In the 2012 film Silver Playbook padsPat, the main character played by Bradley Cooper, stays up all night reading Ernest Hemingway A farewell to arms. Angered by the book’s ending, Pat closes it, screams an expletive, and throws it out the window. He then wakes his parents up at 4am to rant about it.
This is an example of a manic episode.
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While mania can affect people in different ways, those who experience manic episodes typically have racing thoughts and ideas, have trouble sleeping, feel invincible, talk fast, and have grandiose ideas.
Mania is most common in those with bipolar 1 disorder, although there are other disorders with which mania is associated. Researchers are working to better understand what it’s like to experience mania so they can help more patients find the support they need.
What are manic episodes?
Studies have found that people in manic episodes can is not aware have an episode. Their judgment and insight can be skewed. They also have feelings of grandiosity and delusions. With excessive energy and demeanor, they may feel confident and creative and operate on little sleep to pursue ideas or projects.
In one clinical text, for example, a patient is described as a young man who lives at home with his parents. For several days he slept less, but seemed to have more energy. He suddenly began making plans for a rap career, despite having previously shown no interest in music. In another example, a patient’s friends became alarmed after he suddenly bought a $6,000 sofa and began describing his plans to renovate his apartment in an “artificial Romanesque style.”
The manic episode is noticeable to others. The face talk quickly and easily distracted and restless. Manic episodes can last weeks or months and are usually managed through medication in an outpatient setting. Psychiatrists sometimes hospitalize patients who become aggressive, dangerously erratic, or suicidal during their manic episodes.
Scientists aren’t entirely sure what triggers a manic episode, but it may be related to a stressful life event, drug or alcohol use, or a chemical imbalance in the brain. In addition to bipolar 1 disorder, mania is also seen in patients with seasonal affective disorder (PITY), Schizoaffective disorder and Postpartum psychosis.
Read more: Does seasonal affective disorder get worse with age?
Problematically, most patients are not diagnosed until their first manic episode, which can be frightening for the patient and their loved ones.
As mentioned above, manic episodes are mostly seen in people with bipolar 1 disorder, a mood disorder that disrupts a person’s energy level and emotions and causes them to have periods of depression or mania. (There are three types of bipolar disorder: 1, 2, and cyclothymic disorder.) But approx 60 percent of people with bipolar disorder (BD) are initially diagnosed with depression and their BD does not become apparent until they experience their first manic episode.
Experiencing a manic episode
Scientists are currently trying to understand not only what causes manic episodes, but also what it’s like to have and recover from a manic episode. In a 2023 study in Early intervention in psychiatry, researchers conducted qualitative interviews with 11 patients (aged 21 to 35) who had recently experienced their first manic episode. Three strong themes emerged from the responses.
First, participants described feeling a new sense of purpose in their recovery from the manic episode. One participant said that his manic episode made him realize that he wanted to be a visual artist. Another said he planned to continue with law school but realized he needed to maintain his treatment regimen and stay in touch with his support services.
Trying to deal with the trade-offs in their new lives was another major theme. One participant, for example, said he realized he could no longer trust his own thoughts. She described herself as a “ticking time bomb” and worried in moments of happiness that she was slipping back into psychosis.
Participants also shared a desire to prove themselves after their manic episodes. One participant was made to perform better on his exams than the other students. The desire to prove themselves to others made some participants feel as if they were at risk of another manic episode. The authors conclude that there is a “tipping point” between recovery and relapse.
Studies of obsession and advocacy
Advances in imaging technology are helping scientists understand neurological differences among people with BD. Article from 2023 in Advances in neuropsychopharmacology and biological psychiatry performed magnetic resonance imaging (MRI) on 35 participants who had recently experienced their first manic episode.
The researchers knew from other studies that BD changes brain structure. However, they were curious about how soon the brain changed after a person’s first manic episode. The researchers looked for differences between the images of the participants and the control group in terms of cortical thickness or gyrification.
They see no remarkable differences; however, in participants with BD, they saw increased “cortical surface area in the inferior/middle prefrontal and occipito-parietal cortex.”
Read more: Bipolar disorder increases the risk of Parkinson’s sevenfold
Such studies may help in the future by reducing the stigma against people who have manic episodes. Until then, researchers have found that celebrities make people more supportive of BD. Singer/actor Selena Gomez recently appeared in an Apple TV+ documentary and revealed his BD diagnosis.
Similarly, singer Demi Lovato has been public for years about living with bipolar disorder. And 2017 study in Communication studies found that Lovato’s disclosure helped reduce social distancing and stigma against BD. The the authors concluded that having a celebrity ambassador like Lovato can be a viable strategy for raising awareness through public health campaigns.