In the Depths of Hypomanic Bipolar Disorder

hypomanic bipolar disorder

Last Updated on 15 May 2024

Hypomanic bipolar disorder is an underestimated and overlooked mental illness. We can say it is a forgotten mental disease. Most doctors and patients, indeed, are mainly focused on the classic symptoms of the classic bipolar disorder. But the hypomanic “variant” is more widespread and undiagnosed than you think.

In this article, I explored the depths of hypomanic bipolar disorder to help you recognize its subtle symptoms and receive the right diagnosis and a proper treatment. Keep reading this piece to really understand what hypomanic disorder is.

Hypomanic Bipolar Disorder: What Is It?

Hypomanic bipolar disorder is classified as a second type of bipolar disorder. It is also called bipolar disorder 2 or II or, simply, bipolar 2.

Bipolar disorder 2 or hypomanic bipolar disorder is characterized by phases of mild mood excitement, more often irritability, and depression; while bipolar disorder 1 has stages of high mood excitement, such as a great energy and exaggerated activity, followed by depression.

Bipolar disorder 1 and bipolar disorder 2 are the main classification of this mental disease, which, in reality, includes several variants.

There is also a third variant, called cyclothymia, and a fourth one, named hyperthymia. In the past decades, the classification of bipolar disorder also included a not otherwise specified bipolar disorder (NOS BP) that represents the fifth version of the disease.

There is also another disorder, called dysphoria, that, alternatively, may coincide with the hypomanic bipolar disorder, because it consists of alternate stages of irritability and depression.

Furthermore, there is also the mixed disorder, a sort of bipolar disorder where you have irritability (mood excitement) and depression at the same time!

The high variability of bipolar symptoms led clinicians to define the so-called “bipolar spectrum”, where over 10 different bipolar disorders may be detected.

However, the main classification is always between bipolar 1 and bipolar2, because the other variants get included in these two main types of mental disorder.

Let’s explore the symptoms.

Hypomanic Bipolar Disorder Symptoms

Bipolar disorder is characterized by mood swings. The stages of high mood are defined as “mania”, while the stages of low mood are defined as “depression”.

Hence, the main symptoms of bipolar disorder are the mood swings with alternance of excitement (high mood) and low mood (depression).

Elevated mood is always defined as Mania, but in the hypomanic bipolar disorder, the elevated mood is not so intense, it is milder and characterized by excessive irritability, which is defined as “hypomania”.

For this reason, the DSM5 defined bipolar 2 as hypomanic bipolar disorder.

The symptoms of hypomanic bipolar disorder are:

  • irritability
  • intense sensation of rage and frustration
  • sense of guilt
  • lack of concentration
  • agitation
  • sudden changes of ideas
  • anxiety
  • eating too much or too little
  • sleeping too much or too little
  • lack of energy or fatigue
  • fast speaking
  • sadness, sense of failure and emptiness
  • depression

As regards the fatigue after hypomanic and depressive episodes, it seems to be linked to the levels of cortisol (the stress hormone), which, in patients with mental illnesses, is altered and very high. This data confirms the hypothesis of a close relationship between mental disorder and other medical conditions, such as a vitamin B6 deficiency, often related to autoimmune diseases such as Hashimoto’s.

Vitamin B6 is, in fact, pivotal for the immune and nervous systems. It increases the resistance to stress and lowers the levels of cortisol, which, in turn, tends to reach high peaks during bipolar episodes. If cortisol diminishes, the bipolar episode may be less frequent. 

Hypomanic bipolar disorder may be also accompanied by physical symptoms, such as stomach pain and strong headaches. Usually, they are triggered by the hypomanic episodes of irritability and agitation.

Often, hypomanic bipolar disorder occurs with other mental disorders, such as the already mentioned anxiety and even obsessive compulsive disorder.

In reality, in this case, anxiety and obsessive-compulsive disorder are not separate diseases, but symptoms of hypomanic bipolar disorder.

I came across this disorder, several years ago, when I looked for help to heal my depression.

In 2008, in Catania, in the year of the awful global financial crisis, I met psychiatrist Pina Salomone, who defined hypomanic bipolar disorder like this: “It is a mood disorder, based on depression, and caused by difficulty in adapting to reality”.

With these words, this doctor was able to perfectly define this mental illness, letting me understand that hypomanic bipolar disorder is a subtype of depression, rather, one of the most subtle and devastating mood disorders, also known as “bipolar depression”.

At the time, the words of Dr. Salomone allowed me to figure out the psychological causes of hypomanic bipolar disorder. Let’s discover them in the following paragraph.

