What Is Dysphoria in Bipolar Disorder?

Dysphoria has a special meaning when it's applied to bipolar disorder

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Dysphoria is a word that turns up often in the literature and in discussions relating to bipolar disorder. However, the exact meaning of the word dysphoria seems to be rather vague, and its use is often confusing. As a result, patients and doctors may use the term in different ways.

Dysphoria is a state of feeling unwell or unhappy. However, that could describe anything from PMS to raging flu to crying because your goldfish died.

Many medical dictionaries define dysphoria simply as anxiety. But these definitions just do not describe properly the way dysphoria applies to the moods associated with bipolar disorder cycles.

Dysphoric Mania

Dysphoric Mania, as described in the Merck Manual, is "prominent depressive symptoms superimposed on manic psychosis." Symptoms include:

In everyday English, the complex terms above for symptoms of mania with dysphoria include trouble sleeping, racing thoughts, grandiosity, mental and/or physical agitation, thoughts of suicide, feeling persecuted for no reason, hearing things, and having trouble making decisions (along with others).

Dysphoric Depression

Dysphoric depression, which many people think of as a mixed episode, consists of "intrusions of hypomanic symptoms or hyperthymic traits into a retarded major depressive episode" (Merck).

Basically, this means that characteristics of hypomania or overactivity occur during a depression that in general has the patient sluggish or listless. Symptoms include:

  • intractable insomnia
  • increased libido
  • histrionic appearance with expressions of depressive suffering

Once again putting this into more common terms, the symptoms above for depression with dysphoria include: being easily angered, having pressured speech in spite of slowed thinking, being overtired, dwelling on guilt feelings, being anxious in general (for no specific reason), having serious difficulty in sleeping, having extra sex drive, and being melodramatic about feeling depressed. Other manifestations may include quick cycling between extremely euphoric and severely depressed moods.

Treating Dysphoric Mania or Depression

Dysphoric episodes are unusually difficult to treat because the majority of drugs commonly used to treat bipolar disorder address either depression or mania -- but not both. Mood stabilizers and antipsychotic drugs may be effective, but the process of finding the right combination of pharmaceuticals may take time. Often, treatment is a process of trial and error.

Important Note: When associated with either mania or depression, dysphoria is linked with a greatly increased risk for suicide and should always be brought to the attention of a medical professional.

Another condition recently included in the dysphoria spectrum is PMDD -- Premenstrual Dysphoric Disorder.

It is characterized by severe monthly mood swings along with other common symptoms of PMS. The mood swings can include irritability to rage to homicidal feelings, and severe depression to hopelessness to suicidal thoughts and urges. PMDD is a very serious condition and should be treated by a doctor.

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