What Happens In The Manic Phase Of Bipolar Disorder?

These mood swings and behavior changes can significantly impact an individual’s mental, physical, and emotional health. If you’re living with bipolar disorder, you may be curious about the signs and symptoms of a manic episode. This article covers the manic phase of bipolar disorder—its characteristics, risk factors, and treatment.

What is bipolar disorder?

Bipolar disorder, previously called manic depression, is a mental health condition that causes shifts in mood, attention, and ability to function. Bipolar symptoms generally occur during manic and depressive episodes, which are often experienced in succession. Manic episodes are marked by emotional highs, increased energy levels, and elation or excitement. Depressive episodes are characterized by low mood, decreased energy levels, and loss of interest. The National Institute of Mental Health reports that approximately 2.8% of adults have experienced bipolar disorder at some point.

Bipolar disorder is commonly comorbid with multiple mental health disorders, including anxiety disorders. Research suggests that panic disorder, social anxiety disorder, and related disorders are closely connected to bipolar disorder. Additionally, according to the National Institute on Drug Abuse, bipolar disorder and substance use disorder co-occur at high rates. Behavioral disorders—including attention-deficit/hyperactivity disorder (ADHD), conduct disorder, and oppositional defiant disorder—are also frequently comorbid with bipolar disorder. 

There are three primary types of bipolar disorder, bipolar I, bipolar II, and cyclothymia. Manic episodes can look different depending on which type an individual experiences.   

Bipolar I disorder

To be diagnosed with bipolar I, an individual must have experienced at least one episode of mania that persisted for a week or more. With this type of bipolar disorder, manic phase symptoms may precede or follow a depressive episode, but the existence of major depression is not necessary for a diagnosis.  

Bipolar II disorder

An individual must have experienced at least one major depressive episode and one hypomanic episode to be diagnosed with bipolar II disorder. Hypomania is a milder form of mania that typically does not lead to significant impairment in everyday life—though its symptoms can lead to several complications.  

Cyclothymic disorder

Also called cyclothymia, cyclothymic disorder is characterized by depression and hypomania symptoms that do not rise to the level of depressive or hypomanic episodes.

Risk factors for developing bipolar disorder

The exact cause of bipolar disorder remains unknown among mental health professionals. However, certain factors have been associated with an increased risk of the condition. 

Genetics

If you have a first-degree relative with bipolar disorder, such as a parent or sibling, you may be at higher risk for developing the disorder. For many people, the first symptoms tend to appear during the teenage years or in early adulthood. Although bipolar disorder can be diagnosed at any age, the typical age of onset is 25.

Brain functioning

Research suggests that certain abnormalities in the structure and function of the brain may be related to bipolar disorder. 

Environmental factors

High stress environments or situations (e.g., a serious medical condition), trauma, and alcohol or substance use are also thought to be contributing factors to the development of bipolar disorder.

Diagnosing people with bipolar disorder

There was a time when bipolar disorder was confused with other mental health disorders such as schizophrenia or unipolar depression. Today, however, clinicians have a greater understanding of the illness and can identify the signs and symptoms of bipolar disorder and, in most cases, can effectively and safely treat it. Proper diagnosis and treatment can help people with bipolar disorder lead active and healthy lives.

There is no medical diagnostic test, such as blood work or x-rays, to help with the diagnosis of bipolar disorder. However, a healthcare provider can perform a physical exam and may order medical tests that will rule out other medical conditions that have similar symptoms. They may also utilize assessments to determine the severity and frequency of possible symptoms. If other conditions are not found, a referral to another medical or mental health professional may be provided to help with diagnosis.

How Bipolar Disorder Symptoms Manifest

Highs and lows associated with emotion are usually temporary for most people. People with bipolar disorder, however, experience more dramatic changes in mood than the normal ups and downs of life. These shifts are often referred to as bipolar phases or bipolar episodes. Mood swings related to bipolar disorder shift from periods of mania or hypomania to periods of depression. 

Mania is characterized by excitement that manifests as mental and physical hyperactivity, the elevation of mood, and disorganized behavior. Hypomania is a less severe form of mania. During episodes of hypomania, mood and energy levels are heightened, but they are not “out of control”. The depressive symptoms associated with bipolar disorder are similar to those of other major depressive episodes. Individuals with these mood symptoms may experience significant sadness, hopelessness, and irritability. They may also experience sleep disruptions and weight fluctuations due to changes in appetite.

Rapid cycling is the term used to describe changes in mood cycles where the person experiences four or more episodes of bipolar depression, mania, or hypomania within a 12-month period. This rapid change in mood cycles is often described by the person as being like they are on a rollercoaster ride of emotions. Emotions may move from high to low and back again over a period of hours or days. During a rapid-cycling episode, the individual may believe they are out of control. Rapid cycling may have a higher incidence among those who have not been adequately treated for the disorder.

