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What is the Difference Between Mania and Hypomania?

One of the main differences between bipolar I and bipolar II is that bipolar II experiences hypomania and not mania. Last week I wrote from the perspective of a hypomanic mind, but what is hypomania really? Is hypomania fun or is it just plain crazy?

Mania

In type I bipolar, a defining characteristic is mania. Mania symptoms include:

  • Abnormally and persistently elevated, expansive, or irritable mood
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility
  • Increase in goal-directed activity or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequence

applesoranges

In order for the mood to be considered manic, these symptoms must cause a “marked impairment in… functioning… or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features” (official diagnosis criteria).

It’s that last part that’s really key; mania must be severe and result in danger to yourself, others, relationships, employment, etc, typically leading to hospitalization.

Hypomania

For bipolar II we experience hypomania, which I like to call mania-light. All the crazy with half the impairment. It includes symptoms like:

  • A distinct period of persistently elevated, expansive, or irritable mood
  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual or pressure to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Distractibility
  • Increase in goal-directed activity or psychomotor agitation
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences

The mood must also be unusual for the individual and noticeable by others. And now the important part, “the episode is not severe enough to cause marked impairment in… functioning, or to necessitate hospitalization, and there are no psychotic features.” (official diagnosis criteria)

Diagnostically, mania must be at least seven days whereas hypomania has to be at least 4 days.

(Other complexities like mixed-moods and rapid cycling aren’t discussed here.)

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Mania vs. Hypomania

So if you’ve been paying attention, you’ll note that the symptoms of mania and hypomania are virtually identical, the key differentiator is the severity. Mania is very dangerous because people don’t just act abnormally; they typically endanger themselves or vital parts of their lives. Mania often requires hospitalization due to the damage they are doing. Hypomania, on the other hand, may be an unusual mood, and it may cause some harm to the person or their lifestyle, but not to the point where they need to be hospitalized. People in hypomania buy five pairs of shoes, people in a mania buy 50.

Is Hypomania Fun?

So, if hypomania doesn’t get you hospitalized, and doesn’t severely endanger your life, is it fun? Well, it depends who you ask.

Some people say hypomania is enjoyable, happy, fun and the only break they get from their depression. Some people feel they’re more like the person they were before bipolar disorder than at any other time. They’re also fun to be around, creative and are social butterflies at that time. Oh, and the sex tends to be really good too. So, yes, some people really enjoy hypomania and find it fun.

On the other hand, some people get extremely irritable and even angry during hypomanic phases. They become very dissociative and disconnected from the world around them. They feel constantly bombarded by thoughts they can’t control and obsessed with fragments of music or literature that repeats endlessly in their mind. They feel possessed and like they’re being crushed by a very fast, very powerful outside force they can’t control. This is not in the least bit fun.

I Prefer Hypomania

If I got to choose between mania, hypomania and depression, I’d pick hypomania. True, I do feel awfully crazy and disconnected from the world when going through it, and true, the obsessive thoughts are tormenting, but the energy is such a great change of pace from the depression that I’ll take it any day. I’m more creative, can put more energy into achieving goals, and just plain get more done.

But that’s a personal thing. Would anyone care to share their experiences with hypomania?

You can find Natasha Tracy on Facebook or @Natasha_Tracy on Twitter.

This entry was posted in Being Crazy, Hypomania, Understanding Mental Illness and tagged , , , , . Bookmark the permalink.

70 Responses to What is the Difference Between Mania and Hypomania?

  1. Vanessa Castellanos says:

    Also I have the need to go to the gym everyday no excuses but it does help me with my mood very much !

