Hypomania

Hypomania (literally “under mania” or "less than mania") is a mood state characterized by persistent disinhibition and pervasive elevated (euphoric) with or without irritable mood but generally less severe than full mania. Characteristic behaviors are extremely energetic, talkative, and confident commonly exhibited with a flight of creative ideas.^[1] While hypomanic behavior often generates productivity and excitement, it can become troublesome if the subject engages in risky or otherwise inadvisable behaviors.^[2]

Presentation

Individuals in a hypomanic state have a decreased need for sleep, are extremely outgoing and competitive, have a great deal of energy and are otherwise often fully functioning (unlike full mania).^[3]

Distinctive markers

Specifically, hypomania is distinguished from mania by the absence of psychotic symptoms and grandiosity, and by its lesser degree of impact on functioning.^[4][5]

Hypomania is a feature of bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder.^[5] Hypomania is also a feature of bipolar I disorder as it arises in sequential procession as the mood disorder fluctuates between normal mood and mania. Some individuals with bipolar I disorder have hypomanic as well as manic episodes. Hypomania can also occur when moods progress downwards from a manic mood state to a normal mood. Hypomania is sometimes credited with increasing creativity and productive energy.^[6][7]

People who experience hyperthymia, or "chronic hypomania",^[8] encounter the same symptoms as hypomania but long-term.^[9]

Associated disorders

Cyclothymia is a condition of continued mood fluctuations between hypomania and depressive symptoms that do not meet the criteria for a major depressive episode. These are often interspersed with periods of normal moods.^[10]

When a patient presents with a history of one or more hypomanic episodes and one or more depressive episodes that meet the criteria for a major depressive episode, bipolar II disorder is diagnosed. If the depressive episodes are routinely during the winter and the hypomania presents in the spring/summer it is possible that the person may be diagnosed with Seasonal Affective Disorder instead of bipolar II disorder.^[11]

If left untreated, hypomania can transition into mania and sometimes psychosis, in which case, bipolar I disorder is often diagnosed.^[12] (See also, Kindling model)

Causes

Studies show it can be caused by chemical imbalances in the brain. While most often associated with bipolar disorder, hypomania is also a side effect of numerous medications, often those used in psychopharmacotherapy. In cases of true drug-induced hypomania, discontinuation of the drug that caused or triggered the episode—for example antidepressants, steroids, or stimulants such as amphetamine—usually causes a fairly swift return to normal mood. An episode of hypomania may be incorrectly judged to have uncovered an underlying bipolar disorder, but drug-induced hypomania, by definition, does not point to bipolar disorder. Hypomania is less likely to be a side effect in those with pure clinical depression or unipolar depression, unless for example tricyclic antidepressants are given in very high doses.

Cause

Studies find it can be due to a chemical imbalance in the brain. Often in those who have experienced their first episode of hypomania – generally without psychotic features – there might be a long or recent history of depression or a mix of hypomania combined with hypomania known as mixed state prior to the emergence of manic symptoms, and commonly this surfaces in the mid to late teens. Due to this being an emotionally charged time, it is not unusual for mood swings to be passed off as hormonal or teenage ups and downs and for a diagnosis of Bipolar Disorder to be missed until there is evidence of an obvious manic/hypomanic phase.^[13]

Hypomania may also occur as a side effect of pharmaceuticals prescribed for conditions/diseases other than psychological states or mood disorders. In those instances, as in cases of drug-induced hypomanic episodes in unipolar depressives, the hypomania can almost invariably be eliminated by lowering medication dosage, withdrawing the drug entirely, or changing to a different medication if discontinuation of treatment is not possible.^[14]

Hypomania may also be triggered by the occurrence of a highly exciting event in the patient's situation, such as a substantial financial gain or recognition.

Hypomania can be associated with narcissistic personality disorder.^[15]

Evolution

Some commentators believe that hypomania actually has an evolutionary advantage.^[16] People with hypomania are generally perceived as being energetic, euphoric, visionary, overflowing with new ideas, and sometimes overconfident and very charismatic, yet—unlike those with full mania—are sufficiently capable of coherent thought and action to participate in everyday activities. Like mania, there seems to be a significant correlation between hypomania and creativity. A person in the state of hypomania might be immune to fear and doubt and have negligible social and sexual inhibition. People experiencing hypomania usually have a very strong sex drive. Hypomanic people are often the "life of the party". They may talk to strangers easily, offer solutions to problems, and find pleasure in small activities. Such advantages may render them unwilling to submit to treatment, especially when symptoms do not impair functioning.^[17]

Diagnosis

The DSM-IV-TR defines a hypomanic episode as including, over the course of at least four days, elevated mood plus three of the following symptoms OR irritable mood plus four of the following symptoms:

• pressured speech
• inflated self-esteem or grandiosity
• decreased need for sleep
• flight of ideas or the subjective experience that thoughts are racing
• easily distracted and attention-deficit similar to attention deficit hyperactivity disorder
• increase in psychomotor agitation
• involvement in pleasurable activities that may have a high potential for negative psycho-social or physical consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, reckless driving, or foolish business investments).^[18]

Treatment

Medications typically prescribed for hypomania include mood stabilizers such as valproic acid and lithium carbonate as well as atypical antipsychotics such as olanzapine and quetiapine.

If a hypomanic state is the result of medication side effects or drug abuse (e.g. amphetamines), then certain sedatives including benzodiazepines can sometimes normalize an individual's mood and energy levels.

Etymology

The Ancient Greek physician Hippocrates called one personality type 'hypomanic' (Greek: ύπομαινομενοι, ýpomainomenoi).^[19][20] In 19th century psychiatry, when mania had a broad meaning of craziness, hypomania was equated by some to concepts of 'partial insanity' or monomania.^[21][22][23] A more specific usage was advanced by the German neuro-psychiatrist Emanuel Ernst Mendel in 1881, who wrote, "I recommend, taking into consideration the word used by Hippocrates, to name those types of mania that show a less severe phenomenological picture, 'hypomania'".^[19][24] Narrower operational definitions of hypomania were developed from the 1960s/1970s.

See also

• Mania
• Hyperthymic temperament
• Bipolar disorder
• Bipolar I
• Bipolar II
• Cyclothymia
• Clinical depression
• Regression (psychology)
• The Hypomanic Edge by John D. Gartner

References

External links

• Hypomanic Episode – Bipolar Disorder
• Depression and Bipolar Support Alliance – Depression and Bipolar Support Alliance
• Advice for Bipolar Disorder Sufferers and Their Loved Ones