Making It Through Mania
Counselor Eric Patterson and bipolar warrior Sharon Davis discuss ways to get through manic episodes.
Counselor Eric's Advice
People who do not have a solid understanding of bipolar disorder might see a bipolar manic episode in a distorted way. They may believe a manic episode is a welcomed reprieve from the low mood, hopelessness and guilt associated with depressive episodes. After all, manic episodes are marked by:
- An elevated mood
- Increased self-esteem
- Less need for sleep
- Being more talkative and social
- Increase in goal-directed behavior, meaning someone will work on a task until completion
Having a manic episode every month or so would be a great way to feel better and get more accomplished around the house, right?
Wrong. To the outsider, a manic episode sounds like the basis for a comedy movie, but to someone who knows the devastating impact, a manic episode is no laughing matter.
This is because the above symptoms are only part of the mania story. Other, more problematic symptoms include:
- Distractibility with more time spent on low-priority tasks
- Increased irritability
- Feeling agitated
- Increased involvement in dangerous tasks
The last item on the list is the most notable. When people are experiencing a period of mania, they are more likely to engage in risky behavior.
- Financial risk: This includes spending large amounts of money allocated for other expenses like rent, and bills, as well as incurring large amounts of credit card or other debts during the spending sprees.
- Physical health risk: Engaging in risky behaviors that put themselves or others in danger physically is a real concern. Often in mania, people will overestimate their abilities leading to some unwanted consequences.
- Sexual health risk: People in a manic episode are more likely to seek out sex and may do so with people they do not know well. This, paired with the decreased safe sex practices, can lead to the spread of sexually-transmitted diseases and unwanted pregnancies.
- Mental health risk: The above will negatively impact mental health indirectly by increasing long-term stress, but mania will worsen mental health by missing appointments and failing to take medications as prescribed.
Focus on Prevention
With the risks associated with manic episodes being so great, action must be taken to limit the impact. The primary measures focus on prevention.
By stopping symptoms from developing, you are left in a much better position. To practice prevention, you can:
- Maintain your medication. Medications only work when you take them as prescribed, so be sure to let your prescriber know how effective your medications are and what you like and don’t like about them.
- Stay consistent with therapy. Missed appointments are missed opportunities for you and your therapist to better understand your symptoms. Let your therapist know how therapy helps, as well as how it can be more beneficial in the future.
- Know your triggers. For some people, the triggers of their manic episodes are clear; it could be a sleeping change, a seasonal change or another stressor. By identifying your triggers, you can refocus your preventative measures when the time is right.
- Reduce stress. Shifting moods can be brought about by many changes, including increased stress. Spend more time actively working to shrink your stress through relaxation, spending time with friends, exercising, eating well, and getting plenty of sleep.
Focus on Reduction
Unfortunately, despite your best efforts you will never be able to prevent all manic episodes. When they come, choosing appropriate actions and reactions will be vital.
Build a Team
When a period of mania arrives, the symptoms will be largely beyond your control. You cannot make yourself stop being manic, especially since some of the symptoms will feel desirable.
Because of this, you will be well-served to build a team of supports around you. Friends, family, coworkers and mental health professionals will be ideal choices for the team.
Have a Game Plan
Now that you have a team, you need a game plan. What are your goals and how will your team help you achieve these?
Planning really needs to be preventative. By establishing a plan of attack based on your needs and wants, you allow your team to know what to do when the time comes.
Do you want your friends to lock your in your room or engage you in healthy coping skills? Should they encourage continued medication use and attendance in therapy or simply distract you from your symptoms?
The plan should focus on increasing the strategies that worked well last time and avoiding the ones that did not work well.
Being still and moving slowly may seem very difficult, but it is a task worth working on. Everything happens more quickly during a manic episode, so working to be still, stable and calm can help bring down the overall speed of your episode.
Sharon's Tips for Mania and Hypomania
Mania and hypomania are symptoms of bipolar disorder. Though the two terms sound similar, it’s important to know they mean different things.
Mania involves having tremendous energy and no need for sleep. Thoughts are often so rapid that they cannot be organized, leaving you in a state of confusion.
During a manic episode, people lose their inhibitions and sensibilities and can end up engaging in risky behaviors. Anger, irritability, paranoia, grandiosity are some of the emotional states associated with mania — these behaviors can frighten others or drive them away.
Once you enter a manic state, getting help can be difficult because you have a low degree of self-awareness and do not often seek treatment voluntarily.
Hypomania is a less severe form of mania and usually comes before a manic episode. Hypomania is generally associated with a good mood and can be an intoxicating part of the bipolar experience.
Fueled with unending energy, a sense of invincibility and a stream of ideas and emotions, hypomania is hard to resist. It comes on very strong and offers instant gratification.
Yet once hypomania crosses into mania, important life pillars may be destroyed. Employment opportunities, family and finances — things that take years to build up can easily be destroyed in a matter of weeks.
Managing a Manic Episode
Before you enter a manic episode, make sure you have supporters. Once you are fully engaged in a manic episode, it is often difficult to get help because you may not feel you need it.
Make sure you have a few people you trust to step in when you become hypomanic or manic. Although it is hard to surrender control over to others, think about your prior manic episodes and how beneficial a friend would have been.
Once you enter a state of hypomania, make an appointment with your psychiatrist. You may need adjustments in your medications in order to prevent going into full-blown mania.
As always, take your medication as directed and continue to communicate with your doctor if the adjustments are not working.
Turn to Your Supports
Plug into your support systems. Do you have a therapist or a support group? These resources can help you explore solutions to your mania or hypomania.
Plus, there is the added benefit that now more people know what you are going through and you have broadened your support base.
Each person’s struggle with mania/hypomania is unique and will manifest in different problems. Know your demons and seek appropriate help from your family and friends. For example:
- If you struggle with excessive spending, you may want to surrender your credit cards to a trusted friend once you start feeling hypomanic.
- If you struggle with the urge to go out and excessively drink or do drugs, go to a 12-step meeting or set up alternative plans with a friend.
- If you struggle with hyper-sexuality, call a friend or make alternative plans so you do not do something you will later regret.
If you are in a place of grandiosity (excessive thoughts of self-worth) you may consider expressing everything in the confines and safety of your journal. Emotions and ideas flow so freely during mania/hypomania that is easy to say something damaging.
Take Time Off
If needed, take a few days off of work. This can allow you to catch up on your rest or just work out some of your manic energy. Furthermore, it may keep you away from potential conflicts at work.
Work on Mind-Body Connections
Start practicing some mind-body exercises. The mind-body connection is the belief that your thoughts can be used to positively impact your body’s physical response and therefore decreasing stress.
These exercises include:
- Chi Dong
- Tai Chi
Develop a Bedtime Ritual
Lack of sleep accelerates a manic episode, while regular sleep can help keep it under control. To create better sleep, avoid computer use an hour before bedtime, spend some time in meditation or have a cup of tea.
When it comes to managing a manic episode, experience is probably the best teacher. But always stay open to the many people and resources around you!