Q:  Hypomania is More Constant than Episodic

I am confused about whether one can simply just have hypomania and not have it be either (1) an inbetween step from depression to mania, or (2) induced by a reaction to an antidepressant both of which are discussed separately in your cite.  "Hypomania" seems best to apply to me but is more constant than episodic.  the negatives include  agitation, irritability and anger, not risky behavior or grandiosity.  I have exhaustion sometimes.  The bipolar questionnaire doesn't help me much.

I am 43, creative, artistic, high energy, a successful professional with busy family life and young kids.  I've had some shopping problems according to my husband but not to bankruptcy levels.  When I'm "on"  i do seem to be able to multitask and take on way too much because it is easy for me to accomplish.  If i were to describe that i crash, i'd say i have periods where i feel exhausted. I always need 7 hours of sleep.

Recently I have had some marital crisis and went on wellbutrin from a primary care doctor, which made me exceptionally anxious, with true panic attacks.  Then I tried lexapro which made me too sleepy.  My mother was  diagonosed with manic depression in 1970 and was one of the first patients successfully treated with lithium .  She is stlll doing great at 77.  I have not have any true depressive episodes or high mood swings.

 I'm glad that trileptal is not just for epilepsy as my drug store medicine warning sheet seems to indicate.  that is how i found your site.  Plus I finally had the sense to go to a psychiatrist.

thanks for any thoughts/references to any literature.

Laura


Dear Laura
Well, reading your letter is painful and exciting: painful because a good answer here would take a couple of book chapters, not just what you've seen on my website, which I'm glad was enough to get you wondering just as you've written here but falls painfully short of what I'd really want to say in answer to your question.  The exciting part is that I actually wrote those chapters, a year ago, and it took me months to get it right: the right flow of the explanation starting from exactly where you were (before you read my stuff about hypomania and antidepressant-induced hypomania), through to a proper answer to your question. I'm excited because the book is almost out (about a month to go; yeesh, this has taken forever...). The first three chapters, a good third of the book, are the answer.

Summarizing those three chapters (I've been practicing this): there is a continuum from unipolar or "plain" depression with no bipolar component, to full "Bipolar I", the manic-depressive version.  Many people can be found distributed rather evenly all the way along that continuum. Those at the left side (toward "unipolar") can lack any hypomania at all, yet still have "bipolarity", by virtue of family history of bipolar disorder; or repeated episodes of depression (cyclicity); or over-energized responses to antidepressants (and I've heard the sleepy one too, but that is not at all classic). These and more are the "soft signs" you saw on my site, leading to the nickname for such bipolar variations as "soft bipolarity".  

Yet people with "soft bipolar" can still have bad experiences on antidepressants (although many have good responses too; a doctor named Jay Amsterdam has published multiple studies of good outcomes for people with Bipolar II on antidepressant alone; here's a review). What's not so clear is whether they can reliably do well on mood-stabilizers-with-antidepressant-clout; or whether, more generally, the at-least-eight (and some would count lithium too, worth considering in your case given your mother's experience) antidepressants-that-aren't-antidepressants. I hope that essay there might make a lot of sense to you, and give you some stuff to discuss with your doctor. Good luck with that. 

Dr. Phelps

Published April, 2006