Hypomania

Hypomania (literally "under mania" or "less than mania")[1] is a mental and behavioural disorder,[2]
characterised essentially by an apparently non-contextual elevation of mood (euphoria) that contributes to
persistently disinhibited behaviour.

The individual with the condition may experience irritability,[3] not necessarily less severe than full mania;
in fact, the presence of marked irritability is a documented feature of hypomanic and mixed episodes in
Bipolar type II. According to DSM-5 criteria, hypomania is distinct from mania in that there is no
significant functional impairment; mania, by DSM-5 definition, does include significant functional
impairment and may have psychotic features.

Characteristic behaviors of persons experiencing hypomania are a notable decrease in the need for sleep, an
overall increase in energy, unusual behaviors and actions, and a markedly distinctive increase in
talkativeness and confidence, commonly exhibited with a flight of creative ideas. Other symptoms related to
this may include feelings of grandiosity, distractibility, and hypersexuality.[4] While hypomanic behavior
often generates productivity and excitement, it can become troublesome if the subject engages in risky or
otherwise inadvisable behaviors, and/or the symptoms manifest themselves in trouble with everyday life
events.[5] When manic episodes are separated into stages of a progression according to symptomatic
severity and associated features, hypomania constitutes the first stage of the syndrome, wherein the cardinal
features (euphoria or heightened irritability, pressure of speech and activity, increased energy, decreased
need for sleep, and flight of ideas) are most plainly evident.

Contents
Signs and symptoms
Distinctive markers
Associated disorders
Causes
Psychopathology
Diagnosis
Treatment
Medications
Etymology
See also
References
External links

Signs and symptoms

Individuals in a hypomanic state have a decreased need for sleep, are extremely gregarious and competitive,
and have a great deal of energy. They are, otherwise, often fully functioning (unlike individuals
experiencing a manic episode).[6]

Distinctive markers

Specifically, hypomania is distinguished from mania by the absence of psychotic symptoms, and by its
lesser degree of impact on functioning.[7][8]

Hypomania is a feature of bipolar II disorder and cyclothymia, but can also occur in schizoaffective
disorder.[8] Hypomania is also a feature of bipolar I disorder; it arises in sequential procession as the mood
disorder fluctuates between normal mood (euthymia) 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. Numerous people with bipolar disorder have credited hypomania with giving them
an edge in their theater of work.[9][10]

People who experience hyperthymia, or "chronic hypomania",[11] encounter the same symptoms as
hypomania but on a longer-term basis.[12]

Associated disorders

Cyclothymia, a condition of continuous mood fluctuations, is characterized by oscillating experiences of

hypomania and depression that fail to meet the diagnostic criteria for either manic or major depressive
episodes. These periods are often interspersed with periods of relatively normal (euthymic) functioning.[13]

When a patient presents with a history of at least one episode of both hypomania and major depression,
each of which meet the diagnostic criteria, bipolar II disorder is diagnosed. In some cases, depressive
episodes routinely occur during the fall or winter and hypomanic ones in the spring or summer. In such
cases, one speaks of a "seasonal pattern".[14]

If left untreated, and in those so predisposed, hypomania may transition into mania, which may be
psychotic, in which case bipolar I disorder is the correct diagnosis.[15]

Causes
Often in those who have experienced their first episode of hypomania  – generally without psychotic
features – there may be a long or recent history of depression or a mix of hypomania combined with
depression (known as mixed-state) prior to the emergence of manic symptoms. This commonly surfaces in
the mid to late teens. Because the teenage years are typically an emotionally charged time of life, it is not
unusual for mood swings to be passed off as normal hormonal teen behavior and for a diagnosis of bipolar
disorder to be missed until there is evidence of an obvious manic or hypomanic phase.[16]

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.[17]

Hypomania can be associated with narcissistic personality disorder.[18]

