Manic episode in Major Depression?

March 10, 2013 3:38 AM

I have major depression, and am wondering if anyone can explain to me what a manic episode feels like (for someone who might be bipolar but is being treated for depression). I know that no one here can give me any definitive advice (YANMPsych.) but I'm just wondering if I should be curious or if anyone has any experience with this.

I was diagnosed with major recurrent depression in 2008 and have been taking medication for the past five years. I have not been good on keeping up with the therapy aspect as I have been trying to manage my moods on my own with some CBT techniques. I know I should address this, but before I do I just was curious if anyone knows about the delineation between major and bipolar depression or has experience with someone who might have had depression and then later realized they might be bipolar.

I ask because I recently have noticed (over the past month or so) that my mood has altered to the point where I feel hypersocial, and needing to be in constant communication, extremely talkative and hyperactive at socializing or on the internet (on gchat, usually) but have not been able to focus on more productive behavior on a day to day basis. However this mood pattern/lapse is not in alignment with what a typical "weird mood" episode would be for me, which would be just lying in bed all day (a depressive episode). However, I still feel imbalanced but feel the need to constantly be active, socially, or on the internet, or going out. I have also noticed an extremely increased libido and desire to look at porn, or engage in erotic fantasy or reading, etc. (and thus more spent in these activities rather than schoolwork, for example) and some riskier sexual behavior that is really new for me and that I am not sure I am actually comfortable with. I know I should speak with a professional, and I will, but I am just feeling a little confused and I am just wondering if anyone has any knowledge of what a manic episode "feels like" or how it might manifest itself, and if this is something I should actually be curious about, if people ever suddenly "switch" from having unipolar to bipolar depression??

posted by bengalibelle to health & fitness (26 answers total)

I have been depressed 99% of my life and over decades have only had a handful of manic episodes; in fact I didn't even realize I was bipolar and had only clearly identified the more common depressive symptoms until a couple of years ago when I had a super-intense long-lasting manic episode during which I lost a hundred pounds and had what I'd probably have called a religious experience if I weren't an atheist, with intense, racing, grandiose thoughts and musings.

This helped me to then identify a couple of earlier, less intense episodes in past years, although a medical professional I was working with said that it's entirely possible for a person with bipolar disorder to experience only a single manic episode during their entire life. (And this is in my mid-thirties when I've got many aspects of my life squared away, so you have my sympathies to be going through this while you're still in school.)

The symptoms for me match up with what you've described: a massively increased libido resulting in reckless sexual activity completely uncharacteristic for me, a constant buoyant and cheerful mood when I'm normally depressed and discouraged most of the time, much more enthusiasm for socializing than I normally exhibit, hyperactivity and boundless energy (which made it practically effortless to start working out during every spare moment in the day and consequently lose a hundred pounds in less than half a year.)

I found the NIMH guide to bipolar disorder enlightening. I'd say definitely get with a medical professional, with that help start experimenting with mood stabilizer medications to find one that works for you with acceptable side effects, and pull the reins back on doing anything that seems obviously stupid. I came pretty close to making some catastrophically bad decisions during that most severe episode and took the measure of getting in touch with an old and trusted friend who took the time to speak with me often and serve as a sounding board for things so I could better gauge how out of whack my thinking was.
posted by XMLicious at 4:13 AM on March 10 [2 favorites]

I have some history with this.

There is a condition called hypomanic. Dialed down from manic; you feel really really really good, you are sharper than sharp, you are very very very productive-in fact, if it wasn't part of a cycle with a dip, it wouldn't be a bad mode to live your life in. You don't have quite the errors in judgement that a manic person would, but you do talk much more than normally, and your friends can pick up on the difference.

My recommendation, as someone who has been there, is talk this over with your prescribing doc quick. If you do have a condition called bipolar type two, being on antidepressents by themselves is contraindicated, and can even trigger you INTO the condition if you are predisposed. The good news is, if this is the case there are real good meds out there for precisely this.
posted by St. Alia of the Bunnies at 6:14 AM on March 10 [3 favorites]

What you describe constitutes a crisis, based on my experience, which demands immediate intervention from a doctor who understands mood disorders.

