Mania is a condition in which one experiences an atypically elevated mood, where one may present as euphoric, excitable, and energetic.1, 2 A manic episode occurs when one experiences mania over a sustained time.2 At first, the feeling may be welcomed, as many find the experience pleasurable at the onset. However, as the mania intensifies, one may quickly begin acting on impulse while engaging in risk-taking behavior.
Mania Definition: What Is a Manic Episode?
The DSM-5 defines the primary criterion of mania as being a distinct period of abnormally and persistently elevated, expansive, or irritable mood with persistent goal-directed activity or energy.3 The condition is often 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.4
As a symptom of a diagnosable mental health condition, the onset of mania is sometimes a breath of fresh air compared to concurrent periods of severe depression, suicidal ideation, or social withdrawal. But as the condition intensifies, it often presents with undesirable effects. For example, some experience psychosis during manic episodes, including hallucinations, delusions, euphoria, intense moods, and hyperactivity.
Consequently, one may make irrational financial decisions, engage in promiscuous sex, consume substances of abuse, and engage in other self-destructive activities. Accordingly, the individual experiencing mania and others in their environment may be at elevated risk for safety concerns if untreated.
Types of Mania
Like specific phobias, such as arachnophobia (fear of spiders) or acrophobia (fear of heights), numerous types of mania extend well beyond 100+.6 For example, there is plutomania (money mania), pharmacomania (abnormal obsession with trying drugs), and polemomania (mania for war).6 Insofar as more commonly presenting manias, individuals may experience euphoric, dysphoric, psychotic, or hypomania.
These common types of mania are described as follows:7, 8
- Euphoric: Euphoric mania is a condition many describe as incredible, beautiful, unbelievable, fantastic, and expansive. This experience is often welcomed at the onset.
- Dysphoric: Dysphoric mania is a varied experience as a combination of mania with agitated depression. People often describe this as if they are coming out of their skin or their mind and body being at civil war.
- Psychotic: Psychotic mania is a condition in which one experiences delusions (false ideas or beliefs repeatedly met with paranoia) or hallucinations (experiencing things that are not there along the five senses)
- Hypomania: A hypomanic episode is one in which one experiences similar symptoms to mania but to a lesser extent of intensity. Essentially, one’s mood is elevated but not to the size of a full-blown manic episode.
Signs of a Manic Episode
Although manic episodes may feel as though they occur suddenly, there are various tell-tale signs indicating their imminence.
According to the National Alliance on Mental Illness (NAMI), some of the signs of a manic episode include:9
- Insomnia
- Inability to listen to other people
- Spending beyond one’s means
- Unrealistic overconfidence (such as delusions of grandeur)
- Not taking care of oneself
- Inability to focus
- Hypersensitivity to stimuli
- Obsessing over things
Though there are differences among children, teens, adults, and seniors presenting with signs of mania, these indicators should be met with a pause and explored to prevent potentially devastating consequences. Even though bipolar disorder is often diagnosed in late adolescence, some patients may not be diagnosed until older age or not at all, instead accepting these signs as part of their personality. When the condition is left untreated and its consequences become internalized, it damages self-conceptualization, making it difficult for one to function optimally in the environment.
The more pronounced the signs, the more problematic the condition can be. Though many may deny their existence or be completely unaware of what is happening, others around them will notice. These individuals may speak up, avoid the manic individual, or negatively feed into the experience, which can further intensify the condition. Regardless of who notices symptoms, it is essential to be formally assessed to receive proper treatment for the disorder it stems from.
Examples of Mania in Different Mental Health Disorders
Possible disorders where manic symptoms may present include:
Mania in Bipolar Disorder
As a clinician, I have worked with many clients who have presented varied forms of mania in practice. Working with clients undergoing Medically Assisted Treatment (MAT) for opioid use disorder (heroin addiction), those with a dual diagnosis of untreated bipolar disorder fare well for extended periods. At the onset of mania, however, they would gradually begin using substances of abuse leading back up to heroin, where they would experience a full-blown relapse. Many clients repeated this cycle of bipolar mania multiple times before coming to terms with treating bipolar with medication.
