What triggers hypomania
9 Most Common Triggers for Bipolar Mood Episodes
Spats with your sweetheart, chilly weather, grief — a number of scenarios may provoke bipolar mania or depression.
By Madeline R. Vann, MPHMedically Reviewed by Kathryn Keegan, MD
Medically ReviewedJustin Case/Getty Image
Bipolar disorder is characterized by symptoms including unusual shifts in mood and energy. These mood shifts or episodes last at least a week in the case of mania, and at least two weeks in the case of depression, according to psychiatrist Jeffrey Bennett, MD, an associate professor of psychiatry at the Southern Illinois University School of Medicine in Springfield.
There are several types of bipolar and related disorders. In order to be diagnosed with bipolar I, you must have had at least one manic episode that may have been preceded or followed by hypomanic or depressive episodes. In the case of bipolar II, you must have had at least one major depressive episode and at least one hypomanic episode, but never experienced a manic episode.
Both mania and hypomania share the same symptoms, which include feeling unusually upbeat, euphoric, or irritable, with increased energy, mood elevation, a decreased need for sleep, racing thoughts, trouble concentrating, and poor judgment. In cases of mania, these symptoms are severe enough to be causing significant problems in your day-to-day life.
For example, you might be unable to go to work or school, or you may be compulsively spending money. Hypomania is considered a less severe form of mania. In cases of hypomania, your daily functioning isn't significantly impacted. For example, you are able to work and socialize.
When mood shifts are severe enough, they can have a profound effect on your life. Some episodes of depression and mania are accompanied by loss of reality or psychosis, characterized by hallucinations or delusions. "And unfortunately, suicide is common, with some sources estimating it to be as high as 10 to 15 percent," explains Dr. Bennett.
Can these episodes be avoided? Perhaps not. But understanding certain triggers can help you better manage bipolar disorder.
One of the most common bipolar triggers is stress. In a study published in June 2014 in the Journal of Affective Disorders, negative or stressful life events were associated with subsequent mood swings. Earlier in their course, episodes of depression or mania in bipolar disorder appear to be triggered more often by stressful life events.
In addition, with recurrent episodes, some people with bipolar disorder may experience less complete periods of remission and a greater likelihood of relapse, either to depression or mania, according to Bennett.
While causes of stress are highly individual, certain life events and lifestyle patterns may act as triggers. Watch out for these common culprits.
Changes in Sleep Patterns or Lack of SleepGetty Images
A change in your sleep pattern is a hallmark symptom of bipolar disorder — but it can also be a trigger.
Shift workers, people who work long hours, and students who are short on sleep are all at risk for having a recurrence of a mood episode related to a lack of sleep. "In addition, travel beyond one's time zone can be another trigger for a mood episode," says Bennett.
Interpersonal and social rhythms therapy (IPSRT) is one of the most effective preventions, Bennett says. This treatment approach, available in group as well as individual sessions, helps you develop an orderly life schedule of sleep, diet, and exercise habits, to make you more effective at managing bipolar disorder.
Other forms of therapy, including psychoeducation and cognitive-behavioral therapy (CBT), can also be helpful in managing the illness.
Blowout Arguments With Partners, Coworkers, or FriendsPaul Simcock/Getty Images
Broken relationships are too often the result of untreated bipolar disorder.
But getting into a spat with a loved one could also be a red flag: Your argument could be due to the irritability that often occurs during a manic or depressive episode, or could itself cause stress that becomes a contributing factor for a recurrent episode.
Any type of relationship conflict — whether it’s with your partner, coworker, family member, or friend — can trigger stress and send you over the edge. In a study published in May 2015 in the Journal of Affective Disorders, people with bipolar disorder said negative social experiences were among the events that triggered suicidal thinking for them.
The Stress of a Bad Breakup or Failed MarriageGetty Images
A number of people with bipolar disorder — especially those with a history of severe manic episodes — have failed marriages. If you’re going through a divorce, working with your therapist through what is often a drawn-out and extremely stressful process can help.
You might consider a durable power of attorney that allows someone else to make major decisions for you, such as financial ones, when you are going through an episode of depression or mania in relation to or during a breakup.
In fact, assigning a durable power of attorney could be useful for anyone who might be experiencing an episode of bipolar disorder.
Alcohol Abuse and Drug Intoxication, and the AftereffectsIvan Kmit/Alamy
Abusing drugs and alcohol doesn’t cause bipolar disorder, but it can cause an episode to suddenly occur, or it can worsen the underlying illness. What’s more, about one in five people with bipolar disorder have a substance abuse disorder, according to an analysis of data on young adults with mental illness from an article published in February 2015 in the journal Social Psychiatry and Psychiatric Epidemiology.
Intoxication with drugs such as cocaine and amphetamines can cause or worsen manic symptoms, while the aftereffects of cocaine or use of alcohol are associated with worsening of depressive symptoms.
Antidepressants, Corticosteroids, and Other MedicationJeff Wasserman/Stocksy
Can antidepressants make you manic?
The treatment of bipolar disorder can trigger episodes of mania by further setting off unstable moods and behaviors. Many psychiatrists say they've seen patients enter a manic phase after starting antidepressants — and some feel uncomfortable prescribing them to bipolar patients.
What should you do about bipolar depression? Until more research is available on long-term safety, Keming Gao, MD, PhD, a professor of psychiatry at Case Western Reserve School of Medicine in Cleveland, suggests the following: For bipolar I depression, antidepressants should only be used with a mood stabilizer or stabilizers after symptoms haven't responded to FDA-approved treatment options (such as mood stabilizers).
Dr. Gao says that while some recent studies suggest that using an antidepressant alone is as effective as lithium taken alone for some bipolar II patients (those who haven't experienced a manic episode), they should never be used alone for bipolar I depression, and patients and doctors should consider discontinuing use of antidepressants once symptoms have responded.
Other drugs that have been linked to manic symptoms include corticosteroids, thyroid medication, and appetite suppressants.
A Brand-New Season and Abnormal 'Clock Genes'Noelia Ramon/Getty Images
About 20 percent of people with bipolar disorder experience fluctuations in mood when the weather changes. Specifically, they're more likely to undergo seasonal depression during the early winter, and mania or hypomania during the spring or summer, according to a research review published in October 2014 in the Journal of Affective Disorders.