Longer answer, which I'd rather you not read until after you've set an appointment (please be sure to use the words "escalating into mania" with the person setting that appointment.)

What St. Alia and XMLicious said.

I have yet to meet someone who got bipolar as their true initial diagnosis, though I suppose they must be out there someplace. The average amount of time it takes, between first diagnosis of [whatever] and correct professional recognition of bipolar disorder, is 10 years (that average is what they've found in actual studies, not just from people I know.)

My diagnosis was officially major depression for only four years, but when I was 19, doctors who listened to my life history all agreed that I'd been depressed since elementary school.

When I was 20, my diagnosis was changed to bipolar type II, and the doctors (who realized they needed to ask two or three extra questions) suddenly realized that I'd been having classic hypomanic symptoms for most of that time (and that I had a bunch of other problems, actually.)

Most people with Bipolar Type II diagnoses start with Major Depression as the diagnosis; the studies seem to indicate that BP2 people spend the vast majority of their time depressed - far more time than BP1 people do, interestingly. Part of the reason for this is that people with BP2 typically feel bad enough to see a doctor when they're depressed; they don't think of their (relatively milder, earlier in the disease) manic symptoms as a "problem."

One of the biggest risks those of us with bipolar disorder face is that the disorder changes over time, often in response to medications used, but also just with age and the number and severity of previous episodes. There are people who have a diagnosis of BP2 (with hypomanic symptoms) but whose symptoms in later "up" and "mixed" episodes warrant a switch to Schizoaffective, Bipolar type, or BP1.

Oh... and you've already smashed through one of the official "manic" (vs. hypomanic) criteria, for length of episode. If you have any psychotic (hallucinations, delusions, etc.) symptoms, you're automatically "promoted" to BP1 for life.

Which is why I think you need to see a doctor this week.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 7:28 AM on March 10 [8 favorites]

You probably want to get to a doc while your judgment is still basically sound. Also, don't forget to sleep.
posted by flabdablet at 8:03 AM on March 10 [2 favorites]

Yes please see your doctor right away. I have bipolar and what you are describing sounds like mania to me. Anti-depressants can make mania worse, so you may need a change in your treatment. This can escalate, so please see your doctor as quickly as possible.
posted by veerat at 8:04 AM on March 10

I would schedule an appointment with a therapist, psychiatrist, or primary care doctor ASAP - with whoever can see you first.

I'm not a doctor and I certainly can't diagnose you, but your symptoms sound similar enough to mania or hypomania that I am concerned. People having manic episodes very frequently do things they later deeply regret.
posted by insectosaurus at 8:19 AM on March 10

See a doctor. We can't really diagnose you over the internet not seeing you personally and knowing what your baseline is. You could just be feeling non-depressed and not realize that "hey this is what 'normal' feels like", or you could be in hypomania. It's not our place to say. Only someone who has interacted with you for any length of time (hopefully your psychiatrist) can give you any real insight.
posted by patheral at 8:39 AM on March 10 [1 favorite]

I started out with just feeling good. Then my days started to be really good followed by everyday feeling incredible while I rode a wave of euphoria. My senses were alive and everything is more; more to feel and touch, more to taste. That the filter which makes life a little dull, like a dirty window, is gone. My confidence levels sky rocketed and me (all my insecurities) stopped getting in the way of me and what I wanted. I was far more social, and there was an ease to being social that wasn't my normal. I was even more sexual, if that is possible. I wouldn't say you necessarily do more, but you have the desire to because of all the creative thinking you're engaged in. At the height of it I wanted to get lost in a sea of emotions not my own, but along with this incredible high was irritability and constant anxiety that I couldn't bear. I felt like there was a force pushing me from behind, like a bully shoving me, into having a panic attack. By that time it stopped being fun.

