Bipolar Disorder And Hypomania: How A Hypomanic Episode Can Affect Mental Health
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People with bipolar disorder (BD) often face challenges in several areas of daily life. Bipolar disorder symptoms can be disruptive and, when unaddressed, may lead to serious comorbidities and other concerns. One such symptom is hypomania.
This post explores hypomania as a symptom of bipolar disorder, how to recognize it, and how it can affect an individual’s mental health. It also offers suggestions for coping with hypomania and where to seek support to help you balance your moods. To better understand hypomania as a symptom, it may help to first learn more about bipolar disorder.
What are the keys to understanding bipolar disorder?
Bipolar disorder is a mental health condition typically characterized by extreme shifts in mood, energy, and activity levels. People with BD typically swing between periods of mania (or hypomania) and depression. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) classifies five subtypes of BD under the umbrella of bipolar and related disorders. The most common of these include bipolar I (which involves severe manic episodes and depression), bipolar II (which involves hypomania and depression), and cyclothymic disorder (which involves milder, chronic mood swings). Additional subtypes include “other specified bipolar and related disorders” and “unspecified bipolar or related disorders.”
What are some common misconceptions about bipolar disorder?
Misconceptions around bipolar disorder tend to be common, perhaps due to stigma and misunderstanding. One misconception is that people with BD are always either manic or depressed. In reality, individuals with bipolar disorder can experience mixed states, where they have symptoms of both mania and depression at the same time. They can also have periods of euthymia, or balanced mood, between episodes. Other misconceptions include the following:
- BD is an “adulthood” disorder: While often diagnosed in adolescence or adulthood, bipolar disorder can also affect children and teenagers.
- People with BD are violent: People with bipolar disorder are not inherently violent, though irritability and impulsivity during a manic episode may lead to aggressive behavior.
- People with BD must be hospitalized for treatment: Many people with BD never need inpatient care. Symptoms are often managed with outpatient mental health support.
- Medication is the only way to treat BD: While medication is often an integral part of treatment, combining it with therapy, lifestyle changes, and support can lead to better outcomes.
What are symptoms of bipolar I disorder?
Bipolar I disorder is typically characterized by extreme episodes of mania and major depression. For a diagnosis, the individual must experience manic symptoms that last for at least one week or are severe enough to require hospitalization.
What are manic symptoms of bipolar I disorder?
Symptoms of manic episodes in people with BD I might include those listed below:
- Elevated mood
- Increased energy
- Racing thoughts and speech
- Impulsive behavior
- Decreased need for sleep
What are depressive symptoms?
Individuals with bipolar I typically experience depressive episodes, which can involve the following symptoms:
- Persistent sadness
- Fatigue and low energy
- Loss of interest in activities once enjoyed
- Difficulty concentrating
- Suicidal ideation
What about bipolar II disorder?
Bipolar I and bipolar II disorder share several of the same core symptoms, such as mood swings. However, they do have differences. The primary difference between the two lies in the type and severity of the mania/hypomania episodes one experiences. Both types of bipolar disorder feature depressive episodes, but people with bipolar I typically have more intense, full-blown manic episodes, while people with bipolar II have less severe episodes of mania called hypomanic episodes.
What is hypomania?
Common signs of a hypomanic episode
Hypomania can emerge differently between people. People experiencing hypomania may not realize they are experiencing an episode, as hypomania can seem like a particularly good or productive period. However, when such behaviors are out of character or inappropriate for the situation, they may create unique challenges in an individual’s life. Below are a few signs of hypomania:
- Irritable or elevated mood: In addition to unusual high-spiritedness, hypomanic behaviors may include marked irritability and anxiety.
- Increased energy and activity: Individuals with hypomania may experience increased talking, restlessness, and a decreased need for sleep.
- Impulsivity: Risky behaviors like gambling, hypersexual behavior, and reckless spending are examples of impulsivity.
- Difficulty concentrating: Individuals may struggle to focus, experience racing thoughts, and be easily distracted.
What are the impacts of hypomania?
Overall, BD mood swings can lead to significant mental distress and strain. Difficulty in making sound decisions, focusing on tasks, and following through on plans can harm work or school productivity. Hypomania symptoms can also lead to impaired judgment, potentially creating significant challenges in an individual’s life. For example, the heightened energy and euphoria associated with hypomania can increase an individual’s sense of confidence. While such feelings can be positive, they aren’t always balanced and may lead to impulsive decisions like reckless spending, substance use, and engagement in risky sexual behavior. Such impulsive behaviors can strain relationships with family, friends, and romantic partners.
