What Is a Manic Episode?

By Olivia Guy-Evans, published Sept 20, 2021

Fact checked by Saul Mcleod, PhD

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A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week. Manic episodes usually begin abruptly and last for between 2 weeks and 4-5 months (median duration about 4 months).

This condition usually affects about 1% of the population and is usually associated with bipolar disorder or manic depression. Bipolar disorder, formerly known as manic depression, is a mental health condition where an individual will experience extreme mood swings, including emotional highs (mania or hypomania) and lows (depression).

With depression, an individual may experience feelings of hopelessness and lose interest or pleasure in many activities. When the mood shifts to mania, this individual may feel euphoric, intense energy, or irritable. People who experience mania may also experience psychosis symptoms, including hallucinations and delusions, indicating a separation from real life.

Mania and hypomania are two different types of episodes, but with the same symptoms. Hypomania is not as severe as mania, with mania causing more noticeable problems for personal and social functioning. With the possibility of mania resulting in psychosis, this can make the effects of this period more long-lasting and may even result in hospitalization.

Mania can be a dangerous condition as those experiencing an episode may not be able to sleep or eat. They may also engage in more risky behaviors or harm themselves. The symptoms of mania can last for around a week or more and can only be diagnosed if the symptoms of mania are significantly different from the usual behavior of an individual.

Family history may play a factor in somebody experiencing mania, as it has been found that those who have parents or siblings with this condition are more likely to experience a manic episode.

As previously stated, mania could also be a symptom of another mental health condition such as bipolar disorder. Likewise, environmental changes could also be a trigger for mania.

This can include stressful life events such as the death of a loved one, financial strain, breakdowns in relationships, and illness.

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Symptoms

When considering the symptoms of mania, it is important to take into account the individual's typical behavior. Some of the symptoms of mania may be the usual behaviors displayed by an individual, therefore they may not necessarily be linked to experiencing a manic episode.

For mania, it is important to look at the considerable changes in behavior from normal. Below are some of the symptoms that can be associated with mania.

• Irritability and hostility – an individual experiencing mania may display a lot more irritability than usual. They may be quick to start arguments and be easily annoyed by others and their environment.
• Overly energetic - someone experiencing manic episode may become very restless and will search for ways to work off their surplus of energy. They may try to attempt to do many tasks at once or take on several different projects, experiencing bursts of productivity.
• More talkative than usual – a common symptom of mania is that the individual may be talking loud and rapidly. It is important to note that this should be different from their normal volume and speed of talking as many people talk loud and fast normally but would not be considered as experiencing mania.
• Easily distracted – during a manic episode, individuals may not be able to focus on the task at hand. They may find it difficult to focus and constantly get distracted by a variety of things.
• Increased sexual desire – being hypersexual is a common symptom of mania. Individuals experiencing this may seek out sexual interactions more than usual and may engage in more risky sexual behaviors as a result of mania.
• Rapid thinking – whilst experiencing mania, individuals may find that they are experiencing a lot of thoughts at once, or their thoughts are uncontrollably racing. This may not always be noticeable when observing someone from the outside, as they may not be talking any quicker, but on the inside, they may be having several and repetitive thoughts that they cannot handle.
• Risky behaviors – those experiencing a manic episode may engage themselves in more risk-taking behaviors. For example, excessive involvement in pleasurable activities that have a high potential for painful consequences. This could include spending more money than usual, gambling, binge drinking or taking drugs.
• Grandiosity – during a manic episode, some people may experience unrealistic feelings of grandiosity. This is defined as an exaggerated sense of importance, especially over others. People experiencing grandiosity may believe they are more powerful, knowledgeable, and superior to others.
• Suicidal thoughts – In some instances, people experiencing mania may experience very low moods, hopelessness, or feeling worthless. This could result in thoughts about death and suicide.
• Excessive religious dedication – an increase in the amount of religious involvement someone usually displays could be about symptom of mania. This can link back to the symptom of grandiosity as this feeling could be accompanied by religious overtones such as an individual believing that they were sent by a religious entity.
• Decreased need for sleep – often, people experiencing mania find it difficult to sleep. This may be due to symptoms of being overly energetic, experiencing rapid thinking, and irritability. Sleep problems are common for those who have bipolar disorder, with manic episodes leading to sleep problems, and sleep problems encouraging more manic episodes to occur.
• Psychosis – during episodes of mania, individuals may also experience hallucinations, such as seeing, hearing, or smelling things that are not there. They may also experience delusions where they believe things that may seem irrational to others.

