- This article is an expansion of a section entitled Hypomania from within the main article: Bipolar disorder
Hypomania is a state involving a combination of: elevated mood, irritability, racing thoughts, people-seeking, hypersexuality, grandiose thinking, religiosity, and pressured speech. Bipolar II Disorder is characterized by states of hypomania and depression. Hypomania is a less severe form of mania without progression to psychosis.
Many of the symptoms of mania are present, but to a lesser degree than in overt mania. People with hypomania are generally perceived as being energetic, euphoric, overflowing with new ideas, and sometimes highly confident and charismatic, and unlike full-blown mania, they are sufficiently capable of coherent thought and action to participate in everyday life. Hypomania is classified as a bipolar II disorder.
Although the DSM-IV-TR classifies hypomania as a mood episode, it is only considered part of bipolar disorder in the context of cycles into depression or more severe mania. A small percentage of the population may experience hypomania without ever having experienced depression or mania. Although some of these people may require treatment or therapy, according to DSM criteria they do not have bipolar disorder.
John D. Gartner's The Hypomanic Edge (Simon and Schuster) "draws a line between hypomania - recognized by such markers as inflated self-esteem, a decreased need for sleep, and episodes of risky behavior - and its far more dangerous cousin, mania." He then goes on to illustrate his thesis that there may be an "up" side to the less dangerous hypomania. His thesis includes a strong link between, "(a little) Craziness and (a Lot of) Success"; the book features short biographies of such overachievers as Christopher Columbus, Alexander Hamilton, and Andrew Carnegie. It is questionable whether hypomania occurs without being part of a cycle of mania or depression. Patients rarely, if ever, seek out a psychiatrist complaining of hypomania. Gartner contends that many famous people including Christopher Columbus, Alexander Hamilton, Andrew Carnegie, Louis B Mayer, and Craig Venter (who mapped the human genome) owed their ideas and drive (and eccentricities) to their hypomanic temperaments (it is called the hyperthymic temperament in clinical research). The creativity and risky behavior associated with hypomania (and bipolar disorder in general) may suggest why it has survived evolutionary pressures.
Although hypomania sounds in many ways like a desirable condition, it can have significant downsides. Many of the negative symptoms of mania can be present; the primary differentiating factor is the absence of psychosis. Many hypomanic patients have symptoms of disrupted sleep patterns, irritability, racing thoughts, obsessional traits, and poor judgment. Hypomania, like mania, can be associated with recklessness, excessive spending, risky hypersexual activity, general lack of judgment and out-of-character behaviour that the patient may later regret and may cause significant social, interpersonal, career and financial problems.
Hypomania can also signal the beginning of a more severe manic episode, and in people who know that they suffer from bipolar disorder, can be viewed as a warning sign that a manic episode is on the way, allowing them to seek medical treatment while they are still sufficiently self-aware before full-blown mania occurs.
It is classified there as a period of elevated, expansive or irritable mood which lasts at least 4 days which is "clearly different from the usual non-depressed mood" and satisfies a number of additional criteria.
Surprisingly, there are no studies on treating hypomania. Virtually all clinical trials of bipolar medications involve treating patients for severe mania during the acute (initial) phase of mania. Recommended medications doses are based on these trials, where high doses are justified in order to remove the patient from danger. Treating hypomania, however, involves different considerations and demands far greater clinical judgment.
On the one hand, mild hypomania may be a legitimate baseline for many patients, requiring either no medications or only low doses of medication. Medication should simply "take the edge off the edge," in Dr Gartner's words, rather than sedate the personality out of a patient. Dr Gartner contends that clinicians who overmedicate in these situations risk having their patients becoming noncompliant.
On the other hand, hypomania may herald the beginning of a dangerous cycle into more severe mania, which requires immediate intervention. Additionally, the DSM-IV fails to account for mixed states in hypomania, such as depression and irritability, what Trisha Suppes MD, PhD of the University of Texas, Dallas, describes as classic "road rage" cases.
Famous people with hypomania
Hypomanics are commonly found in the world of music. Recently, Radiohead front man Thom Yorke admitted "Hypomania? Yes, that's exactly what it was", when asked about his mental complexion after the release of their classic album OK Computer.
It is also suggested that Richey Edwards, the "fatalistic Manic Street Preacher" (Mojo magazine, 2003) suffered from the same condition as Yorke.
Syd Barrett of the band Pink Floyd has also reportedly suffered from hypomania.
Depression and hypomania
In a patient with bipolar disorder, when the depressive phase has ended, some laypeople may think that the patient is in hypomania because they are acting so different from their "usual" depressed self, doing everyday activities that they were completely incapable of when in the depressed phase, and trying to catch up on activities they fell behind on during the depressive phase, such as cleaning, organizing, and paperwork. Care should be taken at this stage not to induce anxiety in the patient, since excessive anxiety can contribute to and aggravate a manic state. Workaholism and hypomania are easily mistaken for each other.
See also: Mania