An Overview of Bipolar Mania

Bipolar mania, or simply mania, is a phase of bipolar disorder. It is characterized by sustained periods of abnormally elevated or irritable mood, intense energy, racing thoughts, and other extreme and exaggerated behaviors. A manic episode may be interspersed within periods of depression during which an individual could experience symptoms such as fatigue, sadness, and hopelessness.

The signs and features of bipolar mania can vary from person to person and can last anywhere from a few days to several weeks.

Variations

Mania fits into the bipolar puzzle in different ways depending on the type of bipolar disorder involved. Broadly speaking:

• Bipolar I disorder involves severe episodes of mania and commonly, episodes of depression.
• Bipolar II disorder has hypomanic episodes that alternate with periods of severe depression.
• Cyclothymic disorder involves episodes of hypomanic symptoms interspersed with symptoms of depression.

The "classic" signs of the mania present in bipolar I disorder may be what's most often meant by bipolar mania. Bipolar II has milder periods of elation known as hypomania, which is typically shorter-lasting and generally more manageable. Hypomania can evolve into mania.

In addition, there may be specifiers that further characterize bipolar disorders including anxious distress, rapid cycling, mixed, melancholic, atypical, or psychotic features. There also may be a seasonal pattern to the episodes.

Signs and Features

When either confirming or ruling out mania, a licensed mental health professional will look for a period of over a week of persistently elevated or irritable mood with increased activity and energy accompanied by at least three of the following:

• Increased rate of speech marked by rapid and relentless verbosity, including the pressure to keep talking (pressured speech) even when others try to speak
• Grandiose beliefs with inflated self-esteem in which a person believes they are better at doing something than anyone else or is able to accomplish a difficult task in hours instead of days or weeks
• Reduced need for sleep and not feeling fatigued when sleep deprived
• Flight of ideas and/or racing thoughts that manifest a continuous stream of consciousness, a repetitive cycle of thoughts, or as fragmented, incoherent thought: For some, this simply presents as disconnected and very fast (racing) thoughts.
• Being easily distracted, unable to focus, or fixated on a task you can’t pull yourself away from
• Increased goal-directed activity or psychomotor agitation (such as pacing or hand-wringing) is a severe form of restlessness that manifests with pointless movement, jitteriness, and/or repetitive motion.
• Poor judgment and increased pursuit of risky or dangerous activities, including gambling, excessive or lavish spending, and hypersexual behaviors

In extreme circumstances, a person may experience symptoms of psychosis, defined as a break from reality characterized by hallucinations, delusions, or paranoia.

Diagnosis

There is no laboratory test that can diagnose mania. Some medical illnesses can affect your mood, and so your doctor may run laboratory tests to rule out such concerns. Your doctor may then conduct a physical exam, ask you about your personal medical and family history, and then evaluate your signs and symptoms.

If you don't have a doctor who specializes in mental health, you can speak to your primary physician first (who should be able to refer you to a specialized doctor). Be sure to discuss your symptoms and behaviors with your doctor to provide as much detail as possible—the more specific the better.

Bipolar Disorder Discussion Guide

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Since people with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania, your healthcare professional may speak with your family to identify times when you were exhibiting elevated mood and seeming particularly over-energized. As elation often feels good and seems even normal when compared to the lows and depression of bipolar disorder, it's often hard for a person with bipolar disorder to know if the mood was too high.

In and of themselves, none of the signs and behaviors listed will diagnose bipolar mania unless:

• All other causes of the behaviors have been ruled out including drugs or another medical condition.
• The behavior is seen to significantly interfere with a person’s day-to-day living.

A manic episode must last for a period of no less than one week or have required hospitalization.

Treatment

A person diagnosed with a full manic episode will typically be prescribed a mood stabilizer and often an antipsychotic drug. Psychotherapy (including cognitive behavioral therapy (CBT), family-focused therapy, or group therapy) may also be helpful.

Mood stabilizers such as lithium are most often used for long-term management and the prevention of future episodes.

Persons with persistent or severe manic episodes may benefit from electroconvulsive therapy (ECT) if they are not responsive to medications.

During episodes of bipolar mania, additional sleep medications may also be prescribed.

Even with proper treatment for bipolar disorder, mania and mood changes can still occur. Keeping a daily record of your mood symptoms, treatments, sleep patterns, and events happening in your life can be very beneficial when it comes to discussing your symptoms, treatment options, and concerns with your healthcare professional.