Our host, Gabe Howard, often remarks that mania has the best public relations team in the world. Why else would mania be described as an unbelievable feeling of well-being and pure bliss? It seems mania is only ever discussed as an overwhelming positive experience.

For many people, mania doesn’t include a euphoric feeling — prompting the question, is it even mania? In fact, is there such a thing as mania that doesn’t include euphoria? Join us as Gabe and Dr. Nicole discuss dysphoric mania and share how it’s different from a mixed state.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

He is also the host of Healthline Media’s Inside Mental Health podcast available on your favorite podcast player. To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com.

Dr. Nicole Washington
Dr. Nicole Washington

Dr. Nicole Washington is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions.

Find out more at DrNicolePsych.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Gabe: Hey everyone. My name is Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board-certified psychiatrist.

Gabe: Hosting this show has taught me many things about my experience that I’ve had to readjust. And this this episode, it’s kind of a mind blower for me. Dr. Nicole, I have always thought of mania. I’ve literally defined it as euphoria. Now, this is a difference between going to medical school and drawing on lived experience. My lived experience has taught me, whether right or wrong, and it turns out it’s wrong, that mania is always excitement, euphoria. Just. Just this, this, this god-like feeling. But people started writing us and saying, Hey, what about the mania that’s not so happy? And I was like, Well, that’s not mania. And I brought that up to you. And you were like, oh, wow, Gabe It turns out you didn’t go to medical school. You don’t have a degree and you didn’t study this because mania can absolutely be not happy. So, then I started researching and I will confess, Dr. Nicole, I started researching in order to prove you wrong. But you’re right. Mania can have agitation. It can have an anger component. It can. It can be not happy. This was

Dr. Nicole: Yes.

Gabe: Literally mind blowing for me. And I think I may have experienced some of this not so happy mania. But of course, that’s a that’s a that’s a tough thing to say when, you know, just a few moments ago I said, hey, mania is only happy. Dr. Nicole, can you help me wrap my head around this idea that mania is not this happy go lucky, God-like feeling that I have just taught everybody for years that it is.

Dr. Nicole: Yes. And just so you don’t feel quite as bad, I will say, I think even a lot of mental health professionals forget that part of that DSM criteria is euphoria or agitation. So, I don’t think you’re alone in this. There are a lot of people who work in the field who sometimes forget that being agitated may be what this is. It’s the same criteria. It’s the it’s the increased energy, it’s the increased activity, its racing thoughts, talking faster than usual, more than usual, being easily distracted. It’s all those things still engaging in the risky behavior, but it comes with severe agitation versus the happy euphoria that we think of when we think of mania.

Gabe: I have certainly felt agitation and I’ve had those racing thoughts. And you’re right, I’ve had this flurry of activity that is directed not at something positive, but at something negative. Sometimes a person, like where I just have this flurry of activity that this person is out to get me or I have to beat them. Sometimes I get this idea in my head and it was especially prevalent before I was treated where this person is after me and I have to defeat them. I must defeat them. And this is above normal, right? This isn’t like you’re looking at another business and you’re making business decisions on how to sell more widgets than your competition. No, this is. They’re out to get me, and I must stop them. There’s a there’s a gladiator type feeling, and. And it’s me against them. And there’s, there’s it’s irrational, but it does contain, at least in me, these hallmarks of mania. This, this I’m the grandiose figure in the middle of all of this. The difference is, is I’m not the lead singer of a rock band with 100 screaming fans. In this particular manifestation. I’m the gladiator in the arena that all of the opponents are trying to kill. But make no mistake, whether you’re the lead singer or the gladiator, the focus is entirely on you. You’re the most important person on the room, and you and you alone have to prevail. This was shocking to me because I have experienced it. I just always called it like bipolar agitation or bipolar mood swings or once again, mania just did not come up in my thought process for this. And I imagine it’s this way for many people where they’re just like, look, I’m angry, I’m pissed off, I’m annoyed, but I’m certainly not manic.

