What Is a Manic Episode?

What Is a Manic Episode?

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, including hallucinations and delusions, which indicate a separation from reality.

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

Signs of a manic episode
Verywell / Brianna Gilmartin

Symptoms

Recognizing the symptoms of mania is not simply academic. Symptoms of a manic episode can be a medical emergency, just as symptoms of shortness of breath, chest pain, or bleeding are.

When looking to identify possible a possible manic episode, it's important to consider the person's typical behavior as an important element of mania is that it represents a change from you or your loved one's usual behavior.

Here are some of the common behaviors associated with a manic episode—behaviors that you may likely easily observe, so you can recognize the need for help.

If your 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 their psychiatrist immediately. These may be serious symptoms of mania.

Decreased Need for Sleep

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

Being Engaged in Many Activities at Once

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

Talking a Lot or Speaking Loudly, Rapidly, or With Pressured Speech

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

Easily Distracted

Be aware as well if someone starts making "clang" associations (for example, gets 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 are 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 and may include uncharacteristic or risky sexual behavior such as seeking sex workers, pornographic websites, online interactions seeking liaisons, and more.

Increase in Risky Behaviors

Someone experiencing a manic episode may engage in more risky behaviors, particularly with money like overspending, spending sprees, and 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 having repetitive, unquieted thoughts. Don't be afraid to ask what they mean if they talk about their thoughts racing.

Flight of Ideas

For someone entering the manic phase of bipolar disorder, the 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

Be on the alert if your friend or loved one starts having delusions of grandeur, for example, making statements like, "Justin Bieber is sending me love letters," or "We have to move to Yemen this weekend, I've been named president there." Grandiosity is often experienced by people with bipolar disorder during the manic or hypomanic phases.

Grandiosity is defined as an exaggerated sense of importance which may be in power, knowledge, or identity, and which often has religious overtones ("I was sent to be a shepherd for my flock"). It's important to note that delusions of grandeur are not present in hypomania, but grandiose thinking like "I'm going to quit my job and write a novel" is a possible hypomanic symptom.

Again, context is important. If it's a budding writer making this comment, it may be very normal. But the same words spoken by someone who does not enjoy writing and has never talked about writing a novel before is suspect.

Hostility and/or Increased Irritability

Watch out 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 or worthlessness or thoughts about death or suicide.

Excessive Religious Dedication

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

Bright Clothing

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

Mania in Children

Sometimes people may notice symptoms of mania in a child. Unfortunately, with children, the diagnosis of bipolar disorder is relatively rare as the behaviors may be thought of as a behavioral disorder alone.

If you are concerned about a child in your life, talk to your pediatrician. If the child happens to be a relative or a friend's child, this conversation needs to be gentle and thoughtful. You may wish to talk to a mental health professional first for ideas on how to approach the topic.

Diagnosis

In order for a manic episode to be diagnosed in bipolar disorder, a person must have a sustained and abnormally elevated, expansive, or irritable mood for at least one week, and 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

Causes

Manic episodes are common in people with type 1 bipolar disorder but they can also be caused by other factors and health conditions, including:

  • Childbirth (postpartum psychosis)
  • Brain injury
  • Brain tumor
  • Dementia
  • Encephalitis
  • High levels of stress
  • Lupus
  • Medication side effect
  • Recreational drug or alcohol misuse
  • Sleep deprivation
  • Stroke
  • Trauma or abuse

Treatment

While there is no cure for manic episodes, a combination of medication, therapy, and lifestyle changes can help manage symptoms and help you to possibly 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. If you or someone you love is experiencing changes in sleep (being awake for long periods of time), sleep medication may also be prescribed short-term.

Antipsychotics may include:

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

Mood stabilizers may include:

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

Therapy

Psychotherapy with a trained mental health professional can help you identify when your moods are changing as well as triggers that lead to manic episodes. They can also increase medication compliance and provide skills to cope with these episodes and improve your quality of life. Some common therapeutic approaches include:

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

Lifestyle Changes

Beyond medication and therapy, a few relatively simple lifestyle changes can help in the management of a manic episode. Talk to your health provider about other complementary techniques that might work for you.

  • 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 for recording manic and depressive symptoms for yourself. Pay special attention to triggers, like a life event like a job change, break up, or move, or staying out late, listening to loud music, starting a new creating project, moving or going on vacation.
  • Stay on track with doctor appointments as well as prescribed medication.

Coping

If you have a loved one with bipolar disorder, there are many ways in which you can learn more about the disorder, including resources like the Depression and Bipolar Support Alliance: DBSA and the NAMI: National Alliance on Mental Illness. It can be helpful to learn about the diagnostic criteria for bipolar disorder or the symptoms of mania or hypomania in greater depth.

Be vigilant in observing behavior that resembles any of the aforementioned signs. If a loved one has bipolar disorder, try having them share their experiences so you can journal for them.

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.

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