4) Hypomania (My experience of bipolar disorder, first posted November 2014)

“The medical literature refers to bipolar as a mood disorder and the popular conception is one of mood swings from one extreme to the other. In actuality, this represents only a small part of what is visible to both the medical profession and the public, like the spots on measles.”

So, today I was going to describe the ‘third state’ in bipolar disorder, normally known as ‘hypomania’. Literally that means ‘little mania’, and it’s generally described as being like acute mania but without the psychotic symptoms – i.e. full of energy, feeling positive, physically active, quick-thinking, generally just good all over without the crazy. I think I have been like that sometimes, at my best, but it never seems to last long – it either fizzles out, or spirals up into full mania, or, more often in my case, flips into ‘dysphoric hypomania’. This one isn’t always mentioned in the books and medical definitions, but I’ve been reading a LOT, and it sounds like it’s really common, and only just starting to be recognised as a major part of the bipolar spectrum. (More and more psychiatrists and scientists are coming to think of bipolar and depression as well as other psychiatric conditions as different points on a whole continuum of mental illness, rather than as separate illnesses with no connection – and this allows them to recognise variations that have always fallen outside the classical definitions of each one.) Basically, dysphoric hypomania is ‘bad’ hypomania – hyper without the happy.

One description I’ve found goes like this:

“Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms of dysphoric mania”

It can also be called ‘mixed state’:

“In the context of mental disorder, a mixed state, also known as dysphoric mania, agitated depression, or a mixed episode, is a condition during which features of mania and depression—such as agitation, anxiety, fatigue, guilt, impulsiveness, irritability, morbid or suicidal ideation, panic, paranoia, pressured speech and rage—occur simultaneously or in very short succession.
Typical examples include tearfulness during a manic episode or racing thoughts during a depressive episode. One may also feel incredibly frustrated or be prone to fits of rage in this state, since one may feel like a failure and at the same time have a flight of ideas. Mixed states are often the most problematic period of mood disorders (particularly bipolar spectrum disorders), during which susceptibility to substance abuse, panic disorder, commission of violence, suicide attempts, and other complications increase greatly.”

One person simply describes it as: “those who have road rage and can’t sleep”.
And then there’s this:

“For some Bipolar sufferers, a euphoric state is never reached and what they experience may be agitation, irritability, intense anxiety, rapid thoughts which cause confusion, and quick angry outbursts. This dysphoric hypomanic state can cause problems in relationships, not only personal, but social and work related relationships as well.”

Welcome to my world.

Obviously I have had full-blown depressive and manic states at different times in my life, but I would say probably 80% of my time I’ve either been symptom-free or hypomanic. I think the last few years have been mainly hypomanic, and most of that dysphoric. I’m not like that ALL the time, though – I have calm periods, and happy times, but all too often it doesn’t take much for me to shift into that agitated, tense, hyper-irritable state.

Until now, I’ve always just called it ‘stress’. And I’ve tried all sorts of ways to relax and let go of it, but nothing’s worked, or not for long, and now I know why. Normal people have stress, and there are ways to deal with it, but being bipolar I have weird brain wiring so the normal things don’t work. Just wish I’d known a long time ago.

Let me give you my stream-of-consciousness description, as I did with the other states.

Physical energy and stamina are less than manic, but still restless, fidgety, tense. Sleep OK mostly (especially if I’m physically worn out by work or other exercise), but easily woken, and it doesn’t take much to disrupt my sleep. Mind still speedy, but rational – constantly conscious of things to be done, loads of plans and projects but no time to do them = FRUSTRATION. Lists in my head ALL the time, of things I need to remember, to be on time for, to organise, to buy, to fix, to sort out, to clean… = STRESS. Stressed minds don’t work efficiently, can’t focus or concentrate, most of time wasted flapping fruitlessly from one thing to another, trying to do all at once and completing NOTHING = disorganised, panicky, frustrated and more stressed. Hyper-irritable. Not red-mist sustained anger, but a white-hot flash of lightning, a fizzing electrical surge, from nothing to BANG! rage, then gone, left with empty sick shaky feeling you get after adrenaline spike. Usually but not always directed at inanimate objects. Yes, I break things, or more frequently throw them, kick them or swear at them. Exercise is good, definitely calms me, but it takes too much TIME, along with anything else which is calming. So I rely on exercise at work, which works, mostly, and I’m better there than at home. At work a lot of things aren’t my problem or my responsibility, so they don’t stress me, unless I’m in a very wound-up state, but at home EVERYTHING is up to me, there’s no escape from mess and disorder and jobs not done. Routine tasks are good, even like doing my makeup, following a set pattern in the same order so I’m on autopilot, giving my poor frazzled brain a rest. As long as I’m not LATE. Oh God. Anything with a deadline or a time limit just feels like unbearable pressure, even stupid bloody computer games if they’re against the clock. I’ve nearly thrown my DS out the window more than once. I’m amazed I haven’t broken it. Along with my phone, tablet, laptop, freezer. If I’m left to myself, to do my own thing at my own speed, I’m nearly always calm, or calm-ish, but sometimes other people feel like pressure, expectation, judgment. Or as tasks to be dealt with, obligations that take my TIME. I hate how selfish and awful that sounds, but I’m trying to be ruthlessly honest here, baring all, letting you see my worst side. This is what Lee lives with most days. I have good sides too, of course – I’m intelligent, conscientious, ethical, humorous, interested in loads of things, but I can’t live up to my own standards, I can’t make myself happy and I can never ever relax.