Dr. Nicole: Yeah, and it’s complicated because we often think of irritability or agitation with depression. So, we’re very comfortable thinking about, Oh, I’m depressed. And so, I’m more irritable when I’m depressed. And people will tell me that frequently. Like I’m just I’m depressed, I’m more irritable, I’m angry when I’m depressed. But as we tease out what else was going on during that time, it’s not depression at all. They’re manic. They’re angry. There’s only one difference. And it’s euphoria versus being agitated and angry. All the other symptoms are the same, but they can present so differently that it’s scary.

Gabe: This is where the Internet and pop culture and movies has really done people with bipolar disorder a disservice because we romanticize mania. And we did we did a whole episode about Hollywood and we did a whole episode on euphoric mania. So, if you haven’t listened to those episodes and you want to know more about how we just really, really, really don’t treat mania as a serious condition in bipolar disorder, I highly recommend you go back and listen to them. But the main takeaway is many people want mania back. They’re excited about mania. We love mania. I personally, Gabe Howard, have said on more than one occasion. Yeah, sometimes I miss mania. I do. It made me feel good. But of course, the only way that statement is true is if anytime mania made me feel bad, I put it in a different basket and decided that it wasn’t mania. So that’s my question to you, Dr. Nicole, you’re a very, very different vantage point from where I am. You’re a doctor. You treat people when you hear people say, well, I miss mania. Do you ever get any pushback and say, well, you miss being really, really agitated? You miss thinking that all your friends are out to get you? You miss having this flurry of activity to defend yourself against something that’s not real and you miss all of that? Like, that’s really odd to me. Is that something that you can give push back on or does

Dr. Nicole: Well.

Gabe: This just muddy the waters even more?

Dr. Nicole: I give a lot of pushback, period. It’s just what I do. So even with the euphoric mania, when people tell me how great it was, I can always come back with something that went wrong during that episode. So I’m pushing back all the time. I will tell you, it’s more likely to be the euphoric, manic person who is telling me they miss it. The agitation comes with so much. I mean, can you imagine, you know, you talked about TV and how we glorify and we make it look so wonderful. And it’s funny, right? They use euphoric mania because it’s light and it’s kind of funny. And they in some ways kind of make fun of, oh, this manic person and all this stuff. The agitation is scarier for people around. I mean, can you imagine having the increased activity, all that stuff, the grandiosity. But there’s this this physical agitation that goes along with it. I mean, think about you. You’re a you’re a not short man.

Gabe: I am not. I’m gigantic.

Dr. Nicole: You’re a tall man. So, imagine there’s a whole lot of difference between how people are going to relate to you when if you’re euphoric and manic, right? They’re like, oh, that guy is really kind of silly, what’s going on over there? Versus if you’re agitated and you’re yelling or you’re screaming or you’re pacing because you’re so agitated and you look like you’re going to put a whoopin on somebody, that’s a whole different can of worms that we’re opening up.

Gabe: Dr. Nicole Just to make sure that we’re 100% clear is agitated mania dysphoric mania is it the same as a mixed state or is it completely different or does it have a is it where does it fall on its spectrum?

Dr. Nicole: Again, we get back to our definitions and the public’s definition. So, I’m going to always go back to those DSM definitions because I do think it’s important that you know what language your doctor is speaking. A mixed state, by definition, is someone who is either in a depression episode or a manic episode, but they also have symptoms of the other kind of episode interwoven in there. So, it’s a person who’s experiencing symptoms of both mania and depression at the same time. So, if you think about that, that can be pretty tricky to identify. So, a person who is manic and not sleeping and feeling like they’re on top of the world, but at the same time hopeless and suicidal and all those things are mixing together, that would be a mixed episode. Someone who has a dysphoric mania or an agitated mania, they’re going to meet the mania criteria, except there won’t be the fun euphoria. There’ll be the agitation.

Gabe: It sounds like we have a little bit of a situation where doctors are speaking a different language than patients that patients might be calling this non euphoric mania a mixed state, but they are incorrect from a medical point of view. And it’s sort of become maybe in the patient community, we’re like, well, I’m having a mixed state. I’m angry and I’m manic. But in actuality, they’re not having a mixed state at all. But it has become something that maybe patients are sharing, but it’s not the medical definition.

