In the 2012 film Silver Linings Playbook, Pat, the main character played by Bradley Cooper, stays up all night reading Ernest Hemingway’s A Farewell to Arms. Enraged by the book’s ending, Pat snaps it closed, yells an expletive and throws it through the window. He then wakes his parents up at 4 a.m. to rant about it.
This is an example of a manic episode.
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While mania can impact people in different ways, those who experience manic episodes typically have racing thoughts and ideas, struggle with sleep, feel invincible, talk fast and have grand ideas.
Mania is most common in those with bipolar 1 disorder, though there are other disorders mania is associated with. Researchers are working to better understand what experiencing mania is like so they can help more patients find the support they need.
What Are Manic Episodes?
Studies have found that people in manic episodes may not be aware they are having an episode. Their judgment and insight can be skewed. They also have feelings of grandiosity and delusions. With excessive energy and behavior, they might feel confident and creative and operate on little sleep to pursue ideas or projects.
In one clinical text, for example, a patient was described as a young man who lived at home with his parents. Over several days, he slept less but seemed to have more energy. He suddenly started making plans for a rap career, even though he had never shown previous interest in music. In another example, a patient’s friends grew concerned after he suddenly bought a $6,000 couch and began detailing his plans to redo his apartment in a “faux Romanesque style.”
A manic episode is noticeable to others. The person speaks quickly and is easily distracted and restless. Manic episodes can last weeks or months and are typically managed through medication in an outpatient setting. Psychiatrists sometimes hospitalize patients who become violent, 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. Besides bipolar 1 disorder, mania is also seen in patients with Seasonal Affective Disorder (SAD), Schizoaffective Disorder and Postpartum Psychosis.
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Problematically, most patients aren’t diagnosed until their first manic episode, which can be scary for the patient and their loved ones.
As mentioned above, manic episodes are primarily seen in those 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 about 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 is 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 (ages 21 to 35) who had recently experienced their first manic episode. Three strong themes emerged from the responses.
First, the participants described feeling a new sense of purpose in their recovery from the manic episode. One participant said his manic episode made him realize he wanted to be a visual artist. Another said he planned to continue with law school but realized he needed to maintain his medication regime and stay in contact with his support services.
Trying to cope with compromises in their new life was another major theme. One participant, for example, said she realized she could no longer trust her own thoughts. She described herself as a “ticking time bomb” and worried in moments of happiness that she was heading back into psychosis.
Participants also shared a desire to prove themselves after their manic episodes. One participant was driven to perform better on his exams than other students. The desire to prove themselves to others made some participants feel like they risked relapsing into another manic episode. The authors concluded there was a “point of tension” between recovery and relapse.
Mania Studies and Advocacy
Advances in imaging technology are helping scientists understand neurological distinctions among people with BD. A 2023 article in Progress in Neuro-Psychopharmacology and Biological Psychiatry conducted magnetic resonance imaging (MRI) on 35 participants who had recently experienced their first manic episode.
The researchers knew from other studies that BD alters the brain structure. However, they were curious about how soon the brain changed after a person’s first manic episode. Researchers looked for distinctions between the images of the participants and a control group in terms of cortical thickness or gyrification.
They did not see notable differences; however, in the participants with BD, they saw an increased “cortical surface area in the inferior/middle prefrontal and occipito-parietal cortex.”
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Such studies may help in the future by reducing the stigma against people who have manic episodes. Until then, researchers are finding that celebrities are prompting people to become more supportive of BD. Singer/actor Selena Gomez recently participated in an Apple TV+ documentary and disclosed her BD diagnosis.
Similarly, singer Demi Lovato has been public for years about living with bipolar disorder. A 2017 study in Communication Studies found Lovato’s disclosure helped reduce social distancing and stigma against BD. The authors concluded that having a celebrity ambassador like Lovato can be a viable strategy for increasing understanding through public health campaigns.