The Ultimate Guide to Handling Hypomania

There’s no denying the allure of hypomania, but there are real risks to leaving it untreated. Self-knowledge plus practical strategies can help to keep us from crashing.

Understanding Hypomania

Those six projects you’ve been meaning to get to for months? You’re on them all — and you have plans for six more. You are cheerful and creative, gregarious and engaging, and a multitasking master of efficiency and organization.

So what’s the problem?

There isn’t one, necessarily. But if you’ve edged into hypomania, there may be unwelcome consequences.

If left unchecked, hypomania frequently bumps from increasingly energized to out-of-control for those with bipolar 1 disorder. For anyone on the bipolar spectrum, expansive mood often deflates back into depression, according to Cleveland Clinic. And for some people, leaving any mood shift untreated may lead to more frequent and more severe episodes in the future.

It can be hard to distinguish whether you’re hypomanic or simply feeling “normal” again after a depressive streak — especially when depression is your predominant mood state. (A study published in Bipolar Disorders researchers from the Netherlands found that people with bipolar disorder spend three times as many days in depression as in hypomania or mania.)

Energy Imbalance

There’s no denying hypomania’s allure — it’s wonderful to feel wonderful — and, for some, the energy boost creates a fertile opportunity to get things accomplished. For others, however, the added sizzle shoots out in too many different directions or converts to an uncomfortable edginess.

The trick to handling hypomania is recognizing your own limits, knowing your danger zones, and staying attuned to your warning signs.

“Hypomania is a reprieve, a little bit of the Energizer Bunny after being tired of being depressed all the time,” says Aparna Ramaswamy, PhD, a licensed clinical professional counselor in Maryland. “But it’s also an imbalance.”

Hypomania and Risk-Taking Behavior

Many of the downfalls of mania — impaired judgment, impulsivity, grandiose ideas, a self-absorption that alienates those around you — can be present in hypomanic episodes as well.

While hypomania has received relatively little attention in the scientific literature, Australian researchers who looked exclusively at people with bipolar 2 disorder found that risk-taking behaviors in hypomania are common and often detrimental.

“Whilst hypomania is often enjoyed and romanticized by patients, leading to ambivalence around treatment of such states, careful consideration of the impact of risk-taking behavior is necessary,” the study authors wrote in the 2013 issue of the Journal of Affective Disorders.

Is there a “safe” level of hypomania? That’s a tricky question, given that early intervention can prevent future mania and depression, as well as any by-products like overspending and unsafe choices.

If your pepped-up periods typically come at a price, your honest answer would be “no.” You’ll want to watch for changes that tend to precede an episode — sleeping less, talking more, increased irritability, starting lots of projects — and take preemptive action.

For example, consulting your prescribing doctor to reevaluate your medication can keep things from getting out of hand. It’s also helpful to have people around you who are clued in to how hypomania hits you, so they can alert you to the mood shift’s leading edge or, if necessary, make a doctor’s appointment for you if a few days have passed without improvement.

Of course, the conservative clinical advice calls for treating every mood episode to remission — that is, until all symptoms, even mild ones, are gone. In some cases, mood shifts that aren’t fully treated can lead to an increase in the frequency and severity of future episodes.

One of the gravest hazards of hypomania: feeling so good you decide you don’t need your meds at all.

“It’s hard to tell someone, ‘You’re not doing well,’ when they have lots of energy, are meeting new people, and coming up with new ideas,” notes Tammarra Letbetter, a licensed professional counselor in Texas. “But medication should always be taken as prescribed.”

Ramaswamy encourages her clients to regulate their hypomanic buzz. “It’s not so different than fizz in a soda can,” she says. “You don’t shake it up, you contain it.”

Intervening on Hypomanic Impulses

One useful strategy: Building in circuit breakers for safety.

Ramaswamy notes the importance of separating an initial emotional response from any subsequent action. “It takes a while to understand that you will always react, but you don’t have to act based on that reaction. If you buy more time through conscious intervention, most times the negative aspects of hypomania can be contained.”

Nate of Wisconsin, who has bipolar 1 disorder, has a rule for himself when his mind starts coming up with grand ideas.

“I always wait one week before I do something about it or even talk to somebody about it,” he says. “By having that period where I restrain myself from action, I’ve been able to prevent a lot of mistakes.

Nate came up with his rule because he didn’t want to be known anymore as “the guy with big ideas who never follows through.”

Meditation has helped him better regulate surges of enthusiasm that are genuine but not sustainable. After starting a daily 20-minute meditation practice and noticed a difference in self-awareness and self-restraint after about six months.

“Since that time I have been pretty stable and haven’t had any problems with overambition,” says Nate. “I’m able to be more grounded in reality and think twice, even three times, about what I want to do before I get too excited.”

Strategies for Dealing With Hypomanic Energy

Many people find it hard to harness hypomania’s overdrive because distractibility is also a hallmark of the mood state. Attention jumps quickly from one thing to another, making it hard to follow through on projects.

Letbetter recommends writing down everything you’re intending to accomplish. “Put life down on paper so you can physically see what you need to do,” she advises.

Once you’ve got everything listed in black and white, notes Ledbetter, you can distribute your tasks more sensibly across the week or month ahead.

For Patti of Ohio, who was diagnosed with bipolar 2 disorder after a decade of symptoms, life just feels easier when she is hypomanic. As a writer, she’s more prolific. As a wife and mother, she takes things less personally and has a better sense of humor. Normally an introvert, she reaches out to friends she hasn’t talked to in a while and looks for reasons to be more social.

