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Hypomania - my strategy. Thursday December 15, 2016

It's not easy for the people around me when I'm depressed, but it's not impossible for them to recognise it or to understand that it's an illness, that I can't help it, and that I don't mean to be that way.

I think it's harder for them to see the hypomania side as an illness. I seem so happy, so carefree, so selfish. I put my need to run around enjoying myself above everyone and everything else. I interrupt a heartfelt story to prattle on about utter nonsense. I ignore my family's wish for me spend time with them because I would rather be dancing. I crave adventure. I need excitement.

And that's the thing about it. It's a need. I don't just want to be off enjoying myself; I can't stop myself. I can see what it's doing to my family and friends but I just can't not, however hard I try. Somewhere in my head, I know that I am going to regret it, I know that I don't want to hurt those I love, but it's like watching a car crash. I can see what's going to happen but I have no power to stop it. And that's hard for those on the outside to understand.

Let's face it, it's hard for me to understand and I'm the one doing it. So, I get scared when I get high. Scared that this time I'm going to finally go too far and lose everyone. That when I come down, I'll have nothing left: no friends, no family, no money, no job, nothing. I still can't stop though.

That's why I've come up with a new strategy. First, I talk about it when I'm stable, trying to explain how it is for me. Then, when I start to ascend, I allow myself to enjoy it. I try to eat and sleep when I can, but I ride it out cheerfully. I make a promise that any big decisions have to be run by at least two close friends and their opinion is final. And then, I stop fighting it. So far, it's working out.

Caroline
A Moodscope member.

Thoughts on the above? Please feel free to post a comment below.


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Comments

Mary Wednesday Thu, Dec 15th 2016 @ 2:07am

I recognise this. Oh how well I recognise this. Sounds like a plan. But - don't we just hate the selfish, self-centred, self-absorbed aspect of this illness? So out of character of us... (or at least, I hope so!)

Tutti Frutti Thu, Dec 15th 2016 @ 9:29am

Mary What were you doing up at 2am. Hope you are OK. Love TF x

David Thu, Dec 15th 2016 @ 8:29am

Sorry, I think you have a long way to go to bring in substantial controls. A routine in sleep, diet and life skills are essential.

Tutti Frutti Thu, Dec 15th 2016 @ 9:27am

Hi Caroline As you recognize how difficult it is for your family and friends when you are hypomanic surely it is worth getting some help to try and sort out eating and sleeping so that you recover as quickly as possible. I would also see what else your doctor suggests. I am not sure quite what David means about life skills though.

I found your blog very interesting as I tend to go straight up to needing to go into hospital if I go manic, which is thankfully rare for me. I have only once been hypomanic while recovering from a worse episode a few months earlier and I think my hypomania was milder than you describe - though I probably failed to work out just how obnoxious I was being. I have always felt that it would be really good if I only went hypomanic rather than manic but I see your point about hitting problems with people not realising that you are ill. Your strategies of talking about your bipolar when you are well and not taking big decisions on your own both seem good. Hope they keep working well and that you can get even more strategies into place.

Love TF x

Wyvern Thu, Dec 15th 2016 @ 9:34am

Caroline, thank you for this insight. I strongly suspect one of my sons may be bipolar, but as he's an adult and cannot see that there is a problem, he's not going to get any help... I can't do it for him.
Your blog reminded me of a time when I gave him some money to put down a deposit and first month's rent on some accommodation, and he went to London and stayed in a hotel with it instead. He saw nothing wrong with doing that. After all, I had given him the money, so the money was his to spend as he liked, wasn't it? - as he saw it. The repercussions of that one are still with us three years later.
I don't have any answers but I do find that awareness / knowledge about these things helps me to manage situations as they arise.

LP Thu, Dec 15th 2016 @ 9:35am

Hi Caroline,
I'm glad your plan is helping and that you have two good friends who understand and can help.
I find having a plan in itself helps. So does awareness and acceptance. Allowing yourself to relax about it rather than try to fight it takes the power out of it.
I too had a plan recently. I took a risk trying it and it paid off.
Having a plan sounds simple but it gives you confidence and some control.
Thank you for an inspirational blog. Wishing you and all peace and harmony. LPxx

Michael Thu, Dec 15th 2016 @ 9:35am

Caroline that is a very wise strategy.
How do you use moodscope when you are leaving the euthymic state for hypomania? On the face of it you would think the score would be 100%. But hypomania can be an irritable, hostile towards others state and as you say you feel scared. Thus your moodscope score would in fact be dropping.

