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Hypomania: All you need to know

"A hypomanic does not feel like taking rest, is highly energetic all the time, and classically, there is a decreased need for sleep" says Dr Prashant Dash, MBBS, MD Medicine, MBA, chief medical director, DocOnline




Hypomania, even though associated with bipolar disorder, can also occur on its own. A form of mental illness, hypomania is characterised by a period of ‘over-activeness’ which can impact the day-to-day functioning of a person suffering from depression, according to established studies. “Hypomania is characterised by elevated mood in addition to behaviour change including increased energy, increased confidence, increased activity, impulsivity, irritability, disinhibition, and a reduced need for sleep,” as per American Psychological Association (APA, 1994 and World Health Organization (2010).

Less severe than mania, which can last for a week and may cause impairment in an individual, hypomania is said to be “common” in those experiencing type-2 bipolar disorder which is often triggered by less and disturbed sleep, drug abuse and high levels of stress.

While the burst of energy is sometimes associated with ‘increasing creativity and productive energy’, it is one of the most worrisome suspicion of bipolar disorder, as per various studies.

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Signs and symptoms

As per National Center for Biotechnology Information (NCBI) 2018-study, Hypomania Symptoms Across Psychiatric Disorders, “hypomanic episodes last for a distinct period of four or more days, with elevated, expansive or irritable mood, among other symptoms that are observable by others but of insufficient severity or compromise of functionality to meet criteria for full-fledged mania episodes. While mania is more distinctive and easier to identify than hypomania, manic episodes are significantly less frequent than hypomania, and occur only in a specific subtype of Bipolar Spectrum Disorders (BSD). Thus, accurately identifying a current or prior episode of hypomania is decisive for the differential diagnosis of BSD.”

Dr Prashant Dash, MBBS, MD Medicine, MBA, chief medical director, DocOnline tells indianexpress.com about the condition.

“A hypomanic does not feel like taking rest, is highly energetic all the time, and classically, there is a decreased need for sleep. Other associated characteristics may include:
*Increased confidence
*Racing thoughts/Ideas
*More talkative/jokes around
*Engaged in multi-tasking
*Easy distractibility
*Impulsive risky behavior such as unwanted shopping spree, foolish business investments, or engaging in inappropriate sexual activities.”

“Usually, the increased functional capacity and other characteristics are only seen during hypomanic episodes in an otherwise normal person. It does not cause issues with work or socialising. But, if these issues are not related to substance abuse or medications, then you may need to talk to a doctor for suspicion of BSD. Bipolar disorder can not be left untreated as it may lead to serious problems,” asserted Dr Dash.

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Treatment

As per Psychiatric Issues in Neurologic Practice book by Barry S Fogel, Melissa Frumin, in Office Practice of Neurology (second edition), 2003, patients with hypomania, or with a history of hypomania and depression, need ‘mood-stabilising medication’. ‘The first mood-stabilising medication of proven benefit was lithium, which remains the treatment of choice for bipolar disorder with prolonged manic and depressive episodes. It was subsequently discovered that carbamazepine and valproate were effective for bipolar disorder and might be superior to lithium for patients with mixed manic and depressive symptoms or with rapid alternation between hypomania and depression. The efficacy of antiepileptic drugs for mood disorders is not predicted by any electroencephalographic finding,’ as per the book.

As per Harvard Health, for mild or moderate episodes, it may be possible for a person to deal with hypomania by adopting basic healthy lifestyle habits. That means eating regular meals, doing physical activity every day to burn away extra energy, and trying to get at least seven or eight hours of sleep per night. It also states that it may help to learn to recognise common triggers of hypomania, such as sleep deprivation or too much caffeine.

“Keep a check on mood swings, make a note in diary, talk to your psychiatrist regularly via teleconsultation, take your medicines regularly, don’t stop the treatment on your own, and ask for help, whenever needed,” said Dr Dash.

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