Would you know if you are "manic"?

I've never had any mental illness in my life. I have been very depressed, but as a reaction to circumstances rather than as an irrational emotion or anything chemical.

I started on prednisone nearly a month ago. It has given me a lot more energy. I sleep less hours, and whereas I had previously had extreme fatigue, now I have the energy to do more and the timing of the change seems to make it clear it's from the medication.

I've also been getting mood swings though - both good and bad moods. I've had a lot going on in my life - my health is getting overwhelming, I was having problems with doctors and getting a new diagnosis, and other circumstances in my life changed. So I really couldn't say if I'm moody because of the pred or because of what I'm experiencing or maybe both together.

But while the problems in my life might make me feel low or stressed, I've also been having times when I feel really interested in things around me. Not even anything in particular - just watching someting on telly or reading a book, and I'll suddenly be struck by how interesting it is. And posting on forums - I've posted on (non-health related) forums for years, but I've never posted personal information about myself before like I have been doing here recently. And my posts are getting super long - like I suddenly have loads to say and don't feel the need to censor myself. Which isn't like me. It seems a good idea to post at the time, but then later I think - not that I made a fool of myself exactly, but that it's out of character for me. I'm not an extrovert.

I know drugs can mess with our personalities a bit. I've done crazy things after general anaesthetics - nurses tell me everyone does! - and on strong pain killers I've felt a false euphoria.

I know pred can cause "mania" and other psychiatric symptoms in some people. My question is what would this feel like? If you've experienced mania either from a med or just anyway, do you recognise it? How do you know if it's a problem?

Thanks for any input. xx

I would say no, I have a couple of people close to me who have been manic and they didn't have a clue. In fact they just wanted to know what was up with the rest of us because they were so happy, while we were worried for their safety.

Of course if you are worried about any drug side effects I would chat to your nurse or doctor if possible. Good luck.

Thanks. I suppose the fact that I'm aware of mood changes - and that they're reasonably subtle - is evidence in itself that it's not true mania, then. I don't feel out of control of my thoughts or anything like that.

The idea of acting different and not even being aware of it seems even more unnerving than having thoughts/behaviours you're not in control of.

I will be checking in with the doctor, but sometimes they seem as much in the dark as I am. I'm am enjoying the extra physical energy.

When I was on higher doses of pred I was SUPER talkative.

I wouldn't call that TRUE mania but it was I was a minor manic person for a while. It was fun I would also clean everything, run around a lot... never sat still.

Try to enjoy to happy pred beast while you can... its fun

I agree, Katie, I did love the big energy boost when on larger doses of prednisone. Required less sleep and my house was never cleaner, lol!

I wonder why they don't try this drug for people with Chronic Fatigue Syndrome and other illnesses that cause exhaustion. Or for depression even. I know it can have the opposite effect for some people, but you'd think it would be worth trying. I wonder why they don't prescribe based on symptoms and quality of life? If you have an illness without a clear cause - like CFS - they think it's not worth the risks of a medication, with no account for the severity of symptoms or how desperate the patient to try anything. But if you have an autoimmune of inflammatory condition it's considered standard.

Sorry, off topic ramble. But the increase in energy has taken me aback a bit after being exhausted for so long. The boost in mood disconcerts me a little because I want my moods to be rational and based on my circumstances - which they always have been. But at the same time I'm not going to criticise a good thing!

I did end up taking a sleeping pill last night because I didn't want to lie awake for a couple of hours again.

I came across the terms "hypomania" and "hyperthymia" which perhaps describes my current state a little better - though even those are perhaps a bit of an exaggeration, and I'm missing some of the characteristics entirely (like high libido, lol, I don't think any med could make me experience that).

Prednisone absolutely effected my sons mood. He would have that false sense of well being or "high" and sometimes would cry for no reason at all. As he began to taper it got worse but completely went away about a week or two after he was off the prednisone.

