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Navigating mania: understanding the highs and lows of a face of bipolar disorder
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Navigating mania: understanding the highs and lows of a face of bipolar disorder

Experts tell us about mania, which is associated with bipolar disorder, and how to diagnose and address it with focussed strategies
Girl experiencing mania
Representational image | Shutterstock

Mania, a face of bipolar disorder, is an episode that is the opposite of depression and similar to glucose swings in diabetes, says Dr Krishna Prasad M of the National Institute of Mental Health and Neuro Sciences (NIMHANS,) Bengaluru.

The National Mental Health Survey of India report from 2015-16 found that 0.5 per cent people’s lifetime prevalence of bipolar disorder has been reported to be 0.5 per cent. “Individuals experiencing mania remain in a state of high, without a reason. These bouts of energy make the individual feel as if “thoughts are racing” in their mind, which at times reflects in their fast, almost illegible speech, says Chandigarh-based Mahima Sahi, chief psychologist at heyy – a mental healthcare app.

A manic episode, as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), lasts at least one week and is characterised by a high, expansive, or agitated mood – or any duration if hospitalisation is necessary.

Types of mania

Hypermania and hypomania are characterised by elevated or irritable mood, increased energy and activity levels. “Hypermania and hypomania are both symptoms of bipolar disorder but the main difference between the two is in the severity of their symptoms,” says Sahi.

  • Hypermania, full-blown mania or frank mania, is a severe form of mania. During an episode of hypermania, affected persons may experience intense and persistent symptoms that interfere with their ability to function normally. They may also experience hallucinations or delusions, which can be distressing and confusing.
  • Persons experiencing hypomania may experience elevated mood, increased levels of energy and activity. But these symptoms are typically not as severe or persistent as those experienced during an episode of hypermania. The persons may also be able to function normally in their daily life.

What causes an episode

Dr Prasad and Sahi list a few causes of mania.

Psychological causes:

  • Stress: People who are predisposed to bipolar disorder may experience mania as a result of stressful life circumstances like a traumatic event or loss.
  • Cognitive biases: Mania-prone individuals may exhibit faulty thought processes, such as excessive self-assurance, overconfidence or a tendency for making unrealistic plans beyond what may be possible to them.
  • Substance usage: Mania can be caused by the abuse of stimulants like cocaine or amphetamines.

Biological causes:

  • Genetics: Mania has a strong hereditary component, making those with a family history of the condition likely to develop it themselves.
  • Neurochemical imbalances: Mania is associated with abnormalities of neurotransmitters dopamine and serotonin – substances that aid signal transmission in the brain.
  • Hormonal imbalances: Mania may also develop as a result of hormonal imbalances, such as those that occur during pregnancy or menopause.

Symptoms

Here are some symptoms, as listed by Dr Prasad and Sahi:

  • Inflated self-esteem or grandiosity
  • Decreased need for sleep
  • More talkative than usual or pressured to keep talking
  • Flight of ideas or subjective experience that thoughts are racing
  • Persons get easily distracted: their attention is easily drawn to unimportant things
  • Excessive planning and risk-taking
  • Increase in goal-directed activity – either socially, at work or school, or sexually – or psychomotor agitation (a feeling of agitation and anxiety that causes involuntary, repetitive motions)
  • Excessive involvement in pleasurable activities that have a high potential for painful consequences

According to Sahi, to be diagnosed with a manic episode, these symptoms must be severe enough to interfere either with daily functioning, with or without a need for hospitalisation.

How is mania diagnosed?

“Mania is diagnosed by a psychiatrist based on the history of the person or others who have observed the person reliably for more than a week at least,” says Dr Prasad.

Sahi says that to diagnose mania, a mental health professional typically needs to follow these methods:

  1. Make a thorough evaluation, including mental health history and physical examination.
  2. Assess the severity and duration of the symptoms and their impact on the individual’s daily functioning and relationships.
  3. Consider possible causes of the symptoms, such as medical conditions, substance abuse or medications.
  4. Use diagnostic criteria from the manual, DSM-5, to determine whether the individual meets the listed signs and symptoms.

How is it treated?

A combination of prescribed medications and psychotherapy is used to treat mania. Experts urge that anyone experiencing such symptoms should seek help from a medical expert.

The treatment plan will depend on the severity of symptoms and the individual’s needs and preferences.

An integrated approach to mania

Dr Kishore Kumar Ramakrishna, a professor of ayurveda at NIMHANS, explains that both ayurveda and yoga view mania as a type of unmada, a psychological condition. Its principal cause is the abnormal hyperactivity of the body’s air element (called vata dosha) and rajas a type of mental energy that causes aggression or hyperactivity.

Speaking about holistic ways to manage mania Dr Ramakrishna says, “Holistic ways of treating mania include spiritual therapies, pharmacological intervention, and enhancing one’s coping mechanisms and reducing the negative behaviour through ayurvedic and yogic counselling.”

In addition, asana and pranayama modules are known to control the mind and air element.

Ways to prevent it

According to Sahi, there is no sure shot way to prevent mania, as the exact causes of the condition are not fully known. However, individuals with mania can take certain steps as follows to reduce the risk of having an episode:

  • Complying with treatment: Taking medications as prescribed and attending therapy sessions regularly
  • Establishing a regular routine: Maintaining a consistent sleep schedule and engaging in regular activities
  • Avoiding triggers: Identifying and avoiding triggers that may lead to a manic episode, such as stress, substance abuse, or certain medications
  • Managing stress: Engaging in stress-reducing activities such as exercise, meditation or deep breathing
  • Seeking support: Friends, family, or a support group can make it easy to face the challenges of living with mania.

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