Euphoric mania feels wonderful. At the beginning, it is exhilarating. You have lots of confidence. You can talk your way around, out of, and into any situation. You are on top of the world, in fact, you feel like you own and control the world. It is addictive. Your mind is sharp, your perceptions spot on. Now the mania is moving into the next level and your judgment is diminished to the point that you will do some pretty stupid things and after the episode is over, you will look back, cringe, and think “I can’t believe I did that.” You might lose your family, friends, your health, all your money, and/or your career. But you’re manic and you don’t care, you can’t care. Your prefrontal lobes aren’t working, and you can not process information related to the consequences of your actions. When you are manic you absolutely can not see what you are doing to yourself or to those around you.
Bipolar Disorder makes it difficult to regulate your emotions. “Normal” people tend to react “normally” (within a range of behaviors considered normal) to events in predictable ways. People with bipolar disorder often overreact to events that are triggers for them. For example, imagine going to a show that you really loved and coming out of the theatre elated and happy. Those are normal, appropriate, emotions related to an event that you just experienced. Now take the theatre event away, but imagine experiencing those same feelings (magnified 100 times), and that is euphoric mania. There is no rhyme or reason for the feelings. The overblown emotions are caused by the illness. Euphoric mania is wonderful at the beginning but it can turn dark and scary as it progresses towards one of the inevitable outcomes – the crash.
It was well know even in ancient times, that mania can manifest in several ways or change during an episode. During Hippocrates time, scholars observed, described, and recorded different mental states including mania. Aretaeus of Cappadocia, a famous Greek physician, lived in Alexandria in the first century AD and wrote the following: “Some patients with mania are cheerful – they laugh, play, dance day and night, and stroll through the market, sometimes with a garland on their head, as if they had won a game: these patients do not worry their relatives. But others fly into a rage…” In my experience, I am happy and confident, kind and loving to those who support my mania and allow me to revel in my euphoria. I’m the opposite with anyone who tries to thwart me or tell me that I am not myself, and heaven help them if they try to tell me that I need help.
There is a wide range of emotions and behaviors that typify any kind of mania and they include at least one but usually several of the following:
- euphoric mood (excessively happy but may become angry or irritable)
- high self-esteem
- increased psychomotor activity
- optimism
- exuberant energy
- increased goal-directed activity
- diminished need to sleep
- distractibility
- talkativeness
- racing thoughts
- grandiosity
- disinhibition
- impaired insight
- financial extravagance
- increased risk-taking
- high libido
- sexual promiscuity
Here is how Julia A. Fast an author about Bipolar Disorder describes specific symptoms associated with Euphoric Mania.
“An extreme desire for:
- sex with no thoughts of the consequences
- spending with no thought of the cost
- travel – no matter who you leave behind
- creative projects where you stay up all night with an ‘amazing idea!’
- quick results- the manic person finds ‘slow’ people very annoying
- talking with strangers
People with bi-polar euphoric mania also experience:
- less need for sleep with no tiredness the next day
- excessive ideas that just feel so wonderful they have to tell everyone about them!
- a general sense of well being that is hard to describe unless you have experienced it!
- inability to let others talk.”
A friend asked me about treatments for the manic phase of Bipolar Disorder? I found myself stumbling to answer because there are a variety of medications out there but not all of them work well for everyone. What works for one person may not work for another, and that’s why taking time to work with your doctor to find the right medication or combination of medications is critical. I’ve found a nice combination that is working well for me at the moment, but it has taken me more than five years and lots of trail and error to get to this point. The frustrating thing is that medications can work well for a while and then stop working. When they are working they help function and enjoy life more fully. When they fail to work, it just means that you need to go in and make adjustments to your medications with your doctor, and keep adjusting until you get back on track.
In some of the most recent studies, researchers have found that Lithium is highly effective for preventing relapses in mania. Combining Lithium with Depakote is also effective for many people. If someone is in an acute phase of mania, a combination of one of both of these mood stabilizers along with an antipsychotic can be effective in reducing symptoms quickly.
