Mania and hypomania are periods of abnormally elevated, expansive or irritable mood along with increased energy and activity. They are the defining features of bipolar disorder. Symptoms include needing much less sleep without feeling tired, racing thoughts, rapid speech, inflated confidence, distractibility, taking on many projects at once, and impulsive behavior such as spending sprees, risky driving or sexual indiscretion. The difference between the two is severity and duration. Mania lasts at least a week, causes clear impairment, often requires hospitalization and can include psychosis. Hypomania lasts at least four days, is noticeable to others, but does not cause severe impairment or psychosis.
Bipolar I disorder is defined by at least one manic episode; bipolar II by hypomania plus major depressive episodes. Hypomania is easy to miss because it can feel productive and pleasant, so people usually seek help during the depressions that follow. That makes screening important before starting an antidepressant, since antidepressants alone can trigger mania or rapid cycling in someone with unrecognized bipolar disorder. Treatment relies on mood stabilizers such as lithium, valproate and lamotrigine, and on atypical antipsychotics, along with regular sleep, psychotherapy and attention to early warning signs. At Stedfast Psychiatry, every new patient evaluation asks about past episodes of elevated mood and reduced need for sleep, and family history, so that treatment for depression does not accidentally destabilize an underlying bipolar condition.