OBJECTIVES: Relatively little data exists to estimate the true burden of manic episodes on health-care systems, and information on the therapeutic strategies used is lacking. This study was undertaken to identify the treatment strategies chosen and to assess the cost of treating a manic episode for bipolar patients in a “real–world setting”. METHODS: A multi-centre retrospective study over a three-month period. Data are collected from hospital records of patients who had to be hospitalised for a manic episode between 1997 and 1999. Health-care resource utilisation (hospitalisation, nursing home, medications and laboratory tests) was assessed, direct costs were calculated, and treatment strategies analysed. RESULTS: A total of 137 patients files (51.8% female; mean age: 35 years) were reviewed. Data on 185 hospitalisations were collected among which28% of patients had more than one hospitalisation. The breakdown of treatment strategies at D30 of hospitalisation was as follows: neuroleptic and mood-stabiliser, 64% of patients; neuroleptic alone or in association without mood-stabiliser 18%; mood-stabiliser alone or in association without neuroleptic 14%; strategy without mood-stabiliser or neuroleptic 4%. After discharge, the breakdown of these strategies was respectively as follows : 62%; 14%; 22%, and 2%. The mean number of days spent in hospital was 47 over the study period. On average patients had received 4.9 medications at hospital and 3.4 in the community. The mean direct cost incurred over the three-month study period was 22 297 Euros. The breakdown of the cost per patient for the three-month data period is as follows: hospitalisation 98.6%; rehabilitation 0.6% (9 patients out of 137); visits 0.4%; medication 0.3%; laboratory tests <0.01%. CONCLUSION: These results confirm that the costs of treating a manic episode are high, and overwhelmingly due to the cost of hospitalisation.