A friend was concerned: it seemed to be happening to them again. They admitted having much more energy than usual, despite sleeping fewer hours, and feeling giddy with excitement – some of the signs of mania, or its less-severe form, hypomania.

One of the authors of this Guide, Kim, told her friend that when she notices these same signs in herself, she has a plan. In addition to alerting her psychiatrist, she prioritises calming activities and rest. Having lived with bipolar disorder and the threat of manic episodes for several years now, she knows from experience that if she doesn’t take action during the (initially compelling) euphoria of an episode, irritability and disordered thoughts are soon to follow. Her friend, who had been diagnosed more recently, was now beginning to recognise their own patterns and develop a toolkit to manage their symptoms proactively.

For most people with bipolar disorder, diagnosis takes a long time. We hope you arrived here because someone helped you figure out a diagnosis, and now you are doing everything you can to learn how to manage your symptoms, lower the risk of a manic episode, and put tools in place to build your quality of life. Kudos for seeking this information and skill. In this Guide, we will provide some tips – drawn from research, lived experience and clinical expertise – to help you along the path toward stability and recovery.

We see these tips as a way to supplement your medical care. If you are still not sure whether you have bipolar disorder, or you think you probably do, it’s important to see a doctor to get a medical diagnosis and treatment. Medications are available and are considered the best line of defence against these symptoms.

That being said, we know that some people start the hunt for information before they receive a diagnosis. Others may have gotten a diagnosis but wonder what it means. So, before we get into what to do, we’ll briefly talk about how mania and related experiences are defined.

Mania and hypomania

Manic episodes and hypomanic episodes are periods of abnormally heightened or irritable mood, as well as increased activity or energy. There is no chemical test for them; diagnosis depends on recognising certain kinds of behaviour or thinking. The major guidelines for doing this are similar to each other, so here we’ll draw from definitions used in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

Someone who’s experiencing an episode will have at least a few of these symptoms:

• increased self-confidence;
• feeling rested even when sleeping much less;
• talkativeness (eg, difficult to interrupt, talking much more than usual, or talking much more to strangers);
• racing thoughts;
• distractibility;
• increased goal-directed behaviour (either socially, at work or school, or sexually) or psychomotor agitation (difficulty sitting still);
• excessive involvement in pleasurable but risky activities (eg, overspending, risky driving, foolish business decisions).

One difference between mania and hypomania is duration: in a hypomanic episode, symptoms are present most of the day, nearly every day, for at least four days; in a manic episode, they last for at least a week. In both cases, episodes can persist for weeks or, more rarely, months.

Another difference is the severity of symptoms: a hypomanic episode involves changes that are clearly observable, but not severe enough to substantially impair a person’s functioning. In a manic episode, the symptoms are severe enough that they noticeably impair social or occupational functioning, require hospitalisation (to prevent harm to oneself or others), or include psychotic symptoms (such as disorganised speech or delusional beliefs).

Both mania and hypomania are worth planning for. Although many welcome the burst of productivity and creativity or break from depression that often comes with hypomania, these states can still go hand in hand with risk-taking behaviour that has a high potential for serious consequences. Moreover, if left unchecked, hypomanic states can evolve into mania – especially when someone is not feeling tired and their sleep is further disrupted for days on end.

Mania and hypomania are features of several types of bipolar disorder, in which they commonly alternate with depressive states:

• Bipolar I disorder applies to people who have experienced an episode of mania. A majority of people with this diagnosis (though not all) experience an episode of depression at some point as well. Bipolar I is estimated to affect about 0.6 to 1 per cent of people during their lifetime.
• Bipolar II disorder includes people who have experienced an episode of hypomania as well as an episode of depression. Bipolar II affects about 0.4 to 1 per cent of the population.
• Cyclothymic disorder is a less severe form of bipolar disorder. It involves frequent fluctuations between manic and depressive symptoms, but they are more sustained and less severe than a manic, hypomanic or depressive episode. Although the symptoms are less intense, the chronic nature of the disorder takes its toll. This disorder is believed to affect up to 2.5 per cent of people.

You can prepare for the next time

If you have been diagnosed with one of these conditions, then you have already experienced some of the symptoms of mania or hypomania. After going through an episode that may have led to some unfortunate consequences, it’s normal to feel scared or anxious about the future.

