Why No "Unipolar Mania" Listing in DSM-IV?

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Biology 202
2000 Third Web Report
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Why No "Unipolar Mania" Listing in DSM-IV?

Melissa Wachterman

If you were to flip through the mood disorders section of DSM-IV (Diagnostic Statistics Manual), you would find, among other conditions, listings for Major Depressive Disorder (commonly known as unipolar depression) and Bipolar Depression (a.k.a. manic depression). What seems to me to be notably missing is Unipolar Mania. Why is it that people suffer from bipolar disorder, which is marked by both depressive and manic episodes sequentially, or from unipolar depression, but, at least according to DSM-IV, cannot manifest manic episodes in the complete absence of depression? This seems to suggest that there is something about mania that links it inextricably to depression. While this will be one issue that this paper seeks to address, the very notion that mania exists only in the confines of bipolar disorder can be challenged.

Perhaps unipolar mania does, in fact, exist, yet is not considered a pathological condition that has to be diagnosed and treated. After all, we must remember that the classification of behavior as "normal" or "abnormal" reflects societal values and definitions of normality. This is reflected in the cross-cultural differences in what is categorized as pathological. For example, imagine that you proclaimed that you were seeing visions of elaborately clothed spirits who were speaking to you about the future of humanity. You might be touted as the spiritual guru of your village if you were in certain tribal societies in Africa, or you might be labeled as schizophrenic and sent to a psychiatric ward if you resided in Brooklyn, New York or Topeka, Kansas. The labeling of behavior as normal or abnormal depends on certain criteria, and subjective judgments definitely factor into the process. Some might say that abnormal behavior is defined as behavior that is not prevalent amongst the majority of the population, and while this may be true of the conditions we consider pathological, it is clearly not sufficient. After all, people who have IQ's above 150 are statistically in the minority; however, our society does not slap a psychiatric diagnosis on them, but rather labels them as geniuses. Thus, it appears that a major characteristic of what is labeled as "normal", as opposed to "abnormal" behavior, is the ability to function as a productive member of a given society (1).

With this background in mind, we turn back to the issue of whether unipolar mania exists, and consider first the possibility that it does exist physiologically, but is not labeled as "abnormal" behavior, and therefore, does not show up in the DSM-IV listings of psychiatric disorders. It seems fairly clear that people who experience bouts of clinical depression have difficulty functioning in our society, and thus, it is logical that such a condition is considered to be pathological, and an effort is made to diagnose and treat the disorder. The question is whether this is the case with mania. Perhaps the characteristics that are associated with the manic state are adaptive in our society, and therefore, those who have mania, in the absence of the depressive symptomatology that follows in bipolar disorder, have no reason to be diagnosed with any form of psychopathology. This is a highly debatable issue, with some arguing that mania itself is a debilitating condition (2), while others maintaining that the manic aspect of bipolar disorder actually has many incredibly positive aspects.

Consider first the second position which points out that there are well-documented connections between the manic episodes of bipolar disorder and artistry, creativity, and charisma (3).During the manic part of the bipolar cycle, it appears that the entire tempo of life speeds up. People with bipolar disorder have heightened levels of activity and their thoughts speed up (4) which, in some cases, enables them to be super-productive, creative, and energetic. Therefore, it is possible for some people to catch up on the work and activities that they neglected during the period when they were depressed (5). The following is a quote by Dr. Kay Jamison, a professor or psychiatry at Johns Hopkins University and a leading expert on bipolar disorder, who, herself has the condition:

"I have often asked myself whether, given the choice, I would choose to have manic-depressive illness...Strangely enough, I think I would choose to have it. It's complicated...I honestly believe that as a result of it I have felt more things, more deeply; had more experiences, more intensely...Depressed, I have crawled on my hands and knees in order to get across a room and have done it for month after month. But normal or manic, I have run faster, thought faster, and loved faster than most I know." (6).

This quote suggests that while the depression inherent in bipolar disorder is incredibly debilitating, the manic state is quite the opposite. If Dr. Jamison's account is representative of the common experience of the manic state, it seems possible that there are many "unipolar manics" amongst us. Since, unlike those suffering from bipolar disorder, they do not suffer from depressive symptomatology, they are not categorized as having a psychopathological condition. In fact, if we were to try to identify the profile of someone who was "unipolar manic", according to Jamison's characterization of the state, it would include many of the attributes that are considered most central to success and creativity in our society. It is often pointed out that a disproportionate number of the most well-known creative people in history had manic depression. Examples are: (writers) F. Scott Fitzgerald, Ernest Hemingway, Sylvia Plath; (poets) Walt Whitman, Ralph Waldo Emerson; (composers) Rachmaninoff, Tchaikovsky (7). These are not just isolated icons of the disorder, but rather there seems to be a validated link between bipolar disorder and the creative genius (8). In a broad-based study, researchers at Harvard University found that those suffering from manic-depressive disorder had higher levels of creativity than controls (8). I would like to know what point in the bipolar cycle the subjects in these studies were in when tested, and would hypothesize that the most creativity was found in individuals who were experiencing manic or hypomanic episodes. It is possible that there are many individuals who have a predisposition towards mania which feeds their creativity. Yet because they do not have accompanying depression, their "condition" is not labeled, and they are simply considered creative, bright members of our society.

So far, this discussion has been based on a viewpoint that puts a very positive spin on the manic aspect of bipolar disorder. However, as I said at the outset, there is another perspective that argues that full-blown mania in and of itself is incredibly debilitating. Some of the controversy may result from considering different points in the progression of a manic episode. In the early stages of a manic episode, a person may seem to be more social, active, talkative, self-confident, insightful and creative than usual. But as the episode unfolds, common symptoms include extreme irritability, overreaction to stimuli, difficulty understanding what is going on, poor judgment, blaming others for things that go wrong, and loss of touch with reality, in some cases including hallucinations and delusions (2). One bipolar sufferer described the state of mania in the following way:

"The fast ideas become too fast and there are far too many...overwhelming confusion replaces clarity...you stop keeping up with it -- memory goes, infectious humor ceases to amuse. Your friends become frightened...everything is now against the grain...you are irritable, angry, frightened." (9).

These descriptions of mania indicate that it is not just the depression of bipolar disorder that is pathological. Furthermore, it suggests that if a condition such as "unipolar mania" existed, it too would be classified as a psychiatric disorder. Additional support for the incapacitating nature of mania is that treatment for bipolar disorder involves efforts to intervene not only during depressive episodes, but also during manic episodes. One of the most challenging aspects of drug therapy for manic depression is that the anti-depressants prescribed to treat the depression can catapult sufferers into a manic state (10). If the behavioral effects of isolated mania were in line with "super-functioning" or at least normal functioning in our society, then treatment for bipolar disorder would focus entirely on treating depression, which is not the case. Therefore, while the possibility that unipolar mania exists, but is just not listed in DSM-IV cannot be completely ruled out, it seems unlikely that no one would be debilitated enough to be diagnosed with the condition. Before moving on to examine several possible reasons why depression co-occurs with mania, one final point related to this first area of inquiry should be noted. It is possible that mania does in fact exist in the absence of depression, and is diagnosed as another disorder. In my mind, the most likely candidate is Attention Deficit Hyperactivity Disorder (ADHD). Support for this idea comes from the finding that abnormalities in the prefrontal areas have been found in both patients with bipolar disorder and those with ADHD (11).

What biological characteristics of depression and mania might account for the observation that millions of people suffer from Major Depressive Disorder (unipolar depression) and at least 2 million suffer from Manic-Depression (bipolar depression) (9), but based on current understanding, people do not suffer from a pure form of mania? Before delving into an examination of several possible factors, a distinction between two types of bipolar disorder should be made. People who cycle back and forth between major depressive episodes and manic episodes are diagnosed as having Bipolar I, while those with the same depressive symptoms, but less severe manic symptoms (called hypomania) are considered to have Bipolar II (12).

The first area of research to be examined has to do with the proposed abnormal neurochemical aspects of unipolar and bipolar depression. Research in the 1960's resulted in the development of the "Biological Amine Theory of Depression", which is also known as "The Monoamine Hypothesis". The underlying idea behind this theory is that behavioral depression comes as a result of insufficient activity of a certain class of neurons called the monaminergic neurons. It is thought that deficits of norepinephrine, serotonin, or dopamine, all neurotransmitters that have a similar structure, result in a chemical imbalance in certain regions of the brain, and this leads to depression (13). On the other hand, mania is thought to be the result of an excess of these same neurotransmitters (14). This theory was refined during the late 1980's because of several problematic findings. One big concern that could not be explained by the theory was the therapeutic lag that exists following the initiation of pharmacological treatment for depression. While the biological effects of drugs that prevent the reuptake of serotonin and norepinephrine occur within a day or two, patients generally do not have relief of their depressive symptoms until 2-4 weeks later (14). Therefore, during the 1980's, the biological amine theory was modified based in the idea of postsynaptic receptor desensitization. According to this theory, depression was not due to the low levels of norepinephrine per sae, but rather was the result of the hyper-responsiveness of postsynaptic receptors, caused by a decreased availability of norepinephrine (13). By administering agonist drugs (ones that increase the action of neurotransmitters) that blocked the reuptake of norepinephrine in the synapse, normal levels of norepinephrine become available at the receptors, thereby inducing postsynaptic receptors to downgrade their activity to normal levels (14). The amount of time that it takes for receptors to down-regulate coincides with the time for pharmacological treatment to take effect, and therefore, is one explanation that would account for the lag time.

