If you suffer from mania, you’ve also experienced the transition that leads to it.

Someone identified that transition emotion over a thousand years ago. Surprising?  Here we are in the 21st century, with all the technology and neuroscience we’ve discovered at our fingertips, and we still face that same emotion. And it often plays a strong role in bipolar mixed states.

What is it?


So many in our current society speak of various psychiatric disorders as if they’re a product of modern contrivance. Sometimes in psychiatry, our role is not only to treat those suffering from a disorder, but to also defend them against the cruel cynicism of skeptics who discredit their struggle.

For someone who suffers from emotions that plunge so low, so dark, they don’t know how to hang on to a fiber of life… then without warning, those feelings change…shift…and become energized then agitated… with no reason….until they’re replaced by anger then rage….and more energy than can be managed….until they’ve reached a state of euphoria, unlimited possibility, and very high creative energy….  Someone like this knows the helplessness of erratic emotional states.

And if you’ve experienced these wide changes in emotions, you know it’s painful.  When it’s happening inside you, it feels normal. It feels justified…because you don’t realize it’s happening because of malfunctioning signals in your brain.

If you feel anger…even rage… it just must be justified, right?

But many people with a disorder like this have to experience it for many years before they can identify those moments when their mood swings in a new direction. It’s hard.  Really hard.

So let’s talk about this ancient philosopher and physician from the 12th century, Avicenna.

He saw this disorder, this syndrome… and described it.  He talked about how it affected both the psyche and the body.  Pretty profound for a guy who lived around the year 1100 AD.  He called this condition “melancholia” and in present day mental health we might think of melancholia as depression. 

But the syndrome he described included mania. And mania specifically identifies what we now know as bipolar disorder.

In his early descriptions, he divided this condition into two phases, the early phase and the chronic phase. Symptoms of the early phase were described as suspicions of evil, fear without cause, quick anger, involuntary muscle movements, dizziness, and ringing in the ears.  

For the chronic phase of melancholia, he described moaning, suspicion, sadness, restlessness, and abnormal fear such as the “sky falling upon one’s head,” or “being swallowed by the earth.”

In our current environment, we would likely consider these last two as delusions, or psychotic features.

Not all people with bipolar disorder have delusions during manic or depressive episodes. But in some cases, it happens.

Avicenna also described some symptoms we might now see in “bipolar mixed states” such as increased libido, involuntary laughter, and acting as though one is king… which we’d now call “grandiosity.”

These can all be symptoms of the manic phase of bipolar disorder.

These are descriptions that are more than 1100 years old. But they describe a condition that we still see today, and work hard to identify and treat. What is so hard is identifying it first. An episode of anger does not mean you have bipolar disorder — not by a long shot. And even if you have bipolar disorder, getting angry could be just… getting angry. It may not mean you’re in a manic, hypomanic or even mixed state.

How to tell? Sometimes it’s difficult. It may take several episodes. Sometimes it can take years.

You don’t have to let it. The good news is that mixed mood states are treatable. If you’ve been ridiculed for the medicines you take, or the psychiatric treatment you participate in… if people around you don’t believe this is not only a valid and debilitating disorder, or think it’s something modern day doctors have dreamed up, here’s proof your struggle is valid. 

People can be so… uninformed. You have to just shake your head in disbelief.

According to Avicenna, people have been suffering with this at least since the 1100’s. It’s still the real deal.

And he described bipolar mixed states without using the term itself: a combination of depressive and manic symptoms all tangled together at the same time. With a back drop of depression, and the addition of agitation, grandiosity, heightened sexual drive, anger, and emotions that are easily aroused, changed, that alter quickly. 

There are doctors who attempt to diagnose bipolar disorder as specifically depression with at least one clear episode of mania or at least one clear episode of hypomania. But for a large population of patients, this is utterly frustrating. Because what they have–and what you may have–are mixed states, or mixed episodes.

If you’re one of them, you know.

You KNOW you’re not either black or white emotionally. You KNOW you’re not specifically depressed or manic.  

While you may be depressed at times, and you may experience mania at other times, you know that you also have all sorts of combinations of emotions in between the two.

It can feel like you are a vertical accordian with shifting degrees of manic and depressive symptoms at the same time and with the ratio shifting throughout the day, or from day to day … over sometimes every few days. So many variations make it hard to identify, difficult to explain, and frustrating to report. Symptoms like grandiosity and anger can signal other disorders, as well.

And you know it’s real, though you may be told something different.

When you suffer like this, you first need validation that there are things happening inside you that you don’t cause.

This is a very difficult condition, and what you experience may be different than what someone with the same diagnosis experiences. But it’s real.

And it’s treatable.

Bipolar disorder can be challenging to treat effectively — and may need patience and determination for you and your doctor to tame — but hang on to hope.

We’ve only talked about bipolar mixed states and mania but there is also depression in bipolar disorder. And bipolar depression is also extremely difficult to endure. It can be terrible.

Thankfully, bipolar depression can be treated effectively by IV ketamine

Another aspect of the depression in bipolar disorder is the risk of suicidal thoughts. And IV ketamine can remove those thoughts and give you the freedom to live in joy.

At Innovative Psychiatry, we offer IV ketamine treatment for bipolar depression and see patients whose treatment has helped them emerge from the depressive symptoms that held them down. Not everyone, of course, but many.

And these patients often talk about how much easier their condition is to manage since the depression is gone.

While bipolar depression can be tough to break, ketamine treatment can break it. Give yourself the opportunity to see how good you can feel, how productive life can be, without bipolar depression undermining you.

If bipolar depression interferes with your life, call us.

We’re here to help you achieve remission, with resilience, hope, and the joy of a loving and productive life.

To the restoration of your best self,

signature of Lori Calabrese, M.D.

Lori Calabrese, M.D.

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