Hypomanic Bipolar Disorder Causes

Hypomanic bipolar disorder has very complex causes that come from a close interaction between genetic, environmental and psychological factors.

An underestimated cause of the disorder is an autoimmune disease such as Hashimoto’s thyroiditis. I have this disease, which caused me mood disorders and depression. Hence, believe me, I know about what I am discussing.

However, the main cause of this mental illness relates to a chemical alteration in the brain.

A video by the Brain and Behavior Research Foundation explained that unbalanced levels of dopamine may be involved in the onset of bipolar disorders, even in the hypomanic variant.

But a brain chemical imbalance can by itself explain the burst of bipolar episodes? 

Clinicians are by now convinced that the chemical imbalance makes people more vulnerable to this type of mental illness, but there might be other risk factors that trigger the disorder.

It seems that childhood traumas and abuses are some of these risk factors, along with stressful life conditions.

If a vulnerable person meets economic, financial or emotional struggles in his/her lifetime, this person is more likely to develop hypomanic bipolar disorder.

The chemical imbalance is the straw, the stressful life is the fuse that ignites the fire!

How to Diagnose Hypomanic Bipolar Disorder

It is not always easy to discover if you suffer from hypomanic bipolar disorder. Many patients remain undiagnosed for their entire life, with all the awful consequences on their own mental health and the one of their partners and relatives.

Many relationships have been broken just because of hypomanic bipolar disorder. Many other patients also look for hypomania bipolar 2 disorder tests.

These tests are often online and aim to survey the difference between bipolar 1 and bipolar2, in order to detect patients affected by hypomanic bipolar disorder. The bipolar 2 tests should be conducted by skilled psychiatrists to be really effective.

However, the difficulty to diagnose the disorder does not depend only on doctors, but also on patients. The latter, often, look for help only for the depressive stage and not for their hypomania.

Since the initial onset, around 19, 20 years of age, the patients struggle with alternate episodes of irritability followed by depression. They become so accustomed to their irritable mood, that their suffering remains unnoticed to themselves, as well. Hypomanic bipolar patients are often labeled as bad persons or people with a bad temper. They define themselves as bothering persons or grumblers, as well.

They are unaware that their jittery, anxiety and complaints are the ugly face of their hypomania. Only afterward, when the hypomania turns into a sense of failure, pessimism and depression, they look for help and are often diagnosed with unipolar depression.

It happened to me, when I was younger. It took several years to get diagnosed with bipolar depression by the aforementioned Dr. Pina Salomone.

Yes, my depression caused by my Hashimoto’s thyroiditis, prompted, in turn, a difficulty to adaptation to stressful life conditions and only God knows how much is hard to live in a small village in Sicily, with the stressful issues of the corrupted politic and a likewise corrupted labor market (especially for women).

Irritability, a strong sense of frustration and powerlessness, extreme criticism towards the ugliness of my reality of life and, soon after, exhaustion and severe depression. Today, I am a mature woman, and as explained in a previous post, I defeated my depression and learnt to keep my hypomanic temper under control.

Indeed, to soothe bipolar depression, you must heal the hypomania, as well; if you treat only your depression, hypomanic bipolar disorder does not relieve.

I owe all this understanding just to Dr. Pina Salomone. For this reason, I want to report the things she said to me in 2008.

Hypomanic bipolar disorder grows along with the patient and, over time, becomes rooted in his/her personality. It is like a home with hard stone and hard bricks. To treat a bipolar patient, we need to break down this thick and impenetrable wall, and rebuild his personality from scratch!”.

According to this Italian psychiatrist, hence, hypomanic bipolar disorder may become a personality disorder, if it remains untreated.

It is usual that patients in the grip of bipolar crisis change their mindset and even their behavior. When they are raged, and, soon after, depressed, nothing remains of the lovely persons they really are.

For this reason, as soon as the bipolar episodes relieve, they develop a strong and intense sense of guilt. Then, soon after the crisis, their mood gets calm, but their hypomanic depression never has a real remission.

Hypomanic Bipolar Disorder Remission

Bipolar depression of type 2 is a severe e disruptive mental illness that lasts for the entire life. A definitive remission is hard to obtain, there are, instead, frequent and temporary phases of remission. Especially when the stressful life conditions of life loose.

Stress is, in fact, a powerful trigger for bipolar and hypomanic patients. “These patients are unable to face reality – said Dr. Salomome -. They missed a path of personal development and instead of reacting with emotional balance, they develop agitation, anxiety and pessimism”.

It is like if hypomanic persons miss having an umbrella or a coat that protects them from the rain and the storms they will meet over their life. Hypomanic bipolar patients, indeed, have a big difficulty managing their emotions. For this reason, hypomanic bipolar disorder is also known as affective disorder.