Mental illness which involves manic phases would involve more of a break from reality. Often sexual escapades, public nakedness, shopping binges or wild public behavior is involved. The differences are much more extreme. Clinically a diagnosis would be warranted if it begins to effect several areas of your life. For instance if you are fired from your job, or your spouse leaves you for your manic behavior.

The fact that your able to be introspective about your behavior shows that you have not had a break from reality. The years I practiced social work I never met anyone with bipolar (manic/depression) who initially felt they were the problem. They felt everyone else needed to make the adjustment.

I would talk to the Dr. about how you are feeling. Ask close family member or friend if they have seen any major changes in your behavior. I would say what you are feeling is completely normal considering the prednisone but a very small percentage of people can have a strange reaction to meds.

Hopefully you can get off the prednisone soon and life can get back to normal. ((((((Hugs))))))))

Tiffany

A guy that I studied was manic and when he had the mania, he once got naked and drove his car at very high speeds through his town and literally smashed into everything and anything until his car was then unable to move. He then got on the roof (naked) and started jumping up and down until the police got him.

Now, not having a license he has bought a bike and when the mania kicks in he gets on his bike. It's not uncommon for him to bike 100+ km a day.

This is not a joke. Does this sound like you? It's not very common to have true mania

Johnnysmom. Thankyou, it was very useful and reassuring to read your reply. Having read a little more about "mania" and about others' experiences with mood changes on prednisone, I realise there is a clear difference.

My relatives have noticed that I'm sleeping much less and that I'm in a better mood and I've explained it's probably down to the med. They see it as a good thing, I think. I'm usually so exhausted and often found taking naps during the day, or just generally finding it an effort to get up and do anything, so I think they're viewing it an improvement in health, rather than as a side effect (since side effect implies unwanted), which is a little confusing!

I'm seeing my doctor in a couple of weeks and will mention all the effects I've been having. Though it's sometimes a bit difficult to know if a doctor really understands where you're coming from - don't want them to be too dismissive nor overly concerned. I think I'm safe to conclude that, yes, my mood and behaviour is being effected, mostly in positive ways, but not anything that suggests an actual psychiatric disorder. I'll keep monitoring it.

I've done my time at the high dose now, so I have to see whether that means side effects level off or whether I experience new things from reducing the dose, which I believe can happen too.

KWalker: thanks for the reply. No, I'm not doing anything like that. I think I knew I don't have true mania, I just found the changes in mood and knowing they were due to a med and not rational a disconcerting experience, and needed some reassurance that it wasn't likely to progress to the scarier stuff like you describe. It helped me to see the difference put so clearly. Hope things worked out ok for that guy?

I hope you didn't take my comment the wrong way. Its quite possible that the medicine is having an impact on your mood/feelings. I may be wrong but I don't believe that they would progress to such a degree. Of course I could be wrong though. When I was on prednisone I noticed problems with sleeping and never feeling tired, and I felt as if I had amazing days, but would get angry at the dumbest things but those feelings did go away after stopping the meds. Unfortunately problems like this aren't uncommon with steroids.

As far as the guy I mentioned, as far as I know he is doing fairly well, or atleast as well through proper treatment. Instead of doing something destructive as he did with the car incidicent, he now rides a bike and in return gets tons of excercise and it helps deal with the mania.

UnXmas,

Just a word of caution when talking to your Dr. about your moods. When I spoke to my sons G.I. he thought Johnny was an overly anxious child and suggested we he get counseling. We also had to see a pediatric cardiologist because it made his heart race. He made kind of a bigger deal of it than I think was warranted. Honestly all I was looking for was the acknowledgment that Prednisone does indeed effect mood and that it would go away when he was off. I don't want to discourage you from talking to your doctor but I think you are right to be a little guarded. I think ours misunderstood a bit.

Also, the sleeping is really helping your body heal and it is a very good thing. Let yourself be a bit lazy for awhile. It won't last forever. You body is taking on a lot right now. My son went through that phase too. It passes and life really will return to normal, it just takes a while.