Outside of my work with addiction, other clients with bipolar disorder may present more on the depressed end of the spectrum for extended periods. Week after week, sessions would speak to a lack of energy, low affect, social isolation, and suicidal ideation. Then, seemingly out of nowhere, they attend a session in which they feel good about themselves and everything else. They tell me they are now well and no longer require therapy. I discuss the nature of the condition and how positive moods should be celebrated but should also be met with caution, as a manic episode may be impending. In these cases, my warning is shrugged off as they miss multiple sessions and come back several weeks later to share everything they experienced during their manic episode.
Mania in Schizoaffective Disorder
Clients experiencing mania in schizoaffective disorder (vs. schizophrenia) frequently experience heightened awareness around hallucinations and delusions. For example, there have been many clients in practice who would share paranoia around confidentiality. They share stories of their phone being bugged and surveillance cameras planted around their house.
When prodded for evidence of this, none is there. As we process further, they can become paranoid about the counseling process and are concerned over the release of their personal health information. Clinical practice is a difficult balance, as safety is of utmost priority. While it may not be possible to talk the delusions and hallucinations away, safety planning and including loved ones for support is helpful.
Mania in Substance Use Disorders
Mania may be a symptom of some substance use disorders. The individual may experience elevated self-confidence and believe that this combination of symptoms is a superpower instead of something detrimental to well-being.
For example, a client experiencing a multi-day methamphetamine addiction binge who has not slept in days may struggle with the following:
- Thinking clearly
- Experiencing hallucinations and delusions
- Caring for oneself
- Engaging in high-risk behaviors
A former client who relapsed on meth came to the office sharing stories of how Jesus Christ was speaking to them through the television. These manic symptoms occurred not only at their house but also in the clinic’s waiting room. Given that the client was an imminent risk to themself and others, they did accept a complete psychiatric evaluation with hospitalization with the stay lasting two weeks.
Mania in Seasonal Affective Disorder (SAD)
Mania in seasonal affective disorder (SAD) may occur after extended periods of depression specific to undesirable weather conditions (e.g., cold, snow, excessive rain, dark skies). Once the unwanted weather breaks, the excitement becomes so intense with the onset of nice weather that a manic episode may ensue.
A former client with a concurrent diagnosis of SAD and other mental health conditions would present as severely depressed with suicidal ideation in the cold winters, only to be met with manic episodes during the spring. Here, it was common for the client to skip school, run away from home, continue drug use, and become aggressive with others. As we continued to focus on early warning signs of the condition and prepare for this onset, symptoms gradually reduced over several years.
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Symptoms of Mania
A connection between and among common symptoms of mania is that they entail disordered thinking. Consequently, disordered thinking negatively impacts one’s emotional state and outward expressions behaviorally. Functioning is compromised whether one is welcoming of the manic episode or not.
Common symptoms of mania include:
- Delusions – a belief or altered reality that is firmly maintained despite a lack of evidence.
- Hallucinations – associated with the five senses in which one sees, tastes, smells, touches, or hears something that is not truly present.
- Over-engaged activities – becoming obsessed over a particular activity and compulsively engaging in it, even when one wishes not to.
- Talking a lot – struggling to stop talking, even when it entails speaking over others, usually resulting in pressured speech.
- Speaking loudly – elevated volume when speaking.
- Easily distracted – one becomes easily distracted as thoughts are rapid, jumbled, and fleeting.
- Hypersexuality – an increased desire for sexual activity, which may be engaged with one’s partner or promiscuously.
- Risky behaviors – partaking in dangerous activities such as speeding on the highway, substance use, fighting others, and extreme sports without proper training.
- Rapid thoughts – seemingly never-ending thoughts which continue coming faster than one can process, often on uncomfortable topics.
- Flight of ideas – ideas pass by as quickly as they come across.
- Grandiose – experiencing overinflated self-concept.
