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  1. #1

    Hypomanic? Absolutely. But Oh So Productive!

    Hypomanic? Absolutely. But Oh So Productive!
    March 22, 2005
    By BENEDICT CAREY, New York Times

    Sometimes when talking to people, I'll tell them that I've just had a lot of coffee, even though it's not true, because I know I fire off in all directions, and I can talk to you about anything - literature, string theory, rock guitar - I once worked for Leo Fender - and one thing I say to people is that, of course, I live near the edge; the view is better."

    Laurence McKinney, 60, who lives near the edge of Boston, is a business consultant, a Harvard graduate and self-described polymath who has had a career that is every bit as frenzied as his conversational style.

    Among other ventures, he said, he has started pharmaceutical companies, played in rock bands and helped design electric guitars, and written a book about the neuroscience of spirituality. This month, for the first time, he helped start a Web site for people like himself. They are known as hypomanics.

    At some point, almost everyone encounters them - restless, eager people, consumed with confident curiosity. Researchers suspect that their mental fever shares some genetic basis with that of bipolar disorder, known colloquially as manic depression, a psychiatric disorder characterized by effusive emotional highs and bouts of paralyzing despair.

    In recent decades, scientists have found that bipolar disorder is widely variable, and that its milder forms are marked by hypomanias, currents of mental energy and concentration that are less reckless than full-blown manic frenzies, and unspoiled, in many cases, by subsequent gloom.

    New research helps explain how people with manic or hypomanic tendencies navigate the small triumphs and humiliations of daily life, and provides clues to how some of them quickly shake off the emotional troughs that their ambitious natures should make inevitable.

    "It kind of goes against the common assumption, but many people who are inclined to hypomanic or manic symptoms have an underlying resilience," said Dr. Kay Redfield Jamison, a professor of psychiatry at Johns Hopkins University. "They may get trashed by their peers, laid low, but they respond very strongly."

    In a new book, Exuberance, Dr. Jamison argues that flights of joyous energy similar to hypomanic states frequently accompany scientific and literary inspiration. Psychiatrists have known for more than a century that bipolar disorder, unlike any other mental illness, is often associated with some financial and professional accomplishment. Mania can inspire destructive shopping or gambling sprees, but it can also generate bursts of creative and focused work.

    Psychiatrists and psychologists have found ample evidence for bipolar tendencies in the life histories of many famous writers and painters. The composer Robert Schumann, for example, experienced extreme mood swings; so, some now argue, did the poet Emily Dickinson.

    Some studies suggest that first-degree relatives of people with bipolar illness, who are likely to inherit some genetic basis for bipolar disorder, are particularly likely to enjoy high socioeconomic status.

    Most recently, researchers have turned their attention to the mild end of the bipolar spectrum, and sliced it into many permutations. Bipolar II, III and IV, for example, each include depressive episodes and varieties of hypomania, or exuberant moods. Cyclothymic disorder involves rapid cycling from moderate depressive to manic symptoms, and hyperthymia is a state of elevated mood.

    "When you look across the entire bipolar spectrum, you find that maybe 10 percent to 15 percent of these people never get depressed: they're just up," said Dr. Ronald C. Kessler, a professor of health care policy at Harvard Medical School.

    As one psychiatrist put it, Dr. Kessler said, "The goal in life is constant hypomania: you never sleep too much; you're on; you keep going."

    With the exception of Bipolar II and cyclothymic disorder, which are accepted as standard psychiatric diagnoses, these permutations of low-level bipolar disorder overlap with each other and with normal ranges of mental function so much that some scientists question how distinct they are.

    "For some of us, there is a lot of wariness about this tendency to see bipolar disorder everywhere," said Dr. William Coryell, a professor of psychiatry at the University of Iowa School of Medicine, adding that "it's very difficult to determine reliable boundaries between one diagnosis and another" and document the true prevalence of the conditions.

    Yet even if bipolar disorders can be reliably diagnosed in only 2 percent of the population, some now believe that hypomania or similar charged states are more prevalent than previously imagined. About 6 percent of college students score high on personality tests that measure hypomanic tendencies, some studies find, and about 10 percent of children rate as temperamentally "exuberant," a related quality.

    Outsized delight in small successes may be central to what kindles hypomanic natures and sustains them. In an effort to learn how the joys and sorrows of daily life affect mania and depression, Dr. Sheri Johnson, a professor of psychology at the University of Miami, began surveying men and women in whom bipolar disorder had been diagnosed.

    Originally, Dr. Johnson was interested in the effect of negative events, like struggles at work or arguments at home. "But the people in the study told us we were getting it wrong, that it was when good things happened that they felt they had their manias," Dr. Johnson said.

    In two studies involving 149 people, one completed in 2000 and the other a continuing project, Dr. Johnson has found that personal victories like a promotion oran award very often precede or coincide with manic symptoms, though the person may be feeling neither manic nor depressed when life takes a good turn.

    Even when small successes do not arouse manic symptoms, they appear to prompt exaggerated surges of confidence. In one study, scheduled for publication later this year, Dr. Johnson led a team of psychologists who rated a group of 153 college students on a hypomanic scale, which included items like: "There have often been times when I had such an excess of energy that I felt little need to sleep at night," "I often feel excited and happy for no apparent reason," and "I often feel I could outperform almost anyone at anything."

    The scale was intended to identify people at risk for developing bipolar disorders.

