Bipolar dysphoric hypomania can feel agitated, bleak, and confusing. Learn the warning signs and why fast support matters.
Key Takeaways
- Dysphoric hypomania blends the energy of hypomania with the distress and negativity of depression, so it can be easy to miss.
- Ultra-rapid cycling can cause mood shifts within the same day, making symptoms especially confusing.
- Even people who know bipolar disorder well may not recognize a mixed episode in themselves right away.
- A solid management plan can help limit the damage, but early recognition and support are still essential.
____________
After I was diagnosed with bipolar disorder, I created and followed a management plan, I take my meds, and I have a good support team. I’ve become an “expert” on this brain-based disorder and have even written books about it. Yet, I previously had a two-month episode of ultra-rapid-cycling dysphoric hypomanic — and neither I nor anyone else in my life caught it before it started putting my health, my work, and my finances in serious jeopardy.
Understanding Ultra-Rapid-Cycling and Dysphoric Hypomania
“What the heck is ultra-rapid-cycling dysphoric hypomania,” you ask?
It breaks down like this: “Hypomania” comes with the bipolar 2 diagnosis; it’s a milder form of the full-blown mania (intense mania often combined with psychosis) associated with bipolar 1. Rapid cycling means my mood swings occur faster than for most people with the illness; “ultra-rapid” means I often have mood swings daily. Then there is “dysphoric”: The Merck Manual describes it as the restless, irritable, unhappy, and pessimistic part of hypomania, as opposed to the creative, upbeat, and “loud” features of euphoric mania.
What Is Dysphoric Hypomania?
Dysphoric hypomania is a mixed presentation of bipolar disorder that combines the high energy of hypomania with the low mood of depression. Unlike euphoric hypomania, which is often characterized by elation or increased productivity, dysphoric hypomania feels agitated and “dark.” Because many people only associate hypomania with “up” moods, this specific state is often missed or misidentified.
The Reality of Living With a Mixed Episode
Here is how it felt for me: I had trouble sitting down. I often took off and went somewhere, then in a few minutes I’d become so agitated and distracted I’d get up and go somewhere else. Then I’d drive around and get very upset with myself for not staying put and getting something done. My mind constantly told me I was in the wrong place. It was so bad that I just wanted to run away from my life. I kept thinking, “I’ve got to get out of here!”
The most confusing factor was the rapid cycling — I would go in and out of dysphoria without warning. One minute I’d be getting work done, like the coaching I love so much, or having a great time hanging out with friends or my nephew. But that evening I’d be in a dysphoric crying jag, wondering, “How did I let my life get to this stage without accomplishing more or having love in my life?”
My therapist, Robin, said, “Julie, you’re in some kind of crisis, and you’re about to really mess up your life.” She was right, but what was I supposed to do? I didn’t call my psychiatric nurse practitioner because, overall, I thought I was functioning okay, but I was only used to euphoric mania — not whatever “this” was.
How a Management Plan Provides Stability
Eventually, I woke up one Sunday and felt like my normal self, like a switch was turned off. It was scary to realize how very sick I had been. Really scary.
Unbelievably, I didn’t recognize the symptoms in myself that I would recognize in someone else in two seconds. While I was sick, I still followed my management plan of medications, trigger management, and careful monitoring of my lifestyle choices. I didn’t harm any of my relationships, do anything drastic, or miss any deadlines or appointments. My management plan worked. Things would have been much worse if I hadn’t had these tools in place.
Unfortunately, bipolar disorder doesn’t care how well I usually manage the illness. It doesn’t care that my work is all about helping other people. It doesn’t care that I’m a hard worker. Now that I know what to watch out for — and that it can happen to any of us, no matter how much we know about this brain disorder — I will never again let a dysphoric hypomanic episode take over and make me feel like running away from my good life.
Recognizing the Warning Signs of Dysphoric Mania
It’s essential that you know how to recognize the warning signs of dysphoric mania — in yourself or a loved one — so you can get help fast, before things really get out of hand like they almost did with me.
Common symptoms include:
- Elevated and agitated mood
- Extreme anxiety
- Persistent sleep problems
- Indecisiveness and focus problems
- Negative, racing thoughts
- Physical restlessness
- The desire to flee!
UPDATED: Originally printed as “Fast Talk: I’ve Got To Get Out Of Here!”, Winter 2012