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Comment by erokar | Hacker News Reader

Mania is debilitating, that's one of its diagnostic criteria. The milder hypomania can be both productive and pleasant for some though.

It can be useful to think of bipolar mood and behaviour along two axes: depressed vs. elated mood and low vs. high energy levels. Sometimes people with bipolar can be both depressed and energetic, a so called mixed state. Some manic episodes will be energetic and accompanied by an elevated mood of optimism, joy and even ecstasy.

I agree that full blown mania needs to be treated.

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>The milder hypomania can be both productive and pleasant for some though.

> I agree that full blown mania needs to be treated.

Curious - is it your view that hypomanic symptoms don't need to be treated then? If so, why?

Edit: formatting

So as someone who is normally hypomanic but had a reaction to antidepressants that put me fully manic for a while, I don't think hypomania really needs to be treated with anything other than talk therapy. If I'm aware of it, I can manage the downsides pretty well through emotional regulation techniques like breathing / meditation and exercise. Hypomania can be overall positive if you learn to control it.

Mania on the other hand is basically like, you can't control the shit that comes out of your mouth. You act on every fucking thing that pops into your head, even when you recognize that it's hurting the people around you. You just can't stop yourself; its compulsive and incredibly distressing. People are uncomfortable around you and you can tell. Your judgment is impaired and you don't understand the grey area between right and wrong. You have like 15 thoughts flying through your head and you can't keep any of them straight for more than a few seconds at a time. It really, really sucks.

> I don't think hypomania really needs to be treated with anything other than talk therapy

I generally agree with this to my experience, with the caveat that their depressive swings are managed well - via medication or other means.

Hypomania is sometimes called the Entrepreneur's Disease. Let's say Elon Musk has hypomania (it does seem like it). Treatment levels him out and dulls his creativity at same time. Is that a desirable outcome?

I should have clarified in my grandparent question - I'm familiar with Bipolar I/II.

It's easy to idealize a hypomanic phase for the creativity that often comes with it. However, it is important to not confuse creativity with hypomanic behavior.

With proper medication, the creativity is not actually dulled, but rather, the overexertion that comes with the hypomanic phase is reduced, thus minimizing the depressive swing. This enables the patient to be creative in a sustainable way.

What sort of medication? That seems like a very tricky balance. I figure any antipsychotic/DA antagonist would potentially reduce creativity, so is it a different drug class?

Not always, no. In hypomania there is, by definition, no significant functional impairment. However, the underlying bipolar illness usually needs to be treated, and that usually involves reducing the amount of mood cycling. Indirectly that will often reduce the time spent in a hypomanic state.

This is a good educational site with a lot of info about bipolar II and hypomania: https://psycheducation.org/

Thank you for the educational reference. I should have clarified - I'm quite familiar with Bipolar I/II. I was curious of your rational for treating mania but not hypomania.

To what I've personally witnessed, even hypomania needs to be treated too, or at the very least vigilantly managed because even if it's not immediately destructive, the depressive phase inevitably arrives and can be quite destructive.

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