Pablo Thu, Dec 15th 2016 @ 10:10am

Hi Caroline, it must be hard having bi polar. Good luck with your strategies, They look good. I only know about bi polar from what I have read and garnered here on moodscape. Wow, is all I can say. It is tough enough with depression (me) without the added roller coasters that you folks ride on. I do a lot of reading on google and Kings College london are doing quite a bit of research into brain immflamation/depression. That is my area of interest as I suspect an over active immune system is my problem. This is also interesting:- http://bipolarnews.org/?tag=minocycline is anyone here trying minocycline? I am going to run it past my GP on my next visit. I don't think she likes me doing my own research but I know my brain better than her. All the very best, Pablo

Michael Thu, Dec 15th 2016 @ 11:43am

Pablo. For a long time I would become anxious, especially if my moodscope score went from 24 to 60 overnight. I would be worried am I bipolar after all. It felt safer to be 40 and below! I have the utmost respect for all those people having to deal with swinging between both ends of the spectrum. Re your GP comment. A friend of mine with depression recently went to see his new psychiatrist. The first words out of the psychiatrist's mouth were " You are too intelligent for your own good"!!!!! (I have noticed that a lot of people with bipolar are extremely intelligent and when high can run rings around their Drs) And your other point. It was only announced a few days ago that Psychiatrists might start treating depression and psychosis with immune suppressing drugs after it was found that 1 in 11 people with psychosis had raised inflammatory markers due to an overactive immune system. And there you have it, the bodies quest for homeostasis (equilibrium). We become prone to illness both when our immune system is under active and overactive! I think an awful lot of illness (physical and mental) is down to "inflammation". The inflammation being the result of an "overreaction" by the immune system. The list is very very long from MS to Ulcerative Colitis, asthma, hay fever/allergies. Some studies indicate that antidepressants are more effective when taken with anti inflammatory drugs.

E Thu, Dec 15th 2016 @ 1:33pm

Hi Pablo & Micheal, Thanks for the link to Bi-Polar Network news. I have never thought of myself as bi-Polar although I suspect that I may occasionally be slightly hypomanic when "well". I wouldn’t put it any stronger than that. For me my hypomania, if that is what it is, seems to manifest itself at work rather than in my private life. I have nearly been sacked twice from my current employment and have two findings of gross misconduct on my disciplinary record. I wont bore you with the details but I can now see that in todays admittedly pc world I was behaving rather unwisely and I am lucky to be still in employment. My diagnosis is one of recurrent depressive disorder and my Psychiatrist explains my odd and rather out of character behaviour while at work down to a stress reaction. (I don't handle stress well it is true to say). Like you I am increasingly interested in the part the immune system has to play in mental illness. My mother suffered depression and a maternal aunt of hers was diagnosed with schizophrenia and ended up in an institution for most of her adult life. All my siblings are affected with mental instability of one form or another and we all with the exception of my eldest brother are affected with one or more auto-immune disorders ,(including my mother), either hypo or hyper-thyroidism, arthritis or uveitis. There was a very interesting BBC R4 program on about 4 months ago called the inflamed mind which can be listened to at http://www.bbc.co.uk/programmes/b07pj2pw and a BBC article which can be seen here http://www.bbc.co.uk/news/health-37166293 . I have sometimes wonder if one of the side effects of treatment with SSRI antidepressants might be to induce a slightly euphoric and over confidant frame of mind which could be mistaken for hypomania. A study where therapists agreed to take an SSRI for a period experienced a r4eduction in their ability to empathise with their clients during the study (they were otherwise psychologically healthy). I also read an article a while back that suggested an evolutionary function of depression. Namely that when confronted with a stressful or threatening situation an adaptive strategy might be to adopt a passive and withdrawn social position. Clinical depression being an extension of that frame of mind adopted in the absence of any threat.

