A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood together with abnormally and persistently increased activity or energy.
The episode lasts at least 1 week and is present most of the day, nearly every day, unless hospitalization is required sooner.

During the period of mood disturbance and increased energy or activity, 3 or more of the following symptoms are present to a significant degree, or 4 if the mood is only irritable:
Inflated self-esteem or grandiosity.
Decreased need for sleep.
More talkative than usual or pressure to keep talking.
Flight of ideas or racing thoughts.
Distractibility.
Increase in goal-directed activity or psychomotor agitation.
Excessive involvement in risky or high-consequence activities.

The episode is severe enough to cause marked impairment in social or occupational functioning, require hospitalization to prevent harm, or include psychotic features.

The episode is not attributable to substances or another medical condition.
If mania emerges during antidepressant treatment but persists beyond the physiologic effect of treatment, it counts as a manic episode.

Bipolar I disorder is defined by mania. Many patients spend more time depressed than manic, but a single true manic episode changes the diagnostic frame and has major implications for risk, treatment, and long-term planning.
Defining feature: A full manic episode is enough for the diagnosis, even if the person has never had a major depressive episode.
High-risk points: The highest-stakes questions are usually about psychosis, impulsivity, suicidality, spending, sexual risk, agitation, and how fast functioning is falling apart.
Treatment lens: Treatment decisions usually make the most sense when you anchor them to polarity: acute mania, bipolar depression, or maintenance after stabilization.
Clinical focus: Standard clinician-rated tool for manic symptom severity.

Standard clinician-rated tool for manic symptom severity.

Quick global severity and improvement tracking across polarity states.

Often paired with bipolar depression monitoring.

Brief self-report check for manic symptoms between visits.

FDA-indicated options commonly used for manic or mixed states; some are also used in maintenance after stabilization.

FDA-indicated medications specifically tied to bipolar depressive episodes in bipolar I disorder or bipolar depression labeling.

Maintenance choices are used to reduce recurrence risk after acute stabilization and should be individualized by polarity pattern.

ECT is used in severe mania, psychotic mood episodes, and refractory bipolar depression.
Ketamine is being studied and used selectively for bipolar depression in specialty settings.
TMS is under study and used off-label in some bipolar depression programs.

Simple Psych

Bipolar I Disorder