Understanding Mania In Bipolar Disorder: An Examination Of Symptoms And Treatment

Bipolar disorder is a complex and chronic mental health condition marked by significant mood swings, changes in energy levels, and fluctuations in activity. One of the defining features of bipolar disorder is the presence of manic episodes, which significantly impact an individual's ability to function effectively in various aspects of life. Along with functional impairment, people with bipolar disorder may experience symptoms of psychosis, behavioral concerns, and physical health challenges during periods of mania.

A comprehensive understanding of the signs and symptoms of mania in bipolar disorder can be essential for healthcare professionals, clients, family members, and caregivers, as it can aid in early detection, appropriate treatment, and effective management of bipolar disorder. It can be helpful to thoroughly examine the treatment options for mania in bipolar disorder, focusing on the intricacies and nuances of this symptom.

What is bipolar mania? 

Bipolar disorder, also called bipolar affective disorder, is a serious mental health disorder marked by periods of elevated mood (mania) and low mood (depression). There are three primary subtypes of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Bipolar disorder is typically a lifelong condition, though its symptoms can be managed with proper treatment. 

Mania, which occurs in bipolar I disorder, is a specific mood state marked by an abnormally elevated, expansive, or irritable mood that persists for at least one week. This heightened emotional state is often accompanied by a surge in energy levels, which may manifest in increased goal-directed activities, rapid speech, decreased need for sleep, and racing thoughts.

Individuals experiencing mania may exhibit grandiose thinking and heightened self-esteem, leading to unrealistic beliefs about their abilities or accomplishments. During a manic episode, sleep disturbances may be common, as affected individuals often have a diminished need for sleep. They may feel sufficiently rested after only a few hours of sleep, contributing to the perpetuation of the manic state.

In addition, individuals with mania may be prone to engaging in impulsive and risky behaviors, such as excessive spending, reckless driving, or substance use. These behaviors can result in significant consequences, both personally and professionally. Episodes of mania can also be comorbid with certain developmental and mental health conditions, such as substance use disorder, attention-deficit/hyperactivity disorder, and anxiety disorders. 

Mania vs. hypomania: What's the difference? 

When exploring mania, knowing the differences between this state and hypomania can be essential. Hypomania is a less severe form of hyperactivity and energy that can occur in bipolar II disorder. Mania is more severe and only occurs in those diagnosed with bipolar I disorder. Another primary difference between these bipolar episodes is that mania usually causes significant impairment in functioning, while hypomania typically does not. 

Although hypomanic episodes can lead to unhealthy behaviors or symptoms for an individual, it may be less associated with hospitalization, severe distress, psychosis, and delusions like mania. In addition, hypomania may not last as long as mania. 

Types of bipolar disorder

Symptoms of bipolar disorder can vary widely depending on whether an individual is living with bipolar I, bipolar II, or cyclothymia. Below are the characteristics of these diagnostic subtypes of bipolar disorder and their criteria. If you believe you might be living with a type of bipolar disorder, it can be helpful to reach out to a licensed psychologist for guidance and diagnosis. 

Bipolar I disorder 

Bipolar I disorder, often considered the most severe form of bipolar disorder, is characterized by at least one manic episode. A manic episode must last for a week or more and manifest in heightened energy levels, a reduced need for sleep, and impaired judgment.

During a manic episode, individuals may exhibit grandiose thinking and impulsivity and engage in risky behaviors. Although major depressive episodes are not required for a bipolar I disorder diagnosis, they can occur after mania has subsided. 

Bipolar II disorder

Bipolar II disorder is distinguished by at least one hypomanic episode and one major depressive episode. Hypomanic episodes have similarities with manic episodes, including increased energy and impulsivity, but are less severe and shorter in duration. The presence of a major depressive episode is a crucial feature of bipolar II disorder, and these episodes can be debilitating, leading to intense feelings of sadness and loss of interest in daily activities. Without the presence of hypomanic episodes, one may be living with a depressive disorder—such as major depressive disorder or persistent depressive disorder—instead of bipolar disorder. 

Cyclothymic disorder 

Marked by periods of hypomanic and depressive symptoms that do not meet the criteria for full hypomanic or depressive episodes, cyclothymic disorder is considered a milder form of bipolar disorder. These mood swings may be less severe than those observed in bipolar I disorder and bipolar II disorder but can still be disruptive to the individual's daily functioning.

Cyclothymic disorder often develops in adolescence or early adulthood and persists for at least two years in adults or one year in children and adolescents. Due to the chronic nature of this mood disturbance, individuals with cyclothymic disorder may have difficulty maintaining stable relationships and achieving their personal and professional goals.