It sounds like you are tolerating the Pred very well and I am sure you will continue to. I don't think my son really got worse while tapering, I think I just expected him to feel better because there was less in his system and was surprised when he didn't. But your body has to adjust to less prednisone and start making more on its own so if you think about it is understandable to still have an adjustment period.

Hope everything continues to go well.

((((((Hugs))))))) Tiffany

Getting naked and driving recklessly is not mania

A person that is manic, generally, doesn't sleep (employers support people with mania. These folks work day and night, have unprecedented productivity and never seem to get tired). Mania causes one to speak fast, have grandiose ideas (ya, I can cure cancer and make a million dollars in a week, no problem), suffer from fleeting concentration (I gotta concentrate, ok, oh look a butterfly, and clouds and...), has behavior with future dire consequences (Maxing out credit cards on purchases that will never be used, writing rubber checks, stealing, and gratuitous unprotected sexual relations).

Mania can last anywhere from several hours (for rapidly cycling bipolar mania) to several days.

A few antidepressants trigger mania, as do prescribed and/or OTC "uppers".

Unless the sufferer has undergone CBT, he/she does not know they are in the midst of a full blown manic episode.

It is an exhausting, debilitating, life destroying disease.

KWalker said:

I hope you didn't take my comment the wrong way. Its quite possible that the medicine is having an impact on your mood/feelings. I may be wrong but I don't believe that they would progress to such a degree. Of course I could be wrong though. When I was on prednisone I noticed problems with sleeping and never feeling tired, and I felt as if I had amazing days, but would get angry at the dumbest things but those feelings did go away after stopping the meds. Unfortunately problems like this aren't uncommon with steroids.

As far as the guy I mentioned, as far as I know he is doing fairly well, or atleast as well through proper treatment. Instead of doing something destructive as he did with the car incidicent, he now rides a bike and in return gets tons of excercise and it helps deal with the mania.

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I think you're right: it is affecting my mood, but not causing a full-blown mania (or any classifiable psychiatric disorder). The combination of extra phsycial energy and a sort of "boost" in my mood are making me a bit more extroverted, a bit more interested in doing things, and while it ultimately feels good, I think it's good to keep reminding myself it's a medication effect and to keep monitoring myself.

Johnnysmom: I suppose perhaps it was better your doctor was over-cautious than miss a potential problem. I'm always cautious about being labelled with incorrect psychiatric diagonses, so I'm wondering how best to report these side effects to my doctor. The first doctor I'll be seeing knows me well, so it shouldn't be a problem. If I make clear it's obviously come about from the prednisone, hopefully she'll view it accurately for what it is. I'll make sure I emphasise the energery boost - which is a big part of it - rather than coming out with words like "manic" that might set of alarm bells for her.

My experience with pred has been great overall. The side effects have almost made it worth taking it just for those (exhaustion is such a problem for me), though I've had some unwanted side effects too. It has calmed my stomach down and done its job. I just wish it was safer to use long term. At least I know it's there as a reserve if I need it again.

I hope your son is doing well. It sounds like he's been through a lot.

Gut_Doc: Thank you for the information, and for clarifying the difference for me. I'm learning just how bad true mania can be, and am thankful that I'm not getting anywhere close to that. It helps to know what to look out for. Even though the risk of true mania on prednisone is very small, I like to know the possibilities of what may happen, and to understand the changes I'm experiencing for what they are.

The first time I went on Prednisone the first two side affects were- 1-rage 2-depression.
You may also get a sense of (well being)

In no way should this be confused with "maina". Happiness or feeling well is not a sign of mania.

Mania= manic depression= bipolar- is a very dangerous mental disorder and its unusual for the patient to think they have a problem and everyone around them clearly sees the lack of reality in the patient.

Prednisone may be the only choice for alot of IBD patients its scary enough !!

Lauren

What do you do to manage excess energy/anxiety?

I'm used to being bored because I don't have the energy to get up and do things, or to concentrate enough to get into things.