When Kim was still in the early days of her diagnosis and rapid-cycling between depression and mania (ie, having at least four episodes within a year), she felt as if she was constantly picking up the pieces from the previous episode. Exhausted and unsure of what would come next, there were times when she couldn’t trust in her own emotions. She often found herself questioning whether seemingly benign feelings of happiness were the precursor of another manic episode. It took time before she was able to notice patterns in the periods leading up to her mood swings and then translate her observations into a plan of action. This has allowed her to feel more in control of her health and at peace with the regular ebb and flow of emotions in euthymia (periods of stable mood).

By learning to recognise the early signs and responding proactively, you have a much better chance of halting symptoms quickly and protecting against future negative effects on your life. The earlier you can do this, the better. Early intervention can stop or reduce the severity of an episode before it impacts your physical health, relationships, work, school or other areas of importance.

Most people want to play an active role in managing their own health, but it can be hard to know where to start. In the following sections, we’ll share some ways you can monitor and respond to elevations in your mood. We also hope that these tips will help to spark conversations with people in your life, such as family members and care providers, who are invested in your wellbeing. Although bipolar disorder is a lifelong illness, with proper supports in place, it’s completely possible to manage the symptoms and live a fulfilled life.

Start thinking about your warning signs

The thoughts, emotions and behaviours that precede mania or hypomania can serve as warning signs of an oncoming episode. Some of these might overlap with the symptoms we’ve already described. For example, before an episode fully begins, you might find that you are sleeping less, feeling impatient, confident or energetic, talking faster or more frequently than usual, driving faster, or feeling less worried about risks (eg, with spending money). Many people notice subtler signs: sounds and sights seem more intense, colours seem more vivid, or they feel more sexual. Inspiration might come more easily. Some feel more connected to the universe, or more religious.

Many people find it helpful to reflect on the early changes they noticed with previous episodes. Did you start to act differently? Dress differently? Notice changes in your social interactions? Sleep differently? Take on work or other goals with more vigour? You can also ask people close to you what they noticed in terms of early signs.

Future episodes may not always begin the same way previous ones did, since symptoms can vary over time. But an awareness of previous signs can still help you be prepared if they appear again.

Make a checklist and monitor your experience

Self-monitoring is something many people do to better understand themselves and their health. It involves being more aware of certain thoughts, feelings or behaviours, often through tracking or record-keeping. These records can be used to identify patterns over time and inform goals for change. For example, someone might keep track of their exercise patterns to better understand their progress and find areas for improvement. For someone with bipolar disorder, self-monitoring can be useful for developing an awareness of the warning signs leading up to an episode and acting accordingly.

Many people with bipolar disorder track their mood as part of their treatment. They might do this by rating their mood on a numbered scale (eg, from 1 to 10, with lower and higher numbers corresponding to dips and elevations in mood), or by tracking specific symptoms (such as racing thoughts). Daily or weekly mood-tracking can make it easier to notice when you’re starting to shift into an episode. However, we recognise that this level of self-monitoring is not easy, and that some people find it overwhelming. Some also feel as though it is overly negative to focus on their illness from day to day.

For this reason, we recommend first just developing your own checklist of the warning signs that you started to consider in the previous step. You can write this list on paper or put it in a note on your smartphone – as long as it’s somewhere easily accessible. You want to be able to reference this ‘mood check’ at times when you (or your loved ones) are beginning to question whether you are at the brink of a manic or hypomanic episode.

The advantages of doing this are twofold: first, you’re creating a resource that you can use in the moment to determine whether what you’re currently experiencing aligns with your known warning signs. Second, the process of creating this list by reflecting on previous episodes is the start of a new practice of self-awareness. By engaging in routine self-checkups, even for a couple weeks or months, most people become quite good at noticing the signs. At the beginning, this list might be something that you refer to regularly (eg, every week, during therapy). With time and practice, you may notice that these ‘mood checks’ become more automatic.

A word of caution: as people become a little manic, they are often pretty happy about having more energy, ideas and zest for life. The warning signs or symptoms that would seem worrisome when you are between episodes might suddenly seem less worrisome. To prevent yourself from dismissing those early warning signs, we recommend that you make your list as concrete as possible and focus on identifying which signs you would take to heart. Instead of changes in sleep, it can be helpful to check for ‘sleeping at least 2 hours less per night and still feeling energetic.’ Instead of ‘taking risks’, consider listing how much money is more than you should spend, how fast is driving too fast, or what sexual behaviour would be a signal for you.

