Hell on Earth: Bipolar “Mixed States”
Bipolar I, and Bipolar II (was just updated in the DSM5), all tend to come with a symptom that isn’t quite mania nor depression. It can also be called dysphoric mania. It’s like taking the two, throwing them in the blender and see what you get. You can be depressed with a lot of energy (example: racing mind, many suicides are attempted in mixed states) or manic with depressed thoughts.(1) I find myself incredibly irritable and angry during a mixed state.
Sounds fun, eh?
It’s not, at all, even closely remotely to being fun.
“The DSM-IV defines a mixed episode as a period of at least 1 week in which the criteria for both a major depressive episode (MDE) and a manic episode are met nearly every day. During a mixed episode, an individual experiences rapidly alternating periods of sadness and irritability and of euphoria accompanied by symptoms of a manic episode”(2)
Some symptoms include: agitation, insomnia, appetite dysregulation, psychotic features and suicidal thinking. At least 40% of those with bipolar disorder have at least one mixed state in their life. There is a greater rate of suicide, substance abuse (which definitely won’t help it!) It is literally mania littered with depression.
Those with mixed symptoms are generally diagnosed at an earlier age with rapid cycling, suicide attempts, more irritability and Bipolar 1. It affects more women than men.
Mixed episodes are difficult to treat, both states have to be identified, and works best if caught early (and can prevent future mixed episodes from occuring.) The treatment, for the most part, is medication, like Lithium or Depakote. Antidepressants can make the mixed state worse, or blow up into full mania. Mixed states have also been mistaken for ultradian cycling bipolar disorder. Mood stabilizers, antipsychotics (preferably atypicals) help with mixed episodes, and ECT(3) can also be used to zap you out of it. An antidepressant might be temporarily used, but as I said, it can do more bad than good.
Over the years, I’ve had a few mixed episodes. I have bipolar type 1 with rapid cycling. After ECT, my highs and lows weren’t as drastic, but I still get mixed states.
If you’re in a mixed state, or someone close to you thinks you are, please, go to a hospital before it gets worse.