Given this background about the way that receptors and neurotransmitters interact in the brain, let's apply the neurochemical theory, in an attempt to explain the cycling nature of bipolar disorder. Recall that the main question at hand is why episodes of mania are inextricably linked to spells of depression. Reflecting on the information gathered, I posit that there is an overall dysregulation of mood-related neurotransmitter release in bipolar disorder and that the switch from mania to depression is the result of a compensatory effect that the body undergoes in an attempt to maintain homeostasis. An interesting observation is that in bipolar disorder, a depressive episode often follows a manic episode, rather than the other way around (15) (5). This may suggest that some aspect of how the body responds to the manic state predispose the body towards the onset of depression. Since the depression literature explains that abnormally low levels of mood-related neurotransmitters leads to an up-regulation of postsynaptic receptors, it seems logical that in the case of a manic episode, in which norepinephrine (and possibly other mood-related neurotransmitters) levels are abnormally high, down-regulation of post-synaptic receptors may well occur in an attempt to maintain homeostasis. Recall that it is hypothesized that during a manic episode, what is happening on the neurochemical level is that neurotransmitters, most notably norepinephrine, are released at heightened rates (14). However, there is a limiting factor, namely the amount of neurotransmitter available for release. One of the main times that the body replenishes its stores of neurotransmitters is during sleep (16). Therefore, since bipolar disorder is characterized by a decreased need for sleep or a feeling that one does not need to sleep, there is less time for the body to synthesize neurotransmitters. As a result, there must clearly come a point when the rate of neurotransmitter production cannot keep pace with the rate of neurotransmitter release. This is the culmination of the manic episode, and there is reason to believe that, at this point, a person is predisposed to entering a state of depression. First of all, following the heightened neurotransmitter release rate associated with mania, stores of neurotransmitters are depleted. Secondly, recall that in order to maintain homeostasis, the post-synaptic receptors down-regulated their activity (16). Therefore, even a normal amount of neurotransmitter will not be able to adequately activate post-synaptic receptors. The cumulative effect may, at least in part, account for the shift from mania to depression.

In many ways, my theory of how bouts of mania (or hypomania) are inevitably associated with periods of depression is analogous to what occurs following a drug-induced high. When people expose themselves to exogenous "upper" drugs such as the amphetamine, cocaine, the body undergoes a compensatory response in which receptor down-regulation occurs in an effort to maintain homeostasis. Thus, the body becomes dependent on the drug, and when the body is deprived of the drug, people often experience a major crash with depressive symptoms. This is because the receptor s down-regulated as a result of the exposure to the drug, and now the levels of neurotransmitter, in the absence of the agonistic effects of the drug, are no longer sufficient to maintain a non-depressed mood (16).

No discussion of bipolar disorder would be complete without at least mentioning the central role of lithium in the treatment regiment. While the mechanism by which lithium works remains a virtual enigma, its therapeutic efficacy as a mood stabilizer is well-established. The drug offers relief to 60% of individuals with bipolar disorder (the response rate among those with a form of bipolar disorder called "rapid cycling bipolar disorder" is notably lower at 20-40%) (17). Perhaps as more is learned about the mechanism by which lithium functions to stabilize mood in bipolar disorder, such findings will offer insight into possible reasons why a condition based purely in mania does not seem to exist.

A second area of research to be examined has to do with the role of circadian rhythm dysfunctions in bipolar disorder. This realm of research has focused primarily on "rapid cycling bipolar disorder", which is characterized as four or more manic, hypomanic, or depressive episodes in any 12 month period. In reality, episodes are often much more frequent than the definition requires (17).The term "circadian rhythms" comes from the Latin circa dies which means "about one day" (18). It is now known that circadian rhythms, which influence the timing of the release of hormones implicated in sleep and wakefulness, metabolic rate, and body temperature (18) are regulated by the suprachiasmatic nucleus (SCN) of the hypothalamus, and that the SCN modulates the pineal gland's release of the hormone melatonin (11). Melatonin, which is often sold as a cure for insomnia, is the body's shut-down mechanism(11). Light suppresses melatonin secretion, and thus the hormone is usually secreted at night (19). The issue of whether abnormalities in circadian rhythm regulation are involved in the pathogenesis of mood disorders has been examined for at least the last 50 years (19). The interest in this line of inquiry grew out of four clinical observations. The first such observation was that the amount of time that patients sleep undergoes major changes as they cycle between depression (associated with hypersomnia) and mania (associated with extreme and sometimes complete insomnia) (5). The second observation was that 60 percent of depressed patients enter into remission (symptoms cease) after a night or total or partial sleep deprivation (SD), while SD can actually induce a shift into hypomania or mania. This led to the conception that SD, or extended wakefulness is antidepressant/manicogenic (mania-inducing), while sleep is depressogenic (depression-inducing) (19). The third observation is that decreased sleep duration starts prior to the onset of a hypomanic state (19), which suggests that changes in sleep duration are not just symptoms of the disorder, but also play a pathogenic role. The final observation suggesting that abnormal circadian rhythms play a role in the pathogenesis of mood disorders has to do with diurnal variation. Past research has shown that there is continuous improvement in depressed patients' moods as day unfolds, suggesting that extended wakefulness is associated with an antidepressant response. More recent research at the National Institute of Mental Health (NIMH) extended the phenomenon of diurnal variation to bipolar patients with data showing that rapid-cycling patients shift "up" (i.e. from depression to hypomania) during the day and shift "down" (i.e. from hypomania to depression) overnight (19).

Building upon these observations, phase instability, a susceptibility to disturbances in the circadian rhythm, is thought to be one property of bipolar disorder (3). A recent study at the NIMH suggests that there are phase shifts in nocturnal melatonin secretion as bipolar patients cycle between the depressed and hypomanic states. Researchers have collected preliminary data showing that, in rapid-cycling bipolar sufferers, the time of nocturnal melatonin onset is about 90 minutes earlier when they are hypomanic, relative to when they are depressed (19). In some sense, it is as if bipolar patients, particularly rapid-cyclers, have an endogenous form of jet lag, and internally move back and forth over several time zones as they cycle between hypomania and depression. It is important to point out that the most recent theories hypothesize that phase shifts in melatonin secretion are secondary to the primary causes of bipolar disorder, but do have pathogenic effects, playing a role in the progression of a full-blown affective episode (19). It has been proposed that there is a positive feedback loop between sleep and mood in bipolar patients, which accounts for how their circadian rhythms become so off-track. When a patient begins to manifest hypomanic tendencies, he does not want to sleep, and the lack of sleep begins to destabilize his circadian rhythm. This initially slight shift in the circadian rhythm feeds back and makes him more manic, leading him to not want to sleep even more. Along the same lines, when the person is depressed, he will want to sleep more, which will lead him to become more depressed(5). Eventually, over time, the entire circadian rhythm system becomes completely off track, resulting in extreme mood swings between depression and mania (11). A case study published by a major researcher in the field showed that when a strict, lengthened sleep regimen (14 hours of complete darkness) was adhered to, the bipolar patient's sleep became fairly regular and, after a couple of months, mood cycles stopped. The most interesting finding from this case study was that promoting normal sleep appeared to stop not only hypomania, as the sleep-deprivation studies would suggest, but also the depression that used to follow hypomania (5). Obviously larger, double-blind studies are necessary, but the findings suggest that a contributing factor to bipolar disorder is the overall chaos that results from circadian rhythm instability, and thus when normal circadian rhythms are restored through normalizing sleep, the rapid mood shifts may cease to occur.

Understanding the proposed connection between bipolar disorder and circadian rhythm instability offers insight into why mania is not found to exist on its own. The theory is that individuals who suffer from bipolar disorder have a heightened sensitivity to slight changes in circadian rhythms, such that minor shifts that would not disturb a "normal" person, throw the entire system of someone with bipolar disorder from one mood state to another. Circadian rhythms are based in a cyclical process, and it would be surprising if the phase instability that is characteristic of bipolar disorder only became off track in one direction (i.e. only contributed to the escalation of a manic episode). When a system is unstable, it is just as likely that it will be shifted in one direction as the other. There clearly must be a limit as to how far the circadian rhythm can spiral out of control in one direction, and it would seem logical that a counterbalancing shift in the opposite direction might follow. This would further explain why, particularly in the case of rapid-cycling bipolar disorder, the type of bipolar disorder that most strongly implicates circadian dysfunction, there are frequent shifts between hypomanic or manic states and depressed states.

