Q: Hypomania & Being
I have been diagnosed with bipolar II disorder and am taking Lamictal
(100 mgs) and fish oil. (Thanks to your site!) It has worked miracles over the
My question is in regard to hypomania, sleep and/or
exhaustion. I am in one of my very creative, productive, and enthusiastic modes
that I've been told is hypomania.
My question is about sleep. I have not been able to
sleep well for several days - up late and up early, BUT, I am really exhausted!
When I read about hypomania, it seems that patients claim they don't feel tired.
I am full of creative energy and enthusiasm on one end, but would do anything
for some relaxing sleep.
Can I be hypomanic and tired?
(I decreased my dose from 200mgs a few months ago
because of cognitive dysfunction. I work in academia, so that side affect is
difficult to tolerate.)
Dear Jennifer --
There is a model, which I really like, that might explain this experience
(youíre right, itís not common, but I think Iíve heard patients describe
something like this; not usually so outright. Of course there are also quite a
few people with this experience caused by medications that are sedating but not
stopping hypomanic phases; we move on to other solutions when that happens. But
lamotrigine (Lamictal) and fish oil donít generally cause daytime fatigue;
lamotrigine could, perhaps, at its high dose range around 300-400 mg, but youíre
down there at 100. Nevertheless, to be complete, it still should be considered a
possible cause if the timing of the symptom matches the timing of the medication
being started. But Iíll bet there were other variables present at the time that
makes such analysis difficult).
This is a model, mind you, not based directly on
research. But itís an elegant explanation and many of my patients have pointed
at the graphs and said ďthere, thatís me!Ē when prior to that they wondered how
ďbipolar disorderĒ could fit for them. The model was developed by two
psychiatrists who have seen a zillion patients with bipolar disorder, many
variations, Drs. Ron Pies and Dean McKinnon.
says that different components of the mood experience of bipolar disorder can
vary at different rates. So energy can be up when mood is down, or vice versa,
which is fairly close to the experience you describe. The easiest way to
explain that is to refer you to their diagrams, which I have "translated" into
plain English and which can be viewed on my webpage about their article. The
reference itself is also available there.
Have a look.
Published June, 2009