Psychopathology
Mania and hypomania are usually studied together as components of bipolar disorders, and the
pathophysiology is usually assumed to be the same. Given that norepinephrine and dopaminergic drugs are
capable of triggering hypomania, theories relating to monoamine hyperactivity have been proposed. A
theory unifying depression and mania in bipolar individuals proposes that decreased serotonergic regulation
of other monoamines can result in either depressive or manic symptoms. Lesions on the right side frontal
and temporal lobes have further been associated with mania.[19]

Diagnosis
[20]

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, when
the behaviors are clearly different from how the person typically acts when not depressed:

pressured speech
inflated self-esteem or grandiosity
decreased need for sleep
flight of ideas or the subjective experience that thoughts are racing
easily distracted
increase in goal-directed activity (e.g., social activity, at work, or hypersexuality), or
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, physical and verbal conflicts, foolish business
investments, quitting a job to pursue some grandiose goal, etc.).[21]

Treatment

Medications

Antimanic drugs are used to control acute attacks and prevent recurring episodes of hypomania combined
with a range of psychological therapies.[22] The recommended length of treatment ranges from 2 years to 5
years. Anti-depressants may also be required for existing treatments but are avoided in patients who have
had a recent history with hypomania.[23] Sertraline has often been debated to have side effects that can
trigger hypomania.[24][25]

These include antipsychotics such as:[26]

Aripiprazole
Clozapine
Haloperidol
Olanzapine
Paliperidone
Quetiapine
 Risperidone
Ziprasidone

Other anti-manic drugs that are not antipsychotics include:

Carbamazepine
Lithium
Oxcarbazepine
Valproate

Benzodiazepines such as clonazepam or lorazepam may be used to control agitation and excitement in the
short-term.

Other drugs used to treat symptoms of mania/hypomania but considered less effective include:

Gabapentin
Lamotrigine
Levetiracetam
Topiramate

Etymology
The Ancient Greek physician Hippocrates called one personality type 'hypomanic' (Greek: ὑπομαινόμενοι,
hypomainómenoi).[27][28] In 19th century psychiatry, when mania had a broad meaning of insanity,
hypomania was equated by some to concepts of 'partial insanity' or monomania.[29][30][31] 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' ".[27][32] Narrower operational definitions of
hypomania were developed in the 1960s and 1970s.

