Bipolar disorder is made up of both depression and mania. While it’s possible for someone to only ever have depression for weeks or even years at a time, I’ve never heard of someone having mania for weeks or months. How come?
In terms of mechanisms and causes, how does hypomania differ from mania? Has someone ever tried to induce low-intensity hypomania, either in short bouts or prolonged periods?
People have used stimulants which increase dopamine, adrenaline and noradrenaline to induce a hypomania or manic state because they find it enjoyable.
I don’t know enough about the brain chemistry of that disorder to have any info on the other questions though.
IANAD but I think that manic episodes can last a longish period of time, I mean days. And isn’t that what certain meds are for?
Anecdotally, personally: yup and yup.
Most people do not experience being manic as an unpleasant thing, although they may come to regret some of their judgments and choices. There are two situations where one’s state of mind results in clinical attention: the person possessing the state of mind comes in seeking help, or other people pressure the person into being on the receiving end of such services. In the case of mania you’re seeing far less of the first situation.
(Not everyone diagnosed as bipolar regards it as an unfortunate phenomenon. Lots of people prefer to live their lives unmedicated and develop other coping strategies for their roller coaster, and do not consider themselves “mentally ill”)
Not a mental health expert, but a couple of observations.
I review mental health records nearly every day of my job. I have seen instances of bipolar where the manic cycle lasted a couple of weeks, but cannot recall ever seeing one reporting ongoing mania for extended periods. In other words, I don’t think I’ve ever seen a dx of “mania.”
My WAG is that such a “manic” person would be diagnosed with things like ADHD, OCD, personality disorder, etc.
Also, my understanding is that not all people with bipolar necessarily experience both mania and depression.
I had a neighbour, a mad artist, who had long-cycle bipolar disorder. He used to hide away for months at home, living a hermit-like existence and doing nothing only to break out of it into his manic phase, socialising and painting, non-stop night after night.
In the past I have known a couple of other bi-polar suffers, both women and their cycle seemed to be about monthly. One seemed to understand her condition and directed it so that the manic energy was directed into productive work, the lows she moderated using prescription drugs until the tide turned.
If it can be managed effectively, the condition can be a benefit, the creative energy can be highly productive. But having a partner with this condition requires a lot of understanding. It is a roller coaster.
What causes it? Imbalances in various hormone cycles, perhaps? While many are acquainted with monthly hormonal cycles women experience and some of the mood swings, sometimes the condition can be extreme and look very like bipolar. Men also suffer from hormonal imbalances, we all know what too much testosterone does, some have too little.
Now if there was some kind of device to monitor the levels of key hormones…and connect it to a smartphone app so a sufferer could understand where they are on their cycle, that would be a great innovation.
This is in the realms of the ‘quantified self’, implanting a sensor that continuously monitors and reports on hormone levels in the blood to a smartphone or similar device near you, avoiding the need for blood tests.
Sadly this technology does not exist yet for hormones, which are complex chemicals and need lab tests, though there are some devices for simple tests that monitor simpler chemicals like blood glucose (for diabetics) that are showing promise.
There is much we do not know about these conditions that were supposed to be related to mental health but may have a stronger connection with hormone levels. Until we can monitor them constantly, we lack the evidence to draw any conclusions.
It does make you wonder where such a technology could take us. :dubious:
I should have been more precise than to say “short” and “long”. I meant compared to a depressed state which can ebb and flow for years rather than days or weeks.
How come the up has to stop at some point but the down can remain indefinitely?
What personality disorder(s) do you think would be most likely?
Was the duration of the manic episode associated with anything in terms of causes or effects?
From what I understand, hypomania is far less likely to result in regrettable choices. Hence why I asked about that too. I’ve read about people chasing mania but I presume more reasonable people would aim for prolonged hypomania over mania.
What then separates bi-polar depression from uni-polar depression? If mania is not necessarily a required component for diagnosis what makes bi-polar depression unique from all other forms of depression?
