Before We Get Into Mixed Episodes Lets Go Over What Constitutes A Standard Episode Of Mood Elevation Versus A Depressive Episode
Bipolar historically was known as manic depression, and some people will still call it that. So it makes sense to me that many people only associate it with two sort of categories of mood, those being mania and depression, Wendy Marsh, M.D., director of the Bipolar Disorders Specialty Clinic and an associate professor in the department of psychiatry at the University of Massachusetts Medical School, tells SELF.
Symptoms associated with an episode of bipolar depression include lower energy and/or activity levels, difficulty concentrating, loss of interest in things, and changes in appetite and sleep, among others. And to classify as having an episode of depression, you need to be experiencing a gateway symptom of either a sad mood or loss of interest in life pervasively, in addition to at least five of the other symptoms for two weeks, Dr. Marsh says.
To classify an episode as a mood elevationmeaning mania or hypomaniayou must exhibit a prolonged, unusual, high-energy mood, while also showing at least three additional symptoms of mood elevation, including feeling a sense of euphoria, having increased energy and/or self-esteem, racing thoughts, reduced sleep, and others.
Brain Structure And Function
Some research suggests that people with bipolar disorder may have differences in the way their brains are structured and function. As brain functioning is complex, its unclear exactly how these differences may contribute to the development of the bipolar disorder. The chemicals that help regulate mood may also be involved.
The Implications Of Delaying Medication
Individuals who suffer from this disorder and do not undergo medication for these conditions face various hazards that endanger their safety, social interactions, cultural status, and lives.
Suffering from unresolved mental health and drug abuse problems will result in:
- Excessive Dosage
Relatives are also involved in assisting family members with co-occurring disabilities in receiving the treatment they seek. Many patients would choose to stop getting care or remain in doubt because they have a condition requiring medical or psychological intervention if they didnt have their support.
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What Is Rapid Cycling
Some people with bipolar disorder develop rapid cycling where they experience four or more episodes of mania or depression within a 12-month period. Mood swings can occur very quickly, like a rollercoaster randomly moving from high to low and back again over a period of days or even hours. Rapid cycling can leave you feeling dangerously out of control and most commonly occurs if your bipolar disorder symptoms are not being adequately treated.
The different faces of bipolar disorder
Bipolar I Disorder This is the classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usuallybut not alwaysBipolar I Disorder also involves at least one episode of depression.
Bipolar II Disorder In Bipolar II disorder, you dont experience full-blown manic episodes. Instead, the illness involves episodes of hypomania and severe depression.
Cyclothymia Cyclothymia is a milder form of bipolar disorder that consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.
Historical Developments Regarding The Concept Of Mixed Phenomena
FIG. 1Diagnostic criteria for manic, depressive and mixed states according to DSM-5. As opposed to previous editions, in DSM-5 the specifier with mixed features is used for manic, hypomanic or depressive episodes in bipolar spectrum and major depressive disorders. The term mixed episode used in the context of bipolar disorder type I has been discontinued in DSM-5. BD: bipolar disorder, MDD: major depressive disorder, MDE: major depressive episode.
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What Types Of Therapy Are Used To Treat Bipolar Disorder
Psychotherapy, also called talk therapy, can be an effective part of the treatment plan for people with bipolar disorder.
Psychotherapy is a term for a variety of treatment techniques that aim to help you identify and change troubling emotions, thoughts and behaviors. Working with a mental health professional, such as a psychologist or psychiatrist, can provide support, education and guidance to you and your family.
Different types of therapy for bipolar disorder include:
What To Do If You Experience A Bipolar Episode
Remember a bipolar episode is a distinct period of time when specific symptoms are present that, taken together, classify a person’s mood as manic, hypomanic, or depressive.
If you are concerned you are experiencing symptoms of a bipolar episode, please seek care from a mental health professional.
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Living With Bipolar Disorder
Bipolar disorder is a condition of extremes. A person with bipolar disorder may be unaware they’re in the manic phase.
After the episode is over, they may be shocked at their behaviour. But at the time, they may believe other people are being negative or unhelpful.
Some people with bipolar disorder have more frequent and severe episodes than others.
The extreme nature of the condition means staying in a job may be difficult and relationships may become strained. There’s also an increased risk of suicide.
During episodes of mania and depression, someone with bipolar disorder may experience strange sensations, such as seeing, hearing or smelling things that are not there .
They may also believe things that seem irrational to other people . These types of symptoms are known as psychosis or a psychotic episode.
