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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Neuroscience

Clonazepam Side Effects: Hypomania, a study from 48 people by eHealthMe.com

Found eHealthMe—”FDA and Social Media personalized”—with a report on Clonazepam and Hypomania.

“22,881 people reported to have side effects when taking Clonazepam. Among them, 48 people (0.21%) have Hypomania.”

See: Clonazepam Side Effects: Hypomania, a study from 48 people by eHealthMe.com

Hypomania (literally, below mania) is a mood state characterized by persistent and pervasive elevated or irritable mood, as well as thoughts and behaviors that are consistent with such a mood state. 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 by its lower degree of impact on functioning. Hypomania is a feature of bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder. Hypomania is sometimes credited with increasing creativity and productive energy. A significant number of people with creative talents have reportedly experienced hypomania or other symptoms of bipolar disorder and attribute their success to it. Classic symptoms of hypomania include mild euphoria, a flood of ideas, endless energy, and a desire and drive for success. A lesser form of hypomania is called hyperthymia.

Drug-induced hypomania is not invariably indicative of bipolar affective disorders.  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).

Continue reading

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Health

Clonazepam

Benzodiazepines such as Clonazepam have a fast onset of action and high effectiveness rate and low toxicity in overdose but have drawbacks due to adverse reactions including paradoxical effects, drowsiness, and cognitive impairment. Cognitive impairments can persist for at least 6 months after withdrawal of clonazepam; it is unclear whether full recovery of memory functions occurs.

Clonazepam is primarily prescribed for epilepsy, but is also prescribed for panic and anxiety, which are indication of abnormal electrical activity in the brain.

How it Works

In general, Clonazepam produces mild sedation by depressing activity in the central nervous system (the brain and spinal cord). In particular, clonazepam appears to enhance the effect of gamma-aminobutyric acid (GABA), a natural chemical that inhibits the firing of neurons and dampens the transmission of nerve signals, thus decreasing nervous excitation.

[blockquote align=”right”]Cognitive Remediation Therapy (CRT) is designed to improve neurocognitive abilities such as attention, working memory, cognitive flexibility and planning, and executive functioning which leads to improved social functioning. (See Clonazepam long term side effects on cognition.)[/blockquote]

Side Effects

Serious

Difficulty concentrating, outbursts of anger, other behavior problems, depression, hallucinations, low blood pressure (causing faintness or confusion), memory impairment, muscle weakness, skin rash or itching, sore throat, fever and chills, sores or ulcers in throat or mouth, unusual bruising or bleeding, extreme fatigue, yellowish tinge to eyes or skin.

Common

Drowsiness, loss of coordination, unsteady gait, dizziness, lightheadedness, slurred speech.

Less Common

Change in sexual desire or ability, constipation, false sense of well-being, nausea and vomiting, urinary problems, unusual fatigue.

Possible Interactions

Herbs, Vitamins, Minerals

Hawthorn may react antagonistically to clonazepam. Valerian and Kava Kava may interact additively (drowsiness): may exacerbate central nervous system depression (avoid this combination). Kola nut, Siberian ginseng, mate, and ma huang may blunt the benefits of this medicine. While St. John’s Wort is indicated for anxiety, it is also thought to increase (induce) cytochrome P450 enzymes and will tend to blunt clonazepam effectiveness.

Alcohol

Alcohol may increase the depressant effects of this medicament on the brain. It is advisable to avoid alcohol completely throughout the day and night-if it is necessary to drive or to engage in any hazardous activity.

Marijuana

Increased sedation and significant impairment of intellectual and physical performance.

Discontinuation

Do not stop clonazepam suddenly if it was controlling any type of seizure, or if it was taken for more than 4 weeks. Dosing should be slowly decreased (tapered) to prevent a withdrawal syndrome.

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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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Are You There God? It's Me, Gidget, Health

Clonazepam

We were launching Microsoft Expression, and it was my job to bring together a group of people to be known as Microsoft User Experience Evangelists. I also worked with my friends to connect influencers with the right people inside Microsoft to get all kinds of good gooey goodness flowing in the community. I was so proud to work with Dave Shea, Molly Holzschlag, Eric Meyer, Tantek Çelik, Andy Clarke, Jeremy Keith, and Lynda Weinman (whom I’d met previously, and adored)—and then there’s Joe Clark—people who I had “grown up with” on the Internet: they were my idols, soon they were my friends… And then there were the legendary technology & design focused agencies AvenueA/RazorFish, Adaptive Path, Blue Flavor, IDEO, FrogDesign, Zaaz, Y&R (the rest of my Mad Men era I’d already taken care with Creative Services at the Bank)… I’m sure I’m forgetting people (and companies), it was a whirlwind and my memory has never been all that great,—wow—just talking about that year exhausts me.

