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:

1. 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.
   

2. 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.
   

3. 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.
   

4. 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.
   

5. 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.
   

6. 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.
   

7. 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.
   

8. 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.
   

9. 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.
   

10. 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.
    

11. 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.