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When Bipolar Mania Gets Out of Control

For many with bipolar disorder, mania feels dangerously good.
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WebMD Feature

There's no denying the exhilaration that mania brings. For many with bipolar disorder, there's a period of denial -- a disbelief that the wonderful surge of energy and euphoria marks a disease that truly needs treatment.

"Mania is a fascinating thing ... it's the brain creating its own hormonal high," says Carrie Bearden, PhD, a clinical neuropsychologist and assistant professor of psychiatry at UCLA. "Most people first become manic in their early 20s, at a time in life when they're not thinking about death, when they feel immortal."

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Bipolar Disorder: Tips for Family and Friends

Ongoing treatment -- both psychotherapy and medication -- is essential to controlling the mood swings of bipolar disorder. How can family members help their loved one stick with treatment? "Learn as much as you can about the disease," says Kay Redfield Jamison, PhD, professor of psychiatry at John Hopkins University School of Medicine and author of An Unquiet Mind. "Read and read some more. Join support groups. You'll get emotional support and information you need." Also, learn to watch for...

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Indeed, some degree of risky business is the hallmark of mania. Erratic driving and out-of-control spending sprees are common. It's a time when flashy business ideas are borne, torrents of phone calls made.

And yet, that's not true for everyone. There are several types of bipolar disorder, and all involve episodes of mania and depression -- but to varying degrees.

  • With bipolar I, there are severe mood swings.
  • With bipolar II and cyclothymic disorder, there are milder versions of the illness.
  • Mixed bipolar is both mania and depression at the same time -- a dangerous mix of grandiosity, racing thoughts, yet irritable, moody, angry.

People often believe that mania feeds their creativity. The incidence of bipolar disorder is high among poets and writers, Bearden tells WebMD. "A lot of people feel they are most productive during this time. You're up, feeling good, energetic. A lot of patients I've seen, even if they are not in a creative field, pursue some sort of creative endeavor -- writing songs, playing music, writing screenplays."

However, "that simple euphoria doesn't really last," she explains. "It's not like you can hover there. And that's the hardest thing for people to deal with. Frequently it takes people a while to realize that they need to be on medication. It's a trade-off of losing some euphoria to become more stable."

When Bipolar Mania Gets Out of Control

A lot of bad decision-making can happen during the manic phase, Bearden tells WebMD. "It can ruin lives and relationships. There can be extreme irritability. You start yelling at strangers on the street. That's often why they're brought in by police, if they're causing a big disturbance, if they get into a fight in a bar or something like that."

"Insight is not the middle name of mania," says Kay Redfield Jamison, PhD, professor of psychiatry at Johns Hopkins University School of Medicine and author of An Unquiet Mind and other books on bipolar disorder.

"Most manic episodes are highly unpleasant," Jamison tells WebMD. "Even people who get euphoric can end up having terrifying experiences. Some people recognize when it becomes destructive, but certainly not everyone. That's when the family and the law come in."

Many people begin treatment via a trip to the hospital ER -- often, against their will. "To be quite honest, if someone were experiencing only the manias -- even if they recognize things are bad -- it would be difficult to convince them they need to be on medications," Bearden says.

While depression is difficult for anyone, it's especially traumatic if you have bipolar disorder, she tells WebMD. "It's such a dramatic change from the mania. And if the depression becomes very, very severe, people may become suicidal. That's why a lot of people come for treatment. At that point, people realize they need to be on medication for the depression -- and to take the edge off the highs as well."

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