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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Rosy Crucifiction on November 4, 2009, at 22:31:09
Anyone have some firm criteria?
Posted by Phidippus on November 4, 2009, at 23:42:49
In reply to What's the difference - happiness + hypomania?, posted by Rosy Crucifiction on November 4, 2009, at 22:31:09
> Anyone have some firm criteria?
Hypomania usually involves a degree of impulsiveness, pressured action amd irritability not present with serenity. There may be racing thoughts and distractability and unusual errors in judgement. Hypomania may feel like a bit of a high, too-as if one is above situations.
P
Posted by Rosy Crucifiction on November 5, 2009, at 0:10:43
In reply to Re: What's the difference - happiness + hypomania? » Rosy Crucifiction, posted by Phidippus on November 4, 2009, at 23:42:49
So feeling a bit euphoric and happy after a period of depression would not qualify as hypomania?
Posted by delna on November 5, 2009, at 5:12:36
In reply to Re: What's the difference - happiness + hypomania?, posted by Rosy Crucifiction on November 5, 2009, at 0:10:43
Hi
I think they are two VERY different states. As mentioned by Phidippus above hapiness has a sense of serenity to it (like a contended state).
If you are feeling 'euphoric' and it is about nothing at all then I would suspect hypomania. But there have to be other symptoms which go with it- though elated mood is the main one.If something wonderful has just happened to you and you are all cheerful and excited- that is unlikely to be hypomania. And, no coming out of depression usually does not count as a reason.
Plus as mentioned above, I second that hypomania comes with impulsiveness, racing thoughts and also a desire to do many things at once. Also you need to sleep less and overall you can feel a bit out of control.But there is an "official criteria", for hypomania and I'm sure you have read it. But I know many doctors do not stick to it exactly because it is so darn rigid.
But here it is if you haven't seen it recently:
A) A distinct period of persistently elevated, expansive or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
B) During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1) inflated self-esteem or grandiosity
2) decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3) more talkative than usual or pressure to keep talking
4) flight of ideas or subjective experience that thoughts are racing
5) distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6) increase in goal-directed activity (at work, at school, or sexually) or psychomotor agitation
7) excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)and so on....
Also when you are hypomanic people around you notice- this is also a criteria. They may actually find you really annoying because you can be a bit 'in your face. (well that always happens to me ;) )
So certainly they are 2 very different states. I, for one, like happiness. But I hate hypomania!
Take care
Love
D
Posted by delna on November 5, 2009, at 5:15:19
In reply to Re: What's the difference - happiness + hypomania? » Rosy Crucifiction, posted by delna on November 5, 2009, at 5:12:36
oops, what i meant was
" And, no coming out of depression usually does not count as a reason to go high"
Posted by Rosy Crucifiction on November 5, 2009, at 8:19:38
In reply to Re: What's the difference - happiness + hypomania?, posted by delna on November 5, 2009, at 5:15:19
Thanks for the feedback. I think what is difficult for me to parse is that PDocs seem currently motivated to view resistant depression as symptomatic of BP2. Or that it is BP spectrum even in the absence of any hypomanic episode. I'm pretty highly mood reactive, and occasionally feel very good and am highly productive, but have not felt the pressured, racing components of the hypomania definition. Some docs have seen this, along with ADHD inattentive type symptoms as BP. Others have not. I suppose the real answer is what treatments get a sustained, positive response. Still looking for that.
Posted by Phillipa on November 5, 2009, at 11:30:28
In reply to Re: What's the difference - happiness + hypomania?, posted by Rosy Crucifiction on November 5, 2009, at 8:19:38
I get the definition of hypomania but not how addhd is connected or similar? Is needing something to stay awake or alert. Say I drink green tea which also makes me anxious but also wakes me up a bit more and dark chocolate at night makes me tired so what's that? I just don't understand I guess. Love Phillipa late to the thread.
