Hypomania

What is hypomania?

Hypomania is a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level or activity level. This energized level of energy, mood and behavior must be a change from your usual self and be noticeable by others.

Hypomania is a symptom of bipolar disorder, but can also be a symptom of other mental health conditions.

What’s the difference between hypomania and mania?

Hypomania is a less severe form of mania. The criteria that healthcare professionals use to make the diagnosis of either hypomania or mania is what sets them apart. These differences are as follows:

What triggers a hypomanic episode?

Each person’s triggers may be different. Some common triggers include:

• A highly stimulating situation or environment (e.g., lots of noise, bright lights, large crowds).
• A major life change (e.g., divorce, marriage, job loss).
• Lack of sleep.
• Substance use, such as recreational drugs or alcohol.

It’s smart to develop a list of your triggers to know when a hypomanic episode may be starting. Since hypomania doesn’t cause severe changes in your activity level, mood or behavior, it may be helpful to ask family and close friends who you trust and have close contact with to help identify your triggers. They may notice changes from your usual self more easily than you do. Share your trigger list with your close, trusted friends so they can tell when you might need help.

How long does a hypomanic episode last?

According to the criteria for hypomania, hypomania must last at least four days. But it can last up to several months.

What happens after a hypomanic episode?

After a hypomanic episode you may:

• Feel happy or embarrassed about your behavior.
• Feel overwhelmed by all the activities you’ve agreed to take on.
• Have only a few or unclear memories of what happened during your manic episode.
• Feel very tired and need sleep.
• Feel depressed (if your hypomania is part of bipolar disorder).

What are the symptoms of hypomania?

Symptoms of a hypomanic episode are the same but less intense than mania. Hypomanic symptoms, which vary from person to person, include:

• Having an abnormally high level of activity or energy.
• Feeling extremely happy, excited.
• Not sleeping or only getting a few hours of sleep but still feel rested.
• Having an inflated self-esteem, thinking you’re invincible.
• Being more talkative than usual. Talking so much and so fast that others can’t interrupt.
• Having racing thoughts — having lots of thoughts on lots of topics at the same time (called a “flight of ideas”).
• Being easily distracted by unimportant or unrelated things.
• Being obsessed with and completely absorbed in an activity you’re focus on.
• Displaying purposeless movements, such as pacing around your home or office or fidgeting when you’re sitting.
• Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.

What’s the difference between feeling good vs hypomania?

It takes time to know the difference. Everyone enjoys being happy and feeling good. But feeling good doesn’t always mean you are good. Over time, you’ll start to understand yourself and learn the warning signs that you may be starting to have an elevated mood that is different than just feeling good.

Ask family and close friends who you trust, and have frequent contact with, to give you feedback. Ask them to tell you when they see beyond normal changes in your mood or behaviors.

What does hypomania feel and look like?

What hypomania feels like and looks like will be different for each person. Some examples of things you might feel and/or do include:

• Get into an intense cleaning frenzy and clean all surfaces of every room in your house.
• Stay up until 3 a.m. or don’t go to bed at all and not feel tired the next morning.
• Start a project, or more than one project, and work non-stop on these projects for 20 hours straight.
• Feel that you can’t fail at anything you want to do, even if you have no training or experience.
• Call and text all your friends all day and night and post a large number of pictures and comments on social media.
• Quickly jump from subject to subject when talking, and talking very fast.

What causes hypomania?

Scientists aren’t completely sure what causes hypomania. However, there are several factors that are thought to contribute. Causes differ from person to person.

Causes may include:

• Family history. If you have a family member with bipolar illness, you have an increased chance of developing mania. This is not definite though. You may never develop mania even if other family members have.
• Chemical imbalance in your brain.
• Side effect of a medication (such as some antidepressants), alcohol or recreational drugs.
• A significant change in your life, such as a divorce, house move or death of a loved one.
• Difficult life situations, such as trauma or abuse, or problems with housing, money or loneliness.
• High stress level and inability to manage it.
• Lack of sleep or changes in sleep pattern.
• As a symptom of mental health problems including cyclothymia, seasonal affective disorder, postpartum psychosis, schizoaffective disorder or other physical or neurologic condition such as brain injury, brain tumors, stroke, dementia, lupus or encephalitis.

How is hypomania diagnosed?

Your healthcare provider will ask about your medical history, family medical history, current prescriptions and non-prescription medications and any herbal products or supplements you take. Your provider may order blood tests and body scans to rule out other conditions that may mimic mania. One such condition is hyperthyroidism. If other diseases and conditions are ruled out, your provider may refer you to a mental health specialist

To be diagnosed with hypomania, your mental health specialist may follow the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Their criteria for manic episode is:

• You have an abnormal, long-lasting elevated expression of emotion along with a high degree of energy and activity that lasts for at least four consecutive days and is present most of the day, nearly every day.
• You have three or more symptoms to a degree that they’re a noticeable change from your usual behavior (four symptoms if mood is only irritable). (See the symptoms section of this article for a list of the symptoms used as criteria.)
• The hypomanic episode is not severe enough to significantly interfere with your social, work or school functioning and there’s no need for hospitalization.
• The hypomanic episode can’t be caused by the effects of a substance (medications or drug abuse) or another medical condition.

