What is Dysphoric Mania: Causes, Symptoms, Treatment

An individual is said to have Dysphoric Mania when he or she has depressive symptoms coupled with manic episodes. This is usually seen in people with bipolar disorder. It is also known by the name of Mixed Mania. The DSM-V criteria specifies that for an individual to be diagnosed as Dysphoric Mania, it is essential for that individual to show complete episodes of both depression and manic episodes for at least a week.^[1]

Bipolar disorder is a psychological condition that occurs in around 3% of people in the United States. Studies suggest that around 30-40% of people with bipolar disorder suffer from Dysphoric Mania. This is based on a study report published in 2015. Experiencing both depressive symptoms and manic episodes at the same time makes this condition quite a challenge for physicians to first diagnose and then treat. However, there are various treatments available which have been explained below in detail.^[2]

There is no root cause of Dysphoric Mania identified as of yet and research is still ongoing in this regard. Some studies have opined that there is a genetic link to the development of bipolar disorder that further intensifies to Dysphoric Mania. According to various studies there is a whopping 10 times increased risk for people developing bipolar disorder and then Dysphoric Mania in people who have a family history or have a close relative with this disorder. However, many researchers believe that such instances where bipolar disorder or Dysphoric Mania runs in families are quite rare.^[2]

Substance abuse however is something that is closely related to the development of bipolar disorder and subsequent Dysphoric Mania. There are also some risk factors that increase the risk of an individual developing Dysphoric Mania. These factors include seasonal changes that affect the circadian rhythm of an individual which affect the sleep and other factors which have a role to play in an individual’s overall psychological well-being increase the risk of individual developing changes that are seen in Dysphoric Mania.^[2]

Certain classes of medications like tricyclic antidepressants and amphetamines increase the risk of an individual developing bipolar disorder and ultimately Dysphoric Mania. An individual who does not get proper sleep is most at risk for developing Dysphoric Mania. Researchers however believe that further studies need to be done to better understand the cause behind the two states of depression and mania that come to the forefront in an individual with Dysphoric Mania.^[2]

The symptoms of Dysphoric Mania can be divided into two halves which are the symptoms of depression and the symptoms of manic episodes. It is the combination of these two symptoms which makes this condition unique and extremely hard to treat. An individual experiencing symptoms of both mania as well as depression is more at risk for self-harm or harm to others than people who just have either depression or just manic episodes.^[2]

What further makes the treatment difficult is the fact that if one aspect of the illness like depression is treated with antidepressants it often makes the other aspect of the illness that is the manic episodes worse. According the DSM-V, the symptoms of depression include the following:^[2]

• An individual has extended periods of feeling unhappy, helpless, and hopeless about the present and the future. The individual may have periods of crying and tearfulness when describing his or her condition.
• The patient has complete lack of interest in all activities, especially those that the patient used to enjoy before.
• The patient has severe reduction in partaking in any activities whether at home or in social environments.
• The patient has severe increase or decrease in appetite.
• The patient is severely lethargic and has no energy to do anything.
• The patient constantly thinks or speaks about taking his own life or life of others known to him.
• Physical symptoms of aches and pains all over the body.^[2]

The DSM-V describes the symptoms of manic episodes like:

• The patient having periods where his mood is ecstatic and elated.
• The patient feels very high in energy despite having total lack of sleep. In fact, the patient tends to feel extremely fresh even after a 15 minute nap.
• The patient has rush of new ideas and is always eager to do something ultimately resulting in inappropriate thinking and decisions.
• The patient experiences hallucinations and delusions.
• The patient always has a false belief that he is the best.^[2]

What happens in mixed mania is that the individual has alternating periods of depression and mania meaning that there will be periods of complete depression alternating with elated mood in quick succession. This is what makes Dysphoric Mania deadly dangerous. ^[2]

The patient will find pleasure in crying or when in pain or the patient may have a rush of ideas when completely lethargic. The combination of the two conditions with its associated symptoms can increase the risk of suicides multifold. In fact, it becomes a medical emergency and requires immediate treatment.^[2]

As stated, Dysphoric Mania is a tough condition to treat. Many people with depression find antidepressants helpful; however, it makes the symptoms of manic episodes worse and thus caution should be maintained before giving such medications. In most cases, the physician will prescribe mood stabilizers and antipsychotic medications. A standalone therapy will not work in cases of Dysphoric Mania and a combination of drugs which control the symptoms of both depression and mania will be required for treatment of Dysphoric Mania.^[2]

Some of the preferred medications which are used to treat Dysphoric Mania include risperidone. This drug is extremely effective in treating mania but is not so effective in treating depression. Some of the other medications that are used include olanzapine and aripiprazole. The most preferred mood stabilizers which are effective in treating Dysphoric Mania include carbamazepine, divalproex sodium, and oxcarbazepine.^[2]

It should be noted that all the medications given for treatment of Dysphoric Mania have significant side effect profile and in most cases the patients have compliance issues which often makes the treatment ineffective. Some studies suggest that anticonvulsants are quite effective in treatment of Dysphoric Mania. This is especially true if they are used in combination with antipsychotics or an anxiolytic.^[2]

Compliance is something which is absolutely necessary and should be adhered to. As long as the treatment plan is followed diligently by the patient then the episodes of Dysphoric Mania can be controlled to a significant degree. In addition, electroconvulsive therapy is yet another way to treat the symptoms of Dysphoric Mania. This is reserved for people who find medication treatment ineffective or have compliance issues with medications. This procedure involves giving controlled electrical shocks to the patients.^[2]

This form of therapy is used mainly for patients who are extremely suicidal and have constant periods of depression and mania in quick succession. The exact mechanism of how this therapy works and its overall effectiveness is yet to be studied in detail. Additionally, there are certain lifestyle changes that can be quite effective in treating Dysphoric Mania. These include:^[2]

• Taking medications as directed by the physician
• Avoiding caffeine, alcohol, tobacco, and recreational drugs
• Have a regular sleep schedule and maintain good sleep hygiene
• Eat a healthy and nutritious diet
• Daily physical exercises
• Being active socially and not to remain isolated
• Going to the emergency room if having quick periods of alternative depression and manic symptoms.

Attending counseling sessions to cope with stress and mood disturbance more effectively and in a healthful manner top prevent flare of symptoms of Dysphoric Mania.^[2]

References: