Mania And Hypomania (Bipolar Disorder)
WHAT ARE MANIA AND HYPOMANIA?
Mania is the "high" behavior that is part of bipolar disorder; hypomania is the "low." A person with bipolar disorder alternates between extremes of mania (highs) and depression (lows). When a person is manic, he/she is likely to exhibit the following kinds of behavior:
- High levels of physical and mental energy
- A very positive mood, with marked talkativeness and sociability
- Extreme self-confidence
- Extreme aggression
- Agitation and irritability
- Distorted thinking, with delusions
- Racing thoughts and speech
- Little need for sleep; staying awake for long periods without tiring
- Marked distractibility; tendency to be difficult to follow and to go off on tangents
- Impulsive or reckless behavior; tendency to show bad judgment
- Strange or bizarre dress
- Hallucinations
The behavior of a person in the manic phase of bipolar disorder can place him/her in extreme danger. Spending money wildly can result in severe financial consequences for the person and his/her family. Some patients become paranoid or violent during manic episodes; others are openly promiscuous.
An Illness, Not a Character Flaw.
Bipolar disorder is an illness caused by a chemical imbalance in the brain. It affects as many as 2 million American adults. While people who have bipolar disorder can be difficult to live with, their illness is not a character defect or sign of weakness. The disorder can be controlled with the proper treatment and maintenance.
Cycling.
People with bipolar disorder alternate (cycle) between the poles of mania and depression. Each mood swing can last for a few hours or a few months. The disorder can first appear when a person is a child, adolescent, or adult. It affects people of both genders, of all socioeconomic groups, and of all races. It often runs in families and is thought to have a genetic link.
Hypomania.
Similar to mania but less severe and lasting a shorter time, hypomania usually does not require the person to be hospitalized. Although people with hypomania tend to be easily distracted and may not function well in the world, they are less severely impacted by their disorder than those with bipolar disorder. These swings are different from normal mood changes because they can severely disrupt a person’s normal activities. For some patients, hypomania is a sign that a manic phase is about to begin.
The Depression Component.
People who suffer from bipolar disorder experience the highs of mania and the lows of depression. During periods of depression, the person may feel extremely sad, anxious, pessimistic, worthless, hopeless, and apathetic. He/she may have suicidal thoughts. (See the Depression handout in this series for a complete description.)
Levels of Severity.
A person diagnosed with bipolar disorder may have three levels of the disorder: bipolar I disorder (the most severe form, involving extreme manic episodes), bipolar II disorder (less severe), or cyclothymic disorder (less severe mood swings of shorter duration). How It Begins. An episode of manic behavior usually begins suddenly, often following one or more periods of severe depression. When this happens for the first time, the person’s friends and family members may be thankful to see that his/her depression has lifted and that life appears to be returning to normal. However, as the manic phase continues, those around the patient begin to realize that something is not right. The person’s upbeat mood is too extreme, and his/her behavior may be odd or bizarre.
Similar Symptoms.
Bipolar disorder is difficult to diagnose because many of its symptoms are similar to those of other disorders, including schizophrenia, attentiondeficit/hyperactivity disorder (ADHD), adrenal disorders, epilepsy, brain tumors, multiple sclerosis, thyroid disorders, and vitamin B12 deficiency. Manic symptoms may also be caused by certain medications.
People who work in creative or artistic fields are estimated to have bipolar disorder at rates 10 or 20 times higher than the general population. There is also thought to be a higher occurrence of bipolar disorder among people with alcoholism.
Range of Severity.
Bipolar disorder ranges from mild to severe, and it can be infrequent (10 or fewer manic episodes during one’s lifetime) or rapid-cycling (several manicdepressive cycles in a day) and long-term. Because it can have a serious impact on a person and those around him/her, and also because it can result in suicide, proper ongoing treatment is crucial.
IMPORTANT NOTE
If you or someone you know has thoughts of death or suicide, take it seriously.
Immediately contact any of the following and ask for help:
- Police (911)
- Suicide hotline
- Medical professional
- Mental health professional
- Friend or loved one
- Hospital emergency room
WHAT IS THE TREATMENT FOR MANIA AND HYPOMANIA?
The main goals of treatment for bipolar disorder are to reduce its damaging effects and to help the patient live a normal life between episodes. Unfortunately, some people enjoy the effects of mania and avoid treatment because they don’t want to lose the creativity and exhilaration they feel during this part of the cycle. As a result, it is difficult to convince some patients to stay on their medication and continue their psychological treatment. The most effective treatment for bipolar disorder includes both medication and psychotherapy.
Medication.
Lithium, the standard medication for bipolar disorder, is effective in up to 80 percent of manic and hypomanic episodes. It requires careful monitoring. Because it may take weeks to become effective, immediate relief may require other types of treatment.
Electroconvulsive Therapy.
Also called shock treatment, electroconvulsive therapy (ECT) can be an effective treatment for patients who cannot take lithium. Following the administration of a muscle relaxant and anesthetic, ECT involves sending a small amount of current to the brain. The patient has a short seizure and may experience confusion, headache, nausea, memory lapse, and other symptoms. Most people respond to ECT very quickly, making it an effective treatment for patients who need to be stabilized immediately or who cannot take medications.
Psychotherapy.
An important component to the treatment of bipolar disorder is psychotherapy. Because of the guilt, remorse, and depression that often follow a manic phase, it is very important that patients establish and maintain a relationship with a licensed mental health professional. The therapist can encourage the patient to stay on his/her medication and help him/her build self-esteem and develop a support system. The therapist can also refer the patient to a support group for people with bipolar disorder, which can be an excellent source of assistance.
Family Support.
The patient’s friends and family members can provide some of the most important support of all. They can help by understanding that bipolar disorder is an illness, not a character defect. It is important that they learn as much as they can about bipolar disorder and that they listen empathetically, behave in a supportive manner, and plan ahead for the times when the patient experiences mania or depression. They should listen for remarks about suicide and take them seriously.
WHERE CAN I GO FOR MORE INFORMATION?
National Depressive and Manic-Depressive Association (ndmda.org).
Fawcett, Jan, Golden, Bernard, Rosenfeld, Nancy, and Goodwin, Frederick. New Hope for People with Bipolar Disorder. Rocklin, CA: Prima Publishing, 2000.
Mondimore, Francis. Bipolar Disorder: A Guide for Patients and Families. Baltimore: Johns Hopkins University Press, 1999.