Why Some Patients Don’t Want Mania to Stop

Many patients with bipolar disorder see mania not just as a symptom, but as a source of energy, creativity, and identity

STUDY: Luksaite M et al, Psychology and Psychotherapy

STUDY TYPE: Systematic review

FUNDING: Independent

Background

This review drew inspiration from a group therapy session one of the authors ran for bipolar. Only one of ten patients with bipolar disorder wanted mania to stop. Positive beliefs about mania are common, largely unaddressed in treatment, and may quietly drive nonadherence, ambivalence, and relapse.

The Study

• 13 studies with 610 adults with bipolar disorder.
• Nine qualitative, four mixed-methods, and two quantitative studies from the USA, UK, Australia, South Africa, Denmark, and China.

Results

Five themes emerged:

• Enjoyable feelings: They describe highs as pleasurable, intoxicating, with amplified sensory experiences, including enhanced vision, hearing, touch, and sexual satisfaction.
• Vitality: Surges of energy and enthusiasm felt productive and motivating, especially at work.
• Enhanced relationships: Increased confidence, empathy, and social ease during elevated mood.
• Advanced ability and achievement: Many believed they accomplished things during mania they couldn’t have done otherwise: sharper thinking, higher productivity, and a sense of creative flow.
• Creativity: About half the papers identified creativity as the most cherished aspect. Patients saw it as central to their identity and protective during recovery.

Around 25–30% of people with bipolar disorder have an ambivalent relationship with mania. In one study, 73% said they would eliminate their bipolar disorder if possible, but nearly half only if the elimination was reversible, suggesting they weren’t ready to give up the highs entirely.

Practice Implications

1. A good time to open up the conversation is when patients are stable.
2. Ask “Is there anything you miss about your highs?” or “Do you ever wonder how you’d feel off the medication?”
3. On the other hand, I don’t think patients stop mood stabilizers to “get high.” If they do come off, they won’t get that feeling right away. It usually takes 3-12 months for mania to recur. Most patients stop their medications because they don’t feel they are helping.