San Francisco January 18, 2007

January 18, 2007

San Francisco. Snowing trying to catch a cab outside the Dogpatch Studios. Destination: The Clift Hotel to meet @t and @meyerweb.

I was kind of tired of not being tired, I was a little tired of not sleeping. I just wanted to chill out, I’d felt like I’d been running on adrenaline non-stop for the good portion of a year. I watched Tantek nod off, sitting next to me, while Eric and I caught up. Yes, I was working full time learning a new job as a product manager (I wanted to apply design to a different role, I’d been doing design for 10 years and just finished the user experience strategy for another entire Microsoft product lifecycle… time for a change!) going to school carrying more than a full course load  by cutting out of work early. Maybe doing it all wasn’t all I wanted to do right now. Little did I know I’d soon be the one falling asleep, only for me it was at the Playboy party as SxSW tucked away in a corner of the VIP room, a true disco nap, if I’ve ever had one!

January 25, 2007

Chicago. I don’t really remember anything about being here besides dinner. But I don’t remember eating, not even sure I was there. I just remember that steak house I wanted to go to. I think I showed up after everyone was done. Oh! and there was some fantastic pizza. Who ever’s is the most legendary deep dish Chicago style pizza—we ordered from there. I remember that was yummy!

From 2006 to 2007, there was Mix ’06, Microsoft Expression Sessions, designertopia, ReMix, Web Directions North, SxSW, along with the various ones I can’t quite remember, like dropping in on BarCamp—was it? with Tantek—and meeting Chris Messina, and Jina Bolton for the time—the conversations we all had.

These were the women who really got it done—Miwa and Tiffany, the dyna-duo behind Microsoft Expression.

Miwa & Tiffany, the dyna-duo behind Microsoft Expression

January 30th Corrina & Angela NYC

January 30th

New York. Corrina came to meet me in New York City, or maybe she was there for the Vista / Office launch? I can’t recall. I remember being up all night, coming back to grab my bag and catching a cab straight to the airport in the dark, leaving both her—and my running shoes!—behind in the dark. The hotel was lovely and mailed my shoes home for me, where they would be waiting for me on return. Truth be told, I wasn’t using them anyway.

February 1st

073

London. I was there for my European conference for the Microsoft Expression Launch : designertopia.

Angela & Pete at Web Directions North

February 8th

Vancouver, Canada. Web Directions North.

I remember I was only “home” for a few hours in Seattle for right around the middle of the Super Bowl, but even that was actually spent over at Flores’ Super Bowl party…

DSC_1929

So I gave up my hippy-natural-Momma ideals, and went in to see my doctor (who I came to adore) and she prescribed me Clonazepam for my jet lag/insomnia, and said that it would also calm me down. She warned me that they were highly addictive and were more for “symptom” use, but if it worked then we’d see what she could do long term. I also told her about the blue light therapy device, as all the travel had caught up with me—Zürich, London, Reading, Vancouver, Whistler, Chicago, Boston, Seattle, San Francisco, Los Angeles, New York… did I forget any?—and the light seemed to work; it’d put me back on schedule, no matter what time zone I was in.

275

…to be continued.

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Health

Hypomanic Episode

296.40 Bipolar I Disorder, Most Recent Episode Hypomanic

When an individual experiences a discrete episode of persistent and pervasive emotional hypomania, this term may be applied.
  1. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood.
  2. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
    1. inflated self-esteem or grandiosity
    2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
    3. more talkative than usual or pressure to keep talking
    4. flight of ideas or subjective experience that thoughts are racing
    5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
    6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
    7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
  3. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
  4. The disturbance in mood and the change in functioning are observable by others.
  5. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
  6. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

Note: Hypomanic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapyshould not count toward a diagnosis of Bipolar II Disorder.

Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Copyright 1994 American Psychiatric Association

 

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