Manic Symptoms & Environment
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Q:  Manic Symptoms & Environment

my husband has mixed cycling.  He has also had both manic and hypomanic episodes. My question is re: euphoric and dysphoric mania: When he is in a manic state he is energetic (overly)and productive at work but comes home and is irritable and angry. The episodes are much less severe now  because he is on medication (lamotrigine and lithium) but.. is it  this common for mania to present itself differently in different surroundings? Of course when he's manic he says it's because we are so irritating at home. Also would another med help subdue the irritability more?

Dear Karen -- 
Somebody was talking within my earshot the other day about PMS.  She said one must always remember that sometimes husbands just deserve to be hit over the head with a frying pan...

Along those lines, we'll have to keep open the possibility that there are other things (not necessarily you, that's not what I mean; but any home stressors and other environmental factors) that might make him act that way at home besides bipolar disorder.  However, keeping that in mind, yes:  people's manic symptoms can react very quickly to their environment.  Put someone who's manic in a party, and they can be overgregarious and hilarious and flamboyantly dramatic; and that same night, put them in an emergency room with two big security guards, and they can be dangerously paranoid and irritable/hostile and even assaultive.  Then some nice psychiatrist can come in, sometimes when we're having a really good night perhaps, and kind of change the tune back to laughing and joking, and the person calms down (that's the exception, probably, not the rule, but possible I think).  

If it's really clear, especially to him, that he's still having "symptoms", however they are being expressed, then yes: another med or more of what he's on (depending on current doses; and in consultation with his doc' first, of course) could help.  Good luck with your work on figuring this out and getting it addressed. 

Dr. Phelps

Published March, 2004


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