How To Identify A Manic Bipolar Episode?

Bipolar disorder is a mood disorder that used to be known as manic depression. For someone with bipolar disorder, emotions can seem out of control as they involve extreme highs and devastating lows. The highs are known as hypomanic or manic episodes, and the lows are known as depressive episodes. 

Bipolar disorder is a serious mental health condition characterized by changes in mood, energy levels, and cognition. The disorder affects approximately 2.8% of adults in the United States at any given time and around 4.4% of adults over the course of their lives. Often, the severity of bipolar disorder symptoms can be so significant that they hamper an individual's ability to lead a normal life, maintain healthy relationships, or function socially, personally, and professionally. However, this condition is treatable, and support options can help an individual effectively manage symptoms during an episode. 

Causes of bipolar disorder

While there is no way to know exactly why someone has bipolar disorder, medical research has identified potential causes of bipolar disorder, including the following. 

Genetic makeup

Some people are genetically predisposed to mental illnesses, so people with a family history of depression, schizophrenia, or other mental disorders are at a higher risk of developing bipolar disorder. Amongst mental illnesses, bipolar disorder has specifically shown to have a genetic predisposition. However, there are still a lot of unknowns about these family tendencies, and having certain genes does not guarantee the development of the disorder.

Biological makeup

Bipolar disorder is thought of as a disorder of the brain. People with bipolar disorder have abnormalities in brain chemicals called neurotransmitters. However, there is no clear “cure” for these abnormalities or certainty about why they exist.

Addiction and trauma

Additional factors, such as substance use and addiction or experiencing trauma or ongoing abuse, can worsen the symptoms of bipolar disorder, or they may cause the illness if the predisposition is already there.

How to identify a manic episode

Recognizing the signs of bipolar disorder can be helpful not only for individuals with bipolar disorder but also their friends and family members. Symptoms of bipolar disorder often begin in a person's late teens or early 20s. In rare cases, they can first appear during childhood or well into someone's 40s or 50s. Regardless of when they start, the symptoms revolve around four different states or moods. When a person experiences four or more of these states in one year, they are experiencing "rapid cycling." If you believe you’re living with bipolar disorder or another mental illness, a healthcare professional can provide you with screenings and determine whether further testing, diagnosis, and treatment would benefit you.  

The symptoms of mania can cause a person with bipolar disorder to act in ways that deviate substantially from their normal behavior. An individual experiencing acute mania may appear to have increased energy and be unusually euphoric. They might exhibit signs of being in an irritable mood. If they’re experiencing racing thoughts, their speech could be faster or less coherent than normal. A common diagnostic criterion for bipolar disorder is impairment in social or occupational functioning. So, during an acute manic episode, an individual may experience conflict in their relationships or challenges at work. 

In severe cases, an individual experiencing manic symptoms can develop psychosis, which involves an altered perception of reality. Psychosis is more common in manic than major depressive episodes, though it can occur during either. Psychotic symptoms include auditory or visual hallucinations, delusions, or disorganized speech. Psychosis does not occur in hypomania, a less severe form of mania. 

Distinguishing between symptoms of psychosis in bipolar disorder and other mental health conditions, like schizoaffective disorder, can be difficult. Bipolar disorder with psychotic features and schizoaffective disorder share many of the same symptoms. However, psychosis typically occurs only during mood episodes in bipolar disorder, while it may arise with or without a mood disturbance in schizoaffective disorder. Additionally, symptoms of disorders like schizophrenia can mimic mania. Typically, a healthcare provider rules out schizophrenia, schizoaffective disorder, and related conditions before diagnosing someone with bipolar disorder.

Identifying manic vs. hypomania and depression 

If you’re wondering how to identify a manic episode in yourself or someone you love, you may also look at how symptoms of hypomania and depression can manifest and differ. The following are common symptoms of mania, hypomania, and major depression. 

Symptoms of manic episodes

A manic episode lasts for at least a week or is so severe that hospitalization is required. During an episode of mania, the following symptoms may be present:

• Euphoria or intense excitement

• A belief that one is invincible 

• An inflated sense of self

• Delusions of grandeur

• Lack of focus and easy distraction 

• Restlessness

• Racing thoughts

• Speaking quickly 

• Insomnia, as the person is often too excited or energized to sleep

• Agitation, jumpiness, or a sense of being “wired” 

• Engagement in reckless, high-risk, or promiscuous behavior

• Hypersexuality or sexually deviant behavior

• Irritability

• Aggressiveness or hostility

• Hallucinations or delusions

Symptoms of hypomanic episodes

Hypomanic symptoms—which are associated with bipolar II disorder and cyclothymic disorder—are similar to those of mania, as mentioned above. However, hypomania is a less severe form of mania. While a hypomanic episode may not cause significant impairment in everyday functioning, it can still seriously impact an individual’s mental health. Problems may be particularly pronounced when a hypomanic episode precedes or follows a major depressive episode, which is often the case in bipolar II disorder. 

