Subthreshold (Hypo)Mania As A Precursor To Bipolar Disorder

The new Bipolar Spectrum.

“There is growing clinical and epidemiologic evidence that major mood disorders form a spectrum from major depressive disorder to pure mania.”

Subthreshold mania can be seen as a precursor to Bipolar Disorder, subthreshold Bipolar Disorder is defined as “recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania” (Merikangas et al, 2007). Bipolar disorder should be suspected if prominent behavior problems, anxiety, and substance abuse were present during childhood in someone with recurrent depression and a family history of affective disorders. For example, the prevalence of anxiety in children may be prominent in early-onset Bipolar Disorder and may predate affective symptoms. Children with a parent with Bipolar Disorder are more likely to be at risk for early-onset Bipolar Disorder, along with anxiety, depression and other disorders.

Studies have shown that offspring of people with Bipolar Disorder are at high risk for developing Bipolar Disorder because they have a parent with the disorder and generally have significantly higher rates of subthreshold mania or hypomania (13.3% versus 1.2%) or what is known as bipolar disorder not otherwise specified (BP-NOS); manic, mixed, or hypomanic episodes (9.2% versus 0.8%); major depressive episodes (32.0% versus 14.9%); and anxiety disorders (39.9% versus 21.8%) than offspring of parents without the disorder. Subthreshold episodes of mania or hypomania (those that resemble but do not meet the full requirements for bipolar disorder in terms of duration) were the best predictor of later manic episodes.

It should be noted that the American Journal of Psychiatry has a multitude of studies that suggest that people who suffer from Major Depressive Disorder (MDD) have a higher susceptibility to Bipolar Disorder and that subthreshold hypomanic symptoms that are found in people suffering from MDD should be taken into consideration when diagnosing. Placing these people instead on a bipolar spectrum, hence altering their treatment plan by incorporating a mood stabiliser which can also assist with the present MDD.

 

 

The ‘Poster Patient’ of Bipolar Disorder.

When you’re considered the ‘poster patient’ of Bipolar disorder…

I see all my doctors at regular intervals and I take medication daily. That’s the simple side of things, the easy routine and foundations that you are required to build. Depression and hypomania have accompanied me at different interludes, always waiting backstage for the next show to begin. I see myself as so dysfunctional. So haphazard and incapable of maintaining all the demons in check. I’m writing this post because I see myself as all those things, maintaining complete control of my emotions and rhythm is beyond my control, yet my psychologist insists that I’m a ‘poster patient’ for Bipolar Disorder, my ability to be functional when everything has turned on its head. I was so confused when she originally said this. I know my dysfunction, mismanagement and self-sabotage run deep, hence my confusion to the compliment. She referred to how she used me as an example to other patients about what can be achieved. The facts that she presented were right: I have completed a university degree and I am half way through another, I do have a full time job (I work full time as a secondary teacher), exercise, eat regularly and maintain some semblance of social interactions with friends. It hadn’t hit me that this is what is considered to make me less dysfunctional. My moods don’t generally have repercussions on my life, they are damn high mountains to climb over in order to find solace again, but the hike and lightheadedness of the ‘mood mountain’ doesn’t necessarily interfere with my outer world.

I don’t see these facts as things which make me more managed. I am dysfunctional. My ability to manage my life doesn’t make me any less so. As my depression deepened a few weeks ago, I started to have regular suicidal ideations again. Obviously the recognition that the severity of my depression was getting worse, I acted. I wanted to flip the switch. Anything had to be better than those tendencies, those ideations. I have done a lot of research into the vitamin 5-HTP, simply put it can potentially alter the levels of serotonin in your brain which can result in a hypomanic episode. High is much better than being low. Until you’re high….

Then it’s hell, again.

Without going into specific details of my episode, 5-HTP worked by flipping the switch. The worst part about flipping the switch is when you remember how horrible it is to actually be hypomanic at times. My memory had conveniently let myself forget. My mind has the useful ability to allow me to forget how bad things have been at both ends of my imaginary scale, the thermostat of my mind. It’s a protection mechanism, allowing me to move on and forget the consequences of all my subsequent moods. I took 5-HTP for three days before stopping when my head started to *whoosh*. I find everyone’s interpretation of ‘racing thoughts’ to be different, but then again, each episode I have had resulted in ‘racing thoughts’ which were different from previous occurrences. I see these in the following categories: Actual racing thoughts, when you have too many ideas at once – excitement usually accompanies this variation. Then there is the static or *white noise* head background pressure ‘racing thoughts’ which is usually accompanied by irritation and finally there is *whooshing*, when there isn’t an exact thought but your mind is just doing the simple cycle of the washing machine with your ears blocked, accompanied by a bit of depersonalization. It sounds absolutely nuts. Which it is.

