Hypomanic: Something Had to Break

Something Had to Break

Hypomanic

Irritable

On verge of tears

Over-stimulated

Over-scheduled

Too many demands

Too many changes

Too soon

Must scale back

Spoke to psychologist

Contacted psychiatrist

In bed

Resting

Now

 

Creative Writing Prompt: Rainstorm

Irainstorm

Prompt for first creative writing class: RAINSTORM

Rainstorm

The torrential rain kept her awake. She couldn’t sleep. Wasn’t rain supposed to be relaxing? What was it that disturbed her? Why could she not sleep? The rain didn’t lull her, it irritated her. Reminded her that all was not well. The hills may slide. The mud carrying all away. But she was safe. Wasn’t she?

Was it anxiety? Was it caffeine? Was it simply the din amplified by hypomania? Yes, when in this state any noise irritated her. What the hell did she think she was doing this week? Starting to rewrite her book, take a creative writing class, and work out with a personal trainer on the same week her son began college.

He wasn’t away for college. Oh, no. He was attending the local community college and didn’t yet drive. So, on top of everything else, she remained his chauffeur. Fuck. He was getting better. He was more independent than before, but he still relied on her to drive him to classes and to doctors’ appointments. He still didn’t prepare his own breakfast and lunch. He’d just eat a protein bar and banana. At six feet tall and 125 pounds, he needed to eat more.

Caring for him, worrying about him, wore on her. She had hoped that he’d be eating more by now, that he’d make a sandwich or eat a bowl of cereal. She had hoped that he’d feel ready to take his DMV written test, so he could learn to drive.

Though, really, the time that they spent in the car was their special time. Often he wore his headset and cut her off from him. But, there were times when they talked, when they laughed, when he shared his thoughts with her

Back to the storm. Crap transition, but the rainstorm felt like her life. Stormy, but cleansing.

2019 Goals

2019 Goals: Revise book, Writing class, Exercise
White Christmas with snow-dusted ponderosa pines

Christmas 2018

Christmas was both beautiful and bittersweet. We spent the holiday among snow covered ponderosa pines with close family, dearly missing our recently departed father.

2019 Goals

Time for me to get up out of bed, take better care of myself, and accomplish some goals.

Revising My Book

As I’ve mentioned in my previous post, Eliezer Tristan Publishing is publishing my previously self-published collection of blog posts. When I self-published the content in book form, I simply cut and paste my posts in chronological order. Now, I’ve hired book coach Aaron J. Smith to help me organize the content into themes.

Wish me well. I must be sure not to overdo it and trigger hypomania.

Creative Writing Class

Starting Wednesday, I’m taking an Introduction to Creative Writing emeritus class (for older adults like me) at our local community college. I will learn basic elements of fiction and non-fiction writing: audience, structure, voice, description, setting, and manuscript development. Learning these basics elements will help me develop my skills as a writer.

Homework, deadlines, and social stimulation are all potential triggers to hypomania for me. So, I’m both excited and more than a little anxious.

Exercise

Research shows what many have observed — exercise improves mood. I knew that, yet remained sedentary. At my psychologist’s urging, I’ve made a commitment to exercising.

First, I signed up for a class in Qi Gong at my city’s community center. According to the class description:

Qigong is a safe practice that focuses on improving the overall
health and wellness of your mind-body-spirit. It is a sequence of
gentle movements synchronized with the breath to open the body’s
pathways.

This week, I joined a local gym and signed up for personal training. Friday I underwent my initial fitness assessment. I was dying just doing the ten minute warm up. My thighs kill me. I can’t even get up from a sitting position without using my arms to assist me. Obviously, I’m out of shape.

Michael Pipich Guest Post: Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Are You Just Depressed or Is It the Onset of Bipolar Disorder_

This guest post hits close to home. For twenty-one years, from ages eighteen to thirty-nine, I was diagnosed with chronic depression (dysthymia). I’d tell doctors that I was at least cyclothymic, for I my over-productive workaholism led to cyclical depressive crashes. Finally, at thirty-nine years old, I was diagnosed bipolar II. — Kitt

Are You Just Depressed or Is It the Onset of Bipolar Disorder?

Michael G. Pipich, MS, LMFT

About two-thirds of people with bipolar disorder are misdiagnosed with other mental health problems before bipolar is discovered.[1] Among those individuals, a significant majority are given a diagnosis of major depression. Most people with a major depressive disorder that is unrelated to bipolar disorder (typically known as non-bipolar depression or unipolar depression) can be treated safely and effectively with a combination of antidepressant medications and psychotherapy. But when people with undetected bipolar are treated this way, a host of mental health problems can occur, making the underlying bipolar condition much worse.

