A manic episode is a period of at least one week when a person is high spirited or irritable in an extreme way most of the day for most days. A manic episode involves changes in normal behaviour, including showing exaggerated self-esteem or grandiosity, less need for sleep, talking more than usual, talking more loudly and quickly, being easily distracted, doing many activities at once, scheduling more events in a day than can be accomplished, embarking on risky behaviour, uncontrollable racing thoughts, and/or quickly changing ideas or topics. These changes in behaviour are significant and clear to friends and family and are severe enough to cause major dysfunction. A hypomanic episode is similar to a manic episode but the symptoms are less severe and need only last four days in a row. Hypomanic symptoms do not lead to the major problems that mania often causes, and the person is still able to function. The frequency and severity of manic or hypomanic symptoms vary from person to person, and may also vary according to whether the onset of bipolar disorder is in childhood, adolescence, or adulthood.

What is the evidence for mania symptoms in bipolar disorder?

Moderate quality evidence finds the most common mania symptoms reported in youths with bipolar disorder are (in decreasing order); increased energy, irritability, mood lability, distractibility, goal-directed activity, euphoric/elated mood, pressured speech, hyperactivity, racing thoughts, poor judgment, grandiosity, inappropriate laughter, decreased need for sleep, and flight of ideas. Moderate to high quality evidence finds irritability, aggression, and low insight are more common in youths than adults with bipolar disorder. Odd appearance, grandiosity, flight of ideas, decreased sleep, and increased sexual interest are more common in adults with bipolar disorder.

Moderate to high quality evidence finds having a positive family history of any mood disorder is associated with greater likelihood of switching to mania in children with major depression. Moderate quality evidence suggests having subthreshold symptoms of mania, emotional dysregulation, or behaviour problems are also associated with greater likelihood of switching to mania in children with major depression.

In adults with bipolar disorder, moderate to low quality evidence shows increased prior depressive episodes was associated with increased risk of antidepressant-induced mania.

September 2021

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