  2. Faye says:

    I haven’t been to my doctor about this because I wanted to read up on it first(great blog by the way, it was a great help) but from the symptoms described, I’m pretty sure I have hypomania. For about a year now, I’ve been.. well I think depressed? I’ll just sit in my room all day, talk as little as I can, I won’t go out, feel awful about my self, think about things over and over and just feel totally lost. But then about six months ago I started to feel really happy for no reason at random times. I’ll feel really happy and awesome about myself and my self-esteem will go through the roof! I’m also usually shy and awkward around people but in this crazy mood I’ll be running around like a little kid, laughing and singing in public. I’ll also get distracted really easily and want to bye everything. I kinda remind myself of a little kid when I’m like this. There are occasional times where I’m just ‘in the middle’, but normally I’m either really high or really low.

  3. Lee says:

    My husband was hypomanic with sociopathic tendencies. This made him “Fun and Funny and Bad with Money”!

  4. Katrika says:

    I guess I prefer depression when the hypomanic state becomes frightening or uncomfortable and I’m sort of desperate for sleep that might bring me back to a balance (especially if I’m having the obnoxious sounds or things seem to whiz through my field of vision).

    And I prefer hypomanic when in a deep and painful depression, because I’m so desperate to stop the pain. Especially when crying 4 hours straight.

    Most of all I prefer stability. But if I have to choose between hypo and depressed, I’d pick depressed. In all the pain of the depression, I’ve never had the fear of hospitalization. But in hypomanic states I have felt pretty sure I could be close to some kind of precipice where I might lose track of reality.

  5. Julia says:

    Bruce,

    Mixed episodes are the most dangerous of all the types, and they’re also the most difficult to treat. Of course this is in general.

    I suffer primarily from mixed episodes, period. I’m actually currently in one and have been for about a month. I did experience 5-6 weeks of relative normalcy for me prior to that, and these cycles are significantly slowed (ie longer lasting) from before. They are also mild to moderate rather than moderate to severe. Two medications have basically changed for me from the before, (stable on lithium at 1200 mg prior to these changes) and that was:
    1) a switch from effexor (375) to cymbalta (60, then raised to 90)
    2) the addition of seroquel (eventually raised to 300, considered to be the therapeutic dose from trials

    I also take two other meds, one for severe adhd and the other for idiopathic neuropathy (which just means they don’t know why I have it, so I actually call it *idiotic*)

    Lamictal was terrible for me; I got up to just before one of the later titrations, and I realized I hadn’t felt like myself in a while. The next day it was worse and I knew it was the lamictal, so my dr told me stop it. But I had like this paralyzing effect for three days straight, where I couldn’t move but I also couldn’t not move. It felt like I was being shocked, or so I thought.

    I take lithium, but aside from that, I would think it would be a first go-to in terms of choices for mixed episodes. The reason I say that is that the studies have clearly demonstrated an anti-manic effect, especially for acute phases, but it is also among the top in preventing suicidal feelings, gestures, and attempts. The combination of the two say “mixed” to me.

    It’s not uncommon for someone with bipolar (especially a more severe form . . .and I don’t mean I vs II here, but really just simple severity) to need a mood stabilizer and either an antidepressant of some type (usually at a lower dose, and *definitely* not added until after the mood stabilizer) or an anti-psychotic (usually atypical), and in some cases, both.

    As everyone always says, the right combo is different for each person. And over time, that combo can also change. Good luck!

  6. Eliza says:

    I recently,(in the last 6 months) was diagnosed with bipolar. I have been taking antidepressant medication (pristique 100) since the birth of my second child 5 years ago. I suffered post natal depression, (not sure how I got through that), with my first child 9 years ago. I did not seek treatment until the birth of my second as I was terrified to admit that I was not the perfect wife and mother. I have had a few changes of meds in the last 6 months. My gp started me on valproate with my pristique as he though I would not get into see my psych until 3 months. There was a cancellation and I got in the next day, he prescribed me lithium. In response to a previous comment, I agree that every person is different and may respond to different medications in a completely different manner. I have recently started lamictal on a low dose. Now I am taking lithium lamictal and pristique. Such a juggling act. Anyway in case you havn’t noticed I think I have hypomania right now due to lack of sleep and the extreme exercise program I have put myself on. I have been walking 7 kms, half up half down hills and doing 3km sprint intervals against wind resistance every day. This morning I woke up at 3am cleaned the house until 5.45am when it was daylight and started my exercise regime. I happily, said good morning to everyone then came home and reorganised the kitchen loungeroom and filing cabinet, still not really tired. Is this hypomania or mania. I am assuming hypomania because I must admit, if I don’t feel sick because my stomach is twisted with agitation and anxiety I love it!!!!!!

