Hypomania is part of the spectrum of bipolar disorders. Bipolar disorder is characterized by fluctuations between periods of depression and periods of unusually elevated mood, which are sometimes called manic episodes. People experiencing a manic episode typically have increased energy, decreased need for sleep, increased impulsivity, decreased judgment, delusions and hallucinations. Hypomanic episodes are similar to manic episodes but without the delusions and hallucinations. Treatment for hypomanic episodes is similar to treatment for full bipolar disorder but often more conservative, since hypomania is a less debilitating mania.
Lithium
Lithium, in the form of lithium carbonate, is the mainstay of treating bipolar disorder. Lithium is quite effective for treating and preventing hypomanic episodes, but unfortunately its effective dose is very close to its toxic dose. Symptoms of lithium toxicity include nausea, stomach pains, dizziness and weakness. Patients taking lithium need to have their blood levels carefully monitored to ensure that they are high enough to be effective but not so high as to be toxic. Since hypomanic episodes are not as dangerous as full-blown mania, preventing them is less critical. For these reasons, lithium is not always the first choice for treating hypomanic episodes.
Valproic Acid
Valproic acid, sold under the trade name Depakote, is an alternative treatment for bipolar disorder in patients who cannot tolerate lithium and is often used as a first-line treatment for hypomanic episodes. Valproic acid's efficacy in preventing manic episodes is less well-established than lithium's, but the correct dose is easier to find than for lithium. Valproic acid is also useful for treating epileptic seizures; evidence supports the use of other anti-seizure medications, such as carbamazepine and lamotrigine, in bipolar disorders as well, although only lamotrigine has been approved by the FDA for that purpose.
Atypical Antipsychotics
While hypomanic episodes usually occur as part of a milder form of bipolar disorder, they can also be a feature of schizoaffective disorder. Schizoaffective disorder is characterized by fluctuating mood symptoms, similar to bipolar disorder, combined with the flattened emotional response and distorted thought patterns seen in schizophrenia. Atypical antipsychotics are frequently used to treat schizophrenia and have been found to be effective for treating manic and hypomanic episodes as well. Atypical antipsychotics are usually the first choice for treating hypomanic episodes seen as part of schizoaffective disorder.
References
- "Current Diagnosis and Treatment: Psychiatry"; Michael H. Ebert; 2008
- "Principles of Pharmacology"; David E. Golan; 2005
