Angela Glass SxSW 2009 (Photo Credit @JayZombie)
Are You There God? It's Me, Gidget, Neuroscience

Hyperthymia != Bipolar

It was the use and consequential paradoxical effects of Clonazepam—suffering from drug induced episodes of hypomania—which lead to the discovery that I am what they call “a hyperthymic temperament”.

While it is true that patients who experience hypomania as a side effect of Clonazepam may prove to have a form of bipolar disorder that has previously gone unrecognized, drug-induced hypomania is not invariably indicative of bipolar affective disorders.

It’s frustrating because suddenly I’m facing the woes I wrote about in college regarding labeling mental illness, and the impact of the use of labels, such as “creative” or “over-achiever”.

Label it or Leave it?

Happy Hyperthymia and Hyper Hypomania

Hyper Hypomania vs. Happy Hyperthymia

Some people would include in the Bipolar Disorder category a consistently elevated mood called hyperthymia. Being constantly upbeat and always enthusiastic is not unheard of, but it is not the norm in the general population. It is more common to experience a fairly steady, neither-too-high-nor-too-low mood characterized by some contentment, some discontentment, some happiness, and some sadness — usually associated with external events such as receiving good news, problems with personal relationships, etc.

Does a long-lasting, exuberant mood that causes no problem need to be placed on the spectrum of mood disorders? In a clinical sense, no. If it poses no threat to anyone’s health, it is not a concern for psychiatrists. Cataloging and understanding a mental state like this, however, may help us better understand the full spectrum of emotional states related to mood disorders and provide clues about what can go wrong when moods become extreme.

Happy Hyperthymia

Some people always seem to be upbeat and energetic, trying new things and initiating new projects. This trait, which is sometimes called hyperthymia, is not unlike being on a “permanent high.” Some people argue that hyperthymia is a type of mood disorder that results in high activity and inflated sense of self-esteem — something like living with constant hypomania but with the crucial difference that it is not as clearly episodic. Instead, it seems to last and is without any associated depression.

While observations of many people indicate some of them have this mood trait, hyperthymic disorder is not recognized as a mood disorder by either of the two mainstream authorities, the American Psychiatric Association and the World Health Organization. It appears in neither of their diagnostic manuals, the DSM IV and the ICD-10.

On the surface, people with hyperthymia seem optimistic and full of energy. They radiate self-confidence and self-reliance; they seem to believe they can do whatever needs to be done. They thrive on new experiences that promise variety, intrigue, and novelty. Usually, they have a great many personal interests, as well as plans for the future. They also can be articulate and witty.

It might be most accurate to think of hyperthymia as a temperament or personality trait rather than as a marker of a mental disorder. Of course, if this trait causes problems, then it becomes a legitimate subject for psychological or psychiatric care.

In fact, criticism of mainstream psychiatry is often directed at its alleged predisposition to label people with problems that don’t exist. The inclusion of homosexuality in earlier editions of the DSM IV — an error since corrected — is a frequently cited example. The reality is if someone is not unhappy, suffering, or a threat to themselves or others, psychiatrists have no reason to intervene. They are busy enough treating people with serious mental problems. It is only when complaints or serious problems appear that the labels of the DSM IV are applied as part of the process for providing effective treatment. A hyperthymic personality can be satisfying, productive, and creative. But if for some individuals it is a manifestation of a part of a spectrum of mood disorders, it could be problematic. For example, some people later diagnosed with bipolar disorder first seek help with depression after they have experienced a set-back in their lives. A close look back over their lives may reveal that they have been hyperthymic. Rather than having easily recognizable mood swings, these people may have been experiencing years of constant emotional elevation and enthusiasm along with a long history of uncompleted endeavors.

Also, the lack of a healthy response to the full range of life experience might cause problems for some people who always seem to have elevated spirits. A full, healthy life for most people includes periods of elation and introspection, action and reflection. If only one pole of our emotional lives is present, we may miss the benefits of the counterbalancing half of our responses to events. Consequently, we may lack understanding and empathy in the way we interact with people and respond to events in our lives.