  7. Pascal says:

    thanks everyone for sharing their experiences.

    I much prefer the hypomania phase to the deep depression I experienced around the middle of last year. It lasted for months and I struggled with just getting out of bed and being present with my wife and 2 young sons.

    I’m pretty certain I’m in a hypomania phase right now. The difference is striking – I feel so much more engaged and interested in the world around me. I wake up before my alarm rather than struggling to get out of bed. I have so much more energy and motivation to do things. But it does have drawbacks – i get distracted easily. And i’ve noticed i’m more argumentative and less patient with people.

    I was diagnosed with Bipolar Type II early last year. It’s taken the better part of the year to find the right mix of medications. Lovan (aka Prozac) in the morning and Seroquel at night. it’s the best i’ve been feeling in quite some time.

  8. Devin Lee says:

    I have Bipolar 1 with psychotic features. I wish I could have stopped at hypomania. Oh well. I’ve been totally stable on my meds for 4 & 1/2 years now. Off drugs for 5 & 1/2. There is hope. I am a happy, level-headed girl now. It’s even better. (I was so sick that, just 10 years ago, they were going to keep me in the county hospital indefinately – I escaped!)I showed them!

  9. Tim says:

    My Girlfriend was originally diagnosed with GAD. But over the past year I’ve noticed a significant change in her moods. She has anxiety nearly 90% of the time with depression attacks once a week. In addition she has at least two or three sudden anger outbursts a week several really road rage incidents. She also has increased sexual desires which she has never had before. She told me the last depression attack she had was so bad she wanted to leave this earth. When she is in the depressed mode she said she has no romantic feeling for me or any love for anyone. She is taking 25mg of Zoloft but it does not seem to be working. I’m considering leaving the relationship because I cant take the depression attacks any more. She retires from teaching next week and I fear the issues are going to get worse. I an angry at her Therapist because I don’t think they have diagnosed her illness correctly. Her family is also very concerned. The bottom line is I cannot stay in a lopsided relationship any longer. Its not healthy for me. Any advice would be appreciated. thank you

  10. Timn says:

    My Girlfriend was originally diagnosed with GAD. But over the past year I’ve noticed a significant change in her moods. She has anxiety nearly 90% of the time with depression attacks once a week. In addition she has at least two or three sudden anger outbursts a week several really road rage incidents. She also has increased sexual desires which she has never had before. She told me the last depression attack she had was so bad she wanted to leave this earth. When she is in the depressed mode she said she has no romantic feeling for me or any love for anyone. She is taking 25mg of Zoloft but it does not seem to be working. I’m considering leaving the relationship because I cant take the depression attacks any more. She retires from teaching next week and I fear the issues are going to get worse. I an angry at her Therapist because I don’t think they have diagnosed her illness correctly. Her family is also very concerned. The bottom line is I cannot stay in a lopsided relationship any longer. Its not healthy for me. Any advice would be appreciated. thank you

  11. Julia says:

    Timn,
    I can hear your frustration and concern. I have a few questions more than any answers, I think.

    1) About the therapist. How often does your girlfriend see her therapist? Have you met the therapist? What kind of credentials does the therapist have–are they a Liscenced Professional Counselor (LPC), a social worker, a psychologist (PsyD or PhD)?

    2) Has your girlfriend ever seen a psychiatrist? or psychiatric nurse practictioner? Who is prescribing the Zoloft?

    3) What is your girlfriend’s attitude toward all this? For me, I think this would be the most important piece in determining what I as a significant other might do.

    The bottom line is that you want her to get the help she needs. If she wants it, that’s great. If she doesn’t, your hands are more tied, you may have some decisions to make, but you can still talk to her and offer suggestions.

