Dysphoric Mania: Definition, Symptoms, & Treatment

What Is Dysphoric Mania?

Dysphoric mania, or mania with mixed features, is a condition in bipolar disorder when symptoms of mania or hypomania occur at the same time as depressive symptoms.¹ Unlike typical bipolar disorder mania, which is characterized by elevated mood and excessive energy, individuals experiencing dysphoric mania will have manic symptoms alongside feelings of hopelessness, sadness, or suicidal ideation.

The mixed features of dysphoric mania blur the lines between manic and depressive cycles. It is not limited to a particular type of bipolar disorder; it can manifest in both bipolar I and bipolar II. Recognizing and properly managing these mixed episodes is important for providing effective treatment and support to individuals with bipolar disorder.

Can You Be Manic & Depressed at the Same Time?

It’s possible to be both manic and depressed at the same time. In these instances, someone with bipolar disorder experiences a combination of high-energy manic symptoms, like restlessness and impulsivity, alongside low-energy depressive symptoms, such as sadness and hopelessness. This unique emotional state can be confusing and challenging to manage, highlighting the complexity of bipolar disorder.

How Long Does Dysphoric Mania Last?

The length of time a person experiences dysphoric mania can vary from person to person. These episodes can be relatively short, lasting a few days, or more extended, stretching for weeks. It is important to note that the length of dysphoric mania is unpredictable and can be influenced by various factors, including the individual’s unique biology and the effectiveness of their treatment plan.

Reducing the length of time these episodes last is possible with intervention. Monitoring mood changes and working closely with a healthcare professional can help manage and understand the duration of these episodes better. Early intervention and consistent treatment can contribute to shorter and less severe episodes.

Signs & Symptoms of Dysphoric Mania

People with dysphoric mania experience a wide range of symptoms that blend elements of both manic and depressive states. They may feel restless and agitated, struggle with irritability, and exhibit impulsive behaviors. These symptoms often coexist with elevated energy levels. Individuals may also experience the hallmark bipolar disorder symptoms, such as extreme mood swings, changes in sleep patterns, and racing thoughts.

Common mood symptoms of dysphoric mania include:²

• Anxiety or panic
• Irritability
• Unpredictable mood swings
• Agitation
• Overwhelming sadness
• Suicidal ideation (in severe cases)

Common cognitive symptoms of dysphoric mania include:

• Flight of ideas
• Racing thoughts
• Distractibility
• Impaired judgment
• Delusions of grandeur
• Decreased need for sleep
• Difficulty with goal-setting

Common behavioral symptoms of dysphoric mania include:

• Impulsivity and risk-taking behavior
• Hyperactivity
• Aggressive outbursts
• Excessive talking
• Increased social activity
• Sexual promiscuity

Causes of Dysphoric Mania

The exact causes of bipolar disorder, and specifically dysphoric mania, are not fully understood, but several factors may contribute to its development. Genetic factors like family history, life events like chronic stress or trauma, and substance use, including drugs and alcohol, can increase or even trigger these episodes.

Causes of dysphoric mania include:

Genetic & Biological Factors

One study found that bipolar disorder can be hereditary, with a 5-10% increased risk of developing bipolar disorder if you have a first-degree relative with the disorder.³ Another research study discovered that mixed states in bipolar disorders might be connected to genetics and problems with how the body’s internal clock, known as the circadian rhythm, works, as well as how the brain’s dopamine system functions. Dopamine is a chemical in the brain that affects our moods and feelings of pleasure.⁴

Environmental Triggers & Risk Factors

Stressful events or chronic stress can disrupt the delicate balance of brain chemicals, potentially triggering manic episodes. Trauma, especially if it occurred during childhood, can increase vulnerability to mood disorders like dysphoric mania. Major life changes, like job loss or relationship difficulties, can create emotional upheaval, increasing the risk of experiencing dysphoric manic episodes.

Substance Use

Substances can disrupt mood-regulating neurotransmitters in the brain, exacerbating the manic symptoms. Individuals with bipolar disorder are at a higher risk of developing substance use disorders, creating a dangerous cycle of addiction and mood instability. The interplay between bipolar and addiction underscores the importance of addressing both the mood disorder and substance abuse simultaneously in treatment.

Diagnosis of Dysphoric Mania

The diagnostic process for bipolar disorder with mixed symptoms requires a comprehensive evaluation by a mental health professional. It typically involves a thorough assessment of the individual’s medical history, family history of mental illness, and a detailed discussion of their mood fluctuations and behaviors. An important component of the diagnosis is identifying the presence of both manic and depressive symptoms, which can sometimes be subtle or masked.

Psychological assessments and structured interviews are often used to confirm the diagnosis. A proper evaluation is essential as it guides the development of an appropriate treatment plan, ensuring that individuals receive the care and support they need to manage dysphoric mania effectively and improve their quality of life.

Treatment for Dysphoric Mania

Treatment options for dysphoric mania typically involve medications, such as mood stabilizers and antipsychotic drugs, psychotherapy, and lifestyle interventions. A personalized treatment plan for bipolar disorder is developed in collaboration with an individual’s mental health professional to ensure the most effective combination of these interventions to help achieve stability and improved well-being.

Treatment for dysphoric mania can involve:

Medication for Dysphoric Mania

Medications are a cornerstone of treatment for bipolar disorder and can help with dysphoric mania. Mood stabilizers like Lithium, Depakote, and Lamotrigine help regulate mood swings and prevent manic episodes. Antipsychotic medications, such as Quetiapine or Olanzapine, can be used to manage severe manic symptoms or mixed states.

