What Is Mixed Bipolar
Quite simply, a mixed episode is when someone who is diagnosed with bipolar disorder experiences symptoms of depression and mania simultaneously.
Usually, one aspect of bipolar will be more prevalent than the other during a mixed episode. For instance, someone will experience bipolar depression with mixed features, or bipolar mania with mixed features.
Your initial response to the idea of a mixed episode is that such a thing simply cannot exist. How can you be both depressed and manic at the same time? Impossible! Think again.
Brain Structure And Function
Researchers are learning that the brain structure and function of people with bipolar disorder may be different from the brain structure and function of people who do not have bipolar disorder or other psychiatric disorders. Learning about the nature of these brain changes helps doctors better understand bipolar disorder and may in the future help predict which types of treatment will work best for a person with bipolar disorder. At this time, diagnosis is based on symptoms rather than brain imaging or other diagnostic tests.
What Is Bipolar I Disorder
Bipolar I disorder is a mental health illness in which a person has major high and low swings in mood, activity, energy and ability to think clearly. To be diagnosed with bipolar I disorder, you have to have at least one episode of mania that lasts for at least seven days or have an episode that is so severe that it requires hospitalization.
Most people have both episodes of both mania and depression, but you dont have to have depression to be diagnosed with mania. Many people with a bipolar I disorder diagnosis have recurring, back-to-back manic episodes with very few episodes of depression.
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Concerned About Bipolar Disorder
#2, Educate Yourself Education starts with learning the symptoms of manic and depressive episodes and getting up-to-date on research-driven treatment options for bipolar disorder. Share your questions and concerns with your doctor or psychiatrist, and ask them what resources they recommend for you to read or gather. Understanding the illness can help it feel more manageable and assist you in identifying symptoms before they get worse.
#3. Track Symptoms Many people with bipolar disorder find it useful to keep a daily log of their mood, thinking, and behaviors. If you are able to catch small changes in these arenas, then you may be able to stop or decrease the intensity of a mood episode before it worsens. You should can also track stressors or behaviors which may trigger a mood episode, such as lack of sleep, relationship conflict, school or work stress, substance use, or seasonal changes. The more accurately you can report these changes to yourself and your doctor, the greater chance of stabilizing your mood.
Early Warning Signs That You Might Be Slipping Into Mania
WHAT IS BIPOLAR DISORDER?
If you are diagnosed with bipolar disorder, its important to understand what it is and what to look out for so you can pick up on the early warning signs that mania is setting in.
Bipolar Disorder, Type 1 is a mental illness characterized by having prolonged fluctuations between manic and major depressive episodes. Bipolar Disorder, Type II is characterized by fluctuations between hypomanic and major depressive episodes. Hypomania shares the same key symptoms as mania, but is generally less intense with a shorter duration. While you may experience high energy levels, hypomania may not cause the same debilitating problems in your life that mania can.
If you are diagnosed with either type of bipolar disorder, you may experience intense emotional instability and find it difficult to manage or regulate your symptoms if left untreated. Since mania is often misunderstood, it is important to gain a better understanding of this major component of bipolar disorder.
EARLY WARNING SIGNS OF MANIA
The transition into mania can be gradual and slow, and you may not even realize when the changes start to take place. If you are aware of the possible symptoms, its easier to prevent mania from taking over and get the help you need to return to your baseline. Some early warning signs and symptoms of mania can include a combination of any of the following:
HOW TO PREVENT MANIA AND MANAGE SYMPTOMS
Here are a few tangible tips to be able to detect those warning signs:
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What If Im Not Happy With My Treatment
If you arent happy with your treatment you can:
- talk to your doctor about your treatment options,
- ask for a second opinion,
- get an advocate to help you speak to your doctor,
- contact Patient Advice and Liaison Service , or
- make a complaint.
There is more information about these options below.
How can I speak to my doctor about my treatment options?
You can speak to your doctor about your treatment. Explain why you arent happy with it. You could ask what other treatments you could try.
Tell your doctor if there is a type of treatment that you would like to try. Doctors should listen to your preference. If you arent given this treatment, ask your doctor to explain why it isnt suitable for you.
Whats a second opinion?
A second opinion means that you would like a different doctor to give their opinion about what treatment you should have. You can also ask for a second opinion if you disagree with your diagnosis.
You dont have a right to a second opinion. But your doctor should listen to your reason for wanting a second opinion.
What is advocacy?
An advocate is independent from the mental health service. They are free to use. They can be useful if you find it difficult to get your views heard.
There are different types of advocates available. Community advocates can support you to get a health professional to listen to your concerns. And help you to get the treatment that you would like. NHS complaints advocates can help you if you want to complain about the NHS.
What Are The Treatments For Bipolar Disorder
Bipolar disorder is a long-term illness that requires management throughout a person’s life. People who have numerous episodes of mood changes in a year can be much more difficult to treat. Medication is the primary form of treatment, but the additional use of psychotherapy or “talk” therapy is sometimes recommended to help prevent future episodes.