Hypomania and comorbid mental health conditions
Comorbidity can be defined as the co-occurrence of multiple disorders in one person. Previous research reveals that anxiety disorders and substance use disorders tend to be the most prevalent co-occurring psychiatric comorbidities for people with BD, and that individuals with BD are seven times more likely to develop comorbid borderline personality disorder (BPD).
More current research shows a distinct connection between BD and attention-deficit/hyperactivity disorder (ADHD) as well, with experts estimating that roughly one in six individuals with BD has comorbid ADHD. Additionally, medical comorbidities like asthma, thyroid issues, obesity, diabetes, and cardiovascular disease can be common.
Challenges of comorbidity and BD diagnosis
Comorbid conditions can complicate the diagnosis and treatment of bipolar disorder. Overlapping symptoms, such as depression and hypomania, can mask or be confused with the core features of BD, creating challenges in reaching an accurate diagnosis. Misdiagnosis can lead to ineffective, inappropriate, or delayed treatment. Comorbidities can also worsen the clinical course of bipolar disorder, leading to poorer outcomes, treatment response, and quality of life.
What are treatment options?
Bipolar disorder is a lifelong condition that, when left untreated, can progress into full-blown hypomania/mania or lead to major depressive episodes. Studies show that treatments combining medications, therapy, and lifestyle changes tend to be the most effective. If comorbid conditions are present, treatment plans are typically tailored to address them as well.
Medications prescribed for bipolar disorder usually include mood stabilizers, antipsychotics, and antidepressants. Therapeutic modalities like cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), and family-focused therapy can also be key to achieving successful outcomes. Lifestyle changes may include maintaining a consistent sleep schedule, prioritizing nutritious eating habits, and engaging in regular exercise.
Hypomanic episode management strategies
In therapy, individuals with BD may learn how to cope with hypomanic and depressive symptoms in daily life. For example, they may learn to recognize the early warning signs of a hypomanic episode with a mood diary and mindfulness activities. In therapy, individuals can learn to manage impulsivity and hypomanic episodes by using relaxation techniques like deep breathing and grounding exercises. Additionally, individuals may learn to identify and avoid certain stimuli and situations that may affect them negatively, such as stimulant use, excessive caffeine, and sleep deprivation.
Maintaining strong social support and open communication with loved ones, therapists, and doctors can provide a “safety net” during challenging times. Educating themselves and their loved ones about hypomania can help people know what steps to take if a hypomanic episode becomes severe.
Finding online support from a mental health professional
Working closely with a mental health professional to develop and adjust a treatment plan can be key for the effective management of hypomania. While it may not be appropriate in situations where individuals require more intensive care, virtual therapy may remove many of the treatment barriers faced by individuals with BD.
For example, some may have limited access to experienced mental health professionals in their area. Others may be reluctant to seek treatment due to fear of stigma or judgment. Platforms like BetterHelp allow people to speak with a therapist experienced in treating BD from the comfort of their home on a schedule that fits their needs—no need to travel to appointments and attend sessions in an office environment.
Is online therapy effective?
Current and ongoing research suggests that online therapy can be a viable and effective approach for treating BD. For example, one 2023 study found that iCBT (internet-delivered cognitive behavioral therapy) can effectively treat anxiety and depression in people diagnosed with bipolar disorder.
Takeaway
Is ADHD confused with bipolar?
ADHD can be confused with bipolar disorder because they have a lot of overlap. The two conditions share a number of symptoms, including mood changes, hyperactivity, and distractibility. Both are also believed to have a genetic component.
That said, there are features that distinguish these conditions from one another. Symptoms of ADHD are more persistent, while those of bipolar disorder are more cyclical. While many people are diagnosed with ADHD in adulthood, symptoms of ADHD initially develop in childhood. In contrast, the average age of onset for bipolar disorder is 25.
To ensure you get an accurate diagnosis, it can be important to work with a professional who understands both of these conditions. They can also occur together, which can make it easier for one or the other to be overlooked.
How do you know if you are hypomanic?
Hypomania is generally considered a less severe version of mania, and it’s part of the diagnostic criteria for a bipolar II diagnosis. A few symptoms of hypomania include an elevated or irritable mood, increased energy and activity, and risky behavior. This may involve the misuse of recreational drugs and sexual indiscretions like reckless sex. During a period of hypomania, these behaviors are observable to others, but the symptoms are not severe enough to significantly impact functioning or require hospitalization.
Is hypomania a symptom of ADHD?
Hypomania usually isn’t considered a symptom of ADHD. Instead, it’s part of a mood disorder called bipolar II disorder. However, ADHD and the state of hypomania may have some similar symptoms. Both ADHD and bipolar II disorder may be more common in individuals who have a family history of these disorders.
