Hypomania

This article is an expansion of a section titled Hypomania from within the main article: Bipolar disorder.

Hypomania
Specialty	Psychiatry, psychology

Hypomania (literally, below mania) is a mood state characterized by persistent and pervasive elevated or irritable mood, and thoughts and behaviors that are consistent with such a mood state. People experiencing hypomanic symptoms typically have a flight of ideas, a decreased need for sleep and/or rest, are extremely outgoing and daring, and have a great deal of energy. However, unlike full-blown mania, those with hypomanic systems are generally fully functioning. Specifically, it is distinguished from mania by the absence of psychotic symptoms and by its lower degree of impact on functioning. Hypomania is a feature of two mood disorders: bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder. Hypomania is sometimes credited with increasing creativity and productive energy. A number of people with creative talents have reportedly experienced hypomania or other symptoms of bipolar disorder and attribute their success to it. Classic symptoms of hypomania include mild euphoria, a flood of ideas, endless energy, and a desire and drive for success. A lesser form of "hypomania" is called hyperthymia.

Hypomania is also a side-effect of numerous medications, often—though not always—those used in pharmacotherapy. Patients suffering from severe depression who experience hypomania as a side effect of (for example) antidepressants, may prove to have a form of bipolar disorder that has previously gone unrecognized. However, drug-induced hypomania is not invariably indicative of bipolar affective disorders. The difference between uni- and bi-polar disorders is essential for analysis of switches. Consequently, it is important for researchers and mental health professionals to distinguish drug-induced hypomania in bipolar patients from drug-induced hypomania in unipolar (non-bipolar) depressives. Nevertheless if antidepressants trigger the first episode of hypomania, it is strongly suggestive of an underlying diagnosis of Bipolar Disorder, particularly if the manic symptoms (mild, moderate or severe) last for a lengthy period of time after they start. In cases of true drug-induced hypomania, cessation of the antidepressant or whichever drug has triggered this mood state - for example steroid therapy or stimulants such as amphetamine - usually causes a fairly swift return to normal mood. It is far less likely to be a side effect in those with pure Clinical Unipolar Depression, unless for example tricyclic antidepressants are given in very high doses. SSRIs are less likely to trigger manic symptoms except in those individuals where there is an underlying Bipolar Disorder, particularly if administered without a mood stabilizer.

Often in those who have experienced their first episode of hypomania (which is a level of mild to moderate mania) - generally without psychotic features - there will have been a long or recent history of depression 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.

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.

Symptomatic recognition

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; rapid talking but research shows this feature is not found in 25% of individuals with other manic symptoms.
• inflated self-esteem or grandiosity;
• decreased need for sleep;
• flight of ideas or the subjective experience that thoughts are racing;
• easy distractibility and attention-deficit (superficially similar to attention deficit hyperactivity disorder);
• increase in psychomotor agitation; and
• 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, or foolish business investments).

In the hypomanic state, people may feel that they cannot slow their minds down, and that their speeding thoughts are crafted exceptionally well. Some examples are speaking or writing in rhyme or alliteration without planning it first; quick responses to people talking; or the ability to improvise easily.

People in hypomanic episodes do not have delusions or hallucinations. They do not lose touch with reality in the sense that they know who they are and what is real. What can be a problem, however, is that people in a hypomanic state can sometimes overestimate their capabilities and fail to see the risks involved in their ventures. For example, a person may suddenly decide to expand a business in a way that is not really practical or set up schemes for which he or she is ill-prepared.

People experiencing hypomania may also manifest a loss of inhibition, resulting in behavior such as reckless driving, gambling, spending sprees and sexual adventures. They may also report having a host of new ideas, but not following them through. People who are described as hypomanic are often very jolly to be with but may quickly become very impatient or unpleasant if they cannot get what they want.

It is unknown to what degree hypomanic symptoms can occur without a depressive component. Patients may be relatively unlikely to seek psychiatric treatment for hypomania alone. However, many hypomanic patients also experience:

• obsessive behavior, whether mild or severe
• poor judgment
• uncontrolled, or only partially controllable, impulsivity
• excessive sexual activity or sexual risk taking

Plus other out-of-character behaviors that the person may regret following the conclusion of the mood episode. A more mild form of elevated mood, which has fewer negative behaviors, is hyperthymic temperament.

Hypomania can signal the beginning of a more severe manic episode, and often does result in a more severe manic episode if the hypomanic episode remains untreated. A hypomanic episode can also directly precede a depressive episode.

Possible benefits

Some commentators believe that hypomania actually has an evolutionary advantage. People with hypomania are generally perceived as being energetic, euphoric, visionary, overflowing with new ideas, and sometimes over-confident and very charismatic, yet--unlike those with full-blown mania--are sufficiently capable of coherent thought and action to participate in everyday activities. A person in the state of hypomania might be immune to fear and doubt and have little social and sexual inhibition. People experiencing hypomania are often the "life of the party." They may talk to strangers easily, offer solutions to problems, and find pleasure in small activities.

Relationship with 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.

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 left untreated, hypomania can transition into mania and sometimes psychosis, in which case, Bipolar I Disorder is often diagnosed. (See also, Kindling model)

Treatment

Clinical trials of medications for the non-depressive phases of bipolar illnesses generally treat patients for psychotic mania during the initial, or acute, phase of mania. High doses are justified in the case of mania, in order to remove the patient from immediate danger. Hypomania, however, involves different considerations and almost always requires more in-depth clinical judgment. 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.

Famous individuals with hypomanic symptoms

Hypomania appears to be found disproportionately in successful people, especially those in the arts. (For more information, please see List of people affected by bipolar disorder).

Radiohead front man Thom Yorke reportedly responded, "Hypomania? Yes, that's exactly what it was," when asked about his mental state after the release of the group's album OK Computer. Iggy Pop was diagnosed with hypomania during his stay in a mental hospital in the mid-1970s. It has also been suggested that Richey Edwards, the "fatalistic Manic Street Preacher" (Mojo, 2003), and the late Syd Barrett of the band Pink Floyd have experienced hypomania. In the biographical documentary An Unreasonable Man, Ralph Nader is described as having hypomania.

Honoré de Balzac, French author of the Human Comedy, is reported to have had hypomania, writing from midnight to noon, and functioning on four hours of sleep. During these episodes, Balzac would reportedly consume massive amounts of coffee.

John Gartner's book The Hypomanic Edge claims notable people including Christopher Columbus, Alexander Hamilton, Andrew Carnegie, Howard Zinn and Louis B. Mayer owe their innovation and drive, as well as their eccentricities, to hypomanic temperaments. Gartner suggests that the constructive behaviors associated with hypomania may contribute to bipolar disorder's evolutionary survival. Critics charge that Gartner vastly overstates his case, however. He fails to address the possibility that the depressive component may be an evolutionary adaptive mechanism instead, a theory that has been postulated by various evolutionary psychologists.

See also

• Mania
• Hyperthymic temperament
• Bipolar disorder
• Bipolar I
• Bipolar II
• Cyclothymia
• Clinical depression
• Regression

External links

• Hypomanic Episode - Bipolar Disorder
• Depression and Bipolar Support Alliance - Depression and Bipolar Support Alliance
• DSM-IV definition