depressive inhibition override defense mechanism, typically operating in a short-term time frame, to restore physical and mental activity to fitness sustaining or enhancing levels. Over-activity and not mood enhancement enabled hypomania to function as a defense mechanism against the fitness reducing state of depressive inhibition. Contributing to depressive inhibition are the Behavioral Activation System (BAS) and the Behavioral Inhibition System (BIS), two basic motivational systems. Depressive inhibition consists to some extent of low BAS and high BIS. As human intelligence evolved cognitions inhibiting BAS and activating BIS became amplified, resulting in intensified depressive inhibition.

Limitations

A theoretical perspective.

Conclusions

Given its ability to override depressive inhibition hypomania might be viewed as a natural treatment as opposed to a problem to treat, producing maximal improvement in areas where functioning has suffered the most while typically enhancing social behavior.


Is It Mania?

Some people with bipolar disorder become psychotic when manic or depressed -- for example, hearing things that aren't there. They may hold onto false beliefs, too. In some instances, they see themselves as having superhuman skills and powers -- even considering themselves to be god-like. If you have psychotic symptoms then it's mania, not hypomania.

Keep in mind that you may not notice these things in yourself. It might be a friend or family member who notices the patterns. If symptoms last for a week or more and cause problems in your life, it may be mania.

Sources

National Institute for Mental Health: “Bipolar Disorder.”

Massachusetts General Hospital Bipolar Clinic & Research Program: “Understanding bipolar disorder: Frequently asked questions.”

American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."


Psychology

2 areas they work
-presynaptic cleft in periphary:

-CNS depression, bradycardia, hypotension, respiratory depression, miosis, rebound hyper tension with abrupt cessation

more common in males
symptoms starts in early development:

A)restricted repetitive behavior patters
--receptive motor movements
--insists on sameness
--preoccupied with objects (bear)

B)defects in social skills in multiple setting

C) increased head circumference

korsakoff - permanent neurologic condition
-loss of mammory bodies

will get:
confabulation
apathy (lack of interest or concern)
personality changes
amnesia - anter (more common) and retro

-waxing/waning (consciousness)
-reversible

-loss of focus/attention
-disorganized thought
-hallusinations (visual)
-sleep issues (up at night, sleeping during day)

-causes:
alzheimers - #1
stroke #1
lewy body dementia

-occurs in medical and physchiatric disorders
--delirium / schizophrenia

delusions (expressed via speech / words)

disorganized thoughts (expressed via speech paterns)

persecutory - someonse is after me

grandios - i am a millionare

ergomaniac - brad pitt loves me

thought blocking (sudden stop of talking)

loosening assocation (discusion doesnt follow each other)

clanging - words that rhyrm but make no sense

visual (associated with delearium)
auditory (schizophrenia)
smell (aura in tempal lobe epilepsy)

1) recurrent episodes of psychosis
-auditory hallucinations
-delusions - fixed false beliefes

2)cognitive dysfunction
-difficulty with information, attention ETC
-disorganized thoughts
--tangental speech (changes topics frequently)
--circumstanial speech (long round about answers)

-no other abnormal behavior
--no halulucinations, disorganized thoughts, negative symptoms

-gets delusion involving the baby

-associated with trauma
--stress or actual trauma

-two or more distinct identities
--gaps in memory about events when being the other person


LEXAPRO: Judge Experiences Antidepressant-Induced Hypomania

A doctor who is telling the truth about the hypomanic episode this
judge experienced from his antidepressant. How refreshing that
the patient is getting the truth rather than being told he had an
“underlying” Bipolar Disorder that was manifest by his antidepressant
use. Why can’t other doctors be as honest and come right out and
tell the patient that their Bipolar symptoms have been brought on by
their antidepressant?

BUT when a patient experiences mania or hypomania from an
antidepressant, it is ABSOLUTELY INSANE to think they will not
experience it again on a different antidepressant! He and his family
had better hold their breaths!

What a shame when this happened that he did not have a copy of my DVD,
“Bipolar, Shmypolar! Are You Really Bipolar or Misdiagnosed Due to the
Use of or Abrupt Discontinuation of an Antidepressant?” If he had, the
DVD would have served as a warning for him about this common reaction
to both antidepressant use and abrupt withdrawal from antidepressants.

Why are these “Bipolar” patients not told they are suffering
continuous mild seizure activity which is what Bipolar Disorder is – a
sleep/seizure disorder brought on by the drugs?! ANTI-depressants are
stimulants, stimulants over stimulate the brain producing seizures.
The one time of day we all are in seizure activity is during REM sleep
– the dream state. So antidepressants are basically chemically
inducing the dream state during wakefulness.

By the way, the names “Mania” and “Hypomania” should be changed to
“Shear Hell on Earth. ”

Ann Blake-Tracy, Executive Director
International Coalition for Drug Awareness
www.drugawareness.org & www.ssristories.drugawareness.org
Author: Prozac: Panacea or Pandora? – Our Serotonin
Nightmare – The Complete Truth of the Full Impact of
Antidepressants Upon Us & Our World & Help! I
Can’t Get Off My Antidepressant!

First, there was his heart stent surgery in the spring of 2009.

Following surgery, he found himself feeling depressed, a scenario
experienced by some heart patients, he later learned. The depression
was compounded by the death of a good friend, he said.

Next, came a period of his taking an antidepressant, Lexapro, that he
found helpful. But, he said, he stopped the medicine, on his own, too
quickly.

What happened next, he said, was later diagnosed as an episode of
hypomania, an expression of bipolar disorder. . .

Blanche [Downing’s physician], though, describes the episode as a case
of antidepressant-induced hypomania, attributing it to a second
antidepressant that Downing was later prescribed by another physician.

“Medications can commonly cause hypomania, and it’s not really
understood why,” said Dr. Mark Townsend, a professor of psychiatry at
the LSU Health Sciences Center in New Orleans.

Antidepressants can bring on hypomania, as can steroids, he said.

“There’s really not a diagnostic category for antidepressant-induced
hypomania” in the current Diagnostic and Statistical Manual of Mental
Disorders, Blanche said, but he predicted there will be one in the
manual’s next edition.

Former Judge Bob Downing explains episode that led to his resignation

By ELLYN COUVILLION
Advocate staff writer
Published: Mar 13, 2011 – Page: 1D

Bob Downing, former 1st Circuit Court of Appeal judge, whose sudden
resignation from the bench last summer was surrounded by confusion,
can sort out the events on a kind of timeline.

First, there was his heart stent surgery in the spring of 2009.

Following surgery, he found himself feeling depressed, a scenario
experienced by some heart patients, he later learned. The depression
was compounded by the death of a good friend, he said.

Next, came a period of his taking an antidepressant, Lexapro, that he
found helpful. But, he said, he stopped the medicine, on his own, too
quickly.

What happened next, he said, was later diagnosed as an episode of
hypomania, an expression of bipolar disorder.

During the episode that lasted approximately three months, Downing
spent money wildly, alienated family, friends and employees and
resigned from the judicial bench, about the time he was hospitalized
and treated.

“It was a short period. It seemed like an eternity,” Downing, 61, said
recently from an office at the law firm of Dué, Price, Guidry,
Piedrahita and Andrews, where he’s working in an “of counsel” status.

