Mania

What is mania?

Mania is a condition in which you have a period of abnormally elevated, extreme changes in your mood or emotions, energy level or activity level. This highly energized level of physical and mental activity and behavior must be a change from your usual self and be noticeable by others.

What's considered an “abnormal,” extreme change in behavior and what does it look like?

Abnormal manic behavior is behavior that stands out. It’s over-the-top behavior that other people can notice. The behavior could reflect an extreme level of happiness or irritation. For example, you could be extremely excited about an idea for a new healthy snack bar. You believe the snack could make you an instant millionaire, but you’ve never cooked a single meal in your life, don’t know a thing about developing a business plan and have no money to start a business. Another example might be that you strongly disagree with a website “influencer” and not only write a 2,000-word post but do an exhaustive search to find all the websites connected to the influencer so you can post your letter there too.

Although these examples may sound like they could be normal behavior, a person with mania will expend a great deal of time and energy including many sleepless nights working on projects such as these.

What is a manic episode?

A manic episode is a period of time in which you experience one or more symptoms of mania and meet the criteria for a manic episode. In some cases, you may need to be hospitalized.

Can I have a manic episode as its own condition or is it always part of another mental health condition?

Technically if you have a manic episode, you have a mental health condition. Mania can be a part of several mental health conditions including:

• Bipolar I disorder (the most common condition for mania to occur).
• Seasonal affective disorder.
• Postpartum psychosis.
• Schizoaffective disorder.
• Cyclothymia.

What is bipolar I disorder?

Bipolar I disorder is a mental health illness in which a person has major high and low swings in mood, activity, energy and ability to think clearly. To be diagnosed with bipolar I disorder, you have to have at least one episode of mania that lasts for at least seven days or have an episode that is so severe that it requires hospitalization.

Most people have both episodes of both mania and depression, but you don’t have to have depression to be diagnosed with mania. Many people with a bipolar I disorder diagnosis have recurring, back-to-back manic episodes with very few episodes of depression.

What are the triggers of manic episodes?

Manic episode triggers are unique to each person. You’ll have to become a bit of a detective and monitor your mood (even keeping a “mood diary”) and start to track how you feel before an episode and when it occurs. Ask family and close friends who you trust and have close contact with to help identify your triggers. As outside observers, they may notice changes from your usual behavior more easily than you do.

Knowing your triggers can help you prepare for an episode, lessen the effect of an episode or prevent it from happening at all.

Common triggers to be aware of include:

• A highly stimulating situation or environment (for example, lots of noise, bright lights or large crowds).
• A major life change (such as divorce, marriage or job loss).
• Lack of sleep.
• Substance use, such as recreational drugs or alcohol.

What happens after a manic episode?

After a manic episode, you may:

• Feel happy or embarrassed about your behavior.
• Feel overwhelmed by all the activities you’ve agreed to take on.
• Have only a few or unclear memories of what happened during your manic episode.
• Feel very tired and need sleep.
• Feel depressed (if your mania is part of bipolar disorder).

What are the symptoms of mania?

Symptoms of a manic episode

• Having an abnormally high level of activity or energy.
• Feeling extremely happy or excited — even euphoric.
• Not sleeping or only getting a few hours of sleep but still feeling rested.
• Having inflated self-esteem, thinking you’re invincible.
• Being more talkative than usual. Talking so much and so fast that others can’t interrupt.
• Having racing thoughts — having lots of thoughts on lots of topics at the same time (called a “flight of ideas”).
• Being easily distracted by unimportant or unrelated things.
• Being obsessed with and completely absorbed in an activity.
• Displaying purposeless movements, such as pacing around your home or office or fidgeting when you’re sitting.
• Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.

Psychotic symptoms of a manic episode

• Delusions. Delusions are false beliefs or ideas that are incorrect interpretations of information. An example is a person thinking that everyone they see is following them.
• Hallucinations. Having a hallucination means you see, hear, taste, smell or feel things that aren’t really there. An example is a person hearing the voice of someone and talking to them when they’re not really there.

How long does a manic episode last?

Early signs (called “prodromal symptoms”) that you’re getting ready to have a manic episode can last weeks to months. If you’re not already receiving treatment, episodes of bipolar-related mania can last between three and six months. With effective treatment, a manic episode usually improves within about three months.

What causes mania?

Scientists aren’t completely sure what causes mania. However, several factors are thought to contribute. Causes differ from person to person.

Causes may include:

• Family history. If you have a family member with bipolar illness, you have an increased chance of developing mania. This isn't definite though. You may never develop mania even if other family members have.
• A chemical imbalance in the brain.
• A side effect of a medication (such as some antidepressants), alcohol or recreational drugs.
• A significant change in your life, such as a divorce, house move or death of a loved one.
• Difficult life situations, such as trauma or abuse, or problems with housing, money or loneliness.
• A high level of stress and an inability to manage it.
• A lack of sleep or changes in sleep pattern.
• As a side effect of mental health problems including seasonal affective disorder, postpartum psychosis, schizoaffective disorder or other physical or neurologic condition such as brain injury, brain tumors, stroke, dementia, lupus or encephalitis.

How is mania diagnosed?

