Category Archives: hypomania

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 Abnormality of Normalcy.

Who decides what is classified as normality? It’s a self-perceived judgement that we assign to people which has been based on what we pigeon-hole as ‘normal’ versus ‘abnormal’. As a person with bipolar disorder I find is especially difficult to differentiate between the supposed abnormal and normal behaviour that I’m meant to exhibit. Abnormality is defined as a deviation from the accepted thoughts, emotions and behaviour. Normalcy is described as the absence of illness, associated as well-being, the line between the two is difficult to pinpoint with various shades of grey in-between. Normalcy is to abnormality what opportunity is to opposition.

The creation of normalcy can be a strategy of physical as well as mental survival.  Potentially the non- or abnormal (or anomalous), the excluded and marginal, may create their own world of normality.  It can therefore be questioned: how normal are the people who create it? The concept of “normal” has a long history that has been defined and redefined to accommodate that changing perspectives. The Greeks originally linked the concept of “normal” with “natural’, consequently denoting an ideal state in which the regular and average also converges with “healthy” and “good.”

Maybe hypomania and depression is my form of normality, in my mind that is how I perceive myself. That is my normal, anything different is for me abnormal. It is also ‘normal’ for our minds to change what we believe is abnormal, predominately determined by the milieu at the time. Abnormal and normal is completely reliant on context, I think the whole concept of the two is flawed and interchangeable. They are both used to define the other, does that mean that abnormality is a myth merely used to differentiate between people, reliant on perceptions and judgments that aim to reject those who deviate away from common standards? There isn’t a ‘normal’, no one is completely normal, its an invented idea related to conformity, conformity allowing a more functional state within society.

Normal is a measure used to understand realities, society’s problems stemming from the misunderstanding of what we really are versus the social myths that have been adopted to label and separate varying groups of people.

“The real picture consists of nothing but exceptions to the rule.” C.G. Jung


I have a very child-minded perspective of the world that allows little to no room for the areas of grey. The mood swings that people with Bipolar suffer are perceived by them as normal; they are their initial standard, making it difficult to perceive the different moods as ‘wrong’ or abnormal. The negative stigma or ‘untouchable’ topic of Bipolar has to be changed, everyone is abnormal, and normal is merely an unachievable standard that we base our own actions off. Normality is self-perceived and regulated by each individual, the individuality of normalcy makes everyone abnormal.