Dysphoria can occur in both depressive and manic forms. The following excerpt from the Merck Manual online gives a good description of these two difficult-to-endure mental states.


"Mixed states are blends of depressive and manic (or hypomanic) manifestations and distinguish bipolar disorders from their unipolar counterparts. The most typical examples include momentary switches to tearfulness during the height of mania or racing thoughts during a depressive period. In at least 1/3 of persons with bipolar disorders, the entire attack--or a succession of attacks--occurs as a mixed episode. A common presentation consists of a dysphorically excited mood, crying, curtailed sleep, racing thoughts, grandiosity, psychomotor restlessness, suicidal ideation, persecutory delusions, auditory hallucinations, indecisiveness, and confusion. This presentation is referred to as dysphoric mania, ie, prominent depressive symptoms superimposed on manic psychosis. Dysphoric mania often develops in women and in persons with a depressive temperament. Alcohol and sedative-hypnotic abuse contributes to the development or aggravation of mixed states.


Depressive mixed states, which are not specifically characterized in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, are best regarded as intrusions of hypomanic symptoms or hyperthymic traits into a retarded major depressive episode. Antidepressant drugs may aggravate these states by producing a subacute irritable depressive state that lasts many months. The clinical picture consists of irritability, pressure of speech against a background of retardation, extreme fatigue, guilty ruminations, free-floating anxiety, panic attacks, intractable insomnia, increased libido, histrionic appearance yet genuine expressions of depressive suffering, and, in the extreme, suicidal obsessions and impulses. Patients with a depressive mixed state and those with dysphoric mania are at high risk of suicide and require expert clinical management."



  1. Atypical Depression - a collection or resources from Dr. Ivan Goldberg's website.