In that capacity, Downing said that attorneys with the firm will work
with him on cases he brings in, but he is not on salary at the firm.
Downing handles personal injury cases.

Now being treated with medication for what was likely a one-time event
and back to feeling like himself, Downing said he recently decided to
speak out about his experience for several reasons.

“For people who have open heart surgery or stents, watch out for
depression,” Downing said.

One in five people experience an episode of depression after having
heart surgery, according to the website,http://www.psychcentral.com,
an independent mental health and psychology network run by mental
health professionals.

Downing also advises people taking antidepressants to stay in touch
with their doctor.

And, he said, “If you start feeling really wonderful and start
spending a lot of money, you need to see a counselor,” Downing said.

Hypomania is “a condition similar to mania but less severe,” according
to MedicineNet.com, a physician-produced online health-care publishing
company.

“The symptoms are similar, with elevated mood, increased activity,
decreased need for sleep, grandiosity, racing thoughts and the like,”
the company reports at its medical dictionary
website,http://www.medterms.com.

“It is important to diagnose hypomania, because, as an expression of
bipolar disorder, it can cycle into depression and carry an increased
risk of suicide,” the site reports.

Bipolar disorder is marked by periods of elevated or irritable mood —
the mania — alternating with depression, according to the National
Institutes of Health.

The mood swings between mania and depression can be very abrupt, it reports.

“Whether it’s hypomania or mania is a matter of severity,” said local
psychiatrist Dr. Robert Blanche, who is Downing’s physician.

“In general, it’s an elevated or an irritable mood that’s not normal
for the person,” Blanche said.

“In his (Downing’s) case, he was irritable and also, maybe the word is
‘expansive’ in his affects, (showing) euphoria, elation and
excitement,” Blanche said.

“He had never had a history of this before,” Blanche said.

Downing theorizes that his stopping his antidepressant too quickly, on
his own, led to the episode.

Blanche, though, describes the episode as a case of
antidepressant-induced hypomania, attributing it to a second
antidepressant that Downing was later prescribed by another physician.

“Medications can commonly cause hypomania, and it’s not really
understood why,” said Dr. Mark Townsend, a professor of psychiatry at
the LSU Health Sciences Center in New Orleans.

Antidepressants can bring on hypomania, as can steroids, he said.

“There’s really not a diagnostic category for antidepressant-induced
hypomania” in the current Diagnostic and Statistical Manual of Mental
Disorders, Blanche said, but he predicted there will be one in the
manual’s next edition.

Blanche said the only way to arrest the condition of hypomania is for
the person to go into the hospital so that their medications can be
adjusted.

During his own hospitalization, Downing was prescribed a mood
stabilizer, Depakote, classified as an anti-seizure medicine and the
medicine most commonly prescribed for mania by psychiatrists, Blanche
said.

The medicine acts to bind up what can be described as “excitatory”
chemicals in the brain, Blanche said.

Ultimately, though, that can result in a depletion of those chemicals
and a person can slide into a depression, Blanche said.

“If (a patient) is on a mood stabilizer, you can introduce an
antidepressant,” he said.

Downing said that his current antidepressant, Wellbutrin, is working
well for him.

After living through a hypomanic episode, some patients choose to stay
on the medicine, Blanche said.

“Some people will actually choose to stay on the medicine, just
because they don’t want it to ever happen again,” he said.

Fortunately, the condition “is one of the most treatable conditions in
psychiatry,” added Blanche, who serves as the psychiatrist at the East
Baton Rouge Parish jail and is the medical director of an emergency
psychiatric treatment center affiliated with the Earl K. Long Medical
Center.

Downing’s experiences this summer seem to have had all the markings of
manic episodes of bipolar disorder.

“Around the first of June 2010, I started feeling really good, started
talking a lot more, making big plans,” Downing said.

Around that time, he went to speak at a law conference in Carmel, Calif.

“I went to Yosemite, it was beautiful. I would wake up at 3 o’clock, 4
o’clock, 5 o’clock (thinking) ‘You need to retire, buy some foreclosed
properties, fix them up and make money to help people in India dig
wells,” Downing said.

“I was making grandiose plans,” he said.

Usually frugal, he started spending money, too, he said.

Before the episode was over, he had run up debts of almost $100,000,
buying such things as a 1971 Rolls Royce, three Harley-Davidson
motorcycles and a 1952 police car, he said.

He also bought a $1,000 commercial pressure washer, a large lawn
tractor and expensive new tools to help put a formerly homeless man
into business, he said.

“He just wasn’t himself,” said his wife, Pam Downing.

The couple will have been married 30 years on March 29.

“When the person is in that condition, you really can’t reason with
them,” Blanche said.

“The amazing thing about it is that it robs the person of their
insight,” he said.

In contrast, people are “painfully aware” of the other aspect of
bipolar disorder — depression, Blanche said.

Physicians and employers may miss a condition like hypomania, said
Townsend, because, like most people, “we like happy people, perky
people.”

“There’s a little more-rapid thinking, (rapid) speech, a decreased
need for sleep” in someone with mania, he said.

“When it becomes a condition is when it affects functioning,” Townsend said.

“It’s wonderful that the judge is willing to be an advocate for
bipolar disorder” awareness, Townsend said, referring to Downing.

“It’s very common, and people with it can be very productive members
of our society. It’s all around us,” he said.

Downing’s symptoms brought along misunderstandings among friends and
family members and conflicting ideas on the cause and solution of the
situation, he and family members said
Downing said he refused to seek treatment.

Finally, at one point, his eldest daughter, Kathryne Hart, 27, after
consulting with a physician, sought to have her father committed to a
hospital. Hart’s efforts came after Downing threatened suicide if
there was any more talk about his going to see a doctor.

“She was very brave,” Downing said.

But Downing wasn’t at home as expected when sheriff’s deputies arrived
to bring him to the hospital.

Pam Downing, who supported Hart in the decision, had taken the
couple’s son, Wes Downing, then 24, to visit a relative in Missouri
and to get away from the stressful situation at that time. The
Downings also have another daughter, Kiera Downing, 26.

Shortly afterward, a group of Downing’s friends brought Downing to see
Blanche, who then admitted Downing into a psychiatric hospital, and
Downing began the recovery process, Kathryne Hart said.

Hart said that the threat of her father taking his life was something
she couldn’t ignore.

When she was in middle school, she said, two fellow students killed
themselves within a week of each other.

“I couldn’t take that chance,” she said. “I was going to do anything
to save him.”

The family said it took about a month after his hospitalization for
Downing to begin seeming like himself again and to understand what had
happened.

Downing said he has struggled with guilt over the debt he accrued
during the manic episode.

He’s taken heart, he said, from something he read in the book “Words
to Lift Your Spirit” by Dale Brown:

“When we do experience failure in our jobs or in our personal lives,
we must not shackle ourselves with guilt, because it can lead to the
silent suffocation of our spirit.”

Downing said that his speaking about his experience is a way to bring
something positive from it.

“He’s 100 percent better,” Hart said. “He’s completely back to normal.
He’s reconciled with all of us.”

“Something like this either tears a family apart or makes it
stronger,” Pam Downing said.

