People who experience mood disorders, like unipolar depression and bipolar disorder, are most intensely monitored when severe mood disruptions are occurring, such as moderate-severe depression, moderate to severe mania, or episodes with mixed features. Also of deep concern are labile moods where the afflicted quickly cycle between various mood states. In the case of bipolar disorder, this would mean mood fluctuations between depression, hypomania/mania or mixed states within short periods of time (i.e. hours, days or weeks). But what happens in many of these peoples’ treatments when the mood state is uniform/level, but not severe, and yet not completely considered stable either, like in dysthymia or mild hypomania.
I can’t speak for all patients with unipolar depression or bipolar disorder, but many of my psychiatrists have stopped making medication changes at times when I reached long-term uniform mild moods, like mild depression or even mild hypomania. My current psychiatrist stated once that it was time to wait for slow changes to happen on their own over time, hopefully for the better, and not risk further mood disruption. The suggestion was to use therapy to “finish the job” and help ensure long-lasting stability. His argument was also that adding more of a certain medication could have the result of pushing me too far in the wrong direction. I’ll admit that similar trials in the past did have that effect, but at the same time being stuck in mild depression is not where you want to rest for too long. Mild hypomania (for bipolar patients) perhaps isn’t too bad, as long as the mood state does not progress upwards over time, or cause an eventual crash into depressive mood states.
One never knows if mild depression or hypomania will be long-term, but I can say that I personally have experienced these states lasting months on end. In mild depression, I have employed therapeutic steps to raise my mood more naturally. Challenging dysfunctional thoughts, pushing myself physically (they say that can help), struggling to improve my lifestyle, and making efforts to include simple or larger pleasures into my days to lift my moods. Have these things worked at times? For me, they have sometimes, but not always. Also, sometimes I found it easy for my mood to fall back to the mild depression, and through frustration became resigned to the state.
Mild hypomania can yield pleasurable experiences. Feeling more energy and motivation than usual, mild elation, having endorphins flowing. As long as this state doesn’t include too much irritability or agitation, it may be considered a most ideal mood state to live with. In fact, I have known a few people with bipolar disorder that strive to maintain this state. I, myself, have had a long history of long-term mild hypomania, so much so that my psychiatrist once said it was my “baseline” mood. But as I mentioned, this state is not always a bowl of cherries. Irritability with outbursts and agitation can become present. Such characteristics can get you in trouble in many ways (impulsivity, outbursts), even at this mild level. Sometimes the prolonged state eventually causes some people to self-medicate with substances like alcohol or sedatives to improve sleep or wind down. That’s what I did in the past. I never found therapy that helpful in these states, though grounding techniques have been said to be helpful at times. My psychiatrist has given me prn “as needed” medication supplies that can help calm hypomania…if I take them.
It can be a great struggle for many people with mood disorders to find that happy medium. Perfect stability with the mood “seesaw” parallel to the ground takes a lot of work, and some luck, too. Of course that is the goal for most doctors and most patients, but for many it is almost a utopian place to be. Maintaining that position long-term is even harder. Regardless of the challenges, complete long-term stability is what needs to be reached for in mood disorders. I do think we have the right to expect it.