Dr. Nicole: Right. And as I always say, I don’t really care what you call it. I need to be able to figure out what I’m going to call it, and then I will typically share with my patients, okay, technically, this is not what this is. This is what this is because I want my patients to be able to go into other settings and be heard because they’re using the right language.

Gabe: Dr. Nicole, I want to make sure that we define our terms very, very well here. What are some concrete examples of agitated mania or non-euphoric mania?

Dr. Nicole: I’m going to answer your question, but I do want to say I don’t want us to get so bogged down on there being such a huge difference between euphoric and dysphoric mania. The one difference. Is the agitation. Like that’s the only difference. They’re still the talking. Faster or more than usual. The racing thoughts, the grandiosity, they’re still the. Being distracted. There’s still the increase in goal directed activity. Right. Starting the businesses all the things they’re still the increase in risky behavior. All those things are the same, except there’s agitation. So, while this person won’t be dancing naked in the street, singing and singing and having a good time or trying to get you to go party, they may be pacing up and down the street, mumbling to themselves and having lots of physical kind of motor agitation, which is a little bit different presentation when you see it. So, the difference is either you’re agitated or you’re euphoric, but the other symptoms are still the same. For some reason it seems like we in the euphoric state we go, Oh, that’s mania, slam dunk. Like I can list all the things, but when somebody is angry, we don’t say, oh, but they also have racing thoughts, pressure speech. We don’t do that same checklist that we do when we see the euphoric person.

Gabe: So, it really sounds like the primary difference is one type of mania makes you feel really, really good and one type of mania makes you feel really, really bad. And therefore, we don’t connect it over to the mania.

Dr. Nicole: We don’t. And the anger, the agitation, so many different things can cause agitation. So, it it’s complicated.

Gabe: And because you’re not happy, it’s not mania. That seems to be the resting point. Right. I just if you do all of those things but you’re happy about it, it’s mania. If you do all of those things and you have negative consequences and you feel bad, it’s not mania again, isn’t doesn’t mania just skirt responsibility just so. Well, it’s like, hey, we made you feel bad. Let’s go ahead and blame agitation, anger and depression.

Dr. Nicole: Yes.

Gabe: And we fall for it. We fall for it every time. We’re just so desperate to believe that mania is a good thing. That any time we’re faced with anything that shows the destructive nature of mania, we just go ahead and reclassify it somewhere else. And I really think this is this is this is part of manias danger is it not? I mean, hey, if you feel euphoric, it doesn’t matter what you do. It was worth it. Oh, you feel shitty. Oh, then then that’s not even mania. Don’t even worry about it. Just. Just. Oh, crap. No problem.

Dr. Nicole: And I think that for the person who has bipolar illness, they just need to explain the symptoms that they’re experiencing, like just talk it through. When you come in and say, I’m manic, you just assume that the doctor is going to think that you have mania. And you know what that is. Sometimes that’s not the case. I want you to use words and really, really be descriptive in what you’re experiencing, because if you label it as anxiety or you label it, I’m just feeling really irritable or angry. You may miss out on getting the treatment that you need because you didn’t quite go that extra step and say, But I’m also not sleeping and I have tons of energy and I just feel like I can’t sit still. Like I want you to move forward and really, really explain what’s going on with you, not just say, Oh, I’m angry.

Gabe: Looking back on my life, Dr. Nicole, and especially before I was diagnosed and before I was in good recovery, I think about all the times that I was very agitated, angry and annoyed, but I considered it obsession. If you ask me to put a name on it, I would I would say that I was obsessed that the bipolar disorder caused me to become obsessed against an enemy. And maybe there was a thread in there where the person actually did something wrong. You know, I. I bought a sandwich and the sandwich was cold. Right. That’s a that’s a reasonable thing to have happen. But instead of just saying, hey, my sandwich was cold, calling the manager, getting a credit, getting a coupon. No,

Dr. Nicole: Uh-huh.