Experts chalk this up to sunlight: Your circadian rhythm, the body’s internal response to changes in a 24-hour day, is affected by the amount of sunlight you experience. This response is controlled by a complex set of genes commonly referred to as “clock genes.” If some of these genes are abnormal, you could be at risk for seasonal bipolar disorder.
A Visit From the Stork Along With Altered Sleep Patterns and Shifting HormonesCatherine Delahaye/Getty Images
The American College of Obstetrics and Gynecology estimates that women with bipolar disorder have up to a 67 percent chance of experiencing an episode of bipolar disorder in the postpartum period — the weeks and months after birth.
Changing sleep patterns, altered medication prescriptions, and shifting hormones after delivery can combine to serve as risk factors for a postpartum mood or psychotic episode, according to research published in November 2014 in the journal The Lancet.
Use the nine months of pregnancy to work with your entire medical team — your bipolar disorder specialists and your ob-gyn — on treatment approaches you can try during and after pregnancy to help prevent postpartum depression, postpartum mania, or postpartum psychosis.
Bipolar disorder is also strongly associated with postpartum psychosis, a severe mental illness characterized by an inability to respond emotionally to one's newborn, or thoughts of harming one's baby.
Financial and Emotional Strains Due to a Job LossAudtakorn Sutarmjam/Alamy
One of life’s most unpredictable stressors? Losing your job.
And the emotions you may feel about your job loss can be equally unpredictable. People who weren’t satisfied with their work can find it liberating. For others, the financial and emotional strains involved can trigger major stress. Either way, the dramatic shift in emotions could trigger a bipolar episode.
It may be a good idea to put away three to six months of savings to help with the transition, should you lose your job.
The Death of a Loved One and BereavementGetty Images
The death of a loved one may be the most stressful life event any of us will ever face. Many people continue managing bipolar disorder successfully through their mourning, but it may have extreme consequences for others, who can develop “funeral mania,” says Bennett.
This occurs when someone with controlled bipolar disorder attends the funeral of the loved one and has a manic episode over the course of the following week. The period of bereavement should be one of increased monitoring and heightened support, advises Bennett.
Prevention of a bipolar mood episodes may not be possible, but understanding triggers may help you better manage your illness.
What Is It, Comparison vs Mania, Symptoms & Treatment
What is hypomania?
Hypomania is a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level or activity level. This energized level of energy, mood and behavior must be a change from your usual self and be noticeable by others.
Hypomania is a symptom of bipolar disorder, but can also be a symptom of other mental health conditions.
What’s the difference between hypomania and mania?
Hypomania is a less severe form of mania. The criteria that healthcare professionals use to make the diagnosis of either hypomania or mania is what sets them apart. These differences are as follows:
|How long the episode lasts||At least four consecutive days||At least one week|
|Severity of episode||Not severe enough to significantly affect social or work/school functioning||Causes severe impact on social or work/school functioning|
|Need for hospitalization||No||Possibly|
|Need for hospitalization||Can’t be present for a diagnosis of hypomania||Is among possible symptoms|
What triggers a hypomanic episode?
Each person’s triggers may be different. Some common triggers include:
- A highly stimulating situation or environment (e.g., lots of noise, bright lights, large crowds).
- A major life change (e.g., divorce, marriage, job loss).
- Lack of sleep.
- Substance use, such as recreational drugs or alcohol.
It’s smart to develop a list of your triggers to know when a hypomanic episode may be starting. Since hypomania doesn’t cause severe changes in your activity level, mood or behavior, it may be helpful to ask family and close friends who you trust and have close contact with to help identify your triggers. They may notice changes from your usual self more easily than you do. Share your trigger list with your close, trusted friends so they can tell when you might need help.
How long does a hypomanic episode last?
According to the criteria for hypomania, hypomania must last at least four days. But it can last up to several months.
What happens after a hypomanic episode?
After a hypomanic episode you may:
- Feel happy or embarrassed about your behavior.
- Feel overwhelmed by all the activities you’ve agreed to take on.
- Have only a few or unclear memories of what happened during your manic episode.
- Feel very tired and need sleep.
- Feel depressed (if your hypomania is part of bipolar disorder).
Symptoms and Causes
What are the symptoms of hypomania?
Symptoms of a hypomanic episode are the same but less intense than mania. Hypomanic symptoms, which vary from person to person, include:
- Having an abnormally high level of activity or energy.
- Feeling extremely happy, excited.
- Not sleeping or only getting a few hours of sleep but still feel rested.
- Having an inflated self-esteem, thinking you’re invincible.
- Being more talkative than usual. Talking so much and so fast that others can’t interrupt.
- Having racing thoughts — having lots of thoughts on lots of topics at the same time (called a “flight of ideas”).
- Being easily distracted by unimportant or unrelated things.
- Being obsessed with and completely absorbed in an activity you’re focus on.
- Displaying purposeless movements, such as pacing around your home or office or fidgeting when you’re sitting.
- Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.
What’s the difference between feeling good vs hypomania?
It takes time to know the difference. Everyone enjoys being happy and feeling good. But feeling good doesn’t always mean you are good. Over time, you’ll start to understand yourself and learn the warning signs that you may be starting to have an elevated mood that is different than just feeling good.
Ask family and close friends who you trust, and have frequent contact with, to give you feedback. Ask them to tell you when they see beyond normal changes in your mood or behaviors.
What does hypomania feel and look like?
What hypomania feels like and looks like will be different for each person. Some examples of things you might feel and/or do include:
- Get into an intense cleaning frenzy and clean all surfaces of every room in your house.
- Stay up until 3 a.m. or don’t go to bed at all and not feel tired the next morning.
- Start a project, or more than one project, and work non-stop on these projects for 20 hours straight.
- Feel that you can’t fail at anything you want to do, even if you have no training or experience.
- Call and text all your friends all day and night and post a large number of pictures and comments on social media.
- Quickly jump from subject to subject when talking, and talking very fast.
What causes hypomania?
Scientists aren’t completely sure what causes hypomania. However, there are several factors that are thought to contribute. Causes differ from person to person.
Causes may include:
- Family history. If you have a family member with bipolar illness, you have an increased chance of developing mania. This is not definite though. You may never develop mania even if other family members have.
- Chemical imbalance in your brain.
- Side effect of a medication (such as some antidepressants), alcohol or recreational drugs.
