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Although there are no specific statistics regarding the prevalence of hypomania in the UK, we know that hypomania is most commonly associated with bipolar disorder.
Approximately 2% of the UK population has bipolar disorder, which equates to 1.3 million people. However, hypomania could be even more prevalent than we realise, with hypomania also being connected to other mental health conditions. It can even be diagnosed as a stand-alone condition.
Today we are going to look at hypomania in more detail, including common triggers, symptoms and treatments.
What is hypomania?
Hypomania is a condition which is characterised by a period of abnormally elevated moods. It involves marked changes in an individual’s baseline mood, thoughts and behaviour that lasts for a minimum of four consecutive days.
Hypomania is a mood episode condition primarily linked to bipolar disorder, although it is also associated with other mental health conditions. To be diagnosed with bipolar II disorder or cyclothymia (another type of bipolar) an individual must experience both depressive and hypomanic episodes.
Hypomania is a less severe form of mania. A hypomanic episode may present differently in different people but is often characterised by unusually elevated moods and extreme changes in a person’s emotional state, energy levels and activity levels. Behavioural changes will also likely occur.
A person experiencing hypomania is unlikely to recognise the symptoms and changes in themselves; however, the episode may be noticeable to other people. Hypomanic episodes may not impact a person’s ability to function normally, and they may still be able to attend work and social events.
Because hypomania is not as severe as mania, it is possible that the symptoms and episodes are not recognised by the individual or those around them, which can result in the person being misdiagnosed or undiagnosed. The consequences of being misdiagnosed could include inappropriate treatment or medication and the worsening of symptoms.
Because hypomania is considered to be less serious than mania, many people do not realise the serious negative consequences it can have on a person’s life. For example, hypersexuality could result in the ruin of personal relationships or a sexually transmitted infection (STI) or gambling could result in losing significant amounts of money.
Experiencing a hypomanic episode can feel good and the individual may enjoy the elevated mood, increased confidence and other symptoms that they view positively. Distinguishing hypomania from feeling good or euphoric can be difficult. Although some of the symptoms can be similar, hypomania will be out of character for the person and may not be linked to a specific positive event. For example, hypomania is different from the euphoric feeling you may have when falling in love or achieving a longed-for dream.
A person experiencing a hypomanic episode can stay fully functional. In some cases, hypomania can result in a person being focused, productive, goal-oriented and feeling positive. However, there is a fine line between a functioning hypomanic episode and one that can be detrimental and have a negative impact. Hypomania can be harmful if not properly managed. Those who experience hypomania are also likely to experience depressive episodes.
What is the difference between hypomania and mania?
Although very similar, hypomania is a milder form of mania. Symptoms of mania are usually so severe that regular activities cannot be maintained and changes in behaviour are obvious to other people.
However, although hypomania does result in behavioural changes, normal activities can be continued and changes in behaviours may not be noticeable, other than to close family members and friends. However, in both mania and hypomania, the person experiencing the episode may not be able to recognise symptoms and behavioural changes in themselves.
The intensity of the symptoms is usually less severe, and episodes last for a shorter time. The diagnostic criteria for hypomania and mania are different, allowing healthcare professionals to make a more accurate diagnosis.
Some of the main differences between hypomania and mania are:
|Length of each episode||A minimum of four consecutive days||A minimum of one week|
|The severity of each episode||Less severe||Severe|
|Can regular activity be maintained?||Usually||No|
|Is there a need for hospitalisation?||No||Possibly|
|Any delusions or hallucinations?||Do not occur||Visual or auditory hallucinations may occur|
How common is hypomania?
Hypomania most often occurs in people with bipolar disorder, specifically bipolar II disorder and cyclothymia. Hypomanic episodes are part of the diagnostic criteria for both bipolar II and cyclothymia. To be diagnosed with bipolar II disorder, you will need to have experienced a major depressive episode lasting a minimum of two weeks and at least one hypomanic episode lasting at least a few days.
