Is this mania?
April 6, 2015 2:24 AM   Subscribe

I know YANMD, but I've been feeling some things and I don't know if they're worth going to my actual doctor about.

Me: 23, female, UK. Never been diagnosed with anything but I suspect something has been up with my moods for a very long time. Since childhood I have had periods of low self esteem and crippling self-doubt and self-hatred, find it very difficult to self-motivate, with suicidal ideation and inclinations to self harm (which, while I have very occasionally done so, has not been a serious issue for almost a decade). My last relationship essentially ended because I wasn't able to balance these bad spells with living with a partner full-time, and was requiring too much in the way of support and encouragement.

So that's what it is, it's never impacted my functioning on a meaningful level, my grades were always great and I can hold down jobs, and I never thought to get help because these down periods are also extremely ephemeral and come and go all the time with no pattern and extremely rapidly- I can be thinking of suicide in the morning and unable to do anything at my craft (drawing) without wanting to stab something, but then by the evening feel sociable, gregarious, and easy-going and have fun with drawing and everything seems fine. In a way they feel like I can control them, and I'm getting better all the time at mental strategies that hold the bad thoughts at bay.

I haven't had a particularly bad down period for a while, but for the last few days, maybe all of the last week or so, some different stuffs been happening that I haven't experience before:

- I've been incredibly productive creatively. I've written well over 30k words of fanfic in the last week and drawing and feeling great about all the stuff I'm producing. I'm constantly getting new ideas and inspiration and going over plots and mentally editing, and haven't really done much else but type. NB: I'm only casually employed so this isn't a problem in terms of getting in the way of functioning.
- I've been getting a reduced amount of sleep. Normally I am solid and regular sleeper from 11.30 to 7.30, but the last three or four nights I've been waking after only a couple of hours at 4 or 5am and had a lot of trouble getting back to sleep, because my mind's been racing and I want to listen to music, read, edit my writing, check for feedback on AO3. Last night I went to sleep at midnight and then was awake from 3 til 6am, unable to stop my mind whirring. Normally I am good at soothing myself back to sleep with a meditative breath-counting technique, but that was just not working for me, my mind was all over the place. I felt tired when I woke up after managing a couple of hours of sleep between 6 and 8.30, but now (mid-morning) I'm feeling jittery and energetic and want to go for a run or a walk;
- I've had a lot of physical energy in general and have felt on top of the world going for long hill walks and feeling really powerful and strong. Feeling very sexually frustrated, as well.
- While I've had these positive feelings and creativity, my mind's also been going to some dark places and I've been extremely irritable. I've always been on the hot-tempered side, especially when I was younger, and I feel like I'm back to how I was when I was a teen, or when I've had bad PMS: blowing up at literally nothing, feeling other people are incompetent and slow and being unable to stop getting vocally irritated at them, even though I know this is not cool behaviour and is irrational. I've also had some thoughts like "It'd be better if I was dead", because of treating people badly in this way, and feeling like I need to punish myself by not eating or self-harming, visualising self-harm, and yesterday after I blew up at my parents during an Easter festivity and felt terrible about it, I did hurt myself very minorly to ease my frustration (pressure with a blunt object, not cutting.)

Now, writing this down, it does seem like a big deal, but on the other hand it just feels kind of normal as well, like a slightly more intense version of my usual mood swings, and I am so distrustful of the NHS mental health services being able to do anything. I had a round of CBT when I was feeling especially down as a student, but that was based around anxiety and I don't think CBT would help with what essentially just feels like mood swings? And I feel like no Doctor will offer anything more than CBT. And I still feel very in control, I know I'm not going to seriously hurt or endanger myself, I'm not doing crazy reckless things with money or sex- so I don't think this would be diagnosable. I have moved a lot in recent years and don't have an established relationship with a GP. I don't know what if anything could be done, or if anything needs to be done at all. Help.
posted by mymbleth to Health & Fitness (15 answers total) 2 users marked this as a favorite
Hmm, I'm usually of the mindset that if it's bothering you and getting in the way of your life in some fashion that it's worth seeing the doc independent of diagnosis. The thing about some mania is that of course it's getting in the way of nothing(!) because you are so productive! I would be concerned about what is coming next though - severe depression - and maybe now is a good time to find a GP you can build a relationship with while you feel "GREAT!!!"