- A significant change in your life, such as a divorce, house move or death of a loved one.
- Difficult life situations, such as trauma or abuse, or problems with housing, money or loneliness.
- High stress level and inability to manage it.
- Lack of sleep or changes in sleep pattern.
- As a symptom of mental health problems including cyclothymia, seasonal affective disorder, postpartum psychosis, schizoaffective disorder or other physical or neurologic condition such as brain injury, brain tumors, stroke, dementia, lupus or encephalitis.
Diagnosis and Tests
How is hypomania diagnosed?
Your healthcare provider will ask about your medical history, family medical history, current prescriptions and non-prescription medications and any herbal products or supplements you take. Your provider may order blood tests and body scans to rule out other conditions that may mimic mania. One such condition is hyperthyroidism. If other diseases and conditions are ruled out, your provider may refer you to a mental health specialist
To be diagnosed with hypomania, your mental health specialist may follow the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Their criteria for manic episode is:
- You have an abnormal, long-lasting elevated expression of emotion along with a high degree of energy and activity that lasts for at least four consecutive days and is present most of the day, nearly every day.
- You have three or more symptoms to a degree that they’re a noticeable change from your usual behavior (four symptoms if mood is only irritable). (See the symptoms section of this article for a list of the symptoms used as criteria.)
- The hypomanic episode is not severe enough to significantly interfere with your social, work or school functioning and there’s no need for hospitalization.
- The hypomanic episode can’t be caused by the effects of a substance (medications or drug abuse) or another medical condition.
If you have hypomania, you don’t have thoughts that are out of step with reality — you don’t have false beliefs (delusions) or false perceptions (hallucinations). If you do have these symptoms of psychosis, your diagnosis is mania.
What is bipolar II disorder?
Bipolar II disorder is a type of bipolar disorder in which people experience depressive episodes as well as hypomanic episodes (shifting back and forth), but never mania. People with bipolar II disorder tend to have longer and more frequent depressed episodes than people with bipolar I disorder.
If the severity of your symptoms never rises to the level of mania, you have bipolar II disorder. If you have even a single episode of what is considered mania or one psychotic event (delusions or hallucinations) during a hypomanic episode, your diagnosis would change to bipolar I disorder.
Management and Treatment
How is hypomania treated?
Hypomania is treated with psychotherapy, antipsychotic medications and mood stabilizers.
Psychotherapy involves a variety of techniques. During psychotherapy, you’ll talk with a mental health professional who will help you identify hypomania symptoms and triggers and learn ways to cope with or lessen the effects of hypomanic episodes.
Antipsychotic medication choices include:
- Ariprazole (Abilify®).
- Lurasidone (Latuda®).
- Lanzapine (Zyprexa®).
- Quetiapine (Seroquel®).
- Risperridone (Risperdal®).
Mood stabilizers include:
- Valproate (Depakote®).
- Carbamazepine (Tegretol®).
(If you’re pregnant or plan to become pregnant, let your provider know. Valproate can increase the chance of birth defects and learning disabilities and shouldn’t be prescribed to individuals who are able to become pregnant. )
Sometimes antidepressants are also prescribed.
Managing hypomania without medications
If your hypomania is mild, you may be able to cope without medications. Your healthcare provider may suggest having a greater focus on self-care to stay as healthy as possible.
Suggested actions may include:
- Go to bed at the same time each night and get plenty of sleep (six to nine hours).
- Avoid stimulating triggers such as coffee, tea, colas, sugar, noisy and crowded environments.
- Eat a healthy diet, such as the Mediterranean or Dash diet.
- Get 30 minutes of exercise on most days of the week. Even two short walks a day is beneficial.
- Don’t use illegal or recreational drugs or alcohol.
- Learn ways to relax. Yoga, meditation, listening to calming music, aromatherapy are a few examples.
- Take all medications as prescribed or instructed on package labeling. If you think you’re having side effects or new side effects to a medication, call your provider. Never stop taking — or change the dose — of a prescription medication without talking to your provider first. Make sure they know all supplements, herbal products and vitamins you take.
- Join a support group. Ask your provider for contact information for local support groups. You might find it helpful to talk with other people who have similar medical experiences and share problems, ideas for coping and strategies for living and caring for yourself.
Can hypomania be prevented?
Episodes of hypomania can’t always be prevented. However, you can learn ways to better manage your symptoms and prevent them from getting worse.
Suggestions on your “to-do list” might include:
- Keeping a “mood diary” to become more self-aware of events that trigger an oncoming episode of hypomania. These events are unique to you. Sometimes you can’t recognize your own triggers. Ask your trusted, close family and friends to help identify when they see changes in your mood, behavior and energy level that is different from your usual self.
- Following other coping strategies. (See the bulleted list under, “Managing hypomania without drugs,” just above in this article.)
Outlook / Prognosis
What outcome can I expect if I’ve been diagnosed with hypomania?
If you’ve been diagnosed with hypomania, you can have a favorable outcome if you learn about your condition, learn to recognize when you’re having a hypomanic episode and engage in coping strategies to lessen the severity or prevent events. Always take any prescribed medications as directed by your healthcare provider.
A note from Cleveland Clinic
Being amped up about your life and being in a good mood is usually thought to be a good thing. It can be if that’s how you normally are most of the time. This is what makes hypomania a little tricky to diagnose. Key to a diagnosis of hypomania is that your elevated mood, behavior or activity level must last at least four days (all day or most of the day) and must rise to the level that’s beyond normal and is noticeable by others. Know that a team of healthcare professionals — your primary care provider, psychologists and/or psychiatrist — is ready to help you figure this out.
Frequently Asked Questions
Can my diagnosis change between bipolar II disorder and bipolar I disorder?
Yes. If you have been diagnosed with the less severe condition of hypomania and have even a single episode of mania (as defined by the criteria), your diagnosis will change to bipolar I disorder. Once you have a diagnosis of bipolar I disorder – even if you never have another manic episode – your diagnosis can never be changed back to bipolar II disorder. You’ll always have a bipolar I disorder diagnosis.
When it's bad to be happy, or What is hypomania - Daria Varlamova - Health - Site materials - Snob
Diagnosis: happiness over the edge
Imagine the following situation: a patient comes to a psychotherapist. Satisfied, cheerful, elegantly dressed man with a beaming smile on his face.
