A hypomanic episode commonly manifests with unusual gaiety, excitement, flamboyance, or irritation, along with other characteristics such as inflated self-esteem, extreme talkativeness, increased distractibility, reduced need for sleep, and racing thoughts.
Symptoms of Hypomania
The specific symptoms experienced during hypomania can vary from one person to another, and they can also change over time. Examples of hypomanic behaviors and characteristics include:
Behaving inappropriately, such as making crude remarks at a dinner party Dressing and/or behaving flamboyantly Hypersexuality, which may involve making unusual demands on your partner, inappropriate sexual advances, engaging in an affair, or spending a lot of money on phone sex, pornography, or sex workers Jumping from one subject to another unrelated topic when speaking Reduced need for sleep Spending recklessly, like buying a car you cannot afford Taking chances you normally wouldn’t take because you “feel lucky” Talking so fast that it’s difficult for others to follow what’s being said Unusual irritability, excitement, hostility, or aggression
Diagnosis of Hypomania
Diagnosing hypomania depends on the presence of a combination of key symptoms and features. There must be a persistent and abnormally elevated, irritable, or expansive mood accompanied by unusually increased activity and energy for most of the day over at least four days. The mood, activity, and behaviors that are present with hypomania are clearly different from a person’s normal, everyday state and readily noticeable to those around them. A lack of mood fluctuation and persistence of the mood state helps distinguish a hypomanic episode from normal mood variation. It’s also important to rule out medications or recreational substance use as a possible source of the symptoms before making a diagnosis of hypomania.
Hypomania vs. Mania
By definition, certain characteristics and features rule out a diagnosis of hypomania and often point toward a manic episode instead. For example, symptoms of psychosis—such as hallucinations or delusions—exclude the possibility of a hypomanic episode. Additionally, symptoms so severe that they significantly interfere with daily functioning or necessitate hospitalization are manic versus hypomanic.
Bipolar Hypomania
To be diagnosed with bipolar I or bipolar II disorder, a person must generally experience both depressive and manic and/or hypomanic episodes. Experiencing symptoms associated with hypomania and depression without mania suggests bipolar II disorder. Other factors may determine if another diagnosis is more appropriate, such as cyclothymia. Bipolar hypomania is considered present when a person experiences at least three of the following symptoms accompanied by a persistently elevated mood or four of these symptoms in association with a sustained irritable mood:
Easily distracted Excessive involvement in activities with a high potential for negative consequences (such as spending sprees, gambling, sexual indiscretions, or risky financial investments) Feeling intensely driven to accomplish specific goals Fidgetiness, pacing, or restlessness (also known as psychomotor agitation) Flight of ideas or feeling like your thoughts are racing Grandiose thinking, meaning unrealistic thoughts about your powers, talents, or abilities Reduced need for sleep without feeling tired Unusual talkativeness or feeling pressured to keep talking
Causes of Hypomania
While hypomania can be a symptom of bipolar disorder, this state can occur for other reasons as well. Some of the potential causes of hypomania include the following.
Alcohol or Drug Use
Hypomania and/or depression occur in 11% of people with substance use disorder and 55% of people with substance-related impairment.
Changes in Sleep Patterns
Insomnia is associated with hypomanic experiences in some individuals, particularly if the circadian rhythm is consistently disrupted. Although, more research is needed to confirm whether sleep issues cause hypomania or if hypomania causes sleep issues.
Depression
Depression can be part of bipolar disorder, but it can also exist on its own and co-occur with hypomania. In some cases, it is the treatment of depression that leads to hypomania. This is called antidepressant-associated hypomania and occurs in 0.3% to 22.4% of people using depression medications.
Genetics
Research on twins suggests that hypomania may be inherited genetically, with this risk being greater for males (59%) than for females (29%).
High Levels of Stress
A study involving 99 students in an emergency medicine residency program found that not only did the students’ levels of stress increase significantly over the course of the program, but the rate of hypomania increased significantly as well. These findings suggest that higher levels of stress may contribute to the development of hypomanic behaviors.
Medication
It’s also possible that the medicines you’re taking could lead to hypomania. Escitalopram is one, which is a medication often used to treat both depression and generalized anxiety disorder. It is better known by the brand name Lexapro.
Herbal Supplements
Like medication, herbal supplements are not without their risks, and some have been linked with psychiatric symptoms. There are reports of large combinations of herbal supplements causing symptoms of hypomania when taken together over a prolonged period of time.
Impact of Hypomania
Even in the absence of the psychosis and wildly exaggerated moods associated with mania, hypomania can have serious long-term consequences. Hypersexuality can lead to ruined relationships and sexually transmitted infections (STIs), for instance. Reckless spending can result in severe financial hardship and engaging in inappropriate behaviors can cause you to lose your job or alienate your loved ones. To be transparent, not all impacts are negative. For instance, one case study found that hypomania appears to increase aerobic capacity and cardiopulmonary functioning, potentially through increased mobility and hypomania-related goal-directed behavior. Increases in energy can also help you get more done; confidence increases help you feel good mentally; and you may even notice more creativity. The one thing to remember, though, is that these benefits are often associated with pure euphoric hypomania, which is uncommon as hypomania typically morphs into something more negative than positive.
Hypomania Treatment
The use of medications called mood stabilizers is the most common and effective way to treat hypomania, a healthcare provider may prescribe one or more of the following:
Antipsychotics, which can reduce hypomania symptoms until other medicines (such as lithium or valproic acid) take full effect Benzodiazepines, or anti-anxiety drugs Lithium, a mood stabilizer with antidepressant effects Valproic acid, an anticonvulsant
There are also holistic approaches and lifestyle changes that can help in the treatment of hypomania, including:
Avoiding stimulants that could act as triggers such as caffeine, sugar, and loud, crowded social scenes all fall into this category Eating meals regularly Exercising daily Getting seven to eight hours of sleep each night
Coping With Hypomania
If you’ve been experiencing hypomania-like symptoms, make an appointment with a mental healthcare provider such as a psychiatrist. A mental health professional with experience in diagnosing mood disorders can determine if a diagnosis of hypomania is accurate and whether it’s a symptom of underlying bipolar disorder. In the meantime, here are a few tips to help you cope with symptoms of hypomania:
Educate yourself. The more you learn about hypomania and your individual symptoms and triggers, the easier it becomes to manage your condition. Keep a mood diary. Writing in a journal or using an app can help you chart your moods so you and a healthcare provider can work together to keep your hypomanic episodes under control. Stay the treatment course. If you do have bipolar disorder, seeking treatment and complying with your treatment is important to managing hypomania. Ask for support. Whether you reach out to trusted friends and family members or join a support group for people with similar symptoms, it can be beneficial to ask for help.
For more mental health resources, see our National Helpline Database.