Clearly, there is not a straightforward answer to the question of why a condition characterized by manic episodes, but no accompanying depressive episodes, does not exist in DSM-IV. The possibility that "unipolar mania" does exist, but is not considered pathological cannot be entirely discounted. Yet, based on my reading, it seems that while there are most likely points in the earlier stages of a manic episode that stimulate creativity and productivity, once a manic episode progresses past a certain point, one's ability to function is compromised. Therefore, I believe that if severe cases of "unipolar mania" did exist, they would be considered to be pathological, and thus, "unipolar mania" would be a listing in DSM-IV. Based on this reasoning, I have suggested several possible physiologically-based reasons why mania does not exist in isolation from depression. There are no doubt holes in the biological rationale that I propose, reflective of the fact that I am not aware of any research that has directly addressed this issue to date. I think that research into why a completely "manic" condition does not seem to exist is called for, as it will further inform the understanding of the neurobiology of bipolar disorder.

 

WWW Sources

1) Schultz, Marc. Psychology 209, Abnormal Psychology. Bryn Mawr College, February, 1999.

2) Bipolar Mood Disorders

3) Extreme Measures

4) Bipolar Disorders Letter , "Minimized Activity Monitors and New Dosing Strategies Aid Treatment"

5) Bipolar Disorders Letter , "Meeting the Challenge of Rapid-Cycling Bipolar Disorder"

6) Kay Jamison on having manic-depression

7) Famous People with Bipolar Disorders

8) Bipolar Disoder and the Creative Genius , Serendip Website

9) Bipolar Disorder , National Institute of Mental Health homepage

10) Pharmacological treatment of Bipolar Disorder

11) What Causes Bipolar Disorders?

12) Bipolar Disorder - Etiology & Treatment

13) The Neurobiology and Chemical Apspects of Manic Depression/Bipolar Disorder

14) Drug Treatment for Mood Disorders: Depression and Bipolar Disorder

15) Chapter 16 - Mood Disorders

16) Sternberg, Wendy. Psychology 217, Biological Psychology. Haverford College, April 1998

17) Educational Material

18) How the Biological Clock Works

19) Circadian Rhythms Factor in Rapid-Cycling Bipolar Disorder

 

 

Continuing conversation
(to contribute your own observations/thoughts, post a comment below)

06/30/2005, from a Reader on the Web

I have every reason to believe in a condition known as unipolar manic without depression. I believe I am living with one, and I suspect many are self medicating with alcohol, and or drugs to bring them down. In theory, what medication should be used for a manic patient with no depression? Lithium? My father was manic-depressive, and my husband has classic manic symptoms, and has been tested for depression, but does not ever qualify as a depressed patient. I suspect also that much of our diagnosed personality disorders such as narcissim, and socio-paths are really uni-polar manic patients. For when you compare socio-pathic patients to a manic episode it looks an awfully similar.


08/27/2005, from a Reader on the Web

I have been treated for by bipolar disorder for 6 years. First by the VA then by Private pactice care giver. I chose to spend more money because of the basic subject of this article. The VA would waiver on ther exact diganos from unipolar mania to mixed. In the 3 years of treatment, I only recieved mood stabilizers like terotol to help control anger and sleep at the worst. I never was depressed clincally. It seemed that the only question I would be asked is how much sleep I was getting. While sex, ideas, pressure talk, and others that were ever present did not apply. My private care giver is more into the symptoms than the diagnosis. I still take mostly tegrotol and somtimes Klonopin. In all this time my only depression is when the mania fads and I can't possibly do everything I have on my plate. At a 12 step metting recently I have met 2 others that say they are the same and it funny how the meds match more or less. I used to think that the professionals were just jelous and looking to put me in my place, My prefomance in school, work, and personal business was outstanding, hi IQ, and getting things done with a energetic smile I thought irratated them. Now I just don't care, it's not all gold, my sex drive is destructive to my own values, I talk to much, and impatianatly wait for people to shut up so I can set them straight :), I need 12 steps groups, counceling and medication for these. Thank for you article, people like you will make a diffrence and improve mental health care. Dan


11/10/2005, from a Reader on the Web

I've been diagnosed bipolar since I was about 16. In high school my mom put me into an inpatient hospital several times and I was among the many kids diagnosed with manic depression. I was put on Depakote, Trazodone, and Risperdal. I didn't stay on these long term ever, but was constantly "self medicating" with Xanex and other pills along with constantly smoking marijuana to slow everything down. To this day through all of the trouble I got myself into, and all the psychologists and psychiatrists I can't ever remember being depressed or down no matter how things in my life were going. Always just high strung, and fast paced about everything. My dad, who's also a psychology major, and myself thought it was ADHD. I've asked both of them, and the psychologists if there was such a thing as unipolar mania, but nobody's ever said anything about this to me. Now I am 21 and have everything going great in my life. The only problem I still trouble with at work, or school, is the same mania. I am constantly pacing around, talking a mile a minute, and overanalyzing everything. I just need to slow everything down. I don't react well at all to stimulants. They just speed everything up even more. I just recently started trying GABA supplements to see if another route might work. Everything described in the essay about unipolar is how I percieve myself and I was just wondering if anyone had found something that had helped them with this. Thanks for the article and let me know if there's anything I haven't found that might help.


11/12/2005, from a Reader on the Web

Unipolar Manics. I've been one for 9 years now. And of all the medications I've been pumped up with, I've discovered that by cooling down my frontal lobe with a $.99 ice pack for five to ten minutes, I can slow down racing thoughts when such is upon me. I'm not sure if it is slowing the blood oxygen rate or slowing down the dendrites or affecting the glial cells or the hertz level of bio-electrical brain waves. Maybe just one of those, or a combination, or all of the above. But it works. I've spent thousands of dollars on medications (with insurance) and am amazed with the simplicity of the ice pack method.

Additional comments made prior to 2007
having been firstly sectioned for "hypomania when i was 20 and am now 38 and having been in 3 times since then and am quite confused about the labelling system with which the proffesionals seem to use their parameters.having recently seen my phycatrist who has only seen me as an out patient,presented me with my care plan which stated that i am bipolar although i do not really agree with the llabelling system as it seems to be quite devicive and i do not really belive that "madness has any boundaries allthough it is true that the majority of paitients do suffer from from forms of deppression so it would seem logical that the praoffesionals would try to group everyone in some sort of deppresive disorder.i belive i was mad and suffered from acute paranoia on my first stay.2 stay elation paranoia and my last 2 stays became through alchol missuse which triggered my mania.but on every visit i did not sleep for at least 3wks on 2000mls largatile fist 2 times.i do belive that i am a "unipolar manic"but as there seems to be no scientific appraisal ill have to submit myself to the leathargy of proffesional ignorance ... Finbar Taylor, 27 October 2006

 

 

Thank you for this paper. It is important to draw attention to this neglected area ... Sam, 19 December 2006

 

 

As an aging babyboomer with ADHD, the insights that I've had over the last few years in working in a support group environment would suggest that the closest thing to unipolar hypomania appears to be functional ADHD where the person is living on the edge by virtue of well founded support networks and is highly productive. There are many examples of people in the public eye whose output is prodigious, authors, musicians, entrepreneurs sportspersons.

 

In fact, I suspect the Holy Grail of most ADHD sufferers would be to attain a state of grace which could only be described as controlled hypomania ... Richard Windsor, 5 March 2007

 

 

Melissa's research provides an alternative that I think is very interesting. Right now (3/7/07), my brother is in terrible shape due to a manic episode. As noted by Melissa, full blown manic episodes are extreamly disabling.

 

What my brother is not showing (with his bipolar dx) in the rockbottom lows of depression. Sure there's depression, but not on the order of magnitude that is opposite of the manic episode.

