Hypomania and mania

What causes hypomania and mania?

There isn’t one single or clear-cut reason that someone may become hypomanic or manic. It seems to be a combination of long-term and short-term factors, which differ from person to person.

These are some possible causes of hypomania or mania:

• High levels of stress
• Changes in sleep patterns or lack of sleep
• Using recreational drugs or alcohol
• Seasonal changes – for example, some people are more likely to experience hypomania and mania in spring
• A significant change in your life, such as moving house or going through a divorce
• Childbirth – see our page on postpartum psychosis for more information
• Loss or bereavement
• Trauma and abuse
• Difficult life conditions – for example, problems with money, housing or loneliness
• As a side effect of medication
• As a symptom of a physical illness or neurological condition
• Family history – if you have a family member who experiences bipolar moods, you are more likely to experience mania or hypomania

Some of these are long-term factors that might make you more likely to experience hypomania or mania in general. Whereas others are more immediate factors that might trigger an episode.

As a side effect of medication

Some medications can cause hypomania or mania as a side effect. This could either be while you are taking them or as a withdrawal symptom when you stop.

This includes medications for physical conditions and for mental health, including some antidepressants.

If you’re concerned about the effects of any medication you’re taking or have stopped taking, discuss this with your doctor.

As a symptom of a physical illness or neurological condition

Some physical illnesses and neurological conditions can cause hypomania and mania. This includes lupus, encephalitis, dementia, brain injury, brain tumours and stroke.

To make sure you get the correct treatment, your doctor should always check whether there might be a physical cause for your hypomania or mania before you are diagnosed.

Self-care for hypomania and mania

Dealing with hypomania or mania can feel really difficult. But there are lots of things you can try to help manage your moods and look after your wellbeing.

This page covers these tips that might help you to try:

• Get to know your moods, triggers and warning signs
• Make a self-management plan
• Take practical steps
• Look after yourself
• Talk to people you trust
• Try peer support
• Visit a recovery college

Some of us may find these ideas useful, but remember that different things work for different people at different times. Only try what you feel comfortable with. 

Get to know your moods, triggers and warning signs 

Monitor your mood

It can help to keep track of your moods over a period of time. You could try using a mood diary. There are many freely available, such as eMoods. If your mania or hypomania is part of bipolar disorder, you could try Bipolar UK’s mood diary. 

Understand your triggers 

You might notice that certain types of behaviour, experience or situation can trigger a manic or hypomanic episode. For example, you might find that you often feel your mood changing after a late night.

Understanding these patterns can help you take action to avoid a trigger, or minimise its impact.

Learn your warning signs 

You may notice that there is a pattern to how you feel or behave before an episode. This could include changes in how well you sleep, your appetite, or how you spend money.

Being aware that your mood is starting to change can help you make sure you have support in place. And that you can focus on looking after yourself.

Triggers and warning signs can be different for everyone. It may take a little while to work out what yours are. It can also help to discuss any warning signs with people you trust, so they can help you.

Make a self-management plan

When you are well, make a plan for what you can do if you start getting hypomanic or manic. You could plan how to manage your symptoms and prevent things getting worse.

You might need to try a few ideas to find out what works for you. For example:

• Make yourself go to bed, even if you don’t feel tired
• Try to avoid alcohol and caffeine
• Try to remember to eat regularly, even if you don’t feel like it
• Avoid stimulating activities
• Avoid noisy, bright or busy environments and go somewhere quiet and calm
• Do activities you find calming or soothing
• Do relaxation or deep breathing exercises
• Think about how to manage your finances
• Postpone making major life decisions
• Avoid situations where you may take part in risky behaviour, such as driving irresponsibly or taking recreational drugs 

Take practical steps

Stick to a routine

Having a routine can help you feel calmer if your mood is high. And it can help with feeling more stable in general. Your routine could include:

• Day-to-day activities, such as when you eat meals and go to sleep
• Time for relaxation or mindfulness
• Time for hobbies and social plans
• Taking any medication at the same time each day – this can also help you manage side effects and make sure that you have a consistent level of medication in your system

Manage stress 

Stress can trigger hypomanic or manic episodes. There are lots of things you can try to make sure you don’t get stressed. And there are ways to look after yourself when you do feel stressed.

