Why do people always talk about hypo vs. mania? Do your docs want you "down"?

I find it interesting that on this board people talk about hypomania all the time. I think people often confuse hypomania with mania, especially if you're going by the strict definitions.

Per Wikipedia:

Mania:
Mania is a state of abnormally elevated arousal, affect, and energy level, or "a state of heightened overall activation with enhanced affective expression together with lability of affect.

The symptoms of mania are the following: heightened mood (either euphoric or irritable); flight of ideas and pressure of speech; and increased energy, decreased need for sleep, and hyperactivity

Hypomania:
Hypomania (literally "under mania" or "less than mania") is a mood state characterized by persistent disinhibition and pervasive elevated (euphoric) with or without irritable mood but generally less severe than full mania.

I think a lot of what people on here discuss as being hypo is actually more symptomatic of mania. Granted, there is a fine line between the two, but my psychiatrist hardly ever talks about hypomania. He wants to know if I'm depressed or showing manic symptoms.

Anyway, I guess this post is merely a PSA. It would be interesting to hear what you think, though. Do you feel there is any confusion between the two?

I'd say a decent amount of what I see people describing as hypo would more appropriately described as manic. For me, it feels somewhat "safer" to describe how I'm feeling as hypo, but when I get right down to it I experience manic symptoms more often than hypo.

One thing I'm really glad about is that my manic symptoms seem to be under much better control by the use of meds. Unfortunately, that allows more of what I experience to be depressive symptoms. Does anyone else feel their doctor's are more interested in controlling mania vs. depression? I know my wife would rather have my baseline in the depressive side instead of in the manic side. She says that when I'm depressed I just don't do anything, but if I'm manic that she never knows what's going to happen.

I'll have to agree that I get into more trouble when I'm manic vs. depressed, but I do wish my doctor would help tweak my meds so I'm not always below the line and mildly depressed. My previous psychiatrist also expressed that he would rather have me on the depressive side vs the manic side. It does drive me nuts sometimes though, when I want to "feel better" and get told that I'm being kept on the down side intentionally.

I guess I don't really know where I'm going with this post, it's more stream of consciousness than anything else. In the end however, I am curious about these two things - 1) like the title alludes, do you think some things in this board are better described as manic vs. hypo, and 2) do you feel your doctor and support team would prefer to keep you on the "down" side of the spectrum?

Glad to hear anyone's thoughts on these two items.

I'm a person who almost never gets actually manic. My pdoc does talk about hypomania because my episode pattern starts with hypomania, and if not caught and intervened with, it crashes into a mixed state, which for me almost inevitably lands me in the hospital because of the extremely impulsive suicidality that I run into.

My treatment has been more about keeping me out of the depressive and/or mixed end of bipolar disorder: the depression, lethargy, anxiety, irritability, suicidality, ruminations and racing thoughts (always dark and dysphoric).

Man, I really feel for those of you who get mixed states. I can't identify that I've ever been in such a situation, but it sounds awful. I hope your meds are keeping you stable and out of trouble.

I think there can be a pretty big big difference between the two . It's all about level of functioning and all that but I'm too tired from working last night to explain lol. for me there is a difference. for example when I'm manic I wouldn't be on here saying I'm manic. I would be busy be crazy haha. hypo is still functional for me
everyone is different as that story goes

LOL. That's great; I'd be busy being crazy. Good point.

I am actually in remission and have been for three years. Woohoo! I haven't needed meds this whole time and have stayed very stable.

On the contrary, my doctors tend to err on the side of uppish mood rather than depressed. As a result they've let me get manic a few times when they could have intervened sooner.

Just personally, when I speak or post when manic I sound really really crazy. If I'm writing coherent sentences I'm probably hypomanic.

I have noticed that a lot of the posts talk about being hypomanic and then describe what I think are manic symptoms. Of course, they're not all of the manic symptoms I experience...

hmmm... I'm still learning to distinguish between the two. i think hypomania for me is what i considered my norm for most my life without knowing any better. now i notice that when coming out of depression I'm a little more happy and energetic than most peoples "norm". which usually leads back to depression after being really productive for a few weeks or sometimes crashes into mix like somebody else mentioned which is the most uncomfortable state of being I've ever experienced.

only a few times has hypomania led to mania for me. and its clear to me when it happens because i can literally feel the high going through my body from all the feel good hormones being dumbed. its kind of like doing coke but the feeling stays. hypo is the tricky one. am i hypo or just happy? but with mania it gets weird. i get socially awkward and can't direct my energy anymore and it starts to direct me. I also can get paranoid and social anxiety the matches the social anxiety i get when depressed once i switch over from hypo to mania. i think I'm more likely to be delusional while depressed and thinking the whole world is ending than while manic though. while manic i just want to do a butt load of off character activities that have nothing to do with my day to day life or main goals.

Thanks for the note, Moose. You said exactly what I was thinking, and that I took a whole page to describe instead of your concise statement.

I have a history of overblowing my symptoms for attention...well not exactly attention, I was kind of in some sick inner competition with everyone else to be "the worst". Anyway now I have the tendency to minimize my symptoms so that I don't feel like I'm making things up for attention again. Since being properly medicated I rarely get full blown manic. I also was reticent to label it as mania because I am high functioning. I've never gotten in trouble with the law or spent thousands of dollars or anything like that. But a pdoc said to me once that even though I was high functioning, I was delusional, and that pointed toward mania.