 

The comment made by one poster re: ice pack is also interesting. In another article, or cited somewhere, I came across somthing similar in that ice cold water was (for mania) poured inside the left ear to stop, or reverse hypomania/mania, and visa versa, ice cold water was poured down the right side to quell off the depressive side ... Tom, 7 March 2007

 

 

"Why no unipolar mania?" an excellent paper to happen upon. I'd say I'm Bipolar VI as they now call it. All the positive symptoms, graduating college in 3 years, a life of love, insight, not being clinically depressed when you have reason to be. Great thing, no one would say it is wrong. Then you remember the feeling off your body seized in a catatonia, urinating uncontrollably in your second mental hospital, your body having refused sleep and all food for the past week, now everything is wrong and you look schizophrenic. feeling things, hearing things, seeing things all mind you incredibly beautiful and spiritual. Other cultures would call it a vision quest, but you are left in the no man's land of psychiatry. As a patient there you are rare, especially as a female, to the point of non-acknowledgement, treated for a depression you don't have via mechanisms of action unexplained by Na+ pump agonists. My undergraduate schooling is the same as any new doctor, converse with me about nonsense mutations, L-aspartate metabolism, jaundice as a baby, brain derivation of ATP during ketosis, and vitamins needed for mylenation. Either work with me on the science to discover what is wrong, or leave me to the spiritual quacks and another inevitable bout of crazy to wreck havock on my "beautiful, successful, albeit none of my doing" life. Nature is mostly a bell curve and so, sorry for my rant from the 3.5 sigma side of extremity. If you are a doctor and reading this, help, the symptoms that most of your patient's want are doing their best to kill me ... Elle, 24 October 2007

 

 

I feel I suffer from unipolar manic without depression. It has escalated over the years. It is very cyclical and I know when it is coming on. Unfortunately, I do not experience euphoria but I get quite aggressive,loud, excessively hyper, I talk non stop, can't sleep, I think everyone is out to get me, My emotions are exaggerated, and run at a level of constant hysteria. This can last up to 2 weeks. My normal state is quite bubbly but considerably calmer and nothing rattles my cage. I have known for 6 years that something was wrong and I have blamed it on pre menopause but when I looked up the symptoms of pre, peri and post menopause, I have no symptoms. My Thyroid is normal and my estrogen level is normal. I have been known to run without stopping for over and hour to try and tire myself just so I can have peace. I have gone for power walks for 3 hours through the streets of Rome to try and settle down. I have been on the verge of getting fired from my job due to loud aggressive behavior. This is very real and the only thing I do is take Xanax when I am having an episode. In the last 3 years I have suffered 2 breakdowns from anxiety, 2 TIA's and high blood pressure. I am 52 years old. I noticed this starting around the age of 45. If there is anything on this subject or a treatment please let me know ... Denise Carrara, 18 November 2007

 

 

I am an LCSW and work in CA with people who suffer from severe and persistant mental illness. One of my clients clearly becomes manic, but is never depressed. I ran into a problem that I cannot find an appropriate diagnosis in the DSM4. Most of the time she is hypomanic, with frequent manic episodes. However, in her case her mania is clearly disfunctional ... Annushka, 29 November 2007

 

 

I, too, am a manic unipolar. I get sad about things but never depressed, and it's never debilitating the way my mania is. I am just super high strung ... ACG, 26 December 2007

Comments

gregarioussloth's picture

Was curiouscause I know someone

My long term friend displays mania all the time, while not medicated, went 3 weeks without zyprexa, barely slept; as in hardly ever. During that time he began hallucinating. He gets extremely depressed for a short time when life throws him a very problemitic curve ball; typically relationship related. Not to go deeply into his eccentricities, I have never seen him go into a prolonged depressive state, that is my input on this article, and I never knew it was an unrecognized condition. He manages it well enough, manics are known to become violent, not suicidal, he is very good about that, in oregon there is no such thing as legally defending one's self and he has been attacked, has not retaliated, let the other guy get his sentence, right. Neurontoin, gaba pill, allows him to get restful sleep. No street drugs involved, been this way since 14. Go figure. Perhaps just rare?

Serendip Visitor's picture

Goodwin and Jamison (2007)

Goodwin and Jamison (2007) offer a nice description of unipolar mania in "Manic-Depressive Illness." You can view it on Amazon by clicking "look inside" on pp. 13-14.

Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness: bipolar disorders and recurrent depression (Vol. 1). Oxford University Press.

Other relevant sources:

Nurnberger Jr, J., Roose, S. P., Dunner, D. L., & Fieve, R. R. (1979). Unipolar mania: A distinct clinical entity?. The American journal of psychiatry, 136(11), 1420.
Chicago

Yazici, O., & Cakir, S. (2012). Unipolar Mania: A Distinct Entity or Characteristic of Manic Preponderance?. TURK PSIKIYATRI DERGISI, 23(3), 201-205.

Angst, J. (2011). Problems in the current concepts and definitions of bipolar disorders. World Psychiatry, 10(3), 191-192.

Serendip Visitor's picture

Definitely a stand-alone diagnosis

Just read through all the comments - great discussion and a wide range of experiences for everyone. I am a counselor and was diagnosed with Bipolar I about 10 years ago during an episode of postpartum psychosis and out-of-this-world hallucinations. Never had addiction issues, never suicidal, never paranoid, never went into rages, and they said it was late onset bipolar . . . BUT I'm NOT Depressed Doc! just highly expansive, euphoric, creative, and little need for sleep. My total of five episodes over the 10 year period were ALL MANIC, with the exception of one that they called mixed - dad died while I was in the hospital - duh, we call that one GRIEF or situational depression. I've been to hell and back with my experiences over the years - and I'm here to tell ya, there's LOTs of unexamined ego in psychiatry - (who suffers from delusions of grandeur here?) Most psychiatrists understand very little about unipolar mania - i think it BAFFLES them and they just don't know what to do with it - so they just throw every kind of drug at it. With the many I've taken, I've had good luck, finally, with one called loxitane (an old antipsychotic). I finally found a doctor who doesn't pathologize it but recognizes that it can be an asset more than a liability. And by the way, I wonder why they feel so theatened by the idea of someone claiming to be one with God - no separation - no duality - unitive thinking - probably because of their own unexamined belief structures. Psychiatry and spirituality DO NOT MIX in the WESTERN WORLD very well - it's like oil and water. Mania and schizophrenia receive some very different labels when you move to other cultures throughout the world. I could write a book - (one of the gifts of hypomania). . . I finished one recently and it should be released on amazon by October 2013 or sooner where I talk frankly about "crazy" as a concept, the problems with modern-day diagnostic approaches, and what drugs won't do for a person (ex. won't change your thinking, won't heal trauma, won't teach you how to cope, etc.) . It's called "Get Busy Living: The Art of Getting Unstuck". Good luck to all of you in your journey! And remember that you aren't damaged goods - I wouldn't trade my bipolar journey for nothing!! When you've traveled to the edges and extremes, you can find your way back to the center and know real peace for the first time maybe.

Serendip Visitor's picture

Definitely exists

I am a 34-year-old unipolar manic who was treated, after my first episode, with antidepressants, which sent me into a very long and complicated episode. Eventually, I normalized after a year of quetiapine and have been living a more-or-less stable life for seven years. I thought this was a pretty normal thing; the doctor said that sometimes people reacted badly to antidepressants because what they needed was something more tranquilizing instead.

Unipolar Greg's picture

Glad to see others who understand

I have had severe manic episodes for years. But I never swing into depression. I have been misdiagnosed many times by well meaning health care professionals who seem to not "get it" that depression isn't the problem with me. I have tried many of the mood stabilizers and virtually all of them have either had no effect at all or made the situation far worse than it was before I took them. I loved the person above who said she listed the medications alphabetically so she could remember them all. i can relate. Honestly, and in forthright conversations with my doctor I have discovered that the only thing that really "stops the horses from galloping off into a full blown manic episode" is THC...the active ingredient in marijuana. Since I have had a prescription for marinol, which is a synthetic legal form of THC I can intervene when the episode first begins and either stop it or reduce it's severity. Yes, mania does provide some wonder benefits of explosive energy and creativity, but once you have been awake for 7 or 8 days and aren't eating those benefits quickly go away. I have finally found a great therapist also who understands the issues associated with unipolar mania. That's helped a lot too, but it took quite a while and a number of therapists who didn't seem to understand that I didn't need help managing mood swings. I get into mania and move in. It's awful. I am a recovering alcoholic and I understand more that one of the main reasons I drank was to self medicate and slow the whole manic episode down. I had a horrible experience a couple of years ago at the holiday season when I was out of marinol and couldn't get more at the time because of Christmas. I was awake for 8 consecutive days and it ended with a drinking relapse. I know using THC is somewhat controversial, but it's what works for me and despite the fact my AA friends aren't too thrilled with me taking it I won't risk another episode like that one again without it.

ephraim's picture

Unipolar Hypomania is certainly real

Unipolar Hypomania does exist. Perhaps it is a case of bipolar disorder without the complete cycle bringing on the evil twin of depression. In any case, it is not always a gift, because it has its dark, ugly features for some people, which appear as facets of psychotic symptoms suffered by many with the mania of Type 1 Bipolar Disorder. And it has a dangerous side as well.

i have experienced one hypomanic episode lasting a number of weeks. It was triggered by a reaction to Trazodone, an antidepressant that my wife innocently gave me one night thinking it would help me finally get some sleep. It had been prescribed for my wife, not me, as a sleeping pill (a recognized "off-label" use for this medication). I had been unable to sleep for a few weeks due to frozen shoulder, which is notorious for pain at night that keeps sufferers awake without relief. Pain medications were not working. What happens to someone whose circadian rhythm has been disrupted, and who is not depressed when they are suddenly given one dose of anti-deppressant - one routinely used to manage the depression of bipolar disorder? The answer is that such a person could be pushed into a hypomanic episode.

