# Coming down from a hypomanic state and coping skills



## foghlaim (Nov 5, 2006)

I have two questions that i'm hoping to get some feed back on. 

the 1st is:-   how does one know for sure if one is coming down from a hypomanic ep.? 


and the 2nd is:-
I'm wondering if anyone here has any ideas on med-less coping skills that might prevent me from "coming down" or going down too far.  I have read a  various articles on what can happen when one "comes down" but i'm hoping to hear if this coming down can be somehow prevented. maybe some members here have ideas\skills they used?


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## ThatLady (Nov 5, 2006)

*Re: how do you know and coping skills ?*

I can only speak from the perspective of a mother of a bipolar, but my daughter was never able to control the highs and lows without medication. Once she got on the right medications, and with the help of her therapist, she began to see daylight. Up until then, she was at the mercy of her condition. Some of the lows were pretty tough.


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## David Baxter PhD (Nov 5, 2006)

Fog, the cold truth is that an individual with bipolar disorder is not going to be able to manage the mood cycles without medication.


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## stargazer (Nov 6, 2006)

Why is it that some people seem to stay "up" almost all the time & never come down?  I worked with someone like that, and she was almost unbearable at times.  Everyone thought she was "manic" though she said it was ADD.  Also, I myself have been like that *most* of the time, at least since I came out of my initial episode in 2004, but I admit I have been depressed at times, particularly during the recent job loss and shortly thereafter.  It was almost as though I was making up for lost time by sleeping all the time, and I lost direction & motivation.  But usually I'm at least somewhat hyper (though it's been curbed by medication) & I tend not to think I'm ever going to "come down."


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## David Baxter PhD (Nov 6, 2006)

stargazer said:
			
		

> Why is it that some people seem to stay "up" almost all the time & never come down? I worked with someone like that, and she was almost unbearable at times. Everyone thought she was "manic" though she said it was ADD.


First, there are other conditions which can mimic at least some of the symptoms of hypomania, among them hyperthyroidism and I suppose possibly ADHD (hyperactive type) for some people.

Second, there are great variations among people as to the number, frequency, and druation of hypomanic or manic episodes. For example, some well known musicians and composers have shown documented manic episodes lasting several months at a time.


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## ThatLady (Nov 6, 2006)

I also wonder how much might be attributed to the "manic" person's desire to be out and about, with people to see, places to go, and things to do while the "depressed" person is more likely to draw into themselves and stay out of the public eye as much as possible.


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## stargazer (Nov 6, 2006)

That's good to know about the musicians and composers, as I have sometimes wondered if I held a record for the world's longest-running manic episode.  Also, I think that what ThatLady says makes sense to me, in terms of the differences in people's temperaments and sensibilities.


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## David Baxter PhD (Nov 6, 2006)

Robert Schumann was one composer who had quite extended periods of mania and depression. _Scientific American_ had an article several years ago where they documented his creative output against his depressive and manic phases and the correlation was quite striking.

There are numerous other examples, of course, including Mahler, Handel, and probably Beethoven, although in Beethoven's case there have been other hypotheses about the origins of his mood swings, including lead poisoning.


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## stargazer (Nov 6, 2006)

I read a biography of Schumann recently that said that his mental health problems were due to syphilus.  I wasn't sure how that could be.  At one point, he dove into the Rhine river in a suicide attempt and was rescued by boatmen.  They said that they used mercury treatment on him, thought to be effective for syphilus, in the mental hospital, after which he died of mercury poisoning.

Am curious if he had more output during his manic or depressive phases...


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## David Baxter PhD (Nov 6, 2006)

I thought that was Schubert who had syphilis... in any case, I think Schumann's bipolar was fairly well documented.

In one year during a depressive phase, his total output for the year was 4 works; the following year, with a prolonged manic phase, it was in excess of 30 works.


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## foghlaim (Nov 6, 2006)

ThatLady said:


> I also wonder how much might be attributed to the "manic" person's desire to be out and about, with people to see, places to go, and things to do while the "depressed" person is more likely to draw into themselves and stay out of the public eye as much as possible.


