From the Guidelines
Hypomania is diagnosed when a person experiences a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least four consecutive days, as defined by the DSM-IV-TR criteria 1. The diagnostic criteria for hypomania require at least three (or four if the mood is only irritable) of the following symptoms:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Increased talkativeness
- Racing thoughts or flight of ideas
- Distractibility
- Increased goal-directed activity or psychomotor agitation
- Excessive involvement in pleasurable activities with high potential for painful consequences These symptoms must represent a noticeable change from the person's usual behavior and be observable by others. According to the DSM-IV-TR criteria, hypomania is distinguished from mania by the absence of psychotic features and by causing less severe impairment—the episode should not be severe enough to cause marked impairment in social or occupational functioning, require hospitalization, or include psychotic features 1. Hypomania is a key feature of bipolar II disorder, distinguishing it from bipolar I disorder which involves full manic episodes, as noted in the practice parameter for the assessment and treatment of children and adolescents with bipolar disorder 1. Accurate diagnosis is essential because hypomania can escalate to mania in some individuals and requires different treatment approaches than depression alone. The definition of hypomania is critical in the diagnosis of bipolar II disorder, which requires periods of major depression and hypomania (episodes lasting at least 4 days) but no full manic or mixed manic episodes 1.
From the Research
Diagnostic Criteria for Hypomania
The provided studies do not directly address the diagnostic criteria for hypomania. However, they discuss the treatment and management of bipolar disorder, which includes hypomania as a symptom.
Treatment of Bipolar Disorder
- The studies suggest that atypical antipsychotics, such as olanzapine, risperidone, and quetiapine, are effective in treating bipolar mania 2.
- Antidepressants, including selective serotonin reuptake inhibitors (SSRIs), are useful adjuncts in short-term treatment of bipolar depression, but may induce mania 3.
- Lamotrigine is beneficial for both acute treatment of bipolar depression and prevention of recurrent episodes 3.
- A multiple-treatments meta-analysis found that olanzapine + fluoxetine and olanzapine performed best on primary outcome measures for bipolar depression 4.
Medication-Induced Hypomania
- A study found that SSRI-induced hypomania may be dose-dependent, and resolving when the medication is decreased or discontinued 5.
- Another study found that the risk of switch to mania was least likely with ziprasidone and then quetiapine 4.
Combination Therapies
- The studies suggest that combination therapies, such as lithium and valproic acid with SSRIs, are common in the treatment of bipolar depression 6.
- However, the efficacy of many of these combinations has not been studied, and some combinations, such as the use of aripiprazole and concomitant use of two or three antidepressants, contrast with guidelines 6.