Understanding Mania and Manic Episodes

People often use the word mania to describe their increased energy or why they cleaned their kitchen so thoroughly. It has become a bit of a buzzword that gets used casually. However, mania is both more severe and more serious than a bout of increased energy.

Mania comprises signs and symptoms that characterize a mood disorder, not a mood. Mania is a mental health condition that most commonly appears in bipolar disorder diagnoses but can occur with other conditions such as post-partum psychosis and schizoaffective disorder, among others.

What is mania?

When people are manic, they undergo a period of unusually elevated and extreme changes in their energy level, mood, and emotions. To qualify as mania, the shift in mood, energy, activity level, etc., must represent a marked shift from a person’s typical functioning. When someone is manic, it is typically noticeable to other people. In fact, others may notice a change before the person themselves notices it or is willing to acknowledge it.

Some individuals who experience mania also develop psychotic symptoms.

What are the symptoms of mania?

A manic episode lasts for at least one week and is often much longer. Because mania can feel good, especially at the beginning, many people do not think there is anything wrong, so symptoms may progress and behavior may worsen. People are much more likely to seek help when they feel unusually bad rather than when they feel unusually good.

Again, the symptoms represent a deviation from a person’s typical functioning.

Symptoms may include:

• Unusually elevated levels of energy

• Feeling extremely excited/euphoric (out of context)

• Getting very little sleep, but feeling fully rested

• Inflated self-esteem/grandiosity/feeling invincible

• Excessively talkative (pressured speech)

• Racing thoughts, also called flight of ideas

• Easily distracted by irrelevant stimuli

• Becoming obsessed with and absorbed in a new activity or idea

• Increased physical agitation, i.e., pacing, fidgeting

• Impulsive and reckless behavior, i.e., excessive spending, risky sex, substance use, driving fast, etc.

When someone in a manic episode develops psychosis, they will also experience delusions and/or hallucinations. Delusions may be grandiose, such as believing they are famous or secret agents. Delusions can also be paranoid, with people feeling they are being stalked or targeted.

Duration of a manic episode

A manic episode often lasts several months but can be longer if left untreated. It must last at least one week to meet criteria for a manic episode.

Warning signs of mania

Early symptoms of mania are called prodromal symptoms and can last weeks to months. These symptoms are easy to miss for people who have never experienced a manic episode. However, for people who have, they can often recognize their symptoms and reach out for support and increase self-care. In those cases, sometimes a manic episode can be thwarted, or at the very least, it may be more manageable and shorter in duration.

According to NAMI, “about half of people diagnosed with bipolar disorder are able to identify at least three symptoms that indicate impending mania or depression.”

Early warning signs may include:

• Mood swings/changes that are unprovoked or out of context

• Starting to feel the need for less sleep

• Increased activity levels, increased thoughts of sex/sexual activity

• Change in appetite

• Loss of interest in usual activities

• Increased interest in new activities

• Rambling when talking

• Appearance and grooming are changing, sometimes taking on a completely different style (i.e., more expensive, more risqué, or paying significantly less attention than usual to clothes and grooming).

What causes mania?

There is no one cause and people develop mania and related conditions for varied reasons. However, the following are potential causes:

• Family history

• Chemical imbalance

• A side effect of a medication (some antidepressants), alcohol, or other psychoactive drugs

• Big life stressors (death, job loss, divorce)

• Difficult life situations (trauma or abuse, financial stress, housing loss, etc.)

• Lack of coping strategies to manage stressors

• Changes in sleep patterns/lack of sleep

• As a side effect of mental health conditions

How is mania diagnosed?

A physician will initially gather historical information about mental and physical health and may order tests to rule out conditions that produce some manic symptoms such as hyperthyroidism. They will also ask about substance use to ensure the episode is not the direct cause of the symptoms.

They will likely use a standardized assessment based on the DSM criteria for mania. If diagnosed by a therapist, they will refer the person to a psychiatrist for further evaluation and treatment.

How is mania treated?

Mania (or the related diagnosis, i.e., bipolar disorder) is typically best treated via several pathways including medication, therapy, other supports, and lifestyle modifications. Lifestyle changes may include things like improving sleep, having more structure, increasing pleasurable, healthy activities, and stopping the use of substances that can exacerbate symptoms and decrease overall stability such as alcohol, cocaine, methamphetamines, cannabis, and hallucinogens.

Support if you need it.

If drugs and alcohol are impacting your life in negative ways and you need support, reach out. Whatever you are facing, you don’t have to face it alone.

Sources:

• https://my.clevelandclinic.org/health/diseases/21603-mania

• https://www.nami.org/in-the-news/what-is-mania-and-what-does-it-mean-to-have-a-manic-episode-heres-what-experts-say/

• https://www.health.com/condition/mental-health-conditions/mania

• https://screening.mhanational.org/content/what-mania/

• https://www.goodrx.com/well-being/substance-use/drug-induced-psychosis?srsltid=AfmBOoorN8wM32d5NM79i2FgAZcDmfTY_gTwofVDCV-e3dj8NIYYZzoJ

• https://www.nami.org/bipolar-and-related-disorders/how-to-predict-your-next-bipolar-episode/

  
  

About the Author

Kimberly May, LPC-S, LMFT is a therapist at Substance Use Therapy in Austin, TX. Kimberly works with individuals, couples, and families whose lives have been affected by substance use. By using a harm reduction framework, Kimberly works effectively with people in any stage of use. In addition to substance use, she works with other issues such as anger, burn-out, anxiety and grief. Contact today to schedule a no-charge, 30 minute, in-person consultation.