If you are experiencing a manic episode whether you feel euphoric and happy, or pressured, irritable, and short tempered, please contact your psychiatrist right away and get help. Manic episodes may feel good at the beginning but they usually end badly, and can destroy your finances, your health, and your relationships.
References:
Bipolar Disorders, Mixed States, Rapid Cycling and Atypical Forms, 2005, Edited by: Andreas Marnero, Frederick Goodwin,Cambridge University Press.
Julie A. Fast’s Bipolar Happens Blog
I had an appointment with my shrink yesterday. His colleague was in the waiting room working on a PowerPoint presentation preparing for a major talk he was doing that afternoon in Seattle. He seemed extremely stressed out. I thought that he needed Xanax to help him relax. But I’m not a shrink just a cognitive/behavioral psychologist who focuses on how people process information and learn. I thought it prudent to refrain from expressing my opinion. In hindsight, that was wise. His assistant was stressed out too and I don’t think ticking her off would have been smart. She’s quite substantial and very stern looking.
Quietly and calmly, I picked up a Web MD magazine that was sitting on the coffee table in the cramped outer waiting room and started reading an article on how to minimize stress in your life. I couldn’t help but think that getting up and leaving that office would reduce my stress significantly, but just in the nick of time, my carefree, relaxed, happy, and oh-so eccentric doc yelled out from his office door “Hey, Luann, come on in.” I hightailed it into his office.
We talked about his trip to a Biological Psychiatry Conference and what he learned there. I don’t recall all the details, but he talked about using Ketamine for pain, and new data indicating that it can also be effective for relieving panic attacks. I have a bottle of it sitting in my medicine cabinet but I’ve never used it. My Ketamine is for me to use if my lower back or hip ever goes out again and if I find that I can’t move due to extreme pain. That only happened once and I didn’t have the Ketamine prescription back then. Now, if by chance I ever have a panic attack, I can take it for that too! The wonders of modern pharmacology.
I also learned about the properties of Xanax and how the chemical compound is similar to alcohol but different. Molecules in alcohol and Xanax both bind to GABA receptors but the molecule that makes alcohol addictive is not one of the end products of Xanax. The prevalent view is that Xanax is extremely addictive so very few doctors will prescribe it. My doc is adamant that Xanax is not addictive. I do hope that he prescribes some for his stressed out office colleagues. He also said that alcoholism is a disease of old people. I hope he wasn’t thinking that I’m either old or an alcoholic. Oh sorry. I jumped topics pretty abruptly on you. We jump from topic to topic in our sessions too and that suits my mind. Hope you don’t find it too jarring.
Now, let’s see..what have I left out? Oh yes, my doc also talked a bit about Omega 3 Fish Oil. I use it to lower triglycerides and he said that promising data indicate that large intravenous doses of fish oil are effective in reducing or stopping psychosis. Can you imagine the fish oil burbs you’d have to deal with? If I ever become psychotic just give me some Zyprexa or Seroquel. Skip the fish oil.
My shrink also provided me with some very comforting information. Based on research studies and patterns of manic episodes, especially euphoric mania, on average a major euphoric manic episode will occur only once every 2-3 years. Mind you, that’s on average, and it varies across people. He said that there is relatively little chance that I’m going to have another major episode in the near future, and there’s no need for me to spend time worrying that I might run off with my tai chi instructor again any time soon. He also reminded me that no one died during my manic episode, and that all is well and right with the world at the moment. Umm.. I think the world is pretty screwed up actually, but he says not. Now, that’s comforting to know.
On the drive home, I started thinking about euphoric mania recurring every 2-3 years and I had a brilliant idea. I was eager to share it with my husband. I began by telling him what my doc said about the average rate of recurrence of euphoric manic episodes. I followed up with my brilliant idea suggesting that perhaps we should buy a condo, rent it out for 2-3 years at a time, then when I have a euphoric manic episode, I’d have a place to go. When the mania subsides and I come back home, we could rent out the condo again for another 2-3 years. That way I wouldn’t end up spending so much money on housing next time. We’d monetize the mania and make a profit. He said something like ”Ahh I see, you mean we’d be Mania Moguls”.