I've been dealing with major depression for aeons and have never, I thought, had symptoms of hypomania until I took an antidepressant. I know it feels incredibly good, but see a doctor soon.
posted by redindiaink at 9:41 AM on March 10

Hi everyone,

Thanks for your feedback. Actually my mood in terms of valence has not been good. I feel hypersocial but also extremely fearful, guilty for not being productive, and extreme anxiety toward intimacy because I'm afraid to admit that my depression hasn't improved the way everyone thinks it should because I've been taking medication. I've felt that underlying guilt basically since I've started taking the medication. Anyway Here's the problem...my psychiatrist situation is tricky. I had kaiser permanente insurance under my dad and my psychiatrist I saw under KP was just not really an ideal kind of relationship for monitoring moods. I would see him every six months for fifteen minutes and KP stopped offering individual psychotherapy which is part of why I stopped. So now because I have started school in NY (where kaiser basically is meaningless) we have switched to blue cross blue shield so now I have to start all. Over again with a new psychiatrist and this is causing me some anxiety because my father is very resistant to me being on medication at all and basically thinks my depression is kind of just a result of my not being married or something, anyway, I am afraid to start the process all over again of diagnosing esp bc I dont have someone professional who has known me to see if my behavior really is atypical for me, so it's almost like I'll have to make my own case for something and that makes me feel like I am being manipulative or something or going in there with a preconceived notion of what I have, and all with a newpsychiatrist. I just don't know if I trust the diagnostic process that is entailed.Anyway...I guess I just need to bite the bullet and call. Thanks everyone very very much appreciated.
posted by bengalibelle at 10:01 AM on March 10

I have not experienced mania, but a close loved one recently did. What you are describing is very similar to how my loved one's mania started.

Before my loved one's mania, I had known about bipolar disorder through reading about it. I understood the main symptoms (the sorts of things you describe). So, when my loved one was in a state similar to what you describe, I thought, "So, this is mania. It's annoying and disturbing, but he'll be okay."

Ha. Ha. ha. ha.

The reason why everyone is saying to get to a doctor quick is because mania is WAY. WORSE. than what you're experiencing. Bipolar is often discussed in the same context as schizophrenia. Mania can involve psychotic breaks. At one point, my loved one accused me of reading his thoughts and (as far as I can tell) thought he could predict and control the future. The reason why I have to say "as far as I can tell" is because, at the same time, he was so incoherent he could barely string words into sentences.

And that? The psychotic break? That was not the worst part of the manic episode. It got even worse.

It was like my loved one's brain was on fire. That's how I think of it: an uncontrollable electrical fire in the brain. And it was all-consuming. At its height, it had burnt my loved one's personality, his personhood, his very soul into nothingness. It consumed everything he was. It made him into a raging, inchoate mass of screaming and sobbing. He was involuntarily hospitalized because he kept punching himself in the face.

The reason why it was so bad is because it was his first manic episode. He didn't understand how bad it could be. And I, and his other friends, didn't understand, either. The first manic episode is usually the worst because one isn't yet familiar with it, doesn't know what is going on, and doesn't know what treatment to get. If my friend had gone to a hospital a week before he did, he would have been so, so much better off.

I say all this to underline the point others have made: you need to see a doctor, and you need to do so soon. We can't tell you if you are hypomanic. But what you're describing seriously makes warning bells go off for me. Now is the time to take your condition seriously and to seek medical advice. Do it now, so hopefully you can avoid the literal horror that is a bad manic episode.
posted by meese at 10:03 AM on March 10 [4 favorites]

I've had mania like you describe (talkative, hypersexual), but unfortunately, I also go through a version where I am extremely HULK SMASH irritated at everything to an irrational level, almost like someone injected me with a particularly annoying strain of adrenaline. I'm talking both frustration with anything anyone says or does combined with a physical discomfort, like all my nerve endings are tired of your shit as well.