Additionally, antidepressants may be prescribed alongside mood stabilizers but must be carefully monitored to prevent triggering manic episodes. The choice of medication depends on an individual’s specific symptoms and response to treatment. Regular monitoring is crucial to adjust medication dosages and ensure optimal symptom management.

Psychotherapy for Dysphoric Mania

Psychotherapy plays a vital role in helping individuals with dysphoric mania. It allows individuals to explore their emotions, develop coping strategies, and gain insights into their mood fluctuations. There are several approaches used in helping with dysphoric mania, including cognitive behavioral therapy, dialectical behavioral therapy, and family-focused therapy. Psychotherapy is most effective when used alongside medications to treat dysphoric mania.

Therapy options for dysphoric mania include:

• Cognitive behavioral therapy (CBT): CBT for bipolar assists individuals in recognizing and modifying harmful thought patterns and behaviors that contribute to mood swings and impulsivity. By teaching coping skills and strategies to regulate emotions and stress, CBT equips individuals with the tools they need to navigate the unique challenges posed by dysphoric mania effectively.
• Dialectical behavior therapy (DBT): DBT combines cognitive-behavioral techniques with mindfulness practices, helping individuals with bipolar disorder better regulate their emotions, tolerate distress, and improve interpersonal relationships.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT focuses on stabilizing daily routines and improving interpersonal relationships, which can help individuals with bipolar disorder maintain regular sleep patterns and reduce stress triggers.⁵
• Family-focused therapy: Family-focused therapy involves family members in therapy, which can enhance support systems and improve communication, which is particularly valuable for individuals with bipolar disorder during dysphoric mania episodes.
• Support Groups: A supportive therapeutic environment including other individuals struggling with the same symptoms, offering empathy and encouragement, can be beneficial during dysphoric mania and other phases of bipolar disorder, providing emotional support and reducing feelings of isolation.

Lifestyle Changes

Lifestyle changes can be beneficial to individuals dealing with dysphoric mania to reduce stress and improve well-being. Consistent daily schedules, including regular meal times, exercise, and sleep, can help stabilize mood fluctuations. Adequate sleep hygiene, such as avoiding excessive caffeine and establishing a relaxing bedtime routine, can aid in preventing sleep disruptions associated with dysphoric mania.

Additionally, stress management techniques, like mindfulness, meditation, and relaxation exercises, can reduce emotional triggers and help individuals better cope with the challenges of mixed manic and depressive symptoms. Incorporating these lifestyle changes alongside medication and therapy can significantly improve the management of dysphoric mania.

How to Cope With Dysphoric Mania

Coping with dysphoric mania requires a combination of self-awareness and support from loved ones. Recognizing early warning signs, communicating with their healthcare team, maintaining a consistent daily routine, prioritizing sleep, and avoiding stress triggers for individuals to cope with dysphoric mania. These strategies, a strong support network, and medication are key components of long-term symptom management.

Here are ten ways to cope with dysphoric mania:

1. Monitoring mood and symptoms: Regularly tracking mood fluctuations and symptom patterns can help individuals with bipolar disorder identify early warning signs of dysphoric mania. This awareness enables timely intervention, adjustment of treatment plans, and better self-management of mood swings.
2. Building a support network: Asking for help and establishing a strong support network of friends, family, and healthcare professionals is an important part of the treatment plan. This network can offer emotional support, assist in crisis management, and encourage individuals to adhere to treatment recommendations.
3. Stress reduction techniques: Incorporating stress reduction techniques such as progressive muscle relaxation, meditation, and deep breathing exercises can help individuals manage emotional triggers and reduce the impact of stressors on dysphoric mania episodes.
4. Educating loved ones: Providing psychoeducation to loved ones about bipolar disorder and dysphoric mania can foster understanding, empathy, and effective communication. When those close to the individual are informed about the condition, they can offer better support and recognize when professional intervention may be necessary.
5. Medication adherence: Consistently taking prescribed medications as directed by healthcare providers is essential for stabilizing mood and preventing or reducing the frequency/intensity of dysphoric mania episodes.
6. Lifestyle modifications: Maintaining a balanced lifestyle, including regular exercise, a healthy diet, and adequate sleep, can contribute to mood stability and overall well-being. Avoiding substance use and adhering to a routine are also beneficial.
7. Therapy and counseling: Ongoing psychotherapy can equip individuals with effective coping strategies and provide a safe space to discuss their experiences and challenges.
8. Emergency action plan: Creating an emergency plan with healthcare providers and loved ones can be invaluable. It outlines steps during severe episodes, ensuring a swift and effective response.
9. Engaging in creative outlets: Pursuing creative interests, hobbies, or activities can serve as a healthy outlet for managing emotions and reducing stress, offering a constructive way to cope with dysphoric mania.
10. Peer support groups: Joining support groups for individuals with bipolar disorder can provide a sense of community, shared experiences, and additional coping strategies through peer interaction.

When to Seek Professional Support

Individuals with bipolar disorder should consider seeking professional help if they experience significant mood swings, mania, or depression that interfere with daily life or if they experience thoughts of self-harm or suicide. An online therapist directory or online therapy platform can be a convenient option to find qualified therapists who specialize in bipolar disorder.

Finding and choosing a psychiatrist to speak to is an important aspect of bipolar symptom management. These online psychiatrist options for managing medications offer accessible and convenient medication evaluation, adjustments, and monitoring while ensuring proper medical oversight. It’s essential to maintain open communication with healthcare professionals and ensure that any online services adhere to best practices for bipolar disorder treatment.