Coping with Mania

Mania is a symptom associated with bipolar 1 disorder. You may experience the following during a manic episode:

• abnormally elevated mood
• persistently irritable mood
• unusually energetic mood

The DSM-5 is a medical reference commonly used by healthcare professionals to aid in diagnosis. According to this reference, to be considered a manic episode, your symptoms of mania must last at least a week, unless you’re hospitalized. Your symptoms may last less than a week if you’re hospitalized and successfully treated.

During a manic episode, your behavior is very different from normal behavior. While some people are naturally more energetic than others, those experiencing mania have an abnormal level of energy, irritability, or even goal-directed behavior.

Some of the other symptoms you may experience during a manic episode include:

• feelings of inflated self-esteem and self-importance
• feeling like you don’t need sleep, or need very little sleep
• becoming unusually talkative
• experiencing racing thoughts
• being easily distracted
• engaging in risky behaviors, such as shopping sprees, sexual indiscretions, or making big business investments

Mania can cause you to become psychotic. This means you have lost touch with reality.

Manic episodes shouldn’t be taken lightly. They affect your ability to perform as usual in work, school, and social activities. Someone experiencing a manic episode may need to go to the hospital to keep from hurting themselves.

Manic episodes can vary from person to person. Some people can recognize they’re heading toward a manic episode, while others may deny the seriousness of their symptoms.

If you experience mania, in the heat of the moment, you probably won’t realize you’re having a manic episode. So, perhaps the best way to cope with mania is to plan ahead. Here are some steps you can take to prepare.

Reach out to your healthcare team

The first and most important thing to do if you think you have manic episodes, is to reach out to your mental health provider. This could include a psychiatrist, psychiatric nurse practitioner, counselor, social worker, or other mental health professional. If you’re worried that you’re close to the onset of a manic episode, contact your mental health provider as soon as possible to discuss your symptoms.

If you have a loved one or family member who is familiar with your illness, they may also help you receive support.

Identify medications that help

Healthcare providers typically treat acute manic episodes with medications known as antipsychotics. These drugs can reduce manic symptoms more quickly than mood stabilizers. However, long-term treatment with mood stabilizers can help prevent future manic episodes.

Examples of antipsychotics include:

• olanzapine (Zyprexa)
• risperidone (Risperdal
• quetiapine (Seroquel)

Examples of mood stabilizers include:

• lithium (Eskalith)
• divalproex sodium (Depakote
• carbamazepine (Tegretol)

If you’ve taken these medications in the past and have some understanding of how they work for you, you may want to write down that information in a medication card. Or you could have it added to your medical record.

Avoid triggers that worsen your mania

Alcohol, illegal drugs, and mood-altering prescription drugs can all contribute to a manic episode and affect your ability to recover. Avoiding these substances can help you maintain your emotional balance. It may also help make recovery easier.

Maintain a regular eating and sleeping schedule

When you’re living with bipolar disorder, having structure in your daily life is vital. This includes following a healthy diet and avoiding caffeine and sugary foods that could affect your mood.

Getting enough regular sleep can also help you avoid manic or depressive episodes. In addition, it can help reduce the severity of any episodes that do occur.

Watch your finances

Going on spending sprees can be one of the major symptoms of mania. You can cope with this by limiting how easily you can access your finances. For example, keep enough cash to maintain your everyday lifestyle around your home, but do not have extra cash readily available.

You also may want to keep credit cards and other spending methods in places where they’re more difficult to use. Some people find it helpful to give their credit cards to a trusted friend or family member, while others avoid obtaining credit cards altogether.

Set up daily reminders

Create reminders for taking your medications and maintaining a regular bedtime. Also, consider using phone or computer notifications to help you keep your schedule.

In the recovery period, it’s time to start regaining control over your life and schedule. Discuss with your mental health provider and loved ones what you’ve learned from the episode, such as possible triggers. You can also start reestablishing a schedule for sleeping, eating, and exercising.

It’s important to think about what you can learn from this episode and how you can help yourself in the future. This will help you engage later in mania prevention.

Following a manic episode, many people gain insight into what may lead to their episodes. Examples of common mania triggers can include:

• drinking alcohol or abusing illegal drugs
• staying up all night and skipping sleep
• hanging out with others known to be an unhealthy influence (such as those who typically try to convince you to use alcohol or drugs)
• going off your regular diet or exercise program
• stopping or skipping your medications
• skipping therapy sessions

Keeping yourself on a routine as much as possible can help reduce manic episodes. But keep in mind that it won’t prevent them altogether.

If you or a loved one has bipolar disorder, there are certain key preparations you may wish to make.

Wellness recovery action plan

A “Wellness Recovery Action Plan” helps you account for important decisions and contact persons you may need if you get into a crisis. The National Alliance on Mental Illness recommends these plans as a means to avoid a crisis or have easy resources to reach out to. Examples of items on this plan include:

• phone numbers of key family members, friends, and/or healthcare providers
• phone numbers of local crisis lines, walk-in crisis centers and the National Suicide Prevention Lifeline at 1-800-273-TALK (8255)
• your personal address and phone number
• medications that you’re currently taking
• known triggers for mania

You can also create other plans with trusted family members or loved ones. For instance, your plan can record decisions about who will handle certain things during an episode. It might record who will take care of important tasks such as paying your bills or feeding your pets. It can also record who will manage financial details, such as finding sales receipts or making returns if spending sprees become a problem.

Psychiatric advance directive

In addition to your Wellness Recovery Action Plan, you can create a Psychiatric Advance Directive. This legal document appoints a family member or loved one to act on your behalf while you’re experiencing a manic or depressive episode. Doing this can ensure that your wishes, such as where you’d like to be taken if you need to be hospitalized, are carried out if you’re in crisis.

Fire drill

You can also think about holding a “fire drill” for a future manic episode. This is a simulation where you imagine you’re going into a manic episode. You can practice who you would call, and ask them what they would do to help you. If you find any missing steps in your plan, now’s the time to fix them.

Seeking help

While no one likes to think about manic episodes, it’s important to be aware of them and seek support in advance. Examples of organizations that can help include the National Alliance on Mental Illness (www.NAMI.org) and the Depression and Bipolar Support Alliance (DBSAlliance.org).

If you experience mania, you can take steps to decrease your risk of having episodes, such as following your treatment plan and avoiding triggers. These steps can help reduce the number and severity of your episodes.

But because you can’t prevent manic episodes entirely, it also helps to be prepared. Stay connected with your healthcare team, make decisions in advance of manic episodes, and be ready to reach out for help when you need it. Preparing for a manic episode before it happens can help you manage your condition and live more comfortably with bipolar disorder.