For them, the experience has made the family stronger, she said,
adding that they received a lot of support from the pastors of their
church, First Presbyterian.

Downing, who receives a pension for his years of public service,
served as a district judge for 15 years and as a 1st Circuit Court of
Appeal judge for 10 years.

Over the years, he also worked in various volunteer programs for
prison inmates, such as a Bible study and a program that prepared
inmates for getting jobs when they were released.

He also previously served on the boards of Cenikor, a treatment
community to help people end substance abuse, and the Baton Rouge
Marine Institute, now AMIkids Baton Rouge.

Looking back on the events of last summer, he said, “Twenty-five years
in public service and, then, at the end of my career, people are
going, ‘What’s happening? Something’s wrong.’”

Looking ahead to the future, Downing said, “I’ve been a positive
person most of my life. I can see light at the end of the tunnel.”

Bipolar disorder, classified as a mood disorder, affects about 5.7
million Americans or approximately 2.6 percent of the U.S. population.

The disorder, which affects men and women equally, involves periods of
mania — elevated or irritable mood — alternating with periods of
depression. There are two types. Bipolar disorder type I involves
periods of major depression and was formerly called manic depression.
Bipolar disorder type II involves hypomania, with symptoms that aren’t
as extreme as the symptoms of mania.

In most people with bipolar disorder, there is no clear cause.

The following, though, may trigger a manic episode in people
vulnerable to the illness:

Life changes such as childbirth.
Medication such as antidepressants and steroids.
Periods of sleeplessness.
Recreational drug use.

Symptoms of the manic phase can last from days to months and include:

Agitation or irritation.
Inflated self-esteem.
Noticeably elevated mood.
Poor temper control.
Impaired judgment.
Spending sprees.

Medicines called mood stabilizers are the first line of treatment.
Antidepressant medications can be added to mood-stabilizing drugs.
Other medications used to treat bipolar disorder are anti-psychotic
drugs and anti-anxiety drugs.

Source: The National Institutes of Health

Capitol news bureau writer Michelle Millhollon contributed to this story.


Related Conditions

People with bipolar disorder can also experience:

People with bipolar disorder and psychotic symptoms can be wrongly diagnosed with schizophrenia. Bipolar disorder can be also misdiagnosed as Borderline Personality Disorder (BPD).

These other illnesses and misdiagnoses can make it hard to treat bipolar disorder. For example, the antidepressants used to treat OCD and the stimulants used to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode. If you have more than one condition (called co-occurring disorders), be sure to get a treatment plan that works for you.


Dealing with Bipolar Hypomania

I’ve written before about dealing with bipolar hypomania but I think one of the things to remember about hypomania is you might not be able to think logically enough to be able to take even simple advice. Try to remember this. Try to remember that you might not be thinking logically. Try to remember that the advice you thought was good when you were thinking clearly is probably the advice you should follow now, even if you don’t feel like it.

And the most important rule is this – do not encourage bipolar hypomania. To many people bipolar hypomania feels good, especially after a prolonged depression. So they want it and they encourage it by doing things they ought not do like drinking 25 energy drinks and staying up all night long.

But remember this: the higher you fly, the farther there is to fall and the bigger the crater you’ll make once you do. Everything has a price and the price of bipolar hypomania tends to be bone-crushing depression. And that’s something no one thinks feels good.

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About The Author

Natasha Tracy

Natasha Tracy is an award-winning writer, speaker, advocate and consultant from the Pacific Northwest. She has been living with bipolar disorder for 22 years and has written more than 1000 articles on the subject. Find more of Natasha’s work in her acclaimed book: "Lost Marbles: Insights into My Life with Depression & Bipolar" on Amazon.


What to Know About Hypomanic Episodes

Hypomania — periods of intense energetic, happy, or irritated moods — is a part of life for many people with bipolar disorder.

Hypomanic episodes are a type of mood episode in bipolar disorder. Depending on the type of bipolar disorder you have, mood episodes might include highs (mania or hypomania) and/or lows (depression).

Hypomania is a milder form of mania. Although hypomania has a less severe impact than mania, it can still be disruptive and come with its own set of challenges.

While mood episodes can significantly impact your life, the right treatments and coping methods can reduce their impact and improve your overall well-being.

An episode of hypomania is a period of at least 4 days in a row when you have lots of extra energy, and you may feel very happy — or very irritable — for most of the day.

Sometimes, you might enjoy the feelings that come with hypomania. At other times, you might feel like they’re uncomfortable or distressing.

Either way, you’ll typically be able to carry on with your usual daily activities. But, you might also end up making decisions or doing things you wouldn’t normally, and that might have harmful consequences.

A diagnosis of bipolar II disorder requires that you have at least one hypomanic episode, before or after a major depressive episode.

Some people with bipolar I disorder also have hypomania. Hypomania or similar symptoms might occur in seasonal affective disorder or schizoaffective disorder, as well.

During a hypomanic episode, you might feel happy, euphoric, excited, agitated, overly energized, or easily distracted.

These are significant changes to your typical mood and behavior, so people who know you may notice the difference in you.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an episode of hypomania involves at least 3 of the following behavior changes:

  • elevated self-esteem, high self-confidence, or feelings of grandiosity
  • less need for sleep, such as feeling rested after only 3 hours of sleep
  • feeling more talkative than usual or feeling a pressure to keep talking
  • racing thoughts or quickly-changing ideas
  • feeling easily distracted
  • doing many activities at once, such as work tasks, organizing social events, or seemingly purposeless movements
  • engaging in activities that may lead to harmful consequences, such as excessive spending, dangerous driving, or risky financial investments

By definition, the symptoms of hypomania aren’t severe enough to significantly affect your daily life or require hospitalization. If symptoms are severe, it’s more likely that it’s mania.

It is possible to have symptoms of hypomania from taking certain drugs, such as cocaine, or from psychiatric medications, like when starting a new course of antidepressants.

But your doctor likely won’t diagnose hypomania unless the symptoms continue beyond the effects of the drug being in your system.

To diagnose mania or hypomania, your doctor will also rule out other medical conditions that could cause similar symptoms — like hyperthyroidism or diabetes.

And finally, if you have repeated periods of hypomania and depression symptoms — but not enough to reach the criteria for a full episode, your doctor may diagnose cyclothymic disorder.

The symptoms of hypomania and mania are the same. The differences lie in how severe they are and the duration.

In hypomania, your symptoms aren’t severe enough to significantly disrupt your social or work life. They’re also not severe enough that you need hospital care.

There are also no features of psychosis in a hypomanic episode. For instance, you wouldn’t experience hallucinations or delusions, which can be present in a manic episode.

For diagnosing the two episodes, hypomania must last for at least 4 days in a row, while mania must occur for at least 1 week or any duration if hospitalization is required.

Just one episode of mania is enough for diagnosing bipolar I — even if you haven’t experienced an episode of depression.

And while the impacts of hypomania are less severe than those of mania, the DSM-5 states that bipolar II isn’t considered a “milder version” of bipolar I.

This is because the intense mood changes that come with untreated bipolar II usually lead to serious issues in social and work life, and episodes of depression may be longer and more severe.

Treatments for bipolar disorder aim to help you maintain stable moods and keep your symptoms managed. This usually involves a combo of medication and therapy.