Posted by Rosy Crucifiction on November 5, 2009, at 12:23:31
In reply to Re: What's the difference - happiness + hypomania? » Rosy Crucifiction, posted by Phillipa on November 5, 2009, at 11:30:28
When adhd in adults is coupled with chronic major depression, and the question of diagnosis is between that and BP2 without evidence of hypomania, the line seems to me to very blurry. It appears the two can share some of the same symptoms: extended periods of depression, impulsive behavior, excessive talking, physical restlessness, procrastination, outbursts of anger, etc. I gather the major diagnostic distinction used to be between mood cycles (BP2) and mood reactivity (adhd + depression with atypical features). But I hear shrinks talk about BP spectrum without hypomania and with mood reactivity, so I am thoroughly confused.
Posted by g_g_g_unit on November 5, 2009, at 14:02:12
In reply to Re: What's the difference - happiness + hypomania?, posted by Rosy Crucifiction on November 5, 2009, at 12:23:31
by that criteria (the pressured speech, feeling out of control, etc.), 5mg of Memantine produced hypomania in me.
Nardil (during the 12 weeks i was on it) produced euphoria and an increase in motivation, which resulted in behaviours conducive to that state, but which weren't really usual for me, i.e. exercising a lot more (at 7/8am in the morning), mending a relationship with a brother i hadn't spoken to for a year, etc.
since that feeling has been exclusive to Nardil (and plenty of people mention that euphoria), i'm wondering if it's more a Nardil thing than a 'me' thing.
Posted by SLS on November 5, 2009, at 15:01:53
In reply to Re: What's the difference - happiness + hypomania?, posted by g_g_g_unit on November 5, 2009, at 14:02:12
For some people with major depression who are extremely treatment-resistant, one may consider a hypomanic reaction as an ideal opportunity to add in a mood stabilizer to obtain euthymia without discontinuing the antidepressants.
- Scott
Posted by linkadge on November 5, 2009, at 17:32:32
In reply to Re: What's the difference - happiness + hypomania?, posted by SLS on November 5, 2009, at 15:01:53
Posted by Rosy Crucifiction on November 6, 2009, at 12:34:20
In reply to Re: What's the difference - happiness + hypomania?, posted by SLS on November 5, 2009, at 15:01:53
Scott,
Thanks for your post. I would appreciate the wisdom of your experience. It wasn't clear from your post if the result might be a slightly "hypomanic" mood or a flatter euthymia. Clearly I'd prefer a bit if "up". And one man's euthymia may be another's flattened affect.Also, do you think aripiprazole or gabapeptin would work better. Energy is always good for me, but I'm a bit anxious and prone to inappropriate anger. So more GABA would be good too.
Posted by Rosy Crucifiction on November 6, 2009, at 12:42:22
In reply to Re: Loss of insight and self control (nm), posted by linkadge on November 5, 2009, at 17:32:32
You must know me. General lack of insight and self control ;)...
The issue with these diagnoses for me is a matter of degree. Total loss? Never, I think. But clearly somewhere on a spectrum. Do you think this correlates to the BP spectrum? EG, total loss = BP1 mania, partial (with negative results?) = hypomania, slight = euphoria? Again, I get more confused the more I try to get my head around it.
Posted by SLS on November 6, 2009, at 18:52:20
In reply to Re: difference - happiness + hypomania? Scott, posted by Rosy Crucifiction on November 6, 2009, at 12:34:20
Hi.
>It wasn't clear from your post if the result might be a slightly "hypomanic" mood or a flatter euthymia.
For most people, the goal is to reach an affective state that is sometimes called normothymia (equivalent to euthymia). Hypomania is more unpredictable than normothymia. As Linkadge indicated, hypomania often yields impaired judgement and counterproductive behaviors. My guess is that you will be quite happy to be truly normothymic, whatever that may mean to you. If you are disappointed in the way that you feel, it is possible that you would still be experiencing residual depression. Such residual depression might indicate an adjustment in medication or the addition of other medications. It might also indicate that you must give treatment more time to reach its maximal effect.