Michael Thu, Dec 15th 2016 @ 2:18pm

E. Thanks for the links. In the hopefully not too distant future a visit to a psychiatrist will involve blood tests that 1) show if you are lacking a particular liver enzyme. This enzyme is responsible for metabolising drugs in a way that reduces their side effects. An absence of this enzyme means whether it is a simple pain killer or a complex drug, you get every side effect going (these patients were are probably still are characterised by their Drs as "heart sink patients"). 2) Blood test to measure your quinolinic acid levels. There is a correlation between this acid and suicidality. 3) Blood test for inflammatory markers...hopefully we could then track (in a moodscope kind of way) our levels of inflammation and corresponding changes in mood and how effective various drugs and lifestyle strategies effect the inflammation.

E Thu, Dec 15th 2016 @ 7:38pm

we can but hope.

Pablo Fri, Dec 16th 2016 @ 6:10am

Ahmen to all the above. I am going to see my GP today to see if she has any bright ideas as I am really struggling with life at present.

Cyndi Thu, Dec 15th 2016 @ 11:31am

For me, when I get hypomanic, I take on too much and think I can do everything and anything. I am good at administrative stuff, but when I take on too much, I have to be careful of the crash. THis year our quilt guild had their biannual quilt show and I took on more than my share and was co chair to boot. This is after running 2 golf leagues, etc., etc. And we traveled, a lot. All fun but stressful. In October I crashed. Big time. 2 1/2 weeks in the hospital and another med change. Yuck. I also spend more.I have to put away my credit cards, and just say NO!. It is hard though. Then there is the guilt... . Thanks for your blog. It is my agenda for therapy this morning.

Becky Thu, Dec 15th 2016 @ 12:46pm

Caroline, this makes a lot of sense. I think one of the terrifying aspects of hypomania - for me at least - is the awareness that I'm so far out of control and not being able to do much about it. Having a plan might help bring a sense of control where it is otherwise gone.

I am curious about various people's comments saying something to the effect that we need to make sure we get enough sleep. How can this be done? When I am high I can't sleep more than 2 hours and wake up so bouncy and full of excess energy that I don't feel that I need to sleep even that much. After a week of no sleep a few months ago people told me I looked tired but I didn't feel at all tired. I lay down every night to sleep but it was impossible to stay still for more than 20 minutes and that was a stretch. I was taking sleeping tablets but not sleeping and I felt none of the symptoms of sleep deprivation that come with ordinary insomnia.

The nights are hardest. The whole world is asleep and there's no one to talk to and no one to tell me what not to do. I try to keep in mind the bad things that have happened in the past and not go down those paths again but it is SO hard not to do any thing as soon as the thought arrives in my head. Put off a decision for 24 hours has been suggested, but 24 minutes spent in a decision alone in the middle of the night is unrealistic.

Now, while I'm not in the midst of it, I want to join in the thoughts I'm sure are out there among you that I should take more responsibility and try harder to keep out of harm's way. All I can say is that I do try but my efforts are eclipsed by the sheer force of this state.

Michael Thu, Dec 15th 2016 @ 3:27pm

Becky. I'm not thinking that way about you i.e. try harder/more responsibity, and no one would have those judgements if they had experienced hypomania or at least been around it.

Tutti Frutti Fri, Dec 16th 2016 @ 8:46am

Becky Sorry I should have realised that people will have tried sleeping tablets already and that they just don't work for everyone. I really didn't mean to make you feel awful but it was a stupid thing to say. I will try not to dash off remarks without thinking them through properly in future. Sorry again. Love TF x

E Thu, Dec 15th 2016 @ 2:10pm

Hi Caroline,


I have never thought of myself as Bi-Polar although as I have just been explaining to Pablo and Michael I suspect I might be slightly hypomanic at times especially while at work which has resulted in two lengthy periods of suspension in recent years and me nearly loosing my job. The last time I only escaped because they did such a poor job of handling the investigation they would have lost had I taken them to an industrial tribunal. I am not proud of my behaviour and hate playing the “mental illness card” but sometimes you just have to swallow your pride and be honest about how you are feeling. I am now much more “out” at work regarding my mental health which is probably better for all concerned.


My hypomania, if that is what it is, as I say seems to manifest at work rather than at home. At home my partner has to deal with my depressed mood. I can see how having a manic partner must put an enormous strain`on any relationship and it is no secret that many relationships where one or the other partner is bi-polar do not last. I would find it difficult coping with a partner who was argumentative, aggressive and or disinhibited which in the more extreme cases they can be. That must be very difficult to cope with and my partner is thankful not to have to deal with this sort of behaviour. But depression can be just as hard to deal with although the effects are a little more insidious. The constant negativity, and cynicism the lack of any positive emotion and lack of enjoyment can be just as destructive to a relationship in the long run I think.


