What are the symptoms of manic depression

Mania and manic-depressive illness

Mania: Life phase with an exaggerated euphoric mood. Manic phases occur 80% as the opposite of depressive phases in the context of a manic-depressive illness. Both mania and manic-depressive illness belong to the clinical picture of affective disorders. Characteristically, the mood, emotional life and behavior of the person concerned get out of control. In severe cases, in addition to a pathologically increased activity and a euphoric mood, delusions and thought disorders also occur.

Manic-depressive illness (bipolar illness, bipolar disorder, cyclothymia): Severe expression of high mood (manic episodes) alternating with depressive episodes. This emotional instability is also a constant companion in life outside of explicit manic or depressive episodes - sometimes more, sometimes less pronounced.

Worldwide, at least 1.5% of adults suffer from manic-depressive illness. Women and men are equally affected. Many manic-depressive patients take their own lives. They are particularly suicidal in all cultures.

Lighter forms of mania are referred to as Hypomania. However, hypomania is not in itself a clinical picture and is therefore not discussed further in the following. The hypomanic phases that are pleasant for the patient can, however, develop into "real" manias or manic-depressive illness over the years.

Leading complaints

Manic-depressive patients alternate between manic and depressive phases. The symptoms of the depressive phase correspond to the symptoms of depression. The following symptoms occur during the manic phases:

Psychological complaints:

  • Exaggerated and cheerful mood for no reason that does not suit the respective situation.
  • Increased drive, restless overactivity: The manic throws himself into activities at random and can no longer realistically assess his possibilities and limits.
  • Loss of common social inhibitions: those affected are distant. They enthusiastically rush to strangers and quickly establish contacts that remain superficial and self-centered.
  • Volatility in thinking and acting: those affected literally jump from idea to idea, but cannot stick to one topic for long. You start many activities at the same time and don't really finish anything.
  • Overconfidence and megalomania: Excessive optimism often causes manics to take extreme risks that endanger them and others. Shopping frenzy-like purchases, nonsensical business start-ups or sexual excesses are typical.

Physical complaints:

  • Severe overactivity: It usually manifests itself in an incessant urge to talk, a greatly reduced need for sleep, and physical hectic and restlessness.
  • Aggressive breakthroughs: Overexcitation can also lead to patients being very irritable, raving, smashing objects and physically attacking other people.

When to the doctor

In the next few days if the manic state remains unchanged for several days, the level of suffering for the relatives becomes unbearable, the person affected is endangering their own future (e.g. through debt) or a depressive phase begins.

Immediately if the person affected in the manic or depressive phase endangers himself or others.

The illness

A disturbed balance of messenger substances in the brain (neurotransmitters) is an explanatory model for the development of mania and manic-depressive illness, whereby, similar to depression, both genetic and triggering factors are important.

Manic phases usually last a few days to weeks, rarely years. The fact that behind a restless, volatile person who is bursting with ideas and tackling many things at the same time, there is a mentally ill hides, is usually only recognized late by the environment. Namely when the person concerned collapses due to their overconfidence and numerous activities (e.g. due to financial difficulties) or the mania shifts into a depressive phase. The manic-depressive patient experiences the respective manic and depressive phases of illness in different intensities and always alternating with healthy phases, the so-called symptom-free intervals. The duration of the manic and depressive phases can vary widely: from a few weeks and months to years.

The doctor does that

Hospitalization. In the manic phase, patients do not feel any psychological stress. You feel great and see no reason to seek medical treatment. That is why they have to be persuaded to do so with gentle pressure - often a difficult undertaking. In acute conditions, manics can even react extremely irritably to treatment suggestions. Acute manic patients are therefore often admitted to psychiatric clinics by order of the authorities (compulsory admission). People with manic illness often only voluntarily seek treatment when the mania turns into depression and they themselves suffer from the disease. However, there can then be the risk of a misdiagnosis, since the doctor or therapist only sees the depressive symptoms at that moment and the patient usually does not report his manic experience. Experienced doctors and therapists will therefore always ask about manic phases in the patient's past and usually include relatives in the diagnostic discussion.

Psychiatric drugs. In treatment with psychotropic drugs, a distinction is made between treatment of the acute phase of the disease and long-term treatment during the symptom-free interval to prevent further acute phases (phase prophylaxis):

  • Acute drug therapy for mania: Atypical neuroleptics, often in combination, are the drugs of choice today. In order to achieve a quick effect, the medication must initially be dosed in high doses. Alternatively, anti-epileptic substances are used (carbamazepine or valproic acid). In order to alleviate the usually existing sleep deficit, tranquilizers (benzodiazepines) can also be given temporarily.
  • Acute drug therapy for depressive episodes

Phase prophylaxis. To prevent relapses, drug therapy is usually required for years, if not for life. The drugs, which are also effective and well tolerated in acute therapy, are often retained in reduced doses. Then the side effects are usually rather minor. Lithium is of particular importance in phase prophylaxis.

Psychotherapy. During the acute phase of illness, patients usually lack the motivation and insight to work on themselves as part of psychotherapy. If the mania is well controlled with medication, however, those affected recognize the need for psychotherapeutic treatment as they suffer from the difficulties caused by the mania. In the treatment of phase prophylaxis, behavioral therapy and psychoeducation have proven their worth.


For ~ 40% of those affected who endure the necessary long treatment, the chances of recovery are very good. In ~ 20% of patients, however, the disease becomes chronic. These often older people are often unable to live independently. The rest of those affected range between these two extremes.

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The main sufferers of mania and manic-depressive illness are relatives. It is difficult to induce manics to seek treatment or for excesses such as B. to incur over-indebtedness. Relatives can find advice and support from doctors or in self-help groups.

In order to prevent relapses, in addition to regular medication, it is important that the sick person has a regular daily routine, gets enough sleep and that any excessive behavior is set in a friendly but definite way. The best thing is: Overlook such approaches and do not intensify them with additional attention.


Manicists are incapable of doing business in an acute state. There is therefore a good chance that - if the illness is documented by a doctor - nonsensical transactions and borrowing can be legally reversed. Nevertheless, it is worth considering for relatives to take credit cards and, if necessary, ID cards out of circulation for a few days to be on the safe side. Even a call to the bank advisor during acute phases does no harm. There is no point in announcing these steps to the manically ill partner, child or parent out of a misunderstood honesty - it is better to wait a symptom-free interval and then make it clear that these "attacks" occurred in the interests of the person concerned.

Further information

  • www.dgbs.de - Website of the German Society for Bipolar Disorders e. V. (DGBS), Hamburg: represents those affected, relatives and experts and offers help in many categories.
  • www.manic-depressive.de - Internet discussion forum of the DGBS e. V .: For those affected, relatives, friends and those interested.
  • H. Helmchen et al .: Depression and Mania: Ways Back to a Normal Life. Trias, 2001. Guide for the sick and their relatives, in which the clinical picture, therapy and relapse prevention are explained.
  • P. Braunig; G. Dietrich: Living with Bipolar Disorders. Trias, 2004. Answers to the most frequently asked questions and materials for self-help.
  • V. Rupprecht: Soul tide. Schattauer, 2005. A young graphic designer, herself affected, makes the extreme emotions tangible in illustrations - the book is supplemented by short scientific texts.


Gisela Finke, Dr. med. Arne Schäffler in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 16:02

Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.