Mania and hypomania: symptoms, causes and treatments
Mania and hypomania are disorders where chemical imbalances in the brain cause an abnormally and persistently elevated mood.
While this may sound useful or even enjoyable, in reality, these conditions can be unpleasant, upsetting and even life-threatening. Severe mania symptoms can make normal daily life impossible and even lead to admission to hospital.
Often part of a wider mental health condition such as bipolar disorder, treatment for mania and hypomania is available. Both medications and community support can help sufferers stabilise and manage their moods. Learning about self-care is essential too.
What is the difference between mania and hypomania?
Feelings of excitement, over activity and increased energy are present in mania and hypomania. In both cases you may feel:
Happy, elated or euphoric
A sense of extreme wellbeing
Full of ideas and plans with thoughts racing through your head
Restless and unable to sit still
Extra confident to take risks and be adventurous
You can take on lots of new projects or work
Difficulty concentrating and you are easily distracted
Rude and aggressive
Intolerant of other people
Like you don’t want to or can’t sleep
Very friendly towards others with less social inhibitions
Like spending lots of money and splashing out
You can’t get your words out fast enough and are talking very quickly.
The main difference between mania and hypomania is the intensity and severity of the symptoms. In hypomania, the above symptoms are present in a mild form. Other people may notice a change in your behaviour but it doesn’t affect your ability to carry out your daily life. Hypomanic symptoms only last a few days at a time.
In mania, the symptoms are more extreme and longer-lasting. They can affect you for a week or more and can be so severe that you are unable to carry out daily life or in the most serious cases, need admission to hospital.
In addition to the symptoms listed above, mania can also include:
Extreme over activity and no sleep at all
Talking so fast that you don’t make any sense and other people can’t understand you
Feeling untouchable and invincible
Serious risk taking behaviours, such as gambling away all your savings
Using excess alcohol or drugs
Acting completely out of character and often inappropriately
Hallucinations – hearing or seeing things that others don’t
Delusions – fully believing something which is untrue such as that you have special powers or paranoid thoughts that someone is watching you or trying to hurt you.
Mania and hypomania risk factors
Mania and hypomania can happen on their own, but they are often part of a wider mental health problem. The most common one is bipolar disorder, previously called manic depression, where episodes of mania are followed by periods of depression.
The NHS states that this usually develops between age 15 and 19 and rarely develops after 40. Men and women seem to be equally affected, although they can experience the condition in different ways, with women often suffering more depression and quicker cycling between mania and depression than men. Mania on its own is more common over the age of 35.
Other mental health problems that can include mania or hypomania are Seasonal Affective Disorder (SAD), schizoaffective disorder (symptoms of schizophrenia and bipolar disorder) and postpartum psychosis (psychosis after child birth).
What causes mania and hypomania?
When you see your doctor about symptoms of mania or hypomania they will look for an underlying condition of the brain that might be causing your symptoms, including:
Encephalitis (inflammation of the brain)
Brain injury
Brain tumour – both malignant and benign
They will also look at any medications you are taking. Sometimes mania can be a side effect of a medication. For example, antidepressants are designed to lift mood but in some people mood may be elevated so much that it causes mania.
The doctor will also ask whether there is a history in your family of mania or mental health conditions, such as bipolar disorder. Having a family history increases your likelihood of being affected.
Whilst there might not be a specific cause for the mania, there may be triggers which are usually related to lifestyle, such as:
Significant life events such as being bereaved, a relationship break up or giving birth
Drug and alcohol use
Social situations including financial worries, isolation, unemployment or poor housing
Treatments for mania and hypomania
After seeing your GP, expect a referral to the mental health team. You may be assessed directly by a mental health nurse or psychiatrist if you have been seen in an emergency setting such as in Accident and Emergency.
Treatment is aimed at relieving the immediate elevation of your mood but also making sure you have ongoing support to help reduce future episodes. This includes both medication and community support.
Medications
Antipsychotics are used to ease psychotic symptoms such as hallucinations and delusions. They calm the mind and lower an abnormally high mood. Examples include haloperidol, olanzapine, risperidone and quetiapine. Each has their own side effects which will be discussed with you by the doctor that prescribes them.
In situations, such as bipolar disorder, where mood goes up and down then a mood stabilising drug such as lithium, valproate or carbamazepine might be used. These are taken daily to help keep mood level.
If medications have been unsuccessful in controlling mania or it is so severe that it is life-threatening, electric convulsive therapy (ECT) may be considered. Electric currents are passed through the brain under general anaesthetic. This is not used very often and only when other treatments have failed.
Community support
The community mental health team (CMHT) will be a vital source of help for you in both treatment and in monitoring your health. If you have a difficult social situation such as housing issues or financial struggles, then you may be allocated a social worker.
Self-help for mania and hypomania
Because episodes of mania and hypomania can be recurrent, it is important to understand how it affects you, what your triggers are and how you can stay well. This can help you to recognise when you may be becoming unwell so you can get professional help.
Observe your moods. Keep a mood diary to track how you are feeling and spot any patterns that emerge. You can download mood diaries from the internet or just keep a simple, written record of how you feel each day.
Spot your triggers. Look out for things that cause a change in your mood. It might be not getting enough sleep, drinking alcohol or feeling very stressed. Practical steps to avoid triggers such as avoiding alcohol or caffeine, practising relaxation and managing your stress levels can all help.
Learn your warning signs. What happens when your mood starts to elevate too much? Is there a change in your sleep pattern? Do you start becoming irritable or aggressive? Maybe you start to take on too much work? Learn what the signs are for you. You may need to ask others how your behaviour changes as it can be hard to identify it yourself.
Share with others. Letting others know how you feel can be a relief. It can also help if you have specific people you trust who can tell you if they spot your warning sign behaviours. After a manic episode you may have little memory of how you behaved but may also feel shame or regret. Knowing your close friends and family understand is very important.
Follow your treatment plan. Even when you feel well it is important to keep taking any medications prescribed by your doctor and to attend follow up appointments with your community mental health team. They can help you make plans for what to do if you have a crisis and how to access the help you need.
Have a healthy lifestyle. Don’t forget that simple things such as eating healthily, getting a good night’s sleep and exercising regularly will help to keep you physically and mentally well.
Find others. Knowing that someone else is feeling like you can be a huge relief. Making contact with peers through a support group will make you feel less isolated and you can often get good tips and advice on how to manage your condition.
Last updated: 21-10-2020
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