So, go see new doc, explain severe mood swings, explain concerns etc. What would they do? Work with you on managing it and possibly suggest some meds.
posted by Toddles at 2:43 AM on April 6, 2015 [2 favorites]

The last bullet point sounds like you may be having a mixed episode. I really don't want to alarm you, but this can be more dangerous for people than a regular depressive episode, since it combines the negative thoughts of depression with the impulsiveness and energy of mania, making it more likely for someone to act on those negative thoughts. You may feel on top of it now, but things can change.

I think you need to see a new doctor, perhaps with a copy of this question in hand, and ask about the possibility of bipolar disorder. Bipolar is often treated with both therapy and meds, and the earlier you start treatment, the better it tends to go.
posted by Metroid Baby at 3:52 AM on April 6, 2015 [6 favorites]

Yes, this sounds a lot like a mixed episode. It could be any one of a number of other things too, but it's enough of a possibility that I strongly encourage you to go see a doctor.

In regard to CBT, you may want to read up on DBT in addition to seeing a doctor. My partner finds that while CBT helps with cognitive stuff, DBT is much more effective for mood stuff.
posted by Stacey at 3:58 AM on April 6, 2015

It could also be something like hypomania, which is kind of a milder form of mania (though no less of a problem).
posted by Kimmalah at 4:03 AM on April 6, 2015

You're in the UK, so presumably doctor visits are covered by NHS. In which case, make an appointment no question. Ask for a referral for a comprehensive psych workup. Also get a full physical workup especially bloodwork to make sure nothing's off-kilter there.
posted by feckless fecal fear mongering at 4:06 AM on April 6, 2015

Best answer: Irritability is a big red flag, in my experience, when it's a component of either elevated or depressed mood (or both). Based on what you've said, it's definitely worth talking about your concerns and getting checked out.

You will likely need to advocate for yourself pretty hard, though. I'm 25, a woman, based in the UK and was diagnosed with bipolar II last year. That was after thirteen years of symptoms, ten years of seeing doctors about those symptoms, three rounds of psych evaluations (two of which said there was essentially nothing wrong with me apart from being a young woman with some depressive symptoms), five GPs with varying levels of taking me seriously and four different antidepressants, some of which did considerably more harm than good - and only then because I ended up in crisis and saw a really competent psychiatrist. At least some of the time delay was based on seeking treatment for depression primarily when my other bipolar symptoms were only mildly emergent, but some of it was outright bad doctoring and the system being wonky - you might have more luck.

I say this not because a diagnosis is the be-all and end-all - and definitely not to try and put you off - but because this shit is hard and there's a non-trivial risk that you will be dismissed based on your demographic and, as you've pointed out yourself, the fact that your symptoms aren't necessarily causing you crisis-level issues.

The benefit of a diagnosis is that it's a key to adequate treatment - in my case, lithium and a consultant who genuinely cares and takes me seriously. I'm also seeing a private therapist, but I'd be eligible for not-necessarily-CBT talk therapy on the NHS based on my diagnosis if I didn't already have an established relationship with a therapist.

If you want to bring this up with a doctor, I'd suggest that the important bits to talk about are irritability and the fact that it's impacting your quality of life (e.g. your relationship ending) and see what they suggest from there. Present the manic symptoms alongside the depressive ones - I think I made the mistake early on of only seeing a doctor when I was depressed and saying "well sometimes I feel really up too but it's not for very long and I don't remember what anything that isn't horrible feels like right now." Keep a mood diary as best you can - this is often really helpful when you're being evaluated.