Here’s an example of what a useful self-monitoring (or ‘mood check’) form might look like:

Create a ‘fire drill’ plan with others

Just as important as self-monitoring is seeking guidance from a loved one and/or a health professional if you do spot early warning signs. Even if you’re seeing a doctor regularly for bipolar disorder, there are many situations in which it is beneficial to have another set of ‘eyes on the ground’ in your life. If you’re experiencing manic symptoms, there’s a risk that you won’t want to call your doctor, or you might be so caught up in activity that you forget about a check-in appointment. An approach to ensuring your safety in these instances is to pre-plan with loved ones how you would like them to support you if they notice early signs or symptoms. In their book Bipolar Disorder (2010), the clinicians David J Miklowitz and Ellen Frank liken this to a ‘fire drill’.

Having a fire drill plan in place can take away some of the uncertainty about how the people who matter to you most will react when you’re in a crisis. We would advise you to identify at least one specific person now – perhaps a parent, a sibling, a friend, or a partner – who might act as your primary support person in these instances. Then, consider the following things together:

• When should your loved ones worry? Some families need help understanding what the critically important signs are (eg, not sleeping, taking major risks). It could be helpful to share your checklist and discuss specific situations in which a loved one should be concerned. If they were present for previous episodes, they may have even noticed changes that they didn’t realise were symptoms of mania.
• How would you like your loved ones to phrase concerns if they arise? People might want to help but feel unsure how to say something without coming across as patronising or overbearing. You can prepare them for the possibility of you talking or acting differently than what they are used to. The dialogue can be difficult on both sides, and knowing what your preferred words or style would be at that moment can be a huge help for those who care about you. We often advise close others to be as concrete as they can. For example, rather than saying ‘You seem high,’ it might be better for them to say ‘You haven’t been sleeping more than a couple hours, and I notice you’re having a hard time sitting still.’
• Who should they call? If things get tough, which doctor would you prefer your loved ones reach out to? You may need to fill out a Release of Information or other documentation ahead of time with your doctor to authorise them to respond to communications from loved ones in specific circumstances. Are there situations in which you’d want to be included in the conversation (eg, the early stages of an episode)? If there is an imminent threat to your safety, your loved ones should know when to seek immediate medical intervention. Do you have a preferred local hospital?

Recognise and plan for triggers

Beyond looking for changes in your thoughts, feelings and behaviour, it’s good to familiarise yourself with possible triggers: any factors or experiences that might set symptoms in motion. A manic episode can have social or biological triggers, and it can be triggered by sleep deprivation as well.

See if you (or those close to you) can recall anything notable happening around the time of previous experiences with mania or hypomania. Did you travel across time zones just before the episode? Did you have a particularly exciting accomplishment? Had you used drugs that interfered with your sleep? Though it can be challenging to retrace these details, sometimes people find it helpful to draw a timeline, mark when the episode(s) happened, and then reflect on any lifestyle, health, exercise or sleep changes in the one to two months before the episodes. If you identify possible triggers, we suggest adding them to your daily mood check as well.

Here’s a further look at some common triggers, along with some potential strategies for managing your risk:

Social triggers

Several studies suggest that life events that are exciting – such as graduations, weddings and major accomplishments – can be destabilising for people at risk of manic episodes. This is tricky, as life is often at its best when these types of events happen. By all means, we want people to experience and enjoy these events. But it can be helpful to keep an eye on mood, and make sure that you have social support at hand, as well as any prescribed medication, if symptoms emerge. Achieving goals that are fulfilling and meaningful is important – but, as you do so, test the brakes and ensure you’re able to pause for a good night of sleep. If you find that you are not able to pause or sleep, calling a doctor proactively is wise.

Other social triggers can include events that are overly stimulating or agitating. Family conflict, for example, can be particularly agitating for someone with bipolar disorder. Given this, some family therapy for bipolar disorder focuses on helping everyone in the family learn effective ways to communicate and resolve conflicts.

Medication lapses

Stopping a prescribed medication may trigger a new episode. If you find it challenging to consistently take medications long-term, you are not alone – it’s a difficult thing for many people with chronic illnesses. But there are strategies that can help you stick with it:

• If remembering to take medications is difficult, try using a pill box, setting a cellphone alarm, and putting pills someplace visible.
• Some people consider pills a sad reminder of their illness. If this is a struggle for you, it could help to talk about it with a therapist, which might encourage you to see the pills in a different light (eg, as a way of mastering symptoms).
• The motivation to take medication can fluctuate, so it can be helpful to write down the core reasons why medications and stability matter to you, and to use these as a reminder.
• Many people struggle with the side effects of medication. If this is your concern, talk with your prescriber. There may be easy ways for them to shift the timing or dose of the medication, or to try a different medication with fewer side effects.

