Dysphoric mania is a combination of mania and depression symptoms. Though its causes are unclear, treatment includes medication and talk therapy.

Bipolar disorder sometimes features dysphoric mania. When a person lives with bipolar disorder, they experience mood shifts between depression and mania. Sometimes, depression and mania occur together as dysphoric mania.

You may have heard “mixed episode” or “mixed mania” to describe this state, but these terms have fallen out of common use.

Dysphoria is a depression symptom. If you’re experiencing a dysphoric mood, you may feel sad, distressed, or indifferent.

Mania is energy or activity level that’s unusually high, so much that other people might notice. You may feel jumpy or have racing thoughts and exaggerated confidence. Some people get little or no sleep during episodes of mania.

Dysphoric mania isn’t the same as bipolar disorder, but the two are connected.

Bipolar disorder features extreme shifts in mood. Dysphoric mania is one of the moods that can exist in bipolar disorder. Dysphoric mania is an older term that refers to bipolar disorder with mixed features.

About 40% of people living with bipolar disorder experience dysphoric mania, compared to 30% who experience euphoric mania.

Euphoric mania is often called mania and presents as:

  • excitement
  • euphoria
  • high energy

Euphoric mania is more than just an extremely good mood. It can interfere with home life, work, or school because it can impair your judgment and lead to impulsive behavior.

Dysphoric and euphoric mania have some similarities:

  • high energy
  • rapid speech
  • less need for sleep
  • impaired judgment
  • impulsiveness and recklessness
  • restlessness
  • appetite changes
  • may experience delusions and hallucinations

They also have differences:

Dysphoric maniaEuphoric mania
Prevalence in people with bipolar disorder: around 40%Prevalence in people with bipolar disorder: around 30%
suicidal activity or thoughtsexcitement and hyperactivity
irritabilitydelusional high self-esteem

Dysphoric mania can last for 1 or 2 weeks and sometimes longer. Euphoric mania can last at least a week.

Dysphoric mania is a combination of depressive and manic symptoms that occur together. For example, you might have high energy while feeling pessimistic.

Depressive symptoms

  • sadness, anxiety, or “empty” mood
  • fatigue, reduced energy
  • weight and appetite changes
  • feelings of hopelessness, pessimism
  • irritability
  • slower movement and speech
  • guilt
  • feelings of helplessness or worthlessness
  • reduced ability to concentrate, make decisions, and remember
  • change in sleep patterns
  • thoughts of death
  • suicidal thoughts or attempts
  • loss of pleasure from or interest in previously enjoyed activities
  • restlessness

Depressive symptoms can also be physical. An indicator that they’re related to depression is that they don’t have a clear cause or don’t improve with treatment. Physical symptoms of depression include:

  • headaches
  • body aches
  • digestive upset
  • cramps

Manic symptoms

  • elation, euphoria
  • reduced need for sleep
  • excessive energy
  • a flood of new ideas
  • appetite loss
  • irritability
  • jumpiness
  • overestimation of capabilities
  • rapid speech
  • racing thoughts
  • reckless behavior
  • grandiose feelings

Not everyone with depression or mania experiences all symptoms. For example, you might still be able to remember things even if you can’t focus. Or, you might have rapid speech without reckless behavior.

If you’re experiencing dysphoric mania, you might speak quickly while feeling guilt and anxiety. Or you might have racing thoughts with pessimism and hopelessness.

Each person’s experience is unique, so yours may not be the same as someone else’s.

The exact causes of bipolar disorder with mixed features are still unclear, but there are some theories.

Research from 2016 notes that dysphoric mania results from genetics leading to brain chemical changes.

Circadian dysregulation is another possible culprit. Research links mood shifts in bipolar disorder to circadian elements like light intensity and seasonal changes.

Stress and sleep disruption also play a role in causing mood changes, as well as other lifestyle factors like nutrition and exercise.

Specific medications, like tricyclic antidepressants (TCAs) and reuptake inhibitors, can lead to mania in bipolar disorder. People living with Parkinson’s disease may experience mania-like behavior from their medication prescribed to increase norepinephrine and dopamine.

