Symptoms of Bipolar Mania

What Is Bipolar Disorder?

Bipolar disorder, or manic-depressive illness, is a diagnosable mental health condition recognized in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).¹ It is estimated that around 4.4% of U.S. adults experience bipolar disorder at some time in their lives.^{2, 3} Worldwide, the number of adults with bipolar disorder is close to 46 million.⁴ What separates bipolar disorder from major depressive disorder is the experience of at least one manic episode throughout an individual’s lifetime. The condition’s onset generally tends to occur between 20 to 30 years of age, although it may occur at any age.¹

Bipolar disorder is characterized by extreme shifts in mood, energy, and activity levels. People with bipolar disorder experience episodes of mania, with elevated or irritable mood, increased energy, and a decreased need for sleep, and episodes of depression with low mood, loss of interest or pleasure, and feelings of worthlessness or hopelessness.¹ The severity and frequency of these episodes can vary from person to person, and the disorder can significantly impact daily functioning and quality of life.

Types of bipolar disorder conditions include the following:

• Bipolar I: As the most severe type of bipolar disorder, individuals with this diagnosis are most likely to experience psychosis.⁵
• Bipolar II: Though individuals diagnosed with bipolar II are less likely to experience psychosis, they are not immune.⁶
• Cyclothymic disorder: Lesser understood than bipolar I and II, cyclothymic disorder shares similarities with bipolar I and II as well as major depressive disorder but is met with less severe manic and depressive cycles.⁷

Bipolar Mania Symptoms

The DSM-5 defines the primary criterion of mania as being “a distinct period of abnormally and persistently elevated, expansive, or irritable mood” and “abnormally and persistently increased goal-directed activity or energy.”¹ Mania is oftentimes a symptom of bipolar disorder but is not exclusive to this diagnosis. It is also present in cyclothymia, postpartum psychosis, schizoaffective disorder, and seasonal affective disorder.

Per the DSM-5, During the period of mood disturbance and increased energy or activity, 3 or more symptoms are present to a significant degree and represent a noticeable change from usual behavior.

Symptoms of bipolar mania include:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless, non-goal-directed activity)
• Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)”¹

More expanded descriptions of common symptoms are as follows:

Changes in Thought Patterns

Bipolar mania presents notable changes that may appear gradual at first or seemingly come on suddenly. Said changes may be noticeable to the individual experiencing them but ignored or even welcomed in some cases. The manic sensation is deemed more enjoyable than periods of significant depression.

Individuals with bipolar mania may experience a wide range of thought pattern changes, including racing thoughts, grandiosity, flight of ideas, reduced need for sleep, distractibility, impulsivity, irritability, and psychosis. For those in treatment or who are self-aware, early warning signs serve as a call to action to reduce the severity of said manic symptoms.

Psychosis

Psychosis is a mental state characterized by a break from reality. It can include symptoms like delusions (e.g., false beliefs), hallucinations (e.g., seeing, hearing, or feeling imaginary things), disordered thinking, and abnormal behavior. Though not exclusive to bipolar disorder, psychosis can occur during a manic episode. It typically occurs within the most severe conditions.

Early warning signs of psychosis can include changes in sleep patterns, increased energy and activity levels, racing thoughts or rapid speech, irritability or agitation, grandiosity or inflated self-esteem, poor judgment or impulsivity, delusions, or hallucinations.

Impaired Judgment

Impaired judgment in bipolar mania is relatively common. It refers to a state in which an individual experiences a high level of impulsivity and takes actions that are risky or potentially harmful, often without considering the consequences. One may also have difficulty concentrating or making logical decisions and acting on their emotions rather than rational thought.

Impaired judgment can manifest in numerous ways that vary by individual. For example, a person in a manic episode may spend excessively, engage in reckless behaviors such as driving too fast or taking drugs, or make impulsive decisions such as quitting their job or ending a committed relationship.

Changes in Mood

Mood swings are periods of abrupt change in one’s emotional state. Emotional lability, the clinically specific term, is a rapid, often exaggerated, change marked by strong emotions.⁷ A marked difference between a general mood swing and something likely clinical is a lack of a stimulus leading to the shift.

