Do I really need to "deal" with hypomania if I have it?

September 6, 2007 1:00 PM

I think I may have hypomania, but without the depressive episodes (i.e. not bipolar disorder) which I'm not sure can even happen, but I don't know how else to describe what happens to me. I get a number of benefits from these periods, but the irritability that sometimes goes along with them can be a bit challenging. Is it reasonable to want to deal with this without meds to retain the benefits I get and just try to deal with the irritability downside?

Based on the checklists I've seen (wikipedia and google searching) and some comments I've received from friends and others, I think I may be experiencing hypomanic episodes. I've always been a bit highstrung, but happy and outgoing and a bit of a fast-talker - but over the past several years, I've been feeling like it goes beyond that and that I go through periods where these feelings and behaviours are really heightened and noticeable. I do not experience the depressive episodes that would come with bipolar disorder, but I will have a week or a series of days where I have the racing thoughts, decreased sleep, increased creativity, and I'm more impulsive and sometimes dwell or obsess about certain issues.

However, I get a lot of benefit from these periods related to work productivity and creativity (improvisation, happiness, big picture thinking, confidence and charisma increased, quick responses and uber-engagement in interesting conversations about any number of topics, etc). The downside is that I do get irritable around some things, I tend to volunteer for too many things if the idea is interesting and can lack follow through around some big decisions or said volunteer commitments, and I experience regret around looking back at some of the things I talked about or otherwise appeared to behave as a hyperactive flighty person.

I am not willing to give up the benefits, and I don't think my day-to-day functioning is impaired enough by these episodes to want treatment (I realize that not admitting anything is wrong is a symptom of having the problem). I especially I am not interested in taking mood stabilizers or other drugs like that.

Has anyone else experienced hypomania and managed it without the use of medication? Is it really that bad a thing to have if it doesn't escalate to full-blown mania or bipolar disorder (assuming one can keep the irritability part from becoming an ongoing negative impact)?

posted by anonymous to health (21 comments total)

a good therapist ought to be able to help you manage your symptoms. as long as your symptoms don't endanger yourself or others, or limit your life, you shouldn't feel compelled to take medication.
posted by thinkingwoman at 1:10 PM on September 6, 2007

It's hard for strangers to objectively assess what's going on inside you, but I've read your question a few times now, and I don't really understand what the big problem is. You get irritable, you take on more than you can handle... those seem like pretty standard human traits, and pretty manageable ones.

I don't think it's unreasonable at all to want to "manage" your personality without medication, but I'm curious as to why you even thought to ask this. Did someone recently suggest you were way-abnormal or something?
posted by Greg Nog at 1:36 PM on September 6, 2007

Wow. You sound like me. I go through these days every now and then. And I really enjoy the positive things that come out of them. But I find that instead of being irritable or obsessive (which I used to be), I get selfish, introverted, and insomniac. Basically, I get this extra time to go do whatever I want to do—alone. And almost every time now, it doesn't have a negative impact on my social life or mental health and happiness. I am not on medication. Talking to a therapist can really help. That way you can set limits and draw lines, so you are not exacerbating the negative symptoms, causing these episodes, taking them too far, or creating unnecessary stress in your life. Your therapist will work with you to identify triggers and come up with ways to deal with both the positive and symptoms so that your life is balanced and your relationships don't suffer.
posted by iamkimiam at 1:40 PM on September 6, 2007

er, that should read "positive and negative symptoms"
posted by iamkimiam at 1:41 PM on September 6, 2007

There's lots of behavior issues that sound like what you're describing. If you feel like it's causing you crisis or interfering with your relationships with other people, there's trouble. You can start by keeping a mood diary, rating your irritability, sleeplessness, racing thoughts, overall effectiveness etc. Note sleep & diet as well as meds, including vitamins and OTC. This is anal retentive, and hard to do, but excellent to assess how bad is it anyway, and what a mental health pro worth their salt will ask you to do anyway.

If you start to see patterns over a couple of months, head to a professional. If you are truly having hypomania, it will eventually disintegrate into some level of depression, which is no fun, nukes your immune system and potentially deadly.