Psychotherapy, aka talk therapy, can help you identify and change your troubling emotions, thoughts, and behaviors. Some therapy options for bipolar disorder can include:

Medications for bipolar disorder often include:

According to the National Institute of Mental Health, regular exercise can help reduce depression and anxiety symptoms, while promoting better sleep. Being able to get quality sleep can significantly boost your mental health.

Every person’s experience will be different, so of course your coping methods will be different, too.

But with some trial and error, you can find the best ways to cope with episodes of hypomania (and any other symptoms you have).

An important first step is to work out your personal triggers that you’re having or about to have a hypomanic episode. Knowing your triggers can help you feel empowered and more in control.

Tracking your moods — such as through apps or journals — can help you keep track of and notice changes to your moods. You can also check out the Depression and Bipolar Support Alliance (DBSA)’s free wellness tracker that you can print out and stick on your wall or keep in a folder.

You may also find it helpful to ask a loved one or two to let you know when they notice some signs, because you might not always be aware that it’s happening.

Here are some tips for preventing episodes of mania and hypomania:

  • When you notice your triggers, reach out. Accepting help from others takes practice, but if you think you’re about to experience a mood episode, it can really help to reach out to your treatment team, along with family and friends. Noticing your symptoms early and getting help can prevent an episode from worsening.
  • Avoid substance use. Alcohol and drug use can interfere with medications and your moods.
  • Be patient — with yourself and your treatment. Learning the best ways to cope and finding the right meds for you can take time. Be patient and gentle with yourself.
  • Take it one step at a time. Small steps can help things feel more manageable. Think: Setting up a sleep routine, talking with a friend for support, or reaching out to a doctor or therapist.
  • Join a support group. Not everyone you know will understand your symptoms or condition, and while you can try to explain it, joining a support group of like-minded people can be a breath of healing air.
  • Relieve your stress. Try using stress management techniques to relieve stress, which can exacerbate mood symptoms. Try a new exercise or a daily walk, meditation, or deep breathing.
  • Set up a crisis plan. By putting together an emergency action plan, you can get the help you need — fast. Put together a list of resources and people you can call in a moment of crisis.
  • Aim for better sleep. Sleep is often found lacking in people with bipolar disorder, and less sleep can mean more stress. So aim for good sleep hygiene. Sleep at the same time every night and maintain good sleep habits like avoiding screens an hour before bed.

Even if you feel good during a hypomanic episode, it’s important to stick with your treatment plan. In the long term, treatments help stabilize your mood and ultimately reduce the impact of depressive episodes, too.

For more support with managing bipolar disorder, check out the DBSA and International Bipolar Foundation.


Mania and Hypersexuality

Hypersexuality is one of the behaviors that may manifest as a symptom of mania.   It is defined as the increased need for sexual gratification, characterized by lowered inhibitions and/or the desire for forbidden sex.

It is not unusual for people to experience a heightened sense of sexuality during a manic episode. In and of itself, this is not a problem. It is when it is paired with impulsivity, risk-taking, poor judgment, and expansiveness—all features of bipolar mania—that hypersexuality can be destructive.

When the pursuit of sex becomes compulsive, it may even be classified as a sex addiction.   While the classification is still considered controversial, a person is said to have an addiction when he or she spends inordinate amounts of time in sexual-related activity to the point where important social, occupational, or recreational activities are neglected.

Characteristics of sex addiction may include:

  • Anonymous sex with multiple partners
  • Compulsive masturbation
  • Compulsive sex with sex workers
  • Frequent patronizing of sexually-oriented establishments
  • Habitual exhibitionism
  • Habitual voyeurism
  • Inappropriate sexual touching
  • Multiple affairs outside a committed relationship

While hypersexuality and sex addiction are not inherent facets of bipolar mania, it is important to recognize the signs.

Not only might these behaviors hurt otherwise stable relationships, but they can also place the individual at increased risk of sexually transmitted infections and other harms. As such, finding the right combination of medications to control mania is considered essential to keeping hypersexuality from becoming destructive.


Dealing with Bipolar Hypomania

I’ve written before about dealing with bipolar hypomania but I think one of the things to remember about hypomania is you might not be able to think logically enough to be able to take even simple advice. Try to remember this. Try to remember that you might not be thinking logically. Try to remember that the advice you thought was good when you were thinking clearly is probably the advice you should follow now, even if you don’t feel like it.

And the most important rule is this – do not encourage bipolar hypomania. To many people bipolar hypomania feels good, especially after a prolonged depression. So they want it and they encourage it by doing things they ought not do like drinking 25 energy drinks and staying up all night long.

But remember this: the higher you fly, the farther there is to fall and the bigger the crater you’ll make once you do. Everything has a price and the price of bipolar hypomania tends to be bone-crushing depression. And that’s something no one thinks feels good.

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About The Author

Natasha Tracy

Natasha Tracy is an award-winning writer, speaker, advocate and consultant from the Pacific Northwest. She has been living with bipolar disorder for 22 years and has written more than 1000 articles on the subject. Find more of Natasha’s work in her acclaimed book: "Lost Marbles: Insights into My Life with Depression & Bipolar" on Amazon.


Psychology

2 areas they work
-presynaptic cleft in periphary:

-CNS depression, bradycardia, hypotension, respiratory depression, miosis, rebound hyper tension with abrupt cessation

more common in males
symptoms starts in early development:

A)restricted repetitive behavior patters
--receptive motor movements
--insists on sameness
--preoccupied with objects (bear)

B)defects in social skills in multiple setting

C) increased head circumference

korsakoff - permanent neurologic condition
-loss of mammory bodies

will get:
confabulation
apathy (lack of interest or concern)
personality changes
amnesia - anter (more common) and retro

-waxing/waning (consciousness)
-reversible

-loss of focus/attention
-disorganized thought
-hallusinations (visual)
-sleep issues (up at night, sleeping during day)

-causes:
alzheimers - #1
stroke #1
lewy body dementia

-occurs in medical and physchiatric disorders
--delirium / schizophrenia

delusions (expressed via speech / words)

disorganized thoughts (expressed via speech paterns)

persecutory - someonse is after me

grandios - i am a millionare

ergomaniac - brad pitt loves me

thought blocking (sudden stop of talking)

loosening assocation (discusion doesnt follow each other)

clanging - words that rhyrm but make no sense

visual (associated with delearium)
auditory (schizophrenia)
smell (aura in tempal lobe epilepsy)

1) recurrent episodes of psychosis
-auditory hallucinations
-delusions - fixed false beliefes

2)cognitive dysfunction
-difficulty with information, attention ETC
-disorganized thoughts
--tangental speech (changes topics frequently)
--circumstanial speech (long round about answers)

-no other abnormal behavior
--no halulucinations, disorganized thoughts, negative symptoms

-gets delusion involving the baby

-associated with trauma
--stress or actual trauma

-two or more distinct identities
--gaps in memory about events when being the other person


Substance Abuse and Bipolar Disorder

According to the most recent literature on substance abuse and bipolar disorder, these two problems occur together so frequently that all young people with a bipolar diagnosis should also be assessed for drug and alcohol problems. Those who experience mixed states or rapid cycling have the highest rate of danger from substance abuse &mdash the discomfort a person feels in these chaotic moods is so great that she may be willing to do or take almost anything to make it stop.