Gabe: They did it on purpose. So now I’ve become obsessed with taking down $1 billion fast food chain for having the audacity of maliciously and intentionally giving me a cold hamburger. And it expands from there. People are like, Yay, mania, good. But when I focus all of my attention on the cold hamburger means that I have to take down a multi-billion-dollar hamburger joint, people really look at you very differently, as you said. But I still have to say, even as I’m sitting here, even with all the research we’ve done and I am I, I bow to your education, experience, professionalism, you’ve got to be wrong, right? It can’t be mania. It’s got to be something different because mania is so wonderfully feeling. And in those moments, I did not feel wonderful at all. Isn’t that a big difference?

Dr. Nicole: Well, you always say mania has the best PR. Mania has got it covered. It’s interesting that you said you just thought they were obsessions. You didn’t see them as the racing thoughts that come with mania. You were like, oh, I’m just having these obsessions. I can’t tell you how many people over the years have come to me and they report to me this severe anxiety. They’re like, oh, I have this severe anxiety. And when they describe it, it’s mania. So, they say, I don’t know. I just I don’t know. I have these moments where I’m anxious for so many days. Like I’ll just be really anxious and I’m not sleeping because I’m so anxious and I have so much energy. And as they go on and describe it, I’m like, oh, honey, you were manic. Like, that’s not that’s not anxiety. And so, then we have to have a whole conversation. It’s not uncommon early on for someone to think, oh, this is an obsession. Maybe I have OCD. This is this is anxiety. Maybe I have an anxiety disorder. I had a panic attack that lasted a week. I just had somebody tell me that last week. They’re like, oh, I had a panic attack. It lasted all week. And I was like, well, let’s talk about it. So, as we tease it through it, it’s hard for people to wrap their hands around. But if you’ve ever had an agitated mania episode and you’ve had to deal with the consequences of an agitated mania episode, you’ll know that they are huge.

Gabe: I’m always fascinated by the struggles of your profession, Dr. Nicole, because the way that we describe what’s going on in our lives is, of course, through the lens of our own eyes that that is the value of lived experience. We can explain things, how we see them and how we feel them, but you then have to connect that to a medical diagnosis in order to be able to treat us. Now, anybody who’s had children knows that when a child comes out and says, I don’t want to go to sleep, well, maybe they’re afraid of their room. Maybe there’s an aberrant noise. Maybe they just need a little extra consoling or maybe they don’t want to go to bed. They understand that that based on simply what their child says, that’s not the full picture. And we ask questions, we investigate, and we do things to figure out what the actual need or concern of the child is. Do we have this with bipolar disorder? Does everybody just use different words and different phrases? And that really complicates the issue because again, just to keep people on track, we’re not even calling this one mania. We’re calling it obsessions, anxiety, anger, aggression, agitation and mania is nowhere in the room.

Dr. Nicole: Yeah, it’s very complicated. If someone just says, oh, I’m anxious, I have anxiety, it may take a while for us to tease this out. I may have to see somebody multiple times for me to pick up on. Oh, this is not anxiety. This is mania. Unfortunately, it can get misdiagnosed as depression. The agitation, if you tell me that it’s anxiety because you just have all this energy and you feel like you can’t sit still and you can’t sleep at night and you tell me it’s anxiety and we go through the criteria, you could end up getting put on an antidepressant, which is the treatment for depression and generalized anxiety. And we know from previous episodes and we’ve talked about this, antidepressants have the ability in some people to switch them and make their mood more unstable. So, we could now be making this whole thing worse if we don’t get to the bottom of it. So, when someone tells me I’m anxious, it’s my job to not take that at face value. If you say I’m anxious, I’m going to need you to give me some examples. You know, anxiety that comes in a week at a time, every few months, and you’re not sleeping and super anxious. That raises my eyebrow. Like that’s something that’s not a typical presentation if you tell me, oh, I had a panic attack that lasted two weeks and for two weeks I couldn’t sit still and I was Maybe that’s not a panic attack because I know what a panic attack is defined as. What makes it even, even more complicated. Like you said, we don’t use the same words. I like to use the example.

