Hypomania

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This factsheet is intended for those who experience hypomania and their friends and relatives.

What is hypomania?
        Thyroid function

Does hypomania lead to manic depression (bipolar affective disorder)?
        Manic episodes

What treatment is available?        
        Self-management
        Medication
        Talking treatments

What can I do if my friend/relative experiences hypomanic episodes?

Further reading

Useful organisations

References

What is hypomania?

Hypomania is a bit difficult to define, because the term seems to be used slightly differently by different doctors, and the criteria for the diagnosis are slightly different in ICD-10[1]and DSM-IV[2] (the reference books which give standard symptoms for the diagnosis of different conditions).

Hypomania shares symptoms and characteristics with the mania aspect of manic depression, but to a less severe degree (the word hypo comes from the Greek prefix meaning ‘below’). The difference between hypomania and mania is not very clear, but hypomania is not severe enough seriously to disrupt your everyday life. The symptoms must, however, be marked enough to cause a problem to you and to those around you. If your work and social activity are seriously disrupted, or if you are disturbed enough to need to stay in hospital, then the diagnosis would be mania rather than hypomania. It has been suggested that hypomania is sometimes diagnosed when mania would be more accurate, because hypomania sounds more acceptable.[3]

The characteristics of a hypomanic episode, which both DSM-IV and ICD-10 are agreed upon, include:

• feeling exceptionally confident with inflated self-esteem
• feeling a need for less sleep, so that you feel rested after only a few hours’ sleep
• being more talkative than usual, or feeling a need to keep talking
• feeling full of ideas with racing thoughts
• being easily distracted, and darting from one activity to another
• increase in goal-directed activity
• involvement in pleasurable activities that have a high potential for painful consequences. For example, you may go on a spending spree and end up in debt, or have a sexual encounter which you later regret
• feeling very excited and in a euphoric mood for at least several days on end, which can switch to irritability, intolerance and rage
• increased activity and high energy levels
• being unusually friendly, seeking out people, including strangers
• increased productivity and creativity.

The episode has to last for at least four days for the diagnosis to be made, and may last for several months.

You can feel very good during a hypomanic episode and may disagree with anyone who suggests that you are ‘not yourself’.

If you experience more than one episode of hypomania, you will have periods where your mood is stable between them.

Thyroid function
Mood is influenced by the thyroid gland, which controls your metabolic rate.  If you have episodes of hypomania, you could ask your doctor for a thyroid function test.  This is a simple blood test.  Hypomania may be caused by an overactive thyroid gland (hyperthyroid), while depression may be caused by an underactive thyroid (hypothyroid).  Both of these conditions can be successfully treated.

Does hypomania lead to manic depression (bipolar affective disorder)?

Some people can experience hypomania alone, without experiencing depression. However, sometimes people with hypomania do have a period of depression before or after the hypomanic episode. This can lead to a new diagnosis of bipolar affective disorder. Bipolar affective disorder, also known as manic depression, involves experiencing extremes of mood - lows as well as highs. For more information about manic depression, see Mind’s booklet Understanding manic depression.

Manic episodes

Some people with hypomania will do go on to develop episodes of mania. A manic episode differs from a hypomanic episode, in that, it is severe enough to have an adverse effect on a person’s work, relationships or usual social activities.

DSM-IV says, “Manic episodes should be distinguished from hypomanic episodes. Although manic episodes and hypomanic episodes have identical lists of characteristic symptoms, the mood disturbance in hypomanic episodes is not sufficiently severe to cause marked impairment in social or occupational functioning or to require hospitalisation. Some hypomanic episodes may evolve into full manic episodes.”

Someone diagnosed as having a manic episode may have psychotic symptoms such as delusions.

What treatment is available?

Self-management

People who have experienced hypomania often know the signs of an approaching hypomanic episode. To help prevent this from happening there are things you can do such as getting plenty of sleep, avoiding stimulants such as caffeine, trying to induce a sense of calm (complementary therapies such as aromatherapy may help you to achieve this). Getting enough sleep is particularly important.

Try to avoid making major decisions or going on spending sprees if you feel an episode coming on. If you experience financial difficulties as a result of an episode, you may find National Debtline useful (see Useful organisations).

Medication

Lithium can help with stabilising moods. Like all drugs, lithium can have adverse side-effects, and regular blood tests are required to make sure lithium levels are safe. If lithium proves unsuitable or ineffective, carbamazepine or valproate semisodium can be administered in its place. See Mind’s booklet Making sense of lithium and factsheet Alternatives to lithium – carbamazepine and valproate.