1.3 million people in the UK are currently diagnosed with bipolar disorder, which is approximately 2% of the population. However, both bipolar II and cyclothymia can be more difficult to diagnose than bipolar I, meaning that these statistics may not be accurate. This is because someone experiencing a hypomanic episode may not be able to recognise the episode.
Hypomanic episodes are also less noticeable to other people than manic episodes (typically associated with bipolar I), meaning that people with bipolar II may only report their depressive episodes – making them significantly more likely to be misdiagnosed with depression.
All individuals diagnosed with bipolar II disorder must have experienced hypomania at least once, although the occurrence of hypomanic episodes can be significantly reduced with medication and treatment.
In individuals with bipolar disorder, hypomania often occurs alongside other conditions:
- Approximately 75% experience hypomania and anxiety.
- More than 35% experience hypomania and a substance use disorder.
- Approximately 60% experience hypomania with three or more co-occurring conditions.
Hypomania can also occur in people who don’t have bipolar disorder, although this is less common.
Who is at risk of hypomania?
Hypomania is a common feature of bipolar disorder, meaning that anyone with bipolar II or cyclothymia is at risk of hypomania.
Certain factors may mean you are more at risk of hypomania:
- If you have a close relative, such as a parent or sibling, with bipolar disorder or cyclothymia.
- If you have a chemical imbalance in your brain, e.g. if your noradrenaline levels are too high.
If you have a risk factor that makes you predisposed to bipolar, the disorder may be triggered by a life event such as:
- If you have experienced a stressful life event, such as abuse, a bereavement or a relationship breakdown.
- If you experience certain physical illnesses.
- If you have ongoing sleep disturbances.
- If you have ongoing problems in your life that cause you to feel stressed.
Even if you have bipolar II, this doesn’t necessarily mean you will experience hypomanic episodes. Having undiagnosed or uncontrolled bipolar disorder makes you significantly more at risk of experiencing a hypomanic episode and your symptoms are likely to be more severe.
Hypomanic episodes can be triggered by:
- Not correctly taking your medication.
- Sleep deprivation or disturbances.
- Alcohol or drug use.
If you have previously experienced hypomania, you are at increased risk of having another episode.
How to deal with hypomania?
Ensuring that you and the people close to you are aware of the symptoms of hypomania and what your hypomanic episodes look like can help you to recognise the onset of an episode very quickly.
Being aware of your triggers can help you to be in more control of your hypomania. If you think you are about to, or are already, experiencing a hypomanic episode, informing your family and friends and your treatment team can help you to manage the episode.
One way you can recognise a hypomanic episode is by tracking your moods. You can use a mood tracking app or a mood journal to help you recognise any changes in your mood and track your symptoms.
Some other ways you can deal with hypomania and help reduce the likelihood of an episode or alleviate your symptoms are:
- Avoid drinking alcohol and misusing substances, such as drugs. Some people also find avoiding caffeine to be beneficial.
- Create a sleep routine that you stick to.
- Create a day-to-day routine that you stick to.
- Ensure you take your medication at the same time every day.
- Join a support group.
- Employ stress management techniques to keep your daily stress to a minimum.
- Incorporate exercise into your daily routine.
- Practise yoga, meditation, mindfulness or deep breathing exercises.
- Create a personalised plan, based on your typical triggers and symptoms that can be used if you experience a hypomanic episode in the future. For example, if you have previously engaged in gambling during an episode, not being given access to your savings account could be part of your plan.
- If you are experiencing symptoms, avoiding situations that could encourage risky behaviour (such as attending parties with lots of drugs present), avoiding loud, busy environments and engaging in activities that keep you calm is recommended.
What triggers hypomania?
Individual triggers for hypomania can vary. As mentioned earlier, if you have already experienced a hypomanic episode, you are significantly more likely to experience another episode. Because it can be difficult to identify when you are experiencing a hypomanic episode yourself, being aware of your triggers or creating a trigger diary can be beneficial.
