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Mania gray areas...


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What are your typical symptoms of mania/hypomania? Curious because many people (especially of BP2 flavor) don't present with stereotypical symptoms (great excitement, energy, euphoria, delusions, urges, cravings, obsessions, racing thoughts, irritability, rage, psychosis, insomnia and overactivity)...

Can anxiety or distress also be a symptom of mania? There are a broader range of symptoms (than the above) that fit the criteria. If someone mainly experiences depression and only mixed states - does this mean that the person could be BP? The difference between "pure" Bipolar versus someone with multiple co-morbid disorders (i.e. major depression and anxiety, or MDD and OCD and ADHD) is confusing. Can anyone shed some light?

 

Edited by Blahblah
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Abnormally high energy level, racing thoughts, feeling ecstatic/euphoric, grand plans for the future, little need for sleep, irritability, rage, lack of inhibition, impulsivity, inflated self esteem, heightened sex drive/promiscuity, risk taking behaviour like driving recklessly etc, rapid speech, impatience.

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When hypomanic, I sleep less, exercise more, have racing thoughts, make new goals and grand plans, take up new hobbies, and generally feel fantastic. 

When I'm mixed (which has also been dysphoric mania), I am angry and irritable, I lack impulse control, I feel internally restless and agitated but may or may not have the physical energy to exercise more, I feel the need to tell everyone and anyone that they are wrong about everything and anything, I have a hard time winding down and falling asleep but do not feel especially energized in the morning. 

While I do have increased anxiety during mixed states, but I also have an anxiety disorder. Without other symptoms, especially the irritability and impulse control, increased anxiety alone would only be an indication that my general anxiety is not currently well controlled since that can fluctuate without necessarily being tied to a mood episode. 

Edited by thunder
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I can relate to some of the symptoms of mixed like: frequent irritability, agitation (mental, not physical) quite often that my pdoc overlooks...however, I don't have any of the other hypo-type symptoms. Can irritability accompanied by depression be BP2 or must you present with more hypo symptoms of increased energy, impulse control etc?

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@Blahblah I believe we have a similar flavor of BPII.  

I will find myself getting irritated. Like...insanely irritated.  The sound of people's voices, songs on the radio, certain smells will often send me into an outburst of profanity(usually internally).

When I find that I am getting like that I will take my nighttime dose of Seroquel XR 300 and then take another dose as usual at bedtime. 

Do you have "rescue" medication?  

I never have had typical bipolar (hypo)mania symptoms.  My sleep will get pretty wonky along with the agitation. 

Hope this helps!

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7 hours ago, Blahblah said:

I can relate to some of the symptoms of mixed like: frequent irritability, agitation (mental, not physical) quite often that my pdoc overlooks...however, I don't have any of the other hypo-type symptoms. Can irritability accompanied by depression be BP2 or must you present with more hypo symptoms of increased energy, impulse control etc?

That would really be a question for your pdoc. If you feel like your pdoc is ignoring symptoms like your irritability and mental agitation, I would make sure he understands how distressing these symptoms are so that you can find a treatment that lessens them. 

I see that you are currently on Lamictal, which is usually the go-to for BP2 as well as often used for depression when standard antidepressants haven't worked. 100 mg is usually considered the lowest therapeutic dose, so you might need a higher dose.  

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@tommy215  I don't get so agitated that I have an outburst or yell profanities...it's more of a low-level of irritation and crankiness. Like PMS but a bit more intense. I often wonder if the Ritalin is increasing this irritability symptom. Ritalin really helps my focus and concentration, memory and give me a tiny bit of a motivation boost so I hate to stop it!!

Yes, it's bothersome, but is it something I need medication for? Not really. I am trying to employ more meditation and emotional tolerance techniques to decrease this symptom. I guess I was just wondering what level of irritation is considered Bipolar? My depression is something that is much more disabling in my daily life.

I have tried higher levels of Lamictal to iradicate this, but then I get more side effects like blurred vision, balance issues, and cognitive issues/word finding.

Edited by Blahblah
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What other symptoms are you attributing to hypomania? Irritability alone isn't enough. And anxiety alone isn't enough. I would even say irritability with anxiety isn't enough. There has to be some type of increase in activity level/energy. 

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The first stages of hypo are the best, I have so much energy, I can get so much stuff done because of all the extra time from not sleeping, I feels like I can do anything, so I try to do everything, I am president of a happy bubbly wonderland. After a few days of that it starts to become a little less great, but the energy is still there.... I remember standing on my desk a lot in high school, in this like power pose. Someone would piss me off and I would get on their desk and scream at them. I acted like a freaken child. Could just explode like a powder keg. God I hate thinking about things I did, im done with this post.

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For me, one of the key signs that my irritability is part of a hypomanic or mixed episode is the irritability plus a compelling need to inform everyone why they are irritating me and what they should be doing instead. Generally, this includes telling off people where it is clearly inappropriate to do so, like supervisors at work. During these times, if I think about it, I can usually identify other hypo symptoms, but this can be one of the signs. But on its own, I wouldn't consider irritability to be an indicator of mania. For me, it can also be a result of not sleeping well, not having had enough coffee, or not feeling well physically. I'm pretty sure that depression + irritability can be just that.

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geez where do i start...usually i start with the 'typical' mania symptoms ...not sleeping, doing a lot more, racing thoughts, grandiose feelings, wanting to have sex non stop..then it gets to feeling like i'm on the brink of death, like seeing things that are going to kill me. ( idk if that makes sense) i usually get mixed episodes now. feeling on edge, can't sit still, crying, suicidal then thinking i'm on top of the world. i also have a severe anxiety disorder so sometimes it's hard to tell what's what.

 

sorry if that didn't make sense

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On 10/21/2017 at 4:42 PM, Blahblah said:

I can relate to some of the symptoms of mixed like: frequent irritability, agitation (mental, not physical) quite often that my pdoc overlooks...however, I don't have any of the other hypo-type symptoms. Can irritability accompanied by depression be BP2 or must you present with more hypo symptoms of increased energy, impulse control etc?

i was told my unrelenting anxiety and irritability was my "mania" of my BP2, as long as it is bp2

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  • 2 weeks later...

I've had what I believe is rapid cycling now since spring. I continue to try to work but that is getting more and more difficult. When I am manic at work, I feel very professional, reach out to higher ups about my grand plans, then later feel completely worthless, confused, and embarrassed. 

I also have anxiety and mild OCD. I channel some of my rage, energy, and feelings of inherent superiority into cleaning my house. I sweep over and over. 

Mania in general, pretty much as everyone else here has said. I am brilliant, quick, confident, speak quickly, walk with my head up, correct people, become irritable and then furious, then collapse and feel worthless, can't talk to people, cry about the state of everything (even when things are actually OK at home), etc. 

Currently on the down side. Applying for disability finally, can't take another meltdown, I feel like I suck at my job, I am unreliable and now deeply confused by life, the universe, and everything. Currently it all feels like TOO MUCH and the depression makes it impossible for me to find my way back to the surface. the only benefit of having been batshit crazy for so long is that now I know I have to wait and my brain will do something else.

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