Not surprisingly perhaps, my husband wasn’t completely convinced that my idea was totally brilliant. He looked at me a bit strangely and asked me if I’d taken my Lithium, and then he smiled and said that he’d give the condo idea some not-too-serious thought. Luckily, my husband and my shrink both have a great sense of humor!
Have you noticed that it’s past the middle of January already? As a thought exercise this morning, I asked myself to sum up (in one word) how 2010 has been for me so far. Maybe it was the one-word part of the exercise that stumped me, or maybe it was just a very hard question because I’ve just realized very late into the day that I don’t have a one word answer. I failed my own thought exercise.
My first response is that 2010 has been fine so far. What on earth does that mean though, and who will ever read this blog if I use words like fine. Fine is a word writers should avoid like the plague. And 2010 hasn’t been exactly fine so far. It’s been kind of blurry and gray. Opps! That’s two words. Try again.
Ok 2010 has been “vigildent”. It’s often preferable to let readers make their own interpretations, but in the case of the word “vigildent” that just isn’t fair. So, I’ll try to explain.
I’m vigilantly diligent about watching my behavior and moods, trying to ensure that they both stay within the bounds of “near normal”. I also feel kind of vigildent about inspiration. I’m waiting for inspiration and energy to tap me on the shoulder or kick me in the butt. It rarely taps or kicks if you just sit there and wait for it. But lately I’m extremely vigilant about waiting and I’m diligent about being lazy. Overall, I’m being vigildent these days.
Why so vigildent? I think I’ve been worried about becoming “too happy” and going off on another manic tangent. Heaven knows I can’t afford to do that again. I’m still paying on the 6 month lease I took out last time I ran away from home. I don’t think I’d ever run away from home again, but I can’t completely trust myself anymore. So, on go the handcuffs. I’m still fun to be around but I’m tamed down. I’m not boring but I’m on guard.
My last major manic episode started in February 2009 and lasted until around the end of October. It varied in intensity over time, but I don’t recall ever being down. Just full of euphoric energy and extremely irritable at times. I also wanted to save all my relatives and the world. Now, I could care less about relatives and the world. Relatively speaking that is.
Maybe I’m really more worried about crashing. That would make more sense. But worrying about any of it to the point that I keep myself miserably normal is foolish and it won’t work anyway - so it’s a total waste of precious energy, energy that could be much better spent worrying about something much more important like what’s for dinner tonight.
I don’t have any answers but this ”too careful” way of being in the world just doesn’t cut it. I’m going to have to give myself permission to be a little bit less vigildent. In summary, 2010 so far has been packed with vigildence. I hope to be able to report next time that it’s been more carefree and capricious. Opps. That’s two words again.
In my experience recovering from a manic episode takes time. It’s been four months since the peak started to wane and I’m just now able to see and feel more clearly and easily without the devastating mania monster driving my thoughts, feelings, and behaviors. What a relief!
I am surprised at how long it takes for clear-headed thinking to return. The racing thoughts are finally receding. I’m able to be in the present and enjoy people and things around me without that awful pressured feeling. I don’t know how to describe that pressure – it’s almost like you have to keep moving, going, doing, running, racing. It’s exhausting.
Reminders:
- Mania can manifest as euphoria, anger, or anxiety, or all three combined together.
- During manic episodes, you will often not be able to see the havoc you are wreaking, and how you are hurting yourself, your family, and friends. So, you are often reluctant to stop doing what you are doing because you are convinced that it is the “right” thing to be doing.
- I’ve found that it takes weeks even months for the brain to start functioning correctly again, so that you can review what you’ve been through and realize the effects of your actions.
- Early mania feels wonderful, at least to me, and it is very seductive and easy to run with it. Unfortunately, it usually leads to impulsive decisions and actions that end up in disaster.
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