Inside Bipolar Podcast: Is Hypomania “Just” Less Severe Mania?

Meet Your Inside Bipolar Podcast Hosts

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

Episode Transcript:

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Welcome, everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: We’ve been getting a lot of emails about the differences between mania and hypomania, specifically some of the ways that it’s discussed out in the world. For example, it’s almost always discussed as mania light, right? It’s like it’s like it’s like diet mania. And many people who live with bipolar II have pointed out that it’s not mania light. It’s a completely different condition, a separate condition. It’s not less than mania. It’s not easier to deal with than mania. And in many cases, it’s more difficult than mania. And this this this got us talking, Dr. Nicole.

Dr. Nicole: It sure did, because I realized that maybe we’ve done a disservice. And not just me and you, maybe me and you also, but the medical community. Right? So, the mental health world, we have talked about it in these terms to try to simplify it, to make it a little bit easier to understand, to help people differentiate between mania and hypomania. But it makes me wonder with some of the comments we’ve gotten, if we’ve done a disservice and maybe even accidentally minimized the impact that bipolar II has on people’s lives.

Gabe: The first thing I want to say unequivocally is I have used that kind of language before, that hypomania is one step below mania. And as they say in Star Wars, it’s true from a certain point of view. For me personally, hypomania leads into mania. So, if you follow that progression, I guess what I’m saying is accurate. Again, for me, one leads to the other. But if it never progresses into mania and it stops right there, then it leaves people this idea of, oh, you got lucky. At least it didn’t get worse. And that creates a real misunderstanding of what hypomania is and of course, how dangerous it is. Once again, if you’ve got in your mind, oh, there’s something worse that could have happened around the corner, you tend to think of yourself as lucky. But of course, if you’ve experienced the symptoms of hypomania and somebody says, oh, you’re so lucky, it didn’t turn into anything worse, you’re like, wow, that is not supportive in any way whatsoever.

Dr. Nicole: People who’ve had hypomania don’t feel lucky. They may be grateful that it hasn’t been worse, but I don’t know if lucky is the word I would use because it can be equally impairing for them and frustrating. And I think it would be like telling somebody, well, you only have this kind of cancer versus this kind of cancer. Like that’s really, really bad. But you should feel lucky that you don’t have, you know, this more severe cancer. It’s still problematic. It still causes problems. It’s still impairing. And it’s a lot more difficult to pinpoint sometimes. So, the person with hypomania and bipolar II disorder might lightrally go months, years with nobody being able to pick up on the fact that they’re experiencing hypomania, whereas with mania, it’s pretty clear. There’s usually not much question about whether this is mania or not.

Gabe: I think here’s the million-dollar question, Dr. Nicole. Hypomania feels good, so why not just leave it alone?

Dr. Nicole: Because we can’t just leave it. We can’t just leave it alone. We can’t just say we’re going to let your hypomania go unchecked. In doing so, we’re also leaving your depression unchecked because there’s nothing to stop you from eventually getting to a depression episode. What goes up must come down. You will eventually have a depressive episode. So, we need to prevent the depression. And in doing so, if we don’t do it appropriately, if we just use antidepressants or traditional antidepressants, SSRIs, things like that, we run the risk of making your mood even more unstable so that hypomania may not be the feel-good state that you kind of know it to be. We really have to approach treatment of your bipolar disorder from a stance of we want you in the middle. I don’t want you high. I don’t want you low. I want you as close to even as possible. It’s really the only way to address it because we just cannot tease out what mood state we treat and which one we don’t.

Gabe: I’m always fascinated because people living with bipolar disorder, they have someone in their life, they have some friend, family member, coworker who they describe as moody. And it’s a pejorative. It’s an insult. They’re like, oh, that person is so moody and it’s a negative. And then they argue the exact opposite. Like, well, yeah, you know, I’m striving for the middle, but I want these periods of hypomania, right? You recognize that that kind of an extreme is going to make you moody and you see how you respond to. Quote unquote, moody people. And yet you’re advocating to become that. I’m also really fascinated, Dr. Nicole, that we as people living with bipolar disorder were always saying, look, we need holistic interventions, we need our physical health and our mental health to be treated because we are in one body. Right? So, we understand it then. And then later on we’re like, all right, but you know, the hypomania, right? You know, this symptom can you just not treat that? It’s like we were so close. We were so close to having it down. But we just we just missed it by a little bit.