Causes of mania in bipolar disorder 

Although the exact cause of mania may not be entirely understood, research has shown that it could be due to a combination of genetic, environmental, and biological factors. 

Genetic factors 

Genetic factors can play a significant role in the development of bipolar disorder. Bipolar disorder has a heritability of 79-93%, according to some estimates. Studies have shown that the condition tends to run in families, and individuals with a family history of bipolar disorder are at higher risk of developing bipolar disorder. This statistic suggests that there may be a genetic predisposition to the disorder.

Environmental factors 

Environmental factors can also contribute to the development of mania. For example, stressful life events, such as the death of a loved one, a relationship breakup, or financial difficulties are potential risk factors that might incite manic episodes in individuals with bipolar I disorder. In addition, the use of recreational drugs can cause manic episodes and worsen symptoms, potentially contributing to psychosis or delusional thoughts. 

Biological factors 

Biological factors, such as changes in brain chemistry and hormone levels, are also believed to play a role in the development of mania. Abnormalities in brain structure and function that affect the right hemisphere have been linked to the manic phase of bipolar disorder. Additionally, research has shown imbalances in neurotransmitters, such as serotonin, norepinephrine, and dopamine, in individuals with bipolar disorder. Additionally, hormonal imbalances, such as changes in cortisol levels, have been linked to more severe manic episodes.

The existence of certain conditions, such as anxiety disorders or attention-deficit/hyperactivity disorder (ADHD), may also increase an individual’s risk of developing bipolar disorder. In fact, some experts believe that anxiety disorders and attention-deficit/hyperactivity disorder are predictors of bipolar disorder. In one study, researchers found that the presence of attention-deficit/hyperactivity disorder early in life increased the risk of bipolar disorder 10-fold in participants, compared to those who did not have ADHD. When participants’ attention-deficit/hyperactivity disorder was comorbid with an anxiety disorder, the risk of bipolar disorder was 30-fold, compared to those who did not have either condition. 

What incites a manic episode? 

While the exact cause of mania is unknown, certain factors have been identified that can incite manic episodes in individuals with bipolar disorder. These factors may include but are not limited to the following: 

Stressful life events, like the death of a loved one or a relationship breakup, might cause a manic episode in someone with bipolar disorder. Similarly, changes in sleep patterns, such as staying awake late or sleeping too little, could cause an episode. Also, some medications used for major depression (e.g., SSRIs) can cause mania. 

Symptoms of mania in people with bipolar disorder 

During a manic episode, an individual may feel excessively happy and energetic or highly irritable and easily agitated. This elevated mood can be accompanied by racing thoughts, where the individual has difficulty slowing down their thoughts and focusing on one task.

Some individuals may also have grandiose beliefs or delusions of grandeur, believing they are more influential than they are. These beliefs can lead to impulsive or reckless behavior, as the individual may feel invincible and take unnecessary risks. In addition, excessive self-confidence can be an emotional symptom of mania, where the individual may feel confident to the point of feeling better than others. 

Some people with bipolar I disorder experience psychosis, a state of being removed from reality. They may believe that others are out to get them, that they are part of a conspiracy, or that the world isn't "real." Psychosis can be dangerous, so it can be essential for people with these symptoms to seek support. 

How is mania diagnosed? 

Diagnosing mania can be a complex process that requires the expertise of a mental health professional. A psychiatrist or psychologist is trained to diagnose and treat mental health conditions, including bipolar disorder. Below are the steps that may be involved in the diagnosis. 

Clinical interview

The first step in diagnosing mania in bipolar disorder is a clinical interview, where the mental health professional may ask the client about their symptoms, mood changes, and behavior patterns. They might also ask about the client's family and personal history and any other relevant information that may help them make a diagnosis. 

A review of medical and psychiatric history

Mental health professionals can review a client's medical and psychiatric history, including previous diagnoses, treatments, and hospitalizations, to understand their symptoms. This information might provide insight into whether symptoms are being caused by another condition—or how manic symptoms have progressed or changed over time. For example, an individual who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD) may typically exhibit energy levels that are higher than normal. Periods of increased activity, then, may be due to attention-deficit/hyperactivity disorder and not manic symptoms of bipolar disorder. 

Standardized assessment tools

Therapists may use standardized assessment tools, such as the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), to diagnose mania in bipolar disorder. These tools are designed to provide a structured approach to diagnosing mental health conditions and can help the professional determine if the client's symptoms meet the criteria for bipolar disorder.

