Dysphoric Mania Definition, and Diagnosis
Dysphoric mania is a mental illness which usually refers to bipolar disorder with mixed episodes of mania and major depression either experienced simultaneously or in rapid sequence. Dysphoric mania typically involves some form of agitation up to and including outright rage. This condition can be described as agitated depression. The person may cry while claiming they are immensely happy. They may feel the increased energy and euphoria associated with mania while simultaneously feeling sad and hopeless. They may also be depressed and lethargic while simultaneously having racing thoughts and speech. Dysphoric mania tends to be harder to treat than other forms of bipolar disorder. It is also postulated that those who suffer dysphoric mania are more likely to commit suicide (Goldberg, Garno, Petera, Leon, Kocsis, Whiteside, 1999). Abuse of substances is also very common.
The Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (1994) states that "a mixed episode is characterized by a period of time (lasting at least 1 week) in which the criteria are met for both a Manic Episode and for a Major Depressive Episode nearly every day." Furthermore, the symptoms that a person is suffering must be severe enough to significantly impair their life and functioning, or require hospitalization or involve psychotic features.
Agitation, irritability, rage
Loss of energy, fatigue
Suicidal Ideation or thoughts of suicide as well as attempts or completions
Delusions: Particularly persecutory or the belief someone or something is after them or wants to harm them.
Feelings of worthlessness or excessive guilt
Pressured or rapid speech, flight of ideas, distractible
Inflated self-esteem or grandiosity
Decreased ability to concentrate
Significant weight loss or weight gain
Dysphoric mania can be treated with various approaches such as medication, psychotherapy and electroconvulsive therapy. Drugs used to treat bipolar disorder are typically mood stabilizers and/or antipsychotics. However, the challenge with treating dysphoric mania is the need to treat both depression and mania at the same time. Antidepressants often used to treat depression can trigger mania in someone who suffers from bipolar disorder.
Lithium is a mood stabilizer that is often used for the treatment of mania. However, Lithium takes time to build up to therapeutic levels in one's body and therefore works better as a prevention of mania on an ongoing basis than for treating a sudden onset of mania. Depakote is an anti-seizure medication that is often used as a mood stabilizer. It reaches therapeutic levels in one’s body fast and is therefore better for treating sudden onset mania but can also be used as a preventative treatment. Tegretol is another anti-seizure medication that is often used to treat bipolar disorder. An antipsychotic that is often used to treat dysphoric mania or bipolar disorder is Zyprexa.
Psychotherapy is often used in conjunction with medication. Cognitive Behavioral Therapy, CBT, has been proven to be beneficial in the treatment of depression and bipolar disorder. This involves talking to a professional about one’s problems and making changes in one’s life. Changes or healthy lifestyle habits that are beneficial include exercising, a healthy diet, and adequate sleep. CBT also works on making healthy changes in one’s thought patterns.
Finally, if medication and/or therapy are not working or medication cannot be used, electroconvulsive therapy may be beneficial in treating dysphoric mania. This form of treatment is controversial and typically receives a negative response from the average person. However, it appears to be helpful in the treatment major depression and mania particularly in patients who have not responded well to other treatment. It involves inducing seizures by passing an electric current through the patient’s brain. It appears to alter ones brain chemistry immediately. However, ECT has also been known to cause a mixed episode. Speak with a trusted professional and consider all your options when determining the form of treatment that may be right for you.
Naghmeh Mokhber, Carol J Lane, Mohamad R Azarpazhooh, Elham Salari, Reza Fayazi, Mohamad T Shakeri, and Allan H Young: Anticonvulsant treatments of dysphoric mania: a trial of gabapentin, lamotrigine and carbamazepine in Iran; Neuropsychiatric Disorders Treatment. 2008 February; 4(1): 227–234.Published online 2008 February.PMCID: PMC2515896
Goldberg JF, Garno JL, Portera L, Leon AC, Kocsis JH, Whiteside JE: Correlates of suicidal ideation in dysphoric mania; J Affect Disord. 1999 Nov;56(1):75-81.
WebMd: Types of Bipolar Disorder, Reviewed by Raya Almufti Abraham MD; February 25, 2010.
Mayo clinic: Electroconvulsive Therapy (ECT) July 9, 2010
WebMd: What is Mixed Bipolar Disorder, Reviewed by Amal Chakraburtty, MD on Augst 29, 2009.
Bright Hub: Article by; Mandy Dobbins Harris, Edited and Published by Dr. Jerry Kennard: The facts About Bipolar Disorder:
This post is part of the series: Bipolar Disorder
- Defining Bipolar Disorder
- Spotlight on the Types of Bipolar Disorder
- The Facts about Bipolar Mania
- The Facts about Dysphoric Mania