— Hello, what are we complaining about?
— Doctor, I feel too good.
— The sun is so clear. The flowers are so pretty. I listen to jazz - I cry with pleasure. I love my wife - I don’t get out of bed for days. I take up the work - it’s really bursting, how interesting. And everything, you know, turns out so meaningfully, everything in the world is so beautiful and important. I have so many useful ideas and plans - I just want to do everything. It’s even a pity to go to bed at night - it’s too exciting to live ...
Here, in the place of a psychotherapist, any reader, most likely, begins to feel acute envy (and a psychotherapist can also, nothing human is alien to him). I would like to say: what are you complaining about - you would go and burn with napalm, as long as you have the strength. Indeed, for the majority of sluggish, eternally tortured citizens in the metropolis, such a regime is an unattainable dream. To expand the possibilities of living life to the fullest, chemists develop nootropics, artists experiment with consciousness, and ordinary citizens go to various trainings to achieve bliss - but for about 1-7 percent of humanity, all this bouquet of joys is periodically given out just like that, absolutely for nothing. Because the biochemistry of the brain so ordered. Such an “arrival” can last for quite a long time - from several days to several months. nine0005
What's wrong with that?
This condition is called hypomania. Translated from Greek - "a slight degree of mania" (which, as it were, hints at the direction of further development). In order to make a diagnosis, the state of atypical elevation of mood must last 4 days or more. In addition to the sensations of joy and unbearable lightness of being, there is an influx of energy and an increase in physical and mental productivity. That is, a person with hypomania is not just optimistic about his achievements, but is really capable of more, if, of course, he can concentrate on one task and does not deal with several world problems at the same time. And at the same time, it can save a lot of time: as it should be, a "overclocked" hypoman begins to miss 4-5 hours of sleep per day (this is one of the surest signs that a person has not just a bright streak in life, but a specific psychiatric condition). Add to this growing self-confidence and a noticeable improvement in communication skills - a shy nerd in this state can easily give a TED lecture, and then go to a bar with a vending audience. Since this all sounds too good, it begs the question: what's the catch? And of course he is. And not even one. nine0005
First, back to the therapist scene. In real life, it is very unlikely. For obvious reasons, a person in this condition will never go to the doctor. Who in their right mind would be treated for happiness? And, in fact, it would be worth it to be wary, because along with the pleasant gifts of hypomania, side effects await the lucky one: ; nine0024
Okay, let's not talk about carousing and promiscuity as if it's something bad. It's not the end of the world for a respectable family man to suddenly go off the rails and throw himself a Hangover, and it could very well happen without a mental breakdown. But the most important problem is how strong such an uncontrollable rise in mood can reach.
Is it far from mania
Hypomania can appear for several reasons. It can occur as a side effect of drugs (eg, antidepressants) or narcotic substances, sometimes manifests itself in the course of organic brain damage or hyperthyroidism, but most often emerges as part of the symptoms of bipolar affective disorder (BAD). Previously, this disease had a more unpleasant name - "manic-depressive psychosis", but later it was replaced with a politically correct term that perfectly reflects the essence of the problem. BAD is characterized by a change of opposite phases that swing a person like a swing, then up (hypomania and mania), then down (depression). The rhythm of this attraction does not depend on the person himself, which leads to great instability and self-doubt: today you are an energetic superman who can make humanity happy, and the next day you are a meaningless nonentity who does not even have the strength to take a shower. According to the World Health Organization, bipolar disorder is in the top 10 leading to disability, and it carries a much greater risk of suicide than just depression. nine0005
If we could artificially induce and maintain a state of hypomania at a productive level, this would be a very useful discovery. But in fact, relying on this state is not very worth it: in some cases, it can either lead to mania (and this is already a jump of thoughts, delusional ideas, in severe cases, even psychosis or hallucinations), or an organism that has exhausted its energy enters the other pole pendulum and finds himself in a depression. Therefore, having noticed unexpected, but long enough lasting periods of delight and vigorous activity, especially if they alternate with periods of depression, it is worth thinking about and consulting with a specialist just in case. There are people who manage to keep their hypomania in check and use it for productive work (and a number of studies show a correlation between bipolar disorder and creativity quite convincingly), but again, it is better to explore the limits of your abilities under the supervision of a person with a psychiatric education. nine0005
Something to think about
- If you have already consulted a specialist with complaints of depression, do you remember if you have a reverse pole? Bipolar disorder is often underdiagnosed precisely because patients do not consider hypomania to be abnormal, but medications for major depressive disorder may not help with bipolar and vice versa.
- If you are a person of mood, you should not immediately fall into hypochondria: the first thing you should pay attention to is sleep. If you usually sleep 8-9hours and still hardly get up for work, and now you feel like a May rose after 4 hours of sleep, this is a reason to worry. If mood fluctuates and sleep stays the same in duration, bipolar disorder is unlikely.
- In any case, you shouldn't diagnose yourself. It makes sense to familiarize yourself with the lists of symptoms in the International Catalog of Diseases or the American DSM-V diagnostic guide, but in any incomprehensible situation it is better to go to the doctor. nine0024
symptoms of bipolar disorder, how it proceeds, how to find a psychiatrist, diagnosis and treatment
lives with bipolar disorder
The first signs of the disease appeared in my teens, and the psychiatrist diagnosed bipolar disorder at the age of 26.
According to WHO, 45 million people worldwide suffer from bipolar disorder. This disease greatly reduces the quality of life: in some periods you are overly energetic and do things that you can regret, in other periods you are not able to get off the couch to do everyday things. nine0005
I will tell you how I have BAD and what I do to cope with the disorder and live like all ordinary people.
Go see a doctor
Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations. Relying on our point of view or not is up to you. nine0005
What is Bipolar Affective Disorder?
Bipolar Affective Disorder, or BAD, is a mental disorder with alternating emotional ups and downs in mood. It is affective just because it is associated with violations of the emotional state, that is, mood - in psychiatry, the manifestation and experience of emotions is called affect. Previously, this disease was called manic-depressive psychosis.
Bipolar Disorders - A Physician's Handbook MSD
Why bipolar disorder develops is not exactly known. Among the reasons are heredity, traumatic events, violations of the production of neurotransmitters - substances due to which signals are transmitted between brain neurons. The disease often manifests itself in adolescence or in the period between 20 and 30 years.
