Hypomania vs. Mania: What’s the Difference?

Mania involves extreme, elevated changes in mood, emotions, energy, and activity levels that occur in people with bipolar disorder. Hypomania is a form of mania that involves the same symptoms but is milder and usually shorter in duration.

What Are Mania and Hypomania?

Mania is a mood state, not a medical condition. It is a period characterized by persistent elevated, expansive, or irritable mood lasting at least one week.1 In some cases, it can become severe enough to cause delusional thinking and significant problems with functioning in social situations or daily activities.

On the other hand, hypomania can be defined as a milder form of mania. It is a period of persistently elevated, expansive, or irritable mood that lasts for at least four days and up to a week.

It has the same symptoms as mania; however, instead of being severe, it is mild enough that the person can usually function normally in daily activities.

Symptoms of Mania/Hypomania

Below is a list of symptoms that characterize mania or hypomania:2

• Feeling very happy and/or silly for most of the day, nearly every day (euphoria)
• Strong feelings of excitement and energy
• Increased activity level
• Racing thoughts, ideas, and talking (pressured speech; jumping rapidly from one idea to another)
• Distractibility (attention too easily drawn to unimportant or irrelevant external stimuli)
• Decreased need for sleep (feeling rested after only 3-4 hours of sleep; sleeping fewer than 5 hours per night, nearly every day)
• Feeling like you don’t need to eat (not feeling hungry)
• Impulsiveness, taking on too many activities at once
• Reckless decisions, such as the purchase of big-ticket items without considering cost or consequences; gambling; excessive sexual activity; engaging in risky behaviors like reckless driving
• Unusual confidence and optimism about your abilities
• Irritability or aggression

In addition, in the case of severe mania, people may experience psychosis, which is the loss of contact with reality. This can lead to delusions or hallucinations, such as hearing voices or seeing things that are not there.

Psychosis may also involve delusions of persecution, such as the belief that people are plotting against you or delusional jealousy, where a person comes to believe their partner is unfaithful. In the case of hypomania, you will most likely not experience psychosis.

Mania vs. Hypomania

Let’s take a look at the differences and similarities between mania and hypomania.

What Are the Differences Between Mania and Hypomania?

Mania and hypomania differ with respect to duration, intensity, and functional impairment:

• Duration: In mania, an elevated or irritable mood lasts at least one week. In hypomania, symptoms last for at least four days.3
• Intensity: In mania, symptoms are severe, and in hypomania, they are mild to moderate.
• Functional Impairment: In mania, critical life activities such as work and social relationships are impaired. In hypomania, there is no functional impairment.

What Are the Similarities Between Mania and Hypomania?

Both mania and hypomania are associated with increased energy, activity levels, and restlessness. They are also similar in terms of other symptoms such as racing thoughts, distractibility, pressured speech, inflated self-esteem/grandiosity, decreased need for sleep, sexual arousal or pleasure, irritability, or aggression.

In other words, the symptoms of mania and hypomania are very much alike.

Diagnosis

Mania is typically diagnosed as part of bipolar I disorder. Hypomania, however, is part of bipolar II disorder.

People with bipolar I disorder tend to have more depressive episodes, more mixed episodes (episodes in which depression is combined with mania), more hospitalizations, and are at higher risk for suicide than those with bipolar II disorder.

A mental health professional can diagnose these conditions through a thorough psychiatric interview and evaluation.

Hypomania and Mania Triggers

Certain factors may trigger episodes of mania or hypomania, including lack of sleep, drug and alcohol use, medication changes (particularly those that increase norepinephrine), illness, and overwork.4

Below is a list of potential triggers:

• Alcohol and drugs
• Caffeine (excessive consumption)
• Drugs that affect norepinephrine (such as thyroid medications, antihistamines, stimulants, and antidepressants)
• Lack of sleep or insomnia
• Mental stress (such as losing a loved one or completing an important project at work)
• Overwork, overplay, and overexercise
• Sensory overload including excess light, noise, and/or crowds

Causes of Mania and Hypomania

The causes of mania and hypomania include a combination of genetics, neurobiology, and life experiences. Studies suggest that a strong family history of the disorder increases one’s risk for bipolar mania and hypomania.5

Evolutionary psychologists theorize that bipolar disorder evolved as an adaptation to help those in northern climates engage in alternating phases of hibernation and activity.7 This would allow them to store up food and other resources during the summer months when they could easily obtain them. Then in the winter, they would stay in their homes, conserving energy until spring came again.

Treatment of Mania and Hypomania

Treatment for bipolar disorder usually involves psychotherapy, medication, and lifestyle modifications.

Psychotherapy

Evidence-based therapies that are the most effective in the treatment of bipolar disorder include psychoeducation, cognitive-behavioral therapy (CBT), interpersonal and social rhythm therapy, family-focused therapy, and peer-support programs.8

This form of psychotherapy helps individuals to recognize and avoid behaviors or situations that trigger mood episodes. In addition, it can be helpful for individuals to recognize early warning signs of mood episodes so that they can take action before a full episode occurs.

Medications

Psychotropic medications are often used in conjunction with psychotherapy as well, especially if the patient experiences severe manic or mixed episodes. Several medications are specifically approved by the U.S. Food and Drug Administration (FDA).

These include the following:10

• Mood stabilizers such as lithium
• Anticonvulsants (used for cases of bipolar disorder where seizures are present; examples include Lamictal and Neurontin)
• Antipsychotics (used for cases of bipolar depression and mania accompanied by psychotic features such as delusions; examples include Risperdal, Seroquel, Geodon, Abilify, Zyprexa, and Invega)

Coping With Mania and Hypomania

Hypomania and mania often present challenges for people with bipolar disorder in their personal and professional lives.

Below are some tips for coping with episodes of mania or hypomania:

• Watch for early warning signs of mania or hypomania and write them down. If you can recognize your triggers, it will be easier to avoid situations that might lead to full-blown episodes.
• Avoid alcohol, which can trigger manic symptoms in some people. Substances such as marijuana, cocaine, and amphetamines can also set off mania.
• Take your medication as prescribed by your health care provider. Drugs such as lithium can help stabilize moods and ease the symptoms of mania or hypomania. Speak with your doctor about whether these drugs could be right for you.
• Exercise regularly, even if you’re not feeling up to it. Physical activity can help regulate the body’s circadian rhythms, which are disrupted during episodes of mania.
• Keep a regular sleeping schedule seven nights per week. Hypomania can impair judgment and cause you to sacrifice sleep to get more done, but getting too little sleep will only make mania worse. Even if you fall asleep easily at night, you may wake up exhausted if your sleep cycle gets off track. If this is happening, stick to a more consistent bedtime until your body adjusts.
• Eat at regular intervals, and ensure that your meals are well-balanced. Many people with bipolar disorder become impulsive when hypomanic, leaving them susceptible to making poor nutritional choices at the worst possible times. Be sure to eat plenty of fruits, vegetables, whole grains, and high-quality sources of protein to ensure that you’re fueling your body.
• Reach out for support. Seek out family, friends, or others who you trust to help you through difficult times.