Now, at the About.Com: Bipolar Disorder webpage, there are warning signs for mania, hypomania and suicide, by Kimberly Read. I'll apply these to my self below in the parenthesis, and see how I do, while the warning signs themselves are highlighted in red:
Having known a number of people who were manic depressive, including the psychotic features, I don't think I'm manic depressive. I think I'm hypo-manic. So, what does that mean in terms of developing and effective medication regime that can keep me from rapid cycling from happy to despondent in the course of twelve or fewer hours? That's the question.There are a number of warning signs of manic episodes, red flags as many call them, of which we should be aware. By learning these early indicators, red flags will go up before a loved one rockets into a manic spree, before you slide into depression, before a friend actually attempts suicide.
In this article, the first in a four-part series, we look at some of the common red flags for mania and hypomania. Part II looks at depression flags; Part III, the warning flags for Suicide; and Part IV, the early signs of childhood-onset bipolar disorder (COBPD).
These symptoms are organized into broad categories for easier reference; this list of symptoms is gathered from personal experience as well as the resources listed elsewhere on this page.
Increased energy
- Decreased sleep: (I've been sleeping pretty well, since I started taking 2 mg of clonazepam an hour before bedtime. Otherwise, I would stay up reading the newspapers online, or writing, until six in the morning. My wife would call me to bed, but it was no use. Often, I'd go out to an all-night restaurant or take my dog for a long (two-hour) walk on the beach. During my second marriage, I used to leave the house at 1 AM and then walk seventeen miles until the sun came up.)
- Little fatigue: (I feel very often fatigued since I began taking the 2 mg of Clopam (clonazepam) before bed, along with 200 mg.of carbemazepine (Tegrex) as a mood stabilizer, and 150 mg of sertralina (Zoloft) per day. If you've had the experience of using up 2,800 minutes of cellphone time in one month, you might consider a little bit of sleepiness to be a welcomed respite, as I do, mentally and financially.
- An increase in activities: I've been called a whirlwind and had established residences in three countries over the course of six weeks. Let's leave it at that.
- Restlessness: I've come to the conclusion that sometimes the only alternative to losing my mind is traveling, regardless of the cost and consequences. For me, seeing something new and encountering and coping with new circumstances and people works like electric shock therapy works for others. It distracts me from the immediate past and helps me get involved with the present, at least for a time.
- Is having been married three times a symptom of restlessness or simply of poor decision-making?
Speech Disruptions
- Rapid, pressured speech: Sometimes I NEED to talk to someone. I used to talk to suicide hotlines for hours. But no one said my speech was "rapid" or "pressured". I merely felt pressure to continue speaking for fear of what I might think and do when I was alone again.
- Incoherent speech (generally not present in hypomania)
- Clang associations: the association of words based on their sound
(For example, my ex-husband once carried on for some time about vacancies, vagrancies and bacon seeds.)Impaired Judgment
- Lack of insight: Do three marriages show lack of insight?
- Inappropriate humor: I often laugh at movies while others are in shock, cowering beneath their seats. This really ruined a first date one time, and makes people think I'm insane, which I just might be. Once, I was laughing and jovial when my friends visited me in a mental institution after a suicide attempt. When they left, I cried on the floor of my cell. (OK, that's an exaggeration. It was simply a hospital room with no "sharps".)
- Inappropriate behaviors: Would coming on to every woman I know count as an inappropriate behavior? That's what I did before I started taking this cocktail of medicines that I'm taking now. For example, I was going out with a girl who was a twin and I asked her if they wouldn't both like to have sex with me at the same time. That was perceived as "inappropriate", and caused some very hurt feelings.
- Impulsive behaviors: Would telling the customer service woman at the telephone company to suck my dick (in the presence of my fiancée and her mother) count as an impulsive behavior? Would driving 105 miles per hour in the breakdown lane count as an impulsive behavior? Would utterly destroying an isolation room in a mental hospital count as an "impulsive behavior". I wouldn't have done it if I had foreseen the results.
- Financial extravagance: I used my mother's credit card without her permission to purchase tennis lessons. Is that financial extravagance or merely an overwhelming desire to stay fit?
- Grandiose thinking: Hmmm. You never know what's grandiose until you try and fail or succeed.
Increased or Decreased Sexuality
- May include inappropriate or sexual behavior: Would asking a cousin twice my age to have sex with me count as "inappropriate sexual behavior"? Would sex with same-sex strangers count? Mores are changing so quickly in this area.
Changes in Thought Patterns
- Distractibility: It's very hard to distract me. Once I get my mind focused on something, it becomes an obsession until it is complete.
- Creative thinking: Yes. I have my own word in Wikipedia.
- Flight of ideas: Yes. I don't have the flight of ideas typical of flagrant manic depression, especially having experienced such behavior at first hand in my brother and cousin.
- Disorientation: It's been a while since I felt truly disoriented. I think I was traveling in South America at Christmastime, and couldn't figure out what the hell I was doing there and why. So, I bought a plane ticket and traveled somewhere else, where I still felt disoriented. That might be considered symptomatic of "disorientation". But, that was almost thirty years ago!
- Disjointed thinking:
- Racing thoughts
Changes in Mood
- Irritability: Does breaking the sink with a chair count as irritability?
- Excitability: I'm pretty calm, except when I believe that the world is coming to an end and I might as well kill myself.
- Hostility: My ex-girlfriend says that just before I admitted myself to a hospital, I smashed a number of objects in the house and then left the house with a sledge hammer, promising to do something significant to somebody with it. While I was too tired to remember that very well (it was about three in the morning), I do well remember jumping onto the hood of a car at a traffic light and ripping the windshield whiper off, because the driver stopped abruptly next to my leg.
- Feelings of exhilaration
Changes in Perceptions
Hypomania also differs from bipolar mania in that the symptoms are generally less severe so that they do not cause significant impairment of daily activities. There are no psychotic features present in hypomania: I'm not aware of any psychotic features in myself, so hypomania seems a more appropriate diagnosis, although a battery of psychiatrists has disagreed with me. Medications aimed at "simple" mania don't work for me, which might be dispositive, and anti-depressants DO work for me, which might also be dispositive.
- Inflated self-esteem
- Hallucinations (not present in hypomania)
- Delusions (not present in hypomania)
- Paranoia (generally not severe in hypomania)
- Increased religious activities: Would driving three hours per day to sing in three different choirs at my church count as "increased religious activity"? Would it matter if I drove to choir rehearsal at 100 miles per hour?
More often than not, those who are close to us will notice our little red flags long before we will. If someone you love is waving flags, express concern. And if someone you love expresses concern, listen. My friends notice changes in me, but they have no knowledge of the information above. Some of them urge me to try to become independent of the medicine I'm taking, but I compare it to insulin and I ask them if insulin dependent people should try to ween themselves off of it?
Whenever I raise these issues with my brother, he is so desperately uncomfortable that he just wants me to shut up. Maybe it's because my uncle and my brother had manic depression and he's afraid his own children might be next. Or maybe he's just shallow, superficial and petrified. Maybe he simply doesn't care? In any case, I've stopped talking with him, since my every feeling and perception is a landmine for him.
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