    I don’t know her diagnosis, none of us do. She needs to see a specialist in this field, which would be a psychiatrist or clinical (preferably) psychologist. They’re the only ones that can diagnose. Also, a diagnosis is just a label, but its symptoms are what guide treatment. Your girlfriend may, and probably does, have more than one psychiatric disorder and possibly a personality disorder. I have four psych diagnoses (adhd, bipolar I, ocd, gad) and I take medication for 2-3 of them. The others I just do the best I can.

    Your girlfriend is lucky to have you, and I hope that you are able to help her find the treatment she needs.

  12. Sonya says:

    I have bipolar 1. My hypo manias tend to make me more happy and a social butterfly, loud laughing over the top, I just don’t enjoy the no sleep part.
    Unfortunately when I get manic, or mixed this is when things tend to go wrong. Gave blow ups with friends get too full of myself and upset people because I am the inky one who can do the job properly.
    My depressions are the worst. Crying all day and in physical pain from the crying I do. Thankfully my medications have evened me out some what, but I still get the odd mood swing, especially when triggered.

  13. sar says:

    I need help. Iam sure that i have mild to moderate depression. now iam 32 and its been with me since age 15. iam shy from my adolescent age. Prefer to stay at home than to mingle with friends. i got a mild stammerring from age 15, may be because of the stress during school days. both of these are going on in a vicious cycle.
    Iam thinking of starting drugs like sertraline or venlafaxine by myself. but iam worried about the switch to manic episodes if dont start lithium with this.
    Iam not sure weather i have hypomania are not. Only time i feel happy with friends is when iam the centre of attraction, when they encourage me. i feel elated when iam given more preference, when they eagerly listen to my talk. But still i dont think these counts to hypomania.

    I may be also a case of borderline personality disorder.
    My plan is to start sertraline/venlafaxine alone and continue it for whole 1 year.. i need opinion on this.

  14. Julia says:

    Sar,
    I don’t know where you’re from, but I would more than highly recommend you see a dr. Even drs can’t be drs for themselves. There is of course a difference between being your own dr and being highly involved in your care and educating yourself on possibilities. But truly, I cannot say this strongly enough, do NOT be your own dr. Natasha??

  15. Timn says:

    Answering Julia,

    1. My girlfriend sees her Psychologist twice a month. He is a M.S., L.M.F.T.
    2. She has not seen a Psychiatrist. Her Psychologist recommended Zoloft and had her family Dr write the prescription. I am very concerned about this because I think she needs a Psychiatrist that specializes in antidepressants.
    3. My girlfriend’s attitude toward her illness is fair to poor. She says she has had this for over ten years and tends to blame everyone else for making her crazy. She does not seem to have the capacity to take responsibility for her own illness. Two weeks ago I visited her condo and found her in a deep depression state. She once again talked of suicide. She said she had not sleep all weekend and had not eaten in two days. I fixed here a good BBQ chicken salad and made her eat with me. Her energy level improved and she fell asleep in my arms for about 3 hours. When I left her condo I told her she needs help and she said, do not tell my family. On my way home my conscience was bothering me. I felt it was my obligation to tell someone what I had observed. When I got home I called her best friend who she as known for 30 years. Her friend said this is typical and has seen this many times. She said don’t worry and hung up. Within 10 minutes my girlfriend called me screaming on the phone that I had betrayed her trust. Her anger tirade was so bad I hand to hang up. Later I received an email from her stating she never wants to see me again or talk to me again. I tried calling, texting and emailing and she has not responded. At this point in our relationship I cannot continue. She hid her mental issues from me for over a year and now her depression fallout has ended our relationship. The relationship is out of balance. She does not have the capacity to love me back and takes no responsibility for her actions. It’s painful and frustrating to love someone and then find out they have mental issues that are beyond your help. I’m trying my best to move on and put this behind me. I hope she gets the treatment she deserves and someday finds balance in her life that will help her love again. My girlfriend is not the same person I dated for 4 years in collage. 40 years later we reconnected in 2012. I kept looking for the person I knew and not seeing the person she is today. Now maybe you see why I stuck by her side until I began to see the real issues.

