 Mixed mania is a clinically distinct affective state which is likely to be more severe than classical euphoric mania and to have longer episode duration. Mixed mania is associated with longer duration of illness, suicidality, and poor outcome McElroy et al, 1995. Although at present there is no universally agreed on definition for mixed states, 40-60 of patients in acute manic states also meet criteria for either major depression or dysphoria Dilsaver et al,1999; Calabrese et al, 1999; Secunda et al,1985; Sporn and Sacks,1997. Dilsaver at al 1999 in their factor analytic study of manic symptoms were able to differentiate dysphoric and depressed mania. Patients with depressed mania 30 of all patients with mania were as manic as patients with euphoric mania and also met criteria for the Major depressive disorder. Patients with dysphoric mania were less manic and less depressed, but more irritable than both depressed and euphoric manic patients. 