Let's Talk About Bipolar Mania
The manic side of bipolar disorder can feel euphoric—but can lead to some really bad decisions. The first step in dealing with a manic episode is learning to identify what's going on.by Leslie Pepper
If you’re on this page, you may worry that you, or someone you love, has bipolar disorder. That can be scary, as bipolar is a serious mental condition that causes erratic behavior and states of intense ups and downs. Here, we delve more deeply into the ups, which are known as manic episodes, or mania. This phase of bipolar disorder can feel exhilarating but can lead to strange, sometimes delusional, actions that can be confusing to those around you and even dangerous. Understanding the hallmarks of mania can help you identify whether you’re experiencing it—or whether a friend or family member might be having a manic episode. We’re sure you have a lot of questions…and we’ve got the answers you need.
Our Pro Panel
We went to some of the nation's top bipolar disorder experts to bring you the most scientific and up-to-date information possible.
James W. Murrough, M.D., Ph.D.
Director of the Depression and Anxiety Center for Discovery and Treatment and Associate Professor of Psychiatry and Neuroscience
Icahn School of Medicine at Mount Sinai
Po Wang, M.D.
Psychiatrist and Clinic Chief
Bipolar Disorders Clinic at Stanford University Department of Psychiatry
Linda Hubbard, L.M.F.T.
Department of Behavioral Health, Psychiatry & Psychology at the Mayo Clinic
It may sometimes be difficult to share the diagnosis of bipolar with those around you, but it’s important to do so. Friends and family should be aware of the signs and symptoms of the condition, so they can suggest you see your doctor when you need to.
Psychosis, whether delusions or hallucinations, can happen while in a manic state or a depressive state, though they’re more common during a manic state; it’s important to be clear that psychosis only occurs with the type of bipolar disorder called bipolar I. During a hypomanic state—which is a milder version of mania and comes with the bipolar II type of the disorder—psychosis does not occur. (If it does, it is, by definition, a full-blown manic state.)
Yes. If you take certain medications, particularly ones that contain stimulants, (think: diet pills, cocaine, amphetamines), it can sometimes look like you’re in a manic state. The difference between drug-induced mania and bipolar mania is when the medication is out of your system, your mood will go back to its usual state.
If you are going through a manic state, you will display all or some of the mania signs for at least seven days. You might then go through long periods of time without experiencing bipolar highs and lows, or you could have what’s called “rapid cycling” symptoms, in which episodes of bipolar mania or depression crop up four or more times in a year.
Remind Me What Bipolar Disorder Is, Exactly?
Moods run the gamut. On any given week you may feel happy and sad, brave and cowardly, self-confident and insecure. That’s perfectly natural, and part of what makes us human. Bipolar disorder is much different from the high and lows that go with a typical mood swing. Bipolar short-circuits the brain’s ability to think clearly and causes a swing between extreme happiness (or “mania”) and deep sadness (or depression). These intense feelings and behavior changes can cause issues in relationships, careers, and simply the day to day of existing on Planet Earth. But with the right treatment, most people with bipolar can live full and productive lives.
What is Mania?
The “highs” in bipolar disorder are called manic episodes. In order to receive a diagnosis of bipolar I or bipolar II, the two most common types of the disorder, you have to have experienced one episode of mania or hypomania, a milder form (more on that below). While most people will have had—or will have, in the future—a depressive episode, it’s not required for diagnosis.
Those of a certain age may remember the scene in Flashdance, where Jennifer Beals whirls, twirls, and gyrates around the dance floor to the song “Maniac.” But that’s hardly representative of the real definition of “mania.” A true manic state, while energy-driven (minus the ‘80s leotard), has a dark side—and can spiral out of control. People in a manic state can pick fights, lash out when friends won’t go along with their outlandish schemes, gamble all their money away, or cheat on their spouses. Or: all of the above.
Here’s the hitch: Mania can actually be enjoyable for the person experiencing it. And it can be difficult for you to realize anything’s off. Why? Because you’re pumped up, feel more creative and productive than ever, and are friendly and chatty. The high is compared to the high of being on speed minus the actual speed. That’s because the chemicals that flow to the brain from amphetamines may be released in the manic phase.
Do I Have the Symptoms of Mania?
Symptoms may not be the same for everybody, and the symptoms and the intensity of symptoms may not be consistent even within one person. But there’s one constant: If you’re experiencing the mania of bipolar I, the most severe type, the symptoms are usually so debilitating that you’re unable to function and may even require hospitalization.
If you are going through a manic state, you may display all or some of the following signs for at least seven days, nearly every day, for most of the day:
Increased energy. You’re constantly planning, constantly doing, participating in everything you’re offered and more. You call old friends, participate in groups and meetups to connect with new ones, sometimes even insisting you get together at odd hours, in strange places, and demand that those around you follow your lead, regardless of whether they want to or not.
Distractibility. You flit from person to person and activity to activity, sometimes doing dozens of things at once. Your mind feels like it’s going a mile a minute, sometimes hyper-focusing on a single subject, other times pinballing around among dozens. You’re easily distracted, unable to discern what’s important (your friend’s question) from what’s irrelevant (the stain on her blouse).
