The term “transient mania” is a frequent topic of discussion, both in the professional community and in the families of patients with bipolar disorder. From a professional point of view, the term “transient mania” means that a patient with bipolar disorder, during a depressive episode, undergoes the opposite of a depressive episode and the depressive episode is terminated and a typical manic or hypomanic episode occurs. This process of transient mania can either occur suddenly or be completed over several days. Most of the patients experience a mixture of depressive and manic symptoms, but it is only a matter of which symptom is dominant at different stages of the process. Of course, manic episodes or hypomanic episodes can likewise be trans-phase to depressive episodes, which are also trans-phase. The probability of switching from a manic or hypomanic episode to a depressive episode is higher than that of switching from a depressive episode to a manic episode. However, the transition from a depressive episode to a manic episode may occur during antidepressant treatment and involves attribution of its occurrence to possible medical actions, which is often given greater importance to the physician. However, both in the group of clinicians as professionals and in the group of patients’ families, there is a misinterpretation of the concept of “turning manic” or a misjudgment of the phenomenon of “turning manic”, that is, whenever a patient with a depressive episode is seen to have some kind of manifestation that is not typical of That is, whenever a depressive episode patient has a performance that is not a typical depressive symptom, it is often associated with “turning manic”. This phenomenon or tendency is especially obvious or sensitive to patients who are receiving antidepressant treatment, even to the extent of “talking about the tiger”. In fact, the real reason and the exact number of bipolar depression patients who “turn manic” are unclear and inaccurate, only that, phenomenologically, patients who receive antidepressant treatment for depressive episodes have a slightly higher probability of turning manic. Moreover, the available basic data on the assessment of the risk of mania conversion mainly come from several small sample studies, and most of these studies are retrospective, so the scientific significance is not great. In addition, whether there is a causal relationship between antidepressant treatment and transient mania remains inconclusive. In such a context, it is obviously not rational to overemphasize the risk of “turning manic” even to the extent of talking about it. Instead, it is more desirable to accurately and reliably identify the real cases of agitation, to give correct and reasonable treatment, and to investigate the causes of their occurrence on this basis. If we operate according to strict diagnostic criteria, the manifestation of bipolar depressive episode to mania must meet the symptomatological criteria of manic or hypomanic episode, i.e., there is a relatively typical high state of mind or irritability or a marked increase in purposeful activity, along with a reduced need for sleep, active thinking and association with a marked increase in speech or talkativeness, and overestimation and exaggeration of self-evaluation. Therefore, the identification of the core symptoms of depression to mania should be the main symptoms of manic syndrome. What is the main symptom of manic syndrome? In my personal opinion, the abnormal and relatively long-lasting high or euphoria of the state of mind is the most reliable and specific sign of the change of mania. Secondly, the increase of purposeful activity is also one of the more reliable signs. Secondly, increased volitional activity also has high diagnostic value, such as focusing on “grand narrative”, preferring to “point out the way”, expressing “ambition”, and making “grand speech”, etc. As far as the characteristic symptoms of agitation are concerned, the specificity of irritability is not very high, even less than that of reduced need for sleep, active thinking and association, or overestimation and exaggeration of self-evaluation. However, in most cases, “irritability” in the context of the patient’s family, and even in the context of many clinicians, is judged by the phenomenon of “irritability”. As mentioned above, irritability is not the most specific sign of agitation. What psychiatry calls “irritability” is often referred to as “irritability” by the patient’s family, and is a characteristic symptom of bipolar disorder. This symptom is also one of the main manifestations of the “instability” or “volatility” of the core features of bipolar disorder, reflecting the extremely low threshold of stimulation of mood change, and the insignificant stimulus can stimulate or induce extremely strong emotional and behavioral reactions such as The slightest stimulus can trigger or induce extremely strong emotional and behavioral reactions such as rage, aggression, self-injury, etc. From my personal clinical experience, the mood or state of mind behind irritability varies from transient emotional outbursts to relatively persistent bad moods. Thus, irritability can occur when a manic or hypomanic patient is denied exaggerated, risky or unreasonable demands, such as when a patient’s request for a large risky investment is denied by a family member, or when a patient is denied by people around him/her when he/she wants to enjoy “VIP” treatment in a public place, which can cause the patient to have an episode of rage; irritability can also occur when there is a Irritability can also be triggered in depressed patients with persistent bad moods and symptoms of interpersonal sensitivity or rejection sensitivity, who suffer from what they perceive to be “malicious provocation” from others. In the former case, a sincere apology for the anger and aggression can be made after the patient’s mood has calmed down, whereas in the latter case, the cause of the anger and aggression is always blamed on others and is held in such a way that an apology is never possible. In addition, there is a fairly common clinical phenomenon of irritability that differs from the above two conditions. Some adolescent patients who have been pampered by their parents during their growth, have poor psychological maturity, and have personality defects are always in a critical state of emotional outbursts due to their poor state of mind, and they may experience spontaneous outbursts of anger and aggressive, self-injurious behavior at any time. However, it is more common for patients to dwell on current or past trivial or even unrelated “faults” of parents or other relatives without the parents’ knowledge, and to have outbursts of anger that seem to be completely “played up” and seem to be It seems to be a scoundrel-like act of “adding a crime to a crime”. In this way, if psychiatrists can carefully screen the above-mentioned clinical phenomena and exclude irritable phenomena in the context of a bad state of mind, there are actually not many patients who really turn irritable. Because of this, in the treatment of depressive episodes in bipolar disorder, there is no need to choke on the unreliable “conversion” rate and overly restrict the use of antidepressants, which will affect the long-term outcome of patients.