Hypomania

What Causes Hypomania?

Doctors and researchers have not yet determined precisely what causes hypomania, but they have identified several risk factors that increase the likelihood of an individual developing it or related disorders.

• Genetic Predisposition. There is a strong connection between family history of bipolar disorder and new diagnoses of the illness; those with a close relative with bipolar disorder are significantly more likely to develop the condition themselves. The current consensus is that multiple genes contribute to an increased risk of developing the disorder. In addition, external environmental factors may trigger these genes to cause the onset of the illness.
• Stress, Anxiety, or Trauma. Chronic stress or anxiety, or a significant source of sudden trauma, often coincides with the onset of hypomania.
• Lack of Sleep. Lack of sleep is a cause of physical stress that may contribute to the brain chemistry that causes hypomania. Lack of sleep may also contribute to hypomanic episodes after the initial onset of bipolar disorder.
• Drugs and Alcohol. Substance use may be a factor in triggering hypomanic episodes. In some cases, antidepressants may also trigger episodes.

Is Hypomania Hereditary?

There appears to be some genetic component of risk for developing bipolar disorder, but the medical community has not pinpointed the specific genes that increase risk. The current consensus among researchers is that bipolar disorder is not caused by a single gene but by a coincidence of several genes that each increase the risk of developing the condition. In addition, environmental factors likely trigger the development of the disorder even in individuals with genetic risk factors.

How Is Hypomania Detected?

Hypomania symptoms are relatively mild and don’t usually cause significant problems. However, they are, by definition, noticeable to others, so the onset of an episode can be identified if you know what to watch for. With experience, even the person experiencing hypomania can learn to identify the beginning of an episode.

Some possible warning signs of hypomania include:

• Not wanting to sleep and feeling rested even if you get little sleep
• Working intensely and without stopping on projects, housework, etc.
• Feeling sure that you’ll be successful in anything you do
• Talking quickly and not staying focused on a single topic
• Being intensely engaged with texting, social media, etc.

How Is Hypomania Diagnosed?

Diagnosis of hypomania begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that hypomania, bipolar disorder, or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

• A physical exam. This exam aims to rule out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for hypomania. These criteria include:

• The person has experienced an elevated mood that is noticeably different from their typical mood. The change is present most of the time for at least four consecutive days.
• Three or more symptoms are present. Symptoms include inflated self-esteem, decreased need for sleep, racing thoughts, talkativeness, goal-focused behavior, irresponsible behavior, or distractibility.
• The symptoms are noticeable to others.
• Impairment isn’t severe enough to require hospitalization and doesn’t seriously impair functioning.
• The symptoms aren’t caused by substance use or a medical condition.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Hypomania Treated?

There is no known cure for hypomania, and treatment plans are intended to manage symptoms and lessen the severity of episodes when they occur. Treatment often involves a combination of medications and psychotherapy.

Medication

Doctors may prescribe drugs used to treat bipolar disorder to treat hypomania. These drugs may include:

• Mood Stabilizers. Mood-stabilizing drugs commonly prescribed for hypomania include lithium, valproic acid, and carbamazepine.
• Antipsychotics. These drugs are usually prescribed when the symptoms of hypomania don’t respond adequately to other medications alone. Commonly prescribed antipsychotics include aripiprazole, lurasidone, olanzapine, quetiapine, and risperidone.

Psychotherapy

Psychotherapy and counseling may help the patient decrease stress and establish behaviors that help lessen the impact of symptoms.

How Does Hypomania Progress?

While the symptoms of hypomania are relatively mild compared to those of mania, hypomania can lead to serious complications if left untreated. Potential long-term consequences of untreated hypomania include:

• Relationship problems
• Risk of developing bipolar I disorder
• Risk of developing other mental health-related issues such as anxiety disorders
• Substance abuse
• Suicidal thoughts, suicide attempts, or suicide

How Is Hypomania Prevented?

The onset of hypomania cannot be prevented, but early recognition of an episode’s signs can help the person manage the oncoming episode. Strategies for identifying and managing episodes can include:

• Keep a journal of your moods.
• Ask the people close to you to speak up when they see changes in your behavior.
• Get plenty of sleep.
• Exercise and eat a healthy diet.
• Avoid over-stimulating and stressful situations as much as possible.
• Avoid caffeine, alcohol, and other drugs.
• Practice relaxation techniques such as yoga or meditation.

It is vital for those diagnosed with hypomania or bipolar disorder to seek regular evaluation from their mental health providers and adhere faithfully to any prescribed medication plan.