Manage your finances

You might be concerned about how you will manage your finances when you are having a manic or hypomanic episode. You may feel this way especially if you have spent more money than you meant to during a previous episode.

It may help to ask someone you trust to help you limit your spending during an episode. You might also consider making a lasting power of attorney, to formally appoint someone who can help you manage your finances if you became unwell again. See Mind’s pages on lasting power of attorney for information on what this means and whether it might be right for you.

If money worries are affecting your mental health, visit Mind’s pages on money and mental health for tips which may help. You can also contact the National Debtline for free, impartial financial advice about debt.

Plan ahead for a crisis 

When you’re having a mental health crisis, it can be difficult to let others know what kind of help you need. It might help to make a crisis plan while you are well.

This plan can set out what you would like to happen during a crisis, and how you would like to be treated. See this page on planning for a crisis for more information.

Look after yourself

Try to manage your sleep

Many of us with hypomania or mania may struggle with sleep during an episode. Having bad sleep could also trigger an episode.

If you can improve your sleep, this can help you keep your mood stable or shorten an episode. Even if you don’t feel tired, try going to bed at your usual time. See our pages on coping with sleep problems for more tips.

Think about physical activity

Gentle exercise, like yoga or swimming, can help us relax and manage stress. And higher intensity exercise could help to burn off some energy. But some of us may find that intense exercise can trigger a hypomanic or manic episode, or make an episode worse.

If you want to be more active, try to find a type of exercise that works best for you. This might involve monitoring how your mood responds to different forms of exercise.

Talk to people you trust

It can help to talk to people you trust about your mental health, how it affects you and how they can support you. These are some ideas you could try:

Talk about how you feel

It can help to talk about your experiences from previous episodes while you’re feeling well. This could include discussing what you do and don’t find helpful from others.

For example, you might want to say: ‘I find it frustrating that you think I’m hypomanic every time I’m happy or have a good day.’ Or: ‘It’s really helpful when you notice I haven’t been sleeping much and remind me to get a good night’s sleep.’

Involve people in your self-care plan

It may help to involve people you trust when planning how to take care of yourself, and what to do if you’re unwell. For example, you could ask if they have seen any patterns or behaviours around the times that you become unwell. This could help you understand your triggers or warning signs.

Or you might already be aware of your warning signs but find it difficult to spot them. You could talk to someone about your warning signs, and ask them to let you know if they see them developing. They may notice things you don’t, or be able to suggest strategies that you haven’t thought of.

You could talk about what kind of circumstances might mean you need more support. For example, what kind of situation might mean you need to go to hospital.

Try peer support

Making connections with people with similar or shared experiences can help. You could try talking to other people who have experienced hypomania or mania, to share your feelings, experiences and ideas for looking after yourself.

Visit our page on finding peer support to find out how to access peer support. You could also contact Mind’s Infoline or a local Mind to see what support there is in your area visit an online peer support community, such as Mind’s Side by Side.

If you’re seeking peer support online, Mind’s pages on keeping yourself safe online have tips for looking after your wellbeing.

Visit a recovery college

It can also help to see if your local area has a recovery college. Recovery colleges offer courses about mental health and recovery in a supportive environment. You can find local providers on the Mind Recovery Net website.

Treatment for hypomania and mania

There are a range of treatments recommended for hypomania and mania. This page covers:

• Medication
• Community-based support
• Crisis services
• Electroconvulsive therapy (ECT)

We also have information on how to access treatment for hypomania and mania.

Talking therapies

Doctors don’t usually offer talking therapy to treat an episode of hypomania or mania.

But you might be offered talking therapy if you experience hypomania or mania as part of a broader mental health problem. For example, if you have a diagnosis of bipolar disorder.

Medication

If you’re experiencing mania or hypomania, you will normally be offered one of these antipsychotics:

• Haloperidol
• Olanzapine
• Quetiapine
• Risperidone

In some cases, you may be offered a mood stabiliser as well as an antipsychotic. This is more likely if you experience mania or hypomania as part of a mood disorder, such as bipolar disorder. Or if the antipsychotic isn’t working well enough on its own

The mood stabilisers you might be offered include:

• Lithium
• Valproate
• Carbamazepine

You might hear some of these medications called different names. See Mind’s page on drug names for more information.

