Mania

Mania is when your mood, energy or activity level becomes much higher than usual. You may feel overly excited, irritable or full of energy. You might not feel like you need much sleep. You may take risks or act on impulses without thinking them through.

These changes are different from how you usually feel and act and are noticeable to people around you. Mania often happens in bipolar disorder, but it can occur in other conditions, too.

A healthcare provider can help you manage this symptom and its underlying cause.

What is a manic episode?

A manic episode is a period when your mood, behavior and energy level become much higher or more intense than usual. These symptoms last most of the day, almost every day, for at least one week.

In some cases, the symptoms can be severe enough that you may need hospital care. Sometimes, hospital care is the safest way to help you rest, reset your mind and keep you safe while symptoms improve.

Types of mania

Healthcare providers don’t use specific “types” of mania to make a diagnosis. Still, they may describe your symptoms in the following ways:

• Acute/severe mania (current episode): A very intense manic episode that may need urgent care or hospitalization.
• Dysphoric: You have strong feelings of anxiety, anger, irritability or restlessness.
• Euphoric: You have a very high mood and energy. You may feel like you’re on top of the world.
• Mixed features: You have both mania and a few depression symptoms at the same time. For example, you may have high energy, but also feel hopelessness. This combination can raise your risk of suicide.
• Psychosis: You have mania along with symptoms like delusions (false beliefs) or hallucinations (seeing or hearing things that aren’t there).

Mania signs and symptoms

During a manic episode, it can be hard to notice the symptoms yourself. People close to you may see the changes first. Common signs of mania include:

• Acting on impulses, leading to risky or unwise choices
• Feeling unusually driven and starting many activities or projects at the same time
• Moving in ways that don’t have a clear purpose, like pacing or fidgeting
• Socializing more than usual or contacting many people at once
• Talking much more than usual and speaking so fast that others can’t interrupt

What does mania feel like?

Mania feels different for everyone. Common symptoms during a manic episode include:

• Having very high energy or activity levels
• Feeling extremely happy, excited or euphoric (extreme pleasure)
• Sleeping very little but still feeling rested
• Feeling overly confident or thinking you’re invincible
• Having racing thoughts or many ideas at once
• Getting distracted easily by things that aren’t important
• Becoming completely focused on one activity or interest
• Having a higher sex drive or spending more time thinking about sex
• Having delusions or hallucinations

What happens after a manic episode?

After a manic episode, you may feel:

• Depressed or have a low mood
• Happy about your behavior or embarrassed by it
• Like you can’t remember what happened or are unsure about all the details
• Overwhelmed by the activities or commitments you agreed to
• Very tired and need extra sleep

What causes mania?

Scientists aren’t completely sure what causes mania. Research shows it likely develops from a mix of genetic, psychological and social factors. Experts are still studying how these factors work together.

Possible causes include:

• Genetic factors: Mania has a strong genetic link. Biological family studies and studies of identical twins show that genes play a major role, although genetics doesn’t explain everything.
• Brain differences: Brain scans show differences in how certain brain areas work. These include the amygdala, hippocampus, basal ganglia, prefrontal cortex and anterior cingulate. These changes may affect your emotions, judgment and self-control during an episode.

You may be more at risk of developing mania if you have:

• An underlying mental health condition
• A family history of bipolar disorder
• A brain injury, brain tumor or stroke

Mania triggers

Certain things can make a manic episode more likely to happen. These are known as triggers. Common triggers include:

• Having a side effect from a medication, like some antidepressants, or using addictive substances
• Experiencing a major life change, like a divorce, a move or the death of a loved one
• Living through trauma, abuse or other difficult situations
• Having high stress
• Not getting enough sleep or having major changes in your sleep pattern

Manic episode triggers are different for each person. You may need to look closely at your mood and behavior to learn what affects you. Keeping a mood diary can help you track how you feel before and during an episode. You can also ask trusted family members or close friends to help. They may notice changes in your behavior sooner than you do.

Knowing your triggers may help you prepare for an episode.