If you're offered an SSRI, push back strongly. There's plenty of evidence that they make the swinging worse in bipolar people, and not necessarily the first time you take one - I didn't notice a difference with the first and second SSRIs I took, though in retrospect I was slowly getting more swingy, but the third one totally did a number on me, and sparked the worst hypomanic episode of my life, swiftly followed by the worst depression. If I could change anything about the ten years I spent trying to get this treated, I wouldn't take any of the SSRIs I took in the first place, even though they seemed help (though not a lot) at the time.

The main reason to get on the road to sorting this out now (apart from it potentially taking a long time), if you want to, is the theory of bipolar kindling - I can't find good links right now, but the basic idea is that the longer the mood swings go unchecked, the more extreme they get, so what's manageable now might not be in ten or twenty years, and it'll likely be harder to treat then.

When I asked a similar question a few years ago, someone pointed out to me that although my hypomanic episodes might be fun and productive now, they tend to get more dysphoric and irritable as time goes on, and they tend to be followed by much worse (and longer) depressions. And that's definitely been my experience in the meantime. In the last few, I haven't written at all, but I have made some nearly-career-limiting mistakes at work based on not having good control over what's coming out of my mouth. And I get really paranoid. Which is very different to the earlier "I love the trees! I love the sun! Let's write a book!" episodes I had when I was younger.

If validation helps at all, a lot of what you've said echoes my own experience (I wrote a couple of books in no time at all, slept less, felt really good about myself and my work, etc.) - you're not imagining this. I found it really hard in the middle of trying to get my stuff sorted out when I'd have manic symptoms and end up thinking, "well, the psych team told me earlier in the year that they thought I was definitely not bipolar, so I guess this isn't happening", even though it absolutely was happening. Don't second-guess your own experiences, and try to record them as best you can - I've found I forget as my mood shifts what the last one was like.

I'm happy to talk more about this if you've got specific questions or you want to chat - memail me!
posted by terretu at 4:11 AM on April 6, 2015 [11 favorites]

Go see a doctor at least for some meds to knock you out at night. A good night's sleep is the key to mental health. Do whatever you can to get more sleep. If that means doubling or tripling up on exercise do that.
posted by crazycanuck at 4:52 AM on April 6, 2015

If someone I knew was sleeping as little as you were, I would be concerned enough to drive them to the doctor myself.

Are you eating? In my experience, those are the big two issues: sleep and food. If you're not getting much sleep, or if you're not consuming much food, you're probably in a bad situation that can easily catapult to a scary-dangerous situation. (One thing to consider: someone whose manic can fail to judge their sleep and food habits correctly. I know someone who swore he slept 8 full hours when, in reality, it was just 2. My point being: if you're nearing mania, you're nearing a point where your judgment doesn't work right anymore.) Even if you feel fine now, it is worth seeing a doctor because, if things get worse, you won't be rational enough to seek out the help you need.

No one can diagnose you over the Internet. I don't know if you are manic or hypomanic. But no one else knows, either. Please don't trust anyone on the Internet who reassures you that you're fine: they don't know. It's good you asked this question, because it means a lot of us can encourage you to see a doctor. But please remember that none of us can give you a definite answer.
posted by meese at 4:53 AM on April 6, 2015

I agree with what people have said above, go see a doctor.

Meanwhile, how much are you exercising? I think- and I am in no way qualified to offer a professional opinion on this- that too much vigorous exercise can sometimes exacerbate mania. Yes, the exercise is a healthy way of releasing stress, but if you're doing it more than an hour a day try cutting back and see if it helps your mood and sleep. Also, if you're exercising late in the day try doing it first thing in the morning instead.
posted by mareli at 4:58 AM on April 6, 2015

I agree with the consensus that inability to sleep enough along with the other changes is a strong reason to see a doctor, even though you are inclined against it.

As for CBT, I have trouble imagining it will help with excitability and mania, but I did find it mildly helpful against self-defeating thoughts and self loathing, so it may be good to have it in your toolbox.