See also
Bipolar disorder
Bipolar I
Bipolar II
Borderline personality disorder
Clinical depression
Creativity and mental illness
Cyclothymia
Hyperthymic temperament
Bertram D. Lewin
Mania
Narcissistic personality disorder
People with bipolar disorder
Regression (psychology)
Schizoaffective disorder
References
1. "History and Etymology for hypomania" (https://www.merriam-webster.com/dictionary/hypom
ania#:~:text=%3A%20a%20mild%20mania%20especially%20when%20part%20of%20bipol
ar%20disorder). www.merriam-webster.com Merriam Webster. Retrieved 25 June 2021.
2. Drs; Sartorius, Norman; Henderson, A.S.; Strotzka, H.; Lipowski, Z.; Yu-cun, Shen; You-xin,
Xu; Strömgren, E.; Glatzel, J.; Kühne, G.-E.; Misès, R.; Soldatos, C.R.; Pull, C.B.; Giel, R.;
Jegede, R.; Malt, U.; Nadzharov, R.A.; Smulevitch, A.B.; Hagberg, B.; Perris, C.; Scharfetter,
C.; Clare, A.; Cooper, J.E.; Corbett, J.A.; Griffith Edwards, J.; Gelder, M.; Goldberg, D.;
Gossop, M.; Graham, P.; Kendell, R.E.; Marks, I.; Russell, G.; Rutter, M.; Shepherd, M.; West,
D.J.; Wing, J.; Wing, L.; Neki, J.S.; Benson, F.; Cantwell, D.; Guze, S.; Helzer, J.; Holzman,
P.; Kleinman, A.; Kupfer, D.J.; Mezzich, J.; Spitzer, R.; Lokar, J. "The ICD-10 Classification of
Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (https://w
ww.who.int/classifications/icd/en/bluebook.pdf) (PDF). www.who.int World Health
Organization. Microsoft Word. bluebook.doc. pp. 91, 95. Retrieved 23 June 2021 – via
Microsoft Bing.
3. Hypomania Hypomanic Episode (https://www.psychologytoday.com/us/basics/hypomania)
Psychology Today Retrieved 25 June 2021
4. Mania and Hypomania (http://www.patient.co.uk/doctor/Mania-and-Hypomania.htm)
Archived (https://web.archive.org/web/20150402133658/http://www.patient.co.uk/doctor/Man
ia-and-Hypomania.htm) 2015-04-02 at the Wayback Machine
5. Understanding Hypomania and Mania (http://www.mind.org.uk/information-support/types-of-
mental-health-problems/hypomania-and-mania/) Archived (https://web.archive.org/web/2015
0327055443/http://www.mind.org.uk/information-support/types-of-mental-health-problems/hy
pomania-and-mania) 2015-03-27 at the Wayback Machine
6. "Bipolar Disorder in Adults" (https://web.archive.org/web/20150501023521/http://www.nimh.
nih.gov/health/publications/bipolar-disorder-in-adults/Bipolar_Disorder_Adults_CL508_144
295.pdf) (PDF). NIH Publication No. 12-3679. National Institute of Mental Health. 2012.
Archived from the original (http://www.nimh.nih.gov/health/publications/bipolar-disorder-in-a
dults/Bipolar_Disorder_Adults_CL508_144295.pdf) (PDF) on 2015-05-01.
7. Goodwin, Guy (2 January 2018). "Hypomania: What's in a name?" (https://doi.org/10.1192%
2Fbjp.181.2.94). British Journal of Psychiatry. 181 (2): 94–95. doi:10.1192/bjp.181.2.94 (http
s://doi.org/10.1192%2Fbjp.181.2.94).
8. British Psychological Society, National Collaborating Centre for Mental Health (Great
Britain), National Institute for Health and Clinical Excellence (Great Britain) (2006). Bipolar
Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in
Primary and Secondary Care (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0015285/).
Leicester; London: British Psychological Society; Royal College of Psychiatrists. ISBN 978-
1-85433-441-1. Archived (https://web.archive.org/web/20180509172542/https://www.ncbi.nl
m.nih.gov/pubmedhealth/PMH0015285/) from the original on 9 May 2018. Retrieved
3 December 2015.
9. Doran, Christopher (2008). The hypomania handbook : the challenge of elevated mood (http
