During a dysphoric episode, patients can experience a combination of depression and mania at the same time, but they do not usually have the feelings of euphoria.
Medical News Today asked some experts about the symptoms of dysphoric mania, including who is affected and which treatments can help.
Symptoms of dysphoric mania
Because dysphoric mania is marked by depressive symptoms alongside manic ones, it can be exhausting for the patient and pose a threat to their mental well-being.
It is important for individuals with bipolar disorder and their loved ones to be able to recognize symptoms of dysphoric mania, so that they can seek treatment right away.
Dr. Michael Grunebaum, associate professor of Psychiatry at Columbia University Medical Center and research psychiatrist at the New York State Psychiatric Hospital, outlined some classic symptoms of dysphoric mania for MNT.
There may be other classic symptoms of dysphoric mania alongside irritability and agitation.
- Depressed mood
- Suicidal thoughts
- Anger and agitation
- Excessive energy
- Impulsive behavior
- Decreased need for sleep
- Over-the-top actions of superiority
- Rapid speech
- Having poor boundaries or acting intrusively
"The pleasurable mood elevation common with mania is usually missing from dysphoric mania, although sometimes the elevated and depressed mood symptoms may be mixed together or rapidly alternating," Dr. Grunebaum told MNT.
Friends and family are better able to help someone with bipolar disorder if they can understand a little about what a dysphoric episode can feel like for the patient.
Dr. Susan Noonan, a physician and certified peer specialist and consultant at the Massachusetts General Hospital and McLean Hospital, gave MNT an account of her own experience of a dysphoric episode, as a person with bipolar disorder.
She told MNT:
"When it happens, the world is all dark gray and murky, with no hope of it ever changing or improving, no hope for a life of any meaning to you, and it physically feels as if you are moving through heavy molasses. Fatigue is huge and sleep never comes, and I could be wide awake for four to five days straight. At night I get energized in spite of fatigue and take on projects like rearranging the books on my bookcase or painting my basement walls different colors."
"Thoughts are negative and apparently distorted," she added. "It feels like there's a storm in my head, and I am irritated by everyone and everything around me, and constantly agitated. I am told that I walk and move more slowly, and that my speech and thoughts are more rapid and racing, although at the time I do not have insight into this and do not realize it. Sometimes I just walk and pace continuously, sometimes just sit in one place for hours."
Why dysphoric mania occurs
Alcohol and drug dependence may act as triggers for dysphoric mania.
Currently, there is no clear scientific evidence that explains why bipolar patients experience dysphoric mania.
Mental health experts point to theories that suggest it may stem from imbalances in either neurotransmitters or the neural circuits that involve different regions of the brain, or both.
Genetics can also play a role. Although bipolar disorder is considered a complex genetic disorder and there is evidence for genetic risk factors, shared DNA does not appear to be a root cause for dysphoric mania.
A 2014 study points out that many cases of bipolar disorder are isolated. The authors state that: "It is quite rare to find families in which bipolar disorder affects multiple members over several generations."
The study points out that there may be a connection between the appearance of bipolar disorder and nongenetic factors.
The authors say that alcohol and drug dependence, or even physical and sexual abuse, are potential nongenetic factors that could act as triggers for dysphoric mania.
Regarding the link between genetic factors and environmental triggers, Dr. Grunebaum told MNT:
"There is scientific evidence that bipolar disorder, including dysphoric mania, runs in families due to complex genetic predispositions likely involving many different genes, each contributing a small proportion of the risk. As with depression, bipolar disorder is a stress-sensitive illness. So, stressful life events can trigger an episode, though sometimes one can occur without an identifiable stressor or, in some cases, from sleep deprivation."
Triggers are unique to each individual. Other triggers that have been known to cause a dysphoric episode include interruption in medication, such as antidepressants, or a change in diet.
It is important for patients and their loved ones to monitor any suspected triggers and to report them to the doctor in order to help prevent future episodes.
A treatment plan is necessary in order to manage bipolar disorder and dysphoric mania. Most often, doctors will prescribe "mood stabilizers," or anticonvulsant drugs, such as lithium, valproate, carbamazepine, gabapentin, or lamotrigine to help manage dysphoric mania.
Some research suggests that mixed states may be more responsive to anticonvulsants than the more traditional anti-manic drugs. If these drugs are not sufficient, an antipsychotic or anti-anxiety medication may be added.
It is important for those diagnosed with bipolar disorder to take medications on time and regularly, to avoid triggering a dysphoric episode.
One of the main challenges in treating dysphoric mania is to improve the depressive symptoms without bringing about an onset of manic symptoms.
In addition to medication, mental health experts recommend maintaining healthful habits and incorporating counseling as part of a complete treatment plan to best prevent a dysphoric episode.
Dr. Noonan, whose account of a dysphoric episode is mentioned above, recommends the following lifestyle habits to manage dysphoric mania:
It is recommended to visit a healthcare professional as soon as possible if a dysphoric episode occurs.
- Treating all physical conditions
- Taking medications as prescribed
- Avoiding drinking alcohol and using street drugs
- Avoiding excess caffeine intake and tobacco use
- Getting enough sleep and maintaining regular hygiene
- Following a healthy diet and nutrition plan
- Getting daily physical exercise
- Maintaining a regular daily routine
- Avoiding isolation
- Keeping up with family and friends and regularly socializing
- Using inpatient hospital treatment as needed
Psychotherapy and supportive counseling can also help to alleviate stress and depressive symptoms.
When to see a doctor
It is important to see a doctor as soon as a dysphoric episode appears. An episode can put a patient at risk of harm, and symptoms can worsen the longer they are left untreated.
It is also easier to treat symptoms earlier in the episode when they are less severe, Dr. Grunebaum told MNT.
"Episodes can lead persons suffering from dysphoric mania to make impulsive decisions which can cause problems they later regret, another reason why earlier treatment is better. Lastly, there is some evidence that remaining in a state of dysphoric mania is not good for the brain and may lead to more difficult to treat symptoms if prolonged."
Dr. Noonan adds that dysphoric mania is difficult to treat, but treatment is essential because of the risks involved. Hospitalization may be necessary if the person attempts or is considering suicide.
Dysphoric mania can totally disrupt a person's life, but Dr. Noonan's final advice is: "Don't give up, no matter how bleak."