I had zero insight into my elevated moods when I was younger, through maybe 7 years after my bipolar diagnosis. But through my insight has improved, it's not perfect, or at least it takes getting to a medium or higher-level hypomania sometimes for the insight to kick in. Or, my husband, therapist and psychiatrist clue me in. The latter two obviously have decades of experience recognizing it. My husband knew there was something amiss with me early in our relationship, but didn't identify it as mania right away.

My hypomanias and manias were quite problematic when I was younger, but the course of my illness grew worse and worse as I aged, unmedicated. Plus, I eventually realized the damage more. Because of that, I do want to cut them short, if I can. I do so aggressively now, using PRN medications and various "tools" to deescalate. My PRN medication for mood elevations is regular Seroquel. I also have Ativan, but Seroquel is best. If PRN regular Seroquel and the deescalation methods don't work well enough, I call (or am pushed to call) my psychiatrist for intervention. I am extremely fortunate that he is responsive. That care has spared me several hospitalizations over the last 9 years. His usual remedy for me is to increase my base Seroquel XR dose.

One issue that I have written about in the past is "bipolar episode denial". This denial has been especially the case for "downswings", though also "upswings" in mood. After so many years of severe episodes, I just wanted to be well again. It can get deeply frustrating and distressing to have mood issues crop up frequently. In the referenced blog post, I note how when mood tracking in the past, I would often just choose "baseline" all of the time. You know..."I'm just fine," even when I wasn't. Often it took some weeks to realize that. I would then go back and change my mood choices for weeks prior. It is also frustrating when I feel very good or great and people label it as hypomania. I ask "Why can't you just accept that this is me, and not an illness?" I know many of us reject someone calling happiness or extra creativity dysfunctional, in some way. Often they are right. Sometimes, they're not.