What mental health conditions cause mania?

Many cases of mania are linked to an underlying mental health disorder, including:

• Bipolar disorder (bipolar I and sometimes bipolar II)
• Postpartum psychosis
• Schizoaffective disorder
• Cyclothymia

Your provider can help you understand which condition fits the symptoms you have.

How doctors diagnose mania

A healthcare provider will ask about your medical history and your family's medical history. They’ll also ask about any prescriptions, over-the-counter medicines, herbal products or supplements you take.

Your provider may order blood and urine tests or imaging scans to rule out conditions that can cause mania. Once conditions are ruled out, your provider may refer you to a mental health specialist.

To diagnose mania and its underlying cause, a mental health provider will compare your symptoms to the criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. The criteria include:

• You have a long-lasting period of very elevated mood, energy and activity. It lasts at least one week and is present most of the day, nearly every day.
• You have three or more symptoms that are a clear change from your usual behavior.
• Your mood changes are severe enough to cause major problems at home, work or school. You may need hospital care to keep yourself or others safe. You may also have psychotic symptoms, like hallucinations or delusions.
• The episode can’t be explained by substance use (medications or drugs) or another medical condition.

Mania treatment

A healthcare provider may offer medications and therapy to help manage mania. Treatment is unique to each person and may change over time.

Mania medications

Common mania medications include:

• Mood stabilizers or antiseizure medications (lithium, valproic acid, carbamazepine)
• Second-generation antipsychotics (risperidone, olanzapine)
• Short-term sedative (benzodiazepines)

If these medications aren’t effective, your provider may try:

• Clozapine
• Electroconvulsive therapy (ECT)

Each medication comes with possible side effects. Your provider will let you know what these are so you can watch for them. Let your provider know if you’re pregnant or plan on starting a family. Some medications may cause birth defects.

Mania therapy

Your provider may recommend talk therapy to help you understand mania, its cause and learn healthy coping skills. Different types of therapy may support you in different ways:

• Psychotherapy: This uses several techniques to help you look at patterns in your thoughts, feelings and behavior. You’ll talk with a mental health professional who’ll help you identify and work through factors that may trigger this symptom.
• Cognitive behavioral therapy: This helps you notice and change unhelpful thoughts or beliefs about yourself and the world around you.
• Family therapy: This helps your family and loved ones better understand what you’re going through and learn how they can support you.
• Support groups: These connect you with others who have similar experiences. You can share coping ideas and learn new ways to care for yourself. Your provider can help you find local groups.

How long does mania last?

A manic episode lasts at least seven days. It can continue for several weeks or even months. Some episodes last three to six months. Treatment may shorten the length of an episode.

How do I prevent a manic episode?

You can’t always prevent mania. But you can make a plan to manage symptoms early and keep them from getting worse.

Early signs, also called prodromal symptoms, are the first changes you might notice. Your mood may shift, your sleep pattern may change or your energy may slowly increase.

Here are some steps you can try during this time:

• Avoid loud, busy or bright places. Choose calm and relaxing activities instead.
• Choose someone you trust to help manage your finances during an episode.
• Delay major decisions or big purchases.
• Limit social time so you don’t become overly stimulated or excited.
• Stay away from people or situations that may lead to risky choices, like using addictive substances.
• Stick to your routines. Go to bed at the same time each night, even if you don’t feel tired. Keep regular times for meals, medications and exercise.

When should mania be treated by a healthcare provider?

You should seek immediate medical care if you notice:

• Dangerous behavior, like impulsive actions or poor judgment
• Hallucinations or delusions
• Not sleeping for several days
• Severe depression

You should also contact your provider if you:

• Have symptoms that disrupt your daily life, work or school
• Have side effects from treatment
• Have symptoms that are getting worse instead of better
• Notice new symptoms

Tell someone right away if you have thoughts of harming yourself. Contact family, friends, your provider or the Suicide and Crisis Lifeline at 988 (U.S.). Someone is available 24/7.