Dr. Nicole: And we have to think about the whole picture. We cannot just focus on the week of good that you had or the a little beyond good that you had. We really have to look at the whole year. I want to know what the whole year of you looks like. Not just those really good moments. We have to be able to look at the whole picture. And that’s what treating you as a whole allows us to do.

Gabe: I really just want to reiterate that hypomania and mania are two separate mood states. Hypomania is not mania light, despite people thinking of it that way. Hypomania and mania: two unique symptoms of bipolar disorder that require different interventions and impact us in different ways. And I think it would be really, really, really good for us to start thinking about it that way. All right, Dr. Nicole, I’m going to tap into your psychiatry training. What is the definition of hypomania versus the definition of mania?

Dr. Nicole: So, the DSM says that for hypomania or mania, you have to have these are these are the exact words y’all verbatim a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy. So, you have to have a mood shift, either irritable or super high, and you have to have an increase in energy that is above your baseline energy level. You have to have that for both of them. Where we come to differ is the time frame. You have to have at least four days of these things for hypomania and you have to have at least a week of these symptoms for mania. The DSM is very clear. The symptoms are the same, they’re the same symptoms. You don’t see the level of impairment with hypomania that you see with mania and that is where I think we have come to think of hypomania as just a lesser form of mania that we shouldn’t be that concerned about. And we just need to reframe that. Yes, it’s less intense. Yes, it’s less trouble you can get into in hypomania than mania, but it doesn’t make it any less distressing for the person who’s experiencing it.

Gabe: And of course, anything that can disrupt your life, who cares if it’s worse somewhere else? Does that really matter? If you’re losing touch with your friends, your family, losing your job. If you are, as you said, distressed, unhappy, not living your best life, you don’t care that somebody has it worse. The damage that hypomania causes all by itself. It’s really irrelevant if there’s anything worse. I’m making air quotes for those who can’t see me on the video. I just I think it’s a little bit of the suffering Olympics and we do not play the suffering Olympics at Inside Bipolar.

Dr. Nicole: The hard part is people will say, Yeah, sometimes I feel good, sometimes my energy is up, sometimes I’m in a good mood. I’m still stuck wondering, is that is that hypomania? You know, is that mania or is that, I’m depressed a lot. And sometimes I just have a couple good days because, you know, when you’re depressed, you have a couple good days where you have energy and you’re like, oh, am I feeling better? Let’s do all those things. I didn’t have the energy or desire to do when I was super depressed the last three months, and you may have a couple days where you’re like, okay, let’s get stuff done. Let’s do it. I’m cleaning, I’m getting stuff done. But that’s not hypomania or mania. But you would answer yes to that question. So, it gets super, super complicated when we start trying to use our words and terms and criteria to apply to day-to-day life and to ask the question. So, I don’t think we always ask the questions in a way that people can grasp and then really give us an accurate answer.

Gabe: One of the things that I think about from trying to self-report, right. Which is which being how bipolar disorder I and II, hypomania, mania, depression, all the symptoms, they’re all diagnosed by self-reporting. Okay. So, we know the depression is present, right? We can just put that out of the way. So, you’ve experienced depression, you’ve experienced suicidal depression. You’ve been in bed for days at a time, and now all of a sudden you reach a normal mood state. Well, that’s a that’s a huge jump. Comparatively speaking, normal feels amazing.

