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Whilst it is normal to be in a very good mood, someone with hypomania will find their mood goes beyond what is usual. Hypomania usually manifests as an abnormal excitement, irritability, restlessness, and grandiosity.
Someone experiencing hypomania may also talk excessively, be distracted easily, and intensely focus on a single activity. Hypomania is a more energized version of a person that is usually recognizable to others as being beyond their usual self.
Hypomania is a symptom of bipolar II disorder but can also occur as part of other mood disorders such as schizoaffective disorder. Bipolar disorder is a mental health disorder where a person experiences changes in mood, energy, activity levels, and thought patterns.
Depending on the type of bipolar disorder, mood episodes might include extreme highs (either mania or hypomania) and/or extreme lows (depression).
Hypomania Vs Mania
Those with bipolar I disorder will have episodes of mania, while those with bipolar II disorder will have hypomanic episodes. While hypomania and mania can affect a person’s behavior and mood, some differences exist.
Hypomania is considered a less severe form of mania, still causing problems in life, but not to the extent that mania can. Hypomania usually lasts a shorter period than mania, usually a few days, whereas mania can last for a week or more.
| Mania | Hypomania |
|---|---|
| Typically lasts at least a week | Usually lasts a few days to a week |
| May require hospitalization | Does not typically require hospitalization |
| Significant impairment in functioning | Mild impairment in functioning |
| May experience psychotic symptoms | Rarely includes psychotic symptoms |
| Excessive risk-taking behavior | Risk-taking behavior may be present |
| Euphoria or extreme irritability | Euphoria or mild irritability |
| Often abrupt | Can be gradual or abrupt |
| Little need for sleep or insomnia | Decreased need for sleep or insomnia |
| Often requires medication and therapy | May require medication and therapy |
| May progress to a full manic episode | Does not progress to a full manic episode |
The energy levels of someone with hypomania will be higher than normal, but not as intensely as those who experience mania.
The severity of a hypomania episode is usually not severe enough to significantly affect school/work or social functioning. In contrast, a manic episode usually has an impact on social life and school/work.
For hypomanic episodes, there is usually no need for hospitalization, whereas this can be a possibility for manic episodes. There are also no features of psychosis in a hypomanic episode, such as experiencing hallucinations or delusions, which can be present in a manic episode.
Finally, there is usually more high-risk behavior for those with mania, whereas those with hypomania usually have some but not as frequent high-risk behavior.
While hypomanic episodes can have an impact on life, the right treatments and coping methods can help to reduce their impact and improve overall well-being.
Symptoms
The specific symptoms of hypomania can vary from person to person. Below are some of the common signs:
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Having an abnormally high level of activity or energy.
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Feeling extremely happy or excited.
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Unusual irritability, hostility, or aggression.
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Reduced need for sleep
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Talking so fast that it’s difficult for others to follow what is being said.
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Having inflated self-esteem.
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Having racing thoughts on lots of topics at the same time – a flight of ideas.
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Being easily distracted by unimportant or unrelated things.
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Displaying purposeless movements such as pacing around or fidgeting when sitting.
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Feeling overconfident.
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A powerful feeling of physical and mental well-being.
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A stronger desire for sex than usual.
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Psychomotor agitation – a feeling of anxious restlessness that causes a person to make involuntary movements.
Examples
Below are some ways in which hypomania can present and feel:
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Staying up until the early hours of the morning or not going to bed at all and not feeling tired the following day.
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Getting into an intense cleaning frenzy or cleaning the entire house.
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Starting a project, or more than one project, and working nonstop on these projects for extremely long periods.
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Excessively pursuing activities likely to have painful or unwanted consequences.
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Showing impulse behavior that can lead to poor choices such as buying sprees or foolish business investments.
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Being obsessed with and completely absorbed in an activity.
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Taking chances that wouldn’t normally be taken due to feeling lucky.
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Behaving inappropriately in social situations.
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Dressing and/or behaving flamboyantly.
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Hypersexuality, such as inappropriate sexual advances, having an affair or spending money on pornography or sex workers.
Whilst some people may engage in many of these behaviors anyway, the behaviors would have to be considered abnormal to the individual and paired with unusually excessive energy, irritability, or happiness to be considered a hypomanic episode.
After a hypomanic episode
After a hypomanic episode, someone may experience the following:
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They may feel either happy or embarrassed about their behavior.
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They may feel overwhelmed by all the activities or projects they have agreed to take on.
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They may have only a few or unclear memories of what happened during the manic episode.
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They may feel very tired or need a lot of sleep.
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They may feel depressed.
Complications
Many people with bipolar disorder may find that during hypomanic episodes, work gives them a sense of structure, and they find that they might thrive when they are so focused on the task they are doing.
However, for many other people, there can be many negative consequences of experiencing a hypomanic episode, including:
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They could develop substance-use disorders, cognitive problems, and more medical problems.
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The swing in mood episodes can affect their sleep, energy, activity, judgment, behavior, and the ability to think clearly.