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photo, Religion

Caffeine & Lithium Drug Interactions

Here is interesting stuff… so I was using caffeine to increase getting rid of the lithium. However, at that time I didn’t know that I’d been given Clonazepam. It is counterproductive on getting rid of Clonazepam.

[Three doses of] Lithium arguably did something good for me. It released this maniac that I adore… finally I’m the “me” I was when I was younger. Self-confident and assured. Alive and thinking. Living and focused. However, it appears just a half-dose would have done it, as their repeated doses kept me awake for 10 straight days, and besides Navy Seals, I can’t find anyone else who thinks that’s cool, nor good for me.

Clonazepam on the other hand is what makes a real life psycho. Manic sprees, up and downs. Chemically induced symptoms presenting as bipolar.

I’m kicking the caffeine again in favor of being rid of Clonazepam not a day longer than the torturous six months reported half-life.

Momma, keep me safe from these goons. Why don’t they believe me when I tell them their medicine will kill me? Isn’t it right there in all their own drug interaction sheets? I marvel at the psychologist who gave me sheet after sheet of drugs she wanted to “try” on me.

Um, I was just fine before they thought they knew more than me. I am SMRT, and waaaay SMRTer than Valerie, C. Castro or that other guy who barely rates in my memory.

All they did was fuel my apathy and create a revolutionary out of the sleeper that once was busy day dreaming about love, and living forever in a paradise earth that looks a lot like La Jolla. That I blame squarely on the almighty God Jehovah, and being raised as a Jehovah’s Witness. They say religion is just a form of insanity. Perhaps that’s the only means by which I could be convicted.

Damned if I do, damned if I don’t,… if only I believed in hell anywhere besides on earth.

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Ancestry, Neuroscience

Born to Be Happy, Through a Twist of Human Hard Wire

“I know, you’re bi-polar.”

“Old man, look at my life, I’m a lot like you were.”

Born to Be Happy, Through a Twist of Human Hard Wire

By RICHARD A. FRIEDMAN, M.D.

In the course of the last year, the woman lost her husband to cancer and then her job. But she did not come to my office as a patient; she sought advice about her teenage son who was having trouble dealing with his father’s death.

Despite crushing loss and stress, she was not at all depressed – sad, yes, but still upbeat. I found myself stunned by her resilience. What accounted for her ability to weather such sorrow with buoyant optimism? So I asked her directly.

“All my life,” she recalled recently, “I’ve been happy for no good reason. It’s just my nature, I guess.”

But it was more than that. She was a happy extrovert, full of energy and enthusiasm who was indefatigably sociable. And she could get by with five or six hours of sleep each night.

Like this woman, a journalist I know realized when she was a teenager that she was different from others. “It’s actually kind of embarrassing to be so cheerful and happy all the time,” she said. “When I was in high school I read the Robert Browning poem `My Last Duchess.’ In it, the narrator said he killed his wife, the duchess, because, `she had a heart – how shall I say, too soon made glad?’ And I thought, uh-oh, that’s me.”

These two women were lucky to be born with a joyous temperament, which in its most extreme forms is called hyperthymia. Cheerful despite life’s misfortunes, energetic and productive, they are often the envy of all who know them because they don’t even have to work at it.

In a sense, they are the psychiatric mirror image of people who suffer from a chronic, often lifelong, mild depression called dysthymia, which affects about 3 percent of American adults. Always down, dysthymics experience little pleasure and battle through life with a dreary pessimism. Despite whatever fortune comes their way, they remain glum.

But hyperthymia certainly doesn’t look like an illness; there appears to be no disadvantage to being a euphoric extrovert, except, perhaps, for inspiring an occasional homicidal impulse from jealous friends or peers. But little is actually known about people with hyperthymia for the simple reason that they don’t see psychiatrists complaining that they are happy.

