What Is Mania?

Mania is a state of intense and abnormal excitement, enthusiasm, or elevated mood. It is a mental health condition characterised by periods of extreme emotional highs, hyperactivity, racing thoughts, and a heightened sense of well-being. Mania is a key feature of bipolar disorder, which is a mood disorder that involves cycling between periods of mania and depression. This article explores mania in more depth, looking at what mania looks like, how it is diagnosed and what the best treatment options are.

Overview

Mania, also referred to as a manic episode, is a condition where the person experiences a drastic change in thoughts, mood and behaviour that has a significant impact on the person’s life. These changes could include: 

• Elevated mood
• Increased energy levels
• Impulsivity
• Racing thoughts
• Feeling that they need less sleep 
• Grandiosity

The episode should last for at least 1 week to be considered a manic episode. Mania, however, differs from hypomania, which is a less severe form of mania that has less of an impact on the person’s life. It is important to distinguish mania and hypomania because the presence of mania or hypomania is a key factor in determining the type of bipolar disorder.

It's important to note that mania is a symptom and not a diagnosis on its own. When the symptoms of mania are severe and significantly impact daily functioning, it may be a sign of bipolar affective disorder (bipolar I), a medical condition or medication side effects.¹

Studies suggest that 1.6% of the population will experience a manic episode at some point in their lifetime.²

Characteristics of mania

• Elevated mood: The person may feel unusually happy, on top of the world, or invincible
• Increased energy and activity levels: People in a manic state may have a surge of energy and engage in excessive physical activity or take on multiple tasks at once. Increased sexual drive is often associated with this characteristic
• Impulsive behaviour: During mania, people may act impulsively without considering the consequences, leading to risky behaviours like excessive spending, reckless driving, or substance abuse
• Racing thoughts and rapid speech: Thoughts may come rapidly and may be difficult to control, leading to a feeling of mental agitation. This also results in rapid speech that is difficult to follow or does not make much sense, sometimes called “word salad”
• Reduced need for sleep: They might require significantly less sleep than usual but still feel refreshed and full of energy
• Grandiosity and overconfidence: Individuals may have an inflated sense of self-importance, believing they possess special abilities or talents
• Irritability or agitation: Some people may become easily irritated or agitated during a manic episode
• Poor judgement: Mania can impair decision-making abilities and lead to engaging in activities with negative outcomes, such as gambling or excessive spending, promiscuity or dangerous actions

Types of mania

Mania is mostly known as a key feature in bipolar I disorder, however, there are other ways that mania can manifest.

Bipolar disorder

When exploring mania as a symptom of bipolar, this usually refers to bipolar type 1 (or bipolar I), where a manic episode is required to make a diagnosis. 

Bipolar type 2 (bipolar II) is associated with hypomania, a milder form of mania. 

There is also rapid-cycling bipolar where the person experiences at least 4 manic episodes within a 12-month period. People with rapid-cycling bipolar are usually more resistant to medication.²

Substance-induced mania

A range of illicit substances have the potential to induce a mood disorder. This refers to illegal drugs, usually stimulants such as cocaine or amphetamines or depressant drugs such as heroin. Even legal substances such as alcohol and caffeine can result in manic symptoms. Substance-induced mood disorder refers to anxiety, depressive, manic or psychotic states as a result of taking drugs. This mood state can happen during intoxication or during a withdrawal phase.³

Secondary mania

This is usually seen as a result of a reaction to certain medications. Medication like Levopoda, used in the treatment of Parkinson’s disease and steroids such as corticosteroids and anabolic-androgenic steroids are known to cause manic symptoms. Tricyclic antidepressants are also known to cause mania in people who have bipolar disorder.⁴

Diagnosing mania

When a person is suspected to be experiencing a manic episode, a thorough assessment of their physical health must be completed to rule out other possible diagnoses with similar symptoms. A full blood count, comprehensive metabolic panel, thyroid function test and urine drug screen are some of the basic tests performed. In adults over 60 or children under 13, brain imaging from either a CT scan or MRI may be needed.²

A full medical and family history would also be completed as well as the doctor looking at what medication, particularly new medication, the person is taking.

If no medical cause is found then a full psychiatric assessment will take place. The assessor would likely refer to a diagnostic coding manual such as the International Classification of Diseases (ICD-11) or the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) for features of mania. There is, however, no separate coding for mania, and it is not identified as a separate disorder. Instead, it is only codable within the diagnosis of mood disorders.⁵

To meet the criteria for a manic episode, the person must be displaying “several” characteristics of mania for ICD-11 criteria and 3 or more characteristics for DSM-5 criteria.⁵ These must also last for a minimum of 1 week.