Some common triggers for hypomania are:
- Being in an overstimulating environment, e.g. bright, flashing lights, large crowds and loud noises.
- Experiencing a major life change.
- Misusing substances, such as drugs or alcohol.
- Experiencing high levels of stress.
- Changes in sleep patterns.
- Changing or stopping a medication.
- Taking a new type of medication.
- Having recently given birth or becoming a new parent.
- Experiencing certain medical conditions, such as thyroid disease or seizure disorders.
Interestingly, hypomania is more common in spring, compared to other times of the year, suggesting that seasonal changes may trigger a hypomanic episode.
What are the symptoms of hypomania?
Symptoms of hypomania can vary from person to person and from episode to episode. Symptoms can also change over time, as you age.
Some of the most common symptoms of hypomania include:
- Abnormally high energy levels.
- Feelings of extreme happiness or excitement.
- Unusual irritability or aggression.
- Impulsive behaviour.
- Getting no or very little sleep because of a reduced need for sleep.
- Feelings of invincibility or unusually inflated self-esteem or confidence.
- Displaying unusual risk-taking behaviour.
- Talking significantly more and faster than usual.
- Experiencing racing thoughts.
- Being easily distracted.
- Being unusually obsessed or absorbed in an activity.
- Increased restlessness, fidgeting or pacing.
- Increased distractibility and irritability.
- Having decreased inhibitions.
- Behaving, dressing or speaking inappropriately or differently.
- Hypersexuality, such as inappropriate sexual advances, making unusual sexual demands, risky sexual behaviour or out-of-character spending on sex workers or pornography.
- Out-of-control spending.
- Being involved in activities that have a high potential for negative consequences.
- Grandiose thinking (an unrealistic feeling of superiority).
To be diagnosed as having hypomania, you must experience several of these symptoms.
After a hypomanic episode has ended, you may find you enter a period of depression. The mood, thought and behavioural changes that you may have experienced during the episode could also result in:
- Feelings of shame or embarrassment.
- Feelings of anxiety, stress or unhappiness.
- Unclear memories of what happened during the episode.
- Tiredness or fatigue.
- Negative consequences in your personal or professional life, such as negative impacts on your relationships, financial situation or health.
What causes hypomania?
The exact cause of hypomania is undetermined. However, it is a key symptom of several mental health conditions, including:
- Bipolar II disorder.
- Cyclothymic disorder.
- Severe anxiety disorders.
- Severe obsessive-compulsive disorder (OCD).
- Histrionic personality disorder.
- Borderline personality disorder.
- Postpartum psychosis.
Hypomania can also occur in people who do not have another mental health condition.
Once a person has experienced hypomania, they are more likely to experience another hypomanic episode again. However, it is unclear what causes the first hypomanic episode, with a combination of long-term and short-term factors potentially causing hypomania.
Can hypomania be prevented?
Hypomania cannot be prevented.
However, it is possible to manage or lessen the effects of a hypomanic episode or reduce the likelihood of a hypomanic episode occurring:
- Stick to your treatment plan: This includes taking all medications as directed by your doctor and complying with all aspects of your treatment plan.
- Keep your doctor updated on any changes: If a medication is no longer working or you experience any big life changes or stresses, you should update your doctor immediately.
- Educate yourself: Ensure you are educated on hypomania and potential triggers and symptoms. This enables you to avoid potential triggers and recognise symptoms. You could also ensure those close to you are educated about hypomania.
- Maintain your support systems: Your support system could be family, friends or work colleagues. Not only can your support system offer you emotional and physical support, but they may also be able to recognise symptoms of hypomania.
- Maintain a balanced nutritious diet: Certain foods can help reduce symptoms of bipolar disorder, including hypomania.
- Physical activity: Physical activity can help you to regulate your moods and improve your sleep. As a lack of sleep is a potential trigger for hypomania, physical activity can help to reduce the likelihood of a hypomanic episode occurring.