Bipolar persons experience the reaction of “fight or flight”. That is a reaction that belongs to the stage of childhood, but if it lasts into adulthood, also, it may be a sign of hypomanic bipolar disorder.

Furthermore, every type of stress, failure, social injustice, and even challenging, positive events may trigger hypomania crises and depression. Step by step, hypomanic people develop difficulty to have balanced relationships in every aspect of life: work, family, friends and sex.

Their patience is short or totally missing. The difficulty to bear burdensome tasks escalates over time or in particular hormonal conditions, such as pregnancy or menopause.

For this reason, these patients prefer a solitary life or make extreme choices, such as no marriage and no children.

To get the illusion of bipolar remission, patients should keep themselves away from life changes and stress, but these factors never are under our control.

However, changes in lifestyle can be very beneficial to control hypomanic bipolar disorder and conduct a normal life. 

Lifestyle to Cope with Hypomanic Bipolar Disorder

Lifestyle is crucial when you struggle every day with mood swings, anxiety and irritability.

To soothe them, you need to restore a healthy lifestyle.

Start a project that engages you on a regular basis. I overcame the most debilitating effects of my bipolar depression when I started learning a foreign language, for example.

Secondly, try to sleep and wake at the same hour, at night and in the morning, so that you have the right energy to face your daily tasks. If it is true that we can’t control the vicissitudes of life and we can’t spend our existence on a boat floating on a quiet sea, we can find room to walk amid nature.

It has been seen that nature and green are extremely beneficial to reduce stress and soothe the symptoms of hypomanic bipolar disorder.

Also learn to say No to burdensome tasks, respect yourself for your disorder, but above all, respect yourself overall. For your uniqueness, for your suffering, also.

Follow your pace, do what you can do without a sense of guilt and don’t chase dreams or tasks that are hard to face. This way, you’ll start a path of personal development that, as Dr. Pina Salomone said to me, help you build a stronger personality capable of reacting to life stress with a healthy demeanor and with less mood swings.

Furthermore, it is very important, rather, fundamental and necessary, to find a suitable treatment to relieve the most disruptive and pathological aspects of this disorder. Let’s see them together.

Hypomanic Bipolar Disorder Treatment

Since hypomanic bipolar disorder is a lifelong disease, you need to treat it properly if you want to have a normal life, and, above all, a balanced mood.

The bipolar disorder treatments can be psychological or medical. The psychological cures include:

1.   group psychotherapy

2.   cognitive behavioral psychotherapy

Group psychotherapy aims to face any traumas you could have endured as a child and which caused your hypomanic bipolar disorder.

Cognitive behavioral psychotherapy aims to change the wrong emotional patterns which trigger bipolar episodes.

Unfortunately, psychological treatments stop working when they end. Indeed, they are often combined along with medications.

Medical treatments for hypomanic bipolar disorder include the so-called mood stabilizers. These medicines aim to restore the chemical balance in your brain, in order to reduce or eliminate the most debilitating effects of this mood disorder.

The most used medication is lithium or carbon lithium. It has side effects and can slow the function of the thyroid in patients suffering from thyroid diseases.

However, according to a clinical trial, the treatment with lithium:

  • Increases the length of telomeres (parts of chromosomes that shorten with aging);
  • Has positive effects in prevention of other illnesses;
  • Lessens manic episode recurrence;
  • Restores cognition impaired by the disorder;
  • Prevents various aspects of illness progression.

Moreover, the study has revealed that “after a first manic episode, 1 year of randomized treatment with lithium was superior to that of quetiapine, suggesting the importance of having lithium in the treatment regimen”.

Carbon lithium or lithium carbonate is a salt derived from carbon and lithium (a mineral) and initially used to treat bipolar disorder 1. Over time, it has been also prescribed to treat hypomanic bipolar disorder and reduce the related hypomania and depression.

Afterwards, the side effects, observed on patients with kidney and thyroid disorders, led scientists and pharma companies to develop another drug, called quetiapine.

In comparison to lithium, the latter is considered a light drug. It gets prescribed to treat schizophrenia and bipolar disorders. This drug is classified as an antipsychotic and was initially developed by AstraZeneca, the pharma company that also developed one of the early vaccines for Sars-Cov2.

A recent drug developed to treat bipolar disorder is lamotrigine, which works better to cure bipolar 1, while it is used as a maintenance therapy for bipolar 2.

Many bipolar patients, instead, prefer using natural lithium, a dietary supplement containing a different salt of lithium, called lithium orotate. But there is no evidence and no study that currently proves the effectiveness of this type of lithium.