> Clearly I'd prefer a bit if "up". And one man's euthymia may be another's flattened affect.
It is difficult to ascertain what one's mental state should be when healthy if one hasn't been healthy in a long time. However, flattened affect is not normal. Of course, it might be necessary to take a psychological inventory to assess whether there are any issues that might contribute to depressive thinking.
> Also, do you think aripiprazole or gabapeptin would work better. Energy is always good for me, but I'm a bit anxious and prone to inappropriate anger. So more GABA would be good too.
For anger control, you might want to look at Trileptal (oxcarbazepine). Trileptal is an anticonvulsant that is similar to Tegretol (carbamazepine), but lacks the serious side effects that sometimes occurs with Tegretol. Zoloft is also used for anger control.
You will need to be wary of an escalation in angry thoughts or behaviors if hypomania is a risk. Hypomania does not always feel good. It can come with frustration, impatience, and rage. If you feel like everyone around you is thinking and movin too slow for you, that is a good indicator that hypomania is present.
I will need to give more thought to the utility of gabapentin and aripiprazole. I am not sure either drug is appropriate in your case.
What is your current treatment?
What do you feel you would like to see change in the way that you feel, think, or act?
- Scott
Posted by linkadge on November 7, 2009, at 7:47:55
In reply to Re: difference - happiness + hypomania? Scott » Rosy Crucifiction, posted by SLS on November 6, 2009, at 18:52:20
I think one big danger of hypomania is that patients can come across as really high functioning and highly productive people.
Therefore, they may take on jobs, roles, or positions which are manageble during hypomania but not otherwise.
I.e. hypomanics can easily bite off more than they can chew, and end up getting into nasty situations they can't handle when the hypomania ends.
Linkadge
Posted by Rosy Crucifiction on November 7, 2009, at 10:14:53
In reply to Re: difference - happiness + hypomania? Scott » Rosy Crucifiction, posted by SLS on November 6, 2009, at 18:52:20
I'm currently taking:
Liotrix150/30 mcgqd
Concerta54mgqd
Wellbutrin Xl300mgqd
Sertraline50mgqd
Pindolol7.5mgqd
Test Cypionate120 mg im 1 week
Sam-E 400mgbid
N-Acetylcysteine600mgbid
Deplin (Methylfolate)7.5 mgmgqd
Fish Oil 1250epa/750dhamgbidI'm about to raise the sertraline, which is having a positive effect.
What I'd change? Primarily dysthymia with recurring major depression with atypical features; also - avoidant behaviors (procrastination, debilitating social phobia, withdrawal) ; ADHD inattentive features; mood reactivity (which when accompanied by stress can lead to rage); history of alcohol and drug abuse, although that's over. All childhood onset. And I do crave chocolate and carbs when depressed.
Posted by Rosy Crucifiction on November 7, 2009, at 10:22:35
In reply to Re: one *big* danger of hypomania, posted by linkadge on November 7, 2009, at 7:47:55
Again, I have confusion here. I have been very high functioning and "should" be able to maintain that. But have bitten off too much primarily because off episodic depression, withdrawal and social phobia. So is the high functioning hypomania or euthymia? All I know is ADs tend to produce more of the high functioning affect and have never reached a level of long term stability. Amps immediately relieve depression, but don't last. Fatigue is a huge issue. Thoughts?
Posted by linkadge on November 7, 2009, at 12:00:31
In reply to Re: one *big* danger of hypomania, posted by Rosy Crucifiction on November 7, 2009, at 10:22:35
>Again, I have confusion here. I have been very >high functioning and "should" be able to >maintain that.
Perhaps high functioning was the wrong phrase to use. When somebody with a psychiatric / neurological illness is high functioning they are functioning very close to those without the illness.
What I meant was....when people have hypomania they come across as being notably more energetic, hard working and optimistic than a normal person.
