The question of when is a good mood too good and what to do about it lies at the heart of my recurring experience that, as a psychiatrist specializing in working with people with bipolar and depression, I find myself in the uncomfortable position of being a spoilsport from time to time.

Actually, sometimes it is much worse than that. Sometimes a reasonable outside observer might suggest that I like making people unhappy.

An older woman who has wrestled her way through two years of a post-mania depression comes in and is feeling, finally, better, more energetic, more like herself, and, rather than simply rejoicing at her good fortune I feel I must, also, start thinking about how to prevent another manic episode.

Today I found myself with a new dilemma: what to do when a young woman with a three year history of depression and fatigue and no history of bipolar mood variation suddenly feels that she is in an “absolutely perfect” mood after the addition of a small dose of an antidepressant to her existing medications. She has lots of ideas, lots of energy, and is more animated than I have ever seen her.

And mind you this is not someone who is either manic or hypomanic.

She has no impairment of any kind and, in fact, seems to be unusually successful at work and in her friendships. She feels much healthier than she has in years. She is in fact getting by on six and a half hours a night of sleep rather than her usual 8 to 9 hours.

Her mood is the very mildest form of the energized state, which in its extreme is called mania. Psychiatrists call this hyperthymia.

Hyperthymia is a term popularized by bipolar expert Hagop Akiskal to describe moods that are not “abnormal” but are, nonetheless, distinctly energized. An even milder form of the mild mania known as hypomania (yes, this is very confusing, hyperthymia is less manic than hypomania).

Initially, Hagop used the term to describe certain extremely successful business people who seemed to have inexhaustible energy and who never got depressed.

The term is now also used to describe the lightest observable shade of mania.

By definition, hyperthymia is associated with either no impairment or minimal impairment.

So why should I do anything?

One concern is that it is absolutely clear that this, never before experienced mood, was triggered by a medication I’ve prescribed. What are the potential adverse effects of being hyperthymic? We don’t really know. But one can easily imagine it could lead to mood cycling, or a worse depression.

But, since she’s feeling good, after years of chronic depression, and there’s no apparent impairment in function, how could I explain to her any recommendation to stop or reduce the medication?

I ended up focusing on the issue of her reduced sleep and the reasonable observation that 6 hours of sleep a night is probably not enough to avoid long-term negative health consequences.

We agreed to a very gradual and modest reduction in medication dose with a goal of having her sleep at least six and a half to seven and a half hours per night.

Then I started to talk about the fact that her surprising and dramatic response to a small dose of an antidepressant suggested that she might have a better long-term response to a mood stabilizer with antidepressant effects such as lamotrigine.

She was reluctant to switch medications, but we did agree that she will start keeping track of her mood and her sleep more closely using a mood tracking app.

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But Hypomania is Great!