It’s understandable that someone may not immediately be given the bipolar diagnosis if their first mood swing begins in a depression mood zone. This seems particularly true of people who have bipolar II disorder. And sometimes, there may be more than one depressive episode before a manic or hypomanic episode happens in a person with bipolar.

If you’re wondering about whether you may have depression or the beginning of bipolar, there are some keys to keep in mind when seeking treatment.

First of all, when assessing if your depression is a part of bipolar, know that bipolar disorder has distinct genetic foundations. In other words, it runs in families and is passed through family genes. So if you suspect that any family members may have had bipolar disorder, it’s important to inform your doctor or therapist when entering treatment. If the information is available, a thorough family mental health history can really support a proper bipolar diagnosis. Unfortunately, such information isn’t always asked for, so be prepared to volunteer all that you know during an evaluation or treatment session.

Next, your personal history of mood swings should be explored. If you’ve had severe ups and downs during childhood or adolescence, these may be more than the common tumult of growing up. They may instead be early expressions of bipolar disorder. It’s especially important to review periods of hyperactivity, bouts of unexplained rage, self-harm, or suicidal thoughts or actions that could have occurred at any time in life. There certainly may be other explanations for these, such as early life trauma or severe loss and grief experienced during these formative years. But if explosive behaviors or deep depression occurred at different times, especially with little or no provocation, it can point to underlying bipolar disorder.

Usually, most people with bipolar who seek treatment on their own are currently or recently depressed, or are experiencing consequences of untreated bipolar disorder. Any history of mania or hypomania is less obvious, however. And often, bipolar patients will either not understand manic symptoms or will avoid discussion about them. If you have had at least one occurrence in your life of intense euphoria, excitability, unexplained energy and creativity, avoidance of sleep, or impulsive behaviors, inform your treatment professional. But also bear in mind that mania and hypomania may be marked by intense periods of irritability and agitation, know as dysphoria. This is in contrast to the euphoria that most people think about with bipolar mania. Often a dysphoric type of manic or hypomanic episode can be mistaken for the kind of agitation seen in major depression. This can mislead the course of treatment to focus only on depression, while missing the full bipolar condition.

This brings us to the most important part of knowing whether you have depression or bipolar onset. According to the Diagnostic and Statistical Manual of Mental Disorders (5th edition), if a patient is given an antidepressant medication, and it produces manic symptoms, the person is then diagnosed with bipolar disorder.[2] While this is a very clear indication of bipolar, how the mania surfaces in the individual may take different forms. For example, a person in a depression mood zone can improve early in the treatment, and as a result, may not show manic symptoms right away. Any slight improvement may provide a hopeful sign that treatment is working, but when the person starts to get worse because of emerging mania—especially if it’s dysphoric—the unwitting response may be to apply more antidepressant medication. Now we have some real problems.

So, if at some point in your treatment, an antidepressant medication makes you feel more agitated, more irritable, more aggressive, or you start to experience hyperactivity or greater impulsivity, tell your treatment professional right away. This could be the start of a manic episode that is revealing a previously undiagnosed bipolar disorder. Even more importantly, any increase in suicidal thoughts or possible psychotic symptoms, such as hallucinations, should be reported immediately, as these can be life-threatening. Any antidepressants will either likely be eliminated at this point, or possibly paired with a mood stabilizing or antipsychotic drug to keep a lid on mania.

With bipolar finally recognized, bipolar medications can be introduced to decrease manic-type symptoms, while keeping depression in check. Alongside medications, it’s important to have therapy focus on the unique challenges facing people with bipolar disorder. Major depression is frequently considered an acute condition because it often can resolve in time, so medications may be discontinued at some point, along with a shorter overall approach to therapy. But bipolar disorder is a lifelong condition. Even though its symptoms can come and go in episodes, the genetic nature of the condition means the bipolar patient will need continuing care through the lifespan.


[1] Hirschfeld R. M., Lewis, L., & Vornik, L. A. (2003). Perceptions and impact of bipolar disorder: How far have we really come? Results of the National Depressive and Manic-Depressive Association 200 survey of individuals with bipolar disorder. Journal of Clinical Psychiatry, 64(2), 161–174.

[2] American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author, 128-130.


Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder by Michael G. Pipich, MS, LMFT. Foreword by Joseph Shrand, MD.

Michael G. Pipich, MS, LMFT is a psychotherapist and author of Owning Bipolar: How Patients and Families Can Take Control of Bipolar Disorder, (Citadel Press, Sept 2018). He practices in Denver, Colorado, and can be reached at MichaelPipich.com.

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