Hypomania & Being Tired
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Q:  Hypomania & Being Tired

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 last year.

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.

The model 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.

Dr. Phelps

Published June, 2009


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