Dr. Nicole: Yeah. And we see the same thing from the opposite direction. I have people who are, you know, 20 out of 20 manic and then when they get down to a normal mood, they complain to me, I’m slow, I’m slow, I’m moving slow, I’m talking slow, I’m walking slow. And I’m telling them, buddy, you’re not, you’re not. This is normal. You’ve been high for so long that normal feels slow. So, I think your frame of reference is a little skewed when you’re in one of those extreme of mood episodes. But how do we figure out, is it hypomania? Mania? Because even with the memories and you trying to recall and you trying to be the historian and give me the good story, it’s still usually a lot easier for you to say, oh, yeah, I have these moments where, you know, people tell me I talk too fast or they say that, you know, oh, I lost my job. Or one time I took a road trip and didn’t tell anybody and he ended up three states away. And, you know, you have those kinds of stories that I can piece together and go, oh, yeah, that that does sound pretty. That sounds beyond just a normal good mood. But it’s the hypomania that’s the problem. It’s the trying to figure out the line between I’m just in a really good mood versus I’m hypomanic so it still just gets that much more complicated to try to tease that out.

Gabe: That’s almost a verbatim example of some emails that we received, Dr. Nicole, where somebody said, look, when you’re manic, it just looks a certain way people notice it, the people around you, especially if you’ve been working with managing and being supported with bipolar disorder for a while. They basically say things like, look, we can see it in your eyes. We could tell. We knew the minute you woke up and headed out the door, that mania was there. And we did everything we could to stop you. But that hypomania isn’t as easy to deduce because, again, we want people to be excited. You don’t want to remove excitement from people’s lives, right? You’ve got that concert ticket. You’ve got tickets to the Broadway play. You’re on vacation. You’re you see the Northern lights, the Eiffel Tower for the first time. It’s okay to have this exceptionally elevated mood. Right? You watch your little brother, your little sister, get married and you get teary eyed. And I mean, there are moments in our life where we want to experience this, this this elation that is atypical but not symptomatic. Now, I imagine you probably say things like, okay, when you experience this, were you at your little brother or little sister’s wedding? I’m not trying to do your job for you, Dr. Nicole, but when somebody says, Yeah, I really felt that way and you’re like, okay, what was going on? Oh, well, you know, I, I was on vacation that week and my sister had a destination wedding, and I also won the lottery the week before. I imagine that part of diagnosing hypomania is sort of teasing out things that are reasonably making somebody elevated or excited or I’m just going to go with extra happy.

Dr. Nicole: Well, yeah, absolutely. So, I will ask what was going on then. Tell me, tell me what life was like, what was happening. People will say, well, you know, I mean, when I’m on vacation or I’m all happy when we’re on vacation and maybe just a little bit more than our usual baseline level of happy. And that’s okay. Where I want to try to piece together the facts is I want to know. How long does it last? So, hypomania has to last at least four days, whereas mania has to be at least a week. So, time frame comes into play when we are assessing the differences between the two or if it’s even present at all when we are thinking about hypomania. I want to know, you know, what were you like? Did you do anything that was different out of character for who you normally are? Because those things still happen. They may not be. As intense or as severe as the person who’s manic. But it’s a difference. And the problem is the person isn’t always aware of it because it can be so subtle that it’s just hard to determine. I have a patient who I saw years and years and years ago who was a salesperson, and they, during hypomania, would win awards for sale, like outbound sales, because they were hypomanic and they were just like talking and going with it and a little bit expensive, but not all the way expensive. They were working longer hours because they didn’t need as much sleep, so they were making calls to other time zones. And I mean, they were just really killing the game when they were hypomanic, winning awards. And then they would go back to a normal mood, a normal pace, and they were still successful.

Dr. Nicole: But there was just something about that period when they were hypomanic. And I had been treating this person for depression for a while, not ever knowing about these episodes that they were experiencing. But we were having difficulty getting their depression under control, which is usually, I would say, if you’re somebody who has been treated for depression repeatedly and it’s just hard to keep your mood stable, you’re just having these ups and downs and it’s like, ah, what are we doing? And you’re frustrated with the medicine and you’re frustrated with your doctor. Sometimes when you’re not seeing results, we need to come back to the table and reevaluate if we’re treating the right thing. So that would be a time that you might ask your psychiatrist, hey, is this it? Like, is it really just depression? Like, is there something else that could be going on and see what they say? So, we reevaluate it. And that’s when I found out about these episodes that were happening and I had no idea because they had no idea to tell me because in their mind and in a lot of people’s minds who have hypomania. They see it as. But it was a good time. Like. Yeah, wasn’t sleeping as much. Yeah, maybe I went out a little more than I should have. You know, maybe I went on a couple dates that were a little risky and maybe shouldn’t have gone there. But all in all, it was a good time. And they just won’t tell me. So, I think that is the risk of it is because it just goes unchecked and nobody notices that this is a problem.

