Recognizing Signs of a Manic Episode
Medically reviewed by Stephanie Hartselle, MD
A manic episode is a period of elevated mood or euphoria, racing thoughts, pressured speech, increased risk-taking, an inflated sense of self, and decreased need for sleep. These symptoms must persist for at least one week to be considered a manic episode.
Mania involves a significant shift between extreme highs and lows in a person’s mental and emotional state. These shifts can drastically affect functioning, impacting a person’s relationships and causing them to struggle at home, work, and school. Mania is most commonly associated with bipolar disorder, specifically bipolar I.
This article overviews manic episodes, including symptoms, causes, diagnosis, and treatment.
Verywell / Nusha Ashjaee
Manic Episode Symptoms
The "Diagnostic and Statistical Manual of Mental Disorders" (DSM-5) outlines criteria for a manic episode. Mania occurs when a person experiences elevated mood, risky behaviors, decreased need for sleep, pressured speech, racing thoughts, and an inflated sense of self-esteem lasting for at least one week. The symptoms must impact a person most days.
Knowing the signs and symptoms of a manic episode can help you recognize what’s occurring and seek help when needed.
Elevated Mood
A hallmark of mania is feelings of euphoria or elevated mood. Mood disturbances must be present for at least one week.
Decreased Need for Sleep
During a manic episode, a person may feel like they need much less sleep than usual or no sleep at all. This can be harmful, as sleep is an essential function of the mind and body.
Being Engaged in Many Activities at Once
High energy levels can cause someone who is manic to engage in several goal-directed activities. It is often unrealistic to accomplish them, and they may have trouble with follow-through.
Talking Loudly and Quickly
Pressured speech or talking more and louder than usual can be a sign of mania. It might seem like someone’s mind is moving faster than their mouth, and they are having difficulty expressing their thoughts.
Easily Distracted
Inability to concentrate and focus on a thought or task can be a frustrating aspect of mania.
Takeaway
A manic break describes when a person struggles with symptoms for an extended period. In severe cases, mania can be accompanied by psychosis. This can include delusions and hallucinations alongside mania. In these cases, it is essential to seek help.
Increased Risk-Taking Behavior
While manic, a person may engage in high-risk behaviors such as gambling, sexual encounters, spending money, or misusing alcohol or other substances despite their potential negative consequences.
Increased Desire for Sex
Mania can intensify thoughts about sex or engaging in sexual activity, particularly condomless sex with multiple sex partners.
Flight of Ideas
A person's speech can become increasingly disorganized. Someone who is manic may bounce from topic to topic.
Racing Thoughts
Similar to flight of ideas, a person can have difficulty focusing on or expressing a thought.
Grandiosity
During mania, an individual may feel an inflated sense of self-importance or exaggerated self-confidence. They may feel they are particularly powerful or talented.
Irritability or Hostility
Irritability and hostility associated with mania can accompany anger, impatience, and aggressive behavior.
Delusions
In severe cases of mania, a person can experience delusions and hallucinations.
Mania in Children
Irritability, mood swings, trouble sleeping, difficulty focusing, and outbursts may be signs of mania in children. This can impact a child's functioning at home and school.
Thoughts of Suicide
Suicidal thoughts are common with bipolar disorder. It's estimated that one in five people with bipolar disorder dies by suicide.
Help Is Available
When a person is at risk of harming themselves or someone else, they may be in crisis. If you are having suicidal thoughts, contact the National Suicide Prevention Lifeline at 988 for support and assistance from a trained counselor. If you or a loved one is in immediate danger, call 911.
Related: Seeking Help? Mental Health Hotlines Offer a First Step
Diagnosing a Manic Episode
The euphoria that accompanies mania may feel exhilarating. For this reason, people may be less likely to seek help during periods of mania. However, the lows of depression associated with bipolar disorder can be challenging to manage. During these moments, someone may be more likely to talk to their healthcare provider.
To diagnose a manic episode, a healthcare provider will conduct a thorough evaluation. They will ask about your symptoms and their frequency, duration, and intensity.
The criteria for a manic episode stipulate that a person’s mood must be elevated for at least one week with almost daily symptoms. Getting a sense of the highs and lows you experience can help your healthcare provider diagnose bipolar disorder.
Diagnosing bipolar disorder can be tricky. There are different subtypes of bipolar disorder. For example, unipolar depression and depression in bipolar disorder can look similar.
Additionally, other mental health conditions present, like bipolar disorder, including:
Major depressive disorder with psychotic features
A healthcare provider will want to conduct a comprehensive assessment to rule out other disorders.
A diagnosis of bipolar disorder requires at least one episode of mania.
Related: What Are the Differences Between Hypomania and Mania?
Causes of Manic Episodes
Manic episodes are attributed to bipolar disorder I, though the exact cause of bipolar disorder is not entirely known. Many factors may contribute to the onset of the condition, such as genetics, brain chemistry, or environmental factors.
Bipolar Disorder Type I
There are various subtypes of bipolar disorder. Bipolar disorder I is defined by manic episodes and may or may not be followed by episodes of depression.