Collaboration with other healthcare providers

In some cases, the mental health professional may collaborate with other healthcare providers, such as a client's primary care physician or neurologist, to gather additional information relevant to diagnosing bipolar disorder. For example, a neurologist may conduct an electroencephalogram (EEG) to rule out any underlying neurological conditions contributing to the client's symptoms.

Managing mood swings and other bipolar disorder symptoms

Bipolar disorder is usually a lifelong condition, meaning it often requires continuous treatment. While it isn’t possible to prevent bipolar disorder, with an accurate diagnosis and a comprehensive care plan, the negative effects of the condition can be limited. For those who are experiencing a manic or depressive episode of bipolar disorder, proper treatment can help alleviate mood symptoms, improve cognitive challenges, and foster healthy lifestyle choices. Below are a few common treatment options for mania and bipolar disorder. 

Medications

Various medications may partially or fully manage the symptoms that arise during episodes of mania. Often, people who are diagnosed with bipolar disorder are prescribed mood stabilizers. During severe episodes of mania or depression, antipsychotics may also be prescribed. However, consult a doctor before starting, changing, or stopping a medication. Some medications may worsen bipolar disorder or depressive symptoms. For example, selective serotonin reuptake inhibitors have been found to exacerbate symptoms of manic or hypomanic episodes. So, having a proper diagnosis before treatment can be crucial. 

Lifestyle changes

Implementing lifestyle changes can help individuals manage mania and reduce the effects of other mental health conditions (symptoms of anxiety disorders and substance use disorder frequently arise alongside bipolar disorder symptoms). They can also alleviate symptoms of a co-occurring medical condition; for example, maintaining a healthy diet may decrease the severity of both bipolar mood episodes and cardiovascular complications (cardiovascular disease is commonly comorbid with bipolar disorder). 

Additionally, some strategies may be helpful if the individual is living with bipolar disorder that mimics seasonal affective disorder. When depressive and manic episodes follow a pattern similar to that of seasonal affective disorder—called bipolar disorder with seasonal pattern—techniques that emphasize sleep habits may be most important. 

Healthy lifestyle changes include the following: 

• Establishing a regular sleep schedule

• Engaging in regular physical activity

• Reducing stress through relaxation techniques

• Avoiding alcohol and substance use 

• Maintaining a balanced diet

• Keeping a mood journal

Psychotherapy

Therapy can help people with bipolar disorder talk through the emotional challenges of their condition, identify the sources of their symptoms, and address a potential comorbid mental illness, like attention-deficit/hyperactivity disorder (ADHD) or an anxiety disorder. Various types of psychotherapy can be beneficial for individuals with mania, including but not limited to the following: 

• Cognitive-behavioral therapy (CBT) 

• Interpersonal and social rhythm therapy (IPSRT) 

• Acceptance and commitment therapy (ACT) 

• Emotionally focused therapy (EFT) 

• Interpersonal therapy (IPT) 

• Dialectical behavior therapy (DBT) 

• Family-focused therapy 

Electroconvulsive therapy

For individuals who do not respond to medication, talk therapy, or other mental health services, electroconvulsive therapy (ECT) may be utilized to reduce symptoms of bipolar disorder. Electroconvulsive therapy is a form of brain stimulation therapy that works by stimulating certain regions of the brain through electrical currents. Research shows that electroconvulsive therapy can effectively alleviate manic symptoms of bipolar disorder. 

Benefits of therapy for bipolar disorder

Therapy can provide a wealth of benefits for individuals with bipolar disorder and can be an integral part of an effective treatment plan. By working with a mental health professional, individuals with bipolar disorder may better understand their condition and develop skills to manage their symptoms.

Through therapy, individuals can identify and address inciting events that may lead to manic or depressive episodes, such as stress, sleep disturbances, or substance use. As a result, therapy may improve mood stability, reducing the frequency and severity of manic and depressive episodes. Therapy may also help individuals accept and understand their condition, increasing self-esteem and a sense of control over their lives.

If you are facing barriers to treatment, such as financial insecurity or distance, you can also find bipolar treatment online through online platforms like BetterHelp. You can match with a therapist within 48 hours through an internet therapy platform and choose between phone, video, or chat sessions. In addition, when you feel symptoms arising, you may have the chance to message your therapist directly and get a response once they become available.

Studies have also found online therapy effective. One study found that 95% of the clients with bipolar disorder that took part in the study experienced significantly increased quality of life after the study was completed. In many cases, clients also experienced a significant reduction in symptoms.