Gabe: You’ve hit on a common theme, Dr. Nicole, which is mania always skates and the less destructive. And I’m making air quotes because I can’t think of a better word, but the less impactful that mania is, the more desire you have to keep it so know. Yeah, maybe you went on a couple of bad dates, maybe you spent a little extra money. But you know what? It’s just, it’s not the end of the world. And of course, it feels good. I don’t want to tell anyone that it doesn’t feel good. But of course, by not treating that symptom, it goes unchecked. And how long before that hypomania does finally chip away? It sort of reminds me of a of a little leak somewhere. You’re like, ah, it’s just a little drip. I don’t care. And you just ignore it because it’s just a little drip.

Gabe: I don’t care. It’s just a little drip. I don’t care. And then one morning you wake up and your bedroom’s flooded and all of a sudden that little drip that you were just like, Yeah, you know, it’s just. It’s just not worth it. I don’t have time to go to Home Depot. The lines are long. You got to watch a YouTube video. But now you’ve bought yourself a bigger problem. And I really, really believe that between the misunderstandings and the mythos surrounding mania and the fact that hypomania can often present in the beginning, it’s just like a little drip. You know, you can find things, there’s little things here and there that you’re like, oh, that wasn’t ideal. But you know what? For the most part, it was okay. And it certainly beats depression. So, I’m just going to call that one a push. But I want to draw people’s attention to the idea that much like my drip analogy, you could wake up with your bedroom flooded. Is that true? Can you control hypomania and just keep winning sales awards, or does it eventually fester?

Dr. Nicole: It’s going to come for you eventually. Eventually it will show up in a way that you are not proud of or not pleased with. But the other side of that, let’s say, for example, let’s say you’re a hypomania, serves you well and you love it. This is the reality of it, though. It’s not permanent. Nobody lives in a permanent state of hypomania. What goes up will come down. And you can only pray and hope that when it comes down, it just comes down to normal and not to a severe depression, because that’s the problem. We need to keep the depression in check. The depression is what is going to take you down. The hypomania may not be it. I’ll give you that. But that depression, we don’t want to play with it. And we can’t just treat the depression and not treat your bipolar illness. So, we can’t say, well, we’ll just treat the depression part and we’ll not stop you from having hypomania because it’s kind of fun. We kind of want that. We don’t want that. And there’s no way to do one. If we treat you with antidepressants, we have the ability to totally jack up your mood and send you to higher levels of hypomania or even mania that you were not necessarily hoping for. Or we’re just not going to get good control and you’re just going to have this up and down, which that’s also impairing and miserable. I think people want to feel consistently stable. You want to feel stable and being unstable and mood and all that comes with that sounds pretty crummy to me.

Gabe: And I would argue that consistency really, really matters. People want to know that they can depend on you and they want to know what they’re going to get every time you walk through the door. And if you’re one of these people that they’re like, Ah, he’s moody, he’s Dr. Jekyll and Mr. Hyde. Well, she’s good when she’s good, but sometimes she’s not. These are not great reputations, and you’re not going to be able to build a career, a life, relationships off this up and down and up and down and up and down and up and down. If you could turn it on and off when you needed it, you may have some benefit, but you can’t. The real bottom line about bipolar disorder in all its iterations is it’s uncontrollable. And the minute you start thinking you have control, I really feel that’s when the bipolar illness can really, really win because it’s like they’re not paying attention. So, I’m just going to start messing with stuff. And that’s what always got me. That’s what got a lot of the people who I work with. And judging by our emails and comments, it seems like that’s what gets those folks as well.

