Also called: Manic Episode, Manic Disorder
Mania is a psychiatric symptom that causes people to engage in excessive physical activity or to experience extreme feelings, such as elation or anger. Other symptoms related to mania include rapid thoughts and speech patterns, poor judgment and reckless behavior. It is a major component of bipolar disorder, a condition characterized by extreme mood swings between mania and depression. In some cases, mania may occur with relatively little depression.
Mania is associated with many emotions. On the surface, some of these feelings – such as euphoria and increased self-esteem – may appear to be positive. However, these feelings are grossly exaggerated beyond normal proportion. In addition, patients experience a range of clearly negative symptoms during manic episodes. Patients who are manic often have racing thoughts (known as “flight of ideas”) and may easily become irritable or hostile. They are often impatient and may intrude in the lives of others.
During episodes of extreme mania, patients may engage in extremely risky behaviors (e.g., road rage, promiscuity, excessive spending, substance abuse) or experience hallucinations or delusions of grandeur. Patients experiencing mania often need to be hospitalized to prevent harm to themselves or to others.
Mania-type symptoms may also appear as a result of conditions other than bipolar disorder, such as encephalitis (inflammation of the brain) or late-stage syphilis (a sexually transmitted disease). It may also be a side effect of cocaine use or certain medications, including antidepressants.
Mania can be difficult to identify. Patients often deny that anything is wrong with them, and physicians may have to rely on the testimony of friends and family to confirm this symptom. Treatment of mania usually involves the drug lithium, which is effective in controlling mania in 60 percent of patients with bipolar disorder, according to the National Mental Health Association (NMHA).
Patients who do not respond to lithium or who suffer side effects when taking the drug can use alternative medications that often control symptoms without causing negative effects.
Mania is a psychiatric symptom characterized by excess of physical activity or emotions, such as extreme exhilaration or anger. Patients may also exhibit rapid thoughts and speech patterns, poor judgment and impulsive behavior, which all lead to impaired functioning. The extremity of action or emotion is often out of proportion to circumstances or events in the patient’s life.
Mania most often occurs as part of bipolar disorder, which is characterized by extreme swings in mood, from highs (mania) to lows (depression). Manic episodes in bipolar disorder may last from a day up to several months. Some patients who have bipolar disorder may also experience episodes when their manic and depressive feelings coincide. This is known as a mixed state. Bipolar disorder affects 2.3 million Americans, or about 1.2 percent of the adult population, according to the National Alliance on Mental Illness (NAMI). For more information, see bipolar disorder.
During a manic phase, patients may become much more talkative than usual and their speech patterns may reveal that their mind is racing from thought to thought. They may also engage in reckless behavior, such as excessive gambling, risky sexual activity or impulsive spending sprees.
Although mania is usually associated with bipolar disorder, in rare cases it may appear largely without depression. In some cases, a patient may experience manic symptoms that are less intense than those traditionally associated with mania. This is known as hypomania and episodes last less than a week.
Mania is considered a potentially dangerous symptom because people undergoing a manic episode often experience dramatic shifts in their personality and may engage in uncharacteristically reckless behavior. However, mania is more likely to go unidentified in patients than depression, because the feelings of elation that accompany mania are often viewed as positive by patients who have them.
Even when patients see a physician, mania can be difficult to diagnose. People who experience mania often deny that anything is wrong with them. As a result, physicians may have to rely on the testimony of friends and family to help diagnose mania. Because mania is considered to be a psychiatric emergency, patients may be treated in a hospital while undergoing episodes.
Manic episodes typically first manifest in a patient’s 20s, although they may begin as early as adolescence and as late as age 50 or older. Episodes usually begin suddenly, and may escalate rapidly over the course of a few days. Some episodes last from a few weeks to several months.
Mania is associated with many emotions that manifest as related symptoms, including euphoria and increased self-esteem. Patients in the early stages of a manic episode may feel exuberant, energetic and extremely productive.
However, not all the symptoms associated with mania are positive. Patients who are manic often have racing thoughts and are extremely talkative and speak rapidly. They act differently than they normally do. For example, they may begin to collect various items or to stop grooming themselves. They may easily become irritable, hostile or impatient, and may intrude in the lives of others. Mania also makes it difficult to stay focused on one activity, and patients often flit from one task to another.
Feelings of grandiosity are also commonly associated with mania. Patients may falsely believe that they are extremely wealthy and powerful and have an inflated sense of self-esteem. Some believe that they are geniuses, and this can escalate to the delusional belief that they are God.