In this case, it is better to prefer vitamin B6 supplements, because Vitamin B6 is involved in the balance of mood, along with vitamin B1 and B12. The intake of vitamin B6, in fact, showed to reduce mood swings, hypomania, irritability, anxiety and depression.

However, dietary supplements must always be prescribed by a doctor, in order to set the proper dosage and monitor benefits and any side effects.

Conclusion

I hope this article has been helpful to better understand what hypomanic bipolar disorder is. Feel free to send me your comment, if you want.

As always, I talked about my personal experience sourced with medical information coming from doctors, clinicians and psychiatrists.

In the past years, bipolar persons were named “those who have a crack in the brain”. This crack is surely the chemical imbalance that caused the disorder, but we can have other cracks, emotional wounds that must be properly investigated, defeated, and, above all, forgotten.

Several years ago, someone said to me that maybe something bad happened to me when I was a little girl. Maybe it happened, but I preferred forgetting, and, above all, I chose to forgive.

If our wounds stop bleeding, our life will be healthier and above all, free from hypomanic bipolar disorder.

References & Bibliography

  1. Dr. Pina Salomone – psychiatrist at the Public Mental Health Center in Catania
  2. Dr. Federico Baranzini, psychiatrist in Milan, Disturbo Bipolare dell’Umore 1 e 2  https://psichiatra-a-milano.it/work_listing/disturbo-bipolare-dellumore-i-ii/
  3. Reddy MS. The bipolar spectrum. Indian J Psychol Med. 2012;34(1):1-4. doi:10.4103/0253-7176.96146 – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3361834/
  4. Dr. Francesco Giubbolini – psychiatrist in Siena – Il Disturbo Bipolare Tipo I e Tipo II –https://www.studiopsicoterapia.si.it/disturbo-bipolare
  5. Jessica Truschel – Bipolar Definition and DSM-5 Diagnostic Criteria – https://www.psycom.net/bipolar-definition-dsm-5/
  6. Herane-Vives, A., Arnone, D., de Angel, V. et al. Cortisol levels in unmedicated patients with unipolar and bipolar major depression using hair and saliva specimens. Int J Bipolar Disord 8, 15 (2020). https://doi.org/10.1186/s40345-020-0180-x
  7. Anne Duffy, M.D. F.R.C.P.C. – Queen’s University at Kingston, Ontario – Long-term Study Reveals How Bipolar Disorder Emerges in High-Risk Youth – Brain & Behavior Research Foundation. February, 25, 2019 – https://www.bbrfoundation.org/content/long-term-study-reveals-how-bipolar-disorder-emerges-high-risk-youth
  8. Magpie Media – Benefits of Vitamin B for Bipolar Disorder –  August 15, 2013-https://sardaa.org/benefits-of-vitamin-b-for-bipolar-disorder/
  9. Post RM. The New News about Lithium: An Underutilized Treatment in the United States. Neuropsychopharmacology. 2018 Apr;43(5):1174-1179. doi: 10.1038/npp.2017.238. Epub 2017 Oct 4. PMID: 28976944; PMCID: PMC5854802.-https://pubmed.ncbi.nlm.nih.gov/28976944/
  10.  Quetiapina – Medical Encyclopedia – Humanitas Research Hospital –https://www.humanitas.it/enciclopedia/principi-attivi/farmaci-attivi-sul-sistema-nervoso/quetiapina/
  11.  DBSA – Depression and Bipolar Support Alliance – Should I Try Natural Lithium? –https://www.dbsalliance.org/education/ask-the-doc/should-i-try-natural-lithium/
Author: Rosalba Mancuso
Rosalba Mancuso is a medical journalist, an international content writer credited at the University of Washington and a blogger born in Sicily. She is popular for founding four websites in English. On Modernhealthinfo.com, Rosalba writes well researched and detailed health articles backed by her experience as a medical writer for pharma companies and as a PR assistant for a clinical analysis laboratory. She is also a member of the AHCJ, American Association of Health Care Journalists and Center for Excellence in Health Journalism.

2 thoughts on “In the Depths of Hypomanic Bipolar Disorder

  1. May I simply say what a comfort to discover somebody who genuinely knows what they are talking about. You actually understand how to bring a problem to light and make it important. More people ought to check this out and understand this side of the story. I can’t believe you aren’t more popular because you surely possess the gift.

    1. Thank you so much, Samuel, for appreciating this article. Popularity is not important.
      This piece only describes a true, personal experience backed by medical sources of information.
      These are the main ingredients that make health journalism and medical blogging reliable and engaging.

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