hypomanic by Michael Witte

Hypomania [hahy-puh-mey-nee-uh] (literally, ‘below mania’) is a milder former of mania (elevated mood) and is a state characterized by persistent and pervasive elevated (euphoric) or irritable temperament . It is most often associated with the bipolar spectrum. Many who are in a hypomanic state are extremely energetic, talkative, confident, and assertive. They may have a flight of ideas and feel creative.Many people also experience signature hypersexuality.

While hypomania often generates productivity and creativity, it can become troublesome if the subject engages in risky behaviors. Individuals in a hypomanic state have a decreased need for sleep, are extremely outgoing and competitive, and have a great deal of energy. However, unlike with full mania, those with hypomanic symptoms are often fully functioning.

A number of sources have argued that individuals suffering from hypomania are actually more productive, risk accepting, and goal oriented than usual, such as psychologist John D. Gartner in ‘The Hypomanic Edge.’ Many individuals who experience hypomania become extremely goal-oriented, sometimes to an almost obsessive degree. However, unlike mania, individuals in a hypomanic state are often able to keep these goals rational and concise, and can plan around them accordingly. It is for this reason that Gartner asserts that many leaders throughout history have experienced some sort of mental condition that accurately reflects the characteristic of the hypomanic episode. Moreover, the assertion that a great number of historic figures such as Abraham Lincoln and Sir Isaac Newton suffered from various forms of depression throughout their lives leads the author to conclude that many high-achieving individuals throughout human history have most likely suffered from some form of bipolar disorder.

Specifically, hypomania is distinguished from mania by the absence of psychotic symptoms and grandiosity, and by its lesser degree of impact on functioning. Hypomania is a feature of bipolar II disorder and cyclothymia, but can also occur in schizoaffective disorder. Hypomania is also a feature of bipolar I disorder as it arises in sequential procession as the mood disorder fluctuates between normal mood 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. A significant 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, seemingly endless energy, and a desire and drive for success. A lesser form of hypomania is called hyperthymia.

While most often associated with bipolar disorder, hypomania is also a side effect of numerous medications, often those used in psychopharmacotherapy. In cases of true drug-induced hypomania, discontinuation of the antidepressant or drug that has triggered the episode—for example steroid therapy or stimulants such as amphetamine—usually causes a fairly swift return to normal mood. It is less likely to be a side effect in those with pure clinical depression or unipolar depression, unless for example tricyclic antidepressants are given in very high doses. SSRIs are less likely to trigger manic symptoms.

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.

Though Gartner argues that hypomania is better understood as a stable non-pathological temperament rather than an episode of mental illness, the DSM however clearly defines hypomania as an aberrant state, not a stable trait. The DSM-IV 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, 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 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, reckless driving, or foolish business investments).

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 overconfident and very charismatic, yet—unlike those with full-blown mania—are sufficiently capable of coherent thought and action to participate in everyday activities. Like mania, there seems to be a significant correlation between hypomania and creativity. A person in the state of hypomania might be immune to fear and doubt and have negligible social and sexual inhibition. People experiencing hypomania usually have very strong sex-drive. Hypomanic people are often the ‘life of the party.’ They may talk to strangers easily, offer solutions to problems, and find pleasure in small activities. Such advantages may render them unwilling to submit to treatment, especially when disadvantages are minimal.

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 the depressive episodes are routinely during the winter and the hypomania presents in the spring/summer it is possible that the person may be diagnosed with Seasonal Affective Disorder instead of bipolar II disorder. If left untreated, hypomania can transition into mania and sometimes psychosis, in which case, bipolar I disorder is often diagnosed.

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.

Gartner’s book ‘The Hypomanic Edge’ claims notable people including Christopher Columbus, Alexander Hamilton, Andrew Carnegie, 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.

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