What does hypomania look like?

Hypomanic states are rarely observed by the psychiatric clinician. Bipolar  patients are much more commonly depressed  (according to Judd et al, bipolar II patients spent only 1.3% of the time in hypomania over 13 years of follow-up).

http://jamanetwork.com/journals/jamapsychiatry/fullarticle/207252  accessed 1/14/17


The manifestations of hypomania are often quite subtle. By definition, in hypomania the patient is not psychotic, does not need hospitalization, and has no marked impairment in social or occupational functioning.


I am indebted to a patient, whom I have treated for 10 years, and who takes several mood-stabilizing medications, for providing a vivid example of hypomania, and the damage that can result.

Her hypomanic states are infrequent, once every 3 months. They occur 3 days before her period, and end when she gets her menses. First she has extra energy, then she stops sleeping for 1-2 days, then feels “light, happy, like I can do no wrong” for one day, and then crashes and goes back to normal.

She only recognizes her hypomania after the episode has ended. When her partner tries to point it out to her, she becomes irritable and can’t hear her. Earlier in her life, she went shopping when hypomanic.

Unfortunately, considerable damage can result from the impaired judgment typical of hypomanic states. In this case, the patient was involved in litigation. She decided to edit and “improve” a document which had already been submitted to opposing counsel “because I thought it didn’t look professional enough”, without  informing her attorney or asking his opinion. The unfortunate result was that her lawsuit, from which she was likely to get a substantial award, was thrown out, and she was fined a large sum for altering the document.

It is much easier for patients to recognize their depressions than their hypomanias. In hypomania, they feel good and often become irritable when others try to inform them something is not right. Perhaps the best approach is to learn what your hypomanic symptoms look like and to work out in advance what your significant others can say or do to get through to you.

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