How Bipolar Disorder Manifests
BAD usually starts abruptly, followed by periods without symptoms and periods of exacerbations. The peculiarity of the disease is that during periods of exacerbations there are episodes, or phases, with different emotional states that can replace each other in an arbitrary order. nine0005
Bipolar Disorder - Mayo Clinic Blog Article
For example, when the illness escalates, the following conditions may occur.
Mania - a state of elevated or irritable mood. The person feels energetic, actively engaged in something, such as finding a new hobby or even trying to open a business. As a rule, he sleeps little, is self-confident, talkative, he has a lot of ideas, often crazy. Risk sensitivity may decrease - for example, a person invests all the money in a hopeless business or gets into a loan. Hobbies for gambling, extreme sports are not uncommon. At the same time, a person feels great, but often cannot concentrate on one thing, work productively. nine0005
The extreme degree of mania is manic psychosis, when delusions of persecution, hallucinations, excessive activity develop, a person can become dangerous to himself or others.
Hypomania is a kind of mild mania. A person is in a state of emotional uplift, but this uplift is not so pronounced. However, the mood still improves, the need for sleep decreases, the person is creative, relaxed, feels euphoric, and his productivity increases. Although in some people such periods may be accompanied by irritability and a decrease in concentration. nine0005
Depression - low mood, loss of interest in life, fatigue, guilt, indecision, decreased concentration. Sleep and appetite disturbances may occur. Sometimes there are thoughts of suicide, the futility of one's own life.
“It reminded me of a strict regime sanatorium”: how much I spent on treating depression
Between exacerbations, a person can return to normal, although it happens that his performance is still reduced. nine0005
Manifestations of the phases of bipolar disorder, according to the National Institute of Mental Health USA
|Mood||Excitation, joy, irritability, resentment||Sadness, depression, emptiness, anxiety, hopelessness|
|Sleep||Reduced need for sleep||Trouble falling asleep, getting up early or sleeping too much|
|Appetite||Loss of appetite||Often increased appetite, weight gain|
|Communication||Talkativeness||Slow speech, forgetfulness|
|Concentration||Sensation of jumping thoughts, multitasking||Problems with attention and decision making, distraction|
|Behavior||Risk appetite, runaway spending, promiscuous sex||Lack of pleasure and interest in anything, decreased libido|
|Subjective feelings||Feeling of self-importance, talent and power||Feelings of worthlessness, suicidal thoughts, suicide attempts|
Excitement, joy, irritability, resentment
Decreased need for sleep
Loss of appetite
Feeling of thoughts, multitasking
risk, unbridled sex
Feelings of their own importance, talent and power
9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 9000 Mood
Sadness, depression, emptiness, anxiety, hopelessness
Trouble falling asleep, getting up early or sleeping too much
Obly increased appetite, weight gain
Slow speech, forgetfulness
Problems with attention and decision-making, Disperionity
Lack of pleasure and interest in something, decrease in libido
Feelings of worthlessness, suicidal thoughts, suicide attempts
There are two main types of bipolar disorder according to how the disease manifests itself:
- When there was at least one manic episode and depressive episodes recur.
- When there are periods of depression and at least one episode of hypomania, but without full mania.
Bipolar Disorder - National Institute of Mental Health USA
I just have bipolar affective disorder type 2. This means that there are no full-fledged manias, but there are hypomanias and severe depressions.
Hypomania is a very cool time for me. You can do everything: get a second degree, run a marathon, learn English, go on an unplanned trip. And so for several months during which you do not sleep, do not eat, acquire new friends, start novels, end old relationships. You feel all sensations in the maximum range. During the day, it can throw several times from tears and the desire to die to incredible happiness. nine0005 This is what mania looks like in BAD. Source: Twitter
After hypomania comes depression. And immediately there is not enough strength not only for what was started during the previous phase, but also for ordinary things. The most understandable image of depression for me is “pressed down by a concrete slab. ” It becomes hard to do the simplest things: wash the dishes, change clothes, go to the store.
Unfortunately, the brighter the hypomania goes, the worse the depression gets later — that's why, with experience, I stopped enjoying the active phase. nine0252 Now it is even more difficult for me: I understand what is happening with my brain, but I cannot control it.
As I remember now, my first hypomania happened at the age of 12. Then there were periods of exacerbations clearly in a year and a half: hypomania lasts 2-3 months, usually May - July, depression - 5-6 months, usually in October - March, in between remission occurs when I feel normal. If I am in a long-term remission, then I hardly notice phase changes: mood swings are smoothed out with the help of medications or psychotherapy. nine0005
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The usual course of bipolar affective disorder
psychiatrist, science journalist
During an exacerbation of bipolar disorder, episodes of mania or hypomania and depression may alternate. There is a clear separation of phases: first a hypomanic or manic episode, then a depressive episode, it happens that there are recurring episodes of depression, then hypomania. In the latter case, hypomanic phases are sometimes not noticed, a person may be diagnosed with recurrent, that is, recurring depression, and may be prescribed the wrong treatment. nine0005
In fact, in BAD, the phases can alternate in any order, the diagnosis is made if there is any combination of manic and depressive episodes. The first time the disease usually begins with an episode of mania or hypomania, which develops into depression. Less commonly, it starts with depression, then mania or hypomania occurs. But in any case, there must be affective disturbances, that is, mood disturbances.
The exacerbation of the disease lasts from several weeks to several months. This also depends on whether the person is receiving medical treatment. If you respond quickly to an exacerbation, you can sometimes return to normal health in a week. If not treated, the exacerbation can last for several months - especially the depressive phases, episodes of hypomania and mania usually pass faster. nine0005
Seasonality of phases, when there is a connection between the manifestations of the disease and the change of seasons, occurs, but not all patients with bipolar disorder notice it.
How I suspected I had BAD
The first time I thought I was going crazy was when I was 18 years old. Painful relationships ended, obsessive thoughts and images swirled in my head, I listened to the same song in the player, walked for hours and could not stop. This went on for so long and was so unbearable that I almost decided to go to a psychiatrist. However, they didn’t talk about mental disorders then, so I didn’t even know where to turn. Then this state passed by itself. nine0005
I did not see a psychiatrist until seven years later, when I again had a similar severe condition: obsessive thoughts, inability to control emotions, self-harm, sleep and appetite disturbances. Before that, I had three episodes of hypomania every two years, but after them there was no severe depression, and therefore no reason to seek help.
