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What is a Hypomanic Episode?

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  • Written By: Tricia Ellis-Christensen
  • Edited By: O. Wallace
  • Last Modified Date: 28 September 2016
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A hypomanic episode is symptomatic of bipolar disorder II. Hypomania is a lowered level of mania that generally gives people more control over their actions than they would have in a manic state. Describing these episodes is difficult because each person experiences this state differently. A few people feel positive and productive, and are relieved to not feel depressed, while others are tortured by mental activity that seems unending. In the absence of being able to describe how all people experience these episodes, it is still possible to discuss the features that accompany hypomania; they just need to be understood as occurring at different levels in each person with each episode.

Some symptoms identified with hypomania are:

  • Sensation that the mind is running in overdrive.
  • Restlessness and hard time relaxing.
  • Strong panic or anxiety.
  • Flight of ideas (where people converse or think on a number of unrelated topics, one after the other).
  • Inflated sense of importance.
  • Inability to get to or stay asleep.
  • Greater productivity.
  • Abnormally elevated mood.
  • Increased interest in sexuality.
  • Quick mood changes to anger and rage.
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When a hypomanic episode is occurring, the longer it lasts, the more negative it tends to turn. This is an exceptionally dangerous time for the bipolar sufferer. The desire to somehow “switch off the mind” can become so strong that it leads to suicidality. Though depression, the other half of the bipolar II experience, is often linked to suicidal episodes, hypomania may be just as deadly — even more so if recurrent thinking is self-attacking. The person’s energy level and desire to “do something” can make suicide more likely.

Not everyone becomes suicidal, but there are other inherent risks during the hypomanic episode. People often use alcohol or illegal drugs to try to level out or control moods. Hypomania explains the relationship between alcoholism and bipolar because it is the easiest to obtain substance that may create temporary tranquility. The result is temporary and tends to create greater mood instability. A desire to maintain mood balance may fuel an increased dependency on alcohol.

The inflated sense of self and lower judgment threshold also make the hypomanic episode problematic. It is easy for people to make life decisions they will regret like quitting work or having intercourse with the wrong people. Overspending, overeating, and compulsive gambling are other potential pitfalls. Anger levels can also be profoundly disturbing in personal and professional life and create significant damage.

Bipolar II is managed with medication and therapy. If a person is on medication, a hypomanic episode indicates an insufficient medication regimen and a psychiatrist should be consulted immediately. People who think they are hypomanic should also consult a psychiatrist. There are many different drug combinations that treat this condition. Still, it often takes a while for the right combination to be found.

Medications to address bipolar II include either lithium or anti-convulsants (valproic acid, lamotrigine or carbamazepine), and may also include sedatives or atypical antipsychotics. There is great debate on whether antidepressants are appropriate. Their use can create hypomania, but at other times, very tiny amounts of antidepressants effectively treat higher levels of depression.

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