Racing thoughts, restlessness, and sleep changes — these signs can mean different things. Here’s how people with bipolar disorder tell them apart.
Both anxiety and mania (or hypomania) are common in bipolar disorder, and their overlapping symptoms — such as racing thoughts, restlessness, irritability, and sleep issues — can make them hard to tell apart. But understanding the difference is important for effective treatment and stability.
Why It Matters
- Getting the Appropriate Treatment Anxiety and mania or hypomania requires different approaches. Anxiety is often managed with therapy and, in some cases, anti-anxiety medications. Mania and hypomania typically involve mood stabilizers. Misdiagnosing symptoms can lead to ineffective — or even harmful — treatment.
- Preventing Mood Episodes From Escalation Recognizing early signs of mania or hypomania allows for timely intervention, potentially stopping an episode before it intensifies. According to Mayo Clinic, early action is a key strategy in managing bipolar disorder.
- Long-Term Stability Anxiety can impact the course of bipolar disorder, increasing illness severity and making depressive episodes more frequent. Understanding this connection can help with better long-term management.
- Protecting Your Well-Being Getting the correct diagnosis isn’t just about medication — it’s about making informed choices in your daily life. Mistaking mania for anxiety (or vice versa) can lead to unhelpful coping strategies or medication changes that worsen symptoms, according to Cleveland Clinic. Mania, in particular, can lead to impulsive decisions and risky behaviors, so recognizing the signs early can help prevent serious consequences.
We asked our community on Facebook how they tell the difference between anxiety and the early stages of mania or hypomania. Here’s what they shared.
Editor’s note: The following responses have been edited for length and clarity. They reflect personal experiences and perspectives, which may vary from person to person. What works for one individual may not be effective for another.
Hyperfocused When Manic But All Over the Place With Anxiety
With my mania, I’m seriously focused on projects — that’s all I can think about; I have to get it done. With my anxiety, I’m all over the place and feel like my heart’s going to beat out of my chest — I hate it so much.
— M.W.,
I feel an intense urgency with all tasks and action items with mania. Yet when anxious, I just want everything around me to stop and be still so that I feel safer.
— P.L.
Recognizing the Subtle Signs of Escalation vs. Anxiety
They feel very different to me. When I start escalating, I feel fine — no anxiety at all. I feel productive and inspired. That is one of my signs: the lack of anxiety, concern, worry, and so on. However, anxiety is a tightening in my stomach. If I take off my glasses, I realize the tension in my ears. I also sometimes feel like I can’t take a deep breath.
— D.D.
With anxiety, I feel rotten and jumpy. With the early stages of mania, I actually feel pretty good — things look brighter and vivid, and I start ‘riffing.’
— S.H.
I don’t have anxiety when I’m hypomanic.
— A.M.R.
Creativity and Socialibility in Hypomania, Not Anxiety
When entering a hypomanic state, I experience vision changes: My eyes develop flecks of green, and I start seeing everything with highly saturated colors that really pop. Also, I get creative and more social when hypomanic but not when dealing with anxiety.
— H.J.
I think anxiety paralyzes you, but with mania or hypomania, they put you on a hamster wheel, and you’re more talkative.
— L.R.
Racing Speech vs. Restless Pacing
Right before a manic episode, I always talk super fast and stumble over my words — everything is incredibly important and needs to be done now. With anxiety, I start pacing and can’t sit still for even a second.
— S.R.
A Stark Contrast in Energy and Tension
Most of the time, when I’m manic, I’m always busy, can’t stop doing stuff, talking fast, and my mind is spinning all the time. But when I get anxious, my muscles tense up, I start to tremble, and I stutter when speaking. It’s a whole different feeling.
— C.W.
For me, anxiety shows up as scratching my skin or feeling like I can’t settle down. Yet hypomania is racing thoughts or spending money.
— S.C.
With Mania, Engage in Impulsive Behaviors
For me, I have a desire to shop, when I usually don’t like shopping.
— B.H.
Having Different Sleep Issues When Manic vs. Anxious
With anxiety, you try to sleep, and with mania, you think you don’t need sleep.
— J.M.J.
I don’t sleep in the initial stages of mania. I also write down my ideas furiously.
— T.J.S.
With mania, I’m overtired and cannot sleep. With anxiety, I’m sweaty, clammy, nauseous, have a racing heart (and sometimes chest pain), and feel the need to flee to a safe place.
— B.H.
Anxiety as a Symptom of Hypomania or Mania
Anxiety is a feeling in my chest that does not go away after using all my coping mechanisms (like deep breathing) and is probably a symptom of hypomania for me.
— D.S.
Anxiety as a Precursor
I think anxiety can be a precursor [to hypomania]. Useful observation is helpful. I hadn’t really thought about it: I go from anxiety to anger to hypomanic, and my drinking goes up, too.
— A.S.
Mixed States: Recognizing the Key Differences
I experience mixed states — mania with a touch of depression and a dash of anxiety (super fun!). I tell them apart by looking at my sleep and impulsivity. Can I slow myself down enough to make good decisions, avoid overspending, and resist hypersexuality? Am I sleeping through the night and getting at least eight hours? Is my mind racing uncontrollably, or do I still have control over my thoughts?
— J.W.
Hypomania, Mania, and Anxiety: Worlds Apart but Sometimes Overlapping
I have bipolar disorder, and for me, hypomania is not anxiety—it feels like the whole world is smiling at me. My mind overflows with ideas, and I dive into all my projects at once. But when mania escalates, that euphoria shifts into irritability, then rage, and suddenly, everyone around me seems to be moving in slow motion. Anxiety, on the other hand, is completely different. I become hyper-vigilant, my stomach twists into knots, and I tremble. Sometimes, I experience mixed states, and those are the absolute worst.
— C.S.
Consulting With a Healthcare Professional for Their Input
My therapist told me to look at my life and what’s going on, to try to assess if my emotions fit the circumstances. Is there a reason to be anxious, or how else am I feeling?
— C.H.
I talk about how I’m feeling with someone I trust, such as a therapist or my doctor, to help me see if what I’m experiencing looks like mania to them — or not.
— A.R.P.
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