Valproate pregnancy warning 

Valproate carries the highest risk of danger to your baby out of all mood stabilisers.

The regulators of this medicine say that you should not take valproate if you are pregnant.

They also say you should not be prescribed valproate if you are able to become pregnant, unless you have a pregnancy prevention programme in place.

See our information on anticonvulsants during pregnancy and breastfeeding to find out more. 

The Medicines and Healthcare products Regulatory Agency (MHRA) is updating its recommendations on the use of valproate. But if you’re currently taking valproate, it’s important to continue taking it unless your doctor tells you otherwise. Find out about the planned changes. 

What if I’m already taking medication?

Your doctor or healthcare team should review any other medication you’re taking when you develop hypomania or mania.

If you’re taking antidepressants, your doctor may recommend that you stop taking it. This is because antidepressants can sometimes trigger hypomania or mania, or make it more severe.

If you’re already taking lithium and you experience hypomania or mania, your doctor or healthcare team should check your plasma lithium levels.

Before deciding to take any drug, it’s important to make sure you have all the facts you need to make an informed choice.

See Mind’s pages on things to consider before taking medication and your right to refuse medication for more information.

These pages on coming off medication give guidance on how to come off medication safely. 

Community-based support

You might experience episodes that have a significant impact on your ability to carry out daily activities. In this case you may be referred for community-based support. This is more likely if you experience mania than hypomania.

For example, you might get support from a Community Mental Health Team (CMHT). These are teams of healthcare professionals, such as nurses, who offer different types of support.

Or you may get support from your local authority or council, such as help with day-to-day tasks.

If you experience hypomania or mania and you’re struggling with day-to-day living, you may be entitled to a needs assessment. This is to help assess whether you are eligible for support.

See Mind’s pages on health and social care rights for more information.

Crisis services

If you feel very unwell or can’t keep yourself safe, you may need to access crisis services.

These services include:

• Emergency support, such as going to Accident & Emergency (A&E) or calling 999 for an ambulance
• Support from a crisis resolution and home treatment (CRHT) team
• Hospital admission

Electroconvulsive therapy (ECT)

Very rarely, you may be offered a treatment called electroconvulsive therapy (ECT).

The National Institute for Health and Care Excellence (NICE) has guidelines for how doctors should use ECT. These guidelines state that you can be offered ECT if both of these are true:

• You are experiencing a long or severe period of mania
• Other treatments have not worked, or the situation is life-threatening

If you feel like you’re in this situation, your doctor may discuss this option with you. They should explain ECT in a clear and accessible way before you make any decisions.

How can I access treatment for hypomania or mania?

The first step to get treatment for hypomania or mania is usually to visit your GP. They should ask about your symptoms and any possible causes, such as medication.

If you’ve been monitoring your moods, for example using a mood diary, it might help to show them this information.

If your GP thinks you might be experiencing hypomania or mania, they should refer you to a specialist service. This service can then assess you more thoroughly and talk to you about your treatment options.

Helping someone with hypomania or mania

Start a conversation

You could try having an honest conversation with them about their hypomania or mania, and how it affects them.

Ask them questions about their experiences and listen to what they have to say. By talking openly, you can learn more about what things are like for them.

This can also help to build trust, so they feel more comfortable talking about their experiences and able to ask for help.

Ask what you can do

If someone has experienced hypomania or mania before, they will often have an idea of what helps them and what doesn’t.

Ask how you can help. If they don’t know, you could offer to help by exploring options together.

Learn their triggers and warning signs

When they are feeling well, you could talk to them about their triggers and warning signs.

This could help you support them with avoiding things that might trigger an episode. And to notice any warning signs early, so you can offer any support they might need.

Make a plan for hypomanic or manic episodes

You could help them plan what support you can offer during a hypomanic or manic episode. This can help you both feel more prepared for what might happen.

You could discuss ideas such as:

• Enjoying being creative together
• Offering a second opinion about projects or commitments, to help them consider whether they’re taking too much on
• Helping to manage money while they’re unwell, if they’d like you to
• Helping them keep a routine, including regular meals and sleeping patterns

Plan for a crisis

It might also help to make a crisis plan that explains what to do if they become very unwell.