  16. Hans says:

    I am just starting to find out what mood disorders are all about. I have always had mood swings, but they became more pronounced over the last few years. A few months ago I “lost it”, started seeing things that were not there and getting completely stressed out. I am on risperdal now and took a number of tests to determine what really is wrong with me, what has been wrong with me all these years. Some form of autism ? Bi-polar ?
    I feel depressed every mornng and feel good every late afternoon.

    Thanks for listening.

  17. jeff says:

    I am a 9/11 Suvivor and worked Recovery and Debris clean up. So the Bipolar plus The PTSD symptoms lead me to over 25 Institutions and 29 Medication Prescribers, since 9/11
    Right after 9/11 heavy drinking killed the Symptoms and almost me. Obviously I’ve been on a lot of different Meds. I was put into zombylike states with high doses of anti psychotic Meds. Geodon, 900 MG’s of Serous,Lithium. The Haldol and Thorazine they shoot you with at the Psych.Wards are just to put me out. I’ve had periods of not sleeping for five days before. Then I once locked myself into my bedroom for close to 3 months. With Anxiety attacks over having anxiety attacks if anyone can relate. Horrible with a 10 year old son knocking on the door asking me to come out and if I was mad at him that’s why I wouldn’t come out.
    All the MDs PhDs Hypnotherapy MMDR(the two finger waving thing).
    Through all this and a decade later a RNP asked me one question ” do you spend exorbitant amounts of money for no reason?” That’s what it took for me to understand my Bipolar. An extreme example My wife had a year old Volvo. One day just driving to the store turned into me coming home in a new Cadillac for her. I thought she’d love it she said I was an ——-!

    So reading this blog (if that’s what it’s called). I understand everything everyone has said. Obviously my swings were extremes. But finally really understanding and truly accepting, I slowly started to function better. At one point I slept on an air mattress on the kitchen floor of my parents apt. and told when to eat,sleep, shower and dispensed a wheelbarrow full of Meds. By mom.
    After that RNP opened one eye I Met my 29th MD and Board Cert. Psychiatrist.
    I walked in his office older man tall and thin looked up at me for 3 seconds put his head back down and said” boy your a fat puggy —-, and you have no memory ( I forgot my wife’s birthday one year) and the he said ” and how are those nightmares working out for you (a little PTSD thrown into this blog). I met him in the last Institution I’ve been in a year and a half ago. He completely changed my Meds.from heavy anti psychotics to low amounts of mood stabilizer, only 150 MG’s Seroquel from 900 at nite 300mgs morning and 300mgs noonish, small amount of anti anxiety meds. And a medication called Mini press or Prozosin and not a nightmare since that day. So I’m like what happened to the first 28 docs. For the nightmares?? I actually don’t dream at all which is better than violent nightmares could sleep with my wife for years. I would yell and scream and flail around causing bodily harm to her. He put me on ADD Meds. Which usually take me down to Hypo. I used to live in I thought it was called Hypermania my bad, the high level is called just Mania.
    I sleep a few hours a night. I eat when I’m hungry, I shower every night. I can function enough to stay out of Institutions and haven’t been Bakker Acted in a couple years. (Committed).
    My Symptoms can get intensive but WE decided my Doc. And I that no more Heavy doses of Meds. I’ve learned other ways to deal with my illnesses. That are not harmful to me or anyone else. I saw a new Psychologist last week for the first time. I asked her the two stages of Mania were and she couldn’t tell me. I ask her what type of modality does she tend to utilize. She didn’t know what I meant. She has PHD after her name I never finished high school. I went from coffee boy to Managing a multi-million dollar Company. Hands on experience and thinking outside the box. Before 9/11 made me successful. And a little Hypo mania didn’t hurt my climb up the ladder….
    Sorry so long but today I have hope I won’t end up Committed the rest of my life.
    All the progress was Awareness finally and Accepting the cards I’ve been felt. I interview The docs now. Dallas Buyers Club good flick. Medication isn’t the complete answer. Definitely different for everyone. My wife and I have been separated for like 4 years she asked me last week why I didn’t return her call the day she called me o said “I was feeling a little depressed I didn’t want to talk to anyone” she said ” what do you have to be depressed over” somethings never change….Good Luck All There’s Always HOPE!!

