Q: Are These "Manic" Phases?
I've seen questions similar to mine, but not exactly. I'm a
'suspected' bipolar but didn't stay with my pdoc long. I'm just not sure
exactly what I have. Depression is obvious...it's there. I used to have what I
guess would be called 'hypomanic' episodes, but they didn't last long (couple
hours to one day) and I was euphoric for no reason. They were rare. I was put
on ad's at first and that's when I first experience what I think are different
'manias'. I just feel INCREDIBLY tense, like I'm going insane. I clench my
teeth and fists, rock back and forth and just scream, resisting the powerful
urge to hurt myself to make it stop. What is that? Is that mania? I haven't
really had 'hyponmania' in so long. Just those intense...overload of energy
things that last a few hours. I'm completely exhausted after it happens and
often just pass out on the floor. And it's only been there since I was on
ad's, even though I haven't taken them in over a year. Any idea if these are
manic eps? For the past 7 months I've been tense, with brief periods of
depression. Pretty much constant, but much milder, episodes like I described
above. Your thoughts on this would be greatly appreciated. Thanx
Dear Chris --
My thought is that yes, this could be a version of bipolar disorder. Are
those "manic" phases? could be, yes. For more on that ,
although it's not written for you, and I know that's what you were asking for,
here's the answer I wrote for another gal just this week and I hope you'll see
you are both talking about the same issue, no?
Dear Dr. Phelps,
I have had a mood disturbance of some kind since I was very young - about age
9. I'm 28 now. I have seen a dozen therapists, none of whom i liked and about
half a dozen psychiatrists, none of whom were very thorough in sorting through
I have been diagnosed with a myriad of things, the most popular being ADD,
Generalized Anxiety Disoder, Depression, and Dysthymia. When I've suggested to
therapists that i have something more severe, they tend to think I'm being too
hard on myself or anxious. Ritalin blew me away with it's amphetamine effects,
which makes a true ADD diagnosis a little sketchy, don't you think?
i just found out last weekend that mania can be dysphoric. I was shocked.
Since high school I have had many "strange states" that I have
always filed away as "one heck of a bad day" or "i've gone
completely nuts" but never thought of mania because I wasn't euphoric. I
never told a doc because these states felt *so* insane and also because they
were so short lived I could usually ride them out.
Well, I got a grip and told my most recent doc and he's thinking my
"states" sound quite a lot like hypomania. I checked out your web
site comparing ADD to BPII and oh boy, do I ever fall on the side of BPII. And
your one page questionnaire pegs me as bipolar as well.
My lingering doubt is this: these "states" generally only last for
several hours, perhaps a whole day. My depressions last for weeks or months.
Does this still fit?
Because my depression is so severe, and Zoloft works for that, I'm reluctanct
to stop taking it or replace it. But it has increased the frequency of
the "hypomania". Is adding a mood stabilizer the best choice at this
Here's the reply, Chris:
Dear Ms. S. Girl --
You can imagine that if nearly every possible variation of mood swings and
anxiety/difficulty concentrating "fits" under the bipolar umbrella,
that's a mighty big umbrella. So big, you could wonder about how it can
possibly be an accurate "diagnosis", if so many people with so many
types of mood experience, fit under the same "label". I.e. how
can a person who has one clear-cut manic episode with grandiosity and high
energy have the "same" condition as someone like you?!
On the other hand, there are many mood experts who
have described extremely rapid cycling, as little as hours (because there can
be multiple shifts within a day -- so called ultradian,
"beyond a day" cycling). So if ultradian cycling is well
accepted, which it is; and if intense, agitated dysphoria is accepted as a
version of "mania", which it is; then one simply has to combine
those two concepts to come pretty close to your experience. Closer yet,
when you take into account that I see people who have a brief "hypomanic"
phase only once in a long while, like once a month, while the rest of the time
they are experiencing something that sounds a lot more like sustained
depression (although it can get fairly irritable and agitated at times within
that phase. Then, "boing", there's a brief phase of intense
energy, racing around the house doing 6 things at once (and sometimes even
getting all 6 done), talking fast, thinking very fast and very clearly, then
sometimes moving on to a point where the thinking is becoming fragmented and
not productive, and so forth. And that happens just for a few hours, and
only once in a while. That rather sounds like you, doesn't
Anyway, the point is to say "yes" to your
question "does this fit?". What you have could be a
variation of "bipolar disorder". I keep putting quotes around
it because with symptoms like yours, our naming system is too rigid to
encompass your experience -- so every "label" will be wrong to some
extent. Obviously this is the point at which, if you're ready, you just
have to try some treatments (as you have done with the antidepressant) and see
if they take you in the right general direction. If a mood stabilizer
approach does go in that direction, then you've probably figured out that the
other "half" of that treatment approach would be to try gradually
lowering your antidepressant. All of this should be done with your
doctor's advice and guidance and awareness; this is not territory to explore
on your own. (It is territory worth thinking through, and if you must do
that on your own, so be it -- as you have been doing, obviously).
You wouldn't have to try to do anything with your
Zoloft until you were pretty convinced that a mood stabilizer was
helping (unless you want to try lamotrigine first; I wouldn't combine that
with Zoloft; but I would take at least 4 months to taper off Zoloft, whatever
approach you take).
Good on you for having figured things out this far to
at least as your "does this fit?" question. You've probably
figured out that if you were to ask 3 different psychiatrists that question,
you could easily get three different answers. Good luck to you.
Published August, 2001