Pressured Speech in Bipolar Disorder

A Compulsive Urge to Talk Often Signals a Hypomanic or Manic Episode

Pressured Speech
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Everyone occasionally experiences a pressing desire to talk—whether to share good news, or an exciting or unusual experience. If you have bipolar disorder, however, a compulsive urge to talk might represent a symptom called pressured speech. This symptom occurs commonly in adults, adolescents, and children with bipolar disorder experiencing mania or hypomania.

A rapid-fire speech pattern is one of the most frequent initial signs of bipolar disorder.

It usually occurs with other common signs and symptoms, such as increased energy and activity; reduced need for sleep or insomnia; elevated mood; irritability, agitation, or jumpiness; and racing thoughts. Pressured speech alone does not necessarily indicate bipolar disorder. This symptom can occur with other mental and nervous system conditions—such as schizophrenia, dementia, and stroke—and use of certain drugs, like cocaine, methamphetamine, and phencyclidine (PCP).

Characteristic Features of Pressured Speech

Pressured speech differs from ordinary talkativeness and represents a noticeable change in a person's usual manner of speaking. It manifests as a compelling, virtually irresistible desire to talk. A person experiencing this symptom feels driven to talk, typically for prolonged periods and faster than usual. Other common features include speaking loudly and emphatically, and talking over or interrupting others.

Following the conversation can be challenging for the listener because someone with pressured speech also typically experiences racing thoughts. This leads to jumping rapidly from one topic to another, a sign called flight of ideas. With a hypomanic episode, the conversation may seem odd but generally logical.

Pressured speech during a manic episode, however, usually leaves the listener confused because the conversation is characteristically disjointed, illogical, fantastical, or even scary.    

Addressing the Development of Pressured Speech

If you or a loved one develops pressured speech and have not been previously diagnosed with bipolar disorder, medical evaluation is necessary to determine the underlying cause of this symptom. Among people known to have bipolar disorder, the development of this symptom usually signals the start of a hypomanic episode that might progress to full-blown mania. 

If you have bipolar disorder, development of driven speech signals the need to seek help from your doctor or someone designated to work with you to help manage your condition, such as a friend or family member. Ideally, you and your designated helper will have worked out a strategy in advance to handle these episodes. For example, if you are able to identify a trigger that led to the episode, removing yourself from that environment or situation may help calm your symptoms. Getting out into nature, taking a walk, or listening to calming sounds might also help reduce your symptoms. If your symptoms are severe, intensify, or turn violent, it is best to make urgent contact with your doctor or emergency services.

Treating the Underlying Condition

Because pressured speech is a symptom and not a condition, it is important to address the root cause. Particularly among people not previously diagnosed with bipolar disorder, evaluation might involve testing to rule out other conditions, such as a brain injury or drug misuse.

Extreme stress, anxiety, sleep deprivation, and medication changes are among the common triggers of a hypomanic or manic episode. In such cases, pressured speech and other accompanying symptoms might resolve on their own, with or without counseling. For severe, persistent or intensifying symptoms, however, medication may be needed along with counseling.

People with mixed episode bipolar disorder—where manic highs occur simultaneously or in rapid sequence with depressive lows—may require more intensive treatment. Mood stabilizers and/or antipsychotic medications are often prescribed. Temporary hospitalization may be necessary if a person is at risk for suicidal or violent actions during an episode.

Sources:

Bipolar Disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml.

Bope ET, Kellerman RD. Conn's Current Therapy 2017. Philadelphia, PA: Elsevier; 2017.

Connolly KR, Thase ME. The Clinical Management of Bipolar Disorder: A Review of Evidence-Based Guidelines. Prim Care Companion CNS Disord. 2011;13(4):PCC.10r01097. doi:10.4088/PCC.10r01097

Videbeck SL. Psychiatric-Mental Health Nursing. 6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.

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