If you have a basic understanding of bipolar disorder, you probably know that people with the mental illness go through periods of extreme mood swings, intermixed with periods without symptoms. These bipolar episodes, as they’re called, can last weeks or months and be both high and low (depressive or manic)—or somewhere in the middle. Mania is often thought of as the “euphoric” end of the mood spectrum, but there’s a lot more to it, and it can actually be quite disruptive in a person’s life.
Bipolar mania is a period of mood elevation that’s generally characterized by high energy and activity levels—although it’s much more complicated than that.
When a person with bipolar disorder is experiencing a manic episode, they may feel “up,” or jumpy or wired, the National Institute of Mental Health (NIMH) says.
“Mania is a state of high energy, high activity, and less of a need for sleep,” Igor Galynker, M.D., associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel, tells SELF. “People engage in unusual behavior and may have an inflated opinion of oneself.” In severe manic episodes, an individual might hallucinate and experience psychosis. Factors like experiencing a trauma or sleep deprivation can trigger a manic episode, Dr. Galynker adds.
As SELF reported previously, for a person to be diagnosed as manic, they need to have prolonged unusual behavior and high energy, in addition to at least three classic symptoms of mania (such as feeling euphoric, having unusually high self-esteem, and engaging in risky behavior, to name a few). If someone has symptoms that result in psychosis or hospitalization, that’s also considered a manic episode.
It’s worth noting that only people diagnosed with bipolar I will experience full mania. A similar type of mood episode that can present in bipolar disorder is hypomania, which is essentially less severe mania, according to NIMH, and does not necessarily interfere with a person’s ability to live their life and function day to day. If you have bipolar II, you have hypomanic episodes as opposed to full manic episodes (although people with bipolar I can also experience hypomania).
A common misconception about mania is that it’s always a strictly euphoric experience.
“The mood elevations of bipolar (mania or hypomania) are not always the grandiose, feeling on top of the world experiences that people sort of classically think of,” Wendy Marsh, M.D., director of the Bipolar Disorders Specialty Clinic and an associate professor in the department of psychiatry at the University of Massachusetts Medical School, tells SELF. “That definitely does happen, but there are exceptions.”
For example, a person may have a mood elevation with irritability or anger. “So you’ve got this extra energy, your thoughts are moving fast, you’re trying to do ten things at once, you’re easily distracted, but you’re agitated,” Dr. Marsh says.
She adds that many of her patients express mania with irritability as feeling as if things are taking too long: “You can’t sit there at the red light; it’s taking too long. You can’t wait for someone to respond to what you just said because you have three other ideas you have to get express to them ASAP,” she explains. “Your brain is racing, and you don’t need to sleep because you’ve got so many ideas and so much energy to do all these activities, and you’re frustrated things aren’t happening even faster.”
Everyone’s experiences during mania are different, and manic behaviors, thoughts, and feelings can vary greatly.
Emma, 20, has bipolar II, so she experiences hypomania, “which means my manic episodes are not too high of highs,” she tells SELF. When she’s experiencing manic symptoms, it “feels like you're high on life, like nothing can touch you. Nothing bursts your bubble. You don't need sleep. You might not even need to eat. It's like living life at hyper-speed,” she says.
Her worst hypomanic episode was the summer before her senior year of high school, she recalls. “I was out of the house, on my feet, in rehearsal for 16 hours a day,” Emma says. “I got three hours of sleep on that schedule for two months. But I felt euphoric.”
Mike, 66, who has symptoms of bipolar I, describes mania as feeling like you’re on top of the world. “You feel like Superman. Nothing is impossible. Even the most unrealistic goal seems easy and attainable,” he tells SELF.
On the more extreme end of the spectrum, a person may completely lose touch with reality during a manic episode. Bradley, 54, who was diagnosed with bipolar I when he was 48 years old, remembers a few distinct examples of extremely out-of-character behavior during mania. During one episode, “I thought I was teaching English to millions of Chinese people telepathically,” he tells SELF. “How did that feel at the time? Normal.” During another, “I thought I was being watched by everyone on the planet when I showered [or] took a bath. Initially, I felt shy, then I got over it,” he says.
Manic episodes can also make someone act impulsively or carelessly even if they feel “up” or euphoric, and as a result, can lead to serious consequences.
“It’s a common experience for people with bipolar disorder to spend a ton of money during manic episodes. I’ve had patients waste their fortunes or go into debt,” Dr. Galynker says. Mania may also lead someone to become very sexual and behave sexually in ways that may be totally out of character for them. “These are classic examples of risky behaviors associated with mania in bipolar disorder,” Dr. Marsh adds.
Sarah*, 25, who was diagnosed with bipolar II last year, has felt these types of urges during hypomanic episodes: “You feel like you want to spend money and have as much sex as possible,” she says. “It feels almost as if you have taken Adderall or cocaine. You feel confident, like anything you do is right, and there will be no consequences for your behavior.”
Gracie, 30, has experienced these issues firsthand during hypomania. “When I was manic I thought I could take on the world. I craved attention from anyone. I was unfaithful to my live-in boyfriend whom I love beyond words and never wanted to hurt. [I knew] what I was doing would destroy him, but [I was] unable to stop myself from doing it,” she recalls.
Gracie also says she made poor choices with money, by “spending on things I didn’t need and could not afford.” In the back of her mind she knew she was making poor decisions, she says, but she couldn’t get herself to stop.
But Gracie does acknowledge that there are aspects of mania that can feel quite positive in the moment: “I love the amount of energy I have and my ability to multitask, talk fast, keep up with jokes and sarcasm, and be the life of the party without a care in the world while manic,” she says.
Andrea, 46, says that the bursts of energy she gets during a hypomanic episode can “lead to lots of creativity.” (She was diagnosed with bipolar II in 2010.) “When I was younger, I could get by on less sleep and be active all day long,” she tells SELF. “Even now, people call me energetic, though I don't see myself that way at all.”
Dr. Marsh agrees that hypomania or mania can bring on periods of great creativity or confidence for a person with bipolar disorder. “Mania can feel like a wonderful, exciting, productive place to be when it is going on, that absolutely does happen” she says. “But it can also be extremely disconcerting or even dangerous for a person when they still feel this sense that something is not right, that they are not fully in control of themself.”
Prevention and management of bipolar episodes almost always involves medication, but therapy can also be incredibly beneficial.
Treatment for bipolar disorder in general involves medication to help stabilize the individual’s mood, and landing on the right combination of drugs can take some amount of trial and error.
Some medications may be used to treat all types of mood episodes; other medications may only work to help manage mania, hypomania, or a depressive episode individually, as SELF reported previously.
For manic episodes in particular, medications exist that can both treat and prevent these episodes, while other types only work to prevent a manic episode from happening but won’t work to treat it. Additionally, some medications used to treat bipolar disorder, like antidepressants, can also trigger a manic episode, and many drugs come with side effects. So, a person’s bipolar disorder treatment is very nuanced and may need to be adjusted over time.
“If you take your medication, oftentimes a mood elevation can be treated very quickly. For example, you might be having these bizarre thoughts one afternoon, you take your medication at night, and you’re in a much clearer thinking state the next day,” Dr. Marsh explains. “But this isn’t always the case, and the efficacy of medication somewhat depends on the person and how far removed they are from their normal thinking state and function when they do take the medication.”
Psychotherapy is valuable because it can help a person identity the first signs and behaviors they exhibit when a mood episode may be coming on, Dr. Galynker says. “It can be very useful for close family and friends to also participate in this type of therapy work alongside the person so they can help monitor their behavior and support them in taking their medications,” he says.
*Name has been changed.