That said, you can manage mild illness with a lot of cognitive control and record keeping (sleeping and eating and exercise are really key), but it's not always comfortable or pleasant. I've got pretty damn bad BP, but I get by on a teensy bit of meds courtesy of a healthy lifestyle.

OTOH, there is not a lot of margin for error or having a crazy lifestyle.

That overcommitment thing? Right out the window, for starters.
posted by beezy at 1:48 PM on September 6, 2007

Let me preface by telling you that I cannot say whether this does or does not sound like a form of mania, only a doctor would be able to confirm that. But, anecdotally, one of my previous patients while I was in my psych nursing rotation suffered from mania. He really did enjoy the "benefits", as you claim to -- some of those being high energy, elated mood, and confidence. There are manic patients who prefer not to accept treatment, simply because they love how they feel. So, what I'm telling you is that no, it's not at all uncommon to be unwilling to give up those feelings. Some people really do enjoy their mania.

However, I agree with previous suggestions of talking to a therapist especially with regard to triggers and managing your hypomania overall. Talk to someone about this and go from there. Good luck to you.
posted by viachicago at 2:03 PM on September 6, 2007

I don't know how old you are, but bear in mind that these kinds of things generally worsen with age unfortunately. You sound like you have a fairly mild mood disorder, but it's probably worth seeing a shrink for annual reviews so that if the time comes when things worsen you have a rapport with someone who knows what they're doing. As thinkingwoman said, there's no need to take meds unless you're a danger to self or others, but if things do worsen it's better to step into a pre-existing therapeutic relationship than try and make new ones when you're at your most vulnerable.
posted by singingfish at 2:28 PM on September 6, 2007

I get this. Its pretty normal. I'm pretty sure its related to diet or caffeine or sleep, but I am not really sure. Leaning towards sleeping better a few days in a row just makes me feel good.

I just enjoy the days I'm really "on." It sounds like your 'mania' is not destructive in any way, so going the route of therapy or medication seems excessive. A real hypomanic episode involves maxing out all your credit cards, getting into a fist fight over nothing, half-convinced youre jesus or maitreya, getting half the sleep you need, and humping everything in sight.

Feeling good for no real reason is normal, as odd as that sounds. Sounds like youre in the spectrum of normal moods, except with the occasional high. Being moody is part of being human. You should really ask yourself if your irritable moods are a problem. If so, you should talk to your GP and get checked out. This doesnt sound like bipolar but it might be thyroid, allergies, sleep issues, etc.
posted by damn dirty ape at 3:00 PM on September 6, 2007

If it is not interfering with your relationships or your ability to do things you decide to, it isn't a disorder. The second of those you will have to judge for yourself; for the first, other people will have a clearer perspective on it than you will. Ask them, and listen.

Personally, if I had written your description, I would be saying "I am a work in progress, better try to treat people better and be more sober" and not "I may be diseased, better go get a diagnosis;" but if you are more concerned than I am, sure, ask a doctor. Couldn't hurt. And if it is official hypomania, make further inquiries (there and with people in your life) to see if it's doing any notable harm. Certainly find out how it may do harm, and how to recognize and mitigate that. But as long as it's harmless I say your only problem is that you're not yet your best self ... just like the rest of us.

Eating right, sleeping right, and exercising have benefits for officially-healthy people as well as for officially-ill people, so by all means do those. I personally lay no claim to any particular disorder of mind or personality, but when I eat right, sleep right, and exercise I am more serene, vigorous, and insightful; my powers of recall improve and my misanthropy fades. So by all means do that stuff, not as a means of dealing with hypomania but as a means of dealing with life.
posted by eritain at 3:01 PM on September 6, 2007

Without offering any recommendations about what you should or not do, let me say that you are in good company. Kay Redfield Jamison, a psychologist who is afflicted with mood disorder, has written a few popular books exploring the prevalence and impact that such states have (possibly) had upon people through the past. Touched with Fire: Manic-Depressive Illness and the Artistic Temperament gives several examples of such swings enabling some of the great creative minds, while her newer book, Exuberance: The Passion for Life takes on that je ne sais quoi that makes certain people seem to radiate success. Jamison has been interviewed on Fresh Air and another episode I can't find but is excerpted here.
posted by zachxman at 3:53 PM on September 6, 2007

I don't know what it is that you're experiencing.

