Bipolar Disorder: Just Another Manic Monday? How to Tell if You or A Loved One Has Mania

By Tracy Latz

Is There Such a Thing as ‘Manic Season’?

Many of my patients who have been diagnosed in the past with Bipolar Disorder have heard me ask them during their visits with me in the early spring season: “How has your mood been? You know we are now in ‘Manic Season’.”

Mania can actually occur any time of the year if one is given the “perfect storm” of situational stress or sleep deprivation. However, just as depression can often be more prevalent in the darker months of late fall and winter, mania too is often associated with the season of spring with the rapidly increasing length of daylight hours. The decrease in exposure to daylight in the fall/winter months can lead to a decrease in the production of neurotransmitters serotonin and/or dopamine for many sensitive people which can in turn be experienced as depression or anxiety- also known as Seasonal Affective Disorder (see our post on SAD).

The increase in exposure to sunlight in the spring (from about March 1st until about the end of May) can lead to an increase in the production of serotonin and/or dopamine in some sensitive individuals to create feelings of euphoria. This can lead to what many people sense as a slight boost in energy and elevation in mood known as ‘spring fever‘ or it can cause some people to have a more marked increase in mood and energy level known as ‘hypomania‘ that can eventually lead to full-blown ‘mania‘ where a person can then become quite angry or irritable – or even violent. A person in a full manic episode may begin to feel so out of control due to their thoughts or behaviors that they may begin to feel trapped and that suicide is the only way out.

What Are the Symptoms of Mania?

• Experiencing for most of the day (nearly every day) for a period of at least a week of abnormally and persistently elevated/expansive (excessive happiness/joyfulness out of the realm of norm for the circumstances), euphoric  or sudden irritable/angry/hostile mood

• During the period of mood disturbance at least 3 of the following symptoms (4 if the mood is only irritable) have been present to a significant degree:

1. Inflated sense of self or grandiose thinking
2. Decreased need for sleep (feels rested after just 2 to 4 hours of sleep)
3. More talkative than usual or has an internal pressure to keep talking (rapid speech that is difficult to interrupt)
4. Flight of ideas (jumps from one thought to another in an unrelated manner) or a subjective report of the person that their thoughts are racing from one to another
5. Distractibility (attention easily shifted to unimportant or irrelevant external stimuli)
6. Marked boost in energy level/activity (social, work, school or sexual) or significant agitation
7. Excessive involvement in pleasurable activities or risky behaviors that have a high potential for painful consequences (spending money on buying sprees that cannot afford, gambling, high sex drive, sexual indiscretions, or foolish business investments)

• Symptoms have been severe enough to cause marked impairment in ability to function at work or school, in usual social activities, or in relationships with others; or severe enough to be hospitalized to prevent harm to self or others

• Severely manic people can become psychotic (seeing things/hearing things others cannot see, experiencing increasing paranoia, preoccupation with political or religious ideation to the exclusion of usual activities, having an inability to connect thoughts to form intelligible sentences, or believing they have “special powers”)

• Symptoms are NOT initiated and maintained by a known organic cause such as illicit or prescription drugs causing a mood disturbance

Hypomania is a much milder form of mania where there is only mild disturbance in ability to function and there is no psychosis involved.  In hypomania the fast ideas, increased creative bursts of activity, feelings of elevated confidence, boosted sensuality, and euphoria is exciting and the tendency is to want to continue to experience that state of mood.However, it is nearly impossible to “ride the crest of the hypomanic wave” without crashing into either full-blown mania or depression. Many historically well-known artists, musicians and performers have had some of their most creative work manifest during periods of hypomania.

What If I (or my Loved One) Has Bipolar Disorder: What are the Early Warning Signs of Mania?

1. The first thing that I tell my patients or family members of patients to look out for is a decreased need for sleep. It is time to take action (call the treating provider or take something other than alcohol or illicit drugs to assist with sleep) if a person with a known diagnosis of Bipolar Disorder is sleeping 4 hours or less for 3 nights in a row.
2. Stress may trigger mood disturbances – become aware of and monitor for mood changes during periods of time with increased stress. NOTE: Stress may be good (weddings, births, celebrations, holidays, promotions, positive moves, etc) OR stress may be bad (death, loss of job or relationship, divorce, physical illness, surgery, etc).
3. Increased energy or increased talkativeness
4. Increasingly impulsive behaviors

What Can I Do To Help Stabilize My (Or My Loved One’s) Mood?

