Dysphoric Mania: Causes and Treatment for a Dysphoric Mood

Dysphoric mania is a somewhat misunderstood term, besides being somewhat of a contradiction in terms.

Dysphoria is associated with depression, and mania is associated with an excitable mood, so the two seem on opposite edges of the same spectrum.

Dysphoric mania is often part of a bipolar diagnosis. Of the three primary bipolar disorder diagnoses, dysphoric mania is usually included within the umbrella of the most serious of the three bipolar diagnoses; bipolar I disorder. But dysphoric mania can also happen in cases of bipolar II disorder.

Most people understand bipolar disorder to be a condition where a person experiences manic highs and depressive lows. Many assume that when they are not in either of these captive traps, they are – well, okay. But, things are never quite as simple as that.

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You can consider dysphoric mania to be a grey area where the person is experiencing both depressive symptoms and manic symptoms at the same time.

These episodes can be complex to describe, let alone, experience. 

To help better understand the condition, here are the symptoms of depressive and manic episodes:

Symptoms of Depression

  • Losing interest in activities once enjoyed
  • Curtailed sleep or appetite
  • Social isolation
  • Thoughts of death or suicide (suicidal ideation)
  • Inexplicable crying or long periods of sadness
  • Lethargy
  • Indecisiveness or confusion
  • Feelings of worthlessness or guilt

Symptoms of Mania

  • Aggressiveness or irritability
  • Hallucinations or delusions
  • Recklessness and risk-taking behavior
  • Needing less sleep or not feeling tired
  • Rapid, frenzied speech (pressured speech)
  • Purposeless, often relentless, activity (psychomotor agitation)
  • Grandiosity and exaggerated feelings of self-importance
  • Racing thoughts

Clarification of a Dysphoric Manic Episode

To better clarify a mixed or dysphoric mania episode, let’s first detail a depressive and manic episode.

A depressive episode diagnosis must include the patient experiencing either a sad mood or loss of interest in life pervasively, in addition to at least five of the other symptoms for a minimum period of two weeks.

Conversely, for a manic episode to be diagnosed, the person must exhibit a mood that is excitable, prolonged, and unusual. There must also be three symptoms of mood elevation. These can include reduced sleep, increased energy, euphoria, and other symptoms. Mania would also be diagnosed if a person was experiencing psychosis or hallucinations.

Several episodes that people with a bipolar diagnosis experience are considered “mixed” episodes. The person experiences depressive symptoms and those of a mood elevation at the same time. It’s a hard concept for people to grasp and harder still for patients to experience. It’s estimated that between 20-40% of people with bipolar disorder experience these ‘mixed’ or ‘switching’ episodes.

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Updated Diagnosis for Dysphoric Mania

The latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) has been updated to reflect this new understanding of bipolar episodes. Whereas previously in the fourth edition, there was a criterion that a person had to be experiencing the full compendium of manic and depressive symptoms to have a mixed episode diagnosis.

There is now a mixed features specifier that can better describe how many people present. A person does not have to be experiencing all symptoms. They may experience more depressive features, and with a diagnosis of dysphoric mania, they may have a manic episode with some depressive features present. 

What are the Dysphoric Mania Treatment Options?

Treatment options for mixed episodes present difficulties for clinicians. That’s because there are drugs used to treat mania, and depression conversely responds to antipsychotics. But dysphoric episodes are a combination of both.

It’s also important to note that euphoria, such as a feature of a dysphoric episode, is but a symptom. It’s not wise to treat a symptom; rather, you need to treat the underlying condition.

Treatment options vary, but if, for example, the person exhibits mania with underlying depression and suicidal ideation, then hospitalization is often needed to prevent the person from carrying out suicide.

Especially when there are depressive symptoms of suicidal ideation and symptoms of erratic behavior or hallucinations and delusions, hospitalization will always be the most viable treatment plan.

Unfortunately, everyone is an individual, and every mixed episode is different. Therefore, there is no one fixed treatment course. It may be a case of trial and error to achieve a response to treatment. This can frustrate the patient that they are being hospitalized but is necessary to prevent suicide.

Often antidepressants, along with antipsychotics, may be effective. Lithium and anticonvulsants may also be helpful.

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Resources

If you or a friend or family member is experiencing manic symptoms or show depressive signs, it’s vital to seek help. Since dysphoric mania is a crucial feature of bipolar disorder, you likely have a mental health team or contacts helpful for guidance.

If you are concerned, use a crisis team hotline to get immediate assistance. No one is going to complain that you used the hotline when you shouldn’t have done it. It’s up to mental health professionals to assess the seriousness of an episode, not you. If in doubt, a crisis team is an excellent port of call.

If you or a loved one struggles with bipolar disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

US:

If you are in a crisis, please call 1-800-273-TALK (8255) in the US.

UK:

Log on to bipolaruk.org and select crisis-support to get through to a chatbot immediately.

Australia:

Log on to Bipolar Australia. If you need immediate help, select Crisis Contacts for their 24-hour suicide callback service and other options.

Canada:

Seek out options at Canada Mental Health. The 24-hour suicide hotline is

416 535-8501 or 1 800 463-2338 toll-free, staffed 24/7. If you need emergency help, please call 911, visit your local emergency department or CAMHs Psychiatric Emergency Department, or call a local distress center or crisis service.