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Neuroscience

My Momma: Arlene Jean Schaadt Baxley

I was talking with my momma this morning about orthomolecular medicine, and all the work she’s done to help people achieve better health over the years. Most often when I’m thinking about my momma in this regard, I think of how it is that she’s responsible for bringing life to families struggling to have children. What more beautiful work can there be as a humanitarian than to care for the quality of human life, and it’s propagation through it’s generations of families? Continue reading

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Neuroscience, Psychology

Being Sane in Insane Places

“It is no measure of health to be well adjusted to a profoundly sick society.”—J. Krishnamurti

In July 2011, I spent a total of nine days in the San Diego County Psychiatric Hospital. Being sane in an insane place is much harder than you might think, but then again maybe you don’t think I’m sane.*

I know how the caged bird sings, she sings with resonation found only on the super slick floors that only an insane asylum can afford where she sings “Crazy“.

“How do we know precisely what constitutes “normality” or mental illness? Conventional wisdom suggests that specially trained professionals have the ability to make reasonably accurate diagnoses. What is—or is not—“normal” may have much to do with the labels that are applied to people in particular settings.”

The Rosenhan Experiment

The Rosenhan experiment was a famous experiment into the validity of psychiatric diagnosis conducted by psychologist David Rosenhan in 1973. It was published in the journal Science under the title “On Being Sane in Insane Places.” Rosenhan DL (January 1973). The study is considered an important and influential criticism of psychiatric diagnosis. Lauren Slater later revisits the experiment and publishes her findings in Opening Skinner’s Box: Great Psychological Experiments of the Twentieth Century (2004).

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link, Neuroscience

Hyperthymic Personality

Link: Hyperthymic Personality

Now, the better question would be, what if there is no depression? Can people just have mild mania? And the answer to that is at one level it appears that God or nature or Darwin or whoever evolved our brains or created our brains did it in such a way that it doesn’t seem that episodic, mild mania can happen by itself. It has not really been described that people can have intermittent hypomania and nothing else, no depression. It can happen, but it’s probably rare. Just having manic episodes without depressive episodes is reported in maybe 5 to 10 percent of bipolar patients, and we don’t really know if just having hypomanic episodes can happen.

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Health

Happy Hypomania

“If you’re manic, you think you’re Jesus. If you’re hypomanic, you think you are God’s gift to technology investing.”

—John D. Gartner, The Hypomanic Edge: The Link Between (A Little) Craziness and (A Lot of) Success in America

Nearly all conversations about contemporary hypomanics start with the Steve Jobs of Apple, pitchman extraordinaire with a vaguely messianic streak: he can anticipate what people will want before they even know they want it. He is also routinely described as a despot and control freak with a terrifying temper.—Leander Kahney, Inside Steve’s Brain

David Segal in Just Manic Enough: Seeking Perfect Entrepreneurs (New York Times) reports “the attributes that make great entrepreneurs, the experts say, are common in certain manias, though in milder forms and harnessed in ways that are hugely productive. Instead of recklessness, the entrepreneur loves risk. Instead of delusions, the entrepreneur imagines a product that sounds so compelling that it inspires people to bet their careers, or a lot of money, on something that doesn’t exist and may never sell.

So venture capitalists spend a lot of time plumbing the psyches of the people in whom they might invest. It’s not so much about separating the loonies from the slightly manic. It’s more about determining which hypomanics are too arrogant and obnoxious — traits common to the type — and which have some humanity and interpersonal skills, always helpful for recruiting talent and raising money.”

Hypomania

Characteristics of Hypomania

  1. pressured speech (rapid talking)
  2. inflated self-esteem or grandiosity
  3. decreased need for sleep
  4. flight of ideas (thoughts are racing)
  5. easily distractible (attention deficit)
  6. increase in psychomotor agitation (can’t sit still)
  7. pleasurable activities with potential downside (buying spree, sexual indiscretion, foolish business investments, etc.)