This could include how to spot the signs of a crisis, who to contact and what you can do to help. And you could discuss what kind of circumstances might mean they need to go to hospital.

You can agree the plan in advance, and both keep a written copy.

Try not to make assumptions

You might find yourself looking out for signs that they are experiencing mania or hypomania. This is completely understandable. But this might not be the most helpful way to support them.

Remember that it’s possible for anyone to display a range of emotions and behaviour, while still feeling stable overall. And try not to assume that any change in mood is a sign that someone is unwell. If you’re not sure, talking to them is the best way to check. 

Acknowledge their experiences

If they experience mania, they might see, hear or believe things that you don’t. If this happens, it might feel confusing for you. They might also feel angry, annoyed or confused if you don’t share their beliefs or experiences.

Try to remember that what feels real for them is real in those moments. It might help if you try to:

• Stay as calm as you can
• Let them know that, although you don’t share the belief, you understand that it feels real for them
• Try to focus on supporting them with how they are feeling, rather than confirming or challenging their reality

Let them know if you’re worried

If you’re worried that they are becoming unwell, try to address this with them gently. Try to stay calm, avoid criticising or accusing them.

You could explain that you’ve noticed changes in their behaviour and why it concerns you. And ask if they’ve noticed it too. If this has happened before, remind them of this and explain the pattern you see.

If they say they’re fine, you could suggest that you see how things go and talk about it again in a few days.

Discuss challenging behaviour

If someone is very unwell, they may behave in a difficult way and may not see their behaviour as a problem.

If this happens, it’s OK for you to set boundaries. For example, that you will end the conversation if they’re rude or aggressive with you. Or that you won’t take part in any grand ideas or schemes that you are worried might end badly.

Be supportive after an episode

If someone has been unwell, they may feel embarrassed or ashamed of their behaviour. Reassure them that you still care and that you understand this behaviour is part of their hypomania or mania.

If they are worried that their behaviour may have long-term effects, you could offer to help them resolve this. This could be helping with a financial plan, or talking about how to improve relationships that have been affected.

Help them access support

Getting the right care and support can be difficult and frustrating. You could ask if they want your help with this.

For example, you could offer to research treatments, self-care ideas or local support groups. Or you could help them find a mental health advocate.

Look after yourself

It can be challenging to support someone who is unwell. And it’s common to feel overwhelmed sometimes. Try to remember to look after your own mental health too. You could:

• Set boundaries and don’t take too much on. If you become unwell, you might not be able to offer as much support. It can also help to be realistic about how much support you can offer
• Share your caring role with others, if you can. It’s often easier to support someone if you’re not doing it alone
• Talk to others about how you’re feeling. This doesn’t mean you have to share details about the person you support. But talking about your own feelings with someone you trust can help you feel supported too

Useful contacts

Action on Postpartum Psychosis (APP)

app-network.org
Information and support for anyone affected by postpartum psychosis.

Bipolar UK

bipolaruk.org
Information and support for people affected by bipolar disorder, hypomania and mania. Offers a telephone peer support line, an online peer support community, and local support groups across the country.

British Association for Behavioural and Cognitive Psychotherapies (BABCP)

babcp.com
Information about cognitive behavioural therapy and related treatments, including details of accredited therapists.

British Association for Counselling and Psychotherapy (BACP)

bacp.co.uk
Professional body for talking therapy and counselling. Provides information and a list of accredited therapists.

Carers UK

0808 808 7777
advice@carersuk.org
carersuk.org
Advice and support for anyone who provides care.

Hearing Voices Network

hearing-voices.org
Information and support for people who hear voices or have other unshared perceptions, including local support groups.

Mind

Mind’s helplines provide information and support by phone and email.

Local Minds offer face-to-face services across England and Wales. These services include talking therapies, peer support and advocacy.

Side by Side is Mind’s supportive online community for anyone experiencing a mental health problem.

Mood diaries

bipolaruk.org/FAQs/track-your-mood-diary
emoodtracker.com
Some examples of mood diaries – many more are available. Mind doesn’t endorse any particular one.

Samaritans

116 123 (freephone)
jo@samaritans.org
Freepost SAMARITANS LETTERS
samaritans.org
Samaritans are open 24/7 for anyone who needs to talk. You can visit some Samaritans branches in person.