 

can you expand on this for me Tl. 
 the depressed state i can understand..  need more clarity of the manic state tho. 
I tend to being doing things..   i avoid the ppl part which ever mood i'm in, nothing new in that for me.. and   I have managed to stop myself from doing some things that would have been detrimental.. (real over the top stuff), most of the time.  


from reading  the other posts\threads on this forum and other health sites.. all point to meds..   but surely there is another option.. somewhere??


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## David Baxter PhD (Nov 6, 2006)

foghlaim said:
			
		

> from reading the other posts\threads on this forum and other health sites.. all point to meds.. but surely there is another option.. somewhere??


I wish I could tell you there is, fog, because I know that's your preference, but honestly I just do not believe that bipolar disorder is manageable without medication(s). This would be especially true if there is an additional comcomitant disorder such as generalized anxiety or social anxiety.


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## stargazer (Nov 6, 2006)

David Baxter said:
			
		

> I thought that was Schubert who had syphilis... in any case, I think Schumann's bipolar was fairly well documented.  In one year during a depressive phase, his total output for the year was 4 works; the following year, with a prolonged manic phase, it was in excess of 30 works.



I think there was a lot of it going around in those days.  The Schumann biography I read was on Wikipedia.  I also read up on Brahms, Bruchner, and Wagner, but haven't gone any further yet.  I was trying to see if there was anything these composers all had in common.  The main thing I was able to come up with was that their sense of priorities differed from most people's, usually on the practical level.  Wagner moved from town to town, constantly eluding creditors, was often bailed out by his friend Lizst, then betrayed Lizst by marrying Liszt's illegitmate daughter, 24 years his junior.  Schumann invited young Brahms to stay with him to give him freedom to compose, and as Schumann's disorder worsened, Brahms had an affair with Schumann's wife Clara.  Bruchner was a devout Catholic who drank huge drafts of beer and proposed to an alarming number of teen-aged girls.  And so on and so forth.

I asked about the creativity with respect to mania vs depression partly because I've spoken with a few people who say they can *only* create when depressed--my daughter being one of them.  I find this hard to grasp, because usually I create most when manic.  I did compose my flute sonata when depressed, however, and some other earlier works.  Since I've been on meds, I haven't composed anything at all yet.  This is not to say that I can't, but only that I don't feel compelled to do so, especially at the expense of more practical priorities, at this time in my life.


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## David Baxter PhD (Nov 6, 2006)

Your point about priorities is a good one - sometimes, life takes precedence over art. 

Most of the songs I've written were definitely when I was distressed, although some were when I was happy. I don't know if the key is depression versus mania but perhaps the intensity of the emotions involved - and of course one tends to have more physical and psychological energy when not depressed.


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## stargazer (Nov 6, 2006)

Life indeed takes priority over Art at times, however sad but true.  I think also that, as you suggest, in the manic state productivity is more motivated.  A lot of the time if I compose when in a depressed state, it's out of apathy, and being unwilling to do anything more practical or advantageous.  That's what happened recently in San Francisco, if you recall.  I sat in one cafe, on one table, and composed day-long, while burning my money carelessly in motel rooms at night.  It was pretty irresponsible, but no one could stop me.

Outside of my own experience, I would agree that the intensity of the mood would have something to do with it, for anybody.  Often I've run into someone who doesn't write music as a matter of course, and who isn't trained or schooled to do so, but who writes a song all of a sudden because he or she is motivated by a deep feeling.  

I was taught to get up every morning and compose, no matter how I felt, until I developed an "addiction" to it.  My teacher used that exact word: addiction.  The problem there is that I never allow myself to do it.  Instead I wait for some compelling force, such as mania, to drive me.


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## ThatLady (Nov 6, 2006)

foghlaim said:


> can you expand on this for me Tl.
> the depressed state i can understand..  need more clarity of the manic state tho.
> I tend to being doing things..   i avoid the ppl part which ever mood i'm in, nothing new in that for me.. and   I have managed to stop myself from doing some things that would have been detrimental.. (real over the top stuff), most of the time.
> 
> ...