During severe manic episodes, patients may have hallucinations and begin to believe that they are either being helped or hindered by others. Patients often sleep less, exhibit poor judgment and become excessively and impulsively involved in high stakes, reckless behavior such as road rage, risky sex, substance abuse or impulsive spending.
When behavior becomes so extreme that there is no clear link between mood and behavior, it is known as delirious mania. Patients with this condition are at risk of dying of physical exhaustion if they are not immediately hospitalized and treated.
Patients who are manic are frequently unaware that their feelings are not normal.
Potential causes of mania
Many factors have the potential to trigger manic episodes. Although mania is most commonly associated with bipolar disorder, it can also occur as a result of medication use or other illnesses.
Certain types of drugs may cause mania as a side effect of their use. Amphetamines, antidepressants (and withdrawal from antidepressants) and corticosteroids all may cause episodes of mania. Specific medications that have been associated with mania include bromocriptine (used to treat various conditions, including amenorrhea, infertility and Parkinson’s disease), levodopa (used to treat Parkinson’s disease) and methylphenidate (used to treat attention deficit hyperactivity disorder [ADHD]). Cocaine and other stimulant use may also cause mania-like symptoms.
Certain diseases can also trigger manic episodes, including infections such as acquired immune deficiency syndrome (AIDS), encephalitis (inflammation of the brain), influenza and the late stages of syphilis (a sexually transmitted disease). High levels of thyroid hormone and the connective tissue disease systemic lupus erythematosus also are associated with mania.
In addition, several neurologic disorders are known to be potential triggers of mania. These include:
- Brain tumors
- Head injuries
- Huntington’s disease (progressive wasting of nerve cells in the brain)
- Multiple sclerosis (autoimmune disease that affects the central nervous system [CNS])
- Sydenham’s disease (movement disorder associated with rheumatic fever)
- Temporal lobe epilepsy (marked by seizures that cause abnormal electrical activity in the temporal lobe)
Relief options for mania
A physician or mental health professional is likely to diagnose mania if the patient experiences a period of abnormally elevated or irritable mood that lasts at least one week. Mania may also be diagnosed if the changes in mood last for a shorter period of time but require hospitalization.
During the mood disturbance, three or more of the following symptoms must be present (or four symptoms, if the mood is only irritable):
- Heightened self-esteem or feelings of grandiosity
- Reduced need for sleep
- More talkative than usual
- Sense that thoughts are racing
- Easily distracted
- Increase in goal-seeking activity
- Impulsive or risky behavior
These symptoms also cannot be better accounted for by another condition, or caused by the effects of a substance.
Patients who engage in extremely risky behavior may need to be hospitalized during manic episodes to prevent them from harming themselves or others. This is particularly true for patients who reach the stage of delirious mania.
Mood stabilizing drugs such as lithium are the primary medications for treating both mania and bipolar disorder. According to the National Mental Health Association (NMHA), lithium is effective in controlling mania in 60 percent of patients with bipolar disorder. It is also effective in preventing new episodes of both mania and depression and appears effective in reducing suicide among patients with bipolar disorder.
Although lithium is very effective in treating euphoric mania, it may not be beneficial in treating mixed episodes in which mania and depression occur simultaneously. Some patients may experience undesirable side effects, such as hand tremors, excessive thirst, excessive urination and memory problems. These patients may find relief from manic symptoms through the anticonvulsant drug valproic acid. This drug has fewer side effects than lithium, although some patients may experience nausea, drowsiness, dizziness, weight gain or tremors. Valproic acid should be monitored closely in patients who have a liver disorder, because it can cause serious liver damage.
Finally, some patients have found relief from manic symptoms by using certain antipsychotic medications. Side effects of these medications may include sedation, stiffness of arms and legs, weight gain and abnormal movements.
Some patients may have to be monitored when they take medications for mania. Patients often feel a sense of “dullness” after taking medications and miss the “high” of their manic phases. As a result, they may be tempted to stop taking their medications.
Questions for your doctor regarding mania
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following mania-related questions:
- Is it normal for patients to be unaware of their mania?
- My loved one does not experience depression. Is it possible he/she can still have mania?
- What are the risks associated with my loved one’s mania?
- What is the likely source of my loved one’s mania?
- At what point does someone with mania require hospitalization?
- Will my loved one require hospitalization for mania?
- What drugs might work best in controlling my loved one’s condition?
- What are some of the side effects associated with these drugs?
- What are my loved one’s options if drugs such as lithium fail to treat the mania?
- How can I tell the difference between a good mood and mania?