Pressured Speech in Bipolar Disorder

Frenzied, rapid-fire talk is a classic symptom of mania

Pressured Speech
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There are times when "running at the mouth" is used as a figure of speech to describe a person who talks incessantly or babbles. There are others when the term can be applied to a symptom of bipolar disorder called pressured speech.

Pressured speech is one of the hallmarks of mania or hypomania in bipolar disorder. Also known as "cluttered speech," it is one of a roster of symptoms that can be used to confirm the initial diagnosis.

It is, in fact, on one of the most common symptoms seen in bipolar individuals, affecting nearly a third of adults and children.

Pressured speech can occur in other psychiatric disorders and cannot be used on its own to make a bipolar diagnosis. Schizophrenia and illicit drug use (cocaine, methamphetamines) are also associated with pressured speech.

Features of Pressured Speech

Probably the simplest and most evocative way to characterize pressured speech is "motormouth," a term used by Mitzi Waltz in her book Bipolar Disorders.

Someone with pressured speech speaks quickly and loudly. The person can often be difficult to understand, in part because the ideas are coming fast and furious and jump one to the next. If the person is also experiencing a flight of ideas, the speech can appear more disjointed, incoherent, and even scary.

Dr. Jacob L. Driesen, a specialist in behavioral neuroscience and behavioral medicine, has broken down pressured speech into its four key characteristics:

  • Rapid, virtually nonstop talking
  • Speech that is loud and emphatic
  • Thoughts that are seemingly driven
  • A person who is usually hard to interrupt

All of these features together typify the classic case of pressured speech.

How to Address a Manic Episode

If the pressured speech is due to a manic episode, it is important to seek help either from your doctor or someone who has been designated to work with you (such as a peer or family member).

Ideally, that person will be trained in helping you isolate and slow down your thoughts.

In the best-case scenario, you and your designated "buddy" will have worked out a strategy in advance on how to handle these episodes. If things intensify or turn violent, it may be best to contact your doctor or an emergency helpline directly.

If you are able to identify a trigger that led to the episode, remove yourself from that environment or subject matter. Instead, find a place where you are not bombarded by stimuli. Get out in nature, take a walk, or listen to calming sounds such as ocean waves to alleviate the severity of the episode.

Treating the Symptom by Treating the Condition

Because pressured speech is a symptom and not a condition, it is important to address the root cause the manic or hypomanic episode. To do so, a doctor may need to perform tests to rule out brain injury or ask you questions to determine whether a stimulant or drug misuse may have precipitated the event.

Oftentimes, extreme stress or anxiety is enough to trigger an episode. In such case, the pressured speech may resolve on its own with or without counseling. At other times, psychoactive drugs may need to be prescribed along with counseling.

People with mixed episodes of bipolar disorder—where manic highs occur at the same time (or in rapid sequence) to the depressive lows—may require more aggressive intervention. Mood stabilizers and/or antipsychotics will typically be prescribed. Hospitalization may be required if a suicidal risk is present.


Videbeck, S. Psychiatric-Mental Health Nursing, 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2010; ISNB 160547861X.

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