Hypomania vs. Mania: What's the Difference?

Mania and hypomania refer to mental health episodes in which an individual experiences abnormal and extreme mood changes. These mood episodes can vary from elevated or irritable mood, racing thoughts, changing energy levels, and changing sleep patterns.

Both mania and hypomania symptoms commonly occur in people with bipolar disorder. However, symptoms can also occur in those without bipolar disorder.

Continue reading to learn the main differences between mania and hypomania, how they’re diagnosed, what treatments are available, and what symptoms to look for.

What is Mania?

Mania refers to an episode lasting one week or more where an individual experiences a drastic change in their mood and behavior. It disrupts how they function in their day-to-day life. During manic episodes, people typically feel more physically and mentally energized with euphoria, trouble concentrating, and poor sleep. In some instances, severe mania can require hospitalization.

Mania often occurs in people with bipolar I disorder. Such individuals may or may not experience depression at some point.

What Are the Three Stages of Mania?

Mania can be divided into three stages: hypomania, acute mania, and delirious mania.

While mania is commonly present in people with bipolar I disorder, it can also be present in other mental health conditions, such as cyclothymia, seasonal affective disorder, schizoaffective disorder, and postpartum psychosis (Is Postpartum Anxiety Medication Right For You?)

What is Hypomania?

Hypomania is a milder form of mania. During a hypomanic episode, energy levels are higher than usual. However, most people with hypomania do not require hospitalization, and the symptoms only last a few days.

Hypomania commonly occurs in those with bipolar II disorder. In such individuals, hypomania alternates with depressive episodes.

Learn about the difference between bipolar I and bipolar II disorder.

Importance of Distinguishing Between Mania and Hypomania

The type of mood episode you have, mania or hypomania, can determine the diagnosis you receive.

Bipolar I disorder: At least one episode of mania, which may occur before or after a hypomanic or major depressive episode.
Bipolar II disorder: At least one hypomanic episode and one major depressive episode, but no episode of mania.
Cyclothymia: Many periods of mood swings (hypomania and depression) for at least two years (one year in children and teens).
Bipolar disorder with mixed features: Symptoms of mania and depression at the same time, for example, high energy and activity levels, but also sadness, hopelessness, and the need for suicide prevention measures.
Other types: Bipolar disorders caused by drugs or alcohol or medical conditions such as stroke, multiple sclerosis, or Cushing's disease.

Diagnosis of Hypomania and Mania: Key Differences and Similarities

In What Way Does Hypomania Mainly Differ from Mania?

Despite mania and hypomania mainly having the same symptoms, they are different and can be distinguished in the following ways:

Type of bipolar disorder: Those who have experienced at least one manic episode in their lifetime receive a bipolar I disorder diagnosis, while those who have never had an episode of mania but have hypomanic and depressive episodes are diagnosed with bipolar II disorder.
Intensity of symptoms: Hypomania is considered a less severe form of mania. Symptoms tend to be less serious than mania. In contrast, manic episodes can be intense enough to warrant a trip to the emergency room due to severe changes in behavior.
Impact of symptoms on daily life: Manic symptoms are often severe enough to disrupt a person’s functioning in social settings and at work, school, and home. In contrast, hypomanic symptoms do not typically cause any major disruptions to a person's functioning in daily life.
Duration of symptoms: For it to be called a manic episode, symptoms must last for at least one week. Hypomania symptoms last for at least four days.
Presence of hallucinations: A manic episode can lead to psychotic features like auditory or visual hallucinations and delusions. For instance, a person with mania may believe they are a spy or a secret agent. Some may feel paranoid, like they're being stalked or targeted. Hypomania, however, is not associated with delusions or hallucinations.

Diagnostic Criteria for Hypomania and Mania

According to guidelines in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), hypomania is diagnosed if symptoms occur for at least four consecutive days and are present throughout most of the day. These symptoms should not be severe enough to cause functional impairment and should not be attributed to medication or substance use.

Based on the DSM-5, a diagnosis of mania is made if symptoms last for at least a week and are present for most of the day. If hospitalization occurs, the symptoms need not be present for more than one week before a healthcare provider can make a diagnosis of mania.

Symptoms and Manifestations of Mania and Hypomania

Common Symptoms of Hypomania and Mania

Feeling extremely happy or excited (euphoria)
Increased talkativeness and talking quickly
Higher than usual energy levels
Reduced need for sleep
Racing thoughts with new ideas and plans
Increased self-esteem and confidence
Getting easily distracted
Increased irritability or aggression
Impulsivity and making reckless decisions, such as making rash financial decisions, gambling, shopping sprees, or engaging in risky sexual behaviors

Symptoms can vary from person to person. The individual's friends and family might notice a change in their mood and behavior. At the same time, the person experiencing the symptoms of mania or hypomania might not be aware of these changes themselves.

What Does a Hypomanic Episode Look Like?

Different things can set off an episode of hypomania in different people. Common triggers include a lack of sleep, being in a noisy, crowded place, going through a big life change, or substance abuse.

