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Manic Episodes: Know the Signs

Because a person experiencing a manic episode is at risk of harming themselves and others, it’s very important to know the symptoms and when to get help.

What is a manic episode?

A manic episode is when a person has a very elevated mood and is intensely energetic for a period of time. Typically, an episode lasts a week or longer.

While being happy and energized are normally good things, these qualities are so heightened during an acute mania episode that they can lead a person to behave in unhealthy and dangerous ways. They may gamble, have risky sex, or go on shopping sprees they can’t afford.

In some cases, people who are in a manic state develop psychotic symptoms, such as seeing, hearing, tasting, or feeling things that aren’t there. They may also experience delusions, which are beliefs that are out of touch with reality (such as believing they are God).

Often, manic episodes are a sign that a person has bipolar disorder, which causes both manic episodes and periods of depression.

Sometimes, abusing substances or alcohol can cause a manic episode.

People with manic episode symptoms may be at risk of harming themselves or others. It’s important to get help as soon as they or others identify they’re in a manic state. Unfortunately, the affected person often doesn’t recognize that they’re experiencing a manic episode. So, other people’s observations and assistance are essential in getting them help.

Treatment depends on the cause, but often includes talk therapy and medications.

Hypomania vs. mania

Pro Tip

People misconstrue mania for being “hyper.” In order to truly qualify for a diagnosis of mania, the person must display notable personality changes that persist for at least a week (or less if they need to be hospitalized). —Dr. Stephanie Landau

Hypomania is similar to mania but less intense. A person with hypomania may have a shift in mood including increased energy or irritability, but the behavior is less severe or debilitating than during a manic episode. A person with hypomania may only have symptoms for a few days rather than a full week and their symptoms do not require them to be hospitalized.

People with hypomania tend to be diagnosed with Bipolar II Disorder whereas people with mania are diagnosed with Bipolar I Disorder (this is the main difference between the two disorders).

1. Bipolar disorder

Symptoms

  • Excessive energy
  • Elevated mood
  • Irritability
  • Grandiosity (an unrealistic sense of superiority over others)
  • Distractibility
  • Impulsiveness
  • Excessive talkativeness
  • Racing thoughts
  • Sexual promiscuity
  • Insomnia
  • Periods of depression

If manic episodes alternate with depressive episodes, you may have bipolar disorder. In the manic phase of bipolar disorder, you have excessive energy and an elevated mood. But during the depressive episode, you have little motivation to do the things (shower, go to work or school, eat, or talk to friends). You may feel down, hopeless, or worthless, and have thoughts of hurting yourself or suicidal thoughts.

In between episodes of major depression and mania, people with bipolar disorder may function normally and can maintain work responsibilities and relationships.

The causes of bipolar disorder are not fully understood. Genetics play a major role in how likely you are to develop it. But other factors may play a role in developing it as well.

Over 90% of people who have one manic episode have more episodes throughout life. It’s very important to see your doctor right away if you have symptoms.

Effective treatment may include talk therapy with a mental health professional, medication (such as mood stabilizers), and following a healthy sleep routine. However, if you’re in a state where you’re at risk of hurting yourself or others, you may need to be hospitalized.

2. Use or abuse of substances or medication

Dr. Rx

During a manic episode, a person feels on top of the world, gifted, and incredibly creative. They may believe they have special abilities and ideas they’ve never had before. Because they are so chatty, others feel they can’t get a word in. They may dress in a strange or provocative manner, are running on minimal to no sleep, and are engaging in activities that have a high potential for dangerous consequences. In their eyes, nothing is wrong, and they are quick to deny the severity of their symptoms. —Dr. Landau

Symptoms

  • Excessive energy
  • Elevated mood
  • Irritability
  • Grandiosity
  • Distractibility
  • Impulsiveness
  • Pressured (fast) speech
  • Racing thoughts
  • Sexual promiscuity
  • Insomnia

Manic symptoms can be triggered by using or abusing substances like alcohol and drugs. Some medications, such as antidepressants may also trigger manic episodes, especially in people who have not been diagnosed with bipolar disorder yet. The manic state may occur when you are actively using the substance, are intoxicated, or are in withdrawal from the substance.

The cause of substance-induced manic episodes is not fully known. However, it’s thought that they are related to changes that occur in the structure of your brain when you use or abuse substances. Changes to neurotransmitters—the chemical messengers in your body—are also believed to play a role.

Quitting your addiction is key. Symptoms will go away after stopping using the substance or when withdrawal symptoms end (which could take about a month). Talk therapy can help you change your behaviors, find healthy coping strategies, and address underlying mood issues. Getting support from groups like Alcoholics Anonymous and Narcotics Anonymous is also recommended. In addition, medications such as antipsychotic drugs may be used.

Other possible causes

A number of other conditions may also cause a manic episode, though these are either rare or manic episodes are not usually a defining symptom. They include:

When to call the doctor

  • If you suspect that you are experiencing a manic episode
  • If you don’t feel like your usual self for a week
  • Others around you have noticed that you’re not your usual self
  • If you are seeing, hearing, feeling, or tasting things that are not there

Should I go to the ER for a manic episode?

If you’re experiencing symptoms of a manic episode and are at risk of harming yourself or others, call 911 or have someone take you to the ER immediately.

Treatments

Pro Tip

“Touched With Fire: Manic Depressive Illness and the Artistic Temperament” is an amazing book written by a psychologist and artist who has lived with Bipolar Disorder and writes from a place of empathy and compassion. —Dr. Landau

At-home care

  • Follow a healthy sleep routine.
  • Activity schedule to ensure daily exercise, interactions with others, routine meals, and purposeful activities such as work or caring for family.
  • Get support from friends and family.
  • Chart your moods in order to identify when you may be entering into a depressed or manic episode. This helps you become more aware of symptoms that lead up to manic or depressed mood states.
  • Eat a healthy, well-balanced diet.
  • Limit your caffeine intake.

Other treatment options

  • Talk therapy
  • Family therapy
  • Attending support groups
  • Medications such as antipsychotic drugs
  • ECT
  • Hospitalization
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