How Is Bipolar Disorder With Mixed Features Treated
Episodes with mixed features typically indicate a more serious condition, as well as poor response to treatment, according to the 2017 review mentioned earlier.
No single medication is indicated for use in treating mixed features. Usually, a mental health professional will prescribe a combination of two or more medications, depending on your individual circumstances. Using one antidepressant for therapy isnt recommended, according to a
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Treatment For Bipolar Disorder
If you spot the symptoms of bipolar disorder in yourself or someone else, dont wait to get help. Ignoring the problem wont make it go away in fact, it will almost certainly get worse. Living with untreated bipolar disorder can lead to problems in everything from your career to your relationships to your health. But bipolar disorder is highly treatable, so diagnosing the problem and starting treatment as early as possible can help prevent these complications.
If youre reluctant to seek treatment because you like the way you feel when youre manic, remember that the energy and euphoria come with a price. Mania and hypomania often turn destructive, hurting you and the people around you.
What Are The Symptoms Of A Mixed Features Episode
Mixed episodes are defined by symptoms of mania and depression that occur at the same time or in rapid sequence without recovery in between..
- Mania with mixed features usually involves irritability, high energy, racing thoughts and speech, and overactivity or agitation.
- Depression during episodes with mixed features involves the same symptoms as in “regular” depression, with feelings of sadness, loss of interest in activities, low energy, feelings of guilt and worthlessness, and thoughts of suicide.
This may seem impossible. How can someone be manic and depressed at the same time? The high energy of mania with the despair of depression are not mutually exclusive symptoms, and their co-occurrence may be much more common than people realize.
For example, a person in an episode with mixed features could be crying uncontrollably while announcing they have never felt better in their life. Or they could be exuberantly happy, only to suddenly collapse in misery. A short while later they might suddenly return to an ecstatic state.
Mood episodes with mixed features can last from days to weeks or sometimes months if untreated. They may recur ,and recovery can be slower than during episodes of “pure” bipolar depression or “pure” mania or hypomania.
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Symptoms Of Mania With Mixed Features
Your mood episode will meet the criteria for an episode of mania or hypomania, but youll also have at least three symptoms of depression:
- feelings of uneasiness or disconnection from reality
- extreme sadness or tearfulness
- lack of interest or enjoyment in your usual activities
- moving and speaking more slowly than usual
A mixed features episode wont always involve the same euphoria or feelings of grandiosity that often accompanies mania. You wont necessarily feel on top of the world or experience the same elevated self-confidence and self-esteem.
Youre more likely to notice rapid changes in mood, increased irritability, and difficulty controlling strong emotions. In addition:
- Your thoughts might race, or your speech might become very rapid, while you feel very low and slowed down in mind and body.
- You might find yourself unable to stop smiling or laughing despite persistent feelings of guilt or thoughts of suicide.
- Feelings of hopelessness or sadness might show up alongside physical restlessness, anxiety, or increased energy.
Mixed Features: Symptoms And Clinical Picture
Mixed episodes are common in people with bipolar disorder research suggests that half or more people with bipolar disorder have at least some mania symptoms during an entire episode of depression.
Those who develop bipolar disorder at a younger age, especially in adolescence, are more likely to have mixed episodes. People who develop episodes with mixed features may also develop pure depressed or pure manic or hypomanic phases of bipolar illness. It is also interesting that people who have episodes of major depression but not full episodes of mania or hypomania can sometimes have low-grade mania symptoms. However, these are symptoms that are not severe enough to be classified as bipolar disorder.
Within Bipolar disorder, a person with mixed features can have either Mania , usually involving irritability, high energy, racing thoughts, and overactivity/ agitation or Depression with feelings of sadness, loss of interest in activities, low energy, feelings of guilt and worthlessness, and thoughts of suicide and self-harm.
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A Mixed Bipolar Episode Is When A Person Experiences Depressive Symptoms And Those Of A Mood Elevation At The Same Time
Dr. Marsh points out that bipolar is somewhat of a misnomer, because while there are two poles, theyre not necessarily experienced separately, she says. This can be a very hard concept to grasp for someone observing a patient who is having symptoms associated with both poles at the same time, and for the patients themselves.
With bipolar disorder in general, its actually quite common for a person to experience episodes that are mixed, Igor Galynker, M.D., associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel, tells SELF.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders included specific diagnostic criteria for mixed episodes, Dr. Marsh says. But the DSM-5, the latest version of the manