Understanding Mania and Manic Episodes

A manic episode can leave you feeling like you're buzzing with energy. It can be disruptive, and it can even lead to impulsive, risky, and downright dangerous behaviors. Recognizing the signs of mania can help you understand when to seek help to get an accurate diagnosis and appropriate treatment.

A manic episode is characterized by a sustained period of abnormally elevated or irritable mood, intense energy, racing thoughts, and other extreme and exaggerated behaviors. People can also experience psychosis during manic episodes, including hallucinations and delusions, which indicate a separation from reality.

Symptoms of mania can last for a week or more. Manic episodes may be interspersed with periods of depression, with symptoms of fatigue, sadness, and hopelessness. While manic episodes are most common in people with bipolar disorder, there are also other causes for these extreme changes in behavior and mood. 

Signs of Manic Episodes

Symptoms of mania can vary in intensity, duration, and impact. Manic episode symptoms can be a medical emergency, such as shortness of breath, chest pain, and bleeding, which are all symptoms of a serious physical health condition.

Below are some of the common behaviors associated with a manic episode. Many of these behaviors can be easily observed in a loved one, helping you better recognize whether there may be a need for professional help.

Delusions or Hallucinations

If a friend or loved one describes auditory or visual hallucinations (seeing or hearing something that is not there) or shows paranoid or other delusional behavior (believing something that isn't real), contact a doctor or psychiatrist immediately.

Decreased Need for Sleep

Does your loved one stay awake until 4 a.m., then get up at 8 a.m. ready to go? A decreased need for sleep is common during the emergence of mania symptoms. Sleep problems and bipolar disorder can feed off each other, with manic episodes leading to sleep issues and vice versa.

Being Engaged in Many Activities at Once

A person experiencing a manic episode may be restlessly searching for ways to work off extra energy. This symptom is often described as "multitasking on steroids." The person may take on many projects, for instance, or experience a burst in productivity that is beyond what they would normally accomplish during a set period.

Talking a Lot or Speaking Loudly

Talking loudly and quickly is a common symptom at the beginning of a manic or hypomanic episode. It's important to note that, to be categorized as rapid speech, there should be a deviation from the person's usual speech. Some people naturally talk faster than others, but if someone who usually carefully chooses their words and speaks slowly begins to talk rapidly, be aware.

Easily Distracted

Also be aware if someone starts making clang associations (for example, they get distracted by the rhyming of words such as microphones, xylophones, and ice cream cones). Clang associations may at first sound like poetry, but with bipolar disorder, they often appear out of context and out of character for the person with manic symptoms.

Increased Desire for Sex

Hypersexuality is a common manic or hypomanic symptom. It may include uncharacteristic or risky sexual behavior, such as seeking sex workers, using pornographic websites, having online interactions of a sexual nature, and more.

Increase in Risky Behaviors

Someone experiencing a manic episode may engage in more risky behaviors. These include risky behaviors related to money, such as overspending, going on shopping sprees, or gambling.

Rapid Thinking

Notice if your friend or family member complains that their thoughts are racing uncontrollably. Outwardly, a person with bipolar disorder may appear to be talking fluidly and pleasantly while, on the inside, they are having repetitive, unquieted thoughts.

Flight of Ideas

If someone is entering the manic phase of bipolar disorder, their flight of ideas may be hard to follow. If you are finding it hard to make logical sense of the progression of a discussion, take notice.

Flight of ideas might sound something like this: "I wonder what the weather will be like tomorrow. What is the purpose of life? Oh, I forgot to feed the cat."

We all have moments in which our words are thrown together in a non-logical progression. The important thing is to notice a change in your loved one's presentation of their ideas.

Grandiosity

Grandiosity is defined as an exaggerated sense of importance in power, knowledge, or identity. It may occur in both manic and hypomanic episodes.

Grandiose thinking can be someone believing they're famous, for instance. Maybe they say something like, "We shouldn't leave the house today because there might be reporters wanting to talk to me," when there is no basis in reality for these thoughts.

It's also possible for someone experiencing a manic episode to have delusions of grandeur. For example, they may make statements like, "We have to move to Yemen this weekend, I've been named president there." 

Hostility or Increased Irritability

Irritability and hostility are common during manic episodes. Watch also for unreasonable irritability or hostility. Be cautious and get help if you see this type of behavior.

These symptoms are also associated with an increased risk for violence and suicidal behavior. Do not try to handle the situation on your own.

