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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 bipolar disorder?
Manic episodes
What treatment is available?
Self-management
Talking treatments
Medication
What can I do if a friend/relative experiences hypomanic episodes?
Useful organisations
Further reading
This factsheet is for anyone who has been given a diagnosis of hypomania and for their family and friends. It describes hypomania and how it relates to the spectrum of mania and bipolar disorders, and discusses what people can do to help themselves. It will also be of interest to students and health professionals.
What is hypomania?
Hypomania is difficult to define because the term is used differently by different doctors, and the criteria for the diagnosis differ slightly between ICD-10 [1] and DSM-IV [2] (the reference books that give standard symptoms for the diagnosis of mental health conditions and psychiatric disorders).
Hypomania shares symptoms and characteristics with the mania aspect of bipolar disorder (formerly known as manic depression), but to a less severe degree – the word hypo comes from the Greek prefix meaning ‘below’.
Both DSM-IV and ICD-10 give the following characteristics of a hypomanic episode:
- feeling exceptionally confident with inflated self-esteem
- feeling a need for less sleep, and feeling 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
- increased goal-directed activity
- involvement in pleasurable activities that have a high potential for painful consequences (e.g. spending sprees that result in debt, or a sexual encounter that is later regretted)
- 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.
Someone in a hypomanic episode feels very good and may disagree with anyone who suggests that they are ‘not themselves’.
Episodes of hypomania are interspersed by periods of stable mood.
The distinction between hypomania and mania is not very clear. The symptoms must be marked enough to cause a problem to the affected person and those around them, but are not severe enough to seriously disrupt everyday life. The diagnosis would be mania rather hypomania if work and social activities are seriously disrupted, or if a stay in hospital is required. It has been suggested that hypomania is sometimes diagnosed when mania would be more accurate, because hypomania sounds more acceptable. [3]
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Thyroid function
Mood is influenced by the thyroid gland, which controls the metabolic rate. In some cases hypomania may be caused by an overactive thyroid gland (hyperthyroid), while depression may be caused by an underactive thyroid (hypothyroid). An overactive thyroid causes a range of other physical and mental symptoms. Anyone with hypomania should have their thyroid function checked, which can be done with a simple blood test. Both thyroid disorders can be treated. More information is available from Thyromind (see ‘Useful organisations’).
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Does hypomania lead to bipolar disorder?
Some people experience hypomania, without experiencing depression. Others may have a period of depression before or after the hypomanic episode, which can lead to a new diagnosis of bipolar disorder (also known as manic depression). Bipolar disorder is characterised by extremes of mood – lows as well as highs. More information about bipolar disorder can be found in Mind’s booklet Understanding bipolar disorder.
Manic episodes
Some people with hypomania 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 states that, “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.
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What treatment is available?
Self-management
People who have experienced hypomania often know the signs of an approaching episode and can use a variety of strategies to prevent it from happening, such as getting plenty of sleep (this is particularly important), avoiding stimulants such as caffeine, and trying to induce a sense of calm (complementary therapies such as aromatherapy, yoga or meditation can help to achieve this). They also know to avoid making major decisions and to avoid risky behaviour such as spending sprees.
Talking treatments
Counselling and other talking therapies such as cognitive behaviour therapy may be useful in helping a person to recognise when hypomania is developing, and in keeping the symptoms under control, e.g. in helping them to resist the temptation to overspend or indulge in other types of risky behaviour. See ‘Further reading’ for more information.
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Medication
Hypomanic episodes may require treatment to prevent progression into mania. Drugs licensed for mania (so-called antipsychotic drugs) are usually used: olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), or aripiprazole (Abilify).
Other drugs called mood stabilisers may be prescribed for the long-term treatment of mania. These include:
- lithium (Camcolit, Liskonum, Priadel)
- valproate semisodium (Depakote)
- carbamazepine (Tegretol).
These drugs are also used for the treatment of bipolar disorder.
The drugs are initially prescribed by a consultant psychiatrist. Patients taking lithium have blood tests at the start of treatment, to establish the correct dose, and then regularly while taking it to make sure that lithium levels in the body are safe and effective. Patients on carbamazepine also require regular blood tests.
All these drugs can cause side effects. More information is available in Mind’s booklet Making sense of lithium and other mood stabilisers.
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What can I do if a 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 angry if you suggest that there is a problem. You may want to discuss any projects they are planning and try to alert them to possible dangers and the risk of making decisions too quickly. This is particularly important if you feel that they are likely to make life-changing decisions while hypomanic that 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 have another episode.
You may feel that you need to get support for yourself, such as counselling, which provides the opportunity to talk about what the relationship is like for you, the feelings you have about the person and what you can do to look after yourself. MDF The BiPolar Organisation offers support to friends and relatives (see ‘Useful organisations’).
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Useful organisations
British Association for Behavioural and Cognitive Psychotherapies
VictoriaBuildings, 9–13 Silver Street, Bury BL9 0EU
tel: 0161 797 4484
web: www.babcp.com
To find a list of accredited therapists
Institute for Complementary and Natural Medicine (ICNM)
Can-Mezzanine, 32–36 Loman Street, London SE1 0EH
tel: 020 7922 7980
web: www.i-c-m.org.uk
Provides information on complementary therapies.
MDF The BiPolar Organisation
Castle Works, 21 St Georges Road, London SE1 6ES
tel: 0845 634 0540 or 020 7793 2600
web: www.mdf.org.uk
Provides information, advice and support to people with bipolar disorder (including hypomania) and their families and friends.
MDF The BiPolar Organisation Cymru
22–29 Mill Street, Newport NP20 5HA
tel: 01633 244 244 helpline:08456 340 080
web: www.mdfwales.org.uk
National Debtline
Tricorn House, 51–53 Hagley Road, Birmingham B16 8TP
tel: 0808 808 4000 (freephone)
web: www.nationaldebtline.co.uk
Offers confidential advice concerning debts.
Thyromind
www.thyromind.info
Information about thyroid disorders and the importance of thyroid function tests as part of the assessment of a mental health problem.
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Further reading
Booklets
Books (to purchase from Mind)
- Art of recovery: a pocket guide to recovering from mental illness, Simon Heyes, South Somerset Mind, 2005.
- The bipolar disorder survival guide, David Milkowitz, Guilford, 2002.
- Inside out: a guide to self-management of manic depression, MDF The BiPolar Organisation 1995.
- The kitchen shrink: foods and recipes for a healthy mind, Natalie Savona, DBP, 2003.
- Learn to balance your life, Michael and Jessica Hinz, DBP, 2004.
- Manage your mind: the mental health fitness guide, Gillian Butler and Tony Hope, OUP 2007.
- Overcoming mood swings: a self-help guide using cognitive behavioural techniques, Jan Scott, Robinson, 2001.
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References
[1] Diagnostic and statistical manual of mental disorders, Fourth Edition (DSM-IV) 1994, American Psychiatric Association, Washington.
[2] The ICD-10 classification of mental and behavioural disorders 1992, World Health Organization, Geneva.
[3] Goodwin, G. 2002, ‘Hypomania: what’s in a name?’, British Journal of Psychiatry, vol. 181, pp. 94–95.
This factsheet was updated by Katherine Darton, April 2009.
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