Like I said - not at all an expert. (Nor do I tremendously respect the reliability of MUCH mental health diagnosis.) I had long equated bipolar with manic-depression. My sister has an adult son who has been going through some mental health issues which impressed me as schizophrenia. She informs me that he has consistently been diagnosed as bipolar. That diagnosis held when he was experiencing only manic episodes, and later when he only experienced depressed episodes. As I understand my sister (admittedly, not a qualified mental health expert), bipolar refers to cycling. So I’m not sure how it would differ from regularly recurring episodic depression (if that is such a thing.)
I haven’t checked the latest edition of the DSM. Of course, that is an ever-changing document, produced by an organization of providers who profit from the diagnosis and treatment of pathologies, and which may not be consistently/strictly applied by all members of the mental health provider community.
Anecdotal sidenote - Social Security disability benefits used to be available to substance abusers. When such benefits were ended, my impression was that there was a HUGE spike in the number of claims based on bipolar. Simply put, I was astounded to see how many folk carried that diagnosis. Of course, I was only seeing the cases crossing my desk.
Not an expert either. It’s been a long time since I’ve opened a DSM.
I seem to remember that that there was specific care taken to try to distinguish schizophrenia from manic phase of bipolar, as similar symptoms could occur in both (eg flight of ideas).
Entirely minor observation, which may or may not be pertinent: mania requires far more energy output than depression does. By the logic of how energy flows in and out of a person, a depressed person can remain depressed for much longer than they can remain manic, even if they increase their food intake during manic states. And since depression can be made worse by low energy levels, and depression also often negatively impacts appetite, depressions are more likely to be self-reproducing than manic states are.
Around here, a lot of the alcoholics used to be schizophrenic. It didn’t really matter: you could get benefits either way. But they preferred to think of themselves as alcoholics.
I’ve seen “Mania” in older records. Usually it’s coupled with some other term, though. “Religious mania,” “sexual mania”; it makes me think that people who were once “manic” probably would be diagnosed with OCD now. I once read a case history of someone who, in the 1890s, was described as having a “mania” for dogs. I think now she’d be called a “hoarder.” IIRC the text, said something like “Her whole home was given over to the housing and husbandry of these animals, to the neglect of her own care.”
Hoarders usually have some kind of OCD. I worked with a few in community living. We would take them on only if they were in therapy and seeing a psychiatrist to work on their hoarding issues, because we didn’t need our agency to get sued when they trashed a rented house or apartment. Every one of them had some kind of diagnosis, and I’d say 85% had OCD. The rest had some kind of personality disorder, usually schizotypal, or schizoaffective.
Some people with OCD can be really hyperfocused on something, and have meltdowns when they get disrupted, which is a sort of manic-like behavior as well (they aren’t autistic, though, because the behavior usually didn’t manifest until adolescence or early adulthood). They are usually helped by a combination of drugs for OCD, which are often also antidepressants, but only a few very specific ones work for OCD (some, not all of the SSRIs, and for a few people, one of the tricyclics), and antianxiety meds. It’s really quite impressive the difference the drugs can make.
I think the problem is that “manic” is an old-fashioned term which is out of use, and even though Bipolar Disorder used to be called Manic-Depression, it’s a mistake to think of Bipolar Disorder as a euphemism. It’s a renaming to reflect better understanding. Major Depressive Disorder is a separate thing-- it’s not related just because it shares a word, just as Obsessive Compulsive Disorder, and Obsessive Compulsive Personality Disorder are two completely different things that happen to share some words.
I know a psychiatrist who says that sometimes you don’t know a depressed-presenting person has BPD until you prescribe an antidepressant, and they suddenly are whipped into a mania. It may be their first mania EVER, but that’s how you find out that all along it was BPD, and they need valproate, not bupropion.
So, basically, BPD people may be people who have atypical depression. That’s just a guess: IANAP