    The researchers gave the students a hand-eye coordination test, then told them that they had scored very well, regardless of their true scores. Offered a choice of which test to take next, the hypomanic group selected a significantly more challenging exam than their peers did. These students not only expected to do very well, Dr. Johnson reports, they were more willing than peers to pursue difficult goals after an initial success.

    Researchers do not know whether this surging confidence and hunger for challenge persists, or for how long, but it is a familiar pattern to some psychiatrists who treat mild forms of bipolar disorder.

    Dr. John Gartner, a psychiatrist in Baltimore who specializes in treating hypomania, recently published The Hypomanic Edge, a book that identifies hypomanic symptoms in the lives of American historical figures from Christopher Columbus to the biotech entrepreneur J. Craig Venter.

    "These are people who are always moving the goal posts," Dr. Gartner said in an interview. "If they do well at one thing, they shoot for the moon."

    In a footnote in his book, Dr. Gartner recounts the story of how Henry Ford sailed off on a luxury steamer on a whim in 1915 to personally end World War I and bring world peace. "I'll bet this ship against a penny," Ford boasted to the reporters, "that we'll have the boys out of the trenches by Christmas."

    This grandiosity practically begs for a tragic fall. Difficult goals are by definition less likely to be achieved, even by those with mental power packs, and there is little question that people with hypomanic tendencies feel disappointment deeply. For some, their fevered, scavenging curiosity may overwhelm any excess rumination: new projects beckon before the old ones can be mourned.

    "I'm not so much smarter than other people as faster," said Mr. McKinney, the polymath near Boston, who contacted Dr. Gartner after hearing of his book. "I swing more often, I make errors, but I make them faster. That's how I sometimes describe it. If you can focus this energy, you can do great things with it. If not, well, I think it can be difficult."

    And that is one catch. Dr. Peter Whybrow, director of the University of California's Neuropsychiatric Institute in Los Angeles, said that he considered true hypomanic types to be rare and that some of them crashed at midlife, or later.

    "Usually what happens in the clinical domain," Dr. Whybrow said, "is that these people come in when they've had a business reversal and they're very depressed. They look back on their lives and realize that they were hyperactive, hypomanic, that they started a lot of projects but finished very few of them."

    The view may be better, but it is easy to lose your balance.

  2. #2

    Hypomanic? Absolutely. But Oh So Productive!

    Well, I've been here before, but not for a while. I came to Psych Links tonight because I just took my first dosage of new medication for bipolar one disorder and hypomania. It's geodon--I don't know much about it, other than what I've been told.

    Earlier, I was on klonopin, and it wasn't right. In fact, I went off of it cold turkey, which I know is not advisable. Fortunately, I didn't have severe withdrawals or a seizure, but I remained hypomanic for months, and I guess I still am, to a degree.

    For me, the odd thing about hypomnia is that I simply feel really great. I feel as though I am at my best, and yet it is true: a lot of the many projects of which I conceive simply go unfinished. I did finish the libretto to my new musical--rewrote it nine times, in fact, held readings and critiques, did the best I could. But I'm still only 1/3 of the way through notating the piano-vocal score. Before the musical, I wrote a book, then conceived of another book, the rough draft of which is sitting on my hard drive. Three classical pieces are unfinished. I simply could not control the degree to which I was conceiving of new creative projects long enough to finish them all. This has been going on now for almost two years.

    It is rare that I sleep more than five hours a night. Last night I slept two hours. I always feel rested after three or four hours, but I feel a lot better on the rare days that I get as much as seven hours.

    I resisted getting back on medication partly because I simply felt good. But now I'm back. I hope it works, because that klonopin drove me out of my mind---or something did, while I happened to be taking it.

    She prescribed 60mg a night, then up to 120mg after ten nights. I did try abilify and depakote a while back, but I couldn't tolerate the side effects, and I felt non-functional. Anyway, before I ramble further, I want to say that I'm glad I am accepting treatment for this. I have felt good within myself, but my egocentric hard-driving nature has alienated virtually everyone I know.

  3. #3

    Hypomanic? Absolutely. But Oh So Productive!

    Good to see you back, stargazer. And I'm also happy to hear you saying that you are recognizing that there may be some benefits to treatment.

  4. #4

    Hypomanic? Absolutely. But Oh So Productive!

    Yes, that's where I am now, David. I was in such denial before. Unfortunately, we still don't have the right dosage, and I know it will take time. She had me on 60mg geodon a night, and it knocked me flat, I slept fifteen hours, and the side effects were too much for me. I'm going to go back in next week and see if they can reduce the dosage.

    Thanks for everything.

  5. Hypomanic? Absolutely. But Oh So Productive!

    Stargazer! Good to see you back! Also, good to hear you're making progress!

    You're right about the medications, hon. Sometimes, it takes a bit to find the right medication and the right dosage. The trick is to hang in there and keep on trying. One you get the kinks worked out, and start making progress toward your goal, the benefits become very apparent.

    Good luck to you, hon! Hugs! :o)

  6. #6

    Hypomanic? Absolutely. But Oh So Productive!

    Thanks, ThatLady. I've got some time this morning, and I'm going down there now. I was also impessed that the new doctor spent a good two hours diagnosing me. She was so thorough, even though she claimed to have 600 patients. This is encouraging. I'm confident we can eventually find the right dosage of the right med.

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