MANIA: IS IT WRONG TO BE HAPPY?
Mania is a mental health condition that can cause a person to experience episodes of unreasonable euphoria, intense moods, and hyperactivity. In this period, a person feels excited or experiences an energized mood, which can last for days to weeks and even months. [1] Mania is often associated with Bipolar Disorder, a mental illness affecting about 4.5 million people worldwide. The disorder is characterized by periods of mood swings ranging from depressive lows to manic highs. [2]
The unique hallmark of the illness is mania, which is characterized by elevated mood or euphoria, overactivity with a lack of need for sleep, and overconfidence which impairs judgment.
The depressive lows may include symptoms such as low energy, low motivation, and loss of interest in daily activities. The mood episodes can last days to months at a time and may also be linked with psychosis and suicidal thoughts.
There are mainly two types of mania: Organic mania and Bipolar Disorder (Primary Idiopathic Mania)
Organic mania can be used to describe mania that is outside any psychiatric disorder. It consists of continuous irritability and elevated mood. It usually develops in people older than 35, while Bipolar Disorder starts between adolescence and the age of 25. [3]
Symptoms of mania
The symptoms of mania are:
1. Hyperactivity: People experiencing an episode suddenly have a confidence boost and suddenly want to do a lot of things, most of which are unusual.
2. Pressured or dysphoric speech: This is talking a lot, all of sudden, and usually being unable to keep to a line of thought. People experiencing mania are easily distracted and always jumping to the next interesting idea.
3. Suddenly engaging in risky or impulsive behaviors like splurging on a shopping spree, investing spontaneously, or making random donations, etc. This could also be a sudden increase in sex drive.
4. Decreased sleep - feeling like you do not need as much sleep and also feeling energetic on little to no sleep.
5. Irritability. People who are experiencing an episode are easily irritated by others.
Mania & Happiness - when does it become a problem?
Happiness is great for mental health and encourages cognitive flexibility. It is positively correlated with many good experiences such as achieving goals, nurturing bonds, creating social connections, learning, and increasing general well-being. However, despite the numerous good sides, studies have shown that it has a dark side and too much of it can be a source of dysfunction and bring about negative outcomes. [4]
Happiness becomes a problem when it is linked to hyperactivity and unreasonable euphoria that doesn’t have an exact source.
Researchers present an idea called Positive Emotion Persistence (PEP) and the central thesis is that the persistent activation of a positive emotion such as happiness, across different contexts and not minding stimuli is bad, and a marker of dysfunction. One of such is bipolar disorder - Mania.
In 2011, Gruber, Mauss, and Tamir published their study [5] titled “A Dark Side of Happiness? How, When, and Why Happiness Is Not Always Good”.
Intensity is the first aspect that Gruber and colleagues looked at when talking about happiness. Intensity refers to the degree or amount of strength that something has. When something is said to be “intense” it usually means there is a sense of being extreme or too strong. In this case, “too happy” means an intense level of happiness. This is not unusual for people experiencing mania, as it is characterized by high intensity of happiness.
Timing is the next aspect discussed in the study. There is a right time to feel happy, as well as a right time to experience other non- euphoric emotions since all emotions have an adaptive and functional role. Happiness can lead to negative outcomes when experienced in all situations, which is what happens during a manic episode.
Recent psycho-social studies show that certain reward pursuits put individuals at risk for mania. The study examined associations of The Hypomanic Personality Scale, HPS, with positive emotions like joy, pride, and compassion, and side-by-side with ambitious life goals in areas like fame, wealth, friends, and family.
Among 302 participants from two university settings, the results show that higher HPS scores were related to joy and achievement-related traits like pride, compared to traits like compassion and love. The scores were more related to extrinsic traits like fame, compared to other-oriented traits like friends, family. (These effects were independent of current symptoms of mania.)
This study shows that individuals who relentlessly pursue ideas like joy, and achievement-based traits are more at risk of mania and bipolar conditions in general.
