I just received the following question from Alixana on how a person can know if an exciting and endorphin producing event can cause mania.  Here is the question and my long answer- I try to keep it short, but nothing with bipolar disorder is short!

Dear Julie,

Thank you for being so honest about your battle with bipolar disorder, and for chronicling your experiences so that other sufferers can learn from them.I stumbled upon your blog while googling for a link between endorphins and hypomania. So far, nothing I’ve read suggests that an endorphin rush can trigger off a hypomanic episode, but I’m worried that there might be a possible connection between the two.

 To cut a long story short, I took up social dancing a few months ago – at least two studies have shown that it benefits patients with depression, so I thought it’d help with bipolar as well (I have Bipolar II). I gradually realised that after social dancing, my thoughts would start racing, I’d be unable to sleep, and I’d be slightly more irritable in the couple of days following, even though I’m usually on cloud 9 immediately after a session. I didn’t take much notice of it and attributed it to other causes. However, I quickly became hypomanic at a dance party recently without even realising it. When I crashed back down to earth later, the realisation of how terribly and how uncharacteristically I’d behaved sent me straight into a depressive episode.

 I’m trying to figure out if there’s a direct link between endorphins (from dancing) and hypomania. Or is there another explanation for all this, so that I can still continue to dance. I’m seeing my psychiatrist soon and will ask him about this, but I’d really appreciate it if you could drop me an e-mail if you have any thoughts on this.

 Many thanks,

Alixana

**

 Hello Alixana,

I always say that bipolar disorder is a classic chicken or the egg scenario.  What comes first? Mania and then a euphoric endorphin rush or a situation that causes happiness and then a mania response?

The answer is complicated. Here are some questions:

- Is it possible you were already slightly manic (hypomanic) which is why dancing was appealing?
- What is the weather like where you live?  Is it still sunny?
- What effects does the dancing have on your sleep?
- Did you meet anyone at the dance you were attracted to?

That is one scenario as all of the above can lead to manic type symptoms.

Almost always, sleep is the most important question when it comes to mania. If you have a wonderful time dancing and come home with your mind swirling-  which is very common for anyone in a fun and stimulating situation- are you able to go to sleep afterwards?  If not, this is a big precursor to more hypomania if you’re already slightly manic. 

I love karaoke, but if I stay out past 11PM, there is simply no way I will sleep so I either go home early or know I will take my sleep meds.  Also, in the past when I would get fantastic news such as a book deal, I would have about three hours to celebrate and then I went straight to depression from the stress. Stress can be something wonderful like dancing- it doesn’t have to be a negative thing. The bipolar brain often can’t differentiate.

In terms of your going to a dancing event and feeling embarrassed, I bet that the others there simply thought you were a fun person! We judge ourselves so harshly- well, depression judges us so harshly.

There is no question you are rapid cycling- going up and down  between what you call the endorphins and then the depression simply wears you out.

I would say that in terms of the chicken and the egg, all of the above is going on with you.  It’s easy to confuse endorphins – a quick rush of hormones that cause a sense of well being- and the over the top feeling of euphoria that comes with hypomania.  There is a difference. Endorphins don’t usually make you do something dumb! They are short lived- hypomania tends to persist after the event.

It’s great you’re going to see your doctor-  I am sure you will discuss sleep as that is the biggest issue here.  I use my treatment plan (the Health Cards) to track all of my moods so that I can see the triggers and know what came first- the mania or the event! I was always confused before I started writing down all of my symptoms.

Bipolar disorder is an extremely complicated illness- simply because our brains and its hormones are so complicated.  There is absolutely no reason you have to stop dancing- but you will have to learn to manage the dancing so that you can stay stable. It’s completely possible.

Thank you for writing,

Julie

Here is the reply from Alixana- it’s so interesting!

Hi Julie,

Thanks so much for your answer. After reading and re-reading what you wrote, I think I’ve figured out what happened. Basically, I’d not been sleeping for more than 48 hours before the party, and prior to that, sleep has been elusive. So I guess I was already well on my way to hypomania, and the party just had enough triggers to tip me over the edge. It’s reassuring to know that dancing per se might not be the problem. Like you mentioned, I must learn how to handle it so that it doesn’t cause any trouble in future.

Thank you so much – your reply gave me a great deal of reassurance.

Much thanks,

Alixana

Thanks to everyone for your reader comments and questions-  here is one regarding work and bipolar mania.

