Bipolar News

March 25, 2005

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Lighter shades of black Researchers link hypomania to bipolar disorder

International Herald Tribune; 3/24/2005; Benedict Carey

'Sometimes when talking to people, I'll tell them that I've just had a lot of coffee, even though it's not true, because I know I fire off in all directions, and I can talk to you about anything -- literature, string theory, rock guitar -- I once worked for Leo Fender -- and one thing I say to people is that, of course, I live near the edge; the view is better.''

Laurence McKinney, 60, who lives near the edge of Boston, is a business consultant, a Harvard graduate and self-described polymath who has had a career that is every bit as frenzied as his conversational style. Among other ventures, he said, he has started pharmaceutical companies, played in rock bands and helped design electric guitars, and written a book about the neuroscience of spirituality. This month, for the first time, he helped start a Web site for people like himself. They are known as hypomanics.

At some point, almost everyone encounters them -- restless, eager people, consumed with confident curiosity. Researchers suspect that their mental fever shares some genetic basis with that of bipolar disorder, known colloquially as manic depression and characterized by effusive emotional highs and bouts of paralyzing despair.

Scientists have found that bipolar disorder is widely variable, that its milder forms are marked by hypomanias, currents of mental energy and concentration that are less reckless than full-blown manic frenzies, and unspoiled, in many cases, by subsequent gloom.

New research helps explain how people with manic or hypomanic tendencies navigate the small triumphs and humiliations of daily life, and provides clues to how some of them quickly shake off the emotional troughs that their ambitious natures should make inevitable.

''It kind of goes against the common assumption, but many people who are inclined to hypomanic or manic symptoms have an underlying resilience,'' said Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins University. ''They may get trashed by their peers, laid low, but they respond very strongly.'' In her book ''Exuberance,'' Jamison argues that flights of joyous energy similar to hypomanic states frequently accompany scientific and literary inspiration. Psychiatrists have known for more than a century that bipolar disorder, unlike any other mental illness, is often associated with some financial and professional accomplishment. Mania can inspire destructive shopping or gambling sprees, but it can also generate bursts of creative and focused work.

Psychiatrists and psychologists have found ample evidence for bipolar tendencies in the life histories of many famous writers and painters. The composer Robert Schumann, for example, experienced extreme mood swings; so, some now argue, did the poet Emily Dickinson. Some studies suggest that first-degree relatives of people with bipolar illness, who are likely to inherit some genetic basis for bipolar disorder, are particularly likely to enjoy high socioeconomic status.

Most recently, researchers have turned their attention to the mild end of the bipolar spectrum, and sliced it into many permutations. Bipolar II, III and IV, for example, each include depressive episodes and varieties of hypomania, or exuberant moods. Cyclothymic disorder involves rapid cycling from moderate depressive to manic symptoms, and hyperthymia is a state of elevated mood.

''When you look across the entire bipolar spectrum, you find that maybe 10 percent to 15 percent of these people never get depressed: they're just up,'' said Ronald Kessler, a professor of health care policy at Harvard Medical School. As one psychiatrist put it, Kessler said, ''The goal in life is constant hypomania: you never sleep too much; you're on; you keep going.''

With the exception of bipolar II and cyclothymic disorder, which are accepted as standard psychiatric diagnoses, these permutations of low-level bipolar disorder overlap with each other and with normal ranges of mental function so much that some scientists question how distinct they are.

''For some of us, there is a lot of wariness about this tendency to see bipolar disorder everywhere,'' said William Coryell, a professor of psychiatry at the University of Iowa School of Medicine, adding that ''it's very difficult to determine reliable boundaries between one diagnosis and another'' and document the true prevalence of the conditions.

Yet even if bipolar disorders can be reliably diagnosed in only 2 percent of the population, some now believe that hypomania or similar charged states are more prevalent than once thought. About 6 percent of college students score high on personality tests that measure hypomanic tendencies, some studies find, and about 10 percent of children rate as temperamentally ''exuberant,'' a related quality.

Outsized delight in small successes may be central to what kindles hypomanic natures and sustains them. In an effort to learn how the joys and sorrows of daily life affect mania and depression, Sheri Johnson, a professor of psychology at the University of Miami, began surveying men and women in whom bipolar disorder had been diagnosed.

Originally, she was interested in the effect of negative events, like struggles at work or arguments at home. ''But the people in the study told us we were getting it wrong, that it was when good things happened that they felt they had their manias,'' Johnson said.

In two studies involving 149 people, one completed in 2000 and the other a continuing project, Johnson has found that personal victories like a promotion or an award very often precede or coincide with manic symptoms, though the person may be feeling neither manic nor depressed when life takes a good turn.

Even when small successes do not arouse manic symptoms, they appear to prompt exaggerated surges of confidence. In one study, scheduled for publication later this year, Johnson led a team of psychologists who rated a group of 153 college students on a hypomanic scale, which included items like: ''There have often been times when I had such an excess of energy that I felt little need to sleep at night,'' ''I often feel excited and happy for no apparent reason'' and ''I often feel I could outperform almost anyone at anything.''

The scale was intended to identify people at risk for developing bipolar disorders. The researchers gave the students a hand-eye coordination test, then told them that they had scored very well, regardless of their true scores. Offered a choice of which test to take next, the hypomanic group selected a significantly more challenging exam than their peers did. These students not only expected to do very well, Johnson reports, they were more willing than peers to pursue difficult goals after an initial success.

Researchers do not know whether this surging confidence and hunger for challenge persists, or for how long, but it is a familiar pattern to some psychiatrists who treat mild forms of bipolar disorder.

John Gartner, a psychiatrist in Baltimore who specializes in treating hypomania, has published ''The Hypomanic Edge,'' a book that identifies hypomanic symptoms in the lives of n historical figures from Christopher Columbus to the biotech entrepreneur J. Craig Venter. ''These are people who are always moving the goal posts,'' Gartner said in an interview. ''If they do well at one thing, they shoot for the moon.''

This grandiosity practically begs for a tragic fall. Difficult goals are by definition less likely to be achieved, even by those with mental power packs, and there is little question that people with hypomanic tendencies feel disappointment deeply. For some, their fevered, scavenging curiosity may overwhelm any excess rumination: New projects beckon before old ones can be mourned.

2005 Copyright International Herald Tribune.

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