I was relieved to find out this was another version of mania, as I thought I was just a bitch. But getting on the right medication has mostly stopped those episodes.
posted by Lectrolamb at 10:18 AM on March 10 [5 favorites]

Inspired by this question, I'm wondering if my 30 year diagnosis of major depressive disorder is incorrect. Not often, but sometimes, I get hyperactive episodes where I talk fast, and feel almost high. I have a quarterly appointment this week and will discuss with my newest doctor. I'm on a mix of antidepressants and anti-anxiety medication.

Are there any books out there that have realistic portrayals of people with bipolar 2? Is this a common misdiagnosis? I'm open to anything if it means feeling consistently betters
posted by Draccy at 10:28 AM on March 10 [2 favorites]

bengalibelle, I know it is complicated to find a new psychiatrist, but it is very important that you do this ASAP. All best to you. MeMail if you want to vent, or if you want encouragement.
posted by Sidhedevil at 10:33 AM on March 10

Also, print out what you wrote-heck, print out what WE wrote-and take it with you.

But call soon. In some areas it is difficult to get in to see a pdoc quickly, and you might have to wait a few weeks. Till then, do you have a trusted friend to kinda keep tabs on you?

One more thing. Be very very vigilant with your sleep hygeine. Try to go to bed and get up at the same time, and make sure to get enough sleep. I cannot stress how important this is. Even if you have to lay in the bed wide awake in the dark.

That, and if you are feeling up, don't go out in the sun a whole lot unless you have good sunshades. (Like my former doc said, not cheap ones.)

I don't personally think you have to freak out, yet, but I am not a doc. I do think you should call tomorrow, period, simply for the reasons I mentioned.

And if your dad wants to be problematic, tell him I am willing to pm you my private number and he can talk to me while I explain why it is super important for the rest of your life for you to take this seriously. I'm a 54 year old middleaged woman whose life would have been quite a bit different had I been treated correctly when I was your age. The state of the art is much better now.
posted by St. Alia of the Bunnies at 11:48 AM on March 10 [1 favorite]

If you're a student, call the student health center at your school. They almost certainly have some kind of mental health service. (It might be kind of limited. Where I was an undergrad, almost everything requiring medication led to them referring you elsewhere, but if you phoned up and said "I've previously been diagnosed with depression and I think I'm experiencing mania." they'd be able to do something.)
posted by hoyland at 11:57 AM on March 10

Thank you everyone. I called the school urgent health advice line and they recommended I see someone within 24 hours, so I will schedule an appointment (they're usually pretty easy to schedule same-day at my health center) tomorrow morning and also will try to schedule with a new psychiatrist via Blue cross blue shield. I think once I make the decision to call and schedule the appointment my anxiety about this will alleviate and hopefully the mood will seem a little more manageable until I see the doctor. Now the more I think about it and have read, the more I can recognize more hypo-manic types of situations in the past and I also know for a fact that I have intermittently been abusing alcohol as a means of dealing with things, to the point of it having ruined potential relationships and strained my friendships because of my unpredictable behavior and moods. So yeah, this is something that I need to address.

Thank you all for helping me take a step toward it.

I am just worried that things that I have enjoyed about my personality, such as being passionate and extroverted and spontaneous, are all just symptoms of a disorder. This anxiety that I am actually deep down inherently balls to the wall insane has stopped me from being completely straightforward with my therapists in the past about my behavior (not being honest about how much I'd drank, or if I'd blacked out, or done something irresponsible - basically selectively sharing things due to shame). It's weird how much easier it is to type things out on the internet than to say it face to face with someone who is trained in dealing with these things... anyway, thanks again!
posted by bengalibelle at 12:20 PM on March 10 [1 favorite]

Yes, you need to see someone pretty much soon. Like this week, for sure. The tipoff to me is the engaging in sexual behavior you don't feel comfortable with. If you are having these "why in the hell did I do that?" moments, you are probably slipping into mania.