Mania vs. hypomania

Mania and hypomania are both mood states characterised by elevated, expansive, or irritable feelings. However, they are distinct in terms of intensity, duration, and their impact on a person's daily functioning. The table below lays out the differences between mania and hypomania:

Treatment and management of mania

Medication will likely be the preferred treatment for managing a manic episode. This will either be with antipsychotics such as haloperidol, olanzapine, quetiapine or risperidone, or a mood stabiliser such as lithium, valproate or carbamazepine. If you have a diagnosis of bipolar disorder, you will likely have a consultant psychiatrist who regularly reviews your medication.

Psychotherapy is not a recommended treatment option for someone who is experiencing a manic episode due to the nature of the condition.⁶ It would be difficult or near impossible to get a manic person to engage in psychotherapy in a meaningful way. Therapies such as cognitive behavioural therapy (CBT) and general psychoeducation are used most effectively with bipolar patients whilst their mood is stable. This can help them to be mindful of changes in their mood, learn to identify triggers and act accordingly when they notice a deterioration in their mood.⁶

In rare occasions where medication has little effect, doctors have the option to explore electroconvulsive therapy (ECT) for people experiencing mania. There are specific guidelines and protocols to go through before commencing this course of therapy.

FAQs

Can I prevent mania?

Whilst it is not possible to completely prevent yourself from ever experiencing a manic episode, there are some things you can do to reduce your risk. Avoiding the use of illicit drugs, excessive caffeine or excessive alcohol will help to prevent changes in mood and behaviour. 

If you have a diagnosis of bipolar disorder and are prescribed medication, such as mood stabilisers, it is important to stick to your medication regime. Also, if you notice any changes in your mood, behaviour or thoughts, see your mental health team as soon as possible for a review of your prescribed medication.

How common is mania?

Studies suggest that 1.6% of the population will experience a manic episode at some point in their lifetime.²

What are the complications of mania?

The complications of mania manifest if the episode is not detected promptly. The longer a manic episode is left untreated, the more damage it can do to a person’s life and there is a greater potential for risk to themselves or others. Due to the intense destructive nature of the presentation, mania has the potential to affect the person’s relationships with friends and family.

The impulsive and grandiose features coupled with poor judgement can lead to financial ruin for some. People experiencing manic episodes often spend excessive amounts of money on impulsive purchases. They often gamble or take illicit drugs, and because of their poor judgement, often are exploited. They may not attend work, or present as chaotic whilst at work, putting their job in jeopardy.

Drug use is often associated with manic episodes, which only compounds the features of mania making the person more likely to be irritable, angry or aggressive, putting themselves and others at risk.

Finally, there is a risk to the person’s physical health. Experiencing a manic episode puts an enormous strain on their physical well-being. It is common for people with mania to go days without sleep, often exercising excessively or being overly active without any consideration for their well-being. Additionally, stimulants such as cocaine and amphetamines, sometimes used by people during manic episodes, can put extra strain on the heart.

Who is at risk of mania?

Most notably, those at risk of mania are those with a diagnosed bipolar disorder. People who consume illicit substances, especially on a regular basis, are at risk of substance-induced mood disorders. Older adults with medical conditions that especially require treatment with steroids are at risk of mania, as well as those with Parkinson’s disease who are prescribed Levopoda, as these medications are known to produce manic symptoms in some people.

When should I see a doctor?

It is often the case that the manic person does not feel the need to seek help unless they have experienced the symptoms before and have recognised the early signs of relapse. It is far more common that a loved one or someone close to you notices the features of mania. If this is the case, help should be sought immediately due to the person’s lack of insight and potential for harm to themselves or others. Prompt assessment and treatment will be required to limit the fallout from this condition. Sometimes, the person lacks the capacity to consent to treatment and may require a period of time in a mental health hospital or facility.

Summary

Mania is characterised by a range of symptoms that affect the way a person thinks and behaves. These symptoms include elevated mood, increased energy levels, decreased need for sleep, impulsive behaviours, racing thoughts and rapid speech, grandiosity and overconfidence, poor judgement and increased irritability and anger. These last for a minimum of 1 week and can have a significant impact on the person’s life. 

The longer someone experiences a manic episode without treatment, the more damage it is likely to have on their life, relationships, finances, job and health.

Mania is not coded in any diagnostic manual, however, is described as a symptom of other conditions. Mania is mostly associated with bipolar disorder (bipolar I), however, it can also be the result of some prescribed medications or substance abuse.

Treatment is most often effective, however, someone with mania may require a brief period of time in a mental health hospital, if they do not initially agree to take any prescribed medication whilst acutely manic. Hospitalisation also increases the person’s safety and the safety of others.

If someone you know is experiencing symptoms of mania or bipolar disorder, it is crucial to seek professional help from a mental health professional for proper evaluation, diagnosis, and treatment. Bipolar disorder is a lifelong condition, but with proper management of their mood and support, individuals can lead fulfilling lives.