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Treatments for Mania in Bipolar Disorder

Bipolar disorder is a serious diagnosis that affects more than 10 million Americans. Unlike depression, bipolar disorder is equally common in men and women. The onset of the condition typically occurs in the early 20s, but (although rare) the first symptoms can appear in early childhood or late in life.

Although some people may have only one episode, bipolar disorder is a lifelong condition that usually involves recurrent episodes. It's usually marked by episodes of mania or hypomania (low-grade highs) -- elevated mood and excessive energy and activity -- and depression, often with long periods of normalcy in between the mood swings.

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Doctors don't completely understand the causes of bipolar disorder, but they do understand the condition much better than they did 10 years ago. With that understanding has come targeted treatment.  Although there is no cure, its symptoms can be managed effectively.

 

Treating Bipolar Mania

If you have bipolar disorder, you may be having an episode of mania if you suffer three or more of these symptoms most of the day -- nearly every day -- for one week or longer:

  • Increased activity
  • Need less sleep to feel rested and energetic
  • Excessively high, overly euphoric mood
  • Racing thoughts
  • Talking very fast or talking more than usual; speech is pressured, loud, and often difficult to interpret
  • Inflated self-esteem or grandiosity -- unrealistic beliefs in one's ability, intelligence, and powers; may be delusional
  • Increased reckless behaviors (such as lavish spending sprees, impulsive sexual indiscretions, abuse of alcohol or drugs, bad business decisions, or reckless driving)
  • Distractibility

If you have four or more episodes of mania and depression in a year, it's known as "rapid cycling."

If you are suffering from mania, your doctor may initially treat you with an antipsychotic drug or benzodiazepine, a sedative, to quickly control hyperactivity, sleeplessness, hostility, and irritability.

Your doctor will also likely prescribe a mood stabilizer (antimanic drug). Mood stabilizers consist of a variety of drugs that help control mood swings, prevent recurrences, and reduce the risk of suicide. They are usually taken for a long time, sometimes indefinitely, and include lithium and certain anticonvulsant drugs like Depakote, Lamictal, or Tegretol. Very close medical supervision and blood tests may be needed during this approach to rapidly controlling a manic episode.

Treatment of severe mania often requires hospitalization as the risks for unpredictable, reckless behavior and noncompliance with treatment is high. For people with extreme mania, pregnant women with mania, or those people whose mania can't be controlled with mood stabilizers, doctors sometimes also recommend electroconvulsive therapy (ECT).

If mania occurs while on maintenance therapy for bipolar disorder, your doctor may simply change your medication dose or add an antipsychotic or other additional drug to lessen symptoms.

Nondrug treatments such as psychological therapy and establishing a well-ordered routine may help patients in their maintenance phase and are often suggested along with medication.

Here are summaries of each type of treatment:

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