Other types of bipolar disorder include:
Bipolar II: Involves hypomania (a less severe form of mania) that occurs with depressive episodes
Cyclothymic: Involves less severe shifts between hypomanic and depressive symptoms for two years but does not meet the criteria of a full episode
Rapid-cycling: Involves switching between mania or hypomania and depression at least four times within 12 months
Related: Bipolar I vs. Bipolar II Disorder
Other Causes
Other factors that can lead to mania include:
Brain injury or tumor
Dementia
Medication side effects
Stroke
Genetics or family history (having a first-degree relative with the condition)
Lack of sleep
Substance use
Stressful life events
Treatment for Manic Episodes
A manic episode can lead to serious problems. Getting treatment quickly is imperative to reduce a person’s risk of legal, financial, occupational, and psychiatric consequences.
A person who is experiencing mania may not always recognize it. Loved ones can help recognize symptoms and check in to offer support and empower their loved ones to seek help.
Medication
Antipsychotics and mood stabilizers are the first-line treatments for manic episodes. Antipsychotics can help stabilize an individual by decreasing the symptoms of acute mania.
Some antipsychotics a healthcare provider may prescribe include:
Aripiprazole
Olanzapine
Quetiapine
Ziprasidone
Risperidone
Haloperidol
A healthcare provider may suggest mood stabilizers to prevent mania from recurring. One study looked at the use of medications to treat mania and found that some mood stabilizers can improve symptoms. Examples of mood stabilizers include:
Lithium
Carbamazepine
Lamotrigine
Valproic acid
Depending on your symptoms, a healthcare provider may be less likely to prescribe antidepressants due to the risk of triggering mania. Working with your prescriber is the best way to determine what medication will best support your psychological well-being.
Takeaway
Talk to your healthcare provider about any concerns you have with your medication. Do not stop taking your medication or change dosages without seeking consultation. This can lead to intensifying symptoms.
Therapy
In conjunction with medication, psychotherapy (talk therapy) can be beneficial for helping people with mania:
Identify triggers
Monitor episodes
Develop coping and problem-solving skills
Adhere to medication
Implement and maintain lifestyle changes that support well-being
Therapists may use the following approaches:
Psychoeducation: Help you better understand your diagnosis and symptoms, identify warning signs and triggers, and learn various coping skills
Cognitive behavioral therapy (CBT): Helps people challenge negative thoughts and emotions and change them into healthier ones
Dialectical behavioral therapy (DBT): Equips you with interpersonal effectiveness, emotional regulation, distress tolerance, and mindfulness strategies
Interpersonal and social rhythm therapy: Helps people develop and maintain daily routines, as well as manage interpersonal relationships
Lifestyle Changes
In addition to therapy and medication, making changes to support a healthy and balanced lifestyle can help with bipolar disorder. This might include:
Getting good quality sleep
Keeping a routine
Being aware of mania triggers
Finding social support, such as in a support group
Avoiding misuse of alcohol and drugs
Staying consistent with medication
Resources for Bipolar Disorder
If you or a loved one are struggling with bipolar disorder or mania, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area. For more mental health resources, see our National Helpline Database.
Coping: How to Calm a Manic Episode
Mental health professionals recommend that people living with bipolar disorder maintain a routine and balanced lifestyle through daily self-care, stress management, and regular sleep. There are many strategies you can use to calm an episode.
Mood Tracking
Monitoring your mood and symptoms can provide insights into how you’re doing. You can use that information to share with your healthcare provider, develop coping strategies, or make changes to support your emotional health.
Journaling
Journaling is a powerful introspective activity. By writing about your thoughts and feelings, you can uncover things that influence your mood and learn about what coping strategies work or don’t work for you.
Treatment Outreach
Being able to spot when you are hypomanic or manic enables you to reach out to a mental health professional to get support. Some signs might include:
Decreased need for sleep
Pressured speech
Increased risk-taking behavior
Inflated sense of self
Avoid Alcohol and Substance Use
Misusing alcohol and other substances can trigger or intensify symptoms of mania.
Follow Routines
Keeping a consistent schedule with exercise, eating, sleep, and other daily activities can provide structure that can aid your self-care.
Practice Good Sleep Hygiene
Maintaining a consistent schedule, especially with sleep, can help regulate your circadian rhythm, the body’s natural clock. This can help keep mania at bay or help you reset if you're experiencing an episode.
Aim to go to sleep and wake up around the same time every day.
Find Support
It may be difficult for someone who has never experienced mania to relate to or understand your experience. In addition to therapy, seeking support from others who have lived experience, or with a peer specialist, are some ways to empower yourself.
What Happens After a Manic Episode?
When a manic episode ends, you may experience feelings of regret about things you said or did during a manic episode. It is quite common for feelings of depression to occur. Seeking social support, talking with a therapist, and building healthy sleep and daily habits can all help.
Summary
A manic episode is characterized by elevated mood, decreased need for sleep, racing thoughts, pressured speech, and risk-taking behaviors. Mania is associated with bipolar disorder I.
There are evidence-based approaches available to support people during a manic episode. Healthcare providers may use treatment interventions such as medication and therapy. Managing bipolar disorder may also include strategies such as mood tracking, prioritizing sleep, developing balanced thinking, and maintaining a consistent schedule.
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