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For other uses, see Mania (disambiguation).
Manic episode
Classification and external resources
ICD-10 F30
ICD-9 296.0 Single manic episode, 296.4 Most recent episode manic, 296.6 Most recent episode mixed
MeSH D001714

Mania is the mood of an abnormally elevated arousal energy level.[1] Elevated irritability is common along with behavior that seems on the surface to be the opposite of depression. Mania is a necessary symptom for certain psychiatric diagnoses. The word derives from the Greek μανία (mania), "madness, frenzy"[2] and that from the verb μαίνομαι (mainomai), "to be mad, to rage, to be furious".[3]

In addition to mood disorders, persons may exhibit manic behavior increased by drug intoxication (notably stimulants, such as cocaine and methamphetamine), medication side effects (notably SSRIs), and malignancy (the worsening of a condition). Mania is most often associated with bipolar disorder, where episodes of mania may alternate unpredictably with episodes of depression or periods of euthymia. Gelder, Mayou, and Geddes (2005) suggest that it is vital that mania be predicted in the early stages because otherwise the patient becomes reluctant to comply with the treatment. Those who never experience depression also experience cyclical changes in mood. These cycles are often affected by changes in sleep cycle (too much or too little), diurnal rhythms, and environmental stressors.

Mania varies in intensity, from mild mania (hypomania) to full mania with extreme energy, racing thoughts, and forced speech.[4] Standardized tools such as Altman Self-Rating Mania Scale[5] and Young Mania Rating Scale[6] can be used to measure severity of manic episodes. Because mania and hypomania have also been associated with creativity and artistic talent,[7] it is not always the case that the clearly manic bipolar person needs or wants medical help; such persons often either retain sufficient self-control to function normally or are unaware that they have "gone manic" severely enough to be committed or to commit themselves. Manic persons often can be mistaken for being on drugs or other mind-altering substances.


Mixed states[edit]

Main article: Mixed episode




Main article: Hypomania

Hypomania is a lowered state of mania that does little to impair function or decrease quality of life.[8] In hypomania, there is less need for sleep and both goal-motivated behaviour and metabolism increase. Though the elevated mood and energy level typical of hypomania could be seen as a benefit, mania itself generally has many undesirable consequences including suicidal tendencies.

Associated disorders[edit]

A single manic episode is sufficient to diagnose bipolar I disorder. Hypomania may be indicative of bipolar II disorder or cyclothymia. However, if prominent psychotic symptoms are present for a duration significantly longer than the mood episode, a diagnosis of schizoaffective disorder is more appropriate. Several types of "mania" such as kleptomania and pyromania are related more closely to obsessive-compulsive disorder than to bipolar disorder, depending on the severity of these disorders. For instance, someone with kleptomania who suffers from impulses to steal things such as pencils, pens, and paperclips is better diagnosed with a form of OCD.

B12 deficiency can also cause characteristics of mania and psychosis.[9][10]

Hyperthyroidism can produce similar symptoms to those of mania such as agitation, elevated mood, increased energy, hyperactivity, sleep disturbances and sometimes, especially in severe cases, psychosis.[11][12]

Signs and symptoms[edit]



If the person is concurrently depressed, they are said to be having a mixed episode.[13]



One of the most signature symptoms of mania (and to a lesser extent, hypomania) is what many have described as racing thoughts. These are usually instances in which the manic person is excessively distracted by objectively unimportant stimuli.[17] This experience creates an absentmindedness where the manic individual's thoughts totally preoccupy him or her, making him or her unable to keep track of time, or be aware of anything besides the flow of thoughts. Racing thoughts also interfere with the ability to fall asleep.