I talked incessantly for weeks, at a rate so fast that people could not follow most of what I was saying - yet I could not stop talking for even a portion of a second. I could think faster than a computer. I drove like a stunt car driver at racing speeds on highways and streets. On a four lane roadway, I could see at least seven lanes I could use. I have a pretty fast car that holds the road well. For me, all stop signs became yield signs and all stop lights, even on major highways, became stop signs. Most drivers did not even notice, and no one ever even honked a horn until the time i was driving at full speed directly toward oncoming traffic to get around two lanes of traffic in front of me. I could outthink everyone around me in terms of cognitive speed and capacity. My memory was fantastic, going back to a young age, and I was amazed at my ability to recall vivid memories as needed. My mind had multiple processors feeding the core processor with input for final processing. Memories, thoughts, answers, insights and novel ideas came fluidly and without effort. Everything could be juxtaposed with other things so that I could find humour and cogent, relevant ideas, in everyday things - all day, and all night.

I wrote three speeches in two hours - one was about saving sea turtles, one was about times I have saved people who were injured or dying. I decided to appear as a stand up comic at a local comedy cabaret, and wrote at least an hour's worth of material I could use in my six minute gig on stage. I googled God and upon learning that there is nothing written about God on the internet that I don't already know, or that is bullshit, I wrote a poem to the effect that God cannot be Googled because God is not there. I later delivered that speech as my departing gift to my Toastmasters Club on the day I suddenly resigned.

My wife had throat cancer earlier this year, and cannot swallow certain things, especially pills. One night, I stopped her from choking to death on a Tylenol using the Heimlich Manoever, which I applied continuously for twenty minutes until she was able to get air. By her own words, she "would have died".

I began to be able to hear and completely appreciate individual instruments in pieces of familiar music. I have no musical training. I began sitting at a piano and just figuring out the structure of music as it relates to the keyboard. I had, and still have, copious amounts of energy, although I am now walking, rather than running everywhere I go, indoors and outside. I was running up the down escalators in malls, and beating those ascending on the up escalator to the top. (I still am doing that now, but only one flight rather than two). I met brand new people every day, and learned a lot of new, important things from them. It was like a collective Google that I could use for information and insights, but it was more powerful, and more fun, than Google itself.

I cured my frozen shoulder on my own, once I figured out how. Then I worked out how I had cured it, and from that, I know its cause.

I would look at a woman's face and feel a surge in my loins. Erections came along virtually on call. Nice to have.

My daughter asked me when I was going to write a book. Shortly after that, I began to awake at night to work out things in my mind for my a series of health and cognition books I actually began to write. I would jot down notes in the dark, and if it happened a second time, I would just get up and start working. I wrote everything on pen and paper in parallel on multiple notebooks for different subjects. Although i have three computers, they were too painfully slow. When I did use a computer, I would use two at once so that they could keep up to my cognitive speed without me becoming too frustrated. This only worked because I had to walk a few steps between them, since one was at a coffee table and one at a my desk. The delay entailed by those few steps gave the computers time to catch up to me. By pen, I would write up to 4000 words of one book in a day.

When writing quickly, I sometimes transposed letters because I was thinking simultaneously but only able to write letters of a word sequentially. I have noticed that some of the posters have exhibited this same tendency: It is a case of proper spelling being a purely social construct for the reader's sake, but if you cannot follow what I ma typng then toobadsosad you wont understnad me and you wouldnt have anyway. There is too much to do and we cannot take time to drag everyone else with us, so try to keep up. Again, this comes through in a number of the comments. i can tell by the way things are written and what is said that several people are writing while in their hypomanic (or manic) state.

I see also the frustration that some manic patients can experience with doctors who just seem to be dozing through, particularly when it is a doctor who is not familiar with the patient or the case. Because the disorder is rare, most doctors won't have experience. As for unipolar hypomania, well, that is just not in the lexicon, is it?

Strictly given my own experience, I would not want meds for this, and I would argue with a doctor who wanted me to accept them. i assiduously avoid self-medicating (no smoking, no recreational drugs, social drinking only), I am very cautious about over the counter medications, and I am now extremely vigilant about prescribed medications of any type, having experienced a drug interaction between the Trazodone and my Nifedipine (Calcium channel blocker for hypertension) that caused the former to remain in my blood for far longer than normal.

An exception is Ativan, which I used a couple of times just to bring me down from a state so hyperkinetic that I was feeling anxious. I think I will try the ice pack on the front of the head next time. There is some research that shows that this same method helps with insomnia! If only I had known that!

I have suffered no depression either before or after the hypomanic phase - but because it had been working so well for me, I was, at first, a bit sad after it faded. Rest, however, is utterly crucial. Although it feels like sleep is not needed, it is. It is the brain's need for rest that inevitably brings an end to the hypomanic phase. Delaying the inevitable risks bringing on the deep depression. The warning sighs begin once the euphoria has begun to diminish and the impatience with others transforms into frustration, then irritability. At that point, speed talking was preceded and accompanied by ample swearing because i correctly anticipated that I was going to be annoyed with the other person and I did not even want them to attempt to speak to me. Being a know it all who is correct about, and knows, everything, including everything you are likely going to say before you can speak, and recalling details of everything without effort or delay, feels very cool, is self-entertainment, and is even rather useful, but it does leave one feeling chronically impatient with others after a few weeks. The levels of exquisite joy I had been experiencing, the expansiveness and love, had already peaked and no longer seemed to accompany every encounter with others. These were the warning signs that it was definitely time to look for a soft spot to land the space ship, before it goes out of control and crashes. Refuel, sleep, and get proper nutrition. Exercise. Meditate. And make sure your friends and family are still willing to have anything to do with you.

I focus on nutrition for the sake of optimal neuronal health, I exercise, and I have fun. If hypomania ever comes around again, I will be ready for it. But if not, I have gained a lot from the one episode, and many of its strengths remain with me. I am writing my books that will capture the experience, share its benefits with others, and specify the key nutritional requirements that have helped me to maintain stability and to enjoy hypomania as such an invigorating, inspirational episode.

I would love to hear from others of experiences that have come close to my own.

~ Ephraim

Serendip Visitor's picture

What you have described sounds like my son

My son only has manic episodes, and never any type of depression.

What you are describing sounds like him in so many ways.

Is there something other than Lithium for these individuals....he HATES it.

Rik's picture

UCLA

I was a senior. Classes were boring so I talked to the Chairman, F Nowell Jones. He said, why not take some grad classes. I did and one was his. Then all hell broke out and I ended up in the state mental hospital.

After 4 months, I enrolled again at UCLA and again in his class. Got the top mark in the class--full of graduate students.

Never been depressed in my life. Too busy. Have a PhD. Wrote paper in 5 days. It was judged as one of the best.

Have just as many failures. Bad judgment. Life has been fun. Just like playing like a child.

Serendip Visitor's picture

me 2

My mania is always measured in degrees. I'm never really depressed, just slightly less manic. It's calm, focused, mania though. Am i just the zen master or somethin? I started college again after a 10-yr hiatus (drop out) and am rockin a 4.0 (bonehead classes 101 123 math comm music english u get it). But i do notice my mania is somewhat disruptive (I do get bored easily, therefore must engage in risky/unusual behavior) and I do like drugs, always have (mainly psychedelics and opiates....not a stim fan like most ppl....opies are my crack...hmm) I dont need help would just like insight. Actually no I'm just hyper and talkin about myself cuz u gessed it im high on opie. THIS NEEDS TO BE STUDIED W PERSONALITY TYPES. oh wait it has just real knowledge is too hard to acquire (cmon google you're gettin there)

Rik's picture

UCLA

As a senior, I found classes too easy and told the chairman, F Nowell Jones. He said, why not take a few graduate classes. I did. His class and got the top grade until all hell broke loose and I was at the State Mental Hospital.

I stayed their for 4 months, returned to UCLA and took his class over again and got the top mark among the graduate students.

I have never been depressed in my life. But I travel a lot. Have a PhD. Wrote the paper in 5 days. Damn good paper. This has been a rough ride. I had little choice in where I go or what I do.

Rik's picture

Anyone who thinks this is ADD

Anyone who thinks this is ADD is nuts. I hear voices, have delusions of owing 55 billion cash. How do you spend cash?

Got confused and posted this twice.

Been this way since 1968. There is a voice in the back of my head saying to slow down and act normal. Went 38 years without hospitalizations. GL.

