Strategies to help prevent a (hypo)manic episode

Don’t feel like reading? Listen to the audio version here:

 

This is a long one, folks. Hang in there!

‘Cause I’m on top of the world, ‘ey
I’m on top of the world, ‘ey
Waiting on this for a while now
Paying my dues to the dirt
I’ve been waiting to smile, ‘ey
Been holding it in for a while, ‘ey
Take it with me if I can
Been dreaming of this since a child
I’m on top of the world

– Imagine Dragons, On Top of The World

As promised a while ago, I’ll be writing about my experiences with hypomanic episodes, including what I’ve heard from others, and what strategies I have learned and attempted to integrate in my life. Again, these strategies are helpful to me, and some may not resonate with or work for you. But I really hope that they will!

First, an introduction to what hypomania is like for me. It’s kinda long, so you can scroll down to the headline that says “My strategies to prevent a (hypo)manic episode” further down if this is a bit much for you.

It’s  important for me for you to know that I’ve had very few hypomanic episodes, especially compared to the frequency of depressions. This is why it’s a lot harder for me to recall what a hypomanic state feels like, and it’s been more difficult for me to recognize symptoms, triggers, etc.

After being diagnosed, talking to friends and family that have been close to me during those periods has really helped me, because they have a much stronger sense of the shift in my behavior. It’s been more extreme for them to experience how I changed almost from one day to the other. However, no one really talked to me about it as it was happening, as they were just happy to see me happy after long periods of depressive behavior. It was only later that friends told me how they had been surprised back then at how I suddenly started drinking and partying more, starting all sorts of projects, acting more flirtatious, and so on. They thought it was weird, but not necessarily a bad thing.

But for every hypomanic episode, they get worse. I started really losing control, and did things that I would normally never, ever do. Something that I should definitely stay away from is any kind of dating app or dating site. That can very easily get out of control, and you often end up hurting people, because you cannot see the consequences of your actions. Seeing beyond the current moment is not possible. And you don’t realize what you’re doing until it’s too late.

Spending more money is another thing; it’s like the ability to think rationally about purchases goes away. Looking back on my summer holiday 2011, when my brother and I went on a 4-week trip to Japan, I ended up spending around 15000dkk (around 2300 USD). In four weeks. And I had no idea where all that money had gone. It took me a very long time to truly realize that that was incredibly abnormal and worrying behavior for me, as I’ve always been careful with money, bordering frugal. I was always the sensible one concerning money compared to my siblings (sorry Christina and Kenneth, but you know it to be true). Spending 15000dkk on a summer holiday was just… crazy. I’d just graduated from high school, and was about to start university! What the hell was I thinking?

The answer is simple: I wasn’t.

During the same holiday, I went to this place called Mickey House almost every night, a regular café somewhere in Tokyo that was used as a language café after 6pm. I was super out-going, talking to everyone, loudly, in my strong American accent (the only accent I can do in English). Everyone was drawn to me. A 19-year-old girl who’s never had that many friends and was bullied for most of her school life, who had a hard time talking to guys and initiating conversations, was suddenly the center of attention – basking in the limelight, while at the same time not fully realizing it was happening.

I went out to dinner with a Japanese man that was almost old enough to be my dad. I was 19 (still not allowed to drink alcohol under Japanese law), and he must have been at least 35-40. In a hypomanic state, I’m super charming, and, as mentioned, a lot more flirtatious without noticing at all. So I probably sent a lot of wrong signals; I let him buy me strong drinks, and thus I got drunk with a complete stranger, not even knowing exactly where I was in the city anymore.

He brought me back to my hotel around 1am (mind you, I was leaving for Ōsaka with my brother early the next day), and he tried to kiss me. Luckily, I managed to force him off of me, ran into my hotel, and just kinda laughed it off.

I have more stories like these. Thinking back on it, it absolutely terrifies me. I’ve put myself in so many dangerous situations.

So, what have I learned from all of this? First of all, I do not miss hypomanic episodes at all. I truly wish that I’ll never be in that state ever again. Plus, it’s always, always, always followed by a depression, almost immediately. Many people with bipolar miss their highs. They feel numbed by medication, and some decide to stop taking their meds just to experience mania again, not caring about the inevitable depressions. That’s not me at all.

Long introduction. Phew. Hope you got through it alright! Now to the main part of this post:

My strategies to prevent a (hypo)manic episode

The reason why I’ve put ‘hypo’ in parenthesis is because many, if not all, of the strategies I’ll mention can help when dealing with both hypomania and full mania. Of course, I’ve never had a full mania before, but I’ve learned about most of these strategies when in treatment at the hospital, and they were all recommended for both.

I’m going to build upon my previous post, Strategies to help prevent a depressive episode, as a point of reference here, so please go read that, if you haven’t already!