For example, upon receiving the news of a death in the family, it is normal for someone to shift from a happy state to grieving. It is atypical, however, for someone in a positive mood to shift to the negative without anything bad having happened. Should mood swings to this effect occur often and to great severity, it is likely an indication of a problem. Common moods include euphoria, irritability, grandiosity, racing thoughts, decreased need for sleep, increased energy, and impulsivity.

Speech Disruptions

Bipolar mania can cause a variety of speech disruptions. While these may be less readily recognized by the individual, they are oftentimes recognized by others in their presence.

Common speech disruptions with brief explanations are as follows:

• Rapid speech: Someone experiencing bipolar mania may speak very quickly, jumping from topic to topic without pause or interruption.
• Pressured speech: Pressured speech is when someone talks very quickly and with great urgency as if their words cannot come out fast enough. It may be difficult for others to interrupt or interject in the conversation.
• Flight of ideas: Here, an individual expresses a rapid succession of thoughts and ideas that are difficult to follow or keep up with. This can make it difficult to stay on topic or follow a logical conversation.
• Tangential speech: This occurs when someone goes off on tangents while speaking, veering off topic and making it difficult for others to understand what they are trying to say.
• Loosening of associations: Here, an individual’s thoughts and speech become disorganized, making it difficult for others to follow the conversation. They may switch topics rapidly and without warning.

 Sudden Changes in Energy Levels

Sudden changes in energy levels are common for individuals experiencing bipolar mania. During a manic episode, one may have a lot of energy, feel very upbeat and optimistic, and have a decreased need for sleep; however, when the episode ends, they may experience a significant “dip” in energy, which is commonly referred to as a “crash.”

The experience can leave them feeling exhausted, irritable, and depressed. Further, the shift from mania to depression can happen suddenly or gradually. Some people may experience a rapid shift from mania to depression, while others may have a period of stability or hypomania before experiencing a crash.

What Is Hypomania?

A hypomanic episode is one in which one experiences similar symptoms to mania but to a lesser extent.⁹ Essentially, one’s mood is elevated but not to the extent of a full-blown manic episode. It is characterized by a sustained period of elevated or irritable mood, increased energy and activity levels, and a decreased need for sleep.

Hypomania is different than mania because it does not significantly impair a person’s ability to function in their daily life. Some common actions/feelings for someone experiencing hypomania may include increased energy and activity levels, elevated or irritable mood, decreased need for sleep, increased sociability, and impulsivity. Given that the extent and implications of hypomania are less than a full manic episode, this condition may also be welcomed by the individual, which can lead to problems if not addressed accordingly.

How Is Bipolar Mania Diagnosed?

Bipolar mania is diagnosed by mental health professionals in accordance with DSM-5 criteria, which are based on a combination of factors, including the person’s symptoms, medical history, and family history of mental health disorders.  Mental health professionals trained and licensed to diagnose may include a psychiatrist, clinical psychologist, or licensed counselor.

During the evaluation, the mental health professional may ask the person questions about their mood, energy levels, sleep patterns, and behavior, as these are among the most common symptoms. They may also ask about any medications, supplements, or substances the person is taking, as well as any other medical conditions they may have. Further, a physical exam and/or blood test may be required to rule out any underlying or alternative medical conditions contributing to the person’s symptoms.

How Bipolar Mania Is Treated

Though the condition is pervasive without any known cure, bipolar disorder treatment may effectively manage symptoms and improve quality of life as well as prevent hospitalization. Treatment for bipolar mania typically involves a combination of psychotherapy, medication, and lifestyle changes.

A brief description of bipolar treatments is as follows:

• Psychotherapy: Psychotherapy, or talk therapy, can help individuals better understand their condition and learn coping strategies to manage symptoms. Here, cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal and social rhythm therapy (IPSRT), and family-focused therapy are commonly utilized.
• Medication: Mood stabilizers, antipsychotics, and antidepressants may be used to manage symptoms of bipolar mania. The type and dosage of medication depend on the individual, and it may take time to find the right one and dosage. Accordingly, one is encouraged to work closely with their psychiatrist for effective medication management.
• Lifestyle changes: Lifestyle changes are also recommended. Said changes may include getting regular exercise, meditating, maintaining a healthy diet, getting enough sleep, journaling, associating with prosocial support, and avoiding drugs and alcohol.

It’s important to note that a combination of treatment methods is usually the best means of symptom management. While medication alone may help in the short-term, psychotherapy and lifestyle changes can help a person develop long-term coping strategies and improve overall functioning.