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Diagnosis

For mania to be diagnosed, an individual can be evaluated through being asked questions regarding their symptoms. Sometimes direct observations from a physician or psychiatrist can indicate that someone is experiencing a manic episode.

The Diagnostic and Statistical Manual of Mental Disorders (DSM- 5) outlines criteria that an individual must meet in order for mania to be diagnosed.

The DSM-5 criteria states that abnormally and persistently elevated mood must have lasted one week and be present most of the day, every day, to meet the criteria for manic.

During this period, three or more of the following symptoms must be present to a significant degree and represent a noticeable change from usual behavior:

Inflated self-esteem or grandiosity

Decreased need for sleep

More talkative than usual or pressure to keep talking

Flight of ideas or the experience that thoughts are racing

Distractibility, such as attention being drawn to unimportant or irrelevant stimuli

Decreased need for sleep

Increase in goal-directed activity (either socially, at work, school, or sexually) or agitation

Excessive involvement in risk-taking activities such as unrestrained spending sprees, sexual indiscretions, or foolish business investments

These disturbances in mood need to be significantly severe enough to have caused impairment in social or occupational functioning for it to meet the criteria of mania.

Similarly, if there is the need to hospitalize the individual or there are psychotic features, such as hallucinations and delusions, this also meets the criteria for diagnosis.

Finally, it is important to note that for a manic episode to be diagnosed, the episode cannot be attributed to other physiological causes, such as an effect from drug misuse or other medications.

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Treatment

Psychotherapy is also a type of treatment which can help individuals with mania identify when their moods are changing. With a mental health professional such as a psychotherapist, they can also identify the triggers which may cause a manic episode so that moods can be better managed.

Therapies such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) can help individuals to find ways to manage and cope with their mania, understand it better, and work to find methods to help reduce symptoms when they are noticed.

Other methods than can be used to manage a manic episode when they occur are some lifestyle changes that individuals can do on their own. These can include:

• Maintaining a sleep schedule – trying to go to bed at the same time and waking up around the same time can help to keep moods more stable.
• Reduce stress at home and work – if able to, it may be advised to keep regular working hours to avoid getting too stressed. Making time to relax and do an activity which is enjoyable to the individual could help to prevent this build up of stress.
• Keeping a mood diary – keeping track of mood daily could help individuals to see whether they are heading towards a manic episode. If the individual notices mood changing significantly or some warning signs of mood about to change, they can then seek treatment earlier.
• Not using alcohol or illegal drugs – cutting out alcohol and illegal drugs can be helpful to avoiding triggering a manic episode or making an episode worse. As alcohol and drugs can interfere with sleep and mood, it is not advisable to consume these if at risk of mania.
• Support networks – during a manic episode or before one comes on, it may be useful to get help from friends and family members. This can be particularly helpful if someone is having trouble telling the difference between what is real and not real (psychosis). Having a support network of people can help individuals to talk through what is real and they may be able to talk them around or alleviate some of the stress that may trigger an episode.

Sources

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, D.C.; 2013.

Carbray JA, Iennaco JD. Recognizing signs and symptoms of bipolar disorder. J Clin Psychiatry. 2015;76(11):e1479. doi:10.4088/JCP.14073gc1c

Daly, I. (1997). Mania. The Lancet, 349(9059), 1157-1160.

Gold AK, Sylvia LG. The role of sleep in bipolar disorder. Nat Sci Sleep. 2016;8:207-14. doi:10.2147/NSS.S85754

Mayo Clinic (2021, February 16). Bipolar disorder. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955 Nall, R. (2019, November 1). Mania. Healthline. https://www.healthline.com/health/mania#Treatment

Purse, M. (2020, July 11). What Is a Manic Episode? Very Well Mind. https://www.verywellmind.com/how-to-recognize-a-manic-episode-380316#what-is-a-manic-episode

Substance Abuse and Mental Health Services Administration. (2016). DSM-5 Changes: Implications for Child Serious Emotional Disturbance. https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t7/