The headlines in that post are:

1: Keep track 

2: Get to know your symptoms

3. Make a plan

In order to make this less repetitive, I’ll first talk about something called The Cognitive Diamond, and then go on to list symptoms, triggers, and my plan of action for hypomania.

I wouldn’t be surprised if some of you have already been introduced to this little fella. This is great for creating a sort of visual understanding of how your thoughts, behavior, feelings, and physical experiences all affect and influence each other. Negative thoughts affects behavior, which affects your feelings, which affects your physical experience, or the other way around. Here’s an example:

If you have more energy, increased libido, and feeling as if you’re high, your thoughts will start reflecting that. So will your behavior, and so will your feelings. As shown by the arrows, the cycle can start anywhere, and only spirals until you get control over it again. This is what happens when someone is manic. It spirals out of control.

 

STRATEGY NUMBER ONE: Recognize and write down your symptoms and triggers.

Classic symptoms of hypomania and mania
(Symptoms of hypomania are basically just milder versions of those for mania.)

Both a manic and a hypomanic episode include three or more of these symptoms:

• Abnormally upbeat, jumpy or wired
• Increased activity, energy or agitation
• Exaggerated sense of well-being and self-confidence (euphoria)
• Decreased need for sleep
• Unusual talkativeness
• Racing thoughts
• Distractibility
• Poor decision-making — for example, going on buying sprees, taking sexual risks or making foolish investments

(Source: “Bipolar disorder: symptoms and causes”)

The list above actually pretty much sums up my own symptoms of hypomania. Added to those are 1) increased libido, 2) several new interests or hobbies that I start pursuing at the same time, 3) impatience (a tendency to interrupt other people in conversations, because obviously my thoughts are more important than everyone else’s), etc.

Other more severe symptoms of mania and signs of manic psychosis that I’ve heard cases of:

• Believing that you can see and talk to angels
• Hallucinations
• Believing that your child is the next messias
• Convinced that you can fly (and maybe attempt to do so)
• Believing that you can taste colors
• Seeing colors very intensely

Etc.

Triggers for hypomania and mania

• Falling in love
• Using psychodelic drugs (speed, cocain, extacy, etc.) and substance abuse in general (weed, alcohol, etc.), as well as cigarettes
• Starting a big, creative project
• Periods with high personal growth
• Partying all night
• Going on holiday
• Listening to loud music
• Spring
• Energy drinks
• Antidepressants
• Sugar
• Caffeine
• Changes in routines
• Chaotic situations
• Jetlag

Etc.

Of course, everyone has their own personal triggers. Mine include:

• Drinking alcohol and partying
• Slightly increased energy
• Starting more than one passion project at the same time
• Falling in love
• Dating
• Changes in medication

And probably others. As previously mentioned, I’ve had very few hypomanic episodes, and it’s difficult for me to recall what triggers an episode for me. But I’m pretty sure that the few I’ve just mentioned have assisted in triggering episodes for me. Of course, they also fall under the category of symptoms.

 

STRATEGY NUMBER 2: Make a plan of action.

More Danish! Fun, right?!

Anyway. So, my plan of action goes something like this:

1. Contact psychiatrist, GP, dad, close friends
2. Cut down on social activities
3. Regain control over finances
4. Take long walks/bike rides
5. Write down the racing thoughts
6. Drop all the to-do lists
7. Go away for a bit
8. Stay away from places where I can spend money, e.g. shopping malls, Strøget (shopping street in Copenhagen), etc. STAY AWAY FROM SHOPPING.
9. Stay away from alcohol
10. Spend days alone by myself
11. Do meditation and yoga
12. And a very important one: Get. Enough. SLEEP. At least 7-8 hours of sleep every night.

As well as 13: consider changes in medication.

The one strategy that all of my physicians always emphasize is SLEEP. SLEEP IS KEY. As well as staying far, far away from any kinds of drugs and stimulants. And taking the right medication, of course.

Just a small tip: when doing yoga, try to mainly do exercises where you bend downwards and inwards, and not so many where you bend upwards or backwards. The yoga instructor in the exercise group I took part in at the hospital told us that. It’s supposed to be more calming and introverting, I guess? Don’t take my word for it, though!

 

Phew… this turned out a lot longer than I anticipated. Probably because of all the lists, haha. But I really hope that this might help some of you out there, and maybe even give people who don’t know much about bipolar a better understanding of what happens when someone is manic, and what may trigger it.
I hope you made it through to the end. Otherwise, I hope you’ll just read it bit by bit, over a few days, perhaps. And I really, really hope that what I’ve written makes sense to you all. I tried my best!

 

Next Tuesday: “When a friend abandons you – in retrospect.”