Hi Dr. Fink. My husband of 30 years has just been diagnosed “possible Lexapro-induced hypomania/possible true BPD” After a very difficult and abusive childhood with alcoholic parents, he has been seasonally depressed as long as I have known him. Usually starting around November, and not clearing until late spring.
Although fully functional, he was having somatic complaints and once, an episode of chest pain severe enough to take himself to the hospital for evaluation. Two years ago, he agreed to begin treatment with our family PMD for his depression and did EXTREMELY well mentally on Zoloft 150 mg. He stayed on Zoloft for a year but reluctantly changed to Lexapro 20 mg. qd, due to severe, unremitting heartburn with the Zoloft.
On a recent admission to hospital I felt more anger than mania. I felt angry over an involuntary admission. As I vented my feelings of anger, they were perceived as symptomatic of a manic episode. Where does that “fine line” exist? Please tell.
We expect that situations like these occur more often than most professionals would like to admit. Although therapists often point out that “Nobody can make you angry,” sometimes people have very good reason to feel angry, and an involuntary admission certainly qualifies as one of these reasons.
Unfortunately, any expression of that anger is likely to be perceived as a symptom of mania. It’s like being suspected of a violent crime you didn’t commit. The more vehemently you protest, the more your captors suspect you of being a violent person capable of committing such a crime.
My daughter Baker Acted eight days ago. She is 25 with no indication of a problem until a few weeks ago. She has ADD and was taking Adderall. She started taking Phentermine to lose weight and was taking energy drinks – Rock Star etc. She’s had a very demanding sales job in which she needed to go to networking events at night in addition to her job. She lost it this weekend while involved in a very stressful job-related event. It appears she lost her sense of reality – made many charges for clothes, stayed up almost with no sleep three or four days, said and did things out of character, until someone called 911.
Is it possible this was caused by all of these stimulants?
Last week, Joe posted a piece entitled “Bipolar Dilemma: Insensitive Jerk or Irresponsible Oaf?” in an attempt to spark a discussion and collect insights on what to do when you sense that your loved one with bipolar is exhibiting symptoms of mania or hypomania. This week, Dr. Fink weighs in.
This dilemma lies at the heart of so much of the strife that families living with bipolar disorder face every day. I don’t have any magic answers – I suspect that people living with these challenges have creative solutions that will be more helpful to others than anything the doctor might have to offer.
Bipolar mania can really foul up the family dynamic. One minute, your family is cruising along on autopilot, and the next minute you’re in a tailspin. It can begin innocently enough with a barely perceptible increase in irritability and criticism, and then quickly escalate into knock-down, drag-out conflicts, all of which contribute to worsening the mania.
In Bipolar Disorder for Dummies, we talk a little about the differences in how bipolar mania is seen from the outside as opposed to how it is experienced from the inside. Inside, a person experiencing mania may feel…
Outsiders may have a completely different perspective, saying or at least thinking…
I work at home. My wife (who has bipolar) works for the local school district. Several times during the year are difficult for us. It seems, for example, that when we “spring forward” for daylight savings time, we almost invariably spring into mania. We do okay over the summer. When she returns to work in the fall, sometimes we do okay, sometimes not. The Christmas break is also usually a bad time.
Mania isn’t usually a pleasant feeling, but hypomania can be. It can make you feel like you’re on top of the world – highly creative, energetic, effervescent… all that good stuff. Unfortunately, mania tends to follow with all its bad stuff – irritability, anger, conflicts, maybe even paranoia and hallucinations, and then sometimes the big crash into depression. Treatment can level out the highs and lows, when it works, but people who’ve experienced those highs often miss them.