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Mania symptoms: What are the early signs of mania?

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician
Updated Oct. 27, 2023  •  Published May. 17, 2023
Fact Checked
Mania symptoms

Overview: What does mania look like?

Mania is a condition that dramatically elevates someone’s mood, feelings, energy , and behaviors for several days or longer. People with manic symptoms feel highly energized and may seem elated or agitated. They can be overconfident or even feel they are invincible. They talk a lot more and a lot faster than usual. Their minds race, jumping from topic to topic. They often get hyperproductive, working much harder, much longer, and obsessively. They often need to move, fidget, pace, or do other things without purpose. They stop sleeping. Most concerning, they often get reckless and impulsive, doing things they would not usually do, like gamble too much, go on buying sprees, have sex with strangers, or commit a crime. In severe cases, they become psychotic: disconnected from reality, hearing voices, or seeing things that aren’t there. Sometimes, they can also have depressive symptoms. Most people experiencing mania don’t think there’s anything wrong. They feel on top of the world, happy, productive, and energetic. However, people who know them will notice that something is wrong. The person isn’t acting like their usual self and may be doing things that are dangerous to themselves or others. 

Key takeaways:

  • Mania is a common mental health condition that can affect anyone regardless of age, sex, race, or ethnicity. Find updated bipolar disorder statistics here.

  • Early signs of mania include sleeping less, increased energy, increased activity, extreme happiness, racing thoughts, talkativeness, irritability, self-confidence, anxiety, psychosis, reckless behaviors, and physical agitation (fidgeting and pacing).

  • Serious symptoms of mania, such as delusions, hallucinations, or extremely reckless behavior, may require immediate medical attention.

  • Mania is primarily caused by bipolar I disorder, but secondary mania can be caused by drugs such as antidepressants, substance use, thyroid disorders, lupus, infections, nerve disorders, or vitamin deficiencies. You may be at risk for developing mania symptoms if you have a family history of bipolar disorder or other mood disorders. Other risk factors include difficult life changes, stressful situations, poor sleep, some medical conditions, or taking certain types of drugs.

  • Mania  requires a medical diagnosis.

  • Mania  requires treatment. Mania symptoms typically resolve with treatment within weeks to months.

  • Treatment of mania may include mood stabilizers, antipsychotics, sedatives, psychotherapy, and electroconvulsive therapy. Read more about mania treatments here.

  • Untreated mania could result in complications such as significant damage to one’s life, health, career, relationships, and finances.

  • Use coupons for mania treatments like Depakote (divalproex sodium), lithium, Zyprexa (olanzapine), and Ativan (lorazepam) to save up to 80%

What are the early signs of mania?

Before most people with bipolar disorder experience a full manic episode, they will experience some milder  symptoms of mania. This early period can last from a few days to  months. 75% to 100% of people with bipolar disorder can identify at least one early symptom before a manic episode. 

According to one study, the most common early signs experienced before an upcoming manic episode  are:

  • High energy

  • Talkativeness

  • Excessive feelings of happiness

  • Racing thoughts

  • Irritability or anger

However, any symptom of mania can occur before a full manic episode.

Other mania symptoms

The symptoms of mania include

  • A prolonged period of unusually increased energy and elevated or irritated mood

  • An unusual increase in goal-directed behaviors

  • Unusual self-confidence, grandiosity, or feeling invincible

  • Feeling less of a need for sleep, sometimes sleeping very little

  • Unusual increase in talking or an inability to stop talking (pressured speech)

  • Racing thoughts

  • Distractibility

  • Purposeless or agitated physical activity like fidgeting or pacing around

  • Reckless behaviors such as overspending, gambling excessively, or sexual indiscretions

Mania vs. hypomania symptoms

Both mania and hypomania are diagnosed from the same symptoms. They differ only in their severity. Mania lasts longer and is more debilitating. Symptoms can be severe enough to require hospitalization. Hypomania can last for a shorter time and does not cause serious impairment or require hospitalization. 

A history of at least one episode of mania is enough for a diagnosis of bipolar I disorder. Hypomania is characteristic of bipolar II disorder and cyclothymia, conditions that are characterized by less severe swings between elevated mood and periods of depression.

Mania Hypomania
Shared symptoms
  • Persistently elevated mood or irritability
  • Increased energy
  • Increased activity
  • Increased goal-directed activity
  • Inflated self-esteem, overconfidence, or grandiosity
  • Talkativeness, rapid talking, or pressured speech
  • Decreased need or desire for sleep
  • Racing thoughts
  • Easy distractibility
  • Increased physical agitation such as pacing or fidgeting
  • Reckless, impulsive, and sometimes dangerous behaviors or decisions
Unique symptoms
  • Psychosis
  • Symptoms last at least seven days
  • Symptoms significantly impair occupational and social functioning
  • May require hospitalization
  • No psychotic symptoms
  • Symptoms last at least four days
  • Symptoms may or may not affect occupational and social functioning
  • Does not require hospitalization

Types of mania: How can I tell which one I have?

Euphoric mania and dysphoric mania are two different types of mania. They are also referred to as “mania” and “mixed episodes.” The names say it all: euphoria means “happiness,” and “dysphoria” means “unhappiness.” Euphoric mania is marked by increased energy and activity accompanied mainly by positive emotions. Mixed episodes are periods of increased energy accompanied by persistently negative feelings of irritation, anger, depression, or worthlessness. 