Thoughts of Suicide

In some cases, a manic episode can result in feelings of hopelessness, worthlessness, and/or thoughts about death or suicide. If your loved one has thoughts of suicide during a manic episode, seek help immediately.

Excessive Religious Dedication

Increased religious zeal or religious involvement can be another manic symptom. Make note of this if you see it.

Religiosity and spirituality are not signs of mental illness. A sudden intense interest or involvement in religion can be, particularly if other signs of mania accompany it.

Bright Clothing

During a manic or hypomanic episode, a person is more likely to wear brightly colored or flamboyant clothing. A change in how a person dresses may also reflect other symptoms, like having a preference for more revealing clothing due to hypersexuality.

Of course, most people who wear bright-colored clothing are not experiencing a manic or hypomanic episode. But clothing can be a subtle clue if bright choices coincide with other manic or hypomanic symptoms.

How Are Manic Episodes Diagnosed?

For manic episodes to be diagnosed with bipolar disorder, a person must have a sustained and abnormally elevated, expansive, or irritable mood for at least one week. The mania must be severe enough to cause marked impairment in functioning or require hospitalization. They must also have at least three of the following symptoms:

• Easily distracted
• Engaging in multiple tasks at one time (more than can be realistically accomplished in one day)
• Engaging in risky behavior, like gambling or unprotected sex
• Feeling pressured to speak, talking loudly and rapidly
• Grandiosity or an inflated sense of self
• Little need for sleep
• Racing thoughts

To diagnose bipolar I, the "Diagnostic and Statistical Manual of Mental Disorders," Fifth Edition (DSM-5-TR) states that a person must have at least one manic episode that is not "better explained" by schizoaffective disorder, or occurring in someone with schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

What Causes Manic Episodes?

Manic episodes are common in people with bipolar I disorder. But they can also be caused by other factors and health conditions, including:

• Brain injuries
• Brain tumors
• Dementia
• Encephalitis
• Lupus
• Medications (their side effects)
• Recreational drug or alcohol misuse
  
• Schizoaffective disorder
• Strokes
  

Treatment of Manic Episodes

While there is no cure for manic episodes, a combination of medication, therapy, and lifestyle changes can help people manage symptoms and avoid triggers.

Medication

An acute manic episode is often treated with an antipsychotic, while long-term treatment may involve mood stabilizers to prevent future episodes.

Antipsychotics may include:

• Abilify (aripiprazole)
• Latuda (lurasidone)
• Risperdal (risperidone)
• Seroquel (quetiapine)
• Vraylar (cariprazine)
• Zyprexa (olanzapine)

Mood stabilizers may include:

• Depakote (divalproex sodium)
• Lithium
• Tegretol (carbamazepine)

If you or someone you love is experiencing changes in sleep (being awake for extended periods of time), sleep medication may also be prescribed short-term.

Therapy

Psychotherapy with a trained mental health professional can help you identify when your moods are changing, as well as identify triggers that lead to manic episodes. This professional can also support medication compliance and provide skills to cope with these episodes and improve your quality of life.

Some common therapeutic approaches include:

• Cognitive behavioral therapy (CBT)
• Dialectical behavioral therapy (DBT)
• Family therapy

Support Groups

Support is a crucial part of managing manic episodes. You may consider joining a support group for people with bipolar disorder, especially if you lack resources like supportive friends and family. 

Coping With Manic Episodes

Beyond medication and therapy, a few relatively simple lifestyle changes can help in the management of manic episodes. Here are some to consider.

• Make time for exercise. Do your best to get some sort of physical activity daily.
• Stick to a well-rounded diet and avoid skipping meals.
• Focus on proper sleep hygiene, including keeping a consistent sleep-wake cycle (even on weekends).
• Start a journal. You may consider keeping a notebook to record manic and depressive symptoms. Pay special attention to triggers, like a job change, a breakup, a move, or even situational triggers like staying out late, listening to loud music, starting a new project, or going on vacation.
• Stay on track with doctor appointments, as well as prescribed medication.

Helping Loved Ones With Manic Episodes

If you care for a loved one with bipolar disorder, practicing self-care is important. Look after your own health and well-being so you can have the mental and physical strength needed to help them better handle their manic episodes and other bipolar symptoms.

Also, be vigilant in observing behavior that resembles any of the signs of a manic episode. You might even try asking your loved one to share their experiences so you can journal and record their symptoms for them.

It can also be helpful to learn more about the disorder. Resources like the Depression and Bipolar Support Alliance: DBSA and the NAMI: National Alliance on Mental Illness can help. This can help you gain a better understanding of manic episodes, their causes and effects.