What is Hypomania?

What is hypomania (“a little mania”) and what changes when you are hypomanic? Depending on where you sit it can be the most desirable state conceivable or a mood that is terribly destructive to relationships.

We often say that hypomania is a symptom that rarely motivates people for treatment, but often motivates a spouse or partner to insist on treatment.

It is an “energized” state associated with reduced need for sleep, increased productivity (in the DSM it is one of the few defined states of mind that is explicitly noted to not necessarily be associated with any impairment of functioning), and rapid or impulsive decision-making.

John Gartner controversially suggested that it is a state of mind that is responsible for much of what makes America great (see below).

The one thing that we find is most consistently a feature of hypomania is a reduced awareness of risk (it is not a disregard for risk, it is just a reduction in awareness of risk… think of it almost as a form of cognitive “blindness”).

Lori Altshuler, in an article in Biological Psychiatry, showed that hypomania is specifically associate with reduced activity of the orbitofrontal cortex (the part of the brain right over your eyes). This part of the brain is involved in making decisions that involve risk. In depression it tends to be overactive (too much awareness of risk) and in hypomania it seems to be underactive.

You can see a brain scan that highlights this region of the brain in green on the right.

Perhaps the fact that hypomania is related to a reduction of awareness (of a specific kind) is why mindfulness is the form of therapy that we find the most helpful for moderating the effects of hypomania.