Bipolar disorder – Manic phase features

The way mania symptoms manifest, their duration, and their effects can vary from person to person. For example, when manic episodes occur, one person may experience frustration or irritability, while another may exhibit accelerated thinking, hyperactivity, or a decreased need for sleep.

When manic symptoms of bipolar disorder emerge, it’s not uncommon for one to experience creativity, heightened energy, or euphoria. Some people may believe they are destined for greatness or are invincible.

Severe mania can lead to symptoms of psychosis, including delusions, hallucinations, and disorganized thinking. While psychotic features can also arise during severe depressive episodes, they are more common in severe episodes of mania. 

While the increased energy and elation may seem positive at first, manic episodes can cause risky behavior and highs that may be difficult to sustain. For instance, during this phase, some people may become more sexually promiscuous than normal, while others might gamble or indulge in spending sprees. Some people are easily angered, start fights or lash out at others, or blame those who criticize their behavior. These actions can concern an individual’s family and friends, who may be the first to identify a manic episode as it’s often difficult for someone experiencing mania to recognize it in themselves). 

Some common symptoms of manic episodes include:

• Sleeping less, but remaining energetic

• Racing thoughts that jump from one subject to another quickly

• Talking so rapidly that others may not be able to follow what is being said

• Difficulty concentrating, easily distracted

• Being unusually optimistic or euphoric or being extremely irritable

• Impaired judgment or impulsive behavior

• Hallucinations or delusions (in severe cases)

Warning signs of mania 

Typically, people can experience emotional changes and move from one mood to another without difficulty. People with bipolar disorder, however, have more difficulty moving from one phase or mood than others. Recognizing potential warning signs of bipolar disorder is essential for knowing when to seek help. If you or someone you know is experiencing any of the following symptoms of mania that may be associated with bipolar disorder, consider consulting with a professional who can provide screenings and, if necessary, further testing, a diagnosis, and treatment.

• People with bipolar disorder are often overly ambitious during the manic phase of the disorder. During manic episodes, productivity may seem to be much higher. However, as the manic episode begins to shift to a state of depression, it may become difficult to focus on the task at hand, leaving many projects incomplete.

• Manic episodes often involve extremely high levels of energy that may be accompanied by risky behavior. For example, a person experiencing a manic episode may believe that they can accomplish an otherwise seemingly impossible task. They may take on multiple tasks at once believing they can accomplish them without assistance. While their ideas may seem feasible at the moment, when their mood begins to shift, the person can become overwhelmed or disappointed, which may cause the following period of depression to worsen.

• Manic episodes may cause intense anger, irritability, or aggression that is otherwise out of character for the person.

If you or a loved one are in crisis, contact the 988 Suicide and Crisis Lifeline at 988.

Treatment for bipolar disorder

While it isn’t possible to prevent a mental illness like bipolar disorder, bipolar disorder can be effectively treated to help manage symptoms of depressive, manic, or hypomanic episodes. Because bipolar disorder is a chronic, relapsing condition, it often requires long-term treatment. A treatment plan for bipolar disorder will typically include medication, psychotherapy, or a combination of both.

The type of medication that is used to treat bipolar disorder may vary depending on the type of disorder and the severity of symptoms. Antipsychotics and mood stabilizers are common drugs used to treat mania. Always consult with a healthcare professional prior to starting or stopping any medication. 

Psychotherapy involves learning about changes in mood and how to effectively cope with them. Therapists can also educate participants’ families about bipolar disorder symptoms and help them develop ways to be supportive during episodes. Psychotherapy also focuses on recognizing potential triggers for changes in episodes and ways to avoid them. Other therapies, including electroconvulsive therapy (ECT), exist to help quell severe symptoms of bipolar disorder.

Navigating manic episodes with online therapy

Research suggests that online therapy can help individuals address the manic and depressive phases of bipolar disorder. In one broad-based systematic review, which included literature from 12 different studies, researchers concluded that online therapy is a “highly feasible and acceptable method” of providing care for bipolar disorder. The review also notes the ability of online therapy to bridge the treatment gap that exists in mental health care, providing convenient solutions to people who may not otherwise be able to connect with therapists. 

You don’t have to address the symptoms of mania on your own. Working with a licensed therapist through an online therapy platform like BetterHelp, you can learn more about bipolar disorder from the comfort of home, which can be helpful if a manic episode makes leaving home difficult. Online therapy is also a relatively affordable option, and you can cancel a subscription at any time.