s://books.google.com/books?id=uzkvHhsO0vcC&q=Hypomania). Philadelphia: Wolters
Kluwer Health/Lippincott Williams & Wilkins. p. 16. ISBN 9780781775205. Retrieved
3 December 2015.
10. Kaufman, James (2014). Creativity and mental illness (https://books.google.com/books?id=j
CwDBAAAQBAJ&q=Hypomania+creativity&pg=PA214). Cambridge: Cambridge University
Press. p. 214. ISBN 9781316003626. Retrieved 3 December 2015.
11. Ghaemi, S Nassir (2003). Mood disorders : a practical guide (https://books.google.com/book
s?id=W7goUswFLw0C&q=hyperthymia&pg=PA48). Philadelphia: Lippincott Williams &
Wilkins. p. 48. ISBN 9780781727839. Retrieved 4 December 2015.
12. Bloch, Jon (2006). The everything health guide to adult bipolar disorder : reassuring advice
to help you cope (https://archive.org/details/everythinghealth00bloc). Avon, Mass.: Adams
Media. p. 12 (https://archive.org/details/everythinghealth00bloc/page/12).
ISBN 9781593375850. Retrieved 4 December 2015. "hyperthymia."
13. "Cyclothymia" (https://www.behavenet.com/capsules/path/cyclothymia.htm). BehaveNet
Clinical Capsules. Retrieved 2008-01-03.
14. "Bipolar II Disorder" (https://www.behavenet.com/capsules/disorders/bip2dis.htm).
BehaveNet Clinical Capsules. Retrieved 2008-01-03.
15. Post Robert M (2007). "Kindling and sensitization as models for affective episode
recurrence, cyclicity, and tolerance phenomena". Neuroscience & Biobehavioral Reviews.
31 (6): 858–873. doi:10.1016/j.neubiorev.2007.04.003 (https://doi.org/10.1016%2Fj.neubiore
v.2007.04.003). PMID 17555817 (https://pubmed.ncbi.nlm.nih.gov/17555817).
S2CID 21258139 (https://api.semanticscholar.org/CorpusID:21258139).
16. Drug-Induced Dysfunction in Psychiatry. Matcheri S. Keshavan and John S. Kennedy,
Editors (Taylor & Francis, 1992).
17. Bipolar Disorder: A Summary of Clinical Issues and Treatment Options. Bipolar Disorder
Sub-Committee, Canadian Network for Mood and Anxiety Treatments (CANMAT). April
1997
18. Daniel Fulford; Sheri L. Johnson; Charles S. Carver (December 2008). "Commonalities and
differences in characteristics of persons at risk for narcissism and mania" (https://www.ncbi.n
lm.nih.gov/pmc/articles/PMC2849176). J Res Pers. 42 (6): 1427–1438.
doi:10.1016/j.jrp.2008.06.002 (https://doi.org/10.1016%2Fj.jrp.2008.06.002). PMC 2849176
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2849176). PMID 20376289 (https://pubmed.
ncbi.nlm.nih.gov/20376289).
19. Hilty, Donald M.; Leamon, Martin H.; Lim, Russell F.; Kelly, Rosemary H.; Hales, Robert E. (8
January 2017). "A Review of Bipolar Disorder in Adults" (https://www.ncbi.nlm.nih.gov/pmc/a
rticles/PMC2963467). Psychiatry (Edgmont). 3 (9): 43–55. ISSN 1550-5952 (https://www.wor
ldcat.org/issn/1550-5952). PMC 2963467 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC29
63467). PMID 20975827 (https://pubmed.ncbi.nlm.nih.gov/20975827).
20. Drs; Sartorius, Norman; Henderson, A.S.; Strotzka, H.; Lipowski, Z.; Yu-cun, Shen; You-xin,
Xu; Strömgren, E.; Glatzel, J.; Kühne, G.-E.; Misès, R.; Soldatos, C.R.; Pull, C.B.; Giel, R.;
Jegede, R.; Malt, U.; Nadzharov, R.A.; Smulevitch, A.B.; Hagberg, B.; Perris, C.; Scharfetter,
C.; Clare, A.; Cooper, J.E.; Corbett, J.A.; Griffith Edwards, J.; Gelder, M.; Goldberg, D.;
Gossop, M.; Graham, P.; Kendell, R.E.; Marks, I.; Russell, G.; Rutter, M.; Shepherd, M.; West,
D.J.; Wing, J.; Wing, L.; Neki, J.S.; Benson, F.; Cantwell, D.; Guze, S.; Helzer, J.; Holzman,