Let me give you some insignificant examples, of how stupid and petty and bloody-minded my brain is, and why it needs medicating to let me get on with my life.

I wake up, halfway through a day’s sleep. I’m not stressed about anything that day, I’ve gone to bed in a good mood, and I’ve got nothing to worry about later, but I remember that I was intending to text someone later. So while I’m waiting to fall back to sleep, I start composing that text in my head, deciding how to word it. TWO HOURS later I’ve got the words of that text buzzing round my head like malignant bluebottles, waking me up every time I start dozing off. Absolutely meaningless but I can’t shut it off.

And you know one of the worst things you can do? You, my well-meaning family and friends and co-workers? Offer to HELP. How ridiculous is this? I know, my intelligent brain knows perfectly well that 9 times out of 10 when someone offers to help they’re genuinely saying ‘I’d like to give you a hand’. But what my stress-brain actually HEARS is ‘You’re not doing very well, you’re clearly not going to manage that by yourself, so I suppose I’d better take time out of MY busy schedule to do some of it for you!’ And that results in a mixture of rage and humiliation that can really easily flare up into a major temper outburst or a storm of tears. And if I’m pre-menstrual at the time it almost certainly will – the rest of the time I can usually choke it back, especially at work or in public. I’m worse at home, less inhibited from showing my feelings.

So, the pills I’m now on had better work, because it wasn’t really till I actually spelt all that out for myself that I realised how bad things were. They should help, they’re designed to calm hypomanic symptoms, as well as heading off depression or full mania.

What frustrates me most is that I KNOW I can do better. I’m extremely bright, I know I’m creative, I have talents, and I have huge potential. My life is pretty simple, with no obvious reasons for stress or difficulty – way easier than most people have it. I like my job and my home, I have more than enough money to live on, I have a loving family and an extremely forgiving husband who puts up with all my shit and still wants to be here, and yet some stupid short-circuit in my brain makes me tense all the bloody time.

I just realised it’s all tension, really. Apart from in deep depression, I’m always tense in one way or another, and it’s almost as if I’m scared to relax. Maybe I’m just a control-freak, and I think things will fall apart if I don’t stay on top of everything. There feel like so many competing demands for my attention – I NEED to stick to my diet, I need to exercise, I need to keep control of our budget, I need to feed and entertain the kids, I need to plan for Christmas and birthdays, I need to get the house organised and tidy, I need to remember the shopping, I need to get 8 hours sleep, I need to clean out the cat litter and wash my hair and get myself ready and be on time for work, and at some point I need to remember to relax and have fun and love my husband and there just isn’t time for it all. Or if there is time, there just isn’t room in my head. Or something.

I started the pills on Saturday, and the first day I had one, and felt a bit spacey but mainly normal. On Sunday I had 2, and a couple of hours after waking up I got the giggles, over nothing. Later I felt good, but strange. My limbs felt heavy but in a pleasurable way, and I had no desire to talk, but felt like smiling. Took me till now to recognise that I didn’t feel drunk or high or anything like that – but for the first time in a long, long time I was physically relaxed. Today I had 3 pills, and slept for nearly 10 hours, but I don’t feel relaxed, in fact I’m rather agitated. Hopefully writing it all out will help, it always used to. The dosage of the pills is increasing each day up to a maximum of 6 pills at bedtime and 1 when I get up, which will then be the fixed dose. The first couple of days would see the strongest effects as my body hadn’t had them before, but as it gets used to them the dose increases. So I’ll have to wait and see how they work long-term.

Wish me luck. Just don’t offer me help, LOL.

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