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The risk of committing suicide is thought to be significantly higher for people with mania or hypomania compared to the general population.
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It may strain the individual’s family and damage relationships, especially if the person is undiagnosed and thus lacks understanding from those close to them.
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The person may be so focused on other tasks or projects that they neglect their family and friends.
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Over-reckless spending may cause the individual to go into debt.
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They could annoy their friends and co-workers with their excessive talking and overconfidence, aggression, and hostility.
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It may be harder for people who experience hypomania to make and maintain friendships.
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They are more likely to make risky decisions, such as quitting their job without thinking it through.
Diagnosis
If a person notices mood changes that seem stronger than normal, they should consider seeing a healthcare professional.
Bipolar disorder can be difficult to diagnose, but a comprehensive health history, physical examination, and a discussion of moods and symptoms can help.
If a friend or family member appears to have symptoms of hypomania, those closest to them may want to talk to them about seeing a doctor and getting treatment.
A mental health professional must make several considerations when diagnosing hypomania.
For instance, a person who undergoes a hypomanic episode must have experienced at least three symptoms laid out by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
The diagnostic criteria in the DSM-5 explain that these symptoms must be present for a minimum of a four-day period to be diagnosed as a hypomanic episode. The following symptoms include:
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Elevated self-esteem, high self-confidence, or feelings of grandiosity.
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Lack of need for sleep, such as feeling rested after only three hours of sleep.
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Feeling more talkative than usual or feeling pressure to keep talking.
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Racing thoughts or quickly changing ideas.
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Feeling easily distracted.
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Doing many activities at once, such as work tasks, organizing social events, or seemingly purposeless movements.
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Engaging in activities that may lead to harmful consequences, such as excessive spending, dangerous driving, or risky financial investments.
At least three of the symptoms must be abnormal, lasting for at least four consecutive days, and be present for most of the day, nearly every day.
The hypomanic episode must not be severe enough to interfere with social, work, or school functioning significantly, and there is no need for hospitalization.
If the episode lasts longer than a week, significantly interferes with functioning or requires hospitalization, this is more likely to be a manic episode than a hypomanic episode.
To diagnose hypomania, the doctor will also have to rule out other medical conditions or other mental health conditions which could better explain symptoms.
Identifying a history of hypomania can be difficult, and as a result, bipolar disorder is frequently misdiagnosed as major depressive disorder, borderline personality disorder, and others.
Many people with bipolar II disorder are often diagnosed with major depressive disorder since the depressed symptoms are often the most recognizable. People are often more likely to seek help when they are in a depressed episode than when they are experiencing a hypomanic episode.
Consequences of misdiagnosis include inadequate treatment and worsening of the disorder due to inappropriate use of antidepressants which can make the hypomanic symptoms worse.
To address their difficulties, several psychometric tests have been developed to screen for hypomanic episodes and assess their severity.
The Hypomania Checklist-32 is one such self-report questionnaire designed to screen for hypomanic symptoms in people diagnosed with major depressive disorder.
Triggers
It is thought that about 2.5% of the United States population suffers from some form of bipolar disorder. Most people are in their adolescence or early 20s when symptoms of bipolar disorder first start.
Nearly everyone with bipolar disorder II disorder finds that this develops before the age of 50. While hypomania could be a symptom of bipolar II disorder, these episodes can occur for other reasons, including alcohol or drug use, changes in sleep patterns, depression, high levels of stress, and medication side effects.
Hypomania may also be a symptom of other mental health problems such as postpartum psychosis, schizoaffective disorder, or other physical or neurological conditions such as brain injury, brain tumors, and strokes.
Genetics
Bipolar disorder appears to be more common in people who have first-degree relatives, such as a sibling or parent with the same condition.
Researchers are attempting to find genes that may be involved in causing bipolar disorder.
The role of genetics may not be absolute since research has found that a child from a family with a history of bipolar disorder may never develop this disorder. Studies of identical twins have also found that even if one twin develops the disorder, the other may not.
Brain differences
Research has found that people with bipolar disorder appear to have physical changes in their brains; the significance of these changes is uncertain but may eventually help to pinpoint causes.
Although brain scans may not be able to diagnose bipolar disorder, researchers have identified subtle differences in the average size of activation of some brain structures in people with bipolar disorder.
Brain chemistry could also play a significant role in someone developing mood disorders. The neurotransmitter norepinephrine, which usually increases arousal and focus, appears to be a key chemical thought to be lacking severely in depressed individuals but significantly high during manic episodes.
Environmental
There may be a lot of environmental triggers which can contribute to causing a hypomanic episode, including:
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A highly stimulating situation or environment includes lots of noise, bright lights, and large crowds.
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A lack of sleep.
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High levels of stress.
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A major life change such as a breakdown in a relationship, marriage, or job loss.
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Substance abuse, such as recreational drugs or alcohol.
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Problems with money, housing, or loneliness.
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Trauma and abuse.
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Seasonal changes – for instance, some people are more likely to experience hypomania in the spring months.