P.; Kleinman, A.; Kupfer, D.J.; Mezzich, J.; Spitzer, R.; Lokar, J. "The ICD-10 Classification of
Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines" (https://w
ww.who.int/classifications/icd/en/bluebook.pdf) (PDF). www.who.int World Health
Organization. Microsoft Word. bluebook.doc. pp. 91, 95. Retrieved 23 June 2021 – via
Microsoft Bing.
21. "Hypomanic Episode" (https://www.behavenet.com/capsules/disorders/hypomanicep.htm).
BehaveNet Clinical Capsules. Retrieved 2008-01-03.
22. "Hypomania and mania" (http://www.awp.nhs.uk/advice-support/conditions/hypomania-and-
mania/). NHS. Retrieved 2019-07-04.
23. "Mania and hypomania" (https://bnf.nice.org.uk/treatment-summary/mania-and-hypomania.ht
ml). bnf. Retrieved 2019-07-03.
24. Mendhekar, D. N.; Gupta, D.; Girotra, V. (13 June 2003). "Sertraline‐induced hypomania: a
genuine side‐effect". Acta Psychiatrica Scandinavica. wileyonlinelibrary. 108 (1): 70–72.
doi:10.1034/j.1600-0447.2003.00080.x (https://doi.org/10.1034%2Fj.1600-0447.2003.00080.
x). PMID 12807380 (https://pubmed.ncbi.nlm.nih.gov/12807380). S2CID 36573538 (https://a
pi.semanticscholar.org/CorpusID:36573538).
25. Mendhekar, D. N.; Gupta, D.; Girotra, V. (1 July 2003). "Sertraline‐induced hypomania: a
genuine side‐effect". Department of Psychiatry. DCBI. 108 (1): 70–4. doi:10.1034/j.1600-
0447.2003.00080.x (https://doi.org/10.1034%2Fj.1600-0447.2003.00080.x). PMID 12807380
(https://pubmed.ncbi.nlm.nih.gov/12807380). S2CID 36573538 (https://api.semanticscholar.o
rg/CorpusID:36573538).
26. "Medications used when high (hypomania/mania)" (https://bnf.nice.org.uk/treatment-summar
y/mania-and-hypomania.html). bipolaruk. Retrieved 2019-07-03.
27. Emanuel Mendel (1881) Die Manie, p. 36: "Hypomanie" (https://books.google.com/books?id
=sMdnAAAAIAAJ&pg=PA36), Urban & Schwarzenberg, Vienna and Leipzig (in German)
28. Thomas, P (April 2004). "The many forms of bipolar disorder: a modern look at an old
illness". Journal of Affective Disorders. 79: 3–8. doi:10.1016/j.jad.2004.01.001 (https://doi.or
g/10.1016%2Fj.jad.2004.01.001). PMID 15121341 (https://pubmed.ncbi.nlm.nih.gov/151213
41).
29. Baldwin et al. (1902) Dictionary of Philosophy and Psychology, p. 101: "Monomania" (http
s://archive.org/details/beginningthirdr00randgoog/page/n131), Macmillan: New York;
London
30. James Johnson, M.D., Ed. (1843) "Notices of Some New Works: Dr.H. Johnson on Mental
Disorders", The Medical-Chirurgical Review, Vol. 39, p. 460: Hypomania (https://books.goog
le.com/books?id=jugEAAAAQAAJ&pg=PA460)
31. Henry Johnson (1843) On the Arrangement and Nomenclature of Mental Disorders,
Longmans, London, OCLC 706786581 (https://www.worldcat.org/oclc/706786581)
32. Edward Shorter (2005) A Historical Dictionary of Psychiatry, p.132 (https://books.google.co
m/books?id=M49pEDoEpl0C&pg=PA133#v=onepage&q=mendel%20hypomania), Oxford
University Press, US ISBN 978-0-19803-923-5

External links
Hypomanic Episode – Bipolar Disorder (https://web.archive.org/web/20090202111050/http://
www.bipolardisordersymptoms.info/hypomanic-episode.htm)

Retrieved from "https://en.wikipedia.org/w/index.php?title=Hypomania&oldid=1087142246"

This page was last edited on 10 May 2022, at 16:40 (UTC).

Text is available under the Creative Commons Attribution-ShareAlike License 3.0;

additional terms may apply. By
using this site, you agree to the Terms of Use and Privacy Policy. Wikipedia® is a registered trademark of the
Wikimedia Foundation, Inc., a non-profit organization.