Eric's picture

Uni Polar

I'm unipolar manic. My first episode was in 1995 when I was 18. It was much like what is described. My thoughts racing faster and faster, as I went from activity to activity with hardly any or no sleep. It felt amazing, I won't lie. But eventually you're thoughts and actions become too fast. Eventually you can't communicate properly with the people around you. Eventually you reach the point of no return, and will wind up in a behavioral unit. I've had nine such visits, and can say I've seen some crazy things, some scary things, and some sad things as well. I have to remember the different medications I've had in alphabetical order just so as to not exclude one. (I'm still waiting on a 'Q' one!) And the medications have gotten better over the years, but each person reacts differently to them, so be patient. (no pun intended!) doctors tend to over medicate than under medicate, so keep pushing to gradually lower your prescription. But it's a double edged sword. Too little and you're back to square one. The worst part by far, is the fact that most manic individuals embrace an oncoming episode. I'm guilty of it, on more than one occasion. But you have to finally realize that the week or two of mania is followed by months and months of recovery. It can cost you family, friends, jobs, lovers, not to mention exuberant medical bills. The sympathy will turn to apathy and avoidance. Are those two weeks or so worth that? It's something that the unipolar manic must arrive at on their own. And then you have to be careful, realize when you're starting to stress out, recognize the onset, and work with everyone to stifle an episode. This is not like mending a broken bone, the medical profession is still figuring out what is happening, and is creating new treatments. Technology is so rapidly advancing, that we have come pretty damn far from electro-shock therapy just several decades back. You can live a normal life, and things will get better, but it will take time, and you have to want NOT to have episodes. I hope this helps some people, others it will enrage. I used to be one of the later. And I can only hope that eventually your own trial and error of manic episodes brings you to a similar conclusion to lead a healthy and productive life.

Gledwood's picture

mania is not adhd

Someone up there said that mania is obviously adhd; adhd does not make you hear voices, go days without sleeping more than a couple of hours at a time etc etc. I was cycling between depression and mania for about 12 weeks approx a week at a time, so I had 6 manias and 6 depressions in this time. Most of the mania I get is much more extreme than the depression and I agree it is very disabling. When I'm full-on manic I can barely follow or understand anything I read and I can have great difficulty following what people are saying to me. Even doing something simple like going outside: getting keys, money and self together is a major task. Unipolar mania would definitely be considered a mental illness. Everybody could see something was majorly wrong with me when I was manic, but when I'm depressed I can interact normally and get treated normally.

empcaster's picture

Doctors are very close

Doctors are very close minded, to the point of being stupid at times. I suffer from manic episodes. I rarely get depressed though. When I was younger I would get depressed, as though it were "happening" to me. Now I view depression as a choice. When I do feel depressed it is justified by circumstance and transient. I find catharsis and its done.

I am in chronic pain, and, though loathe to diagnose myself, I think dyshedonia is a term that seems fairly accurate in my case. Things which people typically enjoy are difficult for me because of the physical pain I am in. But that is not depression or grief or sadness. I know what depression is and is not.

Bipolar by definition includes two "poles" of which I am short one. Clearly there should be diagnosis of which "mania" is not just a descriptive element but entirely definitive on its own. I am not manic depressive. Any doc can see it, but they can't say it. Its confusing when I see other doctors which I am unfamiliar with because they only know what they read, and think they know it damn well.

Serendip Visitor's picture

Love that comment about being

Love that comment about being one pole short

Smart and with wit.

Serendip Visitor's picture

my mania and my delusions of

my mania and my delusions of grandeur

i cd choose normality. i want this. like the suits i'm driven by greed. i salivate for this lonely paradise. "from the center all round to the sea, i am lord.................. "

Keith Duncan's picture

Unipolar Mania is a blessing and a gift and living in reality

I have unipolar mania. I had two relatively intense episodes over past 3 years that resulted from external stress of a business training environment and one from being defrauded by my then-wife. Characteristics have always been that I trust people when outside indicators are that I shouldn't. It's amazing to me that in almost every situation, I look at the bright side of any activity. That's the positive side of mania. Regarding sleep, I actually feel at my best when I naturally wake up after 5 hours of sleep regardless of the day and get up and go to work on my current adventures. If I sleep in, I get slightly lethargic sometime later that day. I have been through at least 5 physiologists and psychologists who are trained to prescribe medications because it's simpler than acknowledging that maybe we(as unipolar Mania) actually can be highly functioning and productive individuals without the inhibiting effects of Seriquel, Abilify, Divelproxac, and the other long list of medications I have been put on to "suppress" my creativity.
Finally, I have connected with enough other trusted people and realized that unipolar mania at a sustained level is a gift of life. As long as I get adequate sleep, surround myself with positive people and thoughts, my life is quite wonderful. I finally am realizing my true passion of serious inventing and entrepreneurship that drives my efforts every day.
For those of you who never take advantage of others, feel good about yourself, and live on the bright edge of unipolar mania, keep your gift intact. Obviously heed to the observational advice of those closest to you to monitor your activities and ensure you are not swinging emotionally to the dark side of depression. And keep your head up high, because you can and should be a true inspiration to others with our same condition.

Serendip Visitor's picture

unipolar mania

As a nursing student, as I begin to learn about this so called disorder, I have began to think that this may be me. I never fit in and have been known to have episodes of depression however, I have learned that the depression is not normal and that I can CHOOSE to contol it by suppressing it ifI wish and have been successfull for years by doing that. My mania (or what I believe is mania) has helped me to be successful and extremely independant ans I too love to invent thing and my constant Ideas of creating or making something has been of great benefit too me and admired by all however I do not seem to fit in anywhere. I have realized that I am somehow different from others and have never been able to put my finger quite on it until now. As I sit and study for the last few weeks of schooling to obtain my 2nd medical degree, I began to wonder .............. "what is so bad about mania if you do not become violent and hurt know one and it feels so good." My questioning this has lead me to your article. I have to wonder how or why something that is so helpful and so enjoyable can be qualified as something that needs medicating. Is it just me or do those that feel that way need medicating. Why reduce someone to a feeling of less that great, intentionally? Why stifel creativity and a wonderful feeeling in a world that can be so cruel? Let me know your feelings on this.

Meridith Garbutt's picture

Unipolar Mania

I've been living with Unipolar Mania for about six years now. (though I believe I've had it all my life). I've been hospitalized twice for it and my mania manifests as a feeling of having a "direct connection to Source." So much so that I feel and see the good in everything. During my first hospitalization, I would break out into spontaneous prayer. My second hospitalization was characterized by a "complete surrender" to what was happening. All in all, I view this as a gift and not a curse. For years I was self-medicating with weed, alcohol, ecstasy, 'shrooms, and Salvia Divinorum. I started self medicating with drugs and alcohol since around 2001. I've since learned that those items were contributing to my mania. For "normal" people using those substances is fine, but I'm already high all the time and using those substances just pushed me over the edge into another world - but involuntarily. Now, my medication is clean and healthy living - no drugs or alcohol at all. I supplement this medication of clean and healthy living with doses of chanting (as a spiritual practice) as needed. This has proved to be a great help in allowing my Gift (as I call my Unipolar Mania) to blossom and grow.

empcaster's picture

I too used marijuana heavily.

I too used marijuana heavily. To be honest it worked great to control the mania and tone down my ocd as far as intrusive thoughts go. I built a diet and exercise plan around its use to avoid the eventual apathy and resurgence of mania. For me it was manageable as long as I stuck to daily limits of edibles. In the end getting and keeping a job matters, and I'd rather feel some pain and know its real than to be high off my ass and feel like life has no point. That's the inevitable consequence of never feeling discomfort. If everything feels good, then everything matters. If everything matters, then nothing matters. If nothing is taboo then nothing is sacred. I won't have "arrived" until I die. I need some struggle.

Serendip Visitor's picture

you are afraid of nirvana????

you are afraid of nirvana???? HA!

Murray Smith 's picture

uni-polar

Dear Meridith, you might have read my history like you I consider myself a person who only has the manic side of bi-polar, keep up the good work and live a happy and useful life,with self control you can do it , all the best for Xmas,Murray Smith.

Anonymous's picture

mania is positive? maybe LITE mania.

The implication is that mania is positive. I get into lots of terrible trouble when manic. depressed, people dont' want to talk with me or be around me, it's contagious. But manic, I color outside the lines. I cross boundaries. I scare the crap out of venerable institutions and major corporations. I fired my doctor. I was fired from a good job.

Moderate up-mood, yeah, that can be a benefit. Bright, not brilliant. Becoming larger than life and threatening your boss, even if you're right, he is doing illegal and immoral things, well, it's just not prudent.

Maybe that person has not experienced psychosis in mania. When everything seems like it's witchy, and evil, and one has special powers. Or where the performance becomes outrageous and necessary for basic functioning -- like creating a scene to get the internist's receptionist attention (instead of just letting her know you're there).

I believe the mania is the malfunctioning part. and the severe depression the living-death, and start anew. a clean slate. to rebuild the same individual, but this time hopefully do it right, so that the parts and gears are all working properly, and the person does not have to overextend, and explode... and start again.

Some people act like alcoholics but do not go so far that they have to bottom out to start over. They get to keep some things, for their next life. The dont' lose everything. I know, that sounds unrelated. But I'm not so sure.

When I'm manic, I sometimes feel like a woman pretending to be a man pretending to be a woman. Is this related to being a gay man? People don't like to suggest such a thing. The gays have made such progress being seen as normal. Not 'sick'. But the extreme creativity, the hypersexuality, the dressing up in bizarre costumes, well, anyway, there seems to be a similarity and even a connection, to me.