I think the key in what you say, Fog, is that MOST of the time you can stop yourself from doing "over the top stuff". The worry lies in the times you can't stop.

Not all people who are "manic" seek out other people. Some go it alone, running from pillar to post with no real direction and no real goal. Some spend money the don't have, or get into legal trouble and end up in jail. It's not that they're bad people. It's just that they've lost control and can't regain it in time to stop bad things from happening.

I can understand why someone wouldn't want to take medications. However, what would happen if a severe diabetic didn't take insulin? What would happen if someone with severe hypertension didn't take medication to help lower their blood pressure? What, for that matter, how many awful things could happen if someone whose eyesight was very bad didn't wear contacts, or glasses? Taking meds might not be the ideal, but in most cases it beats the heck out of the alternative.


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## foghlaim (Nov 6, 2006)

Thanks you guys... i guess the consensous then it's meds or .....  meds!


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## ThatLady (Nov 6, 2006)

Pretty much, Fog. There's really no other alternative. Taking medications is a heck of a lot better than living every day not knowing what might happen, what you might find yourself doing, or how much you might find yourself hurting. That's not a life, it's a nightmare.


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## stargazer (Nov 7, 2006)

I was reluctant to go back on meds, Foghlaim, because my past experiences with meds had been negative.  They didn't seem to work, and they had negative effects I could do without.  I later found out that those particular meds aren't really effective in the treatment of bipolar.  (I'm not sure that this was a known fact at the time, at least not where I was seeking treatment.  But anyway, it's past.)  The medication I'm on now (depakote) works really well, and there are no noticeable side effects that I've encountered.  It's not full-proof, but it's a lot better than where I was before.  Also, it's not interfering with my normal enjoyment and appreciation of life and of the world around me, as I'd feared it would, and as other meds have in the past.  So there are good meds, and I think you'll be surprised how easy the adjustment is when you get on the right one, and how much better you'll feel overall.


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## foghlaim (Nov 7, 2006)

Thank you SG.. I'm really glad you have found (finally) the right meds to help you.      I know from reading\following your thread you have been thru the mill and back again. 

 I guess i will have to start thinking about changeing my thinking or something...  
To say i'm disappointed or disheartened to find no real alternative (yet or maybe ever) would be an understatement. 

oh well that's life i suppose, you win some, you lose some.


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## Halo (Nov 7, 2006)

> I guess i will have to start thinking about changeing my thinking or something...



I think that this is an important part of what you posted.  I know that it is disheartening to find out that there is no real alternative and that meds are probably your best bet so at least entertaining the idea of meds is a start.  Maybe trying to figure the exact reasons why you are so against or opposed to going on meds is a good start as well.

Take care
:hug:


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## stargazer (Nov 7, 2006)

Because sometimes I've gotten kind of miffed when the subject's arisen, I'm not sure I should state my opinion here.  But it's hard to stay quiet sometimes.  Basically, despite what I said in my last post, and despite what people in the medical profession say, I'm still unconvinced that there isn't an alternative for me.

I *will* say that if I were a diabetic, I would unhesitantly take my insulin, and I wouldn't question that this were the required course.  When the subject comes up, my tendency is either to clam up or to state what I feel.  But this is not to influence your choice in any way, since I don't really know you.  And everything I wrote last night is also true.  I mostly don't mind taking the depakote, but despite what I've been through, I still find myself hoping and even suspecting there's another way.  

Maybe another analogy would be that of an alcoholic who goes to AA and stays there, and forty years after he's stopped drinking, still introduces himself as an alcoholic.  This may work for him, and it may even be the accepted way of treating the illness, but for many people this will not work.  So maybe I am not going to have to stay on this medication forever, because maybe my condition will improve.

I'm not trying to be controversial, by the way.  These are just the thoughts that naturally cross my mind.