Sleep loss

Sleep is restorative for the brain, and there is evidence that losing a night of sleep can trigger manic symptoms. Smaller changes in sleep – such as being unable to sleep more than half the night for days in a row – can also predict the onset of mania. Protecting sleep, then, is key. One way to do this is to keep a regular sleep-wake schedule. If you are having trouble sleeping, some doctors will prescribe a medication that can help with temporary sleep problems. For longer-term patterns of poor sleep, cognitive behavioural therapy for insomnia (CBT-I) provides a set of tools for improving sleep.

Some evidence suggests that one of the biological facets of bipolar disorder is a diminished day-night (circadian) rhythm. When that is the case, the ability to sleep well may be more easily disrupted. Many triggers might operate via sleep disruption. For example, jet lag can interfere with sleep, and it can also sometimes trigger manic symptoms. Many people work with their doctor in advance of travel across time zones to plan good prevention strategies.

Exercise can influence sleep, and the timing can determine whether it has positive or negative effects. Generally, getting exercise early in the day (with guidance from a doctor if you have any health concerns) will help improve sleep. Exercise after dinner can make it harder to fall asleep at night.

Drug use

Drugs that are overly stimulating and reduce the capacity for sleep are also possible triggers for mania. Many people who are vulnerable to mania will experience symptoms after using drugs such as speed or cocaine, or other drugs that disrupt sleep, including excessive caffeine.

It is important to avoid misuse of substances, including street drugs and particularly drugs that can disrupt sleep, and to enlist help from others in doing so. If you do use these substances and find it hard to shift your use, it could be helpful to attend a group such as Alcoholics Anonymous or Narcotics Anonymous, or to see a therapist who specialises in a form of substance-use therapy (such as motivational interviewing).

Protect yourself against risk

Even with medications in place and a lifestyle designed to reduce triggers, relapse sometimes happens. This is one of the incredibly difficult parts of this illness. If symptoms do emerge, there are steps you can take – in addition to calling your doctor – to reduce the severity of the episode and to protect your wellbeing.

When you notice warning signs or symptoms, taking these self-protective steps is more important than a work obligation or a social commitment. Don’t give yourself permission to feel high ‘a little longer’ – time is critical in this process. If you are not sure how to evaluate your mood in the moment, talk to someone in your medical or social support system who can provide an outside perspective.

Some general self-protection strategies include reducing stimulation – such as by resting your body and taking a forced pause from go-go-go activities – as well as doing your best to secure your sleep, even if you don’t feel tired. Exercise can be an outlet for extra energy, though physical activity should be timed so that it doesn’t disrupt sleep (eg, not close to bedtime). Redirecting your energy toward hobbies or activities you find calming can also help protect you from negative consequences. Having someone you trust to talk about it with and help you stay safe if mania unfolds is a huge help.

What follows are some other examples of strategies that may be helpful for addressing specific kinds of risks. When you or a loved one notice signs of (hypo)mania, you might consider implementing some of these strategies as a means of harm reduction:

Feeling overly energised/sleeping less

• Consider talking to your doctor about a sedating medication you can take as needed if sleep is something you struggle with during mood episodes.
• Avoid overly stimulating events.
• Engage in calming hobbies and movement.

Feeling irritable or impulsive

• Avoid overly stimulating events.
• Avoid people you tend to have conflict with.
• Avoid large social gatherings or public speaking.
• Focus on quiet, safe activities until you are able to feel calmer.
• Ask someone you trust to stay with you to help you avoid risky mistakes.

Spending too much money

• Put a warning sticker on credit/debit cards to increase mindfulness around spending. This might say something like: ‘Check your mood and ask loved ones before any big purchase!’
• Put spending limits on credit cards and/or leave them with someone you trust.
• Avoid auto-fill for credit cards on shopping websites.

Speeding

• Give car keys to a loved one when you start to notice warning signs of mania.
• Take public transportation or rideshares in place of driving until you are feeling calmer.

Calling people too late at night or posting excessively on social media

• Ask a loved one to hold on to your phone after a certain time of day.
• Delete social media apps, temporarily lock accounts or change passwords when you start to notice warning signs.

Beyond self-management, a key goal if symptoms emerge is to reach out to your doctor as quickly as possible. Medication adjustments tend to be more powerful and act more quickly when implemented at the start of an episode. And the faster any symptoms are quelled, the lower the risk of troubling consequences for you.