Individuals in a hypomanic state have a decreased need for sleep, are extremely outgoing and competitive, and have a great deal of energy. However, unlike with full mania, those with hypomanic systems are fully functioning, and are often actually more productive than usual. Specifically, hypomania is distinguished from mania by the absence of psychotic symptoms and grandiosity, and by its lower degree of impact on functioning.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) you are hypomanic if you have an “elevated mood” for more than one week, and three or more hypomanic characteristics (see list).

Hyperthymic Temperament

Hyperthymic temperament, or hyperthymia, from Greek hyper (“over“, meaning here excessive) + θυμός (“spirited“), is a proposed personality type characterized by an exceptionally positive mood and disposition

It is basically being “hard wired for happiness“.

The Myers-Briggs Type Indicator for the hyperthymic tempered personality is often ENTJ, and is characterized by:

  • increased energy
  • productivity
  • short sleep patterns
  • vividness, activity extroversion
  • self-assurance, self-confidence
  • strong will
  • extreme talkativeness
  • tendency to repeat oneself
  • risk taking/sensation seeking
  • breaking social norms
  • very strong libido
  • love of attention
  • low threshold for boredom
  • generosity and tendency to overspend
  • emotion sensitivity
  • cheerfulness and joviality
  • unusual warmth
  • expansiveness
  • tirelessness
  • irrepressibility, infectious quality

Me?

I’m an ENFJ, a.k.a. an Extroverted Idealist Intuitive Feeler, and I have a hyperthymic temperament with episodes of hypomania.

References

Christopher M. Doran (2008), The Hypomania Handbook: The Challenge of Elevated Mood, Lippincott Williams & Wilkins

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Cannabis, Neuroscience

Diagnosis!

From: Angela M. Baxley
Date: May 18, 2011 1:19:46 AM EDT
To: BAY
Subject: Diagnosis!

I have a diagnosis: hyperthymic temperament with [drug induced episodes of] hypomania.

Talked to a doctor today (see below). We talked for a little more than an hour, over the phone. He ruled out epilepsy (if a concern, past as childhood) and manic/bipolar, depression.

He said there isn’t much a treatment. Continue Serofin, likely that can reduce “need” for effects of MJ. Should know in about 1 month.

Half-life for Clonazepam is extremely long and he was not at all surprised by any of my experiences.

Apparently I’ll just live with hypothymic [sic] temperament the same way Micheal just lives with dysphoria. I’m the euphoria to his dysphoria. No wonder I was so attracted to him. I always felt he gave me that other half of life perspective.

@ang @baxley


Begin forwarded message:

From: “Vishaal Mehra”
Date: May 16, 2011 3:56:03 PM PDT
To: “‘Angela M. Baxley'”
Subject: RE: Request

Hi Angela

Clonazepam (and other benzodiazepine medication) can have an atypical response in some individuals, such as disinhibition, mood changes, and activation—rather than the expected calming/sedation often seen with these types of meds.

Would you like to talk over the phone to discuss your symptoms further?

I have some availability this week

Let me know

Vishaal

Vishaal Mehra MD, CPI
CEO and Medical Director
Artemis Institute for Clinical Research
8787 Complex Dr, Ste 100
San Diego, CA 92123
Office: (858) ARTEMIS (278-3647)


From: Angela M. Baxley
Sent: Monday, May 16, 2011 3:35 PM
To: Vishaal Mehra
Subject: Re: Request

Hi Vishaal,

Thank you for helping. Matt is a great guy, and I appreciate all his help as well.

I have had unusual symptoms from what I can recall around 15 or so up to today. I would like to see who might be able to professionally guide my search for understanding.

I recently had a panic attack with which I took 2 Clonazepam. That sent me into a rage. That sent me to Wikipedia, where I learned that much of what’s been “wrong” may all be due to the medication.

Please let me know what you need from me.

And once again,
Thank you.

Angela

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