Dr. Nicole: Yeah. Chasing that high cannot be good. It just cannot be. Because, like you said, the fall and all of the inconsistency of you that comes with the fall, it cannot be worth it. I mean, I agree. Consistency is an amazing quality to have as a person. And whether it be because of, if it’s because of your personality disorder, whether it’s because of your bipolar, like whatever it is being consistent and people being able to count on you for consistency and you being able to show up consistently in a way that makes you happy to me is, is fantastic.

SPONSOR BREAK

Gabe: And we’re back discussing the differences between hypomania and mania in bipolar disorder.

Dr. Nicole: So, I don’t want you out there. If you have had that happen to you, it can be very easy to go, Oh, those doctors, they’re idiots. They don’t know what they’re doing. They have no idea. Listen, we miss stuff all the time. It is not. It is not an exact science all the time when it comes to mental health. We my magic wand is often in the shop. I can’t just wave it over you. I would love it if a little, uh, like hologram popped across people’s heads that said this person definitively has bipolar II disorder, blah, blah, blah, blah, blah. I don’t get that. I wish I did, but I don’t. And so, we’re still going to make mistakes. And I know that adds to a lot of frustration that people feel about the system and the mental health system and doctors not knowing. And, you know, I was told I had depression for years and years and years. And all of a sudden they’re telling me I have bipolar II disorder. I know that is extremely, extremely frustrating, but we’re not idiots. We it is easy to miss. I mean, we’ve just talked about all the reasons why you could miss it because it can so be mistaken by just you being in a normal good mood.

Gabe: All right, Dr. Nicole, so that begs the question then, what does a normal good mood look like? Because I’d wager that people with bipolar disorder, we have trouble figuring out where moods go, what mood, and just when we think we get it right, people tell us we’re wrong. It’s a very confusing time.

Dr. Nicole: It is a confusing time. I agree. We do often send mixed messages to people and I will fully, fully own up to that. When I think about a normal mood, I think of just taking life as it comes. If something happens that would typically bring me joy, I can experience it. My joy feels good to me. It doesn’t feel excessive. It doesn’t feel excessive to people around me because they know me and they say, oh, that’s about how I would expect Gabe to respond in this situation. Gabe loves Diet Coke. Fantastic. If Gabe goes to a restaurant and he says, hey, you have Coke or Pepsi products and they say Coke, he’s like, Awesome. I can get my Diet Coke. He’s happy. If, on the other hand, we go to the restaurant and he asks if they have Coke or Pepsi products and they say Coke, he’s not like, whoa, you know, overly excited. If they tell him Pepsi, he’s not falling apart, flipping chairs and tables and becoming very easily angered by these things. He’s not doing that because that would not be normal for Gabe. We know you. So, again, it’s based on consistency and who you are. If you’re a kind of cranky person at baseline or your kind of edgy person at baseline, I’m going to go with that’s your normal mood. That’s not hypomania. I’m angry. That’s I’m just an irritable kind of person. It is what it is.

Dr. Nicole: We all have our baselines. So, whatever your experience and joy is, experience it. When the time comes, if somebody ticks you off, you’re able to kind of process it. You deal with it the way that you normally deal with it. I’m not saying it’s the right way. Sometimes people are normally just angry people and maybe they always flip people off in traffic. Maybe that’s how they roll. Maybe that’s what they do. They may be angry. Little nuggets at baseline and that’s okay. If that’s who you are, who are you? Who are you? And that takes a lot of self-reflection and talking to loved ones. So, I need to establish who you are. Are you handling sad news appropriately? Are you handling anger? Are you handling it in the way that you typically do? If that’s. Yes, that might be your normal like that’s just who you are. And then we have to figure out what your hypomania looks like. Hypomania, by definition, it’s episodic. It’s an episode. It’s not who you normally are. It’s a change. And it may not be a change that you can readily recognize, but it is usually a change that other people can recognize it. And I love when significant others, especially when it’s a man that’s my patient and his wife come in. Let me tell you something. Game over, wives. Notice everything, like wives can look you in your eyes and say something’s wrong.