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## Into The Light (Nov 7, 2006)

i think that if there were other coping skills to be found, they would have been discovered by now. cbt is one such way that works well for depression, and it's been around for a while now. i would imagine that anything like that to help control your mood swings without medication would have been come across, and it hasn't, unfortunately.


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## stargazer (Nov 7, 2006)

I guess what I've been trying to say is that, I have noticed that the "mood swings" are much more evident when I'm in some kind of unacceptable situation, such as losing a great job, or finding myself out on the streets.  Anyone would be disoriented in those situations, and medication might be beneficial.  But when things are good, I don't experience them so much, and never really did.  I mostly experience being in a good space, and I was like this before I took the meds.  

But I'll talk about all of this with the therapist and the doctor.  The doctor, in my case, is definitely not pushing the meds, and that's something that I appreciate.  (It might however be connected to the fact that I'm on a low-cost program through the County, and they simply don't want to have to pay for meds unless it's necessary.  As it is, they're dishing me out all my meds for free.)


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## ThatLady (Nov 7, 2006)

There definitely IS another way, but it requires medication for the vast majority of people who suffer from bipolar illness to get to that other way. If a bipolar sufferer takes their medication as directed, and takes their search for wellness seriously, the medication may not have to be a forever thing. With CBT, one can learn coping mechanisms; however, one's mind has to be able to take in the information being given and put it to use. For those suffering from bipolar illness, there are too many times (in most cases) when they simply are unable to take in that information and use it in a beneficial way. The medications help them to do this. In cases where this is true, the medications are, in actuality, working to make themselves unnecessary.


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## David Baxter PhD (Nov 7, 2006)

There are also individual variations in frequency and intensity of the mood cycles. Some individuals with bipolar may be able to manage fairly well on minimal doses of medication, or in rare cases no medications, for periods of time, provided they know the signs of approaching depression or hypomania and seek prompt medical intervention to increase the dose or resume medication when that occurs. For others, the mood cycles are too frequent and or too severe to make that option feasible


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## stargazer (Nov 7, 2006)

That's good to know, and could be useful information for me.  I definitely appreciate CBT and have felt that the present therapy (and therapist) are pointing me in a positive direction.  Also, you (David) once said that your guess was that I would only need to be on a low dose of a single med--which is what has happened.  As far as I know, I'm on the lowest effective dose.

I see a guy on the bus often who appears to be *severely* bipolar.  When he's manic, he can't seem to control the pace, volume, and excitement of his long speeches.  Sometimes he engages the interest of nearby others, and at other times he frightens everyone around him.  Often the bus driver has to tell him to quiet down, after which he obliges with a brief apology, then perks up again.

At other times, he is completely quiet, looking helpless and dismal, dragged down, almost paralyzed.

My guess is that he's bipolar & untreated.  (The bus driver thinks so, too.)  I honestly do not believe that I have ever come across that way, at least not since I got off the original Kaiser medications that seemed to be complicating things when I *did* have a manic episode and first receive this diagnosis.  Again, I had been on neurontin, trilafon, and klonopin *before* I was ever diagnosed bipolar, and the meds were given me for different reasons.  So I am certain that all the damage of the 2004 huge episode was exacerbated by that mix of meds.

Also, to clarify, I'm not saying that I absolutely *won't* stay on the depakote.  A couple people have said recently, "If a thing works, don't fix it."  I think there's merit to that.  But I'm not saying that I absolutely will either, because I might not need to.  And once I get on my feet again, there will be a cost factor.

So, might as well take one step at a time.


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## stargazer (Nov 7, 2006)

Brief postscript: my Buddhist teacher is an MFT, has a Masters in Psychotherapy, and conducts the meditation classes in a town further up the foothills.  He sent me a story about a woman in his meditation group who overcame bipolar illness through twice-daily practice of meditation.  Not sure how authentic this is, but it might concur with what ThatLady was mentioning, if the woman made enough contact with her "wise mind" to be able to see the approaching mania or depression, and to come to terms with them.


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