When you’re in the throes of a manic episode, you may feel great — excited, highly energetic, and euphoric. You may like yourself this way or perhaps even prefer it. You might feel more open, funny, and interesting than when you’re not in a manic episode, according to the National Alliance on Mental Illness (NAMI). You may like how productive or outgoing you feel. Even more likely, you may just prefer this up period to the alternative, depression.
Unfortunately, manic episodes from bipolar 1 disorder entail more than just feeling ecstatic, says Diane Solomon, PhD, a psychiatric nurse practitioner in Portland, Oregon. It’s more about abnormally and persistently goal-directed behavior or energy. … [During mania, you] may want to paint, rearrange the furniture, or stay up all night and clean out the garage.”
What’s more, during these periods, you can also behave in ways that are out of character or even dangerous or harmful. You may start driving recklessly, gambling too much, or suddenly spending large amounts of money. In severe cases, episodes of mania (and the episodes of depression that may follow) can include symptoms of psychosis, including delusions and hallucinations, according to NAMI.
Common Challenges of Bipolar Manic Episodes
Manic episodes can affect your relationships at work, at school, and at home. That’s because you may feel like you’re invincible and act impulsively in ways you wouldn’t normally. You may have racing thoughts, talk rapidly, and have inaccurate beliefs or perceptions. “During a manic episode, a person might have an affair, overrun their credit card and spend all their money, quit their job, or get fired from their job,” says Dr. Solomon.
Some common challenges of manic episodes in bipolar 1 disorder include:
- Unpredictable mood shifts Not knowing when you’re about to experience a change in mood can be stressful.
- Relationship problems Not surprisingly, sudden mood shifts and particularly impulsive or reckless behavior, can often lead to problems in relationships with romantic partners, family, and friends. A review published in July 2021 in the journal Medicina found that bipolar 1 disorder can negatively impact the partners of people who have the condition. For example, partners can feel overwhelmed, confused, or so stressed that they develop muscle pain or insomnia. The study authors also noted that working with mental health professionals can help couples grow together and find ways to strengthen their relationships, despite the disorder.
- Difficulty accepting a bipolar 1 disorder diagnosis People who have bipolar 1 disorder often struggle with the idea of living with the condition. It can be hard to accept that bipolar 1 is a lifelong condition — plus the stigma and shame associated with the disease. It can also be particularly tricky to live by society’s rules and exert discipline during a manic episode, according to a study published in the International Journal of Bipolar Disorders.
- Missing your manic episodes When a treatment is effective, it means that the episodes of depression and mania are managed. The International Journal of Bipolar Disorders study found that some patients reported missing their manic phases. You may feel like stopping your medication during manic episodes, because you feel so good, but this will end up making you feel worse in the long run. “As the disorder progresses, people tend more towards mixed episodes, where they feel that excess energy, but it’s mixed with not wanting to sleep, and they’re really irritable and their mood is not great,” Solomon adds.
- Mood quickly becoming uncontrollable As much as elevated mood in mania may be appealing, especially if it follows a period of depression, the fact is, a manic episode can spiral out of control, according to NAMI. Your mood can shift from elated to irritable, and you can lose perspective as you behave impulsively and make reckless and risky choices.
Preventing or Managing Manic Episodes in Bipolar 1 Disorder
Manic episodes are actually not inevitable in people with bipolar 1. With the right treatment plan, you can effectively manage them. Some strategies to try to prevent manic episodes — or manage them if they do occur:
1. Practice interpersonal and social rhythm therapy and keep taking your bipolar medication. The best way to prevent a future manic episode is by taking your medication, practicing healthy lifestyle habits, and following a consistent schedule (also known as interpersonal and social rhythm therapy, or IPSRT). A study published in the Annals of General Psychiatry found that IPSRT is effective in improving bipolar disorder symptoms, because it lessens the disruptions of social and circadian rhythms, increases medication adherence, and helps you manage stressful events.
The idea of IPSRT is to regulate your mood using your natural social and biological routines to avoid manic or depressive episodes. Your therapist can teach you how, if they haven’t already. The basics are to follow a schedule, eat at regular times, practice good sleep hygiene and get adequate sleep, exercise regularly, and take your bipolar medication as prescribed, says Solomon.
2. Know the signs of a manic episode. “When you’re noticing you’re starting to get irritable or feeling especially fantastic, you might know from the past that you need to take a break, talk to your provider, use your rescue medication, and not do something that will get you into trouble,” says Solomon. An example of a rescue medication is something your doctor may prescribe to reduce your risk of a manic or depressive episode, such as sleep medication to make sure you get the rest you need, because inadequate sleep can be a trigger.
3. Start to learn your triggers. It can take some time to find out what’s likely to lead to a manic episode, as everyone’s triggers can be different. That said, some common triggers include sleep loss, alcohol, recreational drugs, and major life changes, such as a divorce or job loss, according to Cleveland Clinic.
Begin to take note of what happened right before you experienced an episode, or ask those who are close to you what they’ve observed. One way to do this is by keeping a mood diary. “While you’re doing that, you can see your provider more frequently, go to some support groups to learn from others, read about bipolar, and ask relatives who are also bipolar,” says Solomon.
4. Make amends. If you’ve already done something you didn’t mean to, go back and try to correct the issue as much as you can. You may need to apologize and take responsibility in order to repair a relationship, for instance.
Don’t get discouraged when you have a manic episode. Remember to take the best care of yourself that you can, and work with your therapist to manage the condition. “You deserve to take care of yourself, because bipolar can be really well controlled, and you can have a great quality of life,” says Solomon.