Depression is horrible, don't get me wrong. But I got to rest. all those overextending parts of me. I really did not care about clothes or making outfits or shoes, for over 6 mo. I got to rebuild my other side, my design side. and then one day, I started the other side again. I intend to build it back right this time. and yes, I'm taking lithium and synthroid. But I plan to do what I am built to do, and NOT MORE. My part, and not everyone's. To be me. Not what my mother or my father would like (someone like themselves). I get to sleep. I get to eat. and I get to be ONLY ONE PERSON, not superhuman and saving the world.

Anonymous's picture

medical advice

be careful about giving or receiving any type of medical advice over the internet - JMHO as a medical practitioner,
enough said

Lara's picture

Update on My Medications

Incase anyone is interested, we are trying to treat my psychosis, mania and OCD with one medication now: Ziprasidone (Zeldox in Canada, Geodon in the U.S.) It has properties that help all three. Getting rid of the SSRI's. We'll see what happens.

Lara's picture

My Mania, OCD, psychosis

I have both severe OCD and mania or hypomania with no depression. I have been diagnosed with OCD recently and my psychiatrist is still in the process of figuring out the 'correct diagnosis' for my unipolar mania.

Six years ago I was diagnosed with Psychosis, N.O.S. and placed on antipsychotics. My psychiatrist stopped seeing me, having 'cured' my delusions and I went 5 years without a psychiatrist monitoring me. After a recent 'meltdown', I started seeing another psychiatrist. We are in the process of trying to figure out how to treat my OCD (SSRI's normally) while still keeping me on antipsychotics (for the psychosis) and trying to do something about stabilizing my mood for the mania (four episodes a week on average for over 8 years now).

I am extremely high functioning and have a very successful career but my mind at times is a muddled mess and I have days where I feel like I'm going over the edge.

For as long as I can remember I have had manic episodes, paranoia and obsessions- my mind must have become very good at coping with these. As I said before, only until I recently somewhat 'broke down' and saw a psychiatrist, did I realize that what I have been experiencing is, for lack of a better term, A LOT. (It is amazing how the mind is to cope under extreme conditions when it absolutely needs to.)

Even though I am currently on meds my symptoms include:
During a Psychotic Episode: Delusions, paranoia
OCD: Cycling thoughts, obsessions, some compulsions
Manic Episode: Euphoria, anxiety, agitation, irritability, agression, restlessness, high energy, high sex drive.

Now that I'm on medications, these symptoms are less severe although they are still mildly there- somedays are much worse than others.

My psychiatrist is trying to help me find a good combination of meds, however it seems like it will be a long journey towards recovery since there are many factors to consider.

If I could have my choice I would treat my psychosis first, OCD second, mania third. (Although perhaps my first diagnosis of Psychosis NOS is actually a symptom of my OCD or mania and not a disorder in of itself.)

Right now, I know it's not the best, but I'm on an SSRI and antipsychotics, plus I take Ativan to relax me during my manic episodes. Do I have manic episodes b/c I'm on an antipsychotic medication plus an SSRI? Perhaps. But even when I was only on antipsychotics for years and years I'd have manic episodes. Remember: I can live with my mania, but now that I've experienced freedom from OCD, I refuse to not be treated for that disorder.

So there's my story. Maybe someone has ideas for treatment for my particular situation. I'd love to hear them.

gcvmom's picture

Unipolar Mania vs. Severe ADHD

While "unipolar" mania can look very much like severe ADHD, I don't see how they can be the same disorder when the manic/hypomanic brain (or at least my son's brain) does not respond to the meds used for ADHD the same way it does to meds traditionally used to treat mania/hypomania. Then again, that could be my ignorance about the disorders.

Stimulant meds started out working o.k. for him, but after three or four years, they began to peter out. We tried increasing the dosage for two more years and he ended up on the verge of a full-blown manic episode at the age of 10. Did our ignorant use of stimulants push him over the edge? Maybe. But at age 12 he now cannot tolerate even 2mg of stimulant and requires a mood stabilizer and a high-dose atypical antipsychotic to keep his manic symptoms at bay.

He does not spiral into clinical depression. If anything, it's a constant level of mixed-to-hypomanic symptoms when he's beginning to destabilize. Perhaps because he is so young and we've stayed on top of things that he has not swung completely over to the fully depressive end?

Circadian rhythms are Loooong for this kid, who typically sleeps 15 hours if left to his own devices. And if sleep is disrupted for any period of time, he slips back towards hypomania/mania again. And one missed dose of medication also becomes a destabilizing event. Very sensitive kid whose life will be a tightrope of structure if he is to have any hope of functioning.

Serendip Visitor's picture

Why?

I'm not in your shoes, but I think drugging your son like this is grossly negligent and irresponsible. I was drugged as a child (SSRIs and SNRIs) and I have been left with persistent neurological and endocrine issues. You really have no idea what all of this is doing to his developing brain and body. He's not able to make these decisions for himself due to his age, but unfortunately, he will be the one to live with the consequences.

Serendip Visitor's picture

Medication and children

You obviously have had your own experiences but that's just what they are: YOUR experiences. The reported case is apparently severe and what would be irresponsable would be to neglect or undertreat it. I suggest you leave the decisions to the professionals who have studied these disorders for years and keep your jugemental opinions to yourself. The parent is doing his best to help his child. Scaring and juging him is not helpful.

J.G.'s picture

Mania

I believe Schizophrenia is actually mania. It seems to be the opposite of depression, and it makes sense. It also would explain why genetic links have been found between parents with schizophrenia and children with bipolar disorder, and I believe vice-versa. And a numbed and apathetic personality type is official labled as some sort of schizophrenic personality type too.. I think. If not sociopathic. Personality is another spectrum all of its own.

k's picture

unpolarmania=ADHD

Could it be that unipolar-mania is in the DSM and well known in our society?

It is as common as depression, we just call it ADHD instead of unipolar mania.

That seems extremely obvious.

Stu's picture

Hi, I really enjoyed the

Hi,
I really enjoyed the article although felt that the ending was disappointing. Not that it was badly written or of unsound basis. Just that the beginning gave me hope that I could maintain a state of controlled mania, whereas the end implied that uni-mania is not necessarily possibly.

I first encountered a phase of prolonged mania (3 years) when I was 24. Since then it seems to have been a cycle of extreme highs and lows complicated by both prescribed and recreational drugs.

I have been diagnosed at different times buy various doctors. Some who wanted to label my condition (often with wild inconsistency) and other, more helpful and pragmatic professionals, who discussed the best ways of helping me deal with my life.

Many have wanted to help me eliminate mania all together, mostly by prescribing medication that generally leaves me feeling so flat that I ultimately believe this can be a cause of depression in itself. I enjoy the mania. I am inspiring and feel I have so much to give during these phases.

At 40 I am now trying to find a medication free way of managing this mania such that I can achieve a constant state of controlled mania that will be of benefit to me and those that chose to share my life. From this and other article I have taken on board the importance of sleep. Currently I sleep 4-5 hours a night which, although it does not affect my performance in life, is probably detrimental.

I would welcome any advice from those that have managed to attain a controlled manic phase that no longer scares the life out of their loved ones.

Kind regards,

Stu

spectrum_paradigm's picture

Part II : Bipolar to [unipolar manic] = [psychopath] ?!

6). I must admit that me too as a "unipolar hypomanic guy without depression", I have some psychopathic characteristics : poor social contact, low empathy ... I have tried to change by following catholic principles (pray for the wellness of your enemies, thanksgiving attitude to God's will etc) 10 years ago and it worked ... Sports too have good effect. I think that I must continue doing that even if I'm not as much practising as before ...

7). From bipolar disorder to unipolar hypomania to Psychopathy ... I suppose there is some kind of a spectrum when I ponder on my case ... A spectrum which ranges from unipolar depression to pyschopathy. Actually I'm hypomanic ... May be I'll end up in jail ? I MUST become more "catholic". Thanking God for my actual condition. Praying for people who offend me ... I'll monitor this using a diary.

8). May be there's no DSM VI ? May be unipolar mania has nothing to do with plain bipolar disorder as ... unipolar depression is not bipolar disorder ?

9). Metaphorically, we may consider it like a spectrum of colors in a rainbow http://wfc3.gsfc.nasa.gov/MARCONI/images-basic/spectrum.jpg ranging from RED to VIOLET. Red is red, violet is violet. The CNS spectrum (sounds good) in which Red = psychopathy, violet = unipolar depression, Bipolar II is alternating between orange and blue periodically. Bipolar I is alternating between Red and yellow.
Schizophrenia, autism, alzheimer diseases wouldn't be included in this spectrum. Schizophrenics are more like fractal mathematics.

spectrum_paradigm's picture

Part I : Bipolar to [unipolar manic] = [psychopath] ?!

1). I suppose I'm bipolar. I used to swing between depression and hypomanic states during my twenties. Now 35.

2). Since 2 years, I started having poor sleep quality periods alternating with hypomania. What's strange is that actually, the low phases *without depression* periods are becoming smaller and the hypomanic periods are becoming longer and intensive ...