I was never meant to be this broken, popping pills, waiting for the next mountain to climb.

At least I know that I can climb and conquer.

The Morning After I Killed Myself, I Woke Up.

*Thought this was a pretty epic story by Meggie Royer – for anyone who has thought about the day after it’s all over. 

I made myself breakfast in bed. I added salt and pepper to my eggs and used my toast for a cheese and bacon sandwich. I squeezed a grapefruit into a juice glass. I scraped the ashes from the frying pan and rinsed the butter off the counter. I washed the dishes and folded the towels.

The morning after I killed myself, I fell in love. Not with the boy down the street or the middle school principal. Not with the everyday jogger or the grocer who always left the avocados out of the bag. I fell in love with my mother and the way she sat on the floor of my room holding each rock from my collection in her palms until they grew dark with sweat. I fell in love with my father down at the river as he placed my note into a bottle and sent it into the current. With my brother who once believed in unicorns but who now sat in his desk at school trying desperately to believe I still existed.

The morning after I killed myself, I walked the dog. I watched the way her tail twitched when a bird flew by or how her pace quickened at the sight of a cat. I saw the empty space in her eyes when she reached a stick and turned around to greet me so we could play catch but saw nothing but sky in my place. I stood by as strangers stroked her muzzle and she wilted beneath their touch like she did once for mine.

The morning after I killed myself, I went back to the neighbors’ yard where I left my footprints in concrete as a two year old and examined how they were already fading. I picked a few daylilies and pulled a few weeds and watched the elderly woman through her window as she read the paper with the news of my death. I saw her husband spit tobacco into the kitchen sink and bring her her daily medication.

The morning after I killed myself, I watched the sun come up. Each orange tree opened like a hand and the kid down the street pointed out a single red cloud to his mother.

The morning after I killed myself, I went back to that body in the morgue and tried to talk some sense into her. I told her about the avocados and the stepping stones, the river and her parents. I told her about the sunsets and the dog and the beach.

The morning after I killed myself, I tried to unkill myself, but couldn’t finish what I started.

http://themindsjournal.com/the-morning-after-i-killed-myself/

By Meggie Royer

Nobody Likes You When You’re 23.

It’s looming, coming closer, I can feel the air becoming stagnant and distasteful. I have an overwhelming feeling of unbalance filling my mind, every year it’s the same, on Thursday I will be ‘celebrating’ my birthday…*cue horror screams* Lately I haven’t felt like writing, or doing anything for that matter. Each year it feels like my life has been put up on the high stakes table where it is scrutinised under industrial lights, the winner of the game will take all. Every year I try and fill the day with activities that will divert the always impending dread. The build up to the day acts as a depressive trigger, filling my thoughts with distorted discontentment. The morning after my birthday it’s as if none of it mattered, my emotions are still a little bit dulled and muted, but I would’ve weathered the emotional storm. With each birthday people have to confront the fact that they may not have achieved all they had hoped they would in that year.

That they may not be where they would be like to, the discontentment running deep. I guess at a younger age I always had a vision of where I would be now; birthdays are always filled with both crashing disappointment and anticipatory spikes of happiness. I’m trying to make myself stop and regain sight of things, appreciating the people and things around me instead of the things that are nowhere to be seen. It’s as if a birthday malaise exists, perpetually creeping in each year, slowly whispering in your ear as the day draws nearer and the time to complete your expectations is drawing to a close. I’m not one to let my birthday pass by unnoticed, but I’m highly susceptible to disappointment.