There are many drugs available to treat bipolar disorder. Proposed guidelines for treatment options are based on the three main phases of bipolar disorder, which include the acutemanic/mixed mood states, acute major depressive episodes, and finally the continuation/maintenance phase. As a general rule, avoiding antidepressants and taking two mood stabilizers has proven to be an effective strategy for most patients.
Lithium is a mood-stabilizing drug. It has proven helpful in controlling mania and depression and preventing depression and manic episodes. Lithium will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the condition is completely controlled. Thus other drugs like antipsychotic drugs or antidepressant drugs may also be used to help control symptoms.
Common side effects of lithium include:
- Frequent need to urinate
The following are signs of a lithium overdose. Call your doctor immediately or go to the nearest emergency room if you experience:
- Blurred vision
- Weight gain
- Slight trembling of hands
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Living With Bipolar Disorder Tip : Get Involved In Your Treatment
Be a full and active participant in your own treatment. Learn everything you can about bipolar disorder. Become an expert on the illness. Study up on the symptoms, so you can recognize them in yourself, and research all your available treatment options. The more informed you are, the better prepared youll be to deal with symptoms and make good choices for yourself.
Using what youve learned about bipolar disorder, collaborate with your doctor or therapist in the treatment planning process. Dont be afraid to voice your opinions or questions. The most beneficial relationships between patient and healthcare provider work as a partnership. You may find it helpful to draw up a treatment contract outlining the goals you and your provider have agreed upon.
Improve your treatment by:
Being patient. Dont expect an immediate and total cure. Have patience with the treatment process. It can take time to find the right program that works for you.
Communicating with your treatment provider. Your treatment program will change over time, so keep in close contact with your doctor or therapist. Talk to your provider if your condition or needs change and be honest about your symptoms and any medication side effects.
Taking your medication as instructed. If youre taking medication, follow all instructions and take it faithfully. Dont skip or change your dose without first talking with your doctor.
Need to talk to someone?
Changes In Sleep Patterns Or Lack Of Sleep
A change in your sleep pattern is a hallmark symptom of bipolar disorder but it can also be a trigger.
Shift workers, people who work long hours, and students who are short on sleep are all at risk for having a recurrence of a mood episode related to a lack of sleep. “In addition, travel beyond one’s time zone can be another trigger for a mood episode,” says Bennett.
Interpersonal and social rhythms therapy is one of the most effective preventions, Bennett says. This treatment approach, available in group as well as individual sessions, helps you develop an orderly life schedule of sleep, diet, and exercise habits, to make you more effective at managing bipolar disorder.
Other forms of therapy, including psychoeducation and cognitive-behavioral therapy , can also be helpful in managing the illness.
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How Can You Help Someone With Bipolar Disorder
Dealing with the ups and downs of bipolar disorder can be difficultand not just for the person with the illness. The moods and behaviors of a person with bipolar disorder affect everyone aroundespecially family members and close friends. It can put a strain on your relationship and disrupt all aspects of family life.
During a manic episode, you may have to cope with reckless antics, outrageous demands, explosive outbursts, and irresponsible decisions. And once the whirlwind of mania has passed, it often falls on you to deal with the consequences. During episodes of depression, you may have to pick up the slack for a loved one who doesnt have the energy to meet responsibilities at home or work.
The good news is that most people with bipolar disorder can stabilize their moods with proper treatment, medication, and support. Your patience, love, and understanding can play a significant part in your loved ones treatment and recovery. Often, just having someone to talk to can make all the difference to their outlook and motivation.
But caring for a person with bipolar disorder can also take a toll if you neglect your own needs, so its important to find a balance between supporting your loved one and taking care of yourself.
Recognizing Mania In Myself
Then I waited. Or, more accurately, I worked tirelessly on my passion project and obsessed over when the doctor’s office would call back and if I would lose my mojo once he adjusted my medicine.
The nurse did finally call back, almost at 7 pm, to say that I needed to double the dose of one of my bipolar meds and call her back in a week with an update. I take this pill at bedtime, so I was able to start that night with the double dose.
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What Are The Symptoms Of Mania
Symptoms of a manic episode
- Having an abnormally high level of activity or energy.
- Feeling extremely happy or excited even euphoric.
- Not sleeping or only getting a few hours of sleep but still feeling rested.
- Having an inflated self-esteem, thinking youre invincible.
- Being more talkative than usual. Talking so much and so fast that others cant interrupt.
- Having racing thoughts having lots of thoughts on lots of topics at the same time .
- Being easily distracted by unimportant or unrelated things.
- Being obsessed with and completely absorbed in an activity.
- Displaying purposeless movements, such as pacing around your home or office or fidgeting when youre sitting.
- Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.