Dr. Nicole: My goddaughter, when she was very small, she would say, I have a headache. And you go through all the, okay, what’s going on? But then if I ask a few more questions, she would come back with something like, I have a headache in my stomach. Like she just took I hurt somewhere as a headache and but once we get down to it, she doesn’t have a headache. She’s got stomach aches. She’s got a headache in her stomach. So, I have to be the one to tease that through and figure out what exactly is it that you’re telling me, even if you don’t have the right words? And then to make it even more complicated, some people are just angry individuals by nature. You know, some people are just they’re just irritable. We all know people who are just irritable people. So, we have to then try to figure out, is this person an angry nugget at baseline or is this because of mania? Is this episodic? So, then you start really having to tease through like, is this just who you are? We have people in the hospital and the staff will say, oh, well, but you know, everything is better. They’re sleeping like this isn’t happening. This is improved. They’re still just really angry. I’m like, maybe they’re just an angry nugget. It’s fine. There are other disorders that that people can be angry at baseline, like people who have PTSD or have experienced anger can be there. So, we do have to do a lot of teasing out to see where do we think this anger is coming from?

Sponsor Break

Dr. Nicole: And we’re back discussing not so happy mania.

Gabe: I experienced mania as euphoric. I saw all of these examples of people sharing their lived experience with euphoric mania. I saw all, of course, the Hollywood depictions, which even I have said so many times you can’t trust. But this this helped reinforce my worldview and this created this idea in my head that euphoria was a symptom of mania. Hard stop, the end. If it’s not present, it’s not mania. And here’s the thing. Here’s the segue, Dr. Nicole, the Internet sort of started to agree with this and they started calling it a mixed state. You have both mania and something. But that’s not exactly what a mixed state is. But there’s just tons of information out there about how if you have mania and you lack euphoria, it’s actually a mixed state. I hit it got confusing really, really fast. Can you explain the difference between a mixed state, mania and how all of this fits together?

Dr. Nicole: I’m glad you brought that up because this whole mixed state concept is another one of those things that I don’t know that we speak the same language on. This is very similar to our rapid cycling conversation in a previous episode. And a mixed state, typically, according to the DSM, which is how we define things and how we can make sure that we’re using the same language from doctor to doctor. So, if you go see someone else and I have written in a chart that you were in a mixed state, we both should have some basic understanding that that means the same thing, which is the whole purpose of having something like the DSM, a mixed state we tend to think of is when a person is either in a manic episode and having depression symptoms at the same time or in a depression episode and having manic symptoms at the same time. It’s this very odd mix. And even with someone who is having a more euphoric mania and then they have these depression symptoms at the same time, it can be very confusing. It makes it difficult to diagnose a bipolar disorder when someone’s in that state because you’re like, what am I looking at? It’s so hard to know, which is why I’m always pushing for you to have a psychiatrist that becomes part of your team, but a long-term part of your team. I need to see you several times through multiple episodes to be able to go, oh, I think I know what this is now. It takes time, but a mixed state is typically having met criteria for one of the episodes and then having symptoms of the other interwoven within the other, which you could see would be very complicated.

Gabe: So, couldn’t you have the symptoms of mania and the symptoms of agitation and therefore, it’s a mixed state versus agitated mania.

Dr. Nicole: [Laughter]

Gabe: Which I think is a word I just made up.

Dr. Nicole: It’s not. It’s not. That’s a lot of times how I will describe it as an agitated mania. There’s no difference in the DSM as far as diagnosis goes. But we tend to when we’re talking about, oh, this person tends to have a more agitated mania, this person has a more euphoric mania. You know, I use those terms a lot when I’m counseling someone in the what do we do about medication phase, especially if it’s someone who doesn’t want to take medication. We talk about what do your manic episodes look like? Are they euphoric? Are you fun? Are you getting in trouble or are you meaner than a junkyard dog and you’re pacing and you’re agitated and you’re in danger of either getting assaulted because someone thinks you’re up to something and about to do something to them or they are you in danger of legal problems because you might physically assault somebody, which happens. So, can you have a mixed state and it be mania and something else versus an agitated mania? Only if you are having other depression symptoms interwoven in there. So, if you if your depression is typically more irritable and you have other symptoms of depression, then maybe we could say it’s a mixed state, like we can look at that. But we wouldn’t just say, oh, well, because you’re agitated and you have all these other manic symptoms, because if the euphoria isn’t there and the agitation is, then we’re still going to call it mania. But we’re going to, in our minds, think of it as more of an agitated mania.

