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MANIA

By Julie Fast

"Well, even in that deep misery I felt my energy revive, and I said to myself: in spite of everything I shall rise again, I will take up my pencil, which I have forsaken in great discouragement, and I will go on with my drawing, and from that moment everything has seemed transformed in me." Vincent Van Gogh

Van Gogh sure knew how to describe the wonderful feelings that mania creates when the mood swing first starts. Unfortunately, as Van Gogh found out, these wonderful feelings never last. Mania usually spirals out of control and what started as something pleasurable, productive and all around wonderful eventually becomes a serious and destructive manic mood swing. Even for people with hypomania, the wonderful feelings that start the mood swing rarely lasts. This is one of the cruel tricks of bipolar disorder. We are given a taste of paradise and we want more. But then it turns out that the paradise was not real and we are faced with the depression once again.

One thing is clear - mania must be prevented if a person with bipolar disorder wants to lead a stable and productive life.

Before I talk about my tips for managing mania, I want to clarify the difference between Bipolar I and Bipolar II and the types of mania that go with each diagnosis. (It's important that people with bipolar disorder know their exact diagnosis.) The following is an excerpt from my upcoming book for couples Loving Someone with Bipolar Disorder: How to Help and Understand Your Partner (New Harbinger 2004) it was written with my co-author John Preston Psy. D.

*** excerpt***

Mania (Full blown)

People with Bipolar I have full blown mania. This mania is usually described as either euphoric/expansive mania or dysphoric mania also referred to as mixed mania. (Dysphoric mania has none of the pleasure that is felt in euphoric/expansive mania.) All manias are accompanied by increased energy, racing thoughts, and a decreased need for sleep. Euphoric/expansive mania includes feelings of heightened self-esteem, and often grandiosity (e.g. I'm the smartest person in the world), an intense desire to be active (this takes on many forms such as agitation and restlessness, or an urge to be very outgoing and gregarious), and often very poor judgment (e.g. spending enormous amounts of money and putting one's family in financial jeopardy; sexual promiscuity; reckless behavior such as driving too fast), and substance abuse. In the early phases of a euphoric mania, the person may actually experience a sense of tremendous well being. However, often as energy begins to escalate and thoughts become more rapid, it starts feeling like an engine running out of control. Wildly creative thoughts disintegrate into chaos and confusion…high energy turns to agitation…good judgment is lost and even very bright individuals can no longer think clearly nor recognize that their out-of-control behavior is dangerous to them or to their loved ones. Up-beat moods quickly collapse into intense irritability and the person in the manic episode loses their ability to function normally. Psychosis is often present when a manic mood swing goes this far.

Dysphoric manias also exhibit high energy, racing thoughts, poor judgment and restlessness, but there is no sense of well being. In the context of the frenzy of high energy is a pervasive mood of despair. Just as with major depression, negativity and pessimism dominate. Approximately 50% of people with bipolar disorder have euphoric/expansive manias while the other 50% have dysphoric manias.

The ideas come so fast when I'm manic I can't keep up with them. They're such good ideas that I know I've just created something to change the world. The last time I was manic I stayed up all night writing a new software system that I was positive would revolutionize the industry. I couldn't sleep and felt so full of this amazing energy. The next morning I was very irritated and snapped at my partner. I tried to fix everybody's problems. I soon had trouble writing. Then, I was no longer in control of my thoughts. I remember thinking, "I'm a genius," and I believed it. Then I started to do dangerous things. I walked across a freeway without looking first for on-coming cars. Mania isn't fun when this starts. Things start to unravel and I have to go to the hospital. My partner had to get a court order to keep me in the hospital because I refused treatment. I was put in restraints because the nurse feared I would hurt her. I was in the hospital for three months before I came down.

Hypomania

Hypomania is seen in Bipolar II and is much less intense than full-blown mania. There is an increase in energy, a heightened sense of well being, a decreased need for sleep (but no daytime fatigue), and impaired judgment, though not as serious as that seen in full blown mania. Often during hypomanic episodes, people feel great, are very gregarious and highly productive. This type of mania can last for a few days or go on for months and while everyone around the person can tell something is wrong, it's very difficult for the person experiencing the hypomania to notice the problem until the episode is over. The person's social life often increases as does substance abuse and spending. It's hard for friends or family members to do anything about it as the person is still basically functioning. This is when a person is called wild or irresponsible and the family often gives up on them. However, beneath the veneer of this up-beat mood often lurks irritability. Most people experiencing hypomania don't recognize this mood state as being a part of their illness; rather they feel that it is simply "feeling good" and a welcome relief from depression. Although some hypomanias may last for a week or longer, most last for only 2-4 days.

Hypomania feels so great after a depression. I need it! I finally get things done and can have positive thoughts about myself instead of feeling terrible all of the time. It buzzes inside of me like fabulous and wonderful energy and I just can't think of anything except what I'm doing and feeling and it feels so good! Everything is so easy and I know life is finally going to be better for me. I need a lot less sleep and feel I can finally catch up on things that depression wouldn't let me do. Things look so beautiful. All people are beautiful and I want to know them. It truly feels good to spend money. Everything is heightened: smells, tastes, colors and feelings. The problem is that if the behavior isn't noticed I can really make some terrible and life changing decisions. This hypomania is always followed by a depression for me.