1. Consider evaluation by a trained mental health professional to discuss the risks and benefits of use of mood stabilizing medication, psychotherapy, or other treatments as well as to assess for suicidal or homicidal thoughts and psychosis.
2. Good, well-balanced nutritional intake with avoidance of highly processed, high sugar or caffeine-containing foods or beverages. A diet with good hydration and a balance of daily essential vitamins, protein, reasonable amount of carbohydrates and omega-3 fatty acids can assist with stabilizing mood.
3. Avoid alcohol or opiates/pain pills (while it may initially cause sedation or drowsiness, it tends to eventually fuel either mania or a crash into depression)
4. Avoid psychoactive substances or hallucinogens- while this may seem obvious at first, I have seen many people who will intentionally use cannabis (pot, marijuana) to attempt to “relax” yet the effect in bipolar disorder actually worsens paranoia or psychosis. I also have seen many bipolar patients who will intentionally us pot, hallucinogens, or speed/cocaine to attempt to get into a hypomanic state in an attempt “feel that good again”.
5. Avoid stress – develop a daily centering practice such as meditation, qigong, yoga or time spent walking calmly in nature. We live in a busy, hectic world and it is important for all of us to become quiet and go within in a mindful, centering manner to restore our inner peace daily.
6. Regular exercise – this helps us burn off excess energy during the day and feel tired at our regular bedtime at night. It can assist with resetting our natural internal biorhythms, including our sleep-wake cycles.

Is Mania the same thing as a Mixed Manic Episode?

No, during a manic episode, the symptoms include only the ones listed in the above “Symptoms of Mania”. During a Mixed Manic Episode, a person experiences symptoms of BOTH depression and mania- which can be confusing to both family members, the person with the symptoms and to primary care physicians who may not have been trained to look for this condition. Often the patient will complain or feeling depressed, yet the family members and the treatment provider who spend an hour with the person will begin to see signs of mania such as irritability, mood lability (rapid shifting from sadness to anger to inappropriate laughter or silly behavior). If asked in an interview, the person will begin to let you know of decreased sleep (4 hours or less per 24 hour period) and other signs or symptoms of mania in addition to depressive symptoms. If the manic side is missed and the person is only treated with an antidepressant, they are at high risk for becoming fully manic and possibly paranoid or psychotic.

Is Bipolar Disorder the same thing as Cyclothymia or Borderline Personality Disorder?

No. Cyclothymia is often considered a milder form of Bipolar Disorder. The hallmark is that for a period of at least 2 years there is a presence of numerous hypomanic episodes and numerous periods with depressed mood or loss if interest or pleasure in usual activities that do not meet criteria for a major depressive episode. The repetitive mood disturbances typically last for only a few days and are not solely attributable to reaction to stress or external stimuli or substances.

Borderline Personality Disorder is not the same as Bipolar Disorder either. Bipolar Disorder is considered a major mental illness while Borderline Personality Disorder is considered to be a “characterological” or personality disorder. I have never liked the term “personality disorder” as it seems to denote an idea that someone has a defective personality. What it really is referring to is a pattern of maladaptive coping strategies and ways of thinking about one’s self and the environment that can cause dysfunction at work, school, in the family, social or intimate relationships. I have seen many people with Borderline Personality Disorder who were misdiagnosed with Bipolar Disorder. You can see mood swings with both conditions; however, the mood swings in Borderline Personality Disorder are short-lived (only lasting usually a few hours and rarely more than a few days) and tend to be due to emotional reactivity to an environmental or relationship stressor.

Hope this is helpful! These are the questions family members and patients most often ask me about Mania, Bipolar Disorder & Borderline Personality Disorder.

Happy (and a Balanced Healthy) Spring to you all!

Tracy Latz, M.D., M.S. (a.k.a. one of “The Shift Doctors”)

- To learn more about “The Shift Doctors”, their books, videos & meditation CD’s visit www.shiftyourlife.com   **The Shift Doctors (Tracy Latz, M.D. & Marion Ross, Ph.D.) are available for keynote talks, classes, events or for seminars (1/2 day or up to 2 day) on personal transformation, team-building, motivation, anger management, intuitive development, or collaboration for private groups, conferences, corporations or corporate events. Contact them at info@shiftyourlife.com or find out more about them at www.shiftyourlife.com .

Source: Shift Your Life