Mania is strongly associated with bipolar disorder.

By Jessica Migala
June 28, 2021
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The terms "mania" and "manic episode" describe a state of mind characterized by high energy, excitement, and euphoria over a sustained period of time, typically followed by feelings of depression. It's an extreme change in mood and cognition that can interfere with school, work, or home life. Mania is also the main feature of bipolar disorder, which used to be known as manic depression.

"Mania is the linchpin; you can't have a diagnosis of bipolar disorder without mania," Ken Duckworth, MD, chief medical officer at the National Alliance on Mental Illness (NAMI), tells Health. Here's everything you need to know about mania, including all the signs, what a manic episode feels like, how it's linked to bipolar disorder, and how it can be treated.

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Signs and symptoms of mania

Mania is often detected when a person goes to their doctor seeking help for depression. While mania can feel good sometimes, depression can feel bad, and so you may be more apt to seek help when down. Here are the main signs:

High energy or an "expansive" mood

You may suddenly have a big idea that's goal-directed but unrealistic, such as starting a business on a whim with all your family's life savings, says Dr. Duckworth.

Fast talking

This is more than just speaking quickly. "It's almost as if they can't get the words out fast enough. It's called pressure of speech," Michael Roeske, PsyD, licensed clinical psychologist with Newport Academy and adjunct professor with the University of San Francisco, tells Health. For someone talking to a person in a manic episode "you feel it—it almost presses you against the wall," he says.

Lack of sleep

Sleeping may stop or the person may run on very little sleep. "People with mania often don't need any sleep at all," says Roeske.

Distraction

Racing thoughts may lead you to become easily distracted and start "multitasking on steroids," says Roeske. This might also look like taking on numerous complex tasks and not doing them to completion.

Risky behavior

Spending reckless amounts of cash during a manic episode is not uncommon. "I've had patients who have bought three or four vehicles in a weekend," says Roeske. Unprotected sex, gambling, or a drug or alcohol binge may also occur, Daniel Winarick, PhD, a licensed clinical psychologist in New York City, tells Health. Because of this tendency to seek out risky behavior, "mania is serious and dangerous," Winarick explains. "A person can potentially do something to hurt themselves or someone else."

Psychosis

Severe manic episodes may also involve psychosis, which includes having hallucinations or delusions, according to NAMI.

Mania vs. hypomania

Mania and hypomania are both characterized by sudden mood swings that make a person feel super energetic, wired, and euphoric and then depressed. But hypomania is defined as a less extreme version of mania, according to the Mayo Clinic. Both can lead to issues functioning at work and in your personal life, but hypomania episodes are less likely to cause noticeable problems.

Bipolar disorder and mania

Bipolar disorder is a mental health condition where there are shifts between high moods (or mania) and low moods (aka, depression), according to NAMI. Genetics or family history, stress, and differences in brain function may all play a role in the development of bipolar disorder (and therefore mania). An estimated 2.8% of adults in the US have bipolar disorder, per the NIMH, split equally among men and women. The disorder is most prevalent among young adults, particularly from ages 18 to 29.

For mania to be a sign of bipolar disorder, this elevated and energetic mood and behavior has to last for at least one week and happen most of every day. "To be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania," states NAMI. "To determine what type of bipolar disorder a person has, mental health care professionals assess the pattern of symptoms and how impaired the person is during their most severe episodes."

The warning signs of a manic episode

If you've already been diagnosed with bipolar disorder, know your own warning signs of mania, says Dr. Duckworth. For example, you (or someone you're with) may start:

  • Driving faster than usual
  • Having agitated mannerisms
  • Singing a certain song or using certain phrases (will be entirely unique to the individual)

"One thing we've learned is that people have predictable episodes of mania. If you can recognize patterns and allow people in your life to give you feedback without activating your own defensiveness, then you can participate in collaborative problem-solving," says Dr. Duckworth.

Also, realize that early manic episodes can be "seductive," says Dr. Duckworth. "Some people prefer it because they feel that they're more open, funnier, and interesting. The experience can be reinforcing in the beginning," he says. However, mania can also lead to extreme agitation or irritability, which ultimately won't feel good.

How mania is treated

Medication

During a manic episode, a person is a danger to themself. The risky behavior can lead to losing your job or being kicked out of school, arrested, or hospitalized in a psychiatric emergency room, says Winarick. It's also important to know that for bipolar disorder, in general, the risk of suicide is 10 to 30 times higher than in the general population, according to research.

The first line of treatment might involve using an atypical antipsychotic to stop mania. A long-term a mood stabilizer (like lithium) will then be prescribed to help prevent the recurrence of mania, says Roeske.

One challenge in treating bipolar disorder is that antidepressants may be used in the treatment of depression. However, "antidepressant use is a known risk for mania," says Dr. Duckworth. These medications may activate a manic episode if not used carefully under close supervision and alongside other medications such as mood stabilizers.

If you have a family history of bipolar disorder, then taking an antidepressant alone is a risk. Duckworth points out that clinicians have also seen mania triggered by other therapies for depression, such as light therapy for seasonal affective disorder (SAD). In this case, proper diagnosis and understanding family history is critical in mental illness treatment, whether it's for depression or bipolar disorder.

Therapy and lifestyle changes

While medication is needed to treat bipolar disorder and prevent manic episodes, psychotherapy and lifestyle modifications are also critical.

"One of the advantages we have is that lifestyle makes a big difference," says Dr. Duckworth. This is both about the general structure of your life and your daily habits. Sleep is one of the most important things you need to manage bipolar disorder—and it may also be one of the first disruptions that mania is developing. Practicing good sleep hygiene and having a consistent sleep and wake time that allows for a full night's sleep will help. Minimize stress, too, which can result in or exacerbate manic episodes.

Your psychotherapist can help you become more organized and accomplish tasks, assist you with medication compliance, get healthy habits in place, and develop self-awareness to pinpoint your early warning signs of mania, adds Winarick.

Though about 83% of people with bipolar disorder deal with serious impairment because of their illness, according to the NIMH, many people learn to live with the mania caused by bipolar disorder without significant disruption to their lives, says Roeske.

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