Your healthcare provider will ask about your medical history, family medical history, current prescriptions and non-prescription medications and any herbal products or supplements you take. Your provider may order blood tests and body scans to rule out other conditions that may mimic mania. One such condition is hyperthyroidism. If other diseases and conditions are ruled out, your provider may refer you to a mental health specialist

To be diagnosed with mania, your mental health specialist may follow the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, DSM-5. Their criteria for a manic episode are:

• You have an abnormal, long-lasting elevated expression of emotion along with a high degree of energy and activity that lasts for at least one week and is present most of the day, nearly every day.
• You have three or more symptoms to a degree that they’re a noticeable change from your usual behavior (four symptoms if your mood is only irritable). (See the symptoms section of this article for a list of the symptoms used as criteria.)
• The mood disturbance is severe enough to cause significant harm to your social, work or school functioning or there’s a need to hospitalize you to prevent you from harming yourself or others, or you have psychotic features, such as hallucinations or delusions.
• The manic episode can’t be caused by the effects of a substance (medications or drug abuse) or another medical condition.

How is mania treated?

Mania is treated with medications, talk therapy, self-management and family and friends support.

Medications

If you have mania only, your healthcare provider may prescribe an antipsychotic medication, such as ariprazole (Abilify®), lurasidone (Latuda®), olanzapine (Zyprexa®), quetiapine (Seroquel®) or risperridone (Risperdal®).

If you have mania as part of a mood disorder, your provider may add a mood stabilizer. Some examples include lithium, valproate (Depakote®) and carbamazepine (Tegretol®). (If you’re pregnant or plan to become pregnant, let your provider know. Valproate can increase the chance of birth defects and learning disabilities and shouldn’t be prescribed to individuals who are able to become pregnant.)

Sometimes antidepressants are also prescribed.

Talk therapy (psychotherapy)

• Psychotherapy involves a variety of techniques. During psychotherapy, you’ll talk with a mental health professional who'll help you identify and work through factors that may be triggering your mania and/or depression (if you’re diagnosed with bipolar I disorder).
• Cognitive behavioral therapy can be useful in helping you change inaccurate perceptions that you have about yourself and the world around you.
• Family therapy is important since it’s very helpful for your family members to understand your behavior and what they can do to help.

Ask your provider for contact information for local support groups. You might find it helpful to talk with people with similar medical experiences and share problems, ideas for coping and strategies for living and caring for yourself.

Other treatments

Electroconvulsant therapy (ECT) may be considered in rare cases in individuals who have severe mania or depression (if bipolar). ECT involves applying brief periods of electric current to your brain.

What steps can I take to better cope with or manage my mania?

Although episodes of mania can’t always be prevented, you can make a plan to better manage your symptoms and prevent them from getting worse when you feel a manic episode may be starting.

Some ideas to try during this time include:

• Avoid stimulating activities and environments – such as loud or busy places or bright places. Instead, choose calm and relaxing activities and environments.
• Stick to routines. Go to bed at a set time, even if you’re not tired. Also, stick to the same times for eating meals, taking medications and exercising.
• Limit the number of social contacts to keep you from getting too stimulated and excited.
• Postpone making any major life decisions and big purchases.
• Avoid people and situations that might tempt you to make poor or risky choices, such as taking recreational drugs or drinking alcohol.
• Consider selecting someone to manage your finances during a manic episode.

If you ever have thoughts of harming yourself, tell family or friends, call your healthcare provider or contact the Suicide and Crisis Lifeline at 988. Counselors are available 24/7.

What outcome can I expect if I’ve been diagnosed with mania?

If your mania is related to a diagnosis of bipolar I disorder, this is a lifelong disease. Although there’s no cure for mania, medication and talk therapy (psychotherapy) can manage your condition in most cases.

How can I involve family and friends in understanding my mania?

It’s important to have an honest conversation with your family and closest friends.

• Let your family and friends know what you do and don’t find helpful. For example, if you’d appreciate a friendly reminder about taking your daily medications or a question about if you are getting enough sleep, let them know. On the other hand, if you don’t like always being asked if your current state of happiness is a sign you’re having a manic episode, discuss this.
• Ask your family and friends if they can help identify your triggers if you can’t. They may be able to spot triggers that you can’t spot yourself. Ask what they’ve noticed or any patterns they may see around the times of your episodes. As soon as you recognize an early sign, make an appointment to see your healthcare provider. You may or may not need a medication adjustment. However, it’s good to be on alert since your symptoms could rapidly change.
• Describe how your symptoms feel to you. Your family and friends will have a better understanding of your condition.
• Let family and friends know what type of help you’d like from them and when you’d like it. There may be times when you feel you can cope on your own. Knowing the difference will be helpful for everyone.

What is acute mania?

Acute mania is the manic phase of bipolar I disorder. It is defined as an extremely unstable euphoric or irritable mood along with an excess activity or energy level, excessively rapid thought and speech, reckless behavior and feeling of invincibility.

What is unipolar mania?

Unipolar mania is a disorder in which only excitement, excess activity or energy level and euphoric symptoms are seen. This is a rare condition.

What’s the difference between mania and hypomania?

Hypomania is a less severe form of mania. The criteria that healthcare professionals use to make the diagnosis of either hypomania or mania is what sets them apart. The differences between these two conditions are as follows:

Can my diagnosis change between bipolar I disorder and bipolar II disorder?

No. Once you have a diagnosis of bipolar I disorder — even if you never have another manic episode or a psychotic event (delusions or hallucinations) — your diagnosis can never be changed to bipolar II disorder. You’ll always have a bipolar I disorder diagnosis.

A note from Cleveland Clinic

Problems can develop in your social life, work/school functioning and home life when you have symptoms of mania, which include mood swings and an abnormal level of energy and activity. You may require hospitalization if you have severe hallucinations or delusions, or to prevent you from harming yourself or others. It’s important to have a good understanding of mania, mania symptoms, your particular triggers and ways to better manage your manic episodes. Medications, talk therapy and support groups as well as support from your family and friends can help manage your mania. Stay in close contact with all your healthcare providers, especially during times of manic episodes. Your provider will want to see you and may need changes to your medications or dose.