Then I just went to the district clinic - it turned out that a psychotherapist was there. She checked my symptoms on the Beck scale, diagnosed me with an anxiety-depressive disorder, and prescribed a common antidepressant that is often prescribed for depression. nine0005
Beck Depression Scale - online test
It seemed to me that antidepressants helped me immediately: my mood improved, I got energy, I talked a lot with friends, hung out, worked. Now I know this is a bad sign. Antidepressants usually take a long time to work: it takes about three weeks for the effect to appear, and I got better after a few days. In addition, in bipolar affective disorder, antidepressants can cause hypomania if not mitigated by other drugs. nine0005 This meme is well understood by those who were not immediately given the correct diagnosis. If you add Mentos to Coca-Cola, you get a foamy fountain that will splash out of the bottle. Antidepressants, in particular SSRIs - selective serotonin reuptake inhibitors - have the same effect on the mood of people with BAD
. I went to this psychotherapist several more times, but she did not track my sharp mood swings, and I had one of the most severe hypomanias . I drank and smoked a lot, I had incredible emotional swings, I ruined my relationship with my best friend, I stopped eating and sleeping. nine0005
After a couple of months, my condition stabilized a little, but I continued to take antidepressants: I knew that they should not be stopped abruptly. Before canceling, I went for a consultation with another doctor, already at a paid clinic. She turned out to be a good specialist: she asked questions about mood swings, found out if I had previously had mood swings, ups and downs, depressions. Then everything was fine because of taking antidepressants, so I denied everything.
A year later, as the doctor ordered, I smoothly stopped taking antidepressants, and a few months later I was overcome by one of the most severe depressions. If last time I could attribute depression to circumstances - burnout, relationship difficulties, fatigue - now there was no reason for it. I had a job I loved, a great relationship with my husband, financial stability, a new city. And I wanted to die. nine0005
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This moment became a turning point in the diagnosis. I already knew that there is such a disease as bipolar affective disorder, what are its symptoms and features. Information about BAR appeared in the media field: I read articles and blog posts, watched videos on YouTube.
I was able to describe the last 10 years of my life in phases: there was a strong rise, followed by a decline. For example, in the hypomania of 2012, I worked two jobs, passed the state exams, wrote a diploma, hung out with friends until the middle of the night and completely took care of the life of the family. In hypomania in 2014, she entered the magistracy, graduated from a driving school, traveled, and also ran a marathon. nine0005
Every upsurge was followed by a downturn: I stopped running, didn't pass the exam in the traffic police, and dropped out of the master's program. Each such exacerbation generally lasts a year and a half, and then repeats.
How I was looking for a suitable psychiatrist
After collecting information about BAD, I decided to find a psychiatrist to confirm or deny my diagnosis. It didn't happen right away.
First I went to a psychiatrist on the advice of a friend, he helped her with depression. The doctor saw me in a paid clinic, the appointment cost about 3000 R. The consultation was unsuccessful: the doctor was clearly not interested in my condition, he indifferently asked questions about depression and prescribed antidepressants. And not the ones that were assigned to me last time, but others. I was too depressed to stand my ground, so I just started looking for another doctor. nine0005
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The second doctor was in a state clinic, she was recommended to me on Facebook. At first, I waited a long time for an appointment - the doctor was half an hour late, then I started asking about birth injuries and vascular dystonia. This consultation didn't work for me either. I paid 2,000 rubles for her.
The third appointment was successful: I found a psychiatrist, to whom I still go. She works at the State Institute of Psychiatry, but I see her for a fee. One consultation costs 2500 R.
I pay a psychiatrist for one appointment
The institute where the doctor sees, I was advised somewhere in the comments on the Internet. I called the reception and asked to sign me up for a doctor specializing in affective disorders as soon as possible.
The search for a suitable psychiatrist took about a month, so I went to see a doctor in a completely crushed state, in tears and hysteria. The psychiatrist asked me about the illness, listened to me and offered free hospitalization. However, I refused: I felt that I was controlling myself so as not to commit suicide, and my husband was also nearby, who understood the seriousness of the situation. As a result, I continued the treatment at home. nine0005
When hospitalization is needed for bipolar disorder
psychiatrist, science journalist
Hospitalization for bipolar affective disorder may be necessary if during a manic episode the patient develops strong arousal, he completely loses a critical attitude to his condition, and hallucinations appear rave. Such a condition can end badly for the patient himself or his relatives. In a depressive episode, indications for hospitalization will be suicidal thoughts or suicide attempts. nine0005
Inpatient treatment may also be needed in case of a severe decrease in working capacity.
If you suspect you have bipolar disorder, but are not in the acute phase of the disease, help is not urgent, it is better to spend time looking for a psychiatrist who specializes in bipolar disorder or affective disorders in general. Such a doctor is likely to quickly make the correct diagnosis and select the best treatment.
Before taking, it is worth writing down all the symptoms that bother you, and also, if possible, make a retrospective graph of the expected phases - mania and depression, write down when they occurred and how long they lasted. This will help the doctor understand if this is BAD or something else. nine0005 This is how the BAR phase sequence looks like in my case
BAD treatmentConsultations with a psychiatrist and drug therapy
The psychiatrist first wrote me a prescription for several drugs: antidepressants and mood stabilizers. They are usually prescribed to people with affective disorders.
As they explained to me, treatment is, among other things, checking for the correctness of the diagnosis, a way to distinguish depression from bipolar disorder. If the prescribed drugs help, the diagnosis is correct. nine0252 About two months later, my diagnosis was officially confirmed: bipolar affective disorder type 2.
How bipolar disorder is diagnosed
psychiatrist, science journalist
Bipolar affective disorder is diagnosed by the problems that bother a person. His story should contain a description of typical mood and behavioral disorders, usually there is an alternation of phases of the disease.
For diagnosis, complaints and a history of the disease are enough, sometimes the testimonies of relatives are also taken into account, which can tell about a person's behavior. It happens that a doctor can send you to a clinical psychologist for a psychological examination, but usually an ordinary psychodiagnostic conversation is enough. nine0005
You can suspect the disease on your own, although with hypomania or mania, criticality to one's condition often decreases, that is, a person does not understand that something is wrong with him. Sometimes relatives of the patient come for help, and not he himself. It is better to apply for a diagnosis to a specialist who has worked with BAD, knows what the manifestations of the disease look like.