RELATED: Mental health stigma—and how to overcome it

When to see a doctor for mania symptoms

People with bipolar disorder should see a healthcare provider when symptoms of mania first begin to appear. Early signs of mania can last for weeks or months before a full manic episode. People who get early treatment often have the best outcomes. 

It can be a challenge to tell the difference between a change in energy or mood and the early symptoms of mania, especially in someone who hasn’t been diagnosed with a mood disorder. If high energy or new behaviors start to interfere with daily functioning, damage relationships, or make someone reckless, then it is time to talk to a doctor.

If a person in a manic episode starts seeing or hearing things that aren’t there or expresses bizarre beliefs about the world, it’s time to go to an emergency room. Call 911 if a person has thoughts of harming themselves or others.

Mania is diagnosed by a mental health professional. They will talk to the person having the symptoms as well as friends and family. They will then use the criteria defined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), the diagnostic manual for mental illnesses issued by the American Psychiatric Association. A complete medical history and family history will help determine if bipolar disorder is the correct diagnosis. Because mania might result from a medical condition or drugs, a complete physical examination,  blood and urine tests, and imaging studies could help spot possible causes. 

RELATED: What are the early symptoms of bipolar disorder?

Complications of mania

The most commonly experienced complications are the consequences of what someone does or says in a manic state. This may include job loss, relationship difficulties, loss of friends, divorce, arrest, criminal prosecution, and financial distress. Emotional complications are also common, including shame and embarrassment. Physical consequences of a manic episode may include substance abuse, injuries, or sexually transmitted infections. Some people may feel stressed or overwhelmed by the physical and emotional consequences of a manic episode. 

How to treat mania symptoms

A manic episode is primarily treated with medications such as antipsychotics and mood stabilizers. Benzodiazepines may be used to calm down very agitated people. In severe cases, electroconvulsive therapy (ECT) may help to treat mania.

Once the manic episode has passed, healthcare professionals will prescribe a maintenance treatment plan involving medications and psychotherapy. Medical treatment typically involves just one drug, either a mood stabilizer or an antipsychotic. If these don’t work, the doctor will prescribe two or more drugs or use ECT. Cognitive behavioral therapy (CBT), talk therapy, group therapy, and support groups are essential to preventing relapses and enjoying more prolonged periods of remission and wellness. 

Living with mania

If mania is due to a medical condition or the side effects of a drug, the symptoms will improve when the cause is addressed. If mania is due to bipolar disorder, then a number of tips can help to avoid relapses and better manage the condition:

  • Take all medications as instructed

  • Tell trusted family and friends about your illness and your experience with it

  • Choose one or two family members or friends whom you trust and have them intervene when they notice emerging symptoms of mania

  • Make a safety plan with trusted relatives or friends in case of violent or self-harming thoughts or behaviors

  • Avoid people or environments that invite bad choices like gambling, sexual indiscretions, or drug use 

  • Avoid stressful or stimulating situations

Most importantly, get support from trusted friends and loved ones

Studies have shown that about 1 in 2 people with bipolar disorder are partly unaware of their illness even after a diagnosis. About 1 in 5 are completely unaware of their illness or their symptoms.  This lack of awareness is called anosognosia.  It is a neuropsychiatric aspect of bipolar disorder and other severe mental health issues. Because early treatment for mania is more effective, early intervention by friends or relatives helps to significantly reduce relapses and improve overall well-being. Because of this, identify one or more people who can be fully trusted to alert them of the diagnosis and any related concerns. They will serve as your self-awareness. When someone says it’s time to see a doctor, trust them and do what they ask. Only a doctor can accurately diagnose early signs of mania and start the appropriate treatment.

RELATED: Finding the right medication for your mental health starts with finding the right doctor

FAQs about mania symptoms

What do manic eyes look like?

Most of us are skilled at reading faces, so it’s no surprise that happiness, changes in energy, or depression find some expression in the eyes. However, when we’re reading somebody’s mood, we’re also reading clues from the face, the posture, the way people speak, how they move, what they say, and what they do. Mania is never diagnosed by the appearance of the eyes alone. The diagnosis of mania and hypomania is made through a set of  observable behaviors. 

Do you crash after a manic episode?

A manic episode  may be followed by a period of depression.  Other people might not experience depressive episodes after an episode of mania, but may still feel embarrassed, ashamed, or distressed about things they did or said. Some people may still feel happy after an episode.

What can trigger a manic episode?

Although it’s never been conclusively proven, stressful events may trigger manic episodes. For this reason, people with bipolar disorder are advised to stick to a routine and avoid stressful situations or overstimulating environments.

What’s next? Additional resources for people with mania symptoms

Test and diagnostics

Treatments

Scientific studies and clinical trials

Medically reviewed by Anne Jacobson, MD, MPH
Board-Certified Family Physician

Anne Jacobson, MD, MPH, is a board-certified family physician, writer, editor, teacher, and consultant. She is a graduate of University of Wisconsin School of Medicine and Public Health, and trained at West Suburban Family Medicine in Oak Park, Illinois. She later completed a fellowship in community medicine at PCC Community Wellness and a master's in Public Health at the University of Illinois-Chicago. She lives with her family near Chicago.

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