Hypomania

Hypomania is a state involving combinations 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.

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.

Treating Hypomania
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.

Anecdotal evidence suggests that a single "loading dose" of valproic acid (a higher dose than usual, intended to elevate blood levels of the medicine to steady-state immediately, e.g. 1000-2000mg) may be efficacious in managing hypomania, and potentially also in preventing it from progressing into a manic episode. As always, consult your doctor before relying on such anecdotes.

See also: Mania