I’ve planned small things this year, not wanting to be uncomfortable in group settings, finding comfort in close friends and family. It’s so hard to let go of being depressed about my birthday so that I can actually enjoy it, trying to release the past disappointment to embrace the present, focusing on progress and not the perfections of one’s life. I need to fix my current mental happiness block that I’ve hit head-on. My happiness has become a single defensive tower that is being attacked repetitively by soldier triggers. I’m starving off depression, the stalemate not helping either side gain the higher ground. The overshadowing queen of darkness keeps on approaching, her army gaining size whilst offering the comforting pit of morbidity as parlay.  She plays her game well. Writing this makes me realize how silly and trivial it is to monopolize a day to such great lengths that you allow it to be a tyrant to your emotions.

On Thursday I will be 23, I will try and not let depression encroach, I will try and remember all the wonderful things I have in my life and not the things I don’t, I will try and not let it dominate who I am. After all it is only a day. Thank you Blink182 lyrics: “Nobody likes you when you’re 23”

Dr. Maas acknowledges the “chicken-egg” problem inherent in bipolar and other mood disorders: “Depression can cause extensive insomnia, and insomnia can cause depression—which comes first depends on the individual and the circumstance”.

I Have A New Man In My Life. His Name Is Chandler. Pet Assisted Therapy.

I have a new man in my life. His name is Chandler; he is 8weeks old and absolutely adorable. Introducing him makes me remember kindergarten and doing ‘show and tell’. He is meant to make me more accountable and responsible. Pets are also good for therapy (Animal Assisted Therapy), but all of that doesn’t matter, he is beautiful. My mum has been trying to make me get a dog for weeks, after last night I impulsively accepted a puppy off my boss’ friend, probably the best decision I’ve made in months. Here’s to getting better. He even made me stay home and not drink on a Saturday night because I didn’t want to leave him home alone.

Depression Is The New ‘Black’.

Waking up this morning I’m still so drained from the night, the vivid dreams and disorientation of waking from sleep walking. I routinely get on the scales each morning, the scales determining how I will feel about the day. Today they aren’t bad or good; I’m lying in bed knowing that I should take myself to the gym, not understanding why it has become so important for me to be skinnier. I use to become skinny as an act of revenge (obviously a healthy endeavour), not ever for myself really, but at the moment it’s become a compulsion, but why do I need to be skinny, I ask that to myself, yet each day the same routine and disappointment. I eat enough healthy meals during the day and exercise, yet nothing changes.

Sometimes I like my scars; they show the pain that I’m going through internally. They show the struggles that my mind puts my body through. There are more scars then I remember, thin straight lines, one after the other. I touch them and I can remember the pain. The self-loathing and madness. Today they represent my pain at the moment; I’m becoming more and more discontent, a nasty edge to my demeanour. I’m withdrawing from my friends, preferring my own company. I decided that they were toxic and I needed to clean up my act, but I think it’s become worse. The discontent runs deep, what am I actually aiming for in life? I’m studying to get a job, a job that will take up nearly all my time, to live a life that seems pointless. Living in a stratified society inhibits the achievement of your dreams. In a very abstract view of life as humans our goal is to live and procreate, that’s the bottom-line, yet I can’t see myself wanting that, I can’t see a life where I will be happy. I have no desire to pass on my genes to another generation.

I know that I’m sick and twisted, but I can’t help but enjoy it. It’s a sick sad world. I can feel my hipbones start to show that little bit more, but it’s still not enough. I’m getting high distinctions for nearly all my assignments in university, but it’s still not enough. I’m eating healthy and exercising regularly, but it’s not enough. The discontentment is too deep, too overwhelming. I will not walk along the cliffs at the beach lest I get the same intrusive thoughts from before, the irresistible need to fall. I was so high for so many weeks, guess it was time for that mood to crumble and be replaced by my mental pit of despair. I drink less, party less hard, sit in the sun and exercise, yet why have I suddenly become so unhappy?

HI, my name is Alice** and I’m my own worst enemy and critic, currently enjoying the trappings of my former life. I took my meds today, I take them every day.

• I didn’t immediately post this, I wanted to wait and see if this wasn’t just a bad week, that I could ‘make’ myself better again, it didn’t happen. Depression is the new black; I wonder how much of this acute unhappiness we bring on ourselves and the awareness that we are our own unintentional triggers. I always try and be a positive advocate for mental health, consciously aware of what mental state I have arrived at, but sometimes powerless to lessen its effects. I don’t want to be like this, I want to be in control of my mental state of mind. I’m just going to keep trying.