Mania is a complex and often misunderstood mental health condition characterised by an intense elevation in mood, increased energy levels, and often reckless or impulsive behaviours. While it is most commonly associated with bipolar disorder, mania can also result from other medical or psychological conditions, as well as certain medications and substance use.

Left untreated, mania can disrupt every aspect of a person’s life, from their relationships and work performance to their physical health and sense of reality. Understanding mania in its full context—its symptoms, stages, causes, and treatments—is critical for early detection and effective intervention.

What is Mania?

It typically involves emotional, behavioural, and physical changes that can become increasingly difficult to manage. While people experiencing mania may feel euphoric or invincible, the condition can lead to severe consequences, including financial troubles, damaged relationships, risky behaviours, or even hospitalisation.

Mania can be a part of Bipolar I Disorder, but milder forms, such as hypomania, are often seen in Bipolar II Disorder. Mania may also occur due to schizoaffective disorder, cyclothymic disorder, or as a side effect of medical or psychological issues.

Phases of Mania

Mania is not a one-size-fits-all condition. It usually progresses through different phases, ranging from mild hypomania to severe mania with psychotic features. 

1. Hypomania: The Subtle Onset

Hypomania is a mild form of mania. At first glance, this phase might appear beneficial: increased productivity, confidence, and energy are common. People experiencing hypomania often report feeling more “alive,” creative, or efficient than usual.

Symptoms of Hypomania:

• Excessive energy and activity
• Reduced need for sleep without feeling tired
• Increased sociability and talkativeness
• Boost in self-esteem or confidence
• Elevated mood or irritability

Though hypomania may not severely impact daily life, it can escalate into more serious mania or cause subtle interpersonal issues and financial or emotional consequences if untreated.

2. Moderate Mania: Escalation of Symptoms

The person may have difficulty focusing or behaving appropriately, often due to racing thoughts or grandiosity. While they might still deny anything is wrong, their behaviour can strain relationships and responsibilities.

Key signs of moderate mania:

• Rapid or pressured speech
• Inflated self-importance or delusions of grandeur
• Reckless behaviour (unprotected sex, gambling, risky business decisions)
• Overinvolvement in multiple projects
• Neglect of sleep, meals, or hygiene
• Increased irritability or confrontational behaviour

This phase typically causes distress to family members or colleagues, as the affected individual may behave unpredictably or irresponsibly.

3. Severe Mania: A Break from Reality

Severe mania is the most dangerous phase, often requiring emergency medical attention. Individuals may experience psychosis, including hallucinations and delusions, which disconnect them from reality. In this stage, decision-making is impaired, and safety becomes a concern.

Severe mania symptoms include:

• Extreme agitation or aggression
• Psychotic features (e.g., hearing voices, seeing things that aren’t there)
• Total inability to sleep
• Risk of self-harm or harm to others
• Loss of insight into their condition

People in this phase often do not believe they are unwell, which can delay treatment. Hospitalisation is typically necessary for stabilisation.

What Causes Mania?

Mania results from a variety of interconnected factors. It’s rarely caused by a single issue, but instead arises from a combination of genetic, biological, environmental, and psychological elements.

1. Genetic Factors

A strong family history of bipolar disorder or other mood disorders increases the likelihood of experiencing manic episodes. 

2. Brain Chemistry and Structure

Abnormalities in certain areas of the brain, such as the prefrontal cortex or amygdala, may also contribute.

3. Medical Conditions

Certain physical health conditions, such as thyroid disorders, multiple sclerosis, or brain injuries, can trigger manic symptoms.

4. Substance Abuse

Drugs like cocaine, amphetamines, and even alcohol can induce manic episodes or worsen them. Withdrawal from certain substances may also lead to manic-like behaviour.

5. Medications

Some medications, especially antidepressants, corticosteroids, and stimulants, can trigger mania, particularly in people with an underlying mood disorder.

6. Stress and Trauma

High-stress life events—loss of a loved one, financial hardship, or major life changes—can act as a catalyst for manic episodes, especially in individuals with a predisposition.

7. Sleep Disruption

Even skipping sleep for one night can be a significant trigger for individuals vulnerable to manic episodes.

Diagnosis and Evaluation

Diagnosing mania requires a comprehensive psychiatric evaluation. Mental health professionals use tools such as:

• Clinical interviews
• Mood questionnaires
• Medical and psychiatric history
• Observation of behaviour

Treatment Options for Mania

1. Medication

• Mood Stabilisers: Lithium is the gold standard, but others like valproate or carbamazepine are also effective.
• Antipsychotics: Atypical antipsychotics such as risperidone, aripiprazole, or olanzapine are often prescribed to manage acute symptoms or psychosis.
• Benzodiazepines: Short-term use of drugs like lorazepam may help manage agitation and insomnia.

2. Psychotherapy

• Cognitive Behavioural Therapy (CBT): Helps patients recognise harmful thoughts and behaviours and develop coping strategies.

• Family-Focused Therapy: Involves family members in education and support to create a more stable home environment.

3. Hospitalisation

In severe cases, hospitalisation ensures safety and allows for intensive treatment. It also provides a structured setting to monitor medication responses and stabilise the patient.

Lifestyle and Self-Care Strategies

While medication and therapy form the foundation of treatment, daily habits play a crucial role in long-term stability:

• Maintain a consistent sleep schedule: Sleep disruption is one of the leading triggers for manic episodes.
• Monitor mood changes: Keeping a mood diary can help identify early warning signs of mania or depression.
• Limit caffeine, alcohol, and recreational drugs: These substances can worsen symptoms or interfere with medications.

TalktoAngel: Your Partner in Mental Health

If you or someone you care about is experiencing symptoms of mania, help is available. TalktoAngel is an online mental health platform that connects individuals with certified therapists and psychologists for personalised, confidential care. With services tailored for mood disorders such as bipolar disorder and mania, TalktoAngel offers expert support from the comfort of your home.

Don’t wait for symptoms to escalate. Early intervention can make all the difference. Reach out to TalktoAngel and take the first step toward balance, wellness, and peace of mind.

Contributed by: Contributed by Dr. (Prof.) R. K. Suri, Clinical Psychologist and Life Coach, &  Ms. Riya Rathi, Counselling Psychologist  

References

• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). American Psychiatric Publishing.
• Goodwin, F. K., & Jamison, K. R. (2007). Manic-depressive illness: Bipolar disorders and recurrent depression (2nd ed.). Oxford University Press.
• Grande, I., Berk, M., Birmaher, B., & Vieta, E. (2016). Bipolar disorder. The Lancet, 387(10027), 1561-1572. https://doi.org/10.1016/S0140-6736(15)00241-X
• Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682. https://doi.org/10.1016/S0140-6736(13)60857-0