Beyond self-help

While the strategies we’ve covered above can be greatly helpful, professional support is critical in managing bipolar disorder. Whether you’re seeking treatment for the first time or you’re already working with a healthcare professional and are interested in what else is out there, we’d like to offer some insight into the various resources available to those with bipolar disorder.

International guidelines present medication as the number-one recommendation in the treatment of bipolar disorder. Mood-stabilising medications, such as lithium and certain anticonvulsants, can reduce the risk of relapse, reduce the severity of breakthrough episodes if they happen, and reduce the risk of self-harm. If you have not yet received medication, consider bringing up the possibility with a primary care doctor or psychiatrist.

There is evidence from studies of more than a million participants that many people with bipolar disorder do incredibly well in life. In creative outlets, leadership and entrepreneurship, those with bipolar disorder and those in their families often have an edge compared with the general public. But along the way, it can be difficult and, at times, it may feel hopeless. If you struggle with suicidal thoughts – which can emerge during manic or depressive episodes – know that good treatment can help reduce the despair. In the meantime, support is available by calling helplines such as 988 in the United States, 116 123 in the United Kingdom, and 13 11 14 in Australia, or the help centres listed by Befrienders Worldwide.

There are a variety of therapies and support groups that help people living with bipolar disorder in managing their symptoms and finding community. Some of these evidence-based modalities include:

• Cognitive behavioural therapy (CBT) helps people identify and challenge unhelpful thoughts and behaviours that might contribute to mood episodes. This form of therapy is particularly helpful for people who notice that stress, negative thought patterns or certain behaviours consistently precede depressive states. CBT can also support harm reduction by helping individuals plan ahead to reduce risky behaviours when early signs of mania arise.
• CBT for insomnia (CBT-I) is a specialised therapy that helps individuals build healthier sleep routines and address the thoughts and behaviours that interfere with restful sleep. Many people with bipolar disorder find that disrupted sleep is both a trigger and a symptom of mood episodes. CBT-I can be especially beneficial for those who notice that a lack of sleep often precedes manic episodes, or who struggle with maintaining regular sleep even during periods of stability.
• Interpersonal psychotherapy focuses on improving communication, resolving relationship conflicts, and navigating life transitions – all of which can impact mood. This approach is helpful when interpersonal issues are a significant source of stress or when a person is trying to rebuild relationships that may have been strained or damaged during manic or depressive episodes. It’s also valuable for those who want to strengthen their social support network as part of maintaining stability. Versions of interpersonal psychotherapy for bipolar disorder help increase stability in day-to-day activities.
• Family therapy provides a space for families to learn more about bipolar disorder, communicate more effectively, and develop supportive strategies together. It’s particularly useful when family dynamics are a source of stress or conflict that might trigger episodes. It can also help families respond more constructively when manic symptoms emerge, reducing shame and improving outcomes for everyone involved.
• Support and advocacy groups offer a sense of connection and community, which can reduce isolation and stigma. They provide an opportunity to hear from others who are managing similar challenges, and to exchange coping strategies and resources. These groups can be especially empowering for those seeking validation, peer insight or additional tools for navigating daily life with bipolar disorder. Advocacy groups also offer ways to channel lived experience into meaningful action, reducing stigma and promoting awareness.

Two comprehensive guides include many of the kinds of strategies that appear in this article: the book Bipolar Disorder: A Guide for the Newly Diagnosed (2012) by Sheri L Johnson, Ann M Kring, Janelle M Caponigro and Erica H Lee; and David J Miklowitz’s guide Living Well with Bipolar Disorder (2024). These books also touch on some of the aspects of managing bipolar disorder that can feel overwhelming, such as what treatments are available and how to start the conversation with your loved ones.

The free online resource Crest.BD Quality of Life Tool can help with symptom management by highlighting domains of life where you are thriving or might need extra support.

If you’re seeking a mental healthcare provider, there are many possible starting points online. In the US, that includes websites like the ABCT Therapist Directory, the National Network of Depression Centers, and the VA (for veterans).

Mental health advocacy groups offer educational resources, support and opportunities to engage with the community. The International Bipolar Foundation is an organisation whose mission is to empower those with bipolar disorder and their loved ones. The Depression and Bipolar Support Alliance and the National Alliance on Mental Illness are both US-based advocacy groups with local chapters.

We work hard to bring you the most trustworthy, expert and up-to-date information on psychology and mental health in our Guides. You can learn more about how we ensure that they are a reliable source of information here. This Guide is provided as general information only. It is not a substitute for independent, professional medical or health advice tailored to your specific circumstances. If you are struggling with psychological difficulties, we encourage you to seek help from a professional source.