Ups and Downs: A Look Into What Mania Feels Like in Bipolar Disorder

What is Mania?

Mania is a part of Bipolar Disorder, a condition wherein mood and behaviors swing dramatically up and down like a roller coaster throughout someone’s lifetime. Manic episodes are the defining feature of Bipolar Disorder. But what the heck does a manic episode look like? Let’s consult The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-V) and see:

The DSM-V defines manic episodes as “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary)”. There are some other symptoms related to mania including inflated self-esteem/grandiosity, decreased need for sleep, more talkative than usual or pressured speech, flight of ideas or subjective experience of thoughts racing, distractibility, increased goal directed activities, excessive involvement in activities or psychomotor agitation, excessive involvement in activities that have a high potential for painful consequences.

That’s a great definition, but it’s all descriptors and random symptoms. What exactly does that look like? What does it feel like to have a manic episode?

Professionally, I was never satisfied with the DSM-V’s diagnostic criteria because it didn’t really help me figure out who was and who wasn’t bipolar unless they were clearly manic and doing crazy stuff right in front of me. So, I decided to ask a bunch of people who had true, full blown bipolar disorder with confirmed manic episodes what their mania was like over their lifetimes and how long they’d been suffering from it. Below is a combination of a lot of those anecdotes.

How can this help me?

You might wonder, “Why would this be important for me to know? Shouldn’t the doctor know everything there is to know about bipolar disorder and how to properly diagnose and treat it?” For the longest time, I asked myself the same thing, and that’s why I worked really hard to determine mania was truly like for the patients I worked with. However, this attitude is not very realistic. Psychiatrists are pressed for time when seeing patients, and many of us will focus on getting good at 1-3 things and stick with that. By becoming a more informed patient, you bring more power and knowledge for you own health care. This keeps yourself and your doctor more accountable. The doctor only knows what s/he knows after all, and the same can be said for you. With that being said, let’s dive in and took a closer look at someone who becomes manic.

The Beginning

One morning after maybe a lot of stressful things at work, home, or school, you wake up feeling pretty good. But not just happy or satisfied with your life. You’re PRETTY FREAKING OPTIMISTIC AND HAPPY. Not only that, but your body is filled with TONS of energy. Because of how good you feel about yourself and your increased energy levels, your thoughts may start moving SUPER-fast jumping from one thing to the next at a “million miles per minute”. You may be telling yourself, “all my problem are very solvable”, “all my doubts are completely untrue”, and “the air just feel so much better to breathe, baby!”

Pictured here: how unbelievably happy your brain is saying you are

Because of how fast your thoughts are going and how good you feel, you may tell yourself, “I can do the work of 2 weeks in just 1 day!” And because of all that energy, you do accomplish all of that by cleaning the ENTIRE house/apartment randomly at 3am in the morning, getting started or continuing (or adding on) 5-10 more projects AT THE SAME TIME, deciding that you suddenly need to manage a huge event 300 miles away that you never signed up for, or driving cross-country for 90 hours straight to go see your grandparents without sleeping on the road. Your family and friends will comment that you’re talking abnormally fast and are “all over the place”. Some of them may think you’re on drugs. But for you, you don’t care! You’ve got shit to get done and you will get it done!

When Things Turn Ugly

These feelings of euphoria and increased activity generally go on for around 2-7 days, but there’s a price for these changes. Because of the MAJOR increase in energy, your body will not feel as though it needs sleep. This is OK for the first 2-3 days, but after 4-5 days or more, you may not feel very happy anymore. In fact, you may start feeling downright pissed and incredibly irritable with everyone and everything around you.

Additionally, sleep is very important for our health and survival. When we don’t sleep, we start experiencing very weird things. After 5-7+ days of no sleep, you may start becoming paranoid thinking others are spying on you or trying to poison you. You may start hearing voices and seeing shadows out the corner of your eye. You may even start to become delusional believing that you have secret powers that allow you to walk on walls, that the United States is in a conspiracy to spy on your internal organs, or that only you know the secret to solving world hunger.