Some symptoms of ADHD and hypomania may seem to overlap, which can make it difficult to distinguish between the two. For example, people with ADHD and those experiencing hypomania may talk excessively, be easily distracted, make careless mistakes, and have a difficult time paying attention. People with ADHD may fidget and have a hard time sitting still, while those experiencing hypomania may exhibit signs or restlessness. They may act similarly in social situations, too, and both conditions can cause a lack of inhibition.
Can you be hypomanic without being bipolar?
Hypomania is usually associated with bipolar II disorder, but it may sometimes occur in individuals who do not have this condition. For example, someone with a brain injury may experience hypomania. It can also occur with tumors, dementia, and substance use, as well as some medical conditions, like lupus. People with some other mental health conditions, like major depressive disorder or borderline personality disorder, may also experience hypomanic states. Hypomania can mimic mania but usually involves milder symptoms. Sometimes, in cases of mania, psychotic features may arise.
What leads to hypomania?
A few potential situations that can contribute to an oncoming episode of increased energy and activity called hypomania include the following:
- Sleep deprivation
- Highly stimulating situations and environments
- Major life changes
- Substance use
- Certain social situations
- Hormonal changes, such as during menopause or the postpartum periods
How long does it take to recover from a hypomanic episode?
Most hypomanic episodes last for a few days; in fact, to be considered a true hypomanic episode, they have to last for at least four days. However, they may sometimes last for weeks. Working with a mental health specialist like a therapist can help people who experience hypomania regulate their moods.
What does the end of a hypomanic episode look like?
The end of a hypomanic episode often involves a gradual decrease in energy and activity, leading to usual behavior. A low mood or depression symptoms may develop in some cases.
According to the Cleveland Clinic, to be considered hypomania, the episode must last at least four days. Afterwards, someone may feel happy, embarrassed, or overwhelmed about what occurred during the episode. They may not remember everything that happened, and they may feel very tired. In some cases, people with bipolar disorder may experience signs of depression after a hypomanic episode.
How can you help someone in hypomania?
Talking to the individual about what they’re experiencing and providing them with resources from organizations like the American Psychiatric Association, the Substance Abuse and Mental Health Services Administration, and the National Institute of Mental Health may be helpful. You might also recommend that they seek professional support, particularly if they also live with other mental health conditions or are experiencing other symptoms that you find worrisome.
According to the International Bipolar Foundation, some ways to help someone who is experiencing mania include:
- Avoiding being combative or condescending
- Giving them space
- Not taking things personally
- Protecting them from harm, including physical and financial harm
- Keeping them company
- Proving general support
You can also talk to the person ahead of time and agree on how and when you should interject. For example, you may want to ask them if it is okay for you to take their phone away from them during an episode or when you should call their doctor.
What calms hypomania?
A consistent routine and healthy habits can calm hypomania in some cases. Therapy and prescription medication may also be helpful when a patient presents with hypomania symptoms.
Some specific strategies that may help include:
- Learning about your triggers
- Monitoring your mood patterns
- Picking up on early warning signs
- Making a plan for what to do when you begin to feel an episode coming on ahead of time
- Stick to a regular sleep routine
- Avoid stimulating environments
- Practice meditation or deep breathing exercises to stay calm
- Be diligent about taking any medication, using alarms and reminders if needed
- Manage stress
- Get regular exercise
How can you deal with hypomania irritability?
Therapy tends to be one of the best resources to learn how to manage challenging emotions. A regular routine and frequent exercise can also be helpful in regulating mood, as can sticking to a regular sleep schedule, avoiding stimulating environments, practicing meditation or yoga, and learning how to manage stress effectively.
- Learning about your triggers
- Monitoring your mood
- Learning your warning signs
- Avoiding caffeine and alcohol
- Engaging in activities you find calming
- Making time to relax
- Managing finances
- Setting alarms to remind you to take your medication on time
- Prioritizing sleep
- Getting regular exercise
- Turning to your support system
What is the best treatment for hypomania?
Therapy and medication are the most common treatment options for hypomania. Often, these are most effective alongside lifestyle changes like a consistent sleep schedule, nutritious eating habits, and regular exercise. If you’re experiencing signs of hypomania, talk to your doctor or a mental health professional to learn more about next steps.
How long is a hypomanic episode?
To be considered hypomania, an episode has to last for at least 4 days, but it can last up to weeks or months at a time. These episodes feature a number of symptoms, including inflated self-esteem, decreased need for sleep, flight of ideas, distractibility, and more. These changes are noticeable and observable by others but are not severe enough to impair overall functioning or require hospitalization.
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