Some drugs, including marijuana, downers, alcohol, and opiates, seem to temporarily blunt the effects of mood swings, only to cause ill effects later. Others can actively exacerbate manic depression. Speed (methamphetamine, crank, crystal) and cocaine are two that have sent many abusers into mania, often followed quickly by deep depression and psychotic symptoms. Hallucinogens, including LSD and PCP, can set off psychotic symptoms as well. These drugs are not a good idea for any child or teenager, but their effects on young people with bipolar disorders can be even worse.

As with suicide, accidents, and SIB, the best approach to substance abuse is prevention. First, take a look at your own example: if you find that drugs or alcohol have become important coping strategies for you, seek immediate treatment. Talk to your child about responsible use of alcohol, for example, a glass of wine with a special meal, or a cold beer on a hot day at the ball game. Point out examples of inappropriate or excessive use, from street alcoholics to news stories about young people in trouble due to drug use or drunken driving. You really don&rsquot have to preach, just provide a good example and accurate information to counteract the messages your child will receive from ads, pop culture, and peers.

When a person first begins to try drugs or alcohol, there&rsquos still time to stop without involving a detox center or other strong measures. She needs to think about why she has chosen to try alcohol or drugs, such as feeling self-conscious in social situations or inability to handle peer pressure other activities that might have the same positive effects, such as improving her social skills and ways to avoid temptation, including choosing a different peer group or steering her friends toward something other than bong hits and beer bashes. These are issues that can be discussed with a parent or a counselor.

Most teens will attend a wild party or two, out of curiosity or boredom if nothing else. You may be able to prevent them from coming to harm even when they&rsquove made a bad choice. Many families have drawn up a contract with their children, promising that they will retrieve them from a dangerous situation at any hour, with no lecture to follow. Let them know that while they may make some poor judgment calls, you&rsquore available to come to their rescue.

You may also need to actively help kids whose peers are fixated on drinking and drugs to find other ways to spend their time. This negative aspect of youth culture isn&rsquot just a big-city phenomenon by the way&ndashsmall towns and rural areas, with their lack of activities and places to go, can have extraordinarily high rates of drinking and drug use among teens. The drug and alcohol problems of suburban youth are often covered up, but they&rsquore there in force, spurred by lack of supervision after school, access to cash, and easy mobility.

When substance abuse progresses in frequency or seriousness, or when highly dangerous drugs are involved, early intervention is essential. Experts in treating children and teenagers with a dual diagnosis of bipolar disorder and substance abuse or bipolar disorder and substance dependency say success depends on appropriate medication education about their psychiatric condition, psychiatric medications, and the dangers of drug and alcohol abuse and close monitoring. Lithium has proven to greatly reduce or eliminate substance abuse in as many as 75 percent of dual-diagnosis youth with a bipolar disorder. It can be assumed that when other types of mood stabilizers are tested, they will show at least some positive effect on substance abuse as well. Twelve-step programs such as AA are important for reaching and maintaining recovery.

Although some sources recommend treating the substance abuse first, mostly because drugs and alcohol can have severe interactions with the medication used to treat manic depression, both really need to be addressed at once. Obviously, a person who is not sober is unable to adhere to the lifestyle changes, medication regime, and therapy appointments needed to hold back mood swings. At the same time, most bipolar substance abusers drink or use drugs partly to self-medicate their symptoms, and they may misuse their prescription medications as well.

Drug treatment programs, including inpatient detox centers, are beginning to be more knowledgeable about working with bipolar patients. If your child will be going to a drug treatment program, make sure that its clinical staff is fully aware of the implications of his illness, and that appropriate medication management and psychiatric expertise will be available.

Most detox centers say that about a month is needed to break a true addiction&rsquos physical grasp, and it takes a year of sobriety before an addict can honestly feel mentally comfortable without his substance of abuse. Relapses are common until several years of sobriety have been achieved, and can present severe dangers, including suicide. The earlier a drug or alcohol user seeks effective treatment, however, the more likely he is to achieve complete freedom from substance abuse without progressing to substance dependency.

Many addicts use self-help resources like Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or Rational Recovery to get and stay sober. In these programs, people attend regular meetings to talk about their addiction problems and offer each other support. Former substance abusers who have gotten clean act as mentors to newcomers. Generally speaking, these 12-step programs are an excellent resource for drug and alcohol users in recovery. There are special groups for teens, although many experts recommend teens attend mixed-age groups. Participants in 12-step programs are paired with sponsors who can help them deal with temptation, social pressure, old behavior patterns, and the stress of meeting new expectations.

There are also adjunct groups for the families of addicts. Family support groups can really help you make it through this difficult period. You&rsquoll learn many strategies for helping your child on the road to recovery. Families Anonymous is one with many local chapters.

The only down side of 12-step programs is that a few former addicts are against using prescription medications for brain disorders, seeing them as simply a legal substitute for street drugs or alcohol. This is not an official policy of AA or NA, by the way. To make sure a particular 12-step group doesn&rsquot have this orientation, talk to one of the group&rsquos long-term members or to its institutional sponsor, if any.


Mania and Hypersexuality

Hypersexuality is one of the behaviors that may manifest as a symptom of mania.   It is defined as the increased need for sexual gratification, characterized by lowered inhibitions and/or the desire for forbidden sex.

It is not unusual for people to experience a heightened sense of sexuality during a manic episode. In and of itself, this is not a problem. It is when it is paired with impulsivity, risk-taking, poor judgment, and expansiveness—all features of bipolar mania—that hypersexuality can be destructive.

When the pursuit of sex becomes compulsive, it may even be classified as a sex addiction.   While the classification is still considered controversial, a person is said to have an addiction when he or she spends inordinate amounts of time in sexual-related activity to the point where important social, occupational, or recreational activities are neglected.

Characteristics of sex addiction may include:

  • Anonymous sex with multiple partners
  • Compulsive masturbation
  • Compulsive sex with sex workers
  • Frequent patronizing of sexually-oriented establishments
  • Habitual exhibitionism
  • Habitual voyeurism
  • Inappropriate sexual touching
  • Multiple affairs outside a committed relationship

While hypersexuality and sex addiction are not inherent facets of bipolar mania, it is important to recognize the signs.

Not only might these behaviors hurt otherwise stable relationships, but they can also place the individual at increased risk of sexually transmitted infections and other harms. As such, finding the right combination of medications to control mania is considered essential to keeping hypersexuality from becoming destructive.


LEXAPRO: Judge Experiences Antidepressant-Induced Hypomania

A doctor who is telling the truth about the hypomanic episode this
judge experienced from his antidepressant. How refreshing that
the patient is getting the truth rather than being told he had an
“underlying” Bipolar Disorder that was manifest by his antidepressant
use. Why can’t other doctors be as honest and come right out and
tell the patient that their Bipolar symptoms have been brought on by
their antidepressant?

BUT when a patient experiences mania or hypomania from an
antidepressant, it is ABSOLUTELY INSANE to think they will not
experience it again on a different antidepressant! He and his family
had better hold their breaths!

