Mania is not simply depression flipped upside down
Mania is often pictured as the cheerful opposite of depression, but the elevated mood can just as easily be irritable and miserable. Some people even feel depressive symptoms in the middle of a manic episode, which has led clinicians to wonder whether the two are separate dimensions rather than opposite poles.
Psychiatrists describe mania as a syndrome of abnormally raised mood with hyperactivity and risky behaviour. The core signs include euphoric or irritable mood, ideas tumbling one after another, rapid pressured speech, surging energy and a reduced need for sleep; some people feel rested after only three or four hours. The US diagnostic manual requires the state to last at least a week for most of the day, unless it is severe enough to need hospital care. In the most serious episodes, typical of bipolar I disorder, psychotic features such as grandiose or paranoid delusions may appear.
Hypomania, meaning 'less than mania', is a milder form that may not impair daily life. Creativity has long been linked with it, but a review and meta-analysis concluded the connection is too broad an assumption and lacks solid evidence. Full mania is another matter: people may feel their goals trump everything and consequences hardly exist, leading to spending sprees, reckless driving, gambling or quarrels. Racing thoughts can swallow attention so completely that people lose track of time, and many deny anything is wrong.
The picture is complicated by mixed states, in which someone meets the criteria for a manic or hypomanic episode yet also has three or more depressive symptoms at once. That combination is especially dangerous, because low mood paired with extra energy and drive makes acting on suicidal impulses more likely. Clinicians also describe three stages, from hypomanic euphoria to acute and then delirious forms.
A single manic episode without another explanation is often enough to diagnose bipolar I disorder, while hypomania may point to bipolar II. Other causes must be ruled out: an overactive thyroid can produce similar agitation and energy, and mania can follow strokes affecting the right side of the brain, physical trauma or illness, deep brain stimulation for Parkinson's disease, or postpartum psychosis. Antidepressants are a common trigger for switching into mania, with tricyclic drugs generally carrying a higher risk, and some people notice symptoms cluster in spring.
Source: Mania