If you have hypomania, you don’t have thoughts that are out of step with reality — you don’t have false beliefs (delusions) or false perceptions (hallucinations). If you do have these symptoms of psychosis, your diagnosis is mania.

What is bipolar II disorder?

Bipolar II disorder is a type of bipolar disorder in which people experience depressive episodes as well as hypomanic episodes (shifting back and forth), but never mania. People with bipolar II disorder tend to have longer and more frequent depressed episodes than people with bipolar I disorder.

If the severity of your symptoms never rises to the level of mania, you have bipolar II disorder. If you have even a single episode of what is considered mania or one psychotic event (delusions or hallucinations) during a hypomanic episode, your diagnosis would change to bipolar I disorder.

How is hypomania treated?

Hypomania is treated with psychotherapy, antipsychotic medications and mood stabilizers.

Psychotherapy

Psychotherapy involves a variety of techniques. During psychotherapy, you’ll talk with a mental health professional who will help you identify hypomania symptoms and triggers and learn ways to cope with or lessen the effects of hypomanic episodes.

Medications

Antipsychotic medication choices include:

• Aripiprazole (Abilify®).
• Lurasidone (Latuda®).
• Olanzapine (Zyprexa®).
• Quetiapine (Seroquel®).
• Risperidone (Risperdal®).

Mood stabilizers include:

• Lithium.
• Valproate (Depakote®).
• Carbamazepine (Tegretol®).

(If you’re pregnant or plan to become pregnant, let your provider know. Valproate can increase the chance of birth defects and learning disabilities and shouldn’t be prescribed to individuals who are able to become pregnant.)

Sometimes antidepressants are also prescribed.

Managing hypomania without medications

If your hypomania is mild, you may be able to cope without medications. Your healthcare provider may suggest having a greater focus on self-care to stay as healthy as possible.

Suggested actions may include:

• Go to bed at the same time each night and get plenty of sleep (six to nine hours).
• Avoid stimulating triggers such as coffee, tea, colas, sugar, noisy and crowded environments.
• Eat a healthy diet, such as the Mediterranean or Dash diet.
• Get 30 minutes of exercise on most days of the week. Even two short walks a day is beneficial.
• Don’t use illegal or recreational drugs or alcohol.
• Learn ways to relax. Yoga, meditation, listening to calming music, aromatherapy are a few examples.
• Take all medications as prescribed or instructed on package labeling. If you think you’re having side effects or new side effects to a medication, call your provider. Never stop taking — or change the dose — of a prescription medication without talking to your provider first. Make sure they know all supplements, herbal products and vitamins you take.
• Join a support group. Ask your provider for contact information for local support groups. You might find it helpful to talk with other people who have similar medical experiences and share problems, ideas for coping and strategies for living and caring for yourself.

Can hypomania be prevented?

Episodes of hypomania can’t always be prevented. However, you can learn ways to better manage your symptoms and prevent them from getting worse.

Suggestions on your “to-do list” might include:

• Keeping a “mood diary” to become more self-aware of events that trigger an oncoming episode of hypomania. These events are unique to you. Sometimes you can’t recognize your own triggers. Ask your trusted, close family and friends to help identify when they see changes in your mood, behavior and energy level that is different from your usual self.
• Following other coping strategies. (See the bulleted list under, “Managing hypomania without drugs,” just above in this article.)

What outcome can I expect if I’ve been diagnosed with hypomania?

If you’ve been diagnosed with hypomania, you can have a favorable outcome if you learn about your condition, learn to recognize when you’re having a hypomanic episode and engage in coping strategies to lessen the severity or prevent events. Always take any prescribed medications as directed by your healthcare provider.

A note from Cleveland Clinic

Being amped up about your life and being in a good mood is usually thought to be a good thing. It can be if that’s how you normally are most of the time. This is what makes hypomania a little tricky to diagnose. Key to a diagnosis of hypomania is that your elevated mood, behavior or activity level must last at least four days (all day or most of the day) and must rise to the level that’s beyond normal and is noticeable by others. Know that a team of healthcare professionals — your primary care provider, psychologists and/or psychiatrist — is ready to help you figure this out.

Can my diagnosis change between bipolar II disorder and bipolar I disorder?

Yes. If you have been diagnosed with the less severe condition of hypomania and have even a single episode of mania (as defined by the criteria), your diagnosis will change to bipolar I disorder. Once you have a diagnosis of bipolar I disorder – even if you never have another manic episode – your diagnosis can never be changed back to bipolar II disorder. You’ll always have a bipolar I disorder diagnosis.