The thing about mania (and depression) is that the symptoms aren't always clear and textbook. You can be manic and not feel good. It can manifest as anger or frustration or, as you say, a sort of disappointment in not using your energy for positive purposes.

It could also be something called a mixed episode, where both depressive symptoms and manic symptoms are present at the same time, or vacillate back and forth almost simultaneously.
posted by gjc at 12:25 PM on March 10 [1 favorite]

I am just worried that things that I have enjoyed about my personality, such as being passionate and extroverted and spontaneous, are all just symptoms of a disorder. This anxiety that I am actually deep down inherently balls to the wall insane has stopped me from being completely straightforward with my therapists in the past about my behavior (not being honest about how much I'd drank, or if I'd blacked out, or done something irresponsible - basically selectively sharing things due to shame).

That's part of the disorder. Mania is seductive and almost addictive. In the moment, it feels empowering. But the after effects aren't positive. The good doesn't outweigh the bad.

Your personality will always be there. You are you. What treatment does is help to keep you from going beyond your limits.
posted by gjc at 12:29 PM on March 10 [4 favorites]

By the way, mania, even mild mania, can show up as irritable moods, not just happy, expansive ones. The key is that they both have that high energy component - just that the irritable energy is't any fun (a good thing since it makes it easier to go along with treatment)

It is important that your doctor knows that you might be hypomanic - not only because it can flip over into a full blown episode but also because some antidepressants can trigger mania - if the doctor knows that is a possibility he/she will prescribe the ones that don't do that.

The good news is that there is a middle state - that can involve being cheerful, outgoing and spontaneous without being hyper, impulsive or prone to bad judgement. That is part of the real of you that will still be there even after treatment. There is a wonderful book/website/counseling service called Bipolar In Order that help people who feel too limited by their meds find the right balance (using self-awareness, meds and other coping strategies) to have wider range of feelings without getting out of control.
posted by metahawk at 1:03 PM on March 10 [2 favorites]

I totally understand that fear. But you can't let that stop you from taking care of your health. Because, reasons. Very very good important reasons. You don't want to go down that road.

You will still be you.
posted by St. Alia of the Bunnies at 1:04 PM on March 10 [1 favorite]

Just chiming in to say that that's very very much like how my bipolar friend describes their manic episodes. So I'm glad you're seeing a doctor. Unmanaged, the risky, uncharacteristic behavior and the feeling that your personality is wearing away / burning out gets worse.
posted by hattifattener at 1:26 PM on March 10 [2 favorites]

Like others are saying, you do indeed have a personality separate from the symptoms of mania. You will be okay.

I think I am approaching this thread from a more panicky place than others, given my recent life experiences. So, keep that in mind. All the same, here are some things you may want to talk to your doctor about, provided it is in fact determined that you're experiencing hypomania:

--What are important signs that it is progressing into full-fledged mania? (Ask about objective measures, like hours of sleep per night, amount of food consumed, etc.)
--What should you do, and in what time frame, if it does in fact progress into full-fledged mania? (Important ideas to discuss: calling 911 and going to the ER. Again, ask about objective measures for if doing either is a good idea.)
--What should you ask from friends or loved ones, both given your current condition and if it progresses to full-fledged mania?

You are rational right now, and you are worried about your condition. This is really good, and I really hope you don't end up experiencing a horrible manic episode like my loved one did. But, if your doctor agrees your state right now is hypomania, it will be a good idea to be prepared in case your condition worsens. One of the reasons my loved one's condition got so horribly terrible before he was hospitalized is because he didn't ask the doctors the right questions and no one in a position to help him had the slightest clue what to do. If he had asked the right questions and if he had sat us down and said, "If I do x, y, or z, call 911," he would have gotten treatment much earlier.

