Through metabolic therapies, I've discovered that the positives I once believed were tied to my bipolar illness—like creativity and philosophical thinking—can be retained in recovery. I’ve learned that I can trade frenetic creative energy for a calmer, more stable state that feels equally magical but is grounded and sustainable.

Not long after using nutritional and lifestyle strategies to put my illness into remission, I had the privilege of meeting Dr. Christopher Palmer, the Harvard psychiatrist, metabolic psychiatry pioneer, and author of Brain Energy, whom I credit with saving my life. For about eight months, I had been part of a small, passionate volunteer group helping him raise awareness of metabolic psychiatry. Although I felt I knew him from our virtual meetings, I had never met him in person.

I was grateful when the opportunity arose to sit with him and ask some of my most pressing questions, especially because something had been troubling me. On my drive through the Illinois countryside to meet him in the suburbs of Chicago, I had the windows rolled down, I felt elated as the breeze caressed my hair, and I bopped my head to uplifting music. The golden glow of the rolling cornfields in the afternoon sun struck me with its astonishing beauty. Did I feel too good? I had been experiencing these types of sensations a lot lately;  I associated them with the onset of mania. I had gone off all my medications and had been treating my illness exclusively with metabolic therapies for almost two years at that time. In the past, overwhelming feelings of universal love, seeing incredible beauty in everyday things, and experiencing regular moments of poetic awe were often followed by slipping out of reality and into psychosis. Perhaps only someone with bipolar disorder can understand what it means to fear feeling too good. 

I had an important question for Dr. Palmer: Is this a symptom, and should I be worried? We talked about the stability in my life and, most importantly, how I was still getting an average of eight hours of sleep at night. While he was not my psychiatrist and couldn't give me medical advice, he shared insights from his clinical experience. It seemed to him this was likely healthy and something I could embrace rather than fear. Hearing this on our first meeting was one of the most monumental milestones of my recovery. It was the moment I felt like my shattered pieces were finally reassembled. Like the Japanese practice of Kintsukuroi that mends broken ceramics with gold, I felt like not only was I myself again, I was a better version, enhanced by my journey of post-traumatic growth and what it took to overcome serious mental illness with metabolic therapies.

Recently, a dear friend who has also recovered from Bipolar I Disorder thanks to metabolic therapies asked me an intriguing question: “Do you miss mania or hypomania?” I had to reflect on the altered states I have experienced and how they compare to my newfound stability using metabolic therapies.

What is Bipolar Mania?

Mania is a state of extreme mood elevation or irritability that is a hallmark of Bipolar I Disorder. It’s characterized by increased energy, decreased need for sleep, grandiosity, rapid speech, racing thoughts, and often risky behaviors. While it can lead to a sense of euphoria and heightened creativity, it can also become dysphoric, and often escalates into dangerous and destabilizing behaviors, sometimes resulting in psychosis and hospitalization.

What is Hypomania?

Hypomania is a milder form of mania that occurs in Bipolar I & Bipolar II Disorders. It shares many of the same features as mania—elevated mood, increased energy, reduced need for sleep—but to a lesser degree. Hypomania can feel exhilarating, as it often enhances productivity and creativity without the severe impairments seen in full-blown mania.

The Allure of Hypomania & Mania 

Many moments in hypomania felt magical. My body felt invincible and electric. There were months on end when I could barely sit down because I always wanted to be doing something productive. However, in the past, this unique altered state would ultimately always drive me right over the cliff of reality into a manic, delusional ocean, only to be followed by a lengthy spell of almost drowning in suicidal depression. 

During my last period of hypomania before being hospitalized in 2021, my most vivid memories are of beautiful early mornings. I had already given up drinking and smoking and had begun healthy habits like meditation and exercise. I regularly woke up at 4 am after just four or five hours of sleep, rejuvenated and supercharged. In the morning, I had a ritual of turning on unique lights that projected bright waves of color onto my ceiling and made me feel like I was at the bottom of a mystical ocean looking up. I would taste the sunrise on my morning jog. All my senses were elevated: My jogging playlist felt tactile, and the trees along my path felt musical–I felt deeply alive—before slipping into my final full-blown manic episode.

Many individuals talk about missing hypomania, and some even crave full-blown mania. For me, overall, I see manic psychosis as nightmarish, especially in the context of forced hospitalization, an experience that I found deeply traumatizing as it made me feel like a hostage and, unsurprisingly, exacerbated my paranoia. My last manic episode began with fantastical experiences that had a seductive dream-like quality. Wrapped up in delusions of grandeur with heightened and warped sensory experiences, there is a unique feeling of epic adventure many experience during mania, so I can understand why some patients may actually crave it. However, for me, any temptation to embrace mania is outweighed by having to endure hospitalization and the bottomless pit of depression that follows. 

Treatment Comes with a Price: Poor Adherence to Antipsychotics

We know there is a significant problem with medication adherence in bipolar disorder. For many, the side effects of medications are undesirable, not only diminishing the heightened energy of hypomania, but also causing emotional dullness, mental fog, physical exhaustion, and difficulty with focus and creative thinking.

Many people with bipolar disorder, especially the large number of artists, writers, musicians, and entrepreneurs living with the condition, struggle with the idea of losing the creativity and passion that often accompanies hypomania. It is difficult to trade the heightened energy and vitality of hypomania for stability, and it’s understandable why many resist the medication that seems to dull these vibrant aspects of their personality.

Not only that, but many patients experience cardiometabolic side effects from their medications, leading to substantial weight gain and often other metabolic syndromes. While anti-psychotic medications may inhibit mania and hypomania, they typically do little to tackle depressive symptoms or lead to an optimal quality of life. Dr. Mark Frye, a professor of psychiatry at Mayo Clinic and director of the scientific advisory board for the Depression and Bipolar Support Alliance (DBSA) covers these concerns thoroughly in an excellent interview with Baszucki Group Medical Director, Dr. Bret Scher. 

Rather than blaming people for going off their medications and seeing it as irresponsible noncompliance, it is important to ask why so many patients have trouble staying on their medications. Since medication adherence is so poor, it is clear that we desperately need more effective treatments and better solutions. While some dismiss ketogenic therapy as too difficult or unsustainable, I wonder if they truly understand the seriousness of the side effects from medication or the challenges of living with a treatment-resistant condition. I've spoken to many who, like me, find adhering to medical keto far easier in comparison.

Life Fueled by Ketones and Metabolic Therapies 

I feel fortunate to have found metabolic therapies, including a medical keto diet, fasting, exercise, and meditation, which have been my alternative sole form of treatment for more than three years now. Metabolic therapies keep me mentally stable but also allow me to feel energized and to retain my focus, clarity of thought and creativity. They enable me to thrive. By comparison, on antipsychotics I felt like I was just barely able to keep my head above water—functional but numb, sedated, and relentlessly fatigued. I would choose the way I feel in ketosis over hypomania any day. The creativity, focus, and passion I have while implementing metabolic therapies is dramatically different from what I experience when hypomanic. Stable on metabolic therapies, these positive states are more Zen-like, gentle, calm, and sustainable. One thing I didn't enjoy about hypomania was being unable to sit still and enjoy simple pleasures with friends and family, like just comfortably watching a good movie. I also love the newfound feeling of being able to achieve a flow state in creative practice without it leading to an overflow—an inevitable tsunami of explosive energy leading to disabling manic psychosis. Being able to lose myself in something like writing or painting, then return to everyday life, ready for a power nap and capable of a restorative night of deep sleep, is an incredible feeling. In the end, while the altered states of hypomania and mania have their allure, the steady, constant energy I've found through metabolic therapies is far more rewarding and life-affirming.