Hi Julie,

I have been have episodes where I experience mania, wanting to buy stuff limited need to sleep and the inability to concentrate, focus finish an assigned task. This is a real problem at work as I work at a law firm and my hours are billable. I seem to have the episodes the week before and during my menstrual cycle. Do you know hormonal changes can effect my bi polar cycle/episodes? This is a real problem and I have so much anxiety because my Manager has approached me about my job performance and has sad some threatening thing to me regarding my position. I am so anxious and afraid it has a negative effect on my performance, which does not help the situation at all.

BDA Angel

Hi,

Mood swings affect work performance. That’s a fact of bipolar disorder. It’s one of the reasons I asked the poll question about whether a person with bipolar disorder would hire someone with bipolar disorder! So you are not alone. But… we can also be the greatest at work once we manage the illness because we can be more creative and self aware than most. It’s so essential that we all have a plan to manage mania when it comes to work. I know that I’m extremely creative when I’m hypomanic- but I can also be a bit over the top. I’ve learned to harness the hypomania while making sure I don’t make the mistakes I made in the past. It can be done, but it takes a lot of practice.

 Menstrual cycles can be very, very influential on mood swings. I suggest that you get a mood swing chart and start charting your moods daily- then you will know your pattern and can prepare for the mania days in advance. I would also discuss meds with an experienced health care professional- bipolar disoder medications can be used at certain times of the month and then stopped when they are not needed. This takes monitoring by a HCP though.  I would also be very careful if you’re taking birth control pills- they can affect your moods as well- sometimes in a good way and sometimes adversely! I know my signs of mania to the most miniscule change in mood- but it can still sneak up on me and I’ve used my treatment plan for nine years solid! It gets a lot better once you have a system.

If the mania is affecting your work- it’s essential that you start something now- I sound like a school marm here- but I can’t say enough about the importance of a plan we use every day! We need our work- but we also need to make sure the bipolar doesn’t affect our work adversely.

 Why does it have to be so hard for us! The facts are that it is harder. We have to be more vigilant. But…. once we learn to manage the illness better, we can be stable in relationships and work. I’m working full time now- and that is a dream come true. You can keep your job and even work more effectively once you chart those moods and start a plan! Take Charge of Bipolar Disorder has a mood swing chart in the back- and example of how I use mine.

And one final comment- what is the first sign you have that the mania is showing up when your cycle changes? Write that down and put it in your desk- and on your fridge- you can also tell the people in your life- when you recongnize the sign- you can say to yourself,”It’s time to put my plan into effect so that I don’t let this mood swing adversely affect my work!” I was not able to work at all in the mid ninties. I now have my own business and work daily.  It’s great that you are working as well!

 julie

The only difference between Bipolar I and Bipolar II is the type of mania. Bipolar I has full blown mania- Bipolar II has hypomania. Bipolar II never has full blown mania- if it happens, the diagnosis is changed to Bipolar I. People with Bipolar I can definitely get hypomanic as well as fully manic!

Euphoric and dysphoric mania…..

There are two types of mania seen in both Bipolar I and Bipolar II : euphoric mania and dysphoric mania . Euphoric is just like it sounds. Dysphoric is harder to understand as we are not used to the word! Dysphoric mania means agitated mania. It’s a very uncomfortable feeling!

Naturally, there is a lot of mental and physical agitation with dysphoric mania , but a person in this mood swing can be very aggressive and even violent. There are always sleep problems – the person looks haggard and worn out. They may sweat a lot and usually look pretty wild in the face. I went through this with my former partner Ivan. He was in a dysphoric mania/psychotic episode for three months. He doesn’t get euphoric mania.

 Whew. This illness is very complicated. If you have bipolar disorder, what kind of mania do you experience the most? If you care about someone with the illness, how would you describe their mania?

I have bipolar II hypomania. I am rarely manic, but when I am it’s euphoric. It’s hard to admit I have it as I just want it to last forever. It’s a lot easier to get help for dysphoric mania- as you feel so rotten. But it takes a lot of practice and self awareness to acknowledge and get help for euphoric mania!

Julie

I just received a comment from David that is very familiar- people often ask me- “Hypomania is good, isn’t it?”  David brings up a similar point.

Hi Julie,

I’ve never figured out why the diagnosis of “hypomania” is a problem… it seems like a good thing all around. There’s nothing wrong with chasing hypomania. In fact if you can live your life, or most of your life, in that state, then more power to you.
Mania, on the other hand, is just destructive.

