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Mood Episodes In Bipolar Disorder: What Is Typical For A Manic Episode?

by — 2019-12-24 in Mental Health
Mania is often considered as the “euphoric” part of the bipolar spectrum, but sometimes it can really disrupt lives — even more so than depression. We have more on mania below.

Bipolar disorder is a serious mental condition that affects more than six million Americans and over 46 million people across the world, according to data from 2017. It mainly comes in two episodes, depressive and hypomanic or manic periods. Unfortunately, the causes and the best treatment are still relatively little understood, which makes this condition a major burden within the medical community and an even bigger one for those who have to live with it.

A diagnosis of bipolar disorder requires at least one episode of mania followed by a hypomanic or a depressive episode, as stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Also, the manic episode has to last four or more days to be considered an indicator of bipolar disorder in adults as well as children, although children rarely suffer from this condition.

Both hypomania and mania represent periods of elevated mood. The only difference is that hypomania is a much milder form of mania, without psychotic breaks. Some people diagnosed with bipolar disorder will have hypomanic or manic episodes many times throughout their lives, while others will experience them rarely.

Manic episodes: The science

The DSM-5 defines mania as “a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day.”

Mania is diagnosed if a person has at least three symptoms from the following list, in combination with mood disturbance:

  • Talking more than usual
  • Inflated ego (feeling of grandiosity)
  • Ability to function well without sleeping
  • Racing thoughts (a lot of fresh ideas)
  • Being easily distracted (inability to focus)
  • Psychomotor agitation (unintentional movements, lip or nail biting, etc)
  • Involvement in risky behaviors (sexual adventures, shopping sprees, risky investments).

Behavior typical for those experiencing a manic episode

Mania is so extreme that a person can barely carry on with their everyday life.

In a lot of cases, they will need hospitalization. Mania causes people to lose sleep, to lie, to cheat, gamble, and wonder around like a “maniac” (from medieval Latin word maniacus – afflicted with mania). There’s little to no chance that a manic state will remain unnoticed and can just be ignored.

In a hypomanic state, you feel different than normal but you're still you – only more eccentric and flamboyant. Mania turns us into completely different people with no shame or guilt (shame comes with sobriety). Some people even compared manic episodes to the movie Mask, Jim Carrey’s character Stanley Ipkiss, a regular and even shy guy, is the "normal mood" and mania is “The Mask” – his trickster alter ego.

Why might mania feel enjoyable?

Some people find the elevated mood and feeling of grandiosity that comes with manic episodes appealing and even exhilirating, but the fact is that manic episodes can be very dangerous. It’s a fine line between a “high” that you can control, and unpredictable and impulsive decision-making.

Mania makes us not care about consequences, which has its charms, but in the long run it represents a danger because no one can control the “high”. Suicide is another ever-present risk in the manic part of bipolar disorder, not just depression.

If left untreated, manic episodes cost people relationships, jobs, and overall quality of life — sometimes even life itself. Reckless behaviors such as getting into fights or wandering around alone at night (practices common for people experiencing severe manic episodes) sometimes unfortunately end up in disasters.

How is Bipolar Disorder treated?

There’s an interesting book called Tristimania by British author and journalist Jay Griffiths, about her experience with a year-long mixed-state episode (combination of words triste meaning sad, and mania). It’s written to be relatable even if you never met someone with bipolar disorder. She says that it started when she hurt her ankle and could no longer run, which was her daily dosage of positive endorphins and the way to battle long-term stress, one of the main factors in the onset of most mental disorders.

So, besides physical activity and other complementary approaches such as meditation or religious practices, which can obviously do a lot for our physical and mental health (but should never replace treatment), there are a few other common ways to treat bipolar disorder that are proven effective, such as:

  • Strategies of self-management. Being able to recognize early signs and symptoms of bipolar disorder can help you detect them before they’re in their full power.
  • Psychotherapy. Cognitive behavioral therapy (CBT) has been shown to be most successful in the treatment of several mental disorders, including bipolar disorder and anxiety.
  • Treatment with medications such as mood stabilizers is a recommended long-term treatment for mood disorders. Most commonly prescribed are medications with lithium, which is a naturally-occurring element (Camcolit, Priadel, Liskonum, Lithonate, Li-Liquid, Litarex), anticonvulsants such as lamotrigine (Lamictal), carbamazepine (Tegretol), and valproate (Epilim, Depakote), as well as antipsychotics such as asenepine (Sycrest).
Lithium is most commonly prescribed treatment for mood disorders, and according to patients, it has the ability to bring up the “lows” and balance out the “highs”. It’s true that bipolar disorder is a lifelong disease with symptoms possibly recurring after years of feeling “normal”, but after doctor adjusts the treatment, you can again live a productive life.

Sources & Links

  • Photo courtesy of SteadyHealth

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