How do you know if you’re manic v hypomanic?

[Bumblebeedotty]

A MH professional has reported I’m manic, I just feel quite up, wouldn’t say manic though. Psychiatrist spoke about mania recently too in terms of may happen soon (meds). I was diagnosed bipolar 2, seems not now? But what is the difference between the two? How do you know?

Tricky one because I would swear blind I've never been manic but others disagree. With mania you definitely lack insight so basically if you think you're manic then you likely aren't. If you're still functioning then likely not manic.

Thanks crankyhousewife, I don’t think I’m manic & I don’t think that’s because of lack of insight, but a clinician has said I am. I do know what I think is something people can occassionally experience in mania, but I don’t feel manic, think mania would be way worse than this (besides the thoughts).

The first time I was sectioned for being manic I would ever have said I was, in fact I still don't think it was justified. Was I lacking insight or were they just being heavy handed? Who knows?

I hope you're okay? Are they keeping an eye on you?

It’s hard to know. I think it varies with clinician too.
Um kind of.

I was sectioned last year with first manic episode. When the meds kicked in, I could accept I needed to be there. Mine was classed as hypomania. I think maybe I was hospitalised as they were not sure initially what was wrong, as I’d reached nearly 60 years old without previous noticeable episode.

I don’t think the treatment for hypomania differs much from mania if symptoms are severe enough. I’ve just been told I have bipolar affective disorder - not which type.

it is part of the challenge of the illness that it’s hard to know how ill you are when “high”. Especially if you feel euphoric. I don’t feel euphoric, I feel angst ridden which I suspect helps me spot early signs and is part of the reason I was so late in life being diagnosed.

Are you at home?
is the crisis team involved?

I'm a MH nurse :)

If you were truly manic, you likely wouldn't realise it yourself anyway.

From my experience, hypomania often looks like: sleep is starting to decrease, thoughts are starting to race, a bit more forgetful, having 'creative' thoughts, irritable, some things like eating might decrease a bit, etc. People are generally just a bit more flamboyant and acting in ways they normal wouldn't. Relatives often notice first from my experience. It's a good time to have regular visits with your mental health team and consider whether your meds need tweaking.

Mania I often find looks more like: very impulsive/unsafe decisions that make little sense (e.g. I had a 70yo patient put his house on the market, buy a bird, buy a camper van, and book interailing all working a few days). People get very annoyed at family as in their mind they are doing nothing wrong. Some people might reckless drive. Just generally people doing some very bizarre out of character things, like disappearing for the day to go on a trip, jumping down the stairs as you think you can fly, etc. Some people are sexually disinhibited. Some people experience delusions. You sort of loose sense of social norms.

But everyone has a different baseline and everyone experiences hypomania differently. Some people are aware of it, some people aren't.

Thanks ChristmasMovies, I was told bipolar 2 (hypomania), but now they are saying mania. The thoughts I’m having I know are a manic thing, but I don’t feel manic, not at all. But I do get mixed states. They want me to go to hospital tonight, but I don’t want to go, so not sure what to do.
Feel for you living it with it all that time but not being diagnosed, have meds helped?. Think maybe you’re right about not knowing when you’re high. Who knows. Thanks for your reply

Thank you that really helps, still not sure which it is though as it’s within a mixed state. It is the wanting to fly, really really wanting to (safe currently) but not stairs, buildings that is getting me sent to the hospital tonight. I do know I can’t fly, at least to some extent, but it feels like the best idea on Earth, so exciting, but would say I’m hypomanic..

I think if they’d like you to go to hospital you should go and let them look after you, it’s only because they’re worried about you and want to make sure you’re ok.

A few of my family members have had manic episodes and none of them would’ve agreed at the time they weren’t well, it’s very hard to recognise in yourself.

Sounds like you'll be safer at hospital, OP, though it may not feel like it to you. They don't send people to hospital lightly. It's very hard to get a bed, so you must need it.

Wishing you a speedy recovery and a short stay!

Please take the advice to go to the hospital, is anyone there with you right now?

I don’t think you need to worry too much about the exact diagnosis right now but it’d be best to be somewhere they can look after you.

Hope you’re feeling better soon x

I don’t think they suggest hospital lightly. On my care plan, I’ve written that If they suggest I need to go to hospital, I intend to go. Will they let you go voluntarily if you go tonight?

Meds have been amazing. I’d been to the GP about not feeling right on and off since my early 20s. I threw everything I could at it and in the end self diagnosed with cPTSD (which pretty much shares all the characteristics of bipolar without the mania which I hadn’t had noticeably till last year). I never considered bipolar and never would have done as my highs don’t have a typical presentation.

Once they were sure it was bipolar, they started me on olazapine. A week later they added lithium. Once the lithium was at a stable dose, I then gradually reduced the olazapine. That all took about 6 months. I was in hospital for first month. Currently, I’m just on lithium now.

I’ve read about mixed episodes. They sound challenging.

Thank you so much, I am going tonight, I tried to say no, but was persuaded. You are right, thank you that makes it easier to go when I look at it like you just said. That people just want to make sure I’m ok. Thank you

Thank you so much, really appreciate your help & explanations. Like the short stay idea!!

Thanks so much changingplace, yes I have someone with me, I am ok & safe. I will be going to the hospital. You’re right about diagnosis it doesn’t matter in this moment. Thank you

Thanks ChristmasMovies, yes voluntarily nearly went a few weeks ago but didn’t. It’s hard for you you spent so long with the wrong diagnosis. But at least you have the right meds now.
Mixed episode aren’t easy, really hard to make me stable too. But once stable I’m fine unless meds are touched so I’m lucky in that respect. Thank you so much

I’m glad to hear you’ve got someone there and you’ll be going to the hospital, really hope you’re feeling better soon, take care x

Hope you’re doing ok this morning.

Delusions are the difference for me

When hypomanic lots of energy lots of plans little sleep..
When manic lots of energy lots of plans little sleep believe I can fly, believe people are out to get me, I can control traffic with my mind so don't need to look as i cross the road.
If the delusions are mild like just believing I can control traffic I can be in complete denial of mania and will only admit to hypomania yeah I'm high but I don't believe I can fly so all is good. Once it gets to flying level I'm in complete denial anything is wrong from a MH perspective and just talk about the lack of need of sleep and no one can keep up with me. I have to keep the brief moments of insight to keep engaging but will often not disclose more concerning symptoms in fear of them been taken away.

I didn't find out about my bipolar 1 diagnosis until I was having my daughter. I wasn't ever admitted for high mood so always assumed that meant only hypomania and bipolar 2 but I had 2 episodes where I was almost admitted. It was only after my referral to the perinatal team and it was listed as bipolar 1 on their paperwork I knew.
The first manic episode where I thought I could fly was the closest to an admission I had an emergency psychiatrist appointment the morning I was meant to go away for a few days for him to assess if I was safe enough to go or if I needed an admission. He had increased my meds a few days earlier and that just about gave me enough insight to go although unwisely! This psychiatrist didn't believe I could work whilst manic so put I only had symptoms out of work even though symptoms were causing me to get in trouble at work which factored into his treatment of the episode. I absolutely should have been admitted and I would have got my bipolar diagnosis sooner and stopped me being put on antidepressants without mood stabilisers speeding up me getting to a place of balance! Other times that it went towards mania I was under the early intervention in psychosis team and with intensive support as an out patient seeing a cpn, support worker and psychologist every week with fortnightly psychiatrist appointments got me through the episode without an admission.

I was shocked when finding out but it hasn't changed me or my treatment or how I live my life.