Manic Phase of Bipolar Disorder

Bipolar disorder is defined by two phases that cycle back and forth -- mania and depression. Since depression is also an independent diagnosis that affects many people, that phase is more self-explanatory ... low energy, less interest in life, and generally feeling "down." The symptoms of the manic phase are less well known.

Manic Phase According to DSM IV

• According to the Diagnostic and Statistical Manual of Mental Disorders, the manic phase of bipolar disorder is a distinct period lasting at least one week in which mood is persistently elevated, expansive or irritable. During this period three or more of the following symptoms must also be present: inflated self-esteem, decreased need for sleep, more talkative than usual, racing thoughts, distractibility, increased activity level, and involvement in activities with potentially negative consequences, such as spending sprees or gambling.

The Real-Life Picture

• So what do these symptoms look like in real life? At its simplest, the manic phase is marked by energy and activity that are elevated to the point where they are uncontrollable. This person can't stop talking even though they may not express their thoughts well due to the number of thoughts raging through their head. They literally may not be able to stay still very long much less sleep well. While this may be bothersome to family and friends, the person in a manic phase generally believes they are doing better than ever before ... that they are more intelligent or more creative. In fact, they may begin to believe they are invincible. It is possible that they may become delusional or paranoid. In its most extreme, the manic phase may result in a psychotic break.

Manic Phase - The Bad Side

• A person in the manic phase of bipolar disorder may have an elevated happy mood ... or an irritable angry mood. It is possible for a manic mood to escalate and result in the person with bipolar disorder inflicting child or spousal abuse or exhibiting other violent behavior. While each person will manifest a different combination of symptoms, the bottom line is that the manic phase causes behaviors that interfere with daily functioning. This appears in the form of problems at home, school, or work and potentially as antisocial behavior.

Bipolar Features

• Bipolar disorder tends to run in families. The first manic episode typically follows a major depressive phase. Statistics show that 90 percent of individuals who have one manic episode will go on to have future episodes. Cycling between the depressive and manic phases differs for each person and according to the sub-type of bipolar disorder that is diagnosed. Some may experience four episodes over ten years while others will have four or more in one year.

Treatment

• The first line of treatment is medication to stabilize the manic phases. Lithium is the first medication of choice because it has a proven history of reducing the severity and frequency of manic episodes. Depakote, Tegretol, Lamictal and Trileptal are anticonvulsants that help to prevent mania and depression. Antipsychotics may also be used to control rapid cycling of mania as well as rage or aggression. Psychological therapy -- cognitive behavior therapy, interpersonal psychotherapy, and interpersonal and social rhythm psychotherapy (IPSRT) -- can be implemented to help the individual learn to manage the emotional and behavioral issues related to bipolar disorder.