Psychiatry – Mania/Hypomania: By Kate Huntington M.D.


One surprising fact you need to know about
mania: this diagnosis is frequently missed! When people think of mania they most often
think of the classic euphoric mania with behaviour that is drastically aberrant from a person’s
normal behaviour and that could not be missed by anyone. This is not always the case. There are three main ways that the diagnosis
of mania has been missed: Bipolar Disorder presenting with depression
Many people with bipolar disorder will experience mild episodes of mania that they experience
as ego-syntonic and pleasurable. Even though these episodes do cause some dysfunction,
it is not severe enough to lead them to seek medical attention. If the episode is not registered at the time
as abnormal, after the episode is over, recall of the specific details of this episode are
often lost to the person who was experiencing the symptoms. People are much more likely to seek medical
attention for symptoms of depression as these are much more distressing for them. For this reason, when anyone presents with
symptoms of depression it is essential to screen for symptoms of previous mania including
mild mania and hypomanic episodes. Many experience episodes of mania as pleasurable,
therefore recall is poor.This is because: People do not see these behaviours as warranting
clinical attention and Because they do not necessarily want to prevent
future episode. As they have not registered these symptoms
as abnormal when they occurred, they may genuinely not recall having an episode of these behaviours. Having had manic symptoms however is a little
bit like having had garlic pasta for lunch. The person who has the symptoms may not notice
the symptoms but everyone else around them does. For this reason, it is essential to gather
collateral history to further explore the possibility of past symptoms of mania or hypomania. Loved ones, especially those closest to the
patient are very likely to remember these episodes which may have been quite distressing
to them or disruptive in their life. Manic episodes do not always present with
euphoric mood. They can present with significant irritability. They can also present as mixed episodes where
there are both symptoms of mania and depression within the same time period. These episodes are very frequently missed
as they do not present at all as we most often picture manic episodes. It is therefore essential to screen for manic
symptoms in the context of any depressive episode or in any person presenting with irritable
and angry affect and mood. Typically, people with dysphoric mania or
mixed episodes will present with symptoms of depression as well as irritability, rapid
speech, racing thoughts [for example unable to turn thoughts off at night to go to sleep],
psychomotor agitation, perhaps starting but not able to finish multiple projects, and
distractibility. They also often have severe anxiety. These symptoms present in an episodic fashion
and represent a change from the person’s baseline.

26 comments

  1. Going through an episode rn. I'm happy, hyper and don't need sleep. Went to Psycoloigst and got diagnosed . No bipolar disorder in me. Just need to take sleeping pills and they work.

  2. I have hypomania and it felt great and people told me I appeared like I had done cocaine but I denied it and said they were just jealous that I was happy, I felt euphoric and exercised so much. I felt like I had superpower, had all these ideas, never slept alot and was so social and felt like I was the sexiest person alive. I flirted with alot of people, I also told people they are fantastic and talked alot.

  3. This voice on this video is really soothing, the video is simple, please recommend me more videos of just talking like this in detail about something. I will check out this channel in hopes of finding more videos like this.

  4. Ha my mom said i was acting like I was on meth haha. Not gonna lie i could easily see it very energetic and all that and fidgety and fun.

  5. I'm trying to learn more so please excuse my uninformed questions. Would anyone be kind enough to speak toward how people, dealing with these problems, might face the devastating loss of multiple loved ones? Could this trigger episodes and how might they be different based on severe grief/circumstances? Answers would be greatly appreciated. I'm working to help a life in the balance. Thank you!

  6. I haven’t been diagnosed with any sort of disorder relating to mania, but a lot of the time, I feel like doing all the things and like I’m not doing enough and I don’t feel productive and I have really weird random bursts of energy to the point where people have pulled me aside and asked if I have taken anything, but I also can’t move anything but my arms and my legs which are restricted to bouncing and I shake my head a lot and I have a really high pitched baby voice, and I can’t do anything because I’m overflowing with all sorts of energy and I’m overwhelmed and I feel heavy but also extremely light, if that makes sense. My family doesn’t really pay attention it, mainly because it’s been around for so long.

  7. I can experience severe paranoia when I'm having a hypomanic/manic episode that lasts for several days, does this suggest I am bipolar 1?

  8. question l have been suffering for insomnia last 30 years. Nero Dr. given sleep tablets. I want to leave medicine. please give me sdvise

  9. I was diagnosed ADHD when I was younger but now that I'm in my twenties I'm certain is bipolar. Didn't come to my self-realize until I started blacking out sober and almost got in serious legal trouble… a few times. I think the main problem, in regards to mania, is an overactive glutamatergic system and modulating or antagonizing the NMDA receptor may be answer.

  10. this is crazy. I never thought I had any disorders.
    but since my mom died, my future ended.
    I live in a state of
    never ending Depression. darkness. I'm happy just laying on the coach all day, doing nothing on my days off.
    I'm scared I might be a mixed mania depressive.

  11. I think we like to takes things that fall outside of the realm of predictable order and refer to them as disorders (Even if these “episodes” can result in hyper-productivity and pleasurable feelings) it’s all about the stories you tell yourself people. Take a notebook with you wherever you go and let your mind fill up the papers with the opened floodgates of your thoughts. Socrates called it a divine gift from God. Don’t let people tell you that you have a problem, it only hinders you and puts more money in their pocket. Don’t let them profit from your lot in life, understand you are gifted and allow yourself to be the gift you are. Extraordinary people make ordinary people uncomfortable. Don’t let ordinary people write your story, you’ll find they’re often boring and poor story tellers.

  12. I was diagnosed with Schizophrenia sometime during 2017. Three months ago I started to take Adderall but I had to stop it a month ago, ever since I am in a hypomania state. My doctor told me Adderall is not adviced to people with mental disorder for this reason. I hope this helps, if you are suffering from Schizophrenia you might have a good chance to change it to Bipolar like disease. From my experience Schizophrenia is the worst mental disorder out there. Amphetamines can develop Bipolar symptoms in those with various mental disorder it can be permanent or temporarily, in my case the hypomania lasted for almost a month and I dont know how long it will last.

    Personally I prefer to be hypomanic than Schizophrenic.

  13. i'm currently experiencing hypomania , i have had a past use of methamphetamine which i am sober from but i say that to say this: hypomania/mania is beyond any drug you could take, i mean when it"s "good" mania is stronger than meth itself for me and it continues and continues without you having to do any drugs. idk if anyone else agrees but that is my experience.

  14. Hello I’m a doctor management of manic episodes involves the following;
    (1) the first thing you should do is avoid anti-depressant medication because they increase serotonin levels.
    (2) antipsychotic drugs like aripiprazole or valproate are very effective in treatment but sometimes a combination together with lithium is used if treatment is ineffective.
    95% patients make full recovery but recurrence is common in some patients.

  15. My last hypomania episode was terrible,i was totally freaking out. I was hooking up with any sort of guy,i was exposing myself too much and i've taken lots of risks. When i recovered my sanity,i felt traumatized and promised myself i'd never find someone anymore. My usual behavior is quiet and extremely introverted but when i had that crisis…I became the opposite. I feel quite sad each time i think about what i've done,if i could go back to the past and fix it all,i would.

  16. It's a bummer when you have to diagnose yourself–my therapist completely missed hypomania and was cool with me uprooting and moving to a new city in like a week and a half. Almost signed a lease–it would have been a disaster. Looking for a new therapist who is knowledgeable about bipolar disorder. TIP: If you have a mood disorder–exercise 150 minutes a week, loose extra weight and eat right. Otherwise, you will NEVER get better–I know. Pills are VERY limited in what they can do.

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