What Is Mania? Symptoms of a Manic Episode

Mania is a distinct period, lasting at least a week, in which a person's mood is abnormally and persistently elevated, expansive or irritable and their energy and activity rise along with it. To count as a manic episode, at least three other symptoms must be present (four if the mood is only irritable), such as needing far less sleep, racing thoughts, nonstop talking or reckless spending. One manic episode is enough for a diagnosis of bipolar I disorder. Because the person often feels wonderful, the people around them usually notice first.

If someone is manic right now

If the situation is not an emergency but is clearly getting worse, call the person's prescriber today. The steps further down this page are things family can do while help is on the way.

What makes an episode "manic"

Clinicians use the criteria in the DSM-5-TR, summarized in the Merck Manual. Three elements have to come together. First, a change in mood: elevated, expansive or irritable, most of the day, nearly every day. Second, a rise in activity or energy; DSM-5 added this in 2013 so that mood alone would not carry the diagnosis, according to the American Psychiatric Association. Third, a time rule: at least one week, or any length if the person needs to be hospitalized.

On top of that, the episode must be serious: it causes marked trouble at work, school or home, includes psychotic symptoms, or leads to a hospital stay. The APA describes the behavior changes as clear to friends and family, which is a useful test. A good weekend or an energetic personality is not mania.

The symptoms, in plain language

Some clinicians remember the list with the mnemonic DIGFAST. It is a teaching aid, not a test, but it maps neatly onto the DSM symptoms Merck lists:

Merck also describes a lack of insight: people in a manic episode tend to believe they are in their best mental state. That is why arguing about whether they are "sick" rarely works, and why family observations matter so much at an evaluation.

Mania that looks like anger

Mania is not always euphoric. When the dominant mood is irritable, the criteria require four additional symptoms instead of three. In practice this can look like constant arguments, a hair-trigger temper, or feeling persecuted when others try to slow the person down. Merck notes that this friction can leave a person feeling unjustly treated and can become dangerous.

Irritability alone is common and has many causes, so it never makes the diagnosis by itself. What clinicians look for is irritability that arrives together with less sleep, more energy and racing speech, as a change from the person's usual self. For more on this pattern, see bipolar disorder and anger.

When mania includes psychosis

Severe mania can tip into psychosis. A review in Current Psychiatry Reports found that more than half of people with bipolar disorder have psychotic symptoms at some point, and grandiose delusions are the most common kind: believing one is famous, chosen or able to do impossible things. NIMH notes that in bipolar disorder these symptoms tend to match the extreme mood.

Psychosis settles one question: an elevated episode with psychotic features is mania by definition, never hypomania. It is also a reason for emergency care. Our page on psychosis in bipolar disorder explains mood-congruent and mood-incongruent features and what follow-up looks like afterward.

Mania versus hypomania

Hypomania involves the same kinds of symptoms but is shorter (at least four days rather than seven) and milder: no psychosis, no marked impairment and no hospital stay. A person who has had even one full manic episode is diagnosed with bipolar I disorder; a pattern of hypomania plus major depression is bipolar II. The hypomania guide covers the signs people tend to overlook.

Mania set off by a drug or a medical condition

Not every manic episode starts on its own. Merck describes a substance- or medication-induced category, in which mania develops during or soon after exposure to, intoxication with, or withdrawal from a substance such as cocaine or a corticosteroid. In people who already have bipolar disorder, Merck lists these as possible triggers:

• Stimulants and other sympathomimetics, such as cocaine and amphetamines
• Alcohol
• Corticosteroids (for example, prednisone bursts for asthma or a flare of an autoimmune illness)
• Certain antidepressants, especially when used without a mood stabilizer

Dopamine agonists, an overactive thyroid and, rarely, an adrenal tumor called pheochromocytoma can also produce manic-like symptoms. That is why Merck recommends thyroid tests (T4 and TSH) and checking for stimulant use in new patients. NIMH adds that treating a first depression with an antidepressant alone can trigger mania; antidepressants and bipolar disorder explains how prescribers handle that risk.

A substance can also simply be the spark in someone who has bipolar disorder anyway. Clinicians therefore ask whether manic or depressive symptoms have ever appeared without a drug involved. See bipolar disorder and substance use for alcohol and cannabis.

What family can do tonight

If the person is not in immediate danger but is clearly escalating, these steps help keep things calmer and safer until professional help is in place:

1. Stay calm and keep sentences short. Speak slowly. Do not debate grandiose ideas; acknowledge feelings ("you seem really energized") without agreeing or mocking.
2. Turn the volume down. Fewer people, less noise, screens off, lights low. Stimulation feeds mania.
3. Protect sleep. Encourage rest in a dark, quiet room, even if they do not feel tired. Avoid caffeine and alcohol in the house.
4. Reduce the damage. If it can be done safely and without a fight, hold on to car keys, credit cards or checkbooks for the night.
5. Secure dangerous items. Lock up or remove firearms and stockpiled medications.
6. Write things down. Note when sleep changed, what was spent, what was said, and every medication or supplement taken. Clinicians will ask.
7. Make the call. Contact their prescriber, or call or text 988, or chat at 988lifeline.org for advice. If danger appears, call 911 rather than driving them yourself.

Look after yourself as well. Caregivers of people in a manic episode are often running on no sleep, and 988 counselors talk with family members too.

After the episode: why treatment continues

Acute mania is usually treated with medication, sometimes in the hospital. The CANMAT/ISBD 2018 guidelines list lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone and cariprazine as first-line single-medication options for acute mania, and NICE recommends lithium as the first-line long-term treatment. Which option fits a particular person is a decision for their prescriber; bipolar medications explained gives an overview.

NIMH describes bipolar disorder as an illness that usually needs lifelong treatment. Stopping a mood stabilizer suddenly raises the risk of relapse, so changes should always be planned with the prescriber. Willow & Stone provides outpatient, scheduled care and is not an emergency service. Once someone is stable, bipolar disorder treatment at Willow & Stone offers evaluation and ongoing outpatient care; if a higher level of care is needed, we help you find it. For the bigger picture, see the complete guide to bipolar disorder.

Common Questions

Sources & Further Reading

• Merck Manual Professional: Bipolar Disorders (reviewed Jan 2026)
• American Psychiatric Association: What Are Bipolar Disorders? (2024)
• APA: Highlights of Changes from DSM-IV-TR to DSM-5 (2013)
• NIMH: Bipolar Disorder (NIH Pub. 25-MH-8088, 2025)
• Dunayevich & Keck, Prevalence and description of psychotic features in bipolar mania, Curr Psychiatry Rep 2000
• Yatham et al., CANMAT and ISBD 2018 guidelines for bipolar disorder
• NICE CG185: Bipolar disorder, recommendations (updated 2 Sept 2025)

This article is general education, not a diagnosis or advice for your situation. Do not start, stop, or change a medication without talking to the clinician who prescribes it; stopping a mood stabilizer suddenly can trigger relapse.