What a shame when this happened that he did not have a copy of my DVD,
“Bipolar, Shmypolar! Are You Really Bipolar or Misdiagnosed Due to the
Use of or Abrupt Discontinuation of an Antidepressant?” If he had, the
DVD would have served as a warning for him about this common reaction
to both antidepressant use and abrupt withdrawal from antidepressants.

Why are these “Bipolar” patients not told they are suffering
continuous mild seizure activity which is what Bipolar Disorder is – a
sleep/seizure disorder brought on by the drugs?! ANTI-depressants are
stimulants, stimulants over stimulate the brain producing seizures.
The one time of day we all are in seizure activity is during REM sleep
– the dream state. So antidepressants are basically chemically
inducing the dream state during wakefulness.

By the way, the names “Mania” and “Hypomania” should be changed to
“Shear Hell on Earth. ”

Ann Blake-Tracy, Executive Director
International Coalition for Drug Awareness
www.drugawareness.org & www.ssristories.drugawareness.org
Author: Prozac: Panacea or Pandora? – Our Serotonin
Nightmare – The Complete Truth of the Full Impact of
Antidepressants Upon Us & Our World & Help! I
Can’t Get Off My Antidepressant!

First, there was his heart stent surgery in the spring of 2009.

Following surgery, he found himself feeling depressed, a scenario
experienced by some heart patients, he later learned. The depression
was compounded by the death of a good friend, he said.

Next, came a period of his taking an antidepressant, Lexapro, that he
found helpful. But, he said, he stopped the medicine, on his own, too
quickly.

What happened next, he said, was later diagnosed as an episode of
hypomania, an expression of bipolar disorder. . .

Blanche [Downing’s physician], though, describes the episode as a case
of antidepressant-induced hypomania, attributing it to a second
antidepressant that Downing was later prescribed by another physician.

“Medications can commonly cause hypomania, and it’s not really
understood why,” said Dr. Mark Townsend, a professor of psychiatry at
the LSU Health Sciences Center in New Orleans.

Antidepressants can bring on hypomania, as can steroids, he said.

“There’s really not a diagnostic category for antidepressant-induced
hypomania” in the current Diagnostic and Statistical Manual of Mental
Disorders, Blanche said, but he predicted there will be one in the
manual’s next edition.

Former Judge Bob Downing explains episode that led to his resignation

By ELLYN COUVILLION
Advocate staff writer
Published: Mar 13, 2011 – Page: 1D

Bob Downing, former 1st Circuit Court of Appeal judge, whose sudden
resignation from the bench last summer was surrounded by confusion,
can sort out the events on a kind of timeline.

First, there was his heart stent surgery in the spring of 2009.

Following surgery, he found himself feeling depressed, a scenario
experienced by some heart patients, he later learned. The depression
was compounded by the death of a good friend, he said.

Next, came a period of his taking an antidepressant, Lexapro, that he
found helpful. But, he said, he stopped the medicine, on his own, too
quickly.

What happened next, he said, was later diagnosed as an episode of
hypomania, an expression of bipolar disorder.

During the episode that lasted approximately three months, Downing
spent money wildly, alienated family, friends and employees and
resigned from the judicial bench, about the time he was hospitalized
and treated.

“It was a short period. It seemed like an eternity,” Downing, 61, said
recently from an office at the law firm of Dué, Price, Guidry,
Piedrahita and Andrews, where he’s working in an “of counsel” status.

In that capacity, Downing said that attorneys with the firm will work
with him on cases he brings in, but he is not on salary at the firm.
Downing handles personal injury cases.

Now being treated with medication for what was likely a one-time event
and back to feeling like himself, Downing said he recently decided to
speak out about his experience for several reasons.

“For people who have open heart surgery or stents, watch out for
depression,” Downing said.

One in five people experience an episode of depression after having
heart surgery, according to the website,http://www.psychcentral.com,
an independent mental health and psychology network run by mental
health professionals.

Downing also advises people taking antidepressants to stay in touch
with their doctor.

And, he said, “If you start feeling really wonderful and start
spending a lot of money, you need to see a counselor,” Downing said.

Hypomania is “a condition similar to mania but less severe,” according
to MedicineNet.com, a physician-produced online health-care publishing
company.

“The symptoms are similar, with elevated mood, increased activity,
decreased need for sleep, grandiosity, racing thoughts and the like,”
the company reports at its medical dictionary
website,http://www.medterms.com.

“It is important to diagnose hypomania, because, as an expression of
bipolar disorder, it can cycle into depression and carry an increased
risk of suicide,” the site reports.

Bipolar disorder is marked by periods of elevated or irritable mood —
the mania — alternating with depression, according to the National
Institutes of Health.

The mood swings between mania and depression can be very abrupt, it reports.

“Whether it’s hypomania or mania is a matter of severity,” said local
psychiatrist Dr. Robert Blanche, who is Downing’s physician.

“In general, it’s an elevated or an irritable mood that’s not normal
for the person,” Blanche said.

“In his (Downing’s) case, he was irritable and also, maybe the word is
‘expansive’ in his affects, (showing) euphoria, elation and
excitement,” Blanche said.

“He had never had a history of this before,” Blanche said.

Downing theorizes that his stopping his antidepressant too quickly, on
his own, led to the episode.

Blanche, though, describes the episode as a case of
antidepressant-induced hypomania, attributing it to a second
antidepressant that Downing was later prescribed by another physician.

“Medications can commonly cause hypomania, and it’s not really
understood why,” said Dr. Mark Townsend, a professor of psychiatry at
the LSU Health Sciences Center in New Orleans.

Antidepressants can bring on hypomania, as can steroids, he said.

“There’s really not a diagnostic category for antidepressant-induced
hypomania” in the current Diagnostic and Statistical Manual of Mental
Disorders, Blanche said, but he predicted there will be one in the
manual’s next edition.

Blanche said the only way to arrest the condition of hypomania is for
the person to go into the hospital so that their medications can be
adjusted.

During his own hospitalization, Downing was prescribed a mood
stabilizer, Depakote, classified as an anti-seizure medicine and the
medicine most commonly prescribed for mania by psychiatrists, Blanche
said.

The medicine acts to bind up what can be described as “excitatory”
chemicals in the brain, Blanche said.

Ultimately, though, that can result in a depletion of those chemicals
and a person can slide into a depression, Blanche said.

“If (a patient) is on a mood stabilizer, you can introduce an
antidepressant,” he said.

Downing said that his current antidepressant, Wellbutrin, is working
well for him.

After living through a hypomanic episode, some patients choose to stay
on the medicine, Blanche said.

“Some people will actually choose to stay on the medicine, just
because they don’t want it to ever happen again,” he said.

Fortunately, the condition “is one of the most treatable conditions in
psychiatry,” added Blanche, who serves as the psychiatrist at the East
Baton Rouge Parish jail and is the medical director of an emergency
psychiatric treatment center affiliated with the Earl K. Long Medical
Center.

Downing’s experiences this summer seem to have had all the markings of
manic episodes of bipolar disorder.

“Around the first of June 2010, I started feeling really good, started
talking a lot more, making big plans,” Downing said.

Around that time, he went to speak at a law conference in Carmel, Calif.