*** end excerpt***

People often ask me why I write more about depression than mania. The answer is simple. Depression has a very large treatment window. It's possible to work on getting better even in the middle of a serious depression episode. Mania's treatment window is much smaller. Because of this, the best treatment for mania is prevention. This means that a treatment system such as the Health Cards must be in use at all times to prevent the mania before it gets out of hand. Even hypomania can cause serious problems in a person's life if it's not taken care of as soon as the first signs are noticed.

The following tips focus on preventing mania.

1. Know what your personal mania looks like. (Family members, you will need to know what kind of mania your loved one experiences as well.) You really can't prevent mania unless you know the very first signs of the mood swing. I created the Health Cards for this reason. I was tired of mania sneaking up on me and wrecking my life every few years. What are your first thoughts and actions when you start to get manic? Memorize these symptoms and know that as soon as you have them, you may be starting a manic episode and you need to take immediate action to stop it from going any further.

2. Educate others on what your mania looks and feels like so they can help you when you start to go up. Involve your friends and family in your treatment plan.

3. Deal with money issues when you are well. If you have had more than one full blown manic episode where you spent a lot of money, you have to get real and take serious money precautions so that you don't ruin yourself financially when you are sick.

4. Understand that what goes up must come down. And it always does. Mania is very tricky and makes you think that you will stay happy forever so you give into the mania and let it continue. If you want to find stability, you simply have to let go of the desire to be manic. It's NOT a natural state - no matter how great it feels at first. If you continue to crave the mania, the depression will hit you like a ton of bricks and you will wonder, once again, why you can't just stay stable. Many people with hypomania will let it continue off and on for years because it's a time where things get done and they feel finally feel well, but the reality is that spending problems, poor judgment and an inability to see the future consequences of their actions usually follow.

If you are a person who courts mania, take a hard look at your life and the effect it has on your work ability, money and relationships. If it affects any of these areas, prevention is a much better solution than giving in to the mania. (I'm sorry to sound like such a hardliner here, but it sometimes takes tough talk to get through to those of us who crave mania. People with bipolar II experience so much depression that the mania seems like a relief, but in reality it is just another side of the illness.)

5. If you are a friend or family member of someone with bipolar disorder, it's very important that you understand mania and its very specific symptoms. People with bipolar disorder all have the same manic symptoms. It may seem personal when they do something erratic or downright dangerous, but in reality it's just part of the illness. People with mania can do any of the following:

Spend money recklessly
Lose sexual inhibition/ have affairs
Take unexpected vacations
Do something shocking or "crazy"
Get very creative
Talk to strangers
Make huge life changing decisions such as moving to a new country
Stop working and not be worried
Feel absolutely no guilt or remorse about their behavior
Do extremely cruel and unkind things to their loved ones
Completely lose all rational judgment
Party, party and then party some more
Drink like fish
Work on ten projects at once
Talk very quickly/Can't listen to others
Need little sleep/ need NO sleep
Leave and not tell you where they are going
Etc.

It makes sense that if I can list the symptoms of mania off the top of my head without every meeting your loved one, this means that mania is nothing personal. It's a mood swing of bipolar disorder. Don't take manic behavior personally. It has nothing to do with you. Instead, focus on helping your loved one prevent the mania from going this far.

6. Learn the language of mania

I'm not manic. This is the real me.
You just want to ruin my fun.
That tastes incredible!
Wow! Look at those unbelievable colors.
I just had the greatest idea (and then you get started with it immediately) Etc.

It's up to you to learn your own mania language. You will find that it rarely changes. People tend to get manic in the same way every time. It helps if you use the Health Cards to chart this language so that you can see it as a sign that you need to immediately treat bipolar disorder first and take care of the mania before it goes too far.

7. Learn your specific mania triggers. Mania triggers can include any of the following:

Arguments
Trouble at work/school
Heavy responsibilities
Missing sleep/time changes
Travel
Exciting events
The illness or death of a loved one
A big shock such as a lawsuit or getting laid off
Car accident or any other serious trauma
A move to a new location
Instability in your life or in your living circumstances
Change - any change at all either good or bad
Stress of any kind
Etc

As you can see, mania is often triggered by outside events. This means that you either have to learn to modify these events or stop them all together. People with bipolar disorder have to really think carefully about the future when they make a decision or walk into a situation. You must always ask yourself, could this trigger mania? You will then be ready for the first symptoms and can use the Health Cards or whatever else you use to prevent mania from going too far.

8. Medications. Sometimes the ONLY thing that will help is a pill. This is a fact and one that you may not want to hear. People who have serious manias must constantly monitor themselves for signs that a manic episode is starting. If you have manic episodes when you go off medications, this is telling you something. You have to stay on these medications to stay stable. Using a treatment plan such as the Health Cards can help you prevent the episodes from going too far, which may mean that you can reduce your medications with the help of your doctor. But, and this is a big but, if you can't stop having mania troubles when you are off medications, you need to stay on the meds in order to protect yourself from the illness. The next newsletter is on acceptance and it may have some tips to help you accept the medications in your life. I know this is hard. It's hard for so many of us, but medications are a reality if you want to prevent mania.

Julie Fast, Bipolarhappens, June 7, 2003

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