Now I am feeling restless at times. Is it better to try and relax - read or lie down or something - at times like this, or to do something reasonably active? I know a lot of people here said they clean their houses when they have excess energy! I'm trying to gain weight so anything too active isn't really an option.

I usually only take sleeping aids if pain is keeping me awake, but I'm wondering if people feeling this way from prednisone and other drugs have things that help them sleep? I'm not getting terrible insomnia, but when I'm trying to get to sleep I feel restless rather than easing into sleep - feeling ready to go to bed - like I usually do.

Read and laundry. All. Night. Long.


Lauren

I wrote about my prednisone mania here.

One thing to consider is that mania is not an all-or-nothing thing. There are degrees of mania. Mania doesn't necessarily mean feeling "happy" all the time, having grandiose ideas (I'm Jesus! I'm Napoleon!), sexual escapades, gambling away the house, or other extreme behaviours, but it does often involve restlessness, a reduced need to sleep, racing thoughts, extra energy, tons of new ideas, difficulty concentrating, and increased chattiness. In my case, it also came with enhanced generosity and a compulsion to make lists, sort, and organize things.

Not everyone gets mania from prednisone, but it's a pretty common side effect. And some people, as mentioned above, don't get mania at all, but instead get depression. As for using prednisone to treat depression, there are so many other nasty side effects from systemic-acting steroids like this that it's generally not a good idea. There are lots of antidepressants now that are much more specific in their actions and a lot less harmful to the body in the long run.

Other common symptoms of prednisone (that have been discussed in this forum at length) include water retention, especially in the upper body, acne, hair growth on the face in women, breast growth in men, reduced libido, wasting of the muscles in the legs, and a reduced ability to taste, coupled with increased hunger (hello, weight gain!) Bruising, stretch marks and other symptoms associated with weakened skin are also common. Osteopenia and osteoporosis in long-term use are major downfalls to prednisone, and so is the increased risk of glaucoma. Nasty stuff (but better than starving to death from Crohn's flares).

As for mania being only something associated with bipolar disorder, that's not the case. And mania is different from person to person both in how they experience it, how severe it is, etc. I have two close friends who are bipolar and while we have experienced some similar things, mania associated with prednisone is easy to predict (more prednisone = more mania, less prednisone = less mania) and not associated with depression (though steroid withdrawal is not fun, it does not necessarily case depression).

What gets me is that so many doctors are not aware of the severity of either the mania associated with going on steroids or how prolonged and severe the withdrawal can be. I have found that doctors who trained in the 60s and 70s, when these drugs were relatively new, learned a lot about these symptoms and are more aware of them than doctors who trained later; steroid withdrawal is no longer described in the medical literature because it's one of those things that MDs are expected to have absorbed along the way in med school. A lot of those journals from the 60s and 70s aren't even online (most younger doctors don't even read paper journals), and even when they are, younger doctors are less inclined to trust articles from decades ago, so they just don't get read. I guess the takeaway message here is is that if you have a doctor who isn't treating your steroid-related symptoms or withdrawal symptoms with the appropriate respect, ask for a second opinion from a much older doctor. . .

sickofcrohns: I read your blog entry - thanks for the link, it was very interesting to read your experiences and perspective. (I'm planning to check out more of your blog too - you put key issues in such an articulate way.)

Thanks for the information and reminder of long term side effects.

Although I know I'm not getting definite "manic" symptoms, I am finding the lack of sleep and boredom a bit of a problem, which is kind of related if you view mania as a spectrum. They're symptoms down at less dangerous and less pathological end of the spectrum, but still an issue. I'm not currently working, and doing nothing + sudden newfound energy and time isn't the best combination. I'm reading a lot, but I'm really short of things to do and have noticed I'm geting angsty at times. Not sure if that's just the prednisone, because I'm often quite high-strung naturally. The physical energy, shorter sleep time and boost in mood are definitely medication side effects and I certainly feel better physically and mentaly overall, just also unnerved by feeling "good" due to artificial means, bored a lot more of the time, and, yeah, this occasional anxiety.

