by Tobi Mattingly

Created on: October 04, 2010   Last Updated: October 07, 2010

Bipolar disorder is a complex and confusing illness, difficult to diagnose because of the many ways it can manifest.  Many people associate bipolar disorder with its previous name, manic depression, and particularly the severe highs that a person experiences during an episode of mania: delusions, psychosis and so on.  However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) divides bipolar disorder into four distinct subcategories: Bipolar I, Bipolar II, Cyclothymia, and Bipolar Disorder Not Otherwise Specified.

Hypomania is a symptom of bipolar II disorder.  In fact, it is the single symptom that most distinctly differentiates bipolar II from traditional bipolar I.  In bipolar I, a person moves back and forth between periods of severe depression and severe mania.  A person suffering from Bipolar II will fall into the same depths of depression, but will never reach a full-blown manic episode; switching instead to a period of hypomania.

The word hypomania literally means “little” mania.  A person in the midst of a hypomanic episode is subject to most of the same symptoms as someone in the throes of mania, but will experience them in less severity.  These could include elevated mood, decreased need for sleep, rapid or “pressured” speech and racing thoughts, and difficulty staying focused.

The most significant difference between mania and hypomania is that someone in a hypomanic episode will never experience delusions and other psychotic symptoms.  This does not mean that a hypomanic state is not dangerous, though.  A person in hypomania is likely to impulsively engage in pleasurable but high-risk behaviors, such as rampant shopping sprees or uncharacteristic sexual activity.

Many people experiencing hypomania find themselves more productive and generally feeling great during an episode, particularly if it has followed a recent depression.  Friends and family, however, are more likely to recognize this behavior as another state in the person’s illness.

Hypomania does not always necessarily manifest itself in an elevated or “happy” mood.  In some people, it can instead be experienced as a distinct period of irritability. In his book “Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder,” psychiatrist Jim Phelps, M.D., states the following:

“Unfortunately, ‘hypomania’ is quite a mis-naming. There are many patients whose ‘hypomanic’ phases are an extreme and very negative experience… The ‘racing thoughts’ can have a very negative focus, especially self-criticism. The high energy can be experienced as a severe agitation, to the point where people feel they must pace the floor for hours at a time. Sleep problems can show up as insomnia: an inability to sleep, rather than decreased need.”

For a person whose hypomania manifests in this more negative manner, the hypomanic episode is commonly misdiagnosed as continued depression.  In these cases the first course of action is typically to prescribe antidepressants, which tend to either cease working after a period of time or never have any effect at all in someone with a bipolar spectrum mood disorder.  Better effectiveness is found in treating bipolar II with the same types of mood stabilizers that are used to treat bipolar I, such as Depakote, Lamictal, Tegretol and Trileptal.

Getting a proper diagnosis and finding effective treatment for bipolar II disorder is critical, as untreated hypomanic episodes can progress into mania.

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