As such they tend to take on more than they can really handle. This period is often followed by depression where the individual functions notably worse than an average person.>So is the high functioning hypomania or >euthymia? All I know is ADs tend to produce more >of the high functioning affect and have never >reached a level of long term stability.
Some people think that ADs will give them an edge above normal functioning. I think this type of thinking is more common in bipolar indivuals. Normal depressives just want to get back to normal. Manic depressives get better and then want to be better still. Again, its the whole loss of insight and ballance.
One thing to remember is that the brain is still working during periods of rest. It is working to reflect on what was done so that it can be done more efficiantly in the future. This period of reflection is also necessary to think about the overall direction in ones life and to anticipate potential problems.
This insight is lost in mania. The goal directed behavior produces tunnle vision which can result in things falling subtley falling apart at the seems and thus setting an indivudal up for a more severe depression.
I have a hypomanic (pentacostal -not that it matters but..) friend that opened a buisness. At first it seemed remotely plausable, but over time it became more and more apparent that it was destined to fail. Most indivuals would have pulled the plug long ago, but this person believes that the buisness is God's plan and therefore won't quit. This indivudal has such unrealiastic optimism that the mounting debt and lost employees just doesn't give the hint. There is just a loss of logical thought.
Don't get me wrong, its good to have a dream but...
Linkadge
Posted by bulldog2 on November 10, 2009, at 12:07:53
In reply to Re: one *big* danger of hypomania, posted by linkadge on November 7, 2009, at 12:00:31
> >Again, I have confusion here. I have been very >high functioning and "should" be able to >maintain that.
>
> Perhaps high functioning was the wrong phrase to use. When somebody with a psychiatric / neurological illness is high functioning they are functioning very close to those without the illness.
>
> What I meant was....when people have hypomania they come across as being notably more energetic, hard working and optimistic than a normal person.
> As such they tend to take on more than they can really handle. This period is often followed by depression where the individual functions notably worse than an average person.
>
> >So is the high functioning hypomania or >euthymia? All I know is ADs tend to produce more >of the high functioning affect and have never >reached a level of long term stability.
>
> Some people think that ADs will give them an edge above normal functioning. I think this type of thinking is more common in bipolar indivuals. Normal depressives just want to get back to normal. Manic depressives get better and then want to be better still. Again, its the whole loss of insight and ballance.
>
> One thing to remember is that the brain is still working during periods of rest. It is working to reflect on what was done so that it can be done more efficiantly in the future. This period of reflection is also necessary to think about the overall direction in ones life and to anticipate potential problems.
>
> This insight is lost in mania. The goal directed behavior produces tunnle vision which can result in things falling subtley falling apart at the seems and thus setting an indivudal up for a more severe depression.
>
> I have a hypomanic (pentacostal -not that it matters but..) friend that opened a buisness. At first it seemed remotely plausable, but over time it became more and more apparent that it was destined to fail. Most indivuals would have pulled the plug long ago, but this person believes that the buisness is God's plan and therefore won't quit. This indivudal has such unrealiastic optimism that the mounting debt and lost employees just doesn't give the hint. There is just a loss of logical thought.
>
> Don't get me wrong, its good to have a dream but...
>
> Linkadge
>
>
>
>
>
>Yes I had a summer of mania. Couldn't sleep and was hypersexual. Mania does feel so good. Wouldn't mind it now and than.
Posted by SLS on November 11, 2009, at 6:27:32
In reply to Re: one *big* danger of hypomania » linkadge, posted by bulldog2 on November 10, 2009, at 12:07:53
> Yes I had a summer of mania. Couldn't sleep and was hypersexual.
How do you account for the emergence of mania?
- Scott
Posted by bulldog2 on November 11, 2009, at 12:31:29
In reply to Re: one *big* danger of hypomania » bulldog2, posted by SLS on November 11, 2009, at 6:27:32
> > Yes I had a summer of mania. Couldn't sleep and was hypersexual.