Extremely good mood. The technical name for this is euphoria, which may even be accompanied by acting with no restraint, like you have zero filter at all. You may wear outlandish outfits, strike up conversations with complete strangers, and flirt with anyone you see. While initially this life-of-the-party personality may attract others, that wears thin as you push boundaries and continue to the point of inappropriateness.
Supercharged creativity. You move from one activity to the next, constantly starting new projects. I’m going to cook a gourmet meal! I want to visit Greece! I’m going to be a Broadway star! This, despite the fact that you don’t know how to cook, hate to travel, and can’t sing a note on key.
Grandiosity and inflated self-esteem. You can do anything and everything bigger and better than anyone else. You may claim all the credit for a project at work when in reality you only typed up the minutes of one meeting. You insist you’re going to get rich selling CBD oil, and demand that family and friends must invest. You claim you’re best friends with Taylor Swift and beg your friends to go with you to her concert, even though you don’t even have tickets (“She’ll give them to me when we get there!”). In extreme cases, you may even experience psychosis—a break with reality—where you believe you have superpowers like the ability to fly or see into the future.
Pressured speech. You talk loudly and quickly, jumble words together, and don’t pause properly. You don’t let anyone get a word in edgewise and if they do manage to speak, you don’t listen to what they have to say. Your conversations are unnatural, hurdling around from subject to subject and not making sense with any of them. You may inappropriately joke or even sing when it makes no sense.
Decreased need for sleep. In a manic state, you can go for days without sleep, or only doze a few hours a night for days or even weeks on end. And yet, you’re constantly racing and raring to go and never complain of exhaustion. Not to be confused with insomnia, where you can’t sleep. If you’re in a manic state, you function without sleep.
Engaging in risky behaviors. If you’re in the throes of a manic episode, you become absorbed in activities that bring you pleasure. Unfortunately, they’re likely to lead to destruction, or even ruin. Incessant gambling, shopping sprees, using illegal drugs, or having unsafe sex are just a few examples.
Irritability. You can be restless, pace back and forth, and tap your fingers or feet. You just can’t sit still.
Flight of ideas. The sensation that thoughts are racing. Focus changes from moment to moment. During speech, a play on words may also be seen but associations are usually superficial, for example: “It’s raining. Wet rain, rainbows; bows for ribbons. Do you like red? What time is tea? I have two cats.”
How Is Mania Different From Hypomania?
There’s another form of mania, called hypomania, which is what people with a diagnosis of bipolar II experience. Many of the symptoms are similar, but the major difference between the two is the level of intensity.
In a hypomanic state, your ability to carry out your day-to-day responsibilities and relate to people around you will be slightly compromised or sometimes even better than usual. Contrast that with mania, where functioning is significantly reduced. Another important distinction: Hypomania will never get so severe that it requires hospitalization, nor will it include psychosis. If psychosis is involved, it crosses over to mania.
If you’re experiencing a hypomanic state, you may display at least three of the following symptoms for at least four consecutive days, for most of the day:
Increased energy. While you’re in a manic state, your thoughts race in a disconnected and aimless way, and you never actually get anything done. If you’re in a hypomanic state, however, your flight of ideas is more productive. The manic person empties all the closets and takes every single cleaning product out of the cabinets, while the person in a hypomanic state will clean the entire house top to bottom.
Inflated self-esteem. You may think you look gorgeous in the mirror, but you’ll never reach a state of delusion (believing something that’s not real), which can haappen with full-on mania.
Nonstop talkativeness. You may speak more quickly and loudly than typical, but other people will be able to interrupt you.
Some risk taking. You may behave more recklessly than usual, but not to the point of destruction.
Decreased need for sleep. This is a hallmark of hypomania. Someone in this state may go days with very little sleep, or even no sleep, but still function.
Good mood. In a hypomanic state, you may seem happier than usual.
Increased irritability. Some people experiencing hypomania may seem more touchy and annoyed than ever before.
Flight of ideas. The sensation that thoughts are racing. Focus changes from moment to moment according to distractions or thought processes.
What Is Psychosis?
Bipolar I mood episodes frequently include psychosis. In fact, data on almost 6,000 people with bipolar I and II found that 61% of them had at least one psychotic symptom—which can last days, weeks, or even longer when untreated—during their lifetime.
Psychosis causes a person’s thoughts and perceptions to become so off that they’re unable to separate reality from fantasy. Symptoms of psychosis can involve many things, but typically includes one of these two:
Hallucinations. With hallucinations, people most typically see or hear things that aren’t real, although hallucinations can also affect the senses of touch, smell and taste. Examples include seeing ghosts, hearing voices, or feeling bugs crawling on them.
Delusions. With delusions, people are convinced that certain things are true, even when confronted with facts to the contrary. This could manifest as the belief that they’re able to fly, that aliens have invaded a friend’s mind, or that a co-worker is in love with them.
How Do I Get Help for Mania?
As we mentioned above, the tricky part obout mania is that it can make you feel good, and you can’t tell anything’s off. Which explains why most people with bipolar look for professional help during a depressive episode.
Though it might feel uncomfortable at first, it’s crucial for you to talk to family or close friends, people you trust and who won’t judge you, about your diagnosis, so they can help point out when you’re in the midst of a manic episode. It's also a good idea to sign a release so that your doctor can talk to your loved ones about your case if things spiral out of control for you.