In general, drug therapy for bipolar disorder consists of several types of drugs that relieve different manifestations of the disease. These are normotimics that stabilize mood, antidepressants that help to cope with depression, antipsychotics that relieve excessive arousal. nine0005
Medication for Bipolar Disorders - MSD Handbook
Bipolar Disorder in Adults: Choice of Therapy - Article for Physicians Uptodate
The doctor selects the type of medication and dosage based on the phase the patient is in. Antidepressants are usually used in depressive phases and in combination with mood stabilizers. Antipsychotics - only in manic episodes and also together with normotimics.
In severe cases, a person with bipolar disorder may take up to six different drugs. But you need to strive to get by with one or two. nine0005
I started taking prescribed antidepressants and mood stabilizers immediately after seeing a psychiatrist. This time, the process of getting out of depression was long and smooth.
How therapy is selected for bipolar affective disorder
psychiatrist, scientific journalist
The psychiatrist selects treatment individually, taking into account the clinical picture: in the depressive phase - some drugs, in the hypomanic phase - others, in mania - still others.
It is important to combine drugs correctly. So, if a patient with bipolar disorder is prescribed only antidepressants, this can worsen the situation, even if he is depressed. Antidepressants can "disperse" his condition to hypomania or even mania. It is necessary to normalize a person’s well-being, and not throw him into a state with the opposite sign, so therapy includes normotimics. nine0005
The fact is that depression in BAD is not the same depression as usual, they are not always similar even in external manifestations, there are differences from a biological point of view, that is, in how processes in the brain change.
I visit my psychiatrist regularly: she adjusts the doses of drugs and monitors my condition. In the first year, I visited her six times - it cost me 15,000 R. Now I go to the doctor only during an exacerbation or a presumptive phase change - about four times a year, once every three to four months. It costs 10,000 R per year. In total, I have been seeing a doctor for three years now. nine0005
For two years, until recently, I took antidepressants and mood stabilizers in the minimum dosage. A pack of antidepressants for a month cost about 400 R, mood stabilizers - 600 R. That is, during the period of remission, the pills took 1000 R per month.
I spend on pills a month in remissionMy prescriptions for drugs
However, a few months ago I had an exacerbation, I went into hypomania, so the regimen and dose of drugs had to be changed on the go. Within two weeks, my psychiatrist and I canceled antidepressants, significantly increased the dose of mood stabilizers - 2.5 times, and added antipsychotics. During the exacerbation, which lasted two months, 4000 R per month was spent on tablets. Now 2000 R will go away - the dose of mood stabilizers has been reduced by one and a half times and neuroleptics by half, antidepressants have been removed. nine0005
It is interesting to observe how quickly drug therapy changes the state of the body and how it then returns to normal. Often, drugs do not fit the first time, so you need to regularly visit a psychiatrist and monitor your well-being. But after choosing the right therapy, you can live almost as before, except that you need to be more attentive to yourself.
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BAD treatment cannot be found once and for all
Each patient who is responsible for the treatment of bipolar disorder and is in contact with the doctor has his own scheme for changing the dosage or types of medications, taking into account well-being. For example, if you cannot sleep for more than a few days and stop eating, you add an antipsychotic. If you fall into an abyss of self-hatred and don’t swim for more than a week, an antidepressant will help.
Of course, this does not cancel regular meetings with a psychiatrist, because the process of choosing drugs and dosages is very complicated. Now I can regulate a lot myself, depending on how I feel, but I still see a specialist. nine0005
At the same time, bipolar affective disorder cannot be cured once and for all - you can only go into a long remission. As my doctor told me, this is five years without pronounced phases. In my case, I lasted two years without episodes, and now I need to start the countdown again.
Also, as far as I know from my experience and the experience of people with the same diagnosis, at some point there is an illusion that everything is cool, there is no illness, it seemed to you that you are doing great. At this point, people stop taking pills - this is a bad decision, never do this. If you feel good, first of all, you should check if this is the beginning of hypomania. And secondly, be glad that you have entered remission. nine0005
During these three years, I once stopped drinking pills - depression occurred, once I did not pay attention to the symptoms - I got severe hypomania, now I am trying to go into remission again.
Treatment of bipolar affective disorder can be more effective if drug therapy is combined with psychotherapy. Cognitive behavioral therapy is often used for bipolar disorder. It teaches you how to cope with stress factors, monitor your condition, manage the symptoms of the disease. Even during the sessions, together with the doctor, they work out trigger situations, that is, what can provoke an exacerbation of the disease. nine0005
Bipolar affective disorder and supportive psychotherapy - article on the Uptodate physician website
For example, I have trouble admitting my own mistakes. Every mistake for me is a tragedy, and it seems to me that those around her will never forget. It is difficult for me to admit my own mistakes, oversights cause great anxiety. I also have an ideal image of what I should be: read a lot, earn money, keep my house perfectly clean, have six-packs, study, know two foreign languages, go to exhibitions. Obviously, this is impossible, but a persistent desire to reach an unattainable height is also stressful. I work through all this with a psychotherapist. nine0005
I started therapy only six months ago, on the advice of a doctor, before that I thought that I could cope on my own. At first she was in therapy with a psychotherapist, whom she found through the Inhale project, which helps burnt out employees from the charitable field. I worked with her on this project, then continued after completion.
We looked at situations that increase my anxiety, including fear of making mistakes and being judged, as well as difficulties in life in general. The cost within the project was 400 R per meeting, there were about ten of them in total, then, already outside the project, the price increased to 2400 R.
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Now I went to another psychotherapist - she has a more applied approach, we look for my cognitive distortions and try to remove them. For example, we work with my excessive anxiety about the impression I make on other people, and the fear that I cannot control it.