The criteria for identifying dysphoric mania have changed so that treatment can be more effective.

To be considered bipolar disorder with mixed features, the Diagnostic and Statistical Manual of Mental Disorders 5th edition, text revision (DSM-5-TR) requires that symptoms meet the full criteria for mania or hypomania, plus three depressive symptoms chosen from a specific list.

The DSM-5-TR is the reference manual that mental health professionals use to identify and classify psychiatric conditions.

The previous version, the DSM-IV, required that symptoms meet the full criteria for a manic episode, plus all criteria (except duration) for a major depressive episode, for at least 1 week.

The DSM-5-TR criteria make it easier to identify people experiencing dysphoric mania in bipolar disorder. This can lead to more beneficial treatment.

Using antidepressants alone to treat bipolar disorder with mixed features isn’t recommended. This is because the neurotransmitter action of the antidepressant medication can trigger episodes of dysphoric mania, which may increase the chances of a suicide attempt.

Instead, other treatment options may help.


A 2014 study says that the best medication approach to treat dysphoric mania is to combine atypical antipsychotics with mood stabilizers. You may need to work with your doctor and try several combinations or doses to reach an effective solution.

Some medications to treat dysphoric mania include:

  • Atypical antipsychotics. Risperidone and olanzapine are two types of atypical antipsychotic medications that may reduce the impact of manic episodes.
  • Anticonvulsants. Divalproex and carbamazepine are examples of anticonvulsant medications that work as mood stabilizers.
  • Mood stabilizers. Lithium is an effective bipolar mood stabilizer. There’s also evidence that lithium has antisuicide effects. But doctors may choose other medications to treat dysphoric mania.

Electroconvulsive therapy (ECT)

The mixed state of dysphoric mania can be less responsive to medication than euphoric mania or depression. ECT is a dysphoric mania treatment that may sometimes be helpful if medication doesn’t work.

A 2016 study that included 41 people with bipolar disorder provided evidence to support ECT use for mixed states. Most of the unwanted feelings targeted in the study showed a positive response to ECT treatment.

A larger study from 2017 that included 522 participants resulted in a 72.9% ECT response rate in those experiencing mixed features.


Psychotherapy alone may not be enough to treat dysphoric mania, but it can help as an add-on to medication.

The preferable therapeutic approach for someone who experiences mixed episodes reduces anxiety and lowers the chance of suicide attempts. It should be adapted to your individual needs.

There are various options to try, including:

  • Cognitive behavioral therapy (CBT). CBT is highly effective for people living with anxiety disorders.
  • Acceptance and commitment therapy (ACT). Research shows that ACT can be effective in reducing suicidal ideation.
  • Family focused therapy (FFT). Another effective mood disorder support strategy, FFT helps improve your communication with the people in your life. It equips them to become a part of your network of support.
  • Interpersonal and social rhythm therapy (ISRT). This therapy works to analyze and stabilize your daily schedule. It’s based on the idea that mood episodes can result from changes to a person’s routine.


Lifestyle is an important part of optimal health and mood stability. Important factors to consider include:

  • nutrition
  • exercise
  • sleep
  • stress reduction
  • social connections

A condition like bipolar disorder with dysphoric mania might feel so overwhelming that you don’t have any reserves left to tweak your diet or workout routine.

But once your medication or therapy starts to ease your symptoms, you can improve the effect even more with lifestyle changes.

Dysphoric mania is a combination of depression and mania symptoms that occur together. It’s a common type of mania found in bipolar disorder.

Treatment options can make it easier to live with dysphoric mania. Medication works to adjust brain chemical changes. Therapy helps you to manage your thoughts and regulate your emotions more effectively.

Sometimes connecting with other people who share your experience can help. You can visit Psych Central’s bipolar support groups page to get started. You can also try the Psych Central Mental Health Support page for other resources.

Are you currently in crisis?

If you feel like you’re having a mental health emergency, you can:

If you decide to call an emergency number like 911, ask the operator to send someone trained in mental health, like Crisis Intervention Training (CIT) officers.

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