Gabe: As you were explaining this, I thought about like, colloquialisms, right? Half the country calls it pop; half the country calls it soda. It’s the same drink. Over in England, they call it fizzies. Fizzies, like, I kind of like the name. I want to start calling it fizzies, but it just, it’s the same thing. It just sort of developed a different name. And then in some parts of the country, not so much anymore, but when I was growing up, everything was coke, right? I want a Coke. And then somebody would bring you a Pepsi or I want a Coke and somebody would bring you a root beer. It was just it was just it was just sort of the generic term. And finally, the best example that I have of this is Kleenex. Look, I don’t know how you were raised, Dr. Nicole, but my mom never bought brand name Kleenex, yet I still ask for a Kleenex.

Dr. Nicole: Yes.

Gabe: Kleenex is a brand name.

Dr. Nicole: Yes.

Gabe: It’s so I think that sometimes people with bipolar disorder, we get hung up on the labels. The labels are super important for your side, Dr. Nicole, and all the other doctors, they need those labels. But if you’re explaining your emotions, your stage, your symptoms, your issues to the people around you, your support system, the people who loved you and you call it my bobados and everybody immediately knows what you’re talking about and can provide you with that support that you need, then I’m not inclined to tell you to get it right. But I hope that your doctor understands what bobados equal in the DSM. Is that a fair way of looking at it? That it maybe the label isn’t so important over on the patient side, the lived experience side, but it’s very important over on your side.

Dr. Nicole: Uh, the labels are not important to most people in general. The labels matter to us for sure, and sometimes they matter a little bit too much to us. And so that’s a whole different issue. But I think that that brings up two points. One, that is my extreme frustration with our system, our current system. How can you explain how can we translate what you’re telling me? How can we make sure we know what’s going on with you when we’re only given 15 minutes once every 3 or 4 months in some of these systems where you’re in like a community mental health center and you’re not necessarily able to get in monthly because you don’t have that luxury. And even if you do have the good insurance, as patients tell me, and they are able to see their psychiatrist monthly, how much time do you have? 15, 20 minutes. Is that enough time? That’s my frustration. It also speaks to why we need psychiatrists and mental health professionals who understand a variety of cultural differences because people will say, so I need to have a basic understanding that if the person in front of me says bobados and everybody in the room, all their family is like, Oh yeah, she’s definitely got the bobados dos. I need to know what that means so that when I hear it again, I can know what that means. Unfortunately, sometimes these terms are not the same across the board. So, the nervous breakdown example people like, oh, I had a nervous breakdown. If I ask 50 people what a nervous breakdown is, I’m going to get probably 48 different answers. So, who knows? Bobados in this family might mean something totally different to the family across the street. So, we still have to take the time to ask and to dig a little bit deeper. But sometimes the time is the issue.

Gabe: As I’m really fond of saying on this show, the goal is wellness, right? The goal is leading your best life. I do think that sometimes we just get too bogged down in what words we’re using the are we speaking about it correctly? Are we using the technical terms, the not technical terms? And everybody’s got an opinion, right? Well, you sound like a doctor and that’s bad. Well, you don’t sound like a doctor and that’s bad. And I just want to remind folks that if you’ve got this confused in your mind, but you’ve got a solution that’s working for you, please don’t think that you need to change anything. I really love education and I really love understanding my illness. But I have to confess, personally, I was like, well, do I need to do something different? Like that was the first thing that popped in my mind. I was like, oh, I think I’ve experienced this agitated mania symptom. Do I need to do anything? And, you know, luckily, I have a good support system. They’re like, well, are you having a problem? No, I just learned something new and now I want to act on it. Okay, well, now, that doesn’t make any sense. You’re. You’re doing well. But because you have new information that is really just different words for the information that you already had; you want to go changing things. So, I just want to get that out there for our audience.

Dr. Nicole: I also will say so we know how this goes, right? You learn something new. And now I don’t want y’all to start questioning whether you’re in an agitated, manic episode. Every time you get angry about something, people get angry. Anger is an emotion. We all experience it. So, I don’t want you to take this and turn it into, oh, my gosh, Now I’ve got one more thing to worry about. That might be a sign of mania. I want you to really, really kind of take a deep breath process through this. And remember, all the other symptoms are still there, but it’s just agitation instead of euphoria. You can get angry and it’s okay.

