When you have bipolar disorder, you may have episodes of depression, mania, or both. Dysphoric mania is when you have symptoms of depression and mania at the same time. It’s sometimes called a "mixed state," "mixed mania," "mixed episode," or "mixed features."
While experts used to think it was rare, they now realize it’s common. About 40% of people with bipolar disorder have dysphoric mania at times.
When you have dysphoric mania, you may have a mixture of manic and depressive symptoms at once. Or they may switch quickly, one after the other. You could have symptoms most of the day, every day, for a week or two. Or it might go on longer.
Common symptoms of mania include:
- A happy, high mood
- Crankiness or touchiness
- Feeling jumpy, wired, or extra active
- Racing thoughts
- Fast speech
- Lots of ideas, or talking fast about a lot of things
- Bigger appetite for activities like eating, drinking, and sex
- Feeling extra important, talented, powerful, or capable of doing a lot
- Less need for sleep
Common symptoms of depression include:
- Feeling sad, anxious, or down
- Feeling slow
- Trouble concentrating
- Trouble making decisions
- Problems sleeping
- Talking slowly
- Less interest in activities
- Trouble doing simple tasks
- Hopelessness or worthlessness
- Thoughts of death or suicide
What It Feels Like
Dysphoric mania can feel like a manic episode, but with some symptoms of depression, like a negative mood and sadness. Or you may feel depressed, but with extra energy, restlessness, and emotional discomfort. Your mind might be racing, and you could have trouble sleeping. At the same time, you may feel sad and down on yourself.
A mixed episode can feel intense. You might notice changes in your energy, activity, and behavior. Others around you, like family or friends, may be able to notice it, too.
Mixed episodes can be disruptive, unpredictable, hard to figure out, and challenging to cope with. Since you feel so many emotions, you may feel emotionally exhausted.
What to Watch For
During an episode of dysphoric mania, you have a higher risk of suicide. That's why it’s important to see your doctor or therapist as soon as possible, especially if you’re thinking a lot about death.
It's also linked to conditions like anxiety disorders and substance abuse.
How to Treat It
Your doctor can treat your dysphoric mania with medicine. Your treatment may be a combination of two or more medications, like antipsychotics and mood stabilizers. Your doctor might also recommend talk therapy.
If medication doesn’t work, your doctor may recommend electroconvulsive therapy, or ECT. In ECT, your doctor uses electrodes to pass electric pulses through your brain while you're under anesthesia. It’s a fast-working treatment that helps with symptoms that are hard to control.
Other treatments include:
- Repetitive transcranial magnetic stimulation, in which your doctor uses an electromagnet to stimulate nerve cells in your brain
- Vagus nerve stimulation, in which a device similar to a pacemaker sends mild electric pulses to your brain through your vagus nerve
- Deep brain stimulation, in which a surgeon implants electrodes in areas of your brain. They deliver electrical impulses that help regulate abnormal brain activity.
What You Can Do
If you have dysphoric mania, you can take steps to manage it.
- Talk to someone. Reach out to friends or family members you trust. Talk to others with bipolar disorder. They may help you recognize symptoms or warning signs. A therapist can help you manage it better.
- Learn about it. Educate yourself. Go online to read blogs, follow mental illness hashtags, and join a forum. When you understand dysphoric mania and connect with others with similar experiences, you can learn to cope better.
- Frame it better. Try to learn from each episode. Look back at what it was like so you can prepare for next time. Start a mood journal. Jot down your feelings, mood, and symptoms before and during episodes, then notice the trends. Self-awareness may help you identify your triggers, recognize warning signs, and manage your symptoms better.