The Confusion Between Mania and Hypomania

I have a friend whom we'll call John. For nearly two decades John was diagnosed as a manic depressive. He had been given this diagnosis on four different occasions throughout those years.

John's medical assistance with the condition was on again, off again because of his financial situation. He was never actually on a program long enough to get the right medication. Medications for bipolar disorder are not one size fits all and it can be extremely difficult to get on the right medicine.

Finally, John was able to get into a system that was going to offer long term help regardless of his financial situation. There was finally hope for him.

However, a most curious thing happened when he went through the consultations with his new doctors to verify his condition. After having been diagnosed four times as a manic depressive, they were now telling him that while he may well have depression, he did not have mania and what he really need was anger management classes. He was told that at best he had hypomania.

How could this be? Why was he told so many times that he did have it, and what is hypomania?

Mania vs. Hypomania

John had episodes where he would fly into rages, yell and throw things around. He also had happier episodes where he would go into states of hyperactivity. In these situations he would sing, tell jokes and act silly. That doesn't sound too bad in itself, but when you do it constantly to the point that you are driving people around you nuts, you might have a problem. Especially if you're running up and down the halls doing it.

So John was asked how long those times lasted. The answer was that the rages might go on for days at a time, maybe even a week or two. The super silly part might be on and off for two or three days.

He was also asked if he ever got in his car and drove very fast and recklessly. The answer was no. Then he was asked if he had times of abnormally active sexual behavior. Again, the answer was no. That's when he was told that he did not have mania, but hypomania.

Apparently, hypomania is a much milder version of full-blown mania. In true mania, you may have racing thoughts, hear voices, have delusions of grandeur, increased irritability and anger, and very fast speech.

In hypomania, you have increased levels of creativity and ideas, energy, and feelings of euphoria. While it may not sound all that different from regular mania, it is milder. In fact, many productive workaholics have this condition. That may sound ideal, but the truth is that as time goes on it can progress into full-blown mania, which is not at all desirable.

The treatment for both conditions is essentially the same. A mood stabilizer must be used to keep the mania or hypomania from occurring, and an antidepressant must be used to keep the depression from occurring.

Now that John was all confused about what he was told as opposed to what he had previously been told, it seems the diagnosis was later reversed. The more the doctor's worked with him, they eventually learned that he was indeed a manic depressive and not a 'hypomania depressive'. The difference now was that he was a confused one.