Bipolar disorder is a condition that causes extreme changes in mood. There are different forms of the disorder, some of which involve shifts from mania to depression. The classification of bipolar disorder depends on the severity of manic symptoms and how long they last.
Doctors classify bipolar disorder into one of the following categories:
- Bipolar I: The individual has had at least one manic episode that lasted 7 days or longer or was severe enough to result in hospitalization. The manic episode may precede or follow a major depressive episode, but this is not necessary for a diagnosis of bipolar I.
- Bipolar II: The person has less severe symptoms of mania, called hypomania, that last at least 4 days and are present most of the day, nearly every day. The hypomanic episode may precede or follow a major depressive episode.
- Cyclothymic disorder: This form of the disorder involves periods of hypomania with shifts to periods of depression, none of which are severe enough to meet the diagnostic criteria for a hypomanic episode or a major depressive episode.
Symptoms of mania can include racing thoughts and sleep difficulties.
Everyone experiences mood changes and varying energy levels, but mania is very different than a normal increase in energy or exhilaration.
The symptoms of mania typically include several of the following:
Energy increases to abnormal levels. For example, some people with mania may move from one activity to the next with many ideas of things that they want to do, often starting a variety of projects and not finishing them.
Feeling overly exhilarated
An overly euphoric or elevated mood is one of the most common bipolar mania symptoms. In some cases, instead of an exhilarated mood, individuals experiencing mania are extremely irritable.
Inflated self-esteem is more than just being overconfident. Instead, it involves an exaggerated level of self-importance or an unrealistic sense of superiority. A person may think that they are capable of supernatural abilities or can achieve impossible things, such as ending all disease.
Racing thoughts are typically one of the first symptoms during a manic phase. Racing thoughts may include rapidly changing ideas and an inability to concentrate on one thing.
Pressured speech is the tendency to talk very quickly and loudly. It often goes hand in hand with racing thoughts. Someone with this symptom may urgently state all of their ideas, possibly without making sense. At times, they may not pause to allow anyone else to speak, or they might say things that are inappropriate for the situation.
People with mania may have trouble sleeping or feel that they have less need for sleep. It is not uncommon for someone with mania to stay awake for more than 24 hours or only sleep 3 hours a night, yet report feeling as though they have slept well.
Engaging in risky behaviors
Mania may lead a person to behave impulsively and take part in dangerous or risky activities. Their actions could include excessive spending, reckless driving, and drug use, for example.
Bipolar mania symptoms in children and teens
According to research in the journal Child and Adolescent Mental Health, bipolar disorder occurs in between 1 and 3 percent of children and adolescents.
The International Bipolar Foundation state that children with mania are more likely to experience bouts of aggression, tantrums, or irritability than to have an elated mood. When the condition occurs in teenagers, it presents with symptoms similar to those in adults.
Although it does occur in children, bipolar mania can be difficult to diagnose in people of this age. It can be challenging to distinguish between a child’s normal behavior and bipolar mania symptoms, both of which may include a lack of impulse control and excessive levels of energy.
When to see a doctor and diagnosis
CBT may be one way to treat bipolar mania.
Anyone who suspects that they may have bipolar disorder or could be experiencing a manic episode should see a doctor.
Mania impairs a person’s ability to function. It can also lead to impulsive and risky behavior that can have serious consequences and even be life-threatening. People should seek immediate help if someone with bipolar mania symptoms has thoughts of suicide or self-harm.
In some cases, a person experiencing a manic episode may not be aware of the problem. Loved ones should encourage the individual to get the help that they need. Treatment is available that can lessen symptoms and improve quality of life.
According to the National Alliance on Mental Illness, to have a diagnosis of bipolar disorder, an individual must have had at least one episode of mania. If a person has the symptoms of a major depressive episode but has never had a manic or hypomanic episode, major depressive disorder is likely to be the more appropriate diagnosis.
A diagnosis occurs after an evaluation by a doctor or mental health professional using the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The healthcare professional will only diagnose a person as having a manic episode if the unusual elevated mood or irritability lasts for at least a week or if the symptoms are severe enough to make hospitalization necessary.
Treatment for bipolar mania often involves a combination of medication and psychotherapy. The doctor will first prescribe medications to stabilize the symptoms so that the individual can actively participate in talk therapy.
Medications to treat bipolar mania often include a combination of different classifications of drugs to stabilize rapidly changing moods.
The drugs that doctors use to treat manic episodes in people with bipolar disorder may vary, but they often include:
- mood stabilizers, such as lithium or valproate (Depakote)
- antipsychotics, such as olanzapine (Zyprexa) or risperidone (Risperdal)
- antidepressants, such as sertraline (Zoloft), fluoxetine (Prozac), or paroxetine (Paxil), in some cases
- benzodiazepines, which include lorazepam (Ativan), diazepam (Valium), and alprazolam (Xanax), may be beneficial for a very short period, generally during the manic phase when a person is in the hospital
Psychotherapy may involve a variety of different methods. For example, cognitive behavioral therapy (CBT) is a type of psychotherapy that involves determining how a person’s current thinking patterns cause certain moods and behaviors. People learn ways to identify problematic beliefs and change destructive thought patterns to develop a more positive way of thinking.
A 2017 analysis of 19 randomized controlled trials involving a total of 1,384 people with either bipolar I or II indicated that CBT improved mania severity and decreased the relapse rate.
It is also helpful for people with bipolar disorder to understand that it is a lifelong condition. Although it is manageable, adherence to treatment is essential to prevent a relapse of mania symptoms.
One study followed 300 people with bipolar I or II after discharge from a psychiatric hospital. Of the 300 people, 204 relapsed with bipolar symptoms within 4 years. Researchers concluded that stopping medication or switching to a different prescription drug were risk factors for an earlier relapse.
Bipolar mania symptoms often include an abnormal increase in energy or activity, delusions of grandeur, and racing thoughts.
The type of bipolar disorder depends on the severity and length of a manic episode. In some cases, the symptoms may be so severe that they interfere with work, school, or family life.
The disorder is most common in adults, but it can also present in children and adolescents. People with symptoms of mania should see a mental health professional to develop a treatment plan.
Treatment, which may include both medication and talk therapy, can be effective in managing the disorder and reducing manic symptoms.