Still, I downplay my symptoms in my own mind. However, my doctors must see something I don't bc I tend to get thrown in the hospital fairly often when unwell. I think I've managed to talk myself out of the ER maybe twice in my life. I'm always stunned on here when people say they've gone to the er and been sent home. That almost never happens to me!

As for "keeping me down", my current pdoc is much more scared of mania than depression, which I don't like bc I struggle with depression more often, and it is more detrimental to me. I can't work when severely depressed. So she is very cautious with medication that might induce mania. It's annoying.

>Do you feel there is any confusion between the two?

I do think, that SOME people think that untreated mania will always result in hospitalization. And while it certainly can, that's not in the criteria, and it is certainly avoidable, especially for the less sociable. No one sees me up; no one complains, while my thoughts are racing like nuts, I have no need in my life for consent from anyone to do what those ideas suggest. I straight up go from idea to execution to bored; I need no one's opinion on the matter. :-D

I don't think the doctors seem to have this problem, and it didn't effect how I was diagnosed or the treatment that was suggested. Which is important, because BP1 and BP2 have different treatment response odds.

I honestly sometimes don't know what I'm experiencing. I just call it an episode wether I'm depressed or hypo or manic or mixed because I just don't know. I feel like most the time I'm mixed because when I get depressed I also get very irritable and the racing thoughts and then comes the obsessions and ideas. I sometimes have suicidal ideation but I've not been truly suicidal in a long time. Like I can't really tell sometimes if I'm mixed it just they my cycles at moving so fast back and forth and then there's also my anxiety.

Apparently I am hypomanic right now but I think I am just a bit happier than usual. I can see the symptoms; less need for sleep, chatty, racing thoughts, impulsiveness and desire to spend (my Mum has my credit card for safe keeping - I gave it to her in a moment of lucidity - damn). Still, I don't feel hypomanic, and definitely not manic. Hey, I even wrote this. Can't be that bad.

I have a new pdoc so not sure what he wants. He is on holidays till Thur/Fri so I can ask him then. I want to stay like this. Beats being below stable or floridly manic. Sleeping less gives me more time so I can accomplish more.

Interesting observation.
There is likely some blurring of lines btw. hypo vs mania.
It's interesting to see the definitions.

My pdoc would prefer to keep me more 'up,' if possible.
He thinks I am too critical of any hypomania I experience.


WC

I run mainly up as a baseline. rarely am I depressed thank goodness.
My hypomanias are quite lengthy and can runinto mania if not checked.
my manias include delusions and paranoia, psychosis which is not fun for sure.
bizi

Doubling up on this thread, something occurs to me. Our docs probably don't have a specific mood state in mind. They probably go based on outcome preferences and priorities; alive, alive+functional, alive+productive, alive+productive+happy... or some derivation of that.

If one of our mood states puts the first or second in jeopardy, well, they're going to try pretty hard to avoid that, even if it squishes happy in the meantime.

This is why I label some of my behavior as hypo/mania. The / sometimes indicating that it could be either hypo or just mania. I do notice my pdocs tend to ask about mania and never use the term hypomania. The last mania I had prior to these new symptoms would be around January-February. She upped all my meds so that I wouldn't end up IP. I struggled, but got through that particular episode. Maybe because of my history of BP1, in combo with certain signs that would make me manic, rather than hypomanic is why she shows more concern and recognizes the signs in me. It's true, I think sometimes we label things as hypo that can be actual mania. Actually, I think I am more in manic territory lately. Not full-blown...there's some insight, but things are getting more reckless, confusing, and causing more consequences rather than productivity lately. Or, I've been productive only when it comes to ideas I shouldn't be so fixed on, but I just can't help myself.

I can never tell what is going on mania wise when it is occuring, but looking back I can assign a big "M" or little "m" to it for sure. Same with big "D" or little "d" depression. But I find the following helpful for my doc.

"The basic concept of a bipolar spectrum is more than a century old, having been proposed by the original founders of modern psychiatry in 1970s after a leading psychiatrist proposed classifying mood symptoms as follows:

• Upper-case "M": Episodes of full-blown mania
• Lower-case "m": Episodes of mild mania (hypomania)
• Upper-case "D": Major depressive episodes
• Lower-case "d": Less-severe symptoms of depression

Under this proposed classification, people are described by the combination of their manic and depressive symptoms."

My old pdoc always explained it that hypomania was 3-4 out of the 7 typical manic symptoms and mania was 5+. Not sure how accurate that is. I'll get the racing thoughts, the less need for sleep, and impulsiveness, but my counselor has been hesitant to label it 'mania' and instead just says it's 'hypomania'. So I don't know. I'm still confused about the whole thing really and where the line is.

Yes! Same here.

It's hard to put a classification on something which is essentially a spectrum. I just think of it as.. how bad was I? How expensive the damage? How expensive the impulse buying? One thing that I always think of when it comes to a lot of classic manic behavior.. stuff like flying off to Thailand on a whim, buying a boat driving home from work, etc... you have to be financially CAPABLE of doing these things no matter what the impulse. I suppose if you go rob a bank to do these things.... Manic.

Or simply criminal.

Now jumping naked from a church steeple thinking you can fly. Manic.

But what drives a guy to commit crime? We had a bipolar attorney living in our town. Very well off... respected. But got nailed for shop lifting.

Isn't 'thinking you can fly' more psychotic? Just asking because I never really thought about 'psychotic' until I was diagnosed. And I personally have never experienced that aspect of the disorder. But maybe thinking you can fly is more delusional or grandiose... which would be manic.

Mania often presents with psychosis. It's a very common symptom and one of the diagnostic criteria.