Mania is always relative to the normal rate of intensity of the person being diagnosed with it; therefore, an easily angered person may exhibit mania by getting even angrier even more quickly, and an intelligent person may adopt seemingly "genius" characteristics and an ability to perform and to articulate thought beyond what they can do in a normal mood. A very simple indicator of mania would be if a noticeably clinically depressed person becomes suddenly and inordinately energetic, cheerful, aggressive, or "happy". Other often-less-obvious elements of mania include delusions (of grandeur, potential, persecution, arrogance), hypersensitivity, hypervigilance, hypersexuality, hyper-religiosity, hyperactivity, impulsiveness, compulsion to over explain (keep talking with rapid speech), grandiose ideas and plans, and difficulty falling asleep or decreased need for sleep (e.g. feeling rested after 3 or 4 hours of sleep). The afflicted person's eyes may look, as well as feel abnormally "wide" or "open", rarely blinking; this sometimes contributes to clinicians' misconception that a manic patient is under the influence of a stimulant drug when the patient is either not on any mind-altering substances, or is in fact under the influence of a depressant drug in a misguided effort to stave off destructive and unwanted manic impulses. In manic and hypomanic cases, the afflicted person may engage in out-of-character behaviour, such as questionable business transactions, wasteful expenditures of money (e.g., excessive shopping sprees or unnecessary purchases), risky sexual activity, recreational drug abuse, excessive gambling, reckless behavior (such as fast, reckless driving or daredevil activity), abnormal social interaction, or highly vocal arguments uncharacteristic of previous behaviours. These behaviours may increase stress in personal relationships, lead to problems at work and increase the risk of altercations with law enforcement. There is a high risk of impulsively taking part in activities potentially harmful to self and others.[18][19]


There are different "stages" or "states" of mania. A minor state is essentially hypomania and, like hypomania's characteristics, may involve increased creativity, wit, gregariousness, and ambition. Full-blown mania will make a person feel elated, but perhaps also irritable, frustrated, and even disconnected from reality.


The biological mechanism by which mania occurs is not yet known. Based on the mechanism of action of antimanic agents (such as antipsychotics, valproate, tamoxifen, lithium, carbamazepine, etc.) and abnormalities seen in patients experiencing a manic episode the following is theorised to be involved in the pathophysiology of mania:

Imaging studies have shown that the left amygdala is more active in women who are manic and the orbitofrontal cortex is less active.[24]


Before beginning treatment for mania, careful differential diagnosis must be performed to rule out non-psychiatric causes.

Acute mania in bipolar disorder is typically treated with an atypical antipsychotic medication as these medications tend to produce the most rapid improvement in manic symptoms.[25]


Lithium is the classic mood stabilizer to prevent further manic and depressive episodes. A systematic review found that long term lithium treatment substantially reduces the risk of bipolar manic relapse, by 42%.[27] Anticonvulsants such as valproic acid, oxcarbazepine and carbamazepine are also used for prophylaxis. More recent drug solutions include lamotrigine, which is another anticonvulsant. Clonazepam (Klonopin) is also used. Sometimes atypical antipsychotics are used in combination with the previous mentioned medications as well, including olanzapine (Zyprexa) which helps treat hallucinations or delusions, Asenapine (Saphris, Sycrest), aripiprazole (Abilify), risperidone, ziprasidone, and clozapine which is often used for people who do not respond to lithium or anticonvulsants.

Verapamil, a calcium-channel blocker, is useful in the treatment of hypomania and in those cases where lithium and mood stabilizers are contraindicated or ineffective.[28] Verapamil is effective for both short-term and long-term treatment.[29]


Society and culture[edit]

In Electroboy: A Memoir of Mania by Andy Behrman, he describes his experience of mania as "the most perfect prescription glasses with which to see the appears in front of you like an oversized movie screen".[31] Behrman indicates early in his memoir that he sees himself not as a person suffering from an uncontrollable disabling illness, but as a director of the movie that is his vivid and emotionally alive life. "When I'm manic, I'm so awake and alert, that my eyelashes fluttering on the pillow sound like thunder" .[32] Many people who are artistic and do art in various forms have mania. [33]

See also[edit]