Have you considered some sort of legal power of a attorney when you feel you are getting unwell? After all at heart this is a question of competence is it not? The Capacity Act allows for the state or a close family members to act for an individual when it is felt they are no longer able to act for themselves. Trouble is the Capacity act seems to apply mainly to conditions like dementia where the the condition is usually permanent. For mental illness we have the mental health act and I doubt whether you would meet the criteria for detention under the MHAn and nor would you want to. (Sledge hammers and nuts spring instantly to mind). There are advanced directives, (I think they were called) where patients with a mental illness could leave instruction about how they wanted to be treated when unwell but the problem with those are that they are legally enforceable, still it would be an indication of who you want to do what when you feel yourself becoming unwell.

The Gardener Thu, Dec 15th 2016 @ 2:24pm

Cyndi, when I was manic I did exactly as you do. I do not think that I would have been capable, at those times, of having a 'strategy' as Caroline has. As you have no warning of up or down, and, with me, would have ignored anybody who tried to tell me I was doing too much, I think Caroline must have made a major breakthrough. Our Doctor, when training at Bart's, cited a manic-depressive (presume would have been bi-polar) co-student who would erupt from his room crying 'It's here - blessed mania'. Then proceed to work maniacally. But I doubt useful work is achieved when hypo-manic - it's like cramming - you may take it in fast, and not sleep for days - but, the crash has to come. I think some others have crashed as spectacularly as I did - total collapse, rushed into hospital, and let out to spend a week on non-stop Mogadon. Just achieved (achieved??) near lowest scores ever - remark/homily says 'draw on inner strength'. It's evaporating - Mr G's latest is that if I drop off to sleep in the chair opposite him he will wake me up as I cannot look after him if I'm asleep. Christmas coming - services pared to a minimum or non-existent. Reading 'E' above I don't know which is worse for the partner, depression or mania - probably the former - if regular, mania patterns mean they end like a collapsed balloon - but with depression there's always the fear that the next one may go much deeper. I've written about caring - I don't think, probably totally wrong - that we've had a post on caring for the depressed - and where those carers 'inner strength' comes from.

The Gardener Thu, Dec 15th 2016 @ 2:29pm

Michael, I do Moodscope regularly - never 'worry' about the scores, because just looking at the high/low points on the graph tell me all I need to know. High, visits, Mr G on a week respite - living a 'normal' life, which with my perhaps over-energetic character puts me in the high 60's. Lows are usually traceable to a series of bad nights - or, even, time of day. I might have had a high-ish score if I'd done it in the morning - if the day is bad, and I'm already exhausted, then all the positive cards get low marks.

Sheena Thu, Dec 15th 2016 @ 7:27pm

Caroline, I am impressed with your self awareness which is crucial in managing the problem. Having spent years trying to stay well (I admit that to be many decades - most post a diagnosis at a young age) I would agree with a number of the people above. That is : eat well, sleep well and respect your own wellness as your prime concern. This is what people who may think you behave in a selfish way when unwell, are most probably doing because it is normal for them to do so. Sometimes mania is, just like depression, due to exhaustion. How other people see the change in your behaviour towards them is relative, I would guess. So, look after yourself and then you will be well place to enjoy the company of like minded people. Everyone is special and unique so comparison is odious - just take proper care of yourself and be the person you want to be. Sheena

Freya Fri, Dec 16th 2016 @ 9:26am

Caroline, thanks for posting this. It has been pointed out to me by my partner (who has a bipolar diagnosis) that I almost certainly experience hypomanic episodes. The most recent of which is currently potentially causing us to break up (has yet to be determined). Having been so depressed for so long, that as I feel like I'm recovering I welcome these episodes. But only just realised how damaging they are to my relationships with others around me. Your experiences resonate so well with me, and that has come at a good time. I'm terrified of exploring bipolar as a potentially more accurate diagnosis. Especially as my GP (I've been mentioning it to her for about a year now) keeps dismissing it as 'oh maybe that's just you, maybe that's you being normal'. I hope it isn't normal because I genuinely think I'm a really horrible selfish self absorbed person during these times!

Also, thank you moodscope community. This is my first ever comment despite being a follower for a few years! And writing it I can physically feel the relief flow over me!

Frey

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