  18. kaylee says:

    I just found your blogs tonight online and must say i love reading them. i’ve been up for hours, needless to say i’m probably hypomanic…i personally love it. it is my only break from depression, because i believe i am mostly mixed episodes and normalcy is something i’m not sure of in my life

  19. lululr says:

    Hello all,
    From my adolescence through my twenties, I struggled with depression and difficulty concentrating, without knowing it and thinking it was just “me” (and not liking myself of course). My mother raised the depression question for me during a “deep” phase when I was in my late 20s. She gave me a book on depression that was a revelation for me. I felt I was reading about myself. I then started taking Prozac and feeling so happy to be out of the dumps and not thinking about death, that I didn’t want to think about any chances of my euphoria being due to hypomania/mania … since I did not know what they were in the first place –and since it felt so good. So, for years, when I got out of deep depression bouts with Prozac, I would wean myself off of it when I felt euphoric and happy, thinking I was cured. This “on and off” antidepressants went on for years. After a continuous series of crippling depressive episodes followed by “boosts” during my career in luxury goods, each one resulting in some promotion or being head-hunted, I stopped working thinking I would get my depression straightened out and gave myself a year. At age 47, after being unemployed for 4 years, I found a part-time teaching job and had much success with the students (more for my cheeriness I think). When I was hired full-time, I went into a grand tizzy. I thought I could revolutionize the teaching world and be the best teacher in the whole state (or the universe). I got so lost and overwhelmed with the goals and tasks I made for myself, that a small comment from one of my students triggered a total breakdown, leading to a week of being almost catatonic and having to accept to resign from my job. This job had given me insurance coverage, and this allowed my to receive my first diagnosis of Bi-Polar II, later to be revised into Bi Polar NOS (before that I had lived in France for 17 years and had only depression diagnoses, made mostly by myself). I had to leave the US and go to Africa about 8 months after my diagnosis, and since 2012, I have not had a psychiatrist or any doctor to work with me. I am now 51. I get my meds prescribed by my medical GP in France, and he knows nothing about mental health so has trusted the diagnosis and prescribed medicines that I brought back with me and shared with him. I take Fluoxetine (Prozac) 40 mg/day, Lamoctil 275 mg/day, and occasionally Xeroquel 50 mg or 25 mg. I can just feel that I can use some tweeking in those, and have been doing it on my own. I know I need to look for a new doctor, in France, where I am covered by insurance, or in Spain, where I am currently living. But I just don’t know where to start. I think I am in a hypomania phase now and have been cycling one to three days each way (up and down) for the last year or so. My short term and medium term memory are quite impaired, my visual recognition capabilities are almost nil (I might have met you 20 minutes ago but won’t recognize you) – my libido has been absent for 10 or so years … I am often confused and distracted, and now I am having extreme eye dryness (from the Lamictal I think) to the point of not being able to open my eyes if I wake up in the middle of the night.
    What am I trying to say here? I am just so relieved to be able to express myself to a group that understands. Except I am sure my explanation is so long that most of you are probably running away from your computer right now. Sorry ! I guess I just need to find a doctor who is good, and I am traumatized by having been misdiagnosed for so many years. I would like to have a sex life again … and not feel so handicapped or afraid that I look crazy.
    Thanks for listening.

  20. Margo says:

    Dear lulur,
    I hear you. In other words Your experiences resonate with me. I wish I could go into detail but I don’t have the energy today. Get some expert help. You are worth it . My thoughts are with you

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