- Hostility – experiencing heightened aggression internally and expressing it outwardly.
- Thoughts of suicide – feelings as though one’s situation is hopeless and ending one’s life is the best course of action. This may also entail thoughts of sacrificing oneself to help others.
- Unusual clothing or dressing – individuals may begin dressing out of character and in outlandish styles that may be out of vogue or deemed inappropriate.
- Aggression – acting out on one’s hostility, whether verbally or physically
- Hypomania – experiencing a state of elevated mood that closely resembles mania but not to the fullest extent. This is more of a “mini” episode.
What Causes Mania
Recognizing how mania is triggered is key to preventing more severe episodes and navigating them effectively. Though triggers may differ for every person and condition to the next, being mindful of what can become triggers can help those who experience mania and those who care about them.
Common causes and triggers of mania include:
- Brain trauma – structural changes to the brain impact neurological function.
- Tumors – often associated with mood symptoms, psychosis, memory problems, and personality change.
- Dementia – the link between dementia and mania entails highly associated behavioral agitation.
- Encephalitis – this condition leads to confusion, memory loss, mood disturbances, and sleep deprivation which may lead to mania.
- Lupus – symptomology of the condition may closely resemble schizophrenia or bipolar disorder, which can include manic episodes.
- Medication – substances that interfere with one’s neurotransmitters, hormones, and brain functioning illicit a manic response
- Drug or alcohol misuse – substance misuse compromises the medial prefrontal cortex, which impacts judgment. Lowered inhibitions may emulate or even lead up to what one may experience in a manic state.
- Schizoaffective disorder – experiences with hallucinations and delusions may escalate moods to a state of one experiencing mania.
- Strokes – though rare and more often associated with the development of depression after a stroke, a psychological consequence of stroke may include mania.
- Acute stress – when in an elevated state of fight-flight-freeze, one becomes hypertensive to thoughts and feelings, which compromise behavior—potentially yielding a manic episode
- Hypothyroidism – though the extent to which hypothyroidism leads to mania is not fully known, there are occasional psychiatric symptoms that may include mania.
- Financial stress – when financial stress leads to struggling to meet the basic needs of self and others, an acute-type stress response may occur, potentially triggering mania.
Diagnosis of Mania
Diagnosis is assessed by a mental health professional. In this case, the more comprehensive the assessment, the better. Psychiatrists, neuropsychologists, and others specializing in severe psychiatric conditions are recommended as the best practitioners. Depending on the condition and individual factors, diagnosis may be straightforward or take some time (especially when there are other potential conditions to rule out first). Mania is easier to diagnose at advanced ages of adolescence onward than childhood.
Mania is an associated symptom of various invasive psychiatric conditions, so it is likely to be diagnosed as part of conditions such as:
- Bipolar disorder
- Schizophrenia
- Schizophreniform
- Delusional disorder
- Other psychotic disorders (such as brief psychotic disorders)
Symptom criteria for a manic episode diagnosis according to the DSM-5 include:
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood
- Abnormally persistent increased goal-directed activity or energy
- Both must last for at least one week and be present most of the day, nearly every day (or for any duration if hospitalization is necessary)
To prove the above criteria, three or more of the following symptoms must be present and represent a noticeable change from usual behavior, such as:
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
- More talkative than usual or pressured to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility (i.e., attention too quickly 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)
The mood disturbances must be severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others. The episode is only deemed part of a mental health disorder if not attributable to the effects of a substance (e.g., drug of abuse, medications, or natural products) or another medical condition.3
Treatment of Manic Disorders
Everything begins with awareness. The best way to treat a manic disorder is first to know and acknowledge its existence. From there, a combination of medication and therapy may help to balance brain chemistry while enhancing healthy coping skills. Most diagnoses with manic symptoms are pervasive, meaning they are treatable but not curable. Accordingly, intentional and consistent treatment adherence is recommended to ensure proper management of manic symptoms.