Psychotic symptoms of a manic episode
- Delusions. Delusions are false beliefs or ideas that are incorrect interpretations of information. An example is a person thinking that everyone they see is following them.
- Hallucinations. Having a hallucination means you see, hear, taste, smell or feel things that arent really there. An example is a person hearing the voice of someone and talking to them when theyre not really there.
Closely Observe Your Mood And Symptoms
When youre learning how to deal with bipolar, make sure you are paying close attention to how you feel, your moods and whether youre experiencing any symptoms. If you start noticing even minor changes, you may be able to work with your care providers to prevent those challenges from coming much bigger problems.
A journal can be a good way to keep up with your symptoms and spot red flags early on. Another option is to keep a mood chart handy. This is an easy way to reference how you are feeling and see subtle shifts that may need attention.
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Tips For Coping With A Manic Episode
Manic episodes can vary from person to person. Some people can recognize theyre heading toward a manic episode, while others may deny the seriousness of their symptoms.
If you experience mania, in the heat of the moment, you probably wont realize youre having a manic episode. So, perhaps the best way to cope with mania is to plan ahead. Here are some steps you can take to prepare.
Getting Back To Bipolar Normal
I went to bed like normal, and I didn’t wake up until after 6, a full night of sleep for the first time in 8 days. It was almost more sleep than I’d had in the sum total of the last week, and all in one night! I felt awake and alert and still not at all tired, but I slept so well and being rested made a lot of sense.
Over the next week or so, my moods began to regulate which really sucked. I felt constantly depressed and on the verge of tears which I suppose is normal because I had felt such an exhilarating high when I was manic and there was nowhere to go but down. I can empathize a little with addicts who are obsessed with feeling good and staying high as much as possible because coming down is really, really hard.
Normal has fortunately equalized quite a bit since then, and I don’t feel so bad anymore.
I think I didn’t recognize my manic episode because my only other manic episode was furious. That time, I hated Joe and was ambivalent about my girls and everything single little thing irritated me like a sharp pebble in my shoe. I didn’t want to see or talk to or touch anyone for any reason, and I was completely miserable. It went on for weeks and weeks , and I eventually became suicidal and was hospitalized and diagnosed and prescribed all manner of psychotropic medication.
So that’s what my manic episode was like. It lasted between two and three weeks before I figured it out, and I have been recovering for about a week now.
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Sign That A Person Is Manic
One of the most common signs to see if a person is manic or not is their extent of procrastination.
Most bipolar individuals will have bundles of work too, and they will start doing it.
But in a midway, they will stop doing it because of a lack of desire to do anything.
This is because these individuals are always lost somewhere, which makes it hard for them to come out of that bubble and face the bubble and face reality.
What A Depressive Episode Feels Like
The unpredictable nature of cycling through mood states, being unsure of what symptoms may envelop you next, typically creates underlying anxiety, says Colleen King, LMFT, a psychotherapist who specializes in treating people with bipolar disorder, depression, and anxiety.
People with bipolar disorder can experience mixed states or dysphoric mania, she says. King says her clients experience their dysphoric mania as an excruciatingly difficult mood state that simultaneously combines symptoms of mania and depression, though the typical euphoric feelings are absent.
They also often experience psychomotor agitation, insomnia, anxiety, and restlessness. Sometimes they experience irritability or anger.
You might be especially curt with others and feel like no one understands your experience, says Louisa Sylvia, PhD, associate director of psychology at the Bipolar Clinic and Research Program at Massachusetts General Hospital.
You might lash out and not want to interact with anyone, Sylvia says in her book, The Wellness Workbook for Bipolar Disorder: Your Guide to Getting Healthy and Improving Your Mood.
During a depressive episode, Kings clients tell her that they feel broken or dont care about anything anymore.
They say they dont have the motivation or passion for anything except sleep. Her clients say they cry all the time and feel frustrated and helpless. They fear theyll never feel normal again.
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How Does It Affect People
Bipolar disorder affects both men and women. For many people, the first symptoms show up in their early twenties. However, research has shown that the first episode of bipolar disorder is occurring earlier: It often shows up in adolescence, and even children can have the disorder.
Recent research suggests that kids and teens with bipolar disorder don’t always have the same behavioral patterns that adults with bipolar disorder do. For example, kids who have bipolar disorder may experience particularly rapid mood changes and may have some of the other mood-related symptoms listed below, such as irritability and high levels of anxiety. But they may not show other symptoms that are more commonly seen in adults.
Because brain function is involved, the ways people with bipolar disorder think, act, and feel are all affected. This can make it especially difficult for other people to understand their condition. It can be incredibly frustrating if other people act as though someone with bipolar disorder should just “snap out of it,” as if a person who is sick can become well simply by wanting to.
Bipolar disorder isn’t a sign of weakness or a character flaw it’s a serious medical condition that requires treatment, just like any other condition.