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August 17, 2012
Pebbles, Potholes, and Perspective
Mania with a Depressive Twist
by Sarah Hancock

Have 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.

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” (

People 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.)

Mixed 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.

Mixed 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

When 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.

Mixed 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.

Meanwhile, 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!

Gratefully, many people learn tools to keep symptoms at bay.

So I guess you may be wondering, what can a person with mixed mania do? Here are some things that help me:

a) Journaling. 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.

b) Exercise. 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 energy.

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.

f) Pray. 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 looking.

h) Call your nurse or doctor. 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 chocolate cake.

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 hospitalization. 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.

I’m 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).

I 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.

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