Hypomania is a mood disorder characterized by periods of irritability, hyperactivity, and mood swings. It is still rarely diagnosed as such and remains rather perceived as a moment of very great form. It is often the onset of an episode of depression following the period of hypomania that leads to the diagnosis of the disorder. The combination of drug treatment, psychotherapy and a healthy lifestyle helps stabilize the patient’s mood.

Definition of hypomania

Hypomania is a mood disorder characterized by periods of irritability, hyperactivity and mood swings, associated with sleep disturbances. The duration of these symptoms does not extend beyond four days.

This phase is often followed by another, depressive. We then speak of bipolarity, that is to say of manic depression, alternations of manias and depressions.

Hypomania is usually chronic. It’s a light version of mania. Mania is a pathology that lasts for at least a week and presents a significant alteration in functioning that can lead to hospitalization or the appearance of psychotic symptoms – hallucinations, delusions, paranoia.

Hypomania can also be present as part of an attention deficit disorder with or without hyperactivity – known by the acronym ADHD -, or even a schizoaffective disorder, if it is accompanied by episodes. delusional.

Types d’hypomanies

There is only one type of hypomania.

Causes de l’hypomanie

One of the causes of hypomania is genetic. Recent studies show the involvement of several genes – in particular on chromosomes 9, 10, 14, 13 and 22 – in the onset of the disease. This combination of genes, said to be vulnerable, makes the symptoms, and therefore the treatments, different for each individual.

Another hypothesis puts forward a problem in the processing of thoughts. This concern would come from a dysfunction of certain neurons, which would induce the hyperactivity of the hippocampus – an area of ​​the brain essential for memory and learning. This would then cause a disruption in the activity of neurotransmitters playing a major role in the processing of thoughts. This theory is supported by the relative effectiveness of psychotropic drugs – including mood stabilizers – acting on these neurotransmitters.

Diagnosis of hypomania

Given their low intensity and their brevity, the phases of hypomania are often very difficult to identify, thus leading to an underdiagnosis of these episodes. The entourage believes that the person is in a very good period, in great shape. It is often the onset of a depressive disorder following this hypomanic phase that confirms the diagnosis.

The late diagnosis is often made in late adolescence or early adulthood, at the latest around 20-25 years.

Tools make it possible to better target the hypothesis of the presence of hypomania:

• Le Mood Disorder Questionnary –Original version in English– published in 2000 in theAmerican Journal of Psychiatry, would be able to identify seven out of ten people with bipolar disorder – with alternating (hypo) mania and depression – and to filter nine out of ten people who are not. Original English version: http://www.sadag.org/images/pdf/mdq.pdf. Version translated into French: http://www.cercle-d-excellence-psy.org/fileadmin/Restreint/MDQ%20et%20Cotation.pdf;
• La Checklist d’hypomanie, targeting more hypomania alone, developed in 1998 by Jules Angst, professor of psychiatry: http://fmc31200.free.fr/bibliotheque/hypomanie_angst.pdf.

Be careful, only a healthcare professional can establish a reliable diagnosis using these tools.

People affected by hypomania

The lifetime prevalence rate of hypomania in the general population is 2-3%.

Factors favoring hypomania

Different families of factors promote hypomania.

Factors related to stressful or memorable life events such as:

• Chronic stress – especially experienced during the infantile period;
• A significant sleep debt;
• The loss of a loved one;
• Loss or change of employment;
• Moving.

Factors related to the consumption of specific substances:

• The use of cannabis during pre-adolescence or adolescence;
• Consumption of anabolic androgenic steroids (ASA) – powerful doping agents for athletes);
• Taking tricyclic antidepressants such as desipramine, which are known to induce rapid cycles or manic or hypomanic episodes.

Finally, genetic factors are not to be outdone. And the risk of developing hypomania is multiplied by five if one of our first degree relatives already has it.

Hyperactivity

Hypomania leads to social, professional, school or sexual hyperactivity or agitation – disorderly, pathological and maladaptive psychomotor hyperactivity.

Lack of concentration

Hypomania causes a lack of concentration and attention. People with hypomania are easily distracted and / or attracted to irrelevant or insignificant external stimuli.

Driving at increased risk

The hypomaniac becomes more involved in activities that are pleasurable, but that can have damaging consequences – for example, the person launches unrestrainedly into reckless purchases, reckless sexual behavior or unreasonable business investments.

Depressive disorder

It is often the onset of a depressive disorder following a phase of hyperactivity that confirms the diagnosis.

Other symptoms

• Increased self-esteem or ideas of greatness;
• Expansion;
• Euphoria;
• Reduced sleep time without experiencing fatigue;
• Willingness to speak constantly, great communicability;
• Escape of ideas: the patient passes very quickly from rooster to donkey;
• Irritability;
• Conceited or rude attitudes.

The treatment of hypomania often combines several types of treatment.

Also, in the context of an episode of hypomania where there is no marked alteration in professional functioning, social activities, or interpersonal relationships, hospitalization is not necessary.

Pharmacological treatment can be prescribed over long periods of time, from two to five years, or even for life. This treatment may include:

• A mood stabilizer –or thymoregulator–, which is neither a stimulant nor a sedative, and of which the 3 main ones are lithium, valproate and carbamazepine;
• An atypical antipsychotic (APA): olanzapine, risperidone, aripiprazole and quetiapine.

The latest research establishes that in the medium term – over one or two years – the combination of a mood stabilizer with an APA is a therapeutic strategy that gives better results than monotherapy.

Be careful, however, during a first episode of hypomania, current knowledge invites us to favor monotherapy, to counter a potential poorer tolerance of combinations of molecules.

Psychotherapies are also essential to treat hypomanias. Let us quote:

• Psychoeducation helps develop coping strategies or prevent manic episodes by regulating sleep, diet and physical activity;
• Behavioral and cognitive therapies.

Finally, good eating habits, including fruits and vegetables, and weight control also help channel hypomania.

Preventing hypomania or its relapses requires:

• Maintain a healthy lifestyle;
• Avoid antidepressants – unless a previous prescription was effective and did not cause a mixed hypomanic shift, or if the mood became depressed when stopping the antidepressant;
• Avoid infusions of St. John’s Wort, a natural antidepressant;
• Do not stop treatment – half of relapses are due to stopping treatment after six months.