Dr. Nicole: This is this is not a good day. Wives have a way that I, I, I just love it. I love it when they come through so significant. Others, parents of adult children, they’re always watching like a hawk. They know when something’s different. I rely heavily, heavily on what we call collateral information or information from loved ones during those times, because they’re often the ones who can tell the little subtle differences between what’s normal and what’s hypomania. But I think it’s important to not always see normal as, oh, you’re a happy person and you’re pleasant and this is who you are. Because let’s face it, not all of us are pleasant at baseline. There are lots of people who don’t have bipolar disorder or depression or any other diagnosable mental illness who are just not pleasant people, and that’s just who they are. So, we have to be sure not to mistake personality traits that may not be desirable for hypomania, which again comes with good collateral information and consistency of care with the same person. So again, we always come back to consistency, see somebody continuing treatment because that’s how you tell. If I hadn’t continued to see my patient consistently, I never would have figured out that that’s what was going on. I never would have figured out it was hypomania had I not continued to see them over years to be able to pick up on these trends.

Gabe: I want to switch gears ever so slightly and talk about the pushback. I know that we did an episode on can I keep mania and get rid of depression so we don’t want to fall down the rabbit hole, but I strongly recommend that you listen to it. Hypomania, mania, a lot of people are just like, look, don’t touch that. Go ahead and fix these other things. And we talk for a good half an hour on why that doesn’t work. But what I want to focus on for this episode is, again, a lot of people they’ve got this idea that hypomania just makes them a little better, a little faster. They need a little less sleep. They’re they got a little extra spring in their step. And while they may be afraid of full-blown mania, they’re not so afraid of hypomania. And full disclosure, I am one of those people. I always thought, you know, hey, a little hypomania is a good thing. Now, I now know long story short, I now know that’s not true. But in the early stages of Gabe’s recovery, I really did feel like hypomania was a good thing. And I thought, well, here’s the thing. If I don’t tell my doctor Nicole about it, she won’t be able to take it away from me. This backfired gloriously. Can you explain why not reporting 100% of your symptoms is a really, really bad idea for quality of care.

Dr. Nicole: Well, it’s not good for you. It’s not good for your functioning. It’s. And we can’t develop a treatment plan that will truly help you maintain stability. Which stability is our goal. Stability is our goal. Not just depressed, not a little hypo stability, whatever that looks like for you. That is what we want. And remember, we talked about how if your diagnosis started out as major depressive disorder and we were treating you incorrectly, it was eventually going to cause you some instability that we just didn’t want and that wasn’t functioning for you and somebody out there. There’s somebody listening right now who has been diagnosed with bipolar II disorder, who isn’t quite sure they believe they have bipolar II disorder. It just is what it is. Multiple times a week. I see somebody who says to me, I was told I had depression and then all of a sudden they said I had bipolar II disorder. And I don’t know if I believe it or not. Now, some of those people don’t, I think, actually have bipolar II disorder. And when we go through and we ask those questions about what was going on during that time, what was happening, were you using any substances? Like what was the deal? Then we figure out maybe we don’t think that was accurate. It’s really hard to wrap your hands around.

Dr. Nicole: I went from being told I was depressed all these years and I felt the depression. That’s what that’s what I hated. That’s what made me feel terrible. That’s what took my joy of life away. How are you going to tell me that I have hypomania and I have bipolar II disorder? And I will just say. Just be patient. Let’s trust the process. I want you to step back and think about the fact that obviously there was something going on that wasn’t happening in your favor. Your depression wasn’t being well controlled. You’ve tried multiple antidepressants and you’ve had the opposite effect to them. They’ve made you more irritable or they made you agitated or you felt more unstable. Instead of saying, Oh my God, these antidepressants, they all suck. The medicine makes me worse, so I don’t want to take it. Let’s be open to the idea that the medicine made you worse because we weren’t treating you with the right thing. So that’s why it’s important to let me know that you’ve been having these experiences. I don’t want you depressed. I also don’t want you expansive. And we run the risk of your mood just never getting to that place where you can thrive and function in the space you want to function in. If you’re keeping things from me and I don’t know what’s going on.