Therapy for Mania
Psychotherapy helps treat mania in many ways. First, it allows individuals to understand the condition better while learning the warning signs of a manic onset. Knowing the warning signs is essential; the earlier one notices these, the more one can take action to minimize or prevent the episode. Psychotherapy also allows the therapist and client to engage in medication management. The therapist holds the client accountable for taking medication as prescribed by one’s prescribing physician (i.e., psychiatrist).
Beyond issues specific to mania, psychotherapy addresses anything else of concern. Here, clients may identify and maximize strengths, build a healthy support system, devise a safety plan, and ensure a holistic treatment effort. The timeline for treatment is ongoing, although it is likely that one may decrease the frequency and intensity of therapy while stable.
Common types of therapies used for treating manic episodes include:
- Cognitive behavioral therapy (CBT): Focuses on the four-factor model in which an individual considers associated thoughts, feelings, and behaviors applied in any given situation.
- Dialectical behavioral therapy (DBT): Moves beyond the four-factor model in CBT to applications of mindfulness-based practices; treatment also includes an additional weekly phone session with the therapy and support group.
- Family Therapy: Clients engage in therapy with familial support. Each individual receives support and learns how to function better as a family.
- Interpersonal Therapy: Clients focus on adaptive social skills while learning to better work through interpersonal conflict.
- Social Rhythm Therapy: Though often incorporated in other therapeutic approaches, clients and therapists work together to develop more predictable and healthier daily routines and sleep schedules. Consistency is the goal here.
Medication for Mania
Medication is commonly prescribed for mania, as it helps balance brain chemistry. An individual medical regimen will vary depending on the diagnosis severity, physiology, and other potential diagnoses and prescribed medications. Standard medication classifications for mania include antipsychotics, mood stabilizers, and anticonvulsants. In some cases, benzodiazepines may also be used, especially in the presence of intense anxiety symptoms.
Though a general medical doctor may prescribe medication, seeing someone specializing in mental health, such as a psychiatrist, is recommended. Mental health specialists are better informed on these conditions and are more precise in deciding the best course of treatment. Some medications serve better in events of short-term, acute treatment, while others serve better in the long term.
At the present time, there is solid evidence supporting the use of lithium, the anticonvulsants valproate and carbamazepine, and the antipsychotics chlorpromazine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine in acute mania, and some evidence supporting the use of clozapine or electroconvulsive therapy in treatment-refractory cases. However, combination therapy is the rule rather than the exception in clinical practice. The treatment of acute mania deserves a long-term view, and the evidence base for some treatments may be stronger than for others. – Sanchez-Moreno J. Vieta E (National Library of Medicine)10
Accordingly, a trained mental health prescribing physician should take a full psychiatric assessment before engaging in any medication regimen. From there, it is vital to routinely update one’s provider on progress or lack thereof to ensure stability. This patient/doctor communication is a critical component of treatment.
Antipsychotics may include:
- Abilify (aripiprazole)
- Latuda (lurasidone)
- Risperdal (risperidone)
- Seroquel (quetiapine)
- Vraylar (cariprazine)
- Zyprexa (olanzapine)
Mood Stabilizers may include:
- Lithobid (lithium)
- Tegretol (carbamazepine)
- Depakene (valproic acid)
- Depakote (divalproez sodium)
- Lamictal (lamotrigine)
Anticonvulsants might include:
- Depakene (valproic acid)
- Depakote (divalproez sodium)
- Lamictal (lamotrigine)
Benzodiazepines* might include:
- Xanax (alprazolam)
- Klonopin (clonazepam)
- Valium (diazepam)
*These medications have black box warnings, the most severe kind of warnings from the FDA for abuse or misuse, risk of physical dependence, and risk of severe side effects, including death, when combined with an opioid.
All medications have a risk of adverse effects, some of which can be severe. Before starting any medication, you should discuss the potential benefits and risks with your doctor. Tell them about any medicines, herbs, or supplements you take regularly, and share your health history to ensure a medication is safe for you.