Hi David,

You bring up a great point- it does seem that hypomania would be a good thing. One of the main problems is that though it may start off as a good thing if you have euphoric hypomania – it often takes over a person’s life in a negative way. I had a three month hypomanic episode in 1987 that did not end well- I was high for three months. I got married after knowing someone for one week. Many people with this kind of hypomania drink and do drugs, rarely sleep, make very dangerous decisions, upset their families, leave their jobs, travel without thinking and spend money like crazy.  It can actually be very destructive- the problem is that the person with the hypomania feels so good, they can ‘t see the destruction. Then, most people go down after a hypomania. Unless you have a form of the illness where you’re mostly manic- the saying ‘what goes up most come down’ is applicable here.

I do love hypomania- I really do- but only at the beginning. This is why I never let mine go too far- I always go way down once  it’s over!

Then there is dysphoric hypomania- that’s agitated mild mania that can be mixed with depression. It’s so uncomfortable and often at just a low enough level that you can do a lot of damage to relationships because you’re so darn unpleasant to be around. Sleep is also a problem here.

I guess that hypomania is like being on a drug.  We all know that people originally take drugs to feel better- and hypomania sure does feel good after a downswing- this is why I want to chase it, but I don’t. I am more creative, expansive, outgoing, fun and wild when I’m hypomanic- to the point that I used to make a lot of mistakes- I don’t do that anymore.  Now I have to accept that the hypomania is not good for me!

I think that one of the most confusing things is that people with hypomania don’t have psychosis- which is often what makes full blown mania so awful- and people with hypomania are just high enough to cause problems, but not quite out of it enough to need treatment.  This is a great comment, so I’m going to put it on the blog.

Do any of you have positive hypomania with no downsides or no downswings afterwards?

Julie

I always get confused between what I feel is the normal me and the hypomanic me. I have found that  I tend to guess a bit on the high side- in other words- the slightly hypomanic me feels normal, but of course it’s not. I spent 15 years chasing the normal me and it turned out to be the hypomanic me!

My normal self is actually pretty calm.

How about you? Do you chase mania? It’s easy to do. No one in the world would ever wish for depression. It’s ok to want to chase mania. Actually letting yourself do it is the problem!

Julie

Thanks to everyone for such amazing and insightful comments on the Mania and Sleep blog post. The topic is obviously so important. It really is such a chicken and the egg problem. I can be in bed and unable to sleep and I have to go through my list- am I just wound up because I stayed out late? Will I get to sleep eventually? Is it possible it’s agitated depression? What if it’s hypomania?

Then I have to truly assess if I will actually get to sleep if i just lie there. I listen to my Ipod podcasts – which helps a lot. I do sleep exercises (counting something!) and breathing. I do it all! And if I’m still awake, I say to myself.  “Ok Julie, it’s essential that you sleep at least seven hours. Take your sleep meds!”

Why is it such a struggle? I think we all want to just sleep normally and bipolar can make this super hard- so the chicken and the egg- does the sleep trouble come from a trigger than can then lead to bipolar symptoms- or does the bipolar make it hard to sleep!

 If you look at the blog post below, you will see a small button at the top of the post where you can click to read the comments. Wow, I learn so much from everyone.

 Julie

A mania tip: If you are slightly manic and go to a crowded beach all day- it can increase the mania because of the sunlight. Wear super dark glasses and sit under an umbrella. Isn’t it amazing that the sun can affect us so strongly!

Manic sleeping problems are different from insomnia in many ways- with insomnia you’re tired, you want to sleep, you toss and turn, you worry about how tired you will be in the morning, you want medication relief.

With mania! Whew! you want to stay up, you’re wide awake and doing something, you have unlimited energy, a racing mind, lots of creative thoughts (whether they are truly creative or not, they feel creative.) You have no desire to get in bed and sleeping feels like a real waste of time. It takes more meds to knock you out and there is a chance you will be even more manic the next day.

Here are some of the things you may think when you’re manic at night:

Sleep is SUCH a waste of time.
It’s only 1:00 AM. I could go to the grocery store right now!
The tile really needs to come up in the bathroom.

These manic thoughts can be funny- but many people act on them! When you have insomnia, you just lie in bed and punch your pillow and wish you could just get some sleep so you won’t be tired the next day!

If you’re having trouble sleeping and it’s accompanied by active thoughts that have a lot of energy around them- such as actually cleaning your whole house at 3AM. It’s time to talk with your health care professional. Now.

Julie