Thanks again for such an informative post.

UnXmas said:

sickofcrohns: I read your blog entry - thanks for the link, it was very interesting to read your experiences and perspective.

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Thank you!

UnXmas said:

I'm not currently working, and doing nothing + sudden newfound energy and time isn't the best combination.

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The lack of mental focus and anxiety that comes with it is something I can understand. Have you considered going to the gym or joining an exercise or dance class? It would be a healthy outlet for your energy and it could introduce you to some new people (who might help you in your job hunt. . .) I know you said earlier you were trying to gain weight, but it's important to gain healthy weight (muscle) and not just water and flab, which prednisone tends to, uh, "enhance" by itself. And you don't need to exercise like a fiend, just get moving! It's good to have a routine and to get out of the house, especially when you're bouncing off the walls from prednisone. :ysmile::ybiggrin:

unXmas.

If you are on prednisone having trouble sleeping and have an increased
energy level plus you are bored that is a side affect of your medication
It is not and should not be concisered as on the spectrum
of anything other than a side affect listed on your medication
package.

People who are truely manic are the last ones to see the problem and most
often refuse treatment.


Lauren

sickofcrohns said:

Thank you!



The lack of mental focus and anxiety that comes with it is something I can understand. Have you considered going to the gym or joining an exercise or dance class? It would be a healthy outlet for your energy and it could introduce you to some new people (who might help you in your job hunt. . .) I know you said earlier you were trying to gain weight, but it's important to gain healthy weight (muscle) and not just water and flab, which prednisone tends to, uh, "enhance" by itself. And you don't need to exercise like a fiend, just get moving! It's good to have a routine and to get out of the house, especially when you're bouncing off the walls from prednisone. :ysmile::ybiggrin:

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I am underweight, so don't want to burn off calories (the prednisone doesn't increase my appetite at all!). But I do go out for walks often. I prefer just going out in the countryside to organised exercise classes (grew up doing loads of outdoorsy stuff!). The only times I went to gym were when I was at university and living in a city. But I'll definitely increase my walks to try to cope with the prednisone effects. I think just getting outside will help if I get cabin fever.

If you are on prednisone having trouble sleeping and have an increased
energy level plus you are bored that is a side affect of your medication
It is not and should not be concisered as on the spectrum
of anything other than a side affect listed on your medication
package.

People who are truely manic are the last ones to see the problem and most
often refuse treatment.


Lauren

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Lauren: Thank you for clarifying. I have learned - from this thread and from further reading since I began it - to recognise the difference between my side effects and mania. I understand that what I'm experiencing is from the medication, and that it's a far cry from mania. I knew that steroids can, on occasion, induce true mania in susceptible individuals, and that was my original concern really - that I might be at the beginning of something that worsened; that the medication might have triggered something off that I needed to be aware of. I'm reducing the dose now, though, and the side effects have stayed at a level where I can manage them. Thanks again for the clarification.

sickofcrohns: it's interesting you were motivated to organise and make lists. I don't seem to be able to do anything that productive. My concentration is too poor to do anything like that (it was before prednisone as well).

Now I'm down to a much lower dose of steroids, and am feeling far more of a sense of "well being" than the anxiety I was getting on the higher dose. I hope sleeping will become easier too. I'm just worried that at a lower dose the meds won't carry on doing what they're supposed to do!

Im Bipolar and dont have severe swings but I do have a bit of mania from time to time. My results are usually becoming obsessed with something, this last time it was antique radios, and spendng gobs of money on them and even teaching myself to repair them. Then one day, my meds balance me out and I have ZERO interest in antique radios. I have done that with cars, women, pets, friends, houses and much more. LOL It really sucks to come down from mania and realise your broke and bored as well.

UnXmas-

I hope you are feeling better I hope that your feeling more
Confident in the meds your taking and they are doing their job!!

Lauren


Lauren

Thanks, yes I am feeling much better!