During an episode of hypomania, a person has over-the-top levels of activity, energy, excitement, and happiness, with an inflated sense of importance and self-esteem. They may also have racing thoughts, be easily distracted, talk very fast, pace, and fidget a lot. Their need for sleep may be reduced, and they may be able to work for hours without feeling tired. Additionally, they may participate in risky behavior such as unprotected sex, reckless business decisions, gambling, or shopping sprees.

For example, during a full-blown episode, a person may become abnormally excited about a business idea. They believe they will soon own hundreds of stores, which will make them a millionaire. However, in reality, they know nothing about business, don’t have a business plan, and don’t have the finances to start a business.

A hypomanic episode can last anywhere from 4 days to several months. After the episode ends, an individual may feel like a completely different person, including feeling embarrassed about their behavior and/or regretful about the serious risks they took. Memories of the events may be clear, vague, or absent. It’s also common for people to feel exhausted and experience depression if the hypomania is related to bipolar disorder.

Differences in Symptoms and Intensity: How to Identify a Manic Episode?

The symptoms of a manic episode are similar to a hypomanic episode, but more intense and longer lasting with a bigger impact on daily functioning. In addition, psychotic symptoms may be present during mania but not hypomania. These include delusions (having false beliefs) and hallucinations (seeing, hearing, tasting, smelling, or feeling things that aren’t there).

Causes and Risk Factors of Hypomanic and Manic Episodes

Bipolar Disorder

Mania and hypomania are frequently seen in people with bipolar illness, a condition that requires a diagnosis from a mental health professional. In general, an individual must experience episodes of depression and manic or hypomanic episodes to be diagnosed with bipolar I or bipolar II disorder.

Risk factors for bipolar disorder include a family history (first-degree relative with bipolar disorder), substance use, and traumatic events or periods of high stress. Find out: is depression genetic?

Other Causes

Apart from bipolar disorders, other possible causes of a hypomanic or manic episode include:

Substance abuse (i.e., misuse of alcohol or recreational drugs)
Certain medications, such as an antidepressant called escitalopram
A lack of sleep
Family history or genetics
High levels of stress
A major change in life, such as a death or divorce
Other mood disorders, such as cyclothymic disorder
A history of trauma or abuse

Often, the development of hypomania and mania cannot be attributed to one single cause. In many cases, a combination of short or long-term factors can trigger mania or hypomania.

Treatment and Management Strategies for Mania and Hypomania

Evidence-based treatment plans for mania and hypomania consist of psychotherapy and medications that can be dispensed in an inpatient setting or through an outpatient psychiatry clinic.

Medications

Medications used to manage manic or hypomanic episodes may include:

Mood stabilizers such as lithium
Antipsychotics such as aripiprazole, quetiapine, risperidone, lurasidone, and olanzapine
Anticonvulsant drugs that work as mood stabilizer such as divalproex, carbamazepine, topiramate, and lamotrigine
Antidepressants such as SSRIs (citalopram, escitalopram, fluoxetine, sertraline, paroxetine) for manic depression

Benzodiazepines can be used to provide quicker relief of manic symptoms such as agitation, insomnia, and restlessness. These medications are typically used for a short duration until mood stabilizers can take effect.

Common side effects of medications used for treating mania and hypomania include drowsiness, dizziness, nausea, weight gain, dry mouth, and shakiness.

Psychotherapy

Psychotherapy typically helps individuals recognize and identify triggers for hypomanic or manic episodes. Psychoeducation can also help a person learn coping strategies and detect the early warning signs of an episode so they can take any necessary action before their symptoms worsen.

Lifestyle Changes and Self-Care

Medications and therapy are usually necessary to treat mania. However, hypomania with milder symptoms can sometimes be managed without medications. Self-care, which consists of exercising daily, getting enough sleep, and maintaining a healthy diet, may keep mild symptoms under control. It's also best to avoid known triggers, such as coffee, bright lights, or loud environments, and build a stress management routine.

If you've been diagnosed with hypomania or mania, you can also consider keeping a mood diary to keep track of your mood, emotions, and possible triggers. This can also be a helpful tool for your healthcare professional to keep tabs on your symptoms and your treatment response.

Comprehensive Treatment from a Health Care Provider

If you suspect you or a loved one is experiencing a manic or hypomanic episode, it's important to seek professional advice. Your doctor will conduct a thorough physical exam and ask about your symptoms, medical history, and family history.

If your doctor suspects that you have hypomania, mania, or bipolar disorder, they may refer you to a mental health professional who will be able to make a proper diagnosis and recommend a treatment plan.

Note: Although mania can lead to more severe symptoms, hypomanic episodes still require proper treatment, as they can lead to risky behaviors.

Risks and Impact: When to Seek Help?

Warning Signs of Escalating Mania or Hypomania

Some of the early warning signs of a manic or hypomanic episode may include:

Not sleeping
Increased emotional intensity such as agitation, irritability, argumentativeness
Feeling energized
Neglecting to eat
Losing track of time
Racing thoughts and fast speech
New ideas or plans
Working extreme hours or taking on more work
Spending more money than usual
Flirtatiousness and/or increased sexual drive