you even heard of mixed mania before? I sure hadn’t. In fact, I
wish I’d never heard of it. However, it’s best to be
educated, even if it means defining things you feel uncomfortable
about. So let’s talk about mixed mania.
involves “an intense high where the person feels euphoric,
almost indestructible in areas such as personal finances, business
dealings, or relationships. He may have an elevated self-esteem, be
more talkative than usual, have flight of ideas, a reduced need for
sleep, and be easily distracted”
with mania also make hasty decisions without thought to consequences.
When mania begins to ease, a person diagnosed with bipolar disorder
usually plunges into depression, thus the old term manic-depressive.
That term isn’t used as much now because of the bad
connotations associated with the word manic or maniac. (I’m
sure the pictures you conjure up in your mind associated with the
word “maniac” aren’t pretty.)
mania is different from the euphoric mania previously discussed.
Mixed mania is when a person has all the energy of mania but instead
of euphoria, suffers severe depression. Consequently you get a very
active, person bursting with agitation or anger.
mania is also referred to a dysphoric mania, depressive mania or
mixed bipolar disorder. Interestingly enough, about 30% of people who
have bipolar disorder have this type of mania (as cited in
diagnosed as having bipolar disorder, many people learn about mania
and think, “Gee! I can’t wait till that kicks in so I can
finally feel good!” However, for 30% of people with bipolar
disorder, that type of mania just doesn’t kick in. It never
kicks in. In fact, some people find themselves questioning the
diagnosis. (This is healthy because doing so helps open up the
conversation with your doctor — if he is willing to listen. If
not, change doctors!) Some people diagnosed with bipolar disorder can
experience both mania and mixed mania at different times.
mania can mean periods of time when a person’s energy level
spills into excessive anxiety and stress, creating inhuman levels of
anger pulsing through the veins. Consequently, even when trying to
rein in emotions, the slightest thing can set him off. He doesn’t
just get upset; he gets furious — disproportionate to the
degree of the offense. Often times this leaves his loved ones,
coworkers and the public at large scratching their heads, wondering
what set the person off.
the person who flew off the handle wonders why on earth everyone
can’t see the obvious offense! If people could see it from the
perspective of a person with mixed mania, with imbalanced chemicals,
the injustice would be just as obvious to them! Duh!
many people learn tools to keep symptoms at bay.
I guess you may be wondering, what can a person with mixed mania do?
Here are some things that help me:
Sometimes the desire to scream stupid, rude or downright mean
comments in a person’s face can be overcome by journaling.
Sometimes I have scribbled my thoughts out on paper and then
destroyed it. It’s actually quite satisfying.
Sometimes I go for a walk. It’s pretty effective in getting
energy out. If you can go alone, it gives you time to think and sort
things out. For me, speed walking works in dissipating my angry
c) Watch what you eat!
It may sound silly, but I’m serious. Parents don’t allow
their children to eat much candy or drink a truckload of caffeine
because of the resulting hyperactivity. Following the same rules
often helps people who are struggling with mood issues. Eating
healthy and limiting or eliminating sugar and caffeine intake can
work wonders! (Not that I’m all that successful in eliminating
my sugar, but I’m working on it.)
d) Get sleep!
Just as with mania, mixed mania creates an impossibility to fall and
stay asleep. But there are many remedies. If you cannot sleep, no
matter what you try, call your doctor.
e) Call a friend.
Sometimes I have just needed a sounding board. If you’ve ever
act as a sounding board, bless you! For loved ones who act as
sounding boards, remember that it can be very emotionally draining
and not always healthy. It is important to know your limits, set
appropriate boundaries and then keep them.
It’s as simple as that. When I offer my personal, heartfelt
prayers aloud (picturing Heavenly Father sitting in the room), I’ve
humbly discovered that my anger melts into the background. He picks
me up and I can keep going.
g) Call a counselor.
If you or your loved on doesn’t have a trusted counselor, keep
h) Call your nurse or
If you or your loved one can’t recognize a pattern, often a
careful nurse or doctor can. Recognizing any patterns is the first
key to taking control of the situation.
i) If nothing else
works, ask the doctor about the possibility of adjusting medication.
Let’s face it, a chemical imbalance cannot resolve itself by
simply thinking about it, just as a diabetic can’t raise her
blood sugar by imagining she’s eating a four-layer dark
j) If you or your
loved one is still having problems with mixed mania two or three days
after the meds have changed, discuss the possibility of
In the end it may be better than risking personal safety. Aside from
the anger management issues, mixed mania is often associated with
suicide. As mentioned before, people with mania make hasty decisions
without thought to consequences. This is a dangerous combination.
Suddenly, not only is the person in the depths of depression; he has
the angry energy to do something hasty about it.
not saying that all people with mixed mania are suicidal, nor am I
saying that all people with depression are suicidal. What I am saying
is that people who have depression or mixed mania have an increased
rate of suicide attempts. (2007. González-Pinto A, Aldama A,
Mosquera F, González Gómez C. Epidemiology,
diagnosis and management of mixed mania.
CNS Drugs. 21(8):611-26).
hope one or two of those suggestions can help you or your loved one
conquer mixed mania. It can be a serious problem, but when
recognized, it can be resolved before things get out of control. When
I say “conquer” mixed mania, I’m not saying once a
person conquers it, he will never experience it again. I’m
saying he conquered that episode and now has tools to use when the
next one pops up.
Sarah Hancock is currently in her final year of studies at San Diego State University's
Rehabilitation Counseling Program (just voted 9th in the Nation by U.S. News & World Report)
with a psychiatric emphasis. A portion of her internship was spent as the Coordinator of
Disability Services Office for Alliant International University's San Diego and Irvine Campuses.
Having embarked on her own journey with a mental health diagnosis, she is passionate about
Psychiatric Recovery and teaching others how to strengthen their "Recovery Toolbox." Sarah
finds comfort in writing, having completed more than 29 journal volumes. She teaches
occasional recovery workshops using principles she learned from Recovery Innovations.
Born and raised in San Diego, California, Sarah served a Spanish speaking and ASL mission for
the LDS Church in the Texas Dallas Mission. She was graduated from Ricks College and BYU.
Sarah currently resides in the San Diego area with her husband. They have four teenage children.
She currently loves serving as Young Women secretary and ward missionary.