May 18

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​Getting Down When You Are Too High


There was a time when people died from feeling too good. The brain burns 25% of a person’s calories. The racing thoughts and lack of desire for food that occurs during manic episodes made it impossible to provide enough nutrients to keep the body alive. Two chemical messengers are responsible for this condition:

  • Norepinephrine (which promotes responsiveness to incoming stimuli) is overactive, causing intrusive curiosity and an excess of ideas in the early stages of mania.
  • Dopamine (which produces heightened pleasure and self-stimulation) later becomes dominant. This further increases energy, unusual strength, and euphoria.

CHANGING THE CHEMISTRY OF MANIA

In 1949, an amazing discovery was made that lithium salts could calm a wildly racing mind. Due to safety concerns, its usage was not allowed in the United States until the 1970s. Currently, lithium prevents reoccurrence of mania in 70% of all cases. It may reduce brain excitability by slowing down transmission of impulses along and between nerves and by boosting serotonin. Lithium can take two weeks to have an impact and may not be effective with rapid cycling moods. Therefore, other options are sometimes used:

  • Electroconvulsive therapy (ECT) can stabilize the “beat” of the brain just as a pulse of electricity through the heart resets its rhythm when it is fibrillating (shivering).
  • Antipsychotic medications used to treat thought disorders quickly block dopamine, slowing flights of ideas and stiffening movement. Due to long-term side effects, they are not usually used once lithium or anticonvulsants start working.
  • Hormone replacement therapy used for thyroid problems can stabilize mood or augment antidepressants, particularly if the thyroid is not functioning properly.
  • Anticonvulsants such as Depakote, Tegretol, Lamictal, and Neurotin started being used for bipolar disorders in the 1980s and 1990s. They reduce brain excitability by slowing the speed at which nerves recover after transmitting electrical impulses. These medications are best with rapid cycling and mixed symptoms of mania and depression. They can be combined with lithium to manage the most difficult mood disorders..

Anticonvulsants and lithium require careful monitoring. Blood levels need to be high enough to be therapeutic without producing toxic reactions. Although some people will initially experience side effects, these usually disappear within a month. Any inconvenience from taking these medications is far less disruptive to careers, finances, relationships, and safety than symptoms of mania!

THE BLESSING OF HYPOMANIA

People who are blessed with mild elevations in mood, or hypomania, have an inexhaustible supply of energy, enabling them to live adventurous, successful lives. However, they may be underreactive to internal stimuli and need excitement and even danger to feel alive. Periods of calm or low anxiety can feel intolerable. Serious problems happen when they engage in high-risk behavior or “overcharge” their minds with constant activity. The following ways of modifying habits can sometimes help manage high periods without medication:

  • Balance sources of excitement: Recognize your need for activity but have diverse focuses (work, love, sports, or community) rather than becoming overcharged by or addicted to one source of stimulation.
  • Recognize the early warning signs of “overenergy”: sleeping or eating less; getting too busy; increased conflict or irritability; urgent needs to spend money, travel, or have sex; obsessing on religion; talking or thinking too much.
  • Set firm limits for yourself during high periods: Don’t commit yourself to extra activities outside your usual routine. Turn spare cash and credit cards over to a trusted person. Put off decisions until you have slowed down. Force yourself to have down time (see #6) before you do something exciting or try to resolve a conflict.
  • Avoid foods or drugs that make you hyper: sugar, caffeine and alcohol. Eat regular meals. Do not eat too much of any one thing. Herbs such as grape seeds that may help control dopamine and norepinephrine can provide added focus.
  • Have a bedtime routine: Do not engage in stimulating activity after 7 P.M. Avoid staying out late or up all night. Take sleeping aids if necessary.
  • Postpone some activities: Arrange “down time” in low-stimulation, nonstressful environments. Gradually increase the amount of time you can spend alone or relaxing. Balance moderately exciting activities with down time.
  • Focus on your sense of underarousal during down time: Describe your experience of boredom or aloneness to a tape recorder or in writing to increase your tolerance of low stimulation.
  • Get out of your head and come to your senses: Smell perfume, examine a leaf, listen to calming music, feel textures, or take a bath. Engage senses that help you slow down constant mental chatter.
  • Focus on others’ thoughts rather than your own: Do not do all the talking. Ask people questions and repeat or rephrase what they say. Memorize and recite poems. Play a musical instrument. Boring books and slow movies are better than exciting fiction, romance, or religious material.
  • Slow down your mind: Meditation is a must. A few brief periods throughout the day of observing your breathing, a relaxing image, your thoughts, or the way you drum your fingers may be better than one long period of quieting your mind.
  • Slow down your body: Pick activities that require concentration or release energy without overcharging you. Relaxing swims or weight lifting are better than exercise that makes you hyper. Do tedious, repetitious chores such as scrubbing the floor, knitting, weeding, painting, and cleaning out closets.

If you are not able to slow down with these strategies, do not blame yourself! Medication can be essential to stop the runaway locomotive of your mind. Get help from your doctor immediately!

References

For further information, see The Depression Workbook by Mary Ellen Copeland (New Harbinger Publications, 1992) and Mastering Your Moods by Kinder (Simon & Schuster, 1995).

See Trance-Formation in Everyday Life by Kate Cohen-Posey (Leighton’s Sales Co) to teach yourself to meditate. 877.956.2998 or www.psych-assist.
net.

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