Gabe: I’m always really fascinated at the number of people who say I’m not getting good care and it’s because of the doctor. And then when you delve down a little deeper, it’s like, well, I didn’t tell him I stopped taking this medicine. I didn’t tell him that I cut this medicine in half. I didn’t tell her that I started doing this thing. I lied about this symptom over here. I, I, I judged this over here. I didn’t. I didn’t tell folks I got a new job. It’s like you’re really leaving a lot of information out. And that’s contained within us. Right. That that’s I, I haven’t gotten to Doctor Nicole yet that’s contained within us. Now I can talk until I’m blue in the face about how we lie because we feel that we’re not being heard. We lie because we feel like that’s the only way we can get good care. We lie because we only have 12 minutes and we don’t want to spend time on the symptoms that we don’t care about. We want to spend time on the symptoms that we do. Unfortunately, we the health care system in America often does set us up to fail. That said, we have to find ways around it. And one of the things that I really, really recommend is write down everything, keep a daily journal, just write down your symptoms every day.

Gabe: Write down one, two, three, write down things that are abnormal. Have your spouse, wife, bestie, whomever, write a little paragraph that you can hand to your doctor. Think about your top three, right? Just walk in and say, here are my top three and then answer all of the questions honestly. If you truly and honestly feel like your doctor is out to get you one, you might want to bring that up. It could be a symptom, in all fairness, but it also shows that maybe that is not the doctor for you, which we’ve talked about numerous times. But here’s what I know. Here’s what I know for an absolute fact. If you apply for car insurance and you lie on the insurance forms, you don’t have insurance. That’s just a hard stop. The minute you get in an accident, they’re like, hey, you told me that that your wife didn’t drive the car. You told me that it was parked over here. You told me that you did less than 3000 miles. You told me this was a 1995 Chevy, and it turns out it’s a 2010 Infiniti. Yeah, we’re not covering this accident. And all of a sudden you’re like, But I thought I had insurance. Exactly. But you lied, so you don’t If you are giving misinformation to your doctor, you think you’re getting care, you think you’re getting treatment, you think you’re paying attention, but you’re not. Am I wrong?

Dr. Nicole: No, you are 100% correct because I am not a mind reader and neither is any other psychiatrist that you might see. We just cannot know what’s going on in your world. We rely on you heavily, and I know it might often feel like we’re not listening or we’re not paying attention or we don’t care about those little details. Bring me the details. Like you mentioned, tracking your moods, seeing if you notice patterns. I recommend everybody do that, especially if you’re not achieving stability. If you feel like you’re having these ups and downs that we can’t explain, track it. I need to see what I’m seeing. I need to see what you’re seeing. If you’re a lady, I need to know if you have a uterus. I need to know if it’s related to your menstrual cycles, you know, is it related to sleep? Is it related to substances? Is it related to what Is it related to? Whatever it is I need to know and we need to know so that we can treat you. And really, it is more frustrating for me when people don’t tell me things and I have to piece the history together and I learn things when random relatives call and say, well, he hadn’t told you this, but let me tell you, blah, blah, blah blah blah.

Dr. Nicole: It is more frustrating and takes more time that we typically don’t have to kind of hash all that out. Just lay it all out for me in the beginning. First, two, three minutes. Let us spend our time together working through the pieces of this puzzle. You may be a conundrum. That’s okay, because I do know that sometimes patients leave things out because they’re difficult people, but because they know or they think they know that we don’t want to hear it or we don’t have enough time to talk about it or they think it’s not important. Let me decide what’s not important. Hypomania goes unchecked because people say, oh, it was just a few. It’s not that big a deal. It’s always a big deal because when hypomania is left unchecked and it’s a chronic condition, you’re going to have all kinds of issues that you are just not going to be happy with. So just bring it on. Tell me. I don’t care how bored you think I am; I don’t care how much you think. I don’t care. I don’t care what you think you know about me and what I want to know. Give it to me. Let me figure out how to use it in the way that I need to help you get better.