3). I'm fascinated by this mental illness. I've taken thyroid test, heavy metal intoxication tests, allergy tests (to gluten essentially) and everything is normal. So, my problem seems genetic (brother suicided, paternel side seems affected).

4). Colleagues were speaking about a TV serial called Dexter so I googled and found interesting facts on psychopathy (Bob Hare : http://www.hare.org/links/saturday.html). Seems that my father has lots of common points ... My brother used to say that he would like to kill someone ...

5). To come to the point, it's as if unipolar mania (only the left hemisphere working instead of working with the right : see Dr.Pettigrew's article about interhemispheric switching : http://www.illuminatingscience.org/perceptual-rivarly-part-2/ ), well as if unipolar mania is equal to psychopathy (see the first comment on the article)

easydj's picture

Unipolar Manic

HI guys....I'm a unipolar manic analylic....but have been misdiagnosed for the past 8 years. The condition exists and for the the ultimate way to control is to understand..and of course analyise...
The relationship between so many variables needs to be examined properly. I have found through sodium valporate works as reduces overall activity. But my doses are far higher than what psy. knows but as I never cycle down and predisposition to full blown mania this is what I require. I don't think of it as bad now understanding and control is attained. AS of all the many manifestations that are incorrect, luckly I never got. I just got my lottery ticket.
Others were saying they run around as if controls them. Well thats where their wrong..thats not right....I'm completely normal and run my own business. But can when want think manically. But this to me, is set by boundaries that cannot be crossed or the problem cannot be worked out. The info has to be correct, from real source etc etc etc.
And no I'm not manic now its just that i can turn it off and use it when I want.
Usually end up with more open ended questions and have to google answers.
Good to hear others like me.... but i think controlled this is a facinating disorder that understood could open new doors.
Great talking..sorry typical Sagittarious talk too much..lol bye from aussie

Serendip Visitor's picture

uni-polar

Dear Easydj,you seem to have good control of your life,I am on epilim [sodium valporate] as well, and found it keeps me in normality with no side effects,as a 72 year old, diagnosed 1999 it has saved my life! and made life with other people possible, I hope all is well with you , Murray Smith.

SHANE PAUL ZEILSTRA's picture

haha

i have bipolar and have had from my earliest memories,i have never had treatment nor diagnosis till last year i am now 40,i have always wondered why everyone else was so slow and unfeeling never smilling,my familly will not talk ,i have very few freinds{none to help when the black comes in the middle of the nite when i awaken choking for breath sobbing crying bleeding anguish from my whole body struggle to crawl to the shower turn the hot on and squat there till its over}i smoke pot to slow down both physical and mental action,but lastyear a change occured in my usual rythm and i surged in manic euphoria for 6wks,ah but what a feeling no sleep/haha no reduction of erection and an understanding of myself and everything's conection to me...the psychiatrist's that came to "help"could tell me nothing i saw this in the first minute so i told them what they needed to know ,,yeh i fixed the psychiatrist's,there was 4,,I DO NOT LIE AND ONLY TELL THE TRUTH,,,I HAVE ALWAYS NEEDED TO SEE THE TRUTH...MY question a talent suddenly appears in your repertoire of skills that you have certainly never studied how does this fit in to the patern??thanx with no anx

shane paul zeilstra's picture

intergration

i like the old term SUPERSENSATIVE much better for it puts all of these labels under the one true banner..you see we are EMPATHIC,true phsycics,we are homosapiens evolved amongst those that do not want to evolve.this has gone on for thousands of years,how much longer can we hide from ourselves without total destruction..i say it is now time to grow up open your eyes and minds and smell the roses

M A W's picture

Article about Unipolar Mania

The article "Why No 'Unipolar Mania' Listing in DSM-IV?' addresses an issue that has puzzled me for years. I have known several people afflicted with the bipolar disorder: One of them, tragically, killed himself. Much later, an internist with whom I discussed the matter told me, "Most bipolars never go into the manic phase." This made no sense to me at the time, and it makes even less sense now. I have known people who seem to be ONLY in the manic phase.--I have also heard, from a more reputable doctor than the internist, that people have said that they were not really happy in the manic phase of the bipolar disorder: They were simply geared up, or keyed up, or extremely excitable. They tried to control this phase with strenuous exercise.

In the late 1980s, I saw an excellent television program on the bipolar disorder. At the time I did not own a VCR: Otherwise I would have taped the program. It illustrated graphically what the reputable doctor had told me: It showed people bicycling frantically in order to subdue the excesses of the manic phase. It also demonstrated how and where the gene for the disorder is located.

The bipolar condition is highly hereditary. It is also tragic beyond belief.

Anise's picture

Important to emphasize this

I do think it's important to emphasize that some people just never experience mania as any kind of positive thing. I've only had ONE episode of true depression in my life (a few months when I was fifteen years old,) and other than that, I've had mixed episodes that were predominately manic.
My mother is Bipolar I and has always had 95% mania, very little depression. My grandmother is the same way. Based on family stories, I think my great-grandmother is the same way.

I don't know about any of my relatives, but I absolutely do not feel creative, happy, and/or expansive when manic, and I never, ever have, not even once. I've had hypomanias that have felt great... but while having them, I just desperately wish they would go away. Mania keeps me from being my true self. Creativity and happiness only exist for me when I'm in a stable state. There is nothing, NOTHING about mania that I ever want to experience again. In the long run, though, this might actually turn out to be an incredibly good thing. There is nothing about mania I want to recapture, so I have NO incentive to go off medications, which almost all bipolar people seem to do at some point.

David's picture

Unipolar Mania

My father has been a unipolar manic for the last 13 years. He was studied at John Hopkins, and they could find no explanation for his disorder. When he is having a manic episode, he cannot even recognize it is occurring, yet all those around him can recognize exact patterns of behavior identical to all past episodes. Right now, he is giving away over a hundred "calvary spikes" he made (bent pieces of copper wire shaped like Jesus nails), and he is "ministering" to random people. When he is manic, he often becomes very confused about things. For instance, he keeps thinking I put a CD into his car's player, and it's stuck, but there is no disc in the player. He thinks that because when he tries to put in one of his discs, the audio skips. I looked at the disc, and there is a massive scratch in the disc which provides a perfectly rational explation for the skipping. But even after explaining this to him, he still thinks there must be a CD in his player, and that's why his disc is skipping.

He never has a depressive episode, only a manic episode. I have looked through the DSM-IV myself, and I can testify to the odd lack of a listing for "unipolar mania." My dad's problem is exactly unipolar mania, and psychiatrists don't seem to understand it. There is a listing for unipolar depression, which is probably even more difficult to differentiate between clinical depression, and yet unipolar depression still remains a complete mystery.

Anonymous's picture

interesting!

i have been diagnosed as bipolar 1 at age 29, had horrible reactions to any kind of anti- depressant (wellbutrin made me paranoid enough to hide in closets) and don't physically tolerate anti- convulsants. what's working for me is 300 mg seroquel 2 hours before bed, then another 300 when i go to bed. that's it. sleep is a HUGE thing for me.

i have never met the criteria for a major depressive disorder either. i'm glad i'm not the only one that wondered why that might be.

by the way, that ice pack idea might save me future hospital bills... thank you!

Anonymous's picture

incorrect information

the idea that provides basis for this story is erroneous.
Mania episodes alone are diagnosed as Bipolar Disorder, the depressive episode is not required.
You can find this information in DSM-IV

John's picture

DSM-IV is wrong

DSM-IV 296.4x "Bipolar I disorder, most recent episode manic" includes Unipolar Manic, i.e. one or more manic episodes with no depressive episodes. Bipolar stands for the two poles of mania and depression. So it is plain wrong to classify a unipolar illness under this bipolar category. It is illogical and will have negative consequences like diagnosing counter-productive anti-depressants when only anti-mania is needed. A new category is required without doubt.

The existence of people with unipolar manic disorder is shown by this study http://ajp.psychiatryonline.org/cgi/content/full/160/11/2049

el's picture

Yes, but then when people are

Yes, but then when people are told you have bipolar, they go and google it and get the wrong idea, they say things like yes my husband has depression so I know what you must feel like ...yeah right ! Last time I got locked up they said that it was inappropriate behaviour for me to be singing Fernando in a waiting room - hey I was bored!

murray smith's picture

u/p

Dear Melissa, at last some one who has enough sense to think beyond the square, I am definately uni-polar, I was a late onset diagnosis, age 60y, am now 70y, always said to be a bit crazy, very accident prone, due to rising to a manic state after a period of time in a normal state, never having been depressed during the normal time. The diagnosis of bi-polar was made after a full blown manic eposide culminating with the attendance of 3 police cars,1 ambulance and 3 weeks in hospital, since then I have lived a normal life with 700 mg of epilim daily, and no further occasions of mania present.
If You would like any more information I would be quite happy to tell You.
Thanking You, Murray smith.

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