Treatment
Treatments for bipolar disorder and hypomanic symptoms are aimed at helping those with the condition to maintain stable moods and keep their symptoms managed.
There is no known cure for hypomania, but people can manage their symptoms with medication and talking therapies.
These treatments can help prevent episodes of hypomania, as well as episodes of depression.
Medication
Mood stabilizers are medications that treat and prevent the hypomanic and depressed episodes of bipolar disorder. These are often the most effective way to treat hypomania and include the following:
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Benzodiazepines – these are known as anti-anxiety medications, commonly referred to as minor tranquilizers. These include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). These medications are often used for the short-term control of acute symptoms associated with hypomania such as insomnia or agitation.
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Lithium – this medication is usually highly effective at controlling mood swings, particularly the manic and hypomanic episodes in bipolar disorder. They can take a few weeks to work fully, making this better for long-term treatment than for acute symptoms.
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Valproate – this is an antiseizure medication that works to level out moods. It tends to have a more rapid onset of action than lithium and can be used to prevent extreme highs and lows.
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Antipsychotics – these medications, including risperidone (Risperdal), Aripiprazole (Abilify), and olanzapine (Zyprexa), are usually used to control psychotic symptoms of bipolar disorder but can reduce the hypomanic symptoms until lithium or valproic acid take full effect.
Since bipolar II disorder typically involves recurrent episodes, continuous and ongoing treatment with medication is often recommended for relapse prevention.
People who are taking medication for hypomanic symptoms should not stop taking this medication without talking to their doctor first. Suddenly stopping medication can lead to more severe symptoms when hypomania returns, as well as the risk of dangerous withdrawal symptoms.
Psychotherapy
During psychotherapy, sessions with a mental health professional can help people to identify their hypomanic symptoms and triggers. Once identified, coping strategies can be established to help with or lessen the effects of hypomanic episodes.
During many types of psychotherapy, people can be helped to identify and challenge their troubling emotions, thoughts, and behaviors. Popular types of psychotherapy include the following:
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Interpersonal and social rhythm therapy (IPSRT)
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Psychoeducation
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Family-focused therapy
Electroconvulsive therapy (ECT)
ECT is a brain stimulation procedure that can help people relieve severe symptoms of certain conditions where medication and psychotherapy have not proved effective.
ECT involves sending electric currents through the brain, causing a brief surge of electrical activity, with the aim of relieving symptoms of mental health problems.
Treatment usually takes place over a series of sessions over several weeks and can be effective in treating severe depressive and manic episodes, so it may not always be recommended for bipolar II disorder.
Coping
Every person’s experience with hypomania will be different, so it makes sense to think that the coping methods will be different too. With trial and error, individuals can find the best ways to cope with episodes of hypomania.
Educate yourself
The more you learn about hypomania and the individual symptoms and possible trigger which cause it, the easier it will be to manage the condition.
Stick to treatment plans
Especially if you have been diagnosed with bipolar disorder; complying with your treatment will be the key to managing symptoms.
Ask for support
Reaching out to trusted friends and family or joining a support group for people who also experience hypomania can be really beneficial.
This can be especially useful when you notice you are starting to experience an episode. Reaching out and accepting help from others and your treatment team may help to prevent an episode from worsening.
Having a support system can also help those who have hypomanic episodes feel less alone and understood by others.
Keep a mood diary
Writing in a journal or using an app to document moods can help you and your doctor to keep the hypomanic episodes under control.
Through using a mood diary, you can become more self-aware of the events which can trigger an oncoming episode if you start noticing a pattern in the warning signs.
Sometimes you may not be able to recognize your triggers, so it may be useful to ask a trusted person to help identify when they notice changes in your mood, behavior, and energy level that is different from your usual self.
Lifestyle changes
Although these alone cannot treat hypomania, you can try some lifestyle changes to help manage symptoms, and possibly avoid triggers: eating a healthy diet, avoiding stimulants such as caffeine, sugar, and loud, crowded environments, exercising regularly, and getting enough sleep.
Manage stress
Try using stress management techniques to relieve stress and help to prevent hypomania from triggering. Likewise, removing unnecessary stressors in life where possible may help.
Learn ways to relax
There are many ways in which someone can learn to relax: yoga, meditation, mindfulness, listening to calming music, aromatherapy, and progressive muscle relaxation being a few.
Finding the relaxation techniques that work best for you and incorporating this into your daily life can help you to cope with hypomania.
Be patient
Learning about hypomania, the best ways to cope, and finding the right medication can take time. It’s important to be patient and gentle with yourself, trying not to blame yourself if something does not work the first time.
Set up a crisis plan
By putting together an emergency action plan, especially with someone you trust; you can get the help you need fast. This can include putting together a list of resources and people that can be contacted during a crisis.
Related Articles
References
Proudfoot, J., Whitton, A., Parker, G., Doran, J., Manicavasagar, V., & Delmas, K. (2012). Triggers of mania and depression in young adults with bipolar disorder. Journal of affective disorders, 143(1-3), 196-202.
Dailey, M. W., & Saadabadi, A. (2018). Mania.