Hypomania Caregiver Tips

In addition to seeking support from therapy or a support group, caregivers for someone with hypomania or bipolar disorder should consider some of the following self-care tips:

• First, learn as much as possible about the disorder.
• Make time for yourself away from the condition.
• Take care of your own physical and mental health. Unfortunately, it is not uncommon for caregivers to experience depression or let their own healthy lifestyle suffer because of stress.

Many people with hypomania and bipolar disorder also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the conditions commonly associated with bipolar disorder:

• Most children with BPD also have ADHD.
• About half of people with bipolar disorder also have an anxiety disorder at some point.
• Panic disorder is the most common anxiety disorder in people with BPD.
• Some people with BPD also have other personality disorders, such as borderline personality disorder.
• Alcoholism and substance use disorder are commonly comorbid with BPD. Nearly two-thirds of people with bipolar I also have a substance use disorder.

Hypomania Brain Science

Recent studies have begun to shed new light on brain function and chemistry that could soon revolutionize the diagnosis and treatment of hypomania and bipolar disorder.

• Researchers have identified a difference in brain activity between people with bipolar disorder and those suffering from major depression. The study used MRI scans to look at the function of the amygdala, a part of the brain that is instrumental in the processing of emotion, and found that the left side of the amygdala is less active in people with bipolar disorder than in people with depression. This finding could help lessen the misdiagnosis of depression in people who have bipolar disorder.
• Researchers have found that people with bipolar disorder have generally poorer cognitive abilities such as memory, processing speed, and executive functioning than those without bipolar disorder.
• A recent study found that people with bipolar disorder, who participated in brain-training exercises designed to boost cognitive abilities, saw a significant and sustained improvement in their cognitive skills. The hope is that this kind of brain training can help bipolar sufferers improve their quality of life.
• An international research team has suggested a connection between a gene called EGR3 and a protein called brain-derived neurotrophic factor (BDNF), which, in normal conditions, helps the brain react effectively to stress. Previous studies have shown that people with bipolar disorder have lower levels of BDNF during manic or depressive episodes, and this new research suggests that it may be possible to develop drugs that will improve the function of EGR3 and BDNF in bipolar sufferers.

Hypomania Research

Title: Unobtrusive Monitoring of Affective Symptoms and Cognition Using Keyboard Dynamics (UnMASCK) (UnMASCK)

Stage: Recruiting

Principal investigator: Olusola Ajilore, MD, PhD

University of Illinois at Chicago

Chicago, IL

Mood disorders are associated with significant financial and health costs for the United States, partially due to cognitive problems in these patients that can worsen disease course and impair treatment response. This study proposes using smartphone-based technology to monitor cognitive issues in patients with mood disorders by linking brain network changes with predicted worsening mood symptoms. The proposed study will provide evidence for using smartphone-based passive sensing as a cost-effective way to predict illness course and treatment response.

Title: The Influence of the Menstrual Cycle on Lithium and Sertraline Blood Levels

Stage: Completed

Principal investigator: Mallay B. Occhiogrosso, MD

Weill Cornell Medical College

New York, NY

This study aims to determine whether blood levels of lithium or sertraline are affected by different phases of the menstrual cycle and whether there is an effect on psychiatric symptoms. Subjects are seen for two visits: one visit during the luteal phase and one visit during the follicular phase of the menstrual cycle. They will fill out a depression, anxiety, and mania rating scale on each visit. Also, a 20mL blood sample will be drawn at each visit to measure progesterone level and either a lithium or sertraline level, depending on which medication the patient takes. The primary hypothesis in this study is that blood levels of lithium and sertraline will be significantly lower in women during the luteal phase of the menstrual cycle than during the follicular phase. Examination will also be made of whether symptoms will increase in severity during the luteal phase compared to the follicular phase. The investigators expect a negative linear association between symptom severity and blood level, i.e., expect symptom severity to worsen as blood levels of lithium or sertraline decrease.

Title: Early Intervention for Youth at Risk for Bipolar Disorder

Stage: Completed

Principal investigator: David J Miklowitz, PhD

University of California, Los Angeles

Los Angeles, CA

Children or teens with mood swings or depression who have a parent with bipolar disorder are at high risk for developing bipolar disorder themselves. This study will test a family-based therapy aimed at preventing or reducing the early symptoms of bipolar disorder in high-risk children (ages 9-17). In a randomized trial, the investigators will compare two kinds of family-based treatment (one more and one less intensive) on the course of early mood symptoms and social functioning among high-risk children followed for up to 4 years. The investigators will examine the effects of family treatment on measures of neural activation using functional magnetic resonance imaging.