Symptoms of depressive episodes

Depressive episodes usually last about two weeks and are more common in bipolar II disorder. However, a person with bipolar I disorder can experience depression. A depressive episode consists of symptoms like:

• Low self-esteem and thoughts of worthlessness

• Lack of energy and feelings of fatigue

• Loss of interest in previously enjoyed activities

• Difficulty getting through the day or completing basic tasks

• A change in behavior or sleeping habits

• Fixation on the idea of death

• Attempts to hurt oneself

Episodes with mixed features

An episode of mixed features is a state in which symptoms of both depression and mania are present at the same time. So, someone can be energetic while emotionally down or preoccupied with suicidal thoughts.

The different types of bipolar disorder

Bipolar disorder is divided into three different categories, including bipolar I disorder, bipolar II disorder, and cyclothymia. 

Bipolar I disorder 

Bipolar I disorder occurs when someone has episodes of mania or mixed features that last for at least a week and episodes of depression that, if experienced, last approximately two weeks or longer. The manic phase of bipolar I disorder can be so severe it may require hospitalization.

Bipolar II disorder

Bipolar II disorder occurs when there is a pattern of hypomanic episodes alternating with depressive episodes but no periods of mania or mixed features. This category of bipolar disorder is harder to diagnose since a hypomanic episode may not hamper the individual's life as severely. They may be seen as energetic, hyper, and easily excitable, making diagnosis more difficult. 

Cyclothymia

When someone experiences this type of bipolar disorder, they don’t meet the criteria for other subtypes. They may have hypomanic and depressive episodes, but instead of lasting several weeks or months, the episodes only last a few days. The person also does not experience psychosis, delusions, or hallucinations.

The bipolar disorder diagnostic process

In the case of bipolar disorder, diagnosing and beginning treatment early can make an enormous difference in the individual's life, as the symptoms then have less of a chance to worsen and impact the lives of the individual and their loved ones. Since there is no way of diagnosing the disorder via a blood test or scans, diagnosis for bipolar disorder heavily relies on a person describing their symptoms to a doctor and discussing family and personal history. Tracking symptoms in a journal may also be helpful since frequency, severity, and type of emotion can fluctuate significantly with bipolar disorder.

A person with undiagnosed bipolar disorder may only realize they are struggling when their symptoms cause life challenges. For example, during a manic episode, if a person spends impulsively or engages in promiscuous sex, they could fall deep into debt or contract sexually transmitted infections. These negative outcomes may serve as a wake-up call, prompting a person to become aware they could benefit from support. 

Doctors may conduct tests to rule out other illnesses or potential factors when looking at bipolar disorder. Once they give a bipolar diagnosis, they may refer a person to a psychiatrist, therapist, or other mental health professional for a more in-depth diagnosis and treatment. Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to determine an official diagnosis. A bipolar disorder diagnosis can be life-changing and may take some time to adjust to, but it also allows a person to start a treatment plan that can majorly improve their life.

Types of bipolar disorder treatment 

Treatment for bipolar symptoms typically comprises medication and psychotherapy. 

Medications

Bipolar disorder treatment heavily relies on medication, and these are often given in conjunction with therapy. Medications prescribed for bipolar disorder include the following: 

• Antidepressants: Antidepressants may be used in combination with mood stabilizers. Antidepressants can reduce depression but may incite mania or rapid cycling, so they’re used with caution, more commonly for bipolar II disorder. 

• Anti-psychotics: These medications treat symptoms of psychosis and are highly effective for managing manic episodes. With options of daily oral medications or in long-acting injectable forms, a wide variety of antipsychotic medications are available.

• Anti-anxiety medications: Anti-anxiety medications can reduce anxiety and are instrumental in neutralizing the effects of hypomania and mania episodes. Some anti-anxiety medications can be addictive and are prescribed for a short period only.

• Mood stabilizers: Medications that stabilize mood and control the highs and lows of the disorder are very effective in treating bipolar I disorder, bipolar II disorder, and cyclothymia, but they are less effective for rapid cycling and mixed states.

Do not start, stop, or change a medication for bipolar disorder without consulting your doctor. In addition, the BetterHelp platform is not intended to provide any information regarding which drugs, medication, or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. You should not take any action without consulting a qualified medical professional.

Therapy for bipolar disorder

Psychotherapy is often recommended in the treatment of bipolar disorder. If you are unsure about seeking help in person or want to connect with someone immediately, consider online resources and online counseling. 

Online therapy through a platform like BetterHelp is often convenient and flexible. Through a platform, you don’t have to worry about finding an open appointment with a local therapist or being put on a waiting list. You can be matched with someone available to meet you within around 48 hours. Some people may also be more comfortable talking to someone through a computer or phone screen, which might make it easier to open up and talk about topics you find difficult to discuss.

Research shows that online therapy is effective, too. In one study, online therapy was shown to be a successful treatment for various mental health conditions, including bipolar disorder, anxiety, depression, addiction, and substance use disorders.