Bipolar Disorder Symptoms Mania and Hypomania What Is a Manic Episode? By Marcia Purse Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. Learn about our editorial process Updated on November 08, 2022 Medically reviewed Verywell Mind articles are reviewed by board-certified physicians and mental healthcare professionals. Medical Reviewers confirm the content is thorough and accurate, reflecting the latest evidence-based research. Content is reviewed before publication and upon substantial updates. Learn more. by Steven Gans, MD Medically reviewed by Steven Gans, MD Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Print Table of Contents View All Table of Contents Signs Diagnosis Causes Treatment Coping Helping Others 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. Verywell / Brianna Gilmartin What Is Unipolar Mania? Signs of Manic Episodes Recognizing the symptoms of mania is not simply academic. Manic episode symptoms can be a medical emergency, much like shortness of breath, chest pain, and bleeding 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. Delusions and hallucinations are serious symptoms of mania and require medical attention. 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. Effects of Lack of Sleep on Mental Health 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. Pressured Speech in Bipolar Disorder 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. Don't be afraid to ask your loved one to elaborate on what they mean if they tell you that their thoughts are racing. 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 Watch also for unreasonable irritability or hostility. Be cautious and get help if you see this type of 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. If you or a loved one are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one are in immediate danger, call 911. For more mental health resources, see our National Helpline Database. Excessive Religious Dedication Increased religious zeal or religious involvement can be another manic symptom. Make note of this if you see it. Religious Delusions in Bipolar Disorder 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. Manic Episode Symptoms in Children A child can display signs of mania as well. Unfortunately, with children, the diagnosis of bipolar disorder is relatively rare as the symptoms may be misdiagnosed as a behavioral disorder. If you are concerned about a child in your life, talk to a pediatrician. If the child happens to be a relative or a friend's child, keep the conversation gentle and thoughtful. You may wish to talk to a mental health professional first for ideas on how to approach the topic. Diagnosis of Manic Episodes For manic episodes to be diagnosed in 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; and have at least three of the following symptoms: Easily distractedEngaging in multiple tasks at one time (more than can be realistically accomplished in one day)Engaging in risky behavior, like gambling or unprotected sexFeeling pressured to speak, talking loudly and rapidlyGrandiosity or an inflated sense of selfLittle need for sleepRacing thoughts To diagnose bipolar I, the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) 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. Causes of 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. Treating Bipolar Disorder 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. Talk to your health provider about which complementary techniques might work for you. 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. If you or a loved one are struggling with mania, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database. 16 Sources Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy. Waters F, Collerton D, Ffytche DH, et al. Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease. Schizophr Bull. 2014;40 Suppl 4:S233-45. doi:10.1093/schbul/sbu036 Gold AK, Sylvia LG. The role of sleep in bipolar disorder. Nat Sci Sleep. 2016;8:207-14. doi:10.2147/NSS.S85754 Fiedorowicz JG, Endicott J, Leon AC, Solomon DA, Keller MB, Coryell WH. Subthreshold hypomanic symptoms in progression from unipolar major depression to bipolar disorder. Am J Psychiatry. 2011;168(1):40-8. doi:10.1176/appi.ajp.2010.10030328 Brout JJ, Edelstein M, Erfanian M, et al. Investigating misophonia: A review of the empirical literature, clinical implications, and a research agenda. Front Neurosci. 2018;12:36. doi:10.3389/fnins.2018.00036 Downey J, Friedman RC, Haase E, Goldenberg D, Bell R, Edsall S. Comparison of sexual experience and behavior between bipolar outpatients and outpatients without mood disorders. Psychiatry J. 2016;2016:5839181. doi:10.1155/2016/5839181 Powers RL, Russo M, Mahon K, et al. Impulsivity in bipolar disorder: Relationships with neurocognitive dysfunction and substance use history. Bipolar Disord. 2013;15(8):876-84. doi:10.1111/bdi.12124 Lima IMM, Peckham AD, Johnson SL. Cognitive deficits in bipolar disorders: Implications for emotion. Clin Psychol Rev. 2018;59:126-136. doi:10.1016/j.cpr.2017.11.006 Faurholt-Jepsen M, Frost M, Christensen EM, Bardram JE, Vinberg M, Kessing LV. The association between mixed symptoms, irritability and functioning measured using smartphones in bipolar disorder. Acta Psychiatr Scand. 2019;139(5):443-453. doi:10.1111/acps.13021 Abdel Hamid AAL, Nasreldin M, Gohar SM, Saleh AA, Tarek MA. Sexual and religious obsessions in relation to suicidal ideation in bipolar disorder. Suicide Life Threat Behav. 2019. doi:10.1111/sltb.12540 Hosang GM, Cardno AG, Freeman D, Ronald A. Characterization and structure of hypomania in a British nonclinical adolescent sample. J Affect Disord. 2017;207:228-235. doi:10.1016/j.jad.2016.08.033 Substance Abuse and Mental Health Services Administration. DSM-5 changes: Implications for child serious emotional disturbance manic episode. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Wilson JE, Nian H, Heckers S. The schizoaffective disorder diagnosis: a conundrum in the clinical setting. Eur Arch Psychiatry Clin Neurosci. 2014;264(1):29-34. doi:10.1007/s00406-013-0410-7 National Institute of Mental Health. Bipolar disorder. Vieta E, Sanchez-Moreno J. Acute and long-term treatment of mania. Dialogues Clin Neurosci. 2008;10(2):165-79. Bauer IE, Gálvez JF, Hamilton JE, et al. Lifestyle interventions targeting dietary habits and exercise in bipolar disorder: A systematic review. J Psychiatr Res. 2016;74:1-7. doi:10.1016/j.jpsychires.2015.12.006 Additional Reading American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Blackman KS, Odom AJ, Williamson B, Miller MA, Tewari M, Weismantel D. Self-report tool for recognizing mania (SToRM): A new scale for aiding in the diagnosis of bipolar disorder. Int J Psychiatry Med. 2014;47(3):193-205. doi:10.2190/PM.47.3.b Carbray JA, Iennaco JD. Recognizing signs and symptoms of bipolar disorder. J Clin Psychiatry. 2015;76(11):e1479. doi:10.4088/JCP.14073gc1c By Marcia Purse Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing. See Our Editorial Process Meet Our Review Board Share Feedback Was this page helpful? Thanks for your feedback! What is your feedback? Other Helpful Report an Error Submit Speak to a Therapist Online Advertiser Disclosure × The offers that appear in this table are from partnerships from which Verywell Mind receives compensation.