Keep in mind that the worst part of a condition like mania is that those most desperately in need of help are the least likely to actually seek it out. This is why, if your doctor agrees it is a good idea, you may want to invite close loved ones you trust to help you. This may mean just asking a friend to keep tabs on how much you're sleeping (if nothing else, it'll be good to have someone remind you to keep track). Or, it may mean discussing with friends under what conditions they should call 911 for your own good. Again, keep in mind: I am speaking from experience. Hopefully, my experience is way worse than anything you'll ever encounter... but there's a reason why I keep fixating on preparing for the worst case scenario.

Again, talk to your doctor. Ask a lot of questions, so, if things get worse, you'll be prepared. But also expect that, if things get worst, you'll be the least capable person to get you the help you need.

Good luck.
posted by meese at 1:30 PM on March 10 [2 favorites]

...being passionate and extroverted and spontaneous...

I think these are good things to bring up with a therapist, because there are healthy ways to be extroverted that are better than anxiety-riddled G-chatting, and ways to be spontaneous that don't but you at risk, so your therapist should be able to help you make an action plan to get you to your most awesome version of yourself.
posted by fermezporte at 1:31 PM on March 10 [2 favorites]

I am just worried that things that I have enjoyed about my personality, such as being passionate and extroverted and spontaneous, are all just symptoms of a disorder

One of my close friends has bipolar, and she said this too at the time when she first started getting treatment for it. I have known her for 13 years, and for the first three or four she did not have a diagnosis yet, and as far as I know (and as far as she recalls) she had not experienced any manic episodes. She was certainly passionate and extroverted and spontaneous and I loved those things about her.

Later, when she was going through a manic episode, she thought she was extra passionate and extroverted and spontaneous, but actually she was embarrassingly hypersexual and annoyingly loud and unsafely rash. She felt more intelligent and in control, but she said things that didn't make sense and behaved like she had never heard of the word control.

When she is stable on her meds, she thinks that some of her passion and extroversion and spontaneity are suppressed, but from the outside it is like she is once more that person I knew 13 years ago and just as awesome as ever. The meds are suppressing the stuff that does not make sense to the rest of the world.
posted by lollusc at 5:58 PM on March 10 [2 favorites]

I am just worried that things that I have enjoyed about my personality, such as being passionate and extroverted and spontaneous, are all just symptoms of a disorder.

It's only a disorder if it's ruining your ability to look after yourself and/or treat those around you with the respect they deserve. There are lots of passionate and extroverted and spontaneous people who are not in the least disordered.

Your goal, then, is to remain passionate, extroverted, spontaneous and able to cope. Totally doable.
posted by flabdablet at 6:20 PM on March 10 [2 favorites]

Good job getting in to see a professional ASAP.

One thing I want to mention about feeling "bad" or "sad" or "grouchy" while also feeling activated: you do not have to be happy to be manic. Lots of people are huge jerks, for lack of a better word, when manic or hypomanic. I know one person with bipolar who has never been at all happy during an episode; she actually feels "worse" when manic than when depressed. When people say something like "I wish I was hypomanic sometimes" she wants to smack them in the face even more than I do.

(The definition of mania starts with the words "elevated or irritable.")

Also: it's a bit like being a recovering alcoholic, figuring out what the healthy stuff in your personality is. I don't know anyone with a history of untreated or improperly treated BP1/BP2/schizoaffective who hasn't had to do therapy and a lot of hard work to learn how to live in a stable, healthy way that's true to themselves. Frankly, my perceived reduction of Happy Awesomeness turned out to be an elimination of the stuff that worried and confused everyone around me. My family being worried about my behavior is at the very top of my list of warning signs, along with sudden changes in sleep needs.

My meds don't hurt my ability to socialize, be creative, be spontaneous, or whatever, by the way. The side effects I am dealing with at present have to do with sleepiness and lack of focus, and my doctor is hoping we can fix that with a very slight dosage adjustment. My meds actually help me stay in control under stress, and let me finish things that I've intended to start. And if your meds make you feel like a zombie or completely flat or whatever, they need to be changed.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 7:42 PM on March 10 [2 favorites]