Talking treatments

You may find some form of counselling or therapy, such as cognitive behaviour therapy, useful to help you recognise when you may be developing hypomania. It may also help you to keep the symptoms under control, and resist the temptation to overspend or indulge in other types of risky behaviour.  See Mind's booklet, Making sense of cognitive behaviour therapy.

What can I do if my friend/relative experiences hypomanic episodes?

Supporting someone with hypomania can be difficult, because the person may feel that there is nothing wrong. They may be feeling very good about themselves and full of confidence and may get very angry if you suggest there is a problem. You may want to discuss any projects they are planning with them, to try and alert them to possible dangers, and the risk of making decisions too quickly. This is especially so, if you feel they are likely to make life-changing decisions while hypomanic, which they may regret later.

You could offer to help the person if they decide to self-manage their hypomania. At a time when they are not experiencing hypomania, you could talk about what they would like you to do if they do have another episode.

You may feel you need to get support for yourself and to have time away from the person you care about. You might want to think about counselling, which could give you the opportunity to talk about what the relationship is like for you, the feelings you have about the person and what you might be able to do to look after yourself. The Manic Depression Fellowship offers support to friends and relatives – see Useful organisations.

Further reading

The following publications are available from Mind Publications .

Booklets

How to cope as a carer, Mind 2003
How to deal with anger, Mind 2003
How to improve your mental wellbeing, Mind 2004
How to look after yourself, Mind 2004
Making sense of cognitive behaviour therapy, Mind 2004
Making sense of counselling, Mind 2004
Making sense of psychotherapy and psychoanalysis, Mind 2004
Making sense of lithium, Mind 2004
The Mind guide to food and mood, Mind 2004
The Mind guide to relaxation, Mind 2004
Understanding manic depression, Mind 2003
Understanding talking treatments, Mind 2005

Books

Carbamazapine and manic depression: a guide, Lithium Information Centre 1996.

Coping with bipolar disorder: a guide to living with manic depression, Steven Jones, Peter Hayward and Dominic Lam, Oneworld, 2002.

Coping with depression and elation, Dr Patrick McKeon, Sheldon Press 1997.

The food and mood handbook, Amanda Geary, Thorsons, 2001.

Inside out: a guide to self-management of manic depression, Manic Depression Fellowship 1995.

Manage your mind: the mental health fitness guide, Gillian Butler and Tony Hope, OUP 1995.

Overcoming mood swings: a self-help guide using cognitive behavioural techniques, Jan Scott, Robinson, 2001.

The bipolar disorder survival guide, David J Miklowitz, Guilford, 2002.

The kitchen shrink: foods and recipes for a healthy mind, Natalie Savona, DBP, 2003.

Factsheets

The following factsheets can be downloaded from this website and are also available from MindinfoLine on 0845 766 0163.

Additional Information on Lithium in Pregnancy  Mind 2002
Alternatives to lithium – carbamazepine and valproate  Mind 2002

Useful organisations

Institute for Complementary Medicine
PO Box 194
London SE16 7QZ
tel: 020 7237 5165
fax: 020 7237 5175
email: info@i-c-m.org.uk 
website: www.icmedicine.co.uk
Provides information on complementary therapies.

MDF The Bipolar Organisation
Castle Works
21 St Georges Road
London SE1 6ES
tel: 08456 340 540 (UK only) 0044 20 7793 2600 (rest of world)
fax: 020 7793 2639
email: mdf@mdf.org.uk
website: www.mdf.org.uk
Provides information, advice and support to people with bipolar disorder (including hypomania), and their families and friends.

MDF Cymru
22-29 Mill Street
Newport
South Wales NP20 5HA
tel: 0845 634 0080
fax: 0845 634 0081
email: info@mdfwales.org.uk 
 website: www.mdfwales.org.uk

National Debtline
Tricorn House
51-53 Hagley Road
Birmingham B16 8TP
tel: 0808 808 4000 (freephone)
fax: 0121 410 6230
email: ndl@nationaldebtline.co.uk
website: www.nationaldebtline.co.uk   
Offers confidential advice concerning debts.

Thyromind 
www.thyromind.info 
Information about the importance of thyroid function tests as part of the assessment of a mental health problem.

This factsheet was updated by Katherine Darton, October 2005.