Principles of managing hypomania in adults and young people

For multifaceted management of bipolar disorder that is not restricted to an episode of hypomania, see Principles of managing bipolar disorder in adults and young people.

A hypomanic episode is characterised by symptoms similar to those of a manic episode, but is differentiated from a manic episode by less severe symptoms that do not impair functioning (see Features of bipolar disorder). The symptoms, last at least 4 consecutive days and are present for most of the day. It may be difficult to distinguish symptoms of hypomania from substance intoxication (eg stimulants) or early symptoms of a manic episode. If hypomania is suspected in a patient without a known history of bipolar disorder, refer to a psychiatrist or mental health team for assessment and confirmation of the diagnosis. In a patient with a known history of bipolar disorder, review the patient regularly to determine if their symptoms develop into acute mania.

Patients with bipolar disorder rarely seek treatment during a hypomanic episode because they usually do not recognise their thoughts, feelings or behaviours as unusual, and instead, may see the experience as positive and not indicative of illness. Symptoms of hypomania might be identified by significant others, family or carers.

Unlike acute mania, hypomania is self-limiting and not an emergency. In general, hypomania does not require acute treatment but may require adjustments to the patient’s treatment and use of psychosocial interventions; however, there is little evidence to guide treatment. If the patient is concerned by their symptoms, consider treating specific symptoms, such as:

if the patient is agitated, consider using a benzodiazepine
if the patient has trouble sleeping, see Insomnia in adults for advice on whether short-term pharmacotherapy is indicated.

Consider referral to a psychiatrist or community mental health team.