Gabe: Dr. Nicole, stay on that track for a moment, because there are there seems to be an equal number of people that were in the Gabe camp. Oh, my God, that’s mania. I had no idea. And an equal number of people that were the, you didn’t know that was mania? I am very aware that it’s mania. And I want to talk about that second camp for a moment, because they’re like, nobody’s talking about this. Nobody’s helping me. I keep telling people that I have mania and then I show people the symptoms, I’m agitated, etc. And instead of trying to help me, they’re too busy trying to talk me out of whether or not it’s mania. That’s not the conversation they want to have. They understand whatever it is and they want to move forward. And many people tuned into our mania episode and they’re like, finally, they’re covering mania. They will cover this agitation, this, this, this non-euphoria and give me ways to move forward. And we didn’t. So, I want to correct that right now. If somebody’s experiencing this non-euphoric mania and wants to move forward, what are some hints and tips for them so that they can they can lead their best life?

Dr. Nicole: If that person is out there listening, I want you to know that I get your frustration. A lot of times people who do have more of an agitated mania presentation, they are so frustrated with this whole like, oh, you can’t have bipolar disorder because you’re angry, you’re not euphoric and fun to be around and you’re not funny and they’re not portraying you on the media. So, people don’t they just don’t feel represented. And it’s, you know, you don’t want to go around trying to explain your whole existence to everybody. So, if you start explaining that, oh, this is my mania, that gets old very quickly to have to explain to everybody around you, you know, what your mania is like. So, I get it. You kind of get forgotten. I get that. I think I want you to focus on the consequences of your mania. And I want that to drive you to make sure you’re doing everything you can to prevent that. Because if you have an agitated mania, there really isn’t a lot of fun parts of it. There’s not the, oh, I felt great. And I remember going out and party.

Dr. Nicole: There’s not that there’s not that at all. You may have memories of assaulting somebody or becoming physically aggressive and scaring your family because you punched a hole in the wall. You are pacing. Maybe someone thought you were a suspicious and they came up on you because they were going to try to figure out what’s going on with you because we have a lot of people in the world who feel like they need to solve other people’s problems. So, you are in a situation where your mania is just going to be much more devastating and have the potential for really, really severe consequences. So, I just want you to definitely work with your mental health team and make sure that you’re doing everything you can to prevent the mania. I think that’s my number one for you, is you are in a situation where you just can’t afford to let your mania go unchecked or let your bipolar illness go unchecked because that agitated mania just hits a little bit different. And the consequences can definitely be a lot more serious.

Gabe: I’m thinking about all of the coping skills and hints and tips that I’ve offered for people who are manic. People who realize that that mania is coming and they want to adjust so that they don’t hit it. The first thing that I want to say is medication is extremely helpful in reducing the onset of mania. I don’t want to lose that thread. I could not control mania without being medicated. That that was that was a big, big deal in my life. And it’s a big, big deal in a lot of people’s lives. But medicated or unmedicated talking about actual coping skills that we have control of. If we see that this type of mania, this dysphoric mania, agitated mania, the non-euphoric mania is coming. Do the same coping skills and advice for stopping euphoric mania work to stop this type of mania?

Dr. Nicole: Absolutely. It’s the same stuff, making sure you’re getting a good night’s sleep if you can. So, if you start to notice, oh, these symptoms are coming and I’m more agitated, or if your loved ones say, hey, I think we’re at that point, I think I’m starting to see these symptoms sleep, figuring out what it is that you need to do to get some sleep, whether that’s calling and asking for an additional sleep aid from your person who prescribes your meds. If you don’t take meds, I’m going to encourage you to find somebody and we need to get you sleeping because that is like the number one thing. The other thing I would recommend for you to not do is any kind of illicit substance or drink heavily. Right? Because those things are going to disinhibit you and they’re just going to make the agitation worse. So, while you think, oh, I’m not sleeping, I’ll just have a drink tonight, I don’t really have anything. I’ll just have a drink. You’re going to be disinhibited and probably a little more angry than you already were. So, I would definitely avoid any kind of illicit substances. And those two are two things that we would tell somebody, whether they were in a euphoric mania or approaching a dysphoric mania. It just it’s the same thing.

