What Is a Manic Episode?

Mania involves a significant shift between extreme highs and lows in a person’s mental and emotional state. These shifts can drastically affect functioning, impacting a person’s relationships and causing them to struggle at home, work, and school. Mania is most commonly associated with bipolar disorder, specifically bipolar I.

Mania is characterized by a period of elevated mood or euphoria, racing thoughts, pressured speech, increased risk-taking, an inflated sense of self, and decreased need for sleep. These symptoms must persist for at least one week to be considered a manic episode.

This article provides an overview of manic episodes, including symptoms, causes, diagnosis, and treatment.

Manic Episode Symptoms

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association's handbook for diagnosing mental health conditions, outlines the criteria for mania. However, it's important to remember that symptoms may present differently in each person.

Mood shifts can be intense. A review of studies that examined mania symptoms discussed how mania can disrupt a person’s sleep, judgment, and energy and activity levels.

Knowing the signs and symptoms of a manic episode can help you recognize what’s occurring and seek help when needed. 

Elevated Mood

A hallmark of mania is feelings of euphoria or elevated mood. Mood disturbances must be present for at least one week.

Decreased Need for Sleep

During a manic episode, a person may feel like they need much less sleep than usual or no sleep at all. This can be harmful, as sleep is an essential function of the mind and body. 

Being Engaged in Many Activities at Once

High energy levels can cause someone who is manic to engage in several goal-directed activities. It is often not realistic to accomplish them and they may have trouble with follow-through. 

Talking Loudly and Quickly

Pressured speech or talking more and louder than usual can be a sign of mania. It might seem like someone’s mind is moving faster than their mouth, and they are having difficulty expressing their thoughts. 

Easily Distracted

Inability to concentrate and focus on a thought or task can be a frustrating aspect of mania.

Increased Risk-Taking Behavior

While manic, a person may engage in high-risk behaviors such as gambling, sexual encounters, spending money, or misusing alcohol or other substances, despite their potential negative consequences.

Increased Desire for Sex

Mania can intensify thoughts about sex or engaging in sexual activity, particularly condomless sex with multiple sex partners.

Flight of Ideas

A person's speech can become increasingly disorganized. Someone who is manic may bounce from topic to topic.

Racing Thoughts

Similar to flight of ideas, a person can have difficulty focusing on or expressing a thought.

Grandiosity

During mania, an individual may feel an inflated sense of self-importance or exaggerated self-confidence. They may feel they are particularly powerful or talented.

Irritability or Hostility

Irritability and hostility associated with mania can accompany anger, impatience, and aggressive behavior.

Delusions

In severe cases of mania, a person can experience delusions and hallucinations.

Mania in Children

Irritability, mood swings, trouble sleeping, difficulty focusing, and outbursts may be signs of mania in children. This can impact a child's functioning at home and school.

Thoughts of Suicide

Suicidal thoughts are common with bipolar disorder. It's estimated that 1 in 5 people with bipolar disorder dies by suicide.

What Constitutes a Mental Health Emergency?

People who live with mental health conditions often experience changes in mood, thought, or behavior. Sometimes these changes can lead to a mental health crisis or emergency. Understanding and spotting the signs can help you take action and seek help faster.

When a person is at risk of harming themselves or someone else, they may be in crisis. Some signs of a mental health crisis include:

• Isolation or lack of social support
• Relationship problems
• Traumatic events
• Agitation
• Abuse or violence
• Grief and loss
• Substance use
• Extreme mood swings
• Difficulty with daily tasks and functioning 
• Self-harming behaviors 
• Paranoia
• Thoughts of death or suicidal ideation 

Diagnosing a Manic Episode

The euphoria that accompanies mania may feel exhilarating. For this reason, people may be less likely to seek help during periods of mania. However, the lows of depression associated with bipolar disorder can be difficult to manage. During these moments, someone may be more likely to talk to their healthcare provider. 

To diagnose a manic episode, a healthcare provider will conduct a thorough evaluation. They will ask about your symptoms, as well as their frequency, duration, and intensity.

The criteria for a manic episode stipulates that a person’s mood must be elevated for at least one week with almost daily symptoms. Getting a sense of the highs and lows you experience can help your healthcare provider diagnose bipolar disorder.

Diagnosing bipolar disorder can be tricky. There are different subtypes of bipolar disorder. For example, unipolar depression and depression in bipolar disorder can look similar.

Additionally, there are other mental health conditions that present like bipolar disorder, including:

• Schizophrenia
• Anxiety disorders
• Attention deficient hyperactivity disorder (ADHD)
• Major depressive disorder with psychotic features

A healthcare provider will want to conduct a comprehensive assessment to rule out other disorders.

A diagnosis of bipolar disorder requires at least one episode of mania.

Causes of Manic Episodes

Manic episodes are attributed to bipolar disorder I, though the exact cause of bipolar disorder is not entirely known. Many factors may contribute to the onset of the condition, such as genetics, brain chemistry, or environmental factors.

Bipolar Disorder Type I

There are various subtypes of bipolar disorder. Bipolar disorder I is defined by manic episodes and may or may not be followed by episodes of depression.

