The word manic is casually used to describe someone who is unusually energetic; however, manic episodes are a lot more than a little excess energy. While not all experiences with mania are bad, mania can have devastating effects for the person experiencing it and their loved ones. It’s common for people experiencing mania to act in ways that are damaging to their relationships, risky to their own well-being, and even dangerous to others.
It's important for family and friends to understand what a manic episode looks like because you may be in a unique position to recognize the early stages of mania and help get things back on track.
What is a manic episode?
As a broad overview, mania is characterized by an elevated mood, excessive energy, and apparent lack of a need for sleep. While mania is categorized as high energy, it’s not always euphoria. Some people’s elevated mood actually leads them to feel more irritable or easily angered. A “manic episode” occurs when this shift in mood is persistent for a week or longer and is severe enough to cause problems in the person’s life. Manic episodes are typically associated with bipolar 1 disorder. Characteristics of mania can include:
- Lack of need for sleep
- Increased energy
- Rapid speech
- Impulsive decisions
- Racing thoughts
- Elevated mood
- Excessive spending
According to the DSM-5, the psychiatric manual for mental disorders, an individual must have multiple of these characteristics during the specified time with a distinct end point for their experience to be considered a manic episode.
What happens during a manic episode?
One of the challenges of recognizing a manic episode is that it feels different for the person experiencing the episode and those around them. The symptoms are usually highly personal and different from one person to the next. Hearing individual stories of what it looks like when someone is in a manic episode can help you see these personal characteristics more clearly. Here is an excerpt reproduced from “The Bipolar Disorder Survival Guide” from a 33 year old women with bipolar 1 disorder who describes her experience:
“I start yelling, and then I’m suddenly happy again, my sleep goes all haywire, my thoughts go so fast I can’t grasp them. I get high-spirited and strong-willed. But the weirdest thing to me is that I don’t even know I’m ill, and why would I take my medications if I’m not ill? My husband always knows first, my sister next, and then my best friends. I’m always the last one to know when I’m manic.”- The Bipolar Disorder Survival Guide by David J. Miklowitz
During a manic episode, a person can also exhibit symptoms of psychosis including delusions and hallucinations, like hearing voices. Often this is referred to as a manic episode with “psychotic features”.
- Claudette Pombo, a member of NAMI, describes the experience of her first known manic episode in a video. She talks about related disorders and her experience of psychosis.
- Andy Dunn, a successful CEO and author of the book Burn Rate, describes what a manic episode looks like for him and how it nearly destroyed his personal and professional life.
Ultimately, what your loved one does during their manic episode will be unique to them. As someone close to them, you might notice small shifts in their behavior, speech, or routine. Focusing on what’s happening in the moment can help you identify that a shift has happened for them.
What happens after a manic episode?
A manic episode typically ends with a “crash”. From the outside, it can look like the person’s energy is winding down. For example, your loved one might finally be able to sleep and spend more time in bed. However, what’s happening on the inside varies from person to person.
For some people with bipolar 1 disorder, the end of a manic episode can be the start of a depressive episode. A person’s mood shifts from being elevated and energetic to feelings of emptiness or hopelessness. Many people cycle through the “highs'' and “lows” of mania and depression with their own unique pattern and frequency. However, not everyone who experiences manic episodes experiences depressive episodes.
People with bipolar disorder who do have symptoms of depression often seek support during a depressive episode which can lead to an incorrect diagnosis. It is critical for providers to know about a history of mania even if a person is seeking treatment for depression or something completely different. Some people avoid describing their mania symptoms because they fear the stigma of being seen as “crazy”. For others, mania seems like less of a concern than depression. Having a fuller picture of symptoms allows providers to recommend appropriate treatment options.
Is it a manic episode or something else?
Some people experience similar characteristics and behaviors as a manic episode without actually meeting what would clinically be considered a manic episode. Experiencing mania that doesn't cause the same impairment is referred to as hypomania and is usually associated with bipolar 2 disorder. An episode of hypomania consists of a shift in mood that’s uncharacteristic for the individual and is observable by others for at least 4 consecutive days.
Whether someone is experiencing a manic episode or not, there are still things you can do if you’re concerned about characteristics and behaviors of mania.
What can I do during a manic episode to help?
If possible, stay with them during their episode. Your presence alone can be helpful because mania can be so isolating. You’ll also be there if they try to make impulsive decisions that may have long term consequences. Having someone there can help nudge them in the right direction or keep things calm. It’s likely that your loved one might not want help in the moment because things feel good to them. That’s not a reflection of you or your relationship. Being patient is crucial during an episode because they might want something and then change their mind.
What should I avoid during a manic episode?
The main goal is to avoid arguments or debates. Your loved one is perceiving their experience differently than those around them. Trying to convince them that what they're experiencing is wrong or not real will likely lead to confrontation. It’s okay to be honest about what you’re experiencing and feeling, but it’s not helpful to try to tell them how they’re feeling.
What can they do during an episode to feel better?
The one thing that almost everyone experiencing a manic episode needs is more sleep. You can encourage them to sleep and rest. Loss of sleep can fuel a manic episode, so getting them to rest is important for helping them through it.
What can I do for myself during their manic episode?
Family and friends can feel confused and frustrated during a loved one’s manic episode. Their behaviors and comments can be really hurtful and lead to feelings of anger and resentment. While the goal is to not take their behaviors personally, that's not always possible. It’s okay to take a step back and give yourself some space. Consider connecting to support groups, friends, and family members to get the additional support you need.
What if it feels like the manic episode is never going to end?
Manic episodes can go on for weeks or months and can feel like there is no end in sight. If your loved one has received treatment in the past, help them connect with their established mental health care provider (therapist, psychiatrist, etc.). If they usually take medication, it is possible that they've stopped taking it or that there is an issue with their medication. It’s worth opening a conversation with them about it by asking how things are going with their medication without judgment or accusation.
If your loved one has never received treatment, you can learn about different options in our article on how to get help for a loved one with mental illness. If your loved one refuses treatment, you can learn helpful strategies to support them in our article on how to get someone help when they refuse.
What if they’re in danger or they’re putting someone else in danger?
Calling 911 is an option if your loved one is an immediate danger to themselves or others. Sometimes a manic episode can go on for days or weeks without end or can be a part of a psychotic episode. You can learn about what happens during a 911 call and alternatives to police including asking for a Crisis Intervention Team (CIT). If your loved one isn’t an immediate threat to themselves or others, you can call or text 988, the national number for mental health crises.
How can we be proactive about mania?
It is crucial to learn from an episode when it has settled down. In addition to medications, most of the best therapies for people with bipolar include learning from personal experience and the experiences of others’ experiences with mania. Different people have very different patterns and warning signs of mania. There are similarities, but an individual and their supporters often have to learn what it looks like for them to start to carve a path toward recovery and relapse prevention.