Yet after a few days, her hypomania typically transitions into irritability, then depression. If she’s not careful, she finds herself with a string of half-finished projects.

With help from medication, monthly therapy appointments, and a mood journal, Patti has been learning to manage her bipolar. She’s also learning how to prioritize where she puts her bursts of hypomanic energy. Rather than starting to paint a room, which may not get completed before the mood shift tapers down, she’ll focus on her writing.

“Even if I don’t finish, I can start again,” she says, “and I haven’t trashed the house or inconvenienced my family.”

Experiencing Hypomania: Irritability vs Exuberance

Patti isn’t alone in feeling more social when she’s hypomanic. Some people describe feeling more romantically inclined, too. It’s not uncommon to jump into exciting new relationships, but, meanwhile, ties with those closest to you can fray. The end result: increased isolation.

“Along the way, social supports weaken, love fades, the animosity of some who have been ‘othered’ increases,” notes Len Ramsay, a psychotherapist in Oakville, Ontario.

Both ends of the mood spectrum can be characterized by egocentricity: depression by inward-turning withdrawal, elevated states by increased immersion in your own lavish flow of ideas and activities. Ramsay says that as your pace picks up, you might start seeing others as slow or stupid, which adds to a sense of disconnection.

“It’s lonely to be faster and smarter, more effective than the people around you,” he says.

For some people, hypomania is characterized by irritability rather than exuberance. The ramped-up energy that hypomania can bestow feels like too much to handle. There may be an uncomfortable sense of urgency, agitation, of being pent-up or scattered.

“I don’t get the ‘happy, happy, joy, joy’ that most people get with hypomania,” says Sheila of California. “The irritability is a real hallmark for me.”

Sheila wound up resigning from her job at a large research university because her hypomanic behavior was a continued source of tension between herself, coworkers, and her supervisors. People at her workplace complained about her “acting mad.”

She talked about the tension at therapy and tried to become more self-aware, but the problems didn’t go away. In the end, she left before a formal complaint could be filed.

She since has developed better techniques for distracting herself from her irritability by doing “dull and boring” tasks such as counting, followed by a calming technique such as breathing deeply or going for a short walk.

“I try to recognize my triggers and also pull apart what just happened to determine whether I have a right to be angry, since I can just react and am not always completely conscious of what’s going on,” Sheila says. “Nine times out of 10 now, I can pull it off.”

Sleep Disturbances and the Impact on Emotion Regulation in Hypomania

Sleep may seem overrated when you’re hypomanic, especially since you don’t feel fatigued despite needing less shut-eye than usual. Yet it can be dangerous to rob your body of this important respite. Getting a good night’s rest is crucial for regulating emotion, impulsivity, and risk-taking, as well other important jobs such as cognitive functioning. Healthy sleep also has been shown to decrease the risk of relapse.

In a study on sleep disturbance in bipolar disorder across the lifespan, published in Clinical Psychology: Science and Practice, researchers monitored 78 people periodically over two years. They found a direct correlation between sleep loss and how participants reacted both to negative and positive situations. Negative emotions intensified after a negative stimulus, but positive emotions were more diminished than usual after positive stimuli.

Miranda of Manitoba usually gets three hours of sleep a night during hypomanic episodes, when she tends to become so engrossed in ideas that she can’t let them go long enough to stay in bed. She once went nearly three days without sleeping because her brain “was a freeway of thoughts all going in random directions.”

Her activity follows the same pattern. She’ll try to balance five or six cleaning projects while baking three things. She compiles multiple lists to help her get organized, then doesn’t always remember where she puts them.

She’s also prone to spending sprees that have led to a maxed-out credit card and no money left in her bank overdraft account.

“While I love the productivity hypomania brings on, I can sometimes put myself in hot water,” she admits.

Now on a new medication, Miranda records her symptoms and daily routines in a journal and uses apps on her phone for mental health check-ins. She’s focusing more on feeling grounded.

“I put my energy into more productive areas now, instead of planning what color I want the walls to be next year,” she says.

She also builds in breaks when she’s feeling revved, even if it’s just five minutes every two or three hours.

“I’ll tell myself to slow down, to take deep breaths,” she says. “Sometimes I just text a girlfriend to ask how she’s doing today. Anything to stop myself and get re-centered.”

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Hypomania, Defined

The mood state of hypomania can be found all along the bipolar spectrum. A hypomanic episode paired with one or more lifetime episodes of depression leads to a bipolar 2 diagnosis. Bipolar 1 disorder is diagnosed based on the presence of mania, but hypomania and depression typically form part of the package.

Hypomania is often seen as “mania lite” because both have the same checklist of symptoms (see below). With hypomania, the symptoms don’t last as long and don’t interfere as significantly with work or school, relationships, or social activities, per Mayo Clinic. However, impulsivity, overspending, risky behaviors, and relationship stress can leave calamity in hypomania’s wake.

Hypomania may be an “edge state” into or out of mania — and often foreshadows a subsequent drop into depression.

If symptoms last more than seven days, include any psychotic features, or result in hospitalization, you’ve officially entered a manic episode. Watch for:

• decreased need for sleep
• uncharacteristic feelings of restlessness or lots of energy
• feelings of extreme and intense happiness (euphoria)
• increased distractibility, irritability, and aggression
• more talkative/talking faster than usual
• swarming ideas, racing thoughts
• increased activity, such as taking on new projects and socializing more
• inflated self-esteem or overestimating one’s importance (grandiosity)
• poor judgment and risky behavior, such as chancy financial decisions and promiscuity

Printed as “Flight Plan,” Spring 2016