Other types of bipolar disorder include:

• Bipolar II: Involves hypomania (a less severe form of mania) that occurs with depressive episodes
  
• Cyclothymic: Involves less severe shifts between hypomanic and depressive symptoms for a period of two years, but does not meet the criteria of a full episode
• Rapid-cycling: Involves switching between mania or hypomania and depression at least four times within a 12-month period

Other Causes

Other factors that can lead to mania include:

• Brain injury or tumor
• Dementia
• Medication side effects
• Stroke
• Genetics or family history (having a first-degree relative with the condition)
• Lack of sleep
• Substance use
• Stressful life events

Treatment for Manic Episodes

A manic episode can lead to serious problems. Getting treatment quickly is imperative to reduce a person’s risk of legal, financial, occupational, and psychiatric consequences.

A person who is experiencing mania may not always recognize it. Loved ones can help recognize symptoms and check in to offer support and empower their loved ones to seek help.

Medication

Antipsychotics and mood stabilizers are the first-line treatments for manic episodes.

Antipsychotics can help stabilize an individual by decreasing the symptoms of acute mania.

Some antipsychotics a healthcare provider may prescribe include: 

• Aripiprazole
• Olanzapine
• Quetiapine
• Ziprasidone
• Risperidone
• Haloperidol

A healthcare provider may suggest mood stabilizers to prevent mania from recurring. One study looked at the use of medications to treat mania and found that some mood stabilizers can improve symptoms. Examples of mood stabilizers include:

• Lithium 
• Carbamazepine
• Lamotrigine
• Valproic acid 

Depending on your symptoms, a healthcare provider may be less likely to prescribe antidepressants due to the risk of triggering mania. Working with your prescriber is the best way to determine what medication is going to best support your psychological well-being.

Therapy

In conjunction with medication, psychotherapy (talk therapy) can be incredibly useful for helping people with mania:

• Identify triggers
• Monitor episodes
• Develop coping and problem-solving skills
• Adhere to medication
• Implement and maintain lifestyle changes that support well-being

Therapists may use the following approaches:

• Psychoeducation: Help you better understand your diagnosis and symptoms, identify warning signs and triggers, and learn various coping skills
• Cognitive behavioral therapy (CBT): Helps people challenge negative thoughts and emotions and change them into healthier ones
• Dialectical behavioral therapy (DBT): Equips you with interpersonal effectiveness, emotional regulation, distress tolerance, and mindfulness strategies
• Interpersonal and social rhythm therapy: Helps people develop and maintain daily routines, as well as manage interpersonal relationships

Lifestyle Changes

In addition to therapy and medication, making changes to support a healthy and balanced lifestyle can help with bipolar disorder. These changes might include:

• Getting good quality sleep
• Keeping a routine
• Being aware of mania triggers
• Finding social support, such as in a support group
• Avoiding misuse of alcohol and drugs
• Staying consistent with medication
  

Coping: How to Calm a Manic Episode

Mental health professionals recommend that people living with bipolar disorder maintain a routine and balanced lifestyle through daily self-care, stress management, and regular sleep. There are many strategies you can use to calm an episode. 

Mood Tracking

Knowledge is power. Monitoring your mood and symptoms can provide insights into how you’re doing. You can use that information to share with your healthcare provider, develop coping strategies, or make changes to support your emotional health.

Journaling

Journaling is a powerful introspective activity. By writing about your thoughts and feelings, you can uncover things that influence your mood and learn about what coping strategies work or don’t work for you.

Treatment Outreach

Being able to spot when you are hypomanic or manic gives you the opportunity to reach out to a mental health professional to get support. Some signs might include:

• Decreased need for sleep
• Pressured speech
• Increased risk-taking behavior
• Inflated sense of self

Avoid Alcohol and Substance Use

Misusing alcohol and other substances can trigger or intensify symptoms of mania.

Follow Routines

Keeping a consistent schedule with exercise, eating, sleep, and other daily activities can provide structure that can aid your self-care.

Practice Good Sleep Hygiene

Maintaining a consistent schedule, especially with sleep, can help regulate your circadian rhythm, the body’s natural clock. This can help keep mania at bay or help you reset if you're experiencing an episode.

Aim to go to sleep and wake up around the same time every day.

Find Support

It may be difficult for someone who has never experienced mania to relate or understand your experience. In addition to therapy, seeking support from others who have lived experience, or with a peer specialist, are some ways to empower yourself.

Summary

A manic episode is characterized by elevated mood, decreased need for sleep, racing thoughts, pressured speech, and risk-taking behaviors. Mania is associated with bipolar disorder I.

There are evidence-based approaches available to support people during a manic episode. Healthcare providers may use treatment interventions such as medication and therapy. Managing bipolar disorder may also include strategies such as mood tracking, prioritizing sleep, developing balanced thinking, and maintaining a consistent schedule.

A Word From Verywell

It can be frightening to experience a manic episode or watch someone you love struggle with mania. Learning the signs and understanding factors that can contribute to mania can help you care for yourself and manage an episode when it occurs. If you suspect a manic episode, reach out to a healthcare provider or mental health professional for help.