Hypomania can be a symptom of hyperthyroidism, which can have some serious medical causes.
posted by OmieWise at 4:59 PM on September 6, 2007

There is a huge gray area south of "hypomania," and the real question is, how do these "episodes" impact your life? You don't say how old you are, but what you can get away with at 20 will cost you dearly at 30, and might be ruinous at 40. Trust me on this one.

It will be very difficult to answer that question -- what does this cost me -- honestly if you only ask it of yourself. If it ain't a problem, then no big deal. But my sense is you wouldn't be asking if it wasn't, and you need, as you know, to talk to a psychiatrist, present a full history, and explore treatments to answer most of your questions with anything but anecdote or speculation.

You could also post a throwaway email address. I (and others who have answered here) may have more to tell you in private. But you sound like you want a certain level of reassurance. Take it where you find it, but don't take itas advice to do nothing. Good luck to you.
posted by fourcheesemac at 5:18 PM on September 6, 2007

Also, the short answer is you could very well be bipolar and not experience major depressions. You don't give nearly enough history for an educated guess. Bipolar is a spectrum disorder. Arguably, most people have some of the symptoms some of the time. It's an illness if -- or when, buddy -- it damages your relationships or your health or your happiness or your contribution to the world.
posted by fourcheesemac at 5:21 PM on September 6, 2007

It's pretty uncommon but possible you could be having hypomania without depressive episodes. The main thing is the "swing."

I'd see a doc and talk to him or her. You are under NO obligation to take meds no matter what the doc says but it is true that, untreated, the disease can worsen -if you have it, of course. And irritable hypomania can affect your life and the lives of those around you in pretty significant and negative ways. And you want to have people in your life who are honest enough to let you know how you are coming across at these times-one's selfawareness is often an early casualty of the condition.

In other words, it bears watching.
posted by konolia at 5:49 PM on September 6, 2007

It sounds like Bipolar II. It is like mania writ with a small "m".
Please see a doctor. It can make all of the difference in the world.
posted by hipaa_chik at 6:08 PM on September 6, 2007

It sounds like Bipolar II. It is like mania writ with a small "m".
Please see a doctor. It can make all of the difference in the world. I'm sorry I can't recommend a link right now-- too busy with homework.
posted by hipaa_chik at 6:10 PM on September 6, 2007

There's no way to diagnose you over the internet and it would be irresponsible to try, however, it does not "sound like Bipolar II," which does indeed have the word "hypomania" in the diagnostic criteria, but which is also structured around depression as a major diagnostic feature.

Of course, it could still be that you have Bipolar II, but if so, that isn't evident from the information you provided here.
posted by OmieWise at 7:18 PM on September 6, 2007

Are you familiar with Cognative Behavioral Therapy? It may help you deal with some of the thought patterns that give you trouble during these episodes.
posted by Lazlo Hollyfeld at 7:10 AM on September 7, 2007

One thing to remember is that its more or less impossible to self-diagnose something more complex than a headache. This is double so for people on the internet to diagnose you. The advice in this thread is pretty bad. It doesnt sound at all like bipolar disease. Just looking at the DSM on this tells me your are a poor candidate for bipolar disease. Where are your mood swings? Wheres you depression? Your hypomania sounds more like ordinary euphoria/euthymia. you have no depressive episodes.

There's no shortage of internet people who have self-diagnosed themselves with all sorts of ailments. They spend hours at sites that list symptoms and never see a doctor. Do not become one of these people. If you feel you have a problem, go see a doctor. You most likely are not bipolar, but you may have other issues like thyroid, sleep apnea, allergies, etc.
posted by damn dirty ape at 7:58 AM on September 7, 2007

I see some really bad advice in here. Only a psychiatrist can make this kind of diagnosis. Untreated Bipolar mood disorder didn't work out well for me.
posted by RussHy at 8:06 AM on September 7, 2007

RussHy: I have to confess that you're right about some of the bad advice and too much internet self diagnosis, and some of that was from me. I'm not qualified to diagnose anyone. All I can say in my defense is that I wrote that the writer should see a doctor.
posted by hipaa_chik at 8:32 AM on September 8, 2007