“I went to Yosemite, it was beautiful. I would wake up at 3 o’clock, 4
o’clock, 5 o’clock (thinking) ‘You need to retire, buy some foreclosed
properties, fix them up and make money to help people in India dig
wells,” Downing said.

“I was making grandiose plans,” he said.

Usually frugal, he started spending money, too, he said.

Before the episode was over, he had run up debts of almost $100,000,
buying such things as a 1971 Rolls Royce, three Harley-Davidson
motorcycles and a 1952 police car, he said.

He also bought a $1,000 commercial pressure washer, a large lawn
tractor and expensive new tools to help put a formerly homeless man
into business, he said.

“He just wasn’t himself,” said his wife, Pam Downing.

The couple will have been married 30 years on March 29.

“When the person is in that condition, you really can’t reason with
them,” Blanche said.

“The amazing thing about it is that it robs the person of their
insight,” he said.

In contrast, people are “painfully aware” of the other aspect of
bipolar disorder — depression, Blanche said.

Physicians and employers may miss a condition like hypomania, said
Townsend, because, like most people, “we like happy people, perky
people.”

“There’s a little more-rapid thinking, (rapid) speech, a decreased
need for sleep” in someone with mania, he said.

“When it becomes a condition is when it affects functioning,” Townsend said.

“It’s wonderful that the judge is willing to be an advocate for
bipolar disorder” awareness, Townsend said, referring to Downing.

“It’s very common, and people with it can be very productive members
of our society. It’s all around us,” he said.

Downing’s symptoms brought along misunderstandings among friends and
family members and conflicting ideas on the cause and solution of the
situation, he and family members said
Downing said he refused to seek treatment.

Finally, at one point, his eldest daughter, Kathryne Hart, 27, after
consulting with a physician, sought to have her father committed to a
hospital. Hart’s efforts came after Downing threatened suicide if
there was any more talk about his going to see a doctor.

“She was very brave,” Downing said.

But Downing wasn’t at home as expected when sheriff’s deputies arrived
to bring him to the hospital.

Pam Downing, who supported Hart in the decision, had taken the
couple’s son, Wes Downing, then 24, to visit a relative in Missouri
and to get away from the stressful situation at that time. The
Downings also have another daughter, Kiera Downing, 26.

Shortly afterward, a group of Downing’s friends brought Downing to see
Blanche, who then admitted Downing into a psychiatric hospital, and
Downing began the recovery process, Kathryne Hart said.

Hart said that the threat of her father taking his life was something
she couldn’t ignore.

When she was in middle school, she said, two fellow students killed
themselves within a week of each other.

“I couldn’t take that chance,” she said. “I was going to do anything
to save him.”

The family said it took about a month after his hospitalization for
Downing to begin seeming like himself again and to understand what had
happened.

Downing said he has struggled with guilt over the debt he accrued
during the manic episode.

He’s taken heart, he said, from something he read in the book “Words
to Lift Your Spirit” by Dale Brown:

“When we do experience failure in our jobs or in our personal lives,
we must not shackle ourselves with guilt, because it can lead to the
silent suffocation of our spirit.”

Downing said that his speaking about his experience is a way to bring
something positive from it.

“He’s 100 percent better,” Hart said. “He’s completely back to normal.
He’s reconciled with all of us.”

“Something like this either tears a family apart or makes it
stronger,” Pam Downing said.

For them, the experience has made the family stronger, she said,
adding that they received a lot of support from the pastors of their
church, First Presbyterian.

Downing, who receives a pension for his years of public service,
served as a district judge for 15 years and as a 1st Circuit Court of
Appeal judge for 10 years.

Over the years, he also worked in various volunteer programs for
prison inmates, such as a Bible study and a program that prepared
inmates for getting jobs when they were released.

He also previously served on the boards of Cenikor, a treatment
community to help people end substance abuse, and the Baton Rouge
Marine Institute, now AMIkids Baton Rouge.

Looking back on the events of last summer, he said, “Twenty-five years
in public service and, then, at the end of my career, people are
going, ‘What’s happening? Something’s wrong.’”

Looking ahead to the future, Downing said, “I’ve been a positive
person most of my life. I can see light at the end of the tunnel.”

Bipolar disorder, classified as a mood disorder, affects about 5.7
million Americans or approximately 2.6 percent of the U.S. population.

The disorder, which affects men and women equally, involves periods of
mania — elevated or irritable mood — alternating with periods of
depression. There are two types. Bipolar disorder type I involves
periods of major depression and was formerly called manic depression.
Bipolar disorder type II involves hypomania, with symptoms that aren’t
as extreme as the symptoms of mania.

In most people with bipolar disorder, there is no clear cause.

The following, though, may trigger a manic episode in people
vulnerable to the illness:

Life changes such as childbirth.
Medication such as antidepressants and steroids.
Periods of sleeplessness.
Recreational drug use.

Symptoms of the manic phase can last from days to months and include:

Agitation or irritation.
Inflated self-esteem.
Noticeably elevated mood.
Poor temper control.
Impaired judgment.
Spending sprees.

Medicines called mood stabilizers are the first line of treatment.
Antidepressant medications can be added to mood-stabilizing drugs.
Other medications used to treat bipolar disorder are anti-psychotic
drugs and anti-anxiety drugs.

Source: The National Institutes of Health

Capitol news bureau writer Michelle Millhollon contributed to this story.


Abstract

Objective

Evolutionary perspectives on bipolar disorders can further our understanding of the origins of these conditions, and assist clinicians in distinguishing normal from abnormal states. Hypomania is unique amongst bipolar conditions in that it seems to have beneficial aspects and can be difficult to diagnose, in contrast to full-blown mania and depression. A theoretical perspective regarding the evolution of hypomania as a defense mechanism is presented.

Method

Literature review focused on the fitness reducing aspects of depression and the fitness enhancing aspects of hypomania/mania.

Results

Of all the adversity inherent in depression, inhibition of physical and mental activity—depressive inhibition—has the most detrimental consequences, and throughout our evolution would have significantly reduced fitness. It is proposed that hypomania evolved as a depressive inhibition override defense mechanism, typically operating in a short-term time frame, to restore physical and mental activity to fitness sustaining or enhancing levels. Over-activity and not mood enhancement enabled hypomania to function as a defense mechanism against the fitness reducing state of depressive inhibition. Contributing to depressive inhibition are the Behavioral Activation System (BAS) and the Behavioral Inhibition System (BIS), two basic motivational systems. Depressive inhibition consists to some extent of low BAS and high BIS. As human intelligence evolved cognitions inhibiting BAS and activating BIS became amplified, resulting in intensified depressive inhibition.

Limitations

A theoretical perspective.

Conclusions

Given its ability to override depressive inhibition hypomania might be viewed as a natural treatment as opposed to a problem to treat, producing maximal improvement in areas where functioning has suffered the most while typically enhancing social behavior.


What to Know About Hypomanic Episodes

Hypomania — periods of intense energetic, happy, or irritated moods — is a part of life for many people with bipolar disorder.

Hypomanic episodes are a type of mood episode in bipolar disorder. Depending on the type of bipolar disorder you have, mood episodes might include highs (mania or hypomania) and/or lows (depression).

