Q: Hypomania is More Constant than Episodic
I am confused about whether one can simply just have hypomania and not have it
be either (1) an inbetween step from depression to mania, or (2)
induced by a reaction to an antidepressant both of which are discussed
separately in your cite. "Hypomania" seems best to apply to me but is more
constant than episodic. the negatives include agitation, irritability and
anger, not risky behavior or grandiosity. I have exhaustion sometimes. The
bipolar questionnaire doesn't help me much.
I am 43, creative, artistic, high energy, a successful professional with busy
family life and young kids. I've had some shopping problems according to my
husband but not to bankruptcy levels. When I'm "on" i do seem to be able to
multitask and take on way too much because it is easy for me to accomplish. If
i were to describe that i crash, i'd say i have periods where i feel exhausted.
I always need 7 hours of sleep.
Recently I have had some marital crisis and went on wellbutrin from a primary
care doctor, which made me exceptionally anxious, with true panic attacks. Then
I tried lexapro which made me too sleepy. My mother was diagonosed with manic
depression in 1970 and was one of the first patients successfully treated with
lithium . She is stlll doing great at 77. I have not have any true depressive
episodes or high mood swings.
I'm glad that trileptal is not just for epilepsy as my drug store medicine
warning sheet seems to indicate. that is how i found your site. Plus I finally
had the sense to go to a psychiatrist.
thanks for any thoughts/references to any literature.
Well, reading your letter is painful and exciting: painful because a good answer
here would take a couple of book chapters, not just what you've seen on my
website, which I'm glad was enough to get you wondering just as you've written
here but falls painfully short of what I'd really want to say in answer to your
question. The exciting part is that I actually wrote those chapters, a year
ago, and it took me months to get it right: the right flow of the explanation
starting from exactly where you were (before you read my stuff about hypomania
and antidepressant-induced hypomania), through to a proper answer to your
question. I'm excited because the book is almost out (about a month to go; yeesh,
this has taken forever...). The first three chapters, a good third of the
book, are the answer.
Summarizing those three chapters (I've been practicing
this): there is a continuum from unipolar or "plain" depression with no bipolar
component, to full "Bipolar I", the manic-depressive version. Many people can
be found distributed rather evenly all the way along that continuum. Those at
the left side (toward "unipolar") can lack any hypomania at all, yet still have
"bipolarity", by virtue of family history of bipolar disorder; or repeated
episodes of depression (cyclicity); or over-energized responses to
antidepressants (and I've heard the sleepy one too, but that is not at all
classic). These and more are the "soft
signs" you saw on my site, leading to the nickname for such bipolar
variations as "soft bipolarity".
Yet people with "soft bipolar" can still have bad
experiences on antidepressants (although many have good responses too; a doctor
named Jay Amsterdam has published multiple studies of good outcomes for people
with Bipolar II on antidepressant alone; here's a
review). What's not so clear is whether they can reliably do well on
mood-stabilizers-with-antidepressant-clout; or whether, more generally, the
at-least-eight (and some would count lithium too, worth considering in your case
given your mother's experience)
antidepressants-that-aren't-antidepressants. I hope that essay there might
make a lot of sense to you, and give you some stuff to discuss with your doctor.
Good luck with that.
Published April, 2006