Causes and Triggers of Mania
You might have mania on its own or as part of some mental health problems – including bipolar disorder, seasonal affective disorder, schizoaffective disorder. Some common things which can cause or trigger mania are listed below:
1. Genetics: Genetic factors account for 60-80% of all bipolar disorders. People are more likely to develop mania if they have a close relative with a bipolar condition. 9% more likely for a first-degree close relative and 40-45% more likely for a twin. Twin studies have established that bipolar disorder is among the most heritable of medical disorders. [6]
2. Usage of drugs:
Anti-depressants and recreational drugs can induce a manic episode. Other drugs with a definite propensity to cause manic symptoms include levodopa and corticosteroids. [7] Use of cannabis at baseline can increase the risk for manic symptoms. [8]
3. Childbirth ( Post-partum psychosis): Bipolar disorder has a lot to do with brain chemistry and there is a strong genetic link. The Post-partum period is a time of heightened vulnerability to bipolar disorder with the greatest risk being in the first month after delivery. [9]
4. Stress: Studies of adult bipolar patients and adolescents indicate that life stress and mood symptoms are temporarily and causally related to one another. [10]
5. Alcohol: Alcohol is known to intensify bipolar disorder due to its sedating effects. Alcohol also greatly increases the severity of mania, as many alcohol drinkers find it extremely pleasurable. Indulgence in alcohol also increases the intensity of manic symptoms such as high-risk behavior like impulsivity and aggression.
Prevalence and Treatment
Two million adults (roughly 1% of the adult population) suffer from some form of bipolar disorder which is the primary cause of mania. [11]
While there's no cure for Mania, there are treatments that can delay episodes.
The treatment of mania starts with a correct diagnosis and elementary measures to prevent risks for the patient, relatives, and others. Sometimes, compulsory admission may be required for a few days in the case of acute mania. The treatment of acute mania is a long-term process. [12]
Acute mania can be treated with antipsychotics like dextroamphetamine.
Drugs like lithium, which is a mood stabilizer can also be used. [7]
These drugs are usually used in combination with therapy.
REFERENCES
Belmaker, R., 2004. Bipolar Disorder. New England Journal of Medicine, [online] 351(5), pp.476-486. Available at: <https://www.nejm.org/doi/full/10.1056/NEJMra035354> [Accessed 8 February 2021].
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. (2018). Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. DOI:https://doi.org/10.1016/S0140-6736(18)32279-7
3. Larson, E.W, Richardson E., Mayoclinicproceedingsorg. [Online]. Available from: https://www.mayoclinicproceedings.org/article/S0025-6196(12)62694-9/fulltext [Accessed 8 February 2021].
4. Gruber, J., 2011. Can Feeling Too Good Be Bad?: Positive Emotion Persistence (PEP) in Bipolar Disorder - June Gruber, 2011. [online] SAGE Journals. Available at: <https://journals.sagepub.com/doi/full/10.1177/0963721411414632> [Accessed 8 February 2021].
5. Association for Psychological Science - APS. 2021. Can Feeling Too Good Be Bad? Positive Emotion in Bipolar Disorder. [online] Available at: <https://www.psychologicalscience.org/news/releases/can-feeling-too-good-be-bad-positive-emotion-in-bipolar-disorder.html> [Accessed 8 February 2021].
6. Jennifer B, Jordan S., 2009. The Genetics of Bipolar Disorder. [online] ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637882/ [Accessed 8 February 2021].
7. Peet, M. and Peters, S., 1995. Drug-Induced Mania. Drug Safety, [online] 12(2), pp.146-153. Available at: <https://doi.org/10.2165/00002018-199512020-00007> [Accessed 8 February 2021].
8. Henquet, C., Krabbendam, L., de Graaf, R., ten Have, M. and van Os, J., 2006. Cannabis use and expression of mania in the general population. Journal of Affective Disorders, [online] 95(1-3), pp.103-110. Available at: <https://doi.org/10.1016/j.jad.2006.05.002> [Accessed 8 February 2021].
9. Sharma, V. and Pope, C., 2012. Pregnancy and Bipolar Disorder. The Journal of Clinical Psychiatry, [online] 73(11), pp.1447-1455. Available at: <https://www.psychiatrist.com/JCP/article/Pages/pregnancy-bipolar-disorder-systematic-review.aspx> [Accessed 8 February 2021].\
10. Kim, E., Miklowitz, D., Biuckians, A. and Mullen, K., 2007. Life stress and the course of early-onset bipolar disorder. Journal of Affective Disorders, [online] 99(1-3), pp.37-44. Available at: <https://doi.org/10.1016/j.jad.2006.08.022> [Accessed 16 February 2021].
11. Ketter, T., 2011. Psychlopedia/Diagnostic Features, Prevalence, and Impact of Bipolar Disorder. [online] Cmeinstitute.com. Available at: <https://www.cmeinstitute.com/Psychlopedia/Pages/BipolarDepression/3wibd/sec1/section.aspx> [Accessed 8 February 2021].
12. Michael, G., Sutaeng, H., Donald, T. and Zander, J., 1987. APA PsycNet. [online] Psycnet.apa.org. Available at: <https://psycnet.apa.org/record/1988-33536-001> [Accessed 8 February 2021].