The Crash

If you experience mania, you can have it anywhere from 2-7 days (or 1-3 weeks…or 1-4 months) and then “crash” on the last day of your “high”. At that point, your body will lose all the energy it had like air being released from a balloon in one fell swoop. You may end up sleeping for several days straight. In many cases, you will end up becoming profoundly depressed during this time because of the lack of energy and barely doing anything. Being stuck and confined to bed doesn’t help the situation because you usually end up being bombarded with your increasingly negative thoughts fired up by your inactivity. This low energy state can go on for several days to 3 weeks or longer. This “down” period is the point in time when a lot of people go to the doctor.

The Long-Term Manic Cases

Some unfortunate individuals live in a perpetually semi-manic state every day for years sleeping less than 2-3 hours/night but having a huge amount of energy that won’t allow them to get to sleep. They’re predominantly pissed off and irritable because who wouldn’t be when your brain and body simply won’t allow you to sleep?

Mania vs. Hypomania

Many mental health professionals hem and haw over the difference between hypomania vs. mania. In my experience, the underlying feelings and thought processes are similar between the both of them. Both have the same euphoric moods. Both have the same racing thoughts. Both have the decreased need for sleep. Both would be approached with similar medication regimens. The only categorical difference between the 2 according to the DSM-V is the length of time the person experiences the symptoms and how severe the symptoms can get. This never satisfied me because people with 3-4 days of mania can suffer and be impaired same as those with 7+ days of mania. The real question to ask if you’ve experienced manic episodes is if you want help with it or not. The same mood stabilizing medications and approach are typically used regardless of whether it’s “mania” or “hypomania”. You can think of mania as a spectrum with prolonged periods (5 days or more) causing more problems than shorter periods of mania (3 days or less). Regardless, the aim of treatment is to use medications to prevent the manic episodes from happening as often.

The Implications

If none of the above applies to you and you’re concerned about possibly having bipolar disorder, there’s a good chance you don’t have it. If you’ve experienced any of the above at any time of your life (as young as 7-8yo), there’s a pretty good chance that you experienced a manic episode. Make sure to ask yourself if you were on drugs during any of those times because some drugs can make it look like you have mania when you do not. If you would like to get diagnosed and receive proper treatment, consult with your nearest mental health professional/psychiatrist.

Other Considerations

If you do have manic episodes, you may not want to get treated for your mania. After all, recurrent manic episodes absolutely require medications oftentimes over a lifetime, and all the medications have side effects. Most of the medications make you gain weight! Additionally, you may actually enjoy the high you get when you become manic as it pushes you to become highly productive and accomplish so much. Some patients I worked with would purposely avoid sleep whenever they were going through a hard time because they knew that lack of sleep could precipitate another manic episode.

Finally, monitoring and treating bipolar disorder is HARD WORK. The doctor cannot follow you around all day long with a stopwatch to see when you’re getting manic and when you’re getting depressed. To make the most out of your treatment, you’d have to monitor those things yourself on an ongoing basis. It’d be much easier to just allow your moods to change suddenly and just let the doctors handle it (or the paramedics/police if things get too out of hand).

These are all things to ask yourself before accepting medication treatment for bipolar disorder. If you wrote down for yourself all the good reasons to not get treated, but still believe you’d want to get treated anyway, your response to the medications will be much better. That’s because you will be invested in taking care of yourself rather than asking the doctor to take care of you. Even though it’s a lot of work and requires medications, leaving it up entirely to your doctors will make them want to medicate you MORE because they won’t know if they can trust you to manage it yourself, and they’d want to get you controlled as much as possible. Ultimately, it’s your decision on what you want to do, but the good news is that you have a lot more control over your mental health problems if you are willing to do the hard work.

Concluding Words

When I work with patients who have potential bipolar disorder, I utilize a lot of diagnostic tools to make an accurate diagnosis because I understand the implications of missing a diagnosis like this. I share the exact same anecdote I shared above about what classic mania looks like. This gives the patient and I more comfort in knowing that this was something they didn’t have. And if it was something that they probably did have because they resonated with that anecdote and all the history taking suggested there was bipolar disorder going on, then that was a good thing too as it gave us both a chance to discuss the implications of the diagnosis and what treatment plan to look forward to. I hope you’ve found this information useful. Please do not diagnose yourself or adjust your own medications. Always consult your doctor before making any medical decisions or changes.