If you are counting on eventually getting tired enough that you can sleep, I wouldn't count on that. May not happen.
posted by puddledork at 7:46 AM on April 6, 2015 [1 favorite]

As terretu mentioned, one of the big hurdles to getting a proper diagnosis for people dealing with Bipolar Disorder is that people tend to go in for treatment only when they're depressed rather than when they're feeling full of energy, and doctors and psychiatrists and therapists aren't always good at screening for symptoms of mania/hypomania. So people end up with diagnoses for depression, often for mild depression, because everyone's missing the manic symptoms.

And I still feel very in control, I know I'm not going to seriously hurt or endanger myself, I'm not doing crazy reckless things with money or sex- so I don't think this would be diagnosable

You are likely incorrect; reckless behavior is not required for a diagnosis of a manic or hypomanic episode.
posted by jaguar at 8:01 AM on April 6, 2015

Definitely see a doctor, primarily because you are concerned enough to post this question here. None of us can diagnose you, & I most certainly am not a doctor, but what you describe does sound like bipolar & potentially a mixed state. Unfortunately, bipolar episodes often interfere with someone investigating them further. If you're feeling good, it doesn't seems like there is much of a problem or, if you're feeling bad, you can't gather the motivation to seek help. You're curious and concerned; that's reason enough.

One thing I want to mention is that there are many high-functioning people who have some sort of mental-health issue. For example, they keep & even excel at jobs, fulfill the basic obligations associated with being an adult, & can even appear perfectly fine to almost everyone while being in the throws of a serious depression. All their energy is focused on maintaining a semblance of normalcy, possibly without even being aware of doing this. It's only when they are at home or alone, that they give into the depression. Then, the next day, they wake up & do it all over again. So, keeping a job, getting good grades, & people thinking you're doing great are poor yardsticks for measuring whether you have a mental health issue or not. Please go see a doctor, & I wish you the best of luck.
posted by katemcd at 10:25 AM on April 6, 2015

Terretu's answer is excellent and very well-informed. I would just add a few things.

1) It's my understanding that the person with bipolar is often the last to realise that the up periods can be just as destructive as the down ones. Depression feels bad and everyone knows it's bad. Mania feels (mostly) good but can be very hard on the people around you. The person having a manic episode is often much more irritable, blame-y, and grandiose than they realise. And it sounds like you know about the risks: being bad with money, quitting jobs, recklessness about sex, driving away family and friends, and that kind of thing.

2) Medication is not a magic bullet and my understanding is that it can take years post-diagnosis to get it figured out, and some people never do. People with bipolar are often therefore advised to aim to regulate their moods --in addition to medication or while getting it figured out-- by developing predictable lifestyle habits. Sleep hygiene is super-important: try to keep regular hours. Try to get some sun in the morning, but know that overexposure can trigger a manic episode. Try to exercise regularly, but be aware that too much exercise can also trigger mania. Watch your drinking. Moderation can really help to keep your moods in check, and when you can't manage it, that's a signal you need help.

Good luck. Bipolar is a bitch. If you have someone you can trust to be observant about your moods and give you unvarnished feedback, that may help.
posted by Susan PG at 10:53 AM on April 6, 2015

I have a bipolar II diagnosis. Yes, this absolutely sounds like hypomania to me. Please let some people close to you know that they should keep an eye out for behavior that is unlike you and/or risk-taking. Please go see a doctor right away. You generally feel great and productive now, but if this is bipolar, the depression will follow. And Susan PG very nicely described the damage that can be done by (hypo)mania.
posted by kitcat at 10:58 AM on April 6, 2015

I'm close to someone with bipolar II. Echoing: your lack of sleep(iness) is concerning. Go see a doctor. (Though I have to disagree with kitcat: depression will not necessarily follow.)

In the meantime, you might try striving for calm, restful behavior. Avoid coffee/Red Bull and try OTC sleep aids. These things won't hurt and they may well help to bring you down some.

Also, check out this graphic novel about cartoonist Ellen Forney's experience with bipolar. Maybe you'll find something you recognize.

Finally, I have to give you big props for being attentive to your situation. If there is something wrong, your willingness to recognize it in yourself will go a long way towards making it better. Good job!
posted by the_blizz at 3:49 PM on April 6, 2015

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