Hypomania is a milder form of mania. Although hypomania has a less severe impact than mania, it can still be disruptive and come with its own set of challenges.

While mood episodes can significantly impact your life, the right treatments and coping methods can reduce their impact and improve your overall well-being.

An episode of hypomania is a period of at least 4 days in a row when you have lots of extra energy, and you may feel very happy — or very irritable — for most of the day.

Sometimes, you might enjoy the feelings that come with hypomania. At other times, you might feel like they’re uncomfortable or distressing.

Either way, you’ll typically be able to carry on with your usual daily activities. But, you might also end up making decisions or doing things you wouldn’t normally, and that might have harmful consequences.

A diagnosis of bipolar II disorder requires that you have at least one hypomanic episode, before or after a major depressive episode.

Some people with bipolar I disorder also have hypomania. Hypomania or similar symptoms might occur in seasonal affective disorder or schizoaffective disorder, as well.

During a hypomanic episode, you might feel happy, euphoric, excited, agitated, overly energized, or easily distracted.

These are significant changes to your typical mood and behavior, so people who know you may notice the difference in you.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), an episode of hypomania involves at least 3 of the following behavior changes:

  • elevated self-esteem, high self-confidence, or feelings of grandiosity
  • less need for sleep, such as feeling rested after only 3 hours of sleep
  • feeling more talkative than usual or feeling a pressure to keep talking
  • racing thoughts or quickly-changing ideas
  • feeling easily distracted
  • doing many activities at once, such as work tasks, organizing social events, or seemingly purposeless movements
  • engaging in activities that may lead to harmful consequences, such as excessive spending, dangerous driving, or risky financial investments

By definition, the symptoms of hypomania aren’t severe enough to significantly affect your daily life or require hospitalization. If symptoms are severe, it’s more likely that it’s mania.

It is possible to have symptoms of hypomania from taking certain drugs, such as cocaine, or from psychiatric medications, like when starting a new course of antidepressants.

But your doctor likely won’t diagnose hypomania unless the symptoms continue beyond the effects of the drug being in your system.

To diagnose mania or hypomania, your doctor will also rule out other medical conditions that could cause similar symptoms — like hyperthyroidism or diabetes.

And finally, if you have repeated periods of hypomania and depression symptoms — but not enough to reach the criteria for a full episode, your doctor may diagnose cyclothymic disorder.

The symptoms of hypomania and mania are the same. The differences lie in how severe they are and the duration.

In hypomania, your symptoms aren’t severe enough to significantly disrupt your social or work life. They’re also not severe enough that you need hospital care.

There are also no features of psychosis in a hypomanic episode. For instance, you wouldn’t experience hallucinations or delusions, which can be present in a manic episode.

For diagnosing the two episodes, hypomania must last for at least 4 days in a row, while mania must occur for at least 1 week or any duration if hospitalization is required.

Just one episode of mania is enough for diagnosing bipolar I — even if you haven’t experienced an episode of depression.

And while the impacts of hypomania are less severe than those of mania, the DSM-5 states that bipolar II isn’t considered a “milder version” of bipolar I.

This is because the intense mood changes that come with untreated bipolar II usually lead to serious issues in social and work life, and episodes of depression may be longer and more severe.

Treatments for bipolar disorder aim to help you maintain stable moods and keep your symptoms managed. This usually involves a combo of medication and therapy.

Psychotherapy, aka talk therapy, can help you identify and change your troubling emotions, thoughts, and behaviors. Some therapy options for bipolar disorder can include:

Medications for bipolar disorder often include:

According to the National Institute of Mental Health, regular exercise can help reduce depression and anxiety symptoms, while promoting better sleep. Being able to get quality sleep can significantly boost your mental health.

Every person’s experience will be different, so of course your coping methods will be different, too.

But with some trial and error, you can find the best ways to cope with episodes of hypomania (and any other symptoms you have).

An important first step is to work out your personal triggers that you’re having or about to have a hypomanic episode. Knowing your triggers can help you feel empowered and more in control.

Tracking your moods — such as through apps or journals — can help you keep track of and notice changes to your moods. You can also check out the Depression and Bipolar Support Alliance (DBSA)’s free wellness tracker that you can print out and stick on your wall or keep in a folder.

You may also find it helpful to ask a loved one or two to let you know when they notice some signs, because you might not always be aware that it’s happening.

Here are some tips for preventing episodes of mania and hypomania:

  • When you notice your triggers, reach out. Accepting help from others takes practice, but if you think you’re about to experience a mood episode, it can really help to reach out to your treatment team, along with family and friends. Noticing your symptoms early and getting help can prevent an episode from worsening.
  • Avoid substance use. Alcohol and drug use can interfere with medications and your moods.
  • Be patient — with yourself and your treatment. Learning the best ways to cope and finding the right meds for you can take time. Be patient and gentle with yourself.
  • Take it one step at a time. Small steps can help things feel more manageable. Think: Setting up a sleep routine, talking with a friend for support, or reaching out to a doctor or therapist.
  • Join a support group. Not everyone you know will understand your symptoms or condition, and while you can try to explain it, joining a support group of like-minded people can be a breath of healing air.
  • Relieve your stress. Try using stress management techniques to relieve stress, which can exacerbate mood symptoms. Try a new exercise or a daily walk, meditation, or deep breathing.
  • Set up a crisis plan. By putting together an emergency action plan, you can get the help you need — fast. Put together a list of resources and people you can call in a moment of crisis.
  • Aim for better sleep. Sleep is often found lacking in people with bipolar disorder, and less sleep can mean more stress. So aim for good sleep hygiene. Sleep at the same time every night and maintain good sleep habits like avoiding screens an hour before bed.

Even if you feel good during a hypomanic episode, it’s important to stick with your treatment plan. In the long term, treatments help stabilize your mood and ultimately reduce the impact of depressive episodes, too.

For more support with managing bipolar disorder, check out the DBSA and International Bipolar Foundation.


Is It Mania?

Some people with bipolar disorder become psychotic when manic or depressed -- for example, hearing things that aren't there. They may hold onto false beliefs, too. In some instances, they see themselves as having superhuman skills and powers -- even considering themselves to be god-like. If you have psychotic symptoms then it's mania, not hypomania.

Keep in mind that you may not notice these things in yourself. It might be a friend or family member who notices the patterns. If symptoms last for a week or more and cause problems in your life, it may be mania.

Sources

National Institute for Mental Health: “Bipolar Disorder.”

Massachusetts General Hospital Bipolar Clinic & Research Program: “Understanding bipolar disorder: Frequently asked questions.”

American Psychiatric Association: "Practice Guideline for the Treatment of Patients With Bipolar Disorder."


Related Conditions

People with bipolar disorder can also experience:

People with bipolar disorder and psychotic symptoms can be wrongly diagnosed with schizophrenia. Bipolar disorder can be also misdiagnosed as Borderline Personality Disorder (BPD).

These other illnesses and misdiagnoses can make it hard to treat bipolar disorder. For example, the antidepressants used to treat OCD and the stimulants used to treat ADHD may worsen symptoms of bipolar disorder and may even trigger a manic episode. If you have more than one condition (called co-occurring disorders), be sure to get a treatment plan that works for you.