  1. ^ Berrios GE (2004). "Of mania". History of Psychiatry 15 (57 Pt 1): 105–124. doi:10.1177/0957154X04041829. PMID 15104084. 
  5. ^ Altman E, Hedeker D, Peterson JL, Davis JM (September 2001). "A comparative evaluation of three self-rating scales for acute mania". Biol. Psychiatry 50 (6): 468–71. doi:10.1016/S0006-3223(01)01065-4. PMID 11566165. 
  6. ^ Young RC, Biggs JT, Ziegler VE, Meyer DA (Nov 1978). "A rating scale for mania: reliability, validity and sensitivity". Br J Psychiatry 133 (5): 429–35. doi:10.1192/bjp.133.5.429. PMID 728692. 
  8. ^ NAMI (July 2007). "The many faces & facets of BP". Retrieved 2008-10-02. 
  11. ^ Hyperthyroidism [Internet]. MedlinePlus. 2012 [cited 2013 Oct 2]. Available from:
  12. ^ Lee SL, Ananthakrishnan S. Hyperthyroidism. 2013 Mar 7 [cited 2013 Oct 2]; Available from:
  13. ^ a b c "BehaveNet Clinical Capsule: Manic Episode". Retrieved 18 October 2010. 
  14. ^ "ICD-10". Retrieved 18 October 2010. 
  15. ^ DSM-IV
  18. ^ Fletcher K, Parker G, Paterson A, Synnott H (2013). "High-risk behaviour in hypomanic states". J Affect Disord 150 (1): 50–6. doi:10.1016/j.jad.2013.02.018. PMID 23489397. 
  20. ^ a b c Goodman, Brunton L, Chabner B, Knollman B (2011). Goodman Gilman's pharmacological basis of therapeuti (Twelfth ed.). New York: McGraw-Hill Professional. ISBN 978-0-07-162442-8. 
  21. ^ Li X, Liu M, Cai Z, Wang G, Li X (2010). "Regulation of glycogen synthase kinase-3 during bipolar mania treatment". Bipolar Disord 12 (7): 741–52. doi:10.1111/j.1399-5618.2010.00866.x. PMC 3059222. PMID 21040291. 
  22. ^ Yildiz A, Guleryuz S, Ankerst DP, Ongür D, Renshaw PF (2008). "Protein kinase C inhibition in the treatment of mania: a double-blind, placebo-controlled trial of tamoxifen". Arch. Gen. Psychiatry 65 (3): 255–63. doi:10.1001/archgenpsychiatry.2007.43. PMID 18316672. 
  23. ^ Brietzke E, Stertz L, Fernandes BS, Kauer-Sant'anna M, Mascarenhas M, Escosteguy Vargas A, Chies JA, Kapczinski F (2009). "Comparison of cytokine levels in depressed, manic and euthymic patients with bipolar disorder". J Affect Disord 116 (3): 214–7. doi:10.1016/j.jad.2008.12.001. PMID 19251324. 
  24. ^ Altshuler L, Bookheimer S, Proenza MA, Townsend J, Sabb F, Firestine A, Bartzokis G, Mintz J, Mazziotta J, Cohen MS (2005). "Increased Amygdala Activation During Mania: A Functional Magnetic Resonance Imaging Study". Am J Psychiatry 162 (6): 1211–13. doi:10.1176/appi.ajp.162.6.1211. PMID 15930074. 
  26. ^ Melinda Smith, M.A., Lawrence Robinson, Jeanne Segal, Ph.D., and Damon Ramsey, MD (1 March 2012). "The Bipolar Medication Guide". Retrieved 23 March 2012. 
  27. ^ Geddes JR, Burgess S, Hawton K, Jamison K, Goodwin GM (February 2004). "Long-term lithium therapy for bipolar disorder: systematic review and meta-analysis of randomized controlled trials.". The American Journal of Psychiatry 161 (2): 217–22. doi:10.1176/appi.ajp.161.2.217. PMID 14754766. 
  28. ^ Giannini AJ, Houser WL, Loiselle RH, Giannini MC, Price WA (1984). "Antimanic effects of verapamil". American Journal of Psychiatry 141 (12): 160–1604. PMID 6439057. 
  29. ^ Giannini AJ, Taraszewski R, Loiselle RH (1987). "Verapamil and lithium in maintenance therapy of manic patients". Journal of Clinical Pharmacology 27 (12): 980–985. doi:10.1002/j.1552-4604.1987.tb05600.x. PMID 3325531. 
  30. ^ Nierenberg AA (2010). "A critical appraisal of treatments for bipolar disorder". Primary care companion to the Journal of clinical psychiatry 12 (Suppl 1): 23–29. doi:10.4088/PCC.9064su1c.04. PMC 2902191. PMID 20628503. 
  32. ^
  33. ^

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