- Prioritise sleep: As mentioned above, sleep is a key trigger. Prioritise rest, keep a sleep schedule and go to bed at a reasonable time every night.
- Keep a journal: This can help you to identify any previous triggers and avoid these in the future.
- Avoid stimulants: This could include caffeine and sugar.
How is hypomania diagnosed?
To diagnose hypomania, your doctor will first look at your medical history and your family’s medical history as well as any medications (both prescriptive and non-prescriptive) and any herbal products or supplements you take.
Your doctor may also perform a physical examination and request a blood test or other medical tests to rule out any other medical conditions whose symptoms may mimic hypomania. In order to determine whether your symptoms are consistent with hypomania, your doctor will likely discuss any symptoms and mood and behaviour changes you are aware of.
You will then likely be referred to a mental health specialist who can diagnose hypomania and any other related conditions, such as bipolar disorder. To diagnose hypomania, the mental health specialist will check for a combination of symptoms and features.
In order to achieve a diagnosis the following criteria must be met:
- An abnormally elevated mood and emotional state, including a high level of energy and activity that lasts for four consecutive days. The elevated state will be present for most of each day. This is to ensure that the hypomanic episode is distinguished from naturally occurring mood variations or fluctuations.
- Three or more symptoms that result in noticeable changes in your behaviour. If the person’s mood is irritable rather than elevated, four or more symptoms will need to be present. Being overly energetic or overactive are essential criteria for a diagnosis of hypomania.
- The episode should not be severe enough to have a significant impact on the person’s functioning at work, school or socially. There should also be no need for hospitalisation (as this would be representative of mania rather than hypomania).
- The hypomanic episode is not caused by another medical condition or the effects of substances.
Any changes in the person’s mood, behaviour or activity should be markedly different from the person’s usual state. The changes are likely noticeable to people close to them.
If an individual meets all of the criteria above, the doctor will be able to make a diagnosis of hypomania.
Although hypomania is closely connected to bipolar disorder, the two conditions will be diagnosed separately. This means a person can receive a diagnosis of hypomania without a diagnosis of bipolar disorder.
How is hypomania treated?
There are many different ways to treat hypomania. Because the condition usually manifests with other conditions or symptoms, such as depressive episodes, different types of treatment may work together to treat a range of symptoms.
Your doctor may prescribe a combination of medication and psychotherapy.
Depending on the severity of your symptoms, you may be prescribed one or more types of medication. You may need to try several different types of medication before your doctor finds the combination that treats your hypomania most effectively.
Potential medications could include:
Mood stabilisers can stabilise your mood and change any abnormal brain activity.
There are different types of mood stabilisers including:
- Valproic acid.
Antipsychotics are frequently used to treat the symptoms of bipolar disorder, including hypomania. There are both first-generation and second-generation antipsychotics, with second-generation antipsychotics thought to be particularly effective.
Different types of antipsychotics used to treat hypomania are:
Benzodiazepines are used to treat mood episodes that commonly occur in people with bipolar disorder.
In some cases, hypomania can be treated with lifestyle changes, without the need for medication. In the majority of cases, an individual with hypomania will be asked to attend psychotherapy.
Psychotherapy can help you to identify your triggers and be aware of your symptoms. You will also look at your emotions, thoughts and behaviours and potential coping strategies.
There are several different types of psychotherapy, including:
- Cognitive behavioural therapy (CBT).
- Interpersonal and social rhythm therapy (IPSRT).
- Family-focused therapy.
- Dialectical behavioural therapy (DBT).
Holistic approaches may be recommended and can help to reduce symptoms or prevent hypomanic episodes.
This could include:
- Keeping a mood diary and a trigger diary.
- Avoiding any known triggers.
- Exercising daily and eating a healthy, balanced diet.
- Getting enough sleep.
- Joining a support group for people with hypomania.