>
> How do you account for the emergence of mania?
>
>
> - Scott
>
>I believe I am bipolar. If I lower my dose of klonopin to 1 mg or stop for a day it will emerge.
Posted by SLS on November 11, 2009, at 15:15:26
In reply to Re: one *big* danger of hypomania, posted by bulldog2 on November 11, 2009, at 12:31:29
> > > Yes I had a summer of mania. Couldn't sleep and was hypersexual.
> >
> > How do you account for the emergence of mania?
> >
> >
> > - Scott
> >
> >
>
> I believe I am bipolar. If I lower my dose of klonopin to 1 mg or stop for a day it will emerge.
Where are you at when you are not manic?Are you happy with the way you feel? If not, what symptoms needs attention?
- Scott
Posted by bulldog2 on November 11, 2009, at 17:46:02
In reply to Re: one *big* danger of hypomania » bulldog2, posted by SLS on November 11, 2009, at 15:15:26
> > > > Yes I had a summer of mania. Couldn't sleep and was hypersexual.
> > >
> > > How do you account for the emergence of mania?
> > >
> > >
> > > - Scott
> > >
> > >
> >
> > I believe I am bipolar. If I lower my dose of klonopin to 1 mg or stop for a day it will emerge.
>
>
> Where are you at when you are not manic?
>
> Are you happy with the way you feel? If not, what symptoms needs attention?
>
>
> - ScottWell I am atypical depression, adhd, bipolar, anxiety and panic attacks.
No..Very bad situation..The klonopin helps with anixety issues but leaves me in a state of chronic low grade depression.But without the klonopin my manic states are almost drug like.
So right now I take 1 mg of klonopin at night. During the day I take 1200 mg of neurontin a couple times a day which actually is like a happy pill. It's a unique feeling of a peaceful happiness. I would call it 40-50% remission. However very little initiative to do things. Content to go to the mall and watch tv.
Tried vyvanse for several days. However it neutralized the neurontin and I don't like the way I feel when a stim where's off.
Thanks for asking. How are you doing Scott?
Posted by bulldog2 on November 11, 2009, at 18:03:20
In reply to Re: one *big* danger of hypomania, posted by bulldog2 on November 11, 2009, at 17:46:02
> > > > > Yes I had a summer of mania. Couldn't sleep and was hypersexual.
> > > >
> > > > How do you account for the emergence of mania?
> > > >
> > > >
> > > > - Scott
> > > >
> > > >
> > >
> > > I believe I am bipolar. If I lower my dose of klonopin to 1 mg or stop for a day it will emerge.
> >
> >
> > Where are you at when you are not manic?
> >
> > Are you happy with the way you feel? If not, what symptoms needs attention?
> >
> >
> > - Scott
>
> Well I am atypical depression, adhd, bipolar, anxiety and panic attacks.
>
> No..Very bad situation..The klonopin helps with anixety issues but leaves me in a state of chronic low grade depression.But without the klonopin my manic states are almost drug like.
>
> So right now I take 1 mg of klonopin at night. During the day I take 1200 mg of neurontin a couple times a day which actually is like a happy pill. It's a unique feeling of a peaceful happiness. I would call it 40-50% remission. However very little initiative to do things. Content to go to the mall and watch tv.
>
> Tried vyvanse for several days. However it neutralized the neurontin and I don't like the way I feel when a stim where's off.
>
> Thanks for asking. How are you doing Scott?
>
>
>However I'm not sure how the neurontin helps? As a mild mood stabilizer or as an anti-anxiety agent. I remember years ago having a good happy reaction to zoloft and than paxil. However they do trigger anxiety and needed to come off after 6 weeks due to intense muscle tension.
So the neurontin helps with depression, anxiety but not adhd. Odd how when I combined it with vyvanse I just felt the vyvanse. For me I build a rapid tolerance to them and they start working shortly.
This is the end of the thread.
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