Lifestyle Changes to Manage Mania
It is highly recommended that one undergoes lifestyle changes to maximize success with any treatment regimen, especially for mania. Here, it is important to consider potential triggers to a manic onset and partake in healthy coping mechanisms that help avoid these.
While it is nearly impossible to complete a lifestyle change overnight, it is important to recognize that this takes time. Changes may begin gradually and be built upon with success. Once something is found to work, stick with it. Though mania may come with an undesirable prognosis, the truth is that it is within reach to manage in daily life. Although symptoms may not be fully eradicated, lifestyle changes can prevent the worst outcomes.
13 lifestyle changes to consider when diagnosed with mania include:
- Exercise for mental health
- Breathwork
- Meditation
- Positive self-talk (i.e., mantras)
- Well-rounded diets
- Proper sleep for mental health
- Journaling
- Medication/treatment compliance
- Safety/crisis planning
- Familial and other prosocial support
- Support groups
- Being honest with oneself and others
- Avoiding substances of abuse (i.e., drugs and alcohol)
How to Get Professional Help for Mania
Fortunately, there are numerous options for treating manic episodes. While individuals who experience hypomania may find success with minimal lifestyle changes, a mental health professional is still recommended to assess them to discuss safety planning. Finding a therapist may begin with a general web search (i.e., an online therapist directory) of local providers and go from there. One is encouraged to review and contact multiple providers before making a choice. Ensure that the provider is accessible, specifically treats mania, and is affordable. The more diligent you are in finding a provider, the greater likelihood of desired treatment outcomes.
How to Get Help for a Loved One
Getting help for a friend or loved one follows a similar progression to finding treatment for oneself; however, the process may become complicated if they show resistance. Remember, one cannot be forced into treatment. This decision to pursue therapy must ultimately be followed by the one experiencing mania.
Accordingly, it is advisable to come from a well-informed, supportive place while making yourself available to assist them in the treatment process (e.g., setting up the initial appointment or participating in therapy). In some cases, it may help to speak with a mental health professional before having this conversation with a loved one. Here, one may receive personal support, become educated on the condition and treatment, and proceed with heightened confidence.
How to Get Help for a Child
Given that many disorders that present with mania are diagnosed in later adolescence and adulthood, it may be more difficult to monitor manic symptoms in a child. At the same time, if the symptoms are present, it is a call for concern, and medical intervention is recommended. It may require multiple rounds of assessment from various providers—getting second opinions—but it is worth the effort to begin treatment as early as possible.
By intervening earlier, children may stabilize on medication earlier while integrating healthy coping skills. With childhood and adolescence being the formative years of development, intervening during this critical period may save a lifetime of complications. Accordingly, it may be helpful to understand a highly sensitive child or know what to expect when sending your child or teen to counseling when discussing how to get treatment for mania.
Seeking support for someone else’s child does help to have that child’s parents/guardians on board. Many people go on the defense when faced with a potential mental health diagnosis. Further, many become even more sensitive when considering a diagnosis of a chronic/pervasive condition for their child that requires ongoing psychotherapy and medical management.
Final Thoughts
Experiencing a manic episode can be scary for you and others. Though there is a lot involved with preparing for and working through a manic episode, there are options that effectively minimize their severity or even prevent them from occurring. Early recognition is essential. From there, remaining intentional and consistent with efforts while adjusting treatment when necessary is critical. Numerous people living with mania have found peace with it and live healthy, productive lives. Taking the first step is often the hardest, but it becomes possible to take back control from there. Remember, you and your loved ones are worth it.
For Further Reading
- Online Support Groups – Depression and Bipolar Support Alliance
- Bipolar Hope – bpHope.com
- Mental Health America (MHA)
- Bipolar disorder | NAMI: National Alliance on Mental Illness
- Substance Abuse and Mental Health Services Administration (SAMHSA) Behavioral Health Treatment Services Locator
- Do I Suffer from Mania? Mania Self Assessment
- 18 Best Online Psychiatrists
- How to Get Anxiety Medication
Mania Infographics