Gabe: And that’s really the bottom line when it comes to hypomania. It might be one of those things that you think is insignificant, so you don’t share it, but it can be very significant. It’s often very misunderstood. This also goes to show why details really matter. The little insignificant things that you think are unimportant. They could be clues to diagnosing hypomania and getting control of it before it controls you. Hypomania is really kind of insidious. I, I learned a lot about it for this episode. And really, as we said at the beginning, it’s a disservice to just kind of place it on a step ladder leading up to mania. And I really think this is one of the things that gives hypomania a cover. We think that it’s unimportant so we don’t share it or we’re so busy trying to share what we believe are big details that the little details were. Those clues lie about hypomania. We don’t give you we don’t give our Dr. Nichols. So, while a Dr. Nicole might recognize that immediately as an issue, we think it’s insignificant. The clue about hypomania goes unshared. She doesn’t find it. She can’t diagnose it. She can’t talk to us about it. She can’t ask us follow up questions. And suddenly hypomania is left unchecked, all because we thought that it was insignificant or it was misunderstood and we tried to protect it. I learned a lot about hypomania. And as I said at the beginning, as we said at the beginning, Dr. Nicole really sharing it as an idea that it was just one of the steps up to mania was really a disservice. And I’m glad our listeners called us out on it. I’m glad we could discuss it, and I’m really glad for my own education because it turns out that hypomania is its own unique thing that just sort of has things in common with mania.

Dr. Nicole: Uh huh. And I also want to make sure that we give a little nugget to the loved ones out there, because I know you’re listening. So, I’m talking to you right now, loved ones out there in the world. You’re in danger of poo pooing people’s hypomania because you also have heard, oh, it’s just kind of, you know, less intense. It’s not that severe. It’s not that big a deal. So, some people out there are fully aware of their hypomania and they do feel distressed by it because it’s not their normal mood. It’s not who they are. They don’t like being this person that is not who they normally are. They want to show up consistently in the world. And sometimes the hypomania can lead to them showing up in ways they aren’t proud of. They can be irritable. You can be just as irritable with hypomania is just like mania has the expansive mood.

Dr. Nicole: Or you can be like meaner than a junkyard dog. You can be irritable and edgy with hypomania, too, that can interfere with relationships, that can cause you to not be the person you want to be with the people you love. And a lot of times I will have people tell me, well, you know, she said she was hypomanic, but I just think she’s being a jerk. So, we still often will not give people the benefit of the doubt in our lives when they have bipolar II disorder because we think, oh, it’s hypomania, it’s not that intense. It’s not that severe. I just want you all to hear me say it can still be impairing, it can still interfere with how your loved one shows up in the world. It can still be something that that can put a kink in the chain. I want you to also be open to the fact that it could be their hypomania and not just them being a jerk to you. We already said it. Sometimes people are jerks at baseline. That’s how they roll. It’s the lane they drive in and that’s different. But if you know your person is this way normally and they have these moments, let’s also think how we can support them through those moments. Just like we talk about supporting people through actual manic episodes.

Gabe: Dr. Nicole, I feel like you stole a page out of my book where you were like, I’m talking right to you. Hear me now. You

Dr. Nicole: Think.

Gabe: Did that with the love. I love that. I love that. I feel like we’re rubbing off on each other. Like we’re growing together as podcast co-hosts.

Dr. Nicole: Well, I guess next I’ll start drinking Diet Coke every day. I’ll start drinking Diet Coke every day. Who knows?

Gabe: Who knows? Who knows? Thank you so much, everybody, for listening. We really, really appreciate you. My name is Gabe Howard and I’m an award-winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but hey, don’t do that. Go to my website and grab a signed copy. That website is gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on all social media platforms @DrNicolePsych or my website, DrNicolePsych.com.

Gabe: Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. And listen, can you do Dr. Nicole and I a favor? Recommend the show. Tell people in a support group, share it on social media, Send someone an email. Send somebody a text. Because sharing the show is how we grow. We will see everybody next time on Inside Bipolar.

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