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 feel out of control as they involve both extreme highs and devastating lows. The highs are known as 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.

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.

Genetic makeup

Studies show that 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. But there are still a lot of unknowns about these family tendencies, and simply 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. Unfortunately, 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 trigger the illness if the predisposition is already there.

If you or someone you know is or may be experiencing abuse, please call the National Domestic Violence Hotline, available 24/7, at 1-800-799-7233 or text "START" to 88788. Live chat is also available on the National Domestic Violence Hotline website.

How to identify a manic episode

Symptoms of bipolar disorder often begin in a person's late teens or early twenties. 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, it's called "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, a diagnosis, and treatment are necessary. 

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 feel 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. 

It can sometimes be difficult to distinguish between symptoms of psychosis in bipolar disorder and other mental health conditions, like schizoaffective disorder. Bipolar disorder with psychotic features and schizoaffective disorder have 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 will have to rule out schizophrenia, schizoaffective disorder, and related conditions before diagnosing someone with bipolar disorder.

If you’re wondering how to identify a manic episode in yourself or someone you love, it can help to know how not only manic symptoms, but also hypomanic and depressive symptoms, may manifest. The following are common symptoms of mania, hypomania, and major depression. 

Symptoms of manic episodes

A manic episode usually lasts for at least a week. During an episode of mania, the following symptoms may be present:

• Euphoria or intense excitement

• Feeling invincible

• An inflated sense of self

• Delusions of grandeur

• Lack of focus and getting easily distracted

• Restlessness

• Racing thoughts

• Speaking too fast

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

• Agitation or feeling jumpy and wired

• Engaging 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.  

Symptoms of depressive episodes

Depressive episodes usually last about two weeks and are more common in bipolar II disorder. A depressive episode consists of symptoms like:

• Low self-esteem and feelings 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 one's self

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 feel energetic while emotionally down or preoccupied with suicidal thoughts.

The different types of bipolar disorder

Bipolar disorder is divided into three different categories:

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. 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 simply be seen as someone who is very energetic, hyper, and easily excitable at times, which can make it hard for them to recognize there is an issue.

Cyclothymia

When someone experiences this type of bipolar disorder, they have a milder form of the illness. 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.

Diagnosis and treatment

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. It may also be helpful to track symptoms in a journal, since frequency, severity, and type of emotion can fluctuate significantly with bipolar disorder.

In many cases, a person with undiagnosed bipolar disorder may only realize something is wrong and that they genuinely need help when things spin out of control. For example, 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 that they require help.

When they suspect a person has bipolar disorder, a doctor may conduct tests to rule out other illnesses or potential factors. 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 (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.

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:

Antidepressants

Antidepressants may be used in combination with mood stabilizers. Antidepressants help with feelings of depression, but there is a risk that using them can trigger episodes of mania or rapid cycling.

Anti-psychotics

These medications treat any symptoms of psychosis that may be present and are highly effective for managing manic episodes. Risperidone is a commonly prescribed medication for psychotic symptoms. 

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 and II disorders and cyclothymia but less effective for rapid cycling and mixed states. Lithium is a mood stabilizer that is widely utilized for mania symptoms. 

Therapy for bipolar disorder

An essential component of treating bipolar disorder is psychotherapy. If you are unsure about seeking help in person or want to connect with someone immediately, consider online resources and online counseling. 

Online therapy can help

If your doctor has diagnosed you with bipolar disorder and recommended therapy, or if you want to talk to someone about better managing your symptoms, online therapy may be a good option.

Online therapy is convenient and flexible. You don’t have to worry about finding an open appointment with a local therapist or being put on a waiting list. With online therapy, you’re matched with someone who is available to start meeting with you right away. Some people also feel more comfortable talking to someone through a computer or phone screen, which might make it easier to open up and talk about things 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.