Gabe: One of the things that we as mental health advocates have to do a lot is retrofit what’s out there to help people because everything’s not covered for a long list of reasons. But it really does sound like you can Google any mania, hints and tips and retrofitted over to your type of mania. And I like that because there is a ton of writing on avoiding mania, handling mania, how mania is dangerous, how mania has the best public relations team in the world. And if you can go find all of that information and including our previous episodes. We, of course, frame the conversation as euphoric mania, but it also works for dysphoric mania, agitated mania, mixed states, etc. Now, Dr. Nicole over on episode 21 of Inside Bipolar, we did touch on agitation and irritability. But I want to warn everybody, there is nothing about mania in that entire episode. It does that advice apply to people who are experiencing non-euphoric mania or does it just not go far enough? I really think you should listen to every single episode that we do. But applying this to this type of mania, is there good in that episode for folks to listen to?

Dr. Nicole: In that episode, we talked a little bit about your team. We talked about maybe that loved one not allowing you to drive when you’re in that state, maybe monitoring your behaviors. I guess that’s a good way to describe it, but maybe they can figure out how to monitor them in a way that doesn’t agitate you further. Because the last thing anyone who’s manic and agitated wants is someone monitoring their behaviors, but someone who can say, hey, I don’t think it’s a good idea for you to drive. You want to go confront this person that you think did something to you. I do not think that’s a good idea. You know, those are all still great ideas. I do think we didn’t quite go far enough and we didn’t talk specifically about mania. And as you know, once a person is in a manic episode, reasoning with them is not always doable. It’s not always something that can happen. So, they may end up in the E.R. Unfortunately, they may end up in jail. Unfortunately, they may end up in the hospital. Medications may happen, all those things might happen. So, I think that episode just didn’t quite go deep enough. It was more surface-level irritability versus agitation kind of things.

Gabe: I know we’re nearing the end of the episode, but I want to confess it’s very humbling to realize there’s still so much about bipolar disorder that I don’t know. I do this for a living. I live with bipolar. I’ve read a lot. I interview a lot of people. And I just I just missed it. I missed it because I’m not a medical professional and I need to remember that there’s always more to learn. And I think that’s great advice for our listeners as well. I think there’s just always so much more to learn and so much more to understand about our personal journeys. So, I want to thank you, Dr. Nicole, for teaching me all of this stuff and for also educating our listeners. Before we hop on out of here, do you have any last tidbits of information for people who are experiencing non euphoric mania or any last just well, you know, I’m going to call it morsels of wisdom.

Dr. Nicole: I like that. Morsels of wisdom, little bites. If you think that you have this dysphoric mania after listening to this episode and you think, wow, I think that might be me. You owe it to you to have that conversation with whoever is your treatment person, whether it’s a psychiatrist, therapist, whoever it is. If you don’t have a treatment person or a team, then I am going to tell you that this is not something that you want to leave unchecked. I have seen people have significant legal difficulties during a dysphoric manic episode because we all know what happens when a person is angry and agitated out in public. People intervene and sometimes not in the best ways. And none of us have the luxury of being able to just go to jail for random periods of time and not have it affect us negatively. So, if you think, wow, I think that’s me. You owe it to yourself because you’re important and this is important to go and make sure your treatment team understands what you’re going through.

Gabe: Thank you so much for being here, everyone. My name is Gabe Howard and I’m an award-winning public speaker who could be available for your next event. I’m also the author of “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. But listen, if you head over to my website, you can get a signed copy with free swag. Just go to gabehoward.com.

Dr. Nicole: And I’m Dr. Nicole Washington. You can find me on pretty much all social media platforms @DrNicolePsych to see all the things I have my hand in at any given moment.

Gabe: And hey, wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free. And hey, do us a favor. Recommend the show. Whether it’s in a support group on social media, send an email. Send a text. Sharing the show is how we grow. We will see everybody next time on Inside Bipolar.

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