Medications for Bipolar Mania

For those experiencing bipolar mania, it is highly likely that medication for bipolar disorder is necessary. Common medication classifications include atypical, typical, antidepressants, and antianxiety. Among these medications, common side effects associated include drowsiness, weight gain, tremors, nausea, and dizziness.

As each medication serves a specific purpose, descriptions are as follows:

1. Mood stabilizers: Mood stabilizers are the most used medications for bipolar disorder, as they help stabilize mood swings and prevent manic and depressive episodes. Examples include lithium, valproic acid, and carbamazepine.
2. Atypical antipsychotics: Atypical antipsychotics can help reduce symptoms such as hallucinations, delusions, and irritability. These include risperidone, olanzapine, and quetiapine.
3. Typical antipsychotics: Typical antipsychotics such as haloperidol and chlorpromazine are sometimes used to treat severe manic episodes, as they can help reduce symptoms including agitation, aggression, and psychosis.
4. Antidepressants: Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be used to treat depressive episodes but can sometimes trigger manic episodes, which is why they should be avoided or used with caution by those who experience mania.
5. Anti-anxiety medications: Anti-anxiety medications such as benzodiazepines (i.e., Xanax) may be used to treat anxiety or agitation associated with bipolar disorder. However, they are generally not used as a first-line treatment due to their potential for addiction and abuse.

Therapy

The goal of therapy is to help individuals better manage their symptoms, improve relationships, and develop relapse-prevention strategies.

Common forms of psychotherapy include:

• Cognitive-behavioral therapy (CBT): CBT focuses on identifying and changing negative thought patterns and behaviors that contribute to bipolar disorder. During CBT for bipolar, the individual learns coping strategies to manage symptoms and prevent relapse.
• Dialectical behavior therapy (DBT): DBT focuses on developing skills to manage emotions, improve relationships, and increase mindfulness. DBT can be helpful for individuals who struggle with impulsivity and emotional regulation.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT is a type of therapy that focuses on stabilizing daily routines and improving relationships to reduce the risk of manic or depressive episodes.
• Family-focused therapy: Family therapy involves the individual and their family members (or loved ones) and focuses on improving communication and relationships. What is important to note is that all parties become educated on bipolar disorder and learn healthier means of communicating and coping. Working together maximizes relapse prevention while improving overall functioning.

Regardless of the therapeutic modality, it’s important to work closely with a mental health professional to find the right therapy and treatment plan that works for the individual. Individual results vary, and it may take some time to find the right therapist and approach. Just because one style might not have worked does not mean all hope is lost.

How to Get Help for Bipolar Disorder

Treatment can help people better manage their symptoms, improve relationships, and develop strategies to prevent relapse. Treatment can also improve overall functioning and quality of life. The first step in getting help for bipolar disorder is recognizing the symptoms, which is best done through a formal diagnosis.

Diagnosis of bipolar disorder is a formal process reserved for mental health professionals such as a psychiatrist, clinical psychologist, or licensed counselor who will conduct a comprehensive evaluation that includes a review of one’s medical history, symptoms, and family history. Once a diagnosis is made, the mental health professional will work with the individual to develop a treatment plan that addresses their needs. It often includes a combination of medication, psychotherapy, and lifestyle changes.

A diagnosis of bipolar disorder can be the start of a treatment plan to help the individual manage their symptoms and feel better. Pinpointing the diagnosis can provide relief, as it can help the individual and their loved ones better understand their condition and develop effective strategies to manage symptoms. Catching early signs of bipolar mania is important, as it may help prevent full-blown episodes, reduce the severity of symptoms, prevent negative consequences, and improve treatment outcomes. Accordingly, the earlier one seeks help, the better. Online therapy options and online therapist directories can provide a beneficial starting point for finding beneficial treatments.

Final Thoughts

If you or a loved one is suffering from bipolar disorder, it’s important to know that help is available and relief is possible with an individualized treatment plan. Remember, bipolar disorder is a treatable condition, and many people with the condition go on to live fulfilling lives. With treatment, you can learn to manage your symptoms, develop effective coping strategies, and prevent relapse. Neither you nor your loved ones must suffer in silence or alone. You already took the first step by reading this article and may find more useful information by reviewing the resources provided below.