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How My Experience With Dysphoric Mania Led to a Psychiatric Hospitalization

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Editor's Note

If you experience suicidal thoughts, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741741.

Please see a doctor before starting or stopping a medication.

Dysphoric mania, what is it?

A quick Google search says it’s a mixed state of depression and mania people with bipolar disorder can experience. Dual Diagnosis states, “The combination of depression and the agitated state of mania can lead to extreme behaviors, such as attempted suicide or violence.” More recently, doctors and therapists refer to this period of mania as a “mixed state” or “mixed mania.”

• What is Bipolar disorder?

So, what does it look like for someone with bipolar disorder?

I can only write from my perspective and talk about my experiences, but recently I had a pretty bad bout of dysphoric mania and I wanted to share as I couldn’t find much about it on the internet from a personal, non-doctor perspective.

My story begins with medication changes. In August, I had genetic testing done that pointed toward a bit of attention deficit/hyperactivity disorder (ADHD). I started stimulant medication to treat this and I began tapering off my antipsychotic due to some physical issues caused by the medication. Things were going great! I felt amazing! I had energy! I was motivated and going to the gym every day! I felt inspired to get things done I had always wanted to, but previously didn’t have the energy or drive to do! I was actually stable for once … that was, until I completely tapered off the antipsychotic medication.

Enter hypomania. I found myself, around Thanksgiving, struggling with rapid speech and the inability to stop moving. I was cleaning the house every day and was cleaning at work too much. I wasn’t sleeping. I would wake up in the middle of the night ready to start my day. I mentioned to my wife on the way home from Thanksgiving dinner I felt I was hypomanic and she was kind of like, “you think?” in a way that was like, “no duh, Sherlock.” I reached out to my therapist and my psychiatrist. My psychiatrist was able to start me on a mood stabilizer. Unfortunately (after looking up side effects which I no longer allow myself to do), this mood stabilizer launched me into fatigue, brain fog and extreme suicidal ideation. I told my psychiatrist I was no longer going to take the medication after a week or so of taking it. She understood, and started me on an antidepressant that in low doses worked as an antihistamine which she hoped would help me sleep.

I ended up having an allergic reaction to this antidepressant that left me with hives all over my body (the opposite of what an antihistamine should do). I stopped taking the medication and reached back out to my psychiatrist. I had an appointment set for the new year, but things began to get wildly dark for me. I was super depressed at moments — couldn’t get out of bed, didn’t want to go to work. And then wildly hyper at other moments — waking up at 2 a.m. and deciding to make macaroni and cheese, cleaning the house in the middle of the night. My mind was filled with intrusive thoughts of self-harm and suicidal ideation. I ended up drinking on Christmas, ruining my 450-plus day sober streak. I reached out to my therapist and explained how I was feeling. He did an emergency phone session with me and we contracted for safety. I called my psychiatrist’s office and was able to get in with her sooner than the new year. She started me on another mood stabilizer and an antipsychotic for sleep, but kept me on a lower dose of my stimulant medication.

I would go on to have a very trying 40-hour weekend at work where I work with teens with behavioral and mental health issues. I decided for my sake and for the sake of the people I worked with I would take FMLA leave which I thankfully qualified for. About a week and a half after qualifying for my FMLA, I would end up coming completely clean with my therapist in an attempt to be completely honest this year about my mental health. We share a Google doc and I wrote him what was almost a novel about how I had been feeling recently. I made the decision to allow myself  to be uncomfortable and read it out loud in our session. Within this novel, I talked about how my moods had been swinging wildly from depressed to hypomanic, how I felt extremely exhausted which was causing me to be super suicidal and how I had considered dying by suicide. I also shared with him two poems I had written, one of which could have been considered a suicide note.

My therapist, thankfully, wouldn’t allow me to leave his office that day. He immediately expressed how I needed to be admitted because I needed more care than he or my psychiatrist could provide at the time and asked if he could make some phone calls. He called one of the best mental health hospitals in the area and found me a bed. He allowed my wife to come pick me up and bring me there instead of making me take an ambulance. He made sure my car would be OK at his office for a few days until my wife could come and move it back home. He reassured me he was proud of me and he cared about me and if I was angry with him, we could try to repair the relationship later on, but I had to be alive to do that.

I spent 12 days in that hospital. They would try a couple of different medication combinations before they finally knocked down the mania and got me to sleep. I was able to see a psychiatrist or nurse practitioner every day Monday through Saturday, with a doctor being on-call on Sundays and during evenings and I saw a therapist assigned to me three days a week. I went to groups every day, went on scheduled walks and got to explore and rediscover my love for arts and crafts. The other patients in the hospital were all there because they wanted to be there and that made for an incredible vibe between us all. We would go on to exchange contact information and continue the friendships outside of the hospital. I also wrote my therapist a letter thanking him for making the decision for me (because I had been in a place where I knew I needed more help, but couldn’t make that decision for myself) and attached two new and more positive poems to it I had written while in the hospital. When I was discharged, I left the hospital feeling more stable and prepared to face life again.

My psychiatrist and I are still working to figure out my medications, but I feel in a much safer and better space than I did before I ended up in the hospital. For some people, dysphoric mania comes on fast and goes away fast, but unfortunately for me, it seemed the lack of sleep from being hypomanic created a month-long nightmare. If you’re noticing you’re feeling hypomanic or manic and suddenly start having depressive symptoms and suicidal ideation, please reach out to your providers as soon as you start noticing them. Be honest with how you’re feeling. As my therapist said to me, you can repair relationships with people and you can work on bettering yourself, but to do so, you need to be alive. So do your best to stay alive.

Original photo by author

Originally published: February 8, 2020
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