The cost of sessions with this specialist is 2500 R per visit. Now I go to her every 10-14 days, that is, 2-3 times a month. In general, I have been working with my condition on my own for quite a long time, so the therapist only directs me in the right direction. nine0005
Is psychotherapy mandatory for bipolar disorder
psychiatrist, science journalist
Cognitive behavioral therapy is most often prescribed for bipolar disorder. This is an optional therapy, that is, an auxiliary method of treatment, you only need to take medication. However, psychotherapy can greatly improve the quality of life: it complements the action of drugs well, helps to control and change those things that pills do not work on. First of all, cognitive-behavioral therapy helps to control emotions, better cope with your illness. nine0005
Many also benefit from support groups for people with bipolar disorder. I tried to go to such a meeting, but it didn’t work for me: I don’t want to define myself through illness, this is part of my life - but not me.
The largest project holding such meetings is Sunday BAR. They support not only people with bipolar disorder, but also their loved ones. Meetings are held online and offline.
List of support groups in different cities for people with BAD and other disordersPDF, 275 KB
Universal advice given for bipolar disorder and beyond includes the following recommendations: maintain sleep and work-life balance, eat right, do not drink alcohol, play sports.
All this really helps, but in fact, organizing your life is difficult: meetings with friends, vacations, unexpected work do not fit into the routine, you want to work more, and alcohol looks like a great way to cope with anxiety, although in fact it can lead to depression. nine0005
I try to keep the correct regimen to the best of my ability. True, according to my feelings, depression comes by itself, without any triggers from the outside, and I cannot influence it. But hypomania is fueled by new projects, loves, and other emotions. For example, even a small amount of falling in love causes hypomania, which, in turn, increases falling in love. It doesn't end well.
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I lived in St. Petersburg for quite a long time, where during the white nights you don't feel like sleeping at all - and this provokes hypomania. One of the psychiatrists even forbade me to go to St. Petersburg for some time.
Now I have a well-established sleep and eating regime, I quickly notice its violation - this is a signal that an exacerbation has begun. Unfortunately, sometimes the regime is knocked down by external circumstances, then it is more difficult to notice the exacerbation of BAD.
Sleep is very important to me - it's my priority. I try not to hang out until the middle of the night, and if I didn’t manage to get enough sleep, then I try to sleep in the afternoon. I usually go to bed around midnight, get up at 8-9hours of the morning is a comfortable mode for me and my work. I very rarely stay awake at night or wake up later than 10 am.
I have a fitness bracelet that tracks the phases and amount of sleep - it helps to see the dynamics and notice deviations. When I see a sleep disorder, I start drinking light tranquilizers and antipsychotics to return to a comfortable mode.
|Sleeping less than seven hours on pills indicates an episode of hypomania, without drugs in this phase I would sleep less than four hours||And sleep for more than seven hours is already the normalization of the state after the addition of other tablets|
I am lucky that I take my job seriously: it is responsible and resource-intensive, it is important for me to be productive, it disciplines and helps me to keep the regime.
What to do to reduce the frequency of exacerbations
psychiatrist, science journalist
In BAD, it is important to have a daily routine that allows you to maintain normal behavior. This reduces the frequency of exacerbations, sometimes helps to completely avoid the recurrence of episodes of the disease. In addition to quality sleep and proper nutrition, you need to avoid overwork, work in an exhausted state, give yourself a rest. Doctors usually insist on the exclusion of alcohol, drugs are also dangerous, especially stimulants, which can cause psychosis in a healthy person. nine0005
Exacerbations of the disease can occur on their own, without the influence of external factors, or they can be caused by external events, both tragic, such as the death of a loved one or a break in relationships, and joyful. Therefore, it is important to learn to recognize your emotions, to identify in time what provokes a new episode, both independently and with the help of psychotherapy.
How I live with BAD now
Accepting the diagnosis was not easy: on the one hand, it finally became clear what was happening to me and that it could be regulated. On the other hand, this is a diagnosis for life. You need to constantly monitor your condition, take pills, consult with doctors. nine0005
The most difficult thing for me was the inability to separate myself as a person from the disease. What of what I did in life was the result of my choice, and what was a symptom of the disease? Moving from city to city, changing jobs, partners, hobbies - what if all this is just a disease, and I'm not behind it? Three years have passed - and I still cannot separate myself from BAD, it seems impossible.
Now life has become easier: now I know what to expect in the near future, because the phase schedule is still respected. It is clear when to slow down with the pace of life, and when to add antidepressants. nine0005
My work is related to people. Of course, the disease affects my mood and state: in depression I have less strength and the ability to give out emotions, in hypomania, on the contrary, there are a lot of emotions, but there is not enough concentration. It's good that work allows you to vary the load depending on the phase: in depression I can work a little less, and in hypomania - a little more.
At the time of my first diagnosed depression, I had an unloved job, it took the entire resource. I cried in the mornings, afternoons and evenings because it was difficult for me to keep working. Now I really love my job, it gives me more resources than it takes. nine0005
I continue to take medication, see a psychiatrist several times a year and a psychotherapist several times a month. In March, at the most difficult moment of the exacerbation, I spent on medicines, an appointment with a psychiatrist and three meetings with a psychologist 13,000 R.
I go into remission and spend about 8,000-10,000 R per month on medications, a psychologist, and periodic appointments with a psychiatrist. A significant amount, but it allows me to remain in a resourceful and efficient state. nine0005
The unobvious difficulty of living with bipolar disorder is the need to strictly control one's financial situation. In hypomania, money flies away easily, you make decisions instantly - for example, you can decide in a minute to fly to Spain and buy tickets. When you are depressed, you spend less, but it is also difficult to earn money. I try to keep a financial cushion in case of an aggravation, and also take into account all expenses in the application so as not to get into debt. Fortunately, so far my financial anxiety is stronger than bipolar, so there has never been a credit card debt. nine0005
I spent 58,800 rubles on BAD treatment in a year
|Psychiatric appointment||10 000 R, total 4 receptions of 2500 R|
|Psychotherapist appointment||25 000 R, total 10 receptions of 2500 R|
|Antidepressants||4800 R, 12 packs of 400 R|
|Antipsychotics||7000 R, 7 packs of 1000 R|
|Normotimics||12000 R, 15 packs of 800 R|
Reception of a psychiatrist
10 000 r, total 400 r
Reception of a psychotherapist
25,000 r, total 10 doses of 2500 r
4800 r, 12 packages of 400 p
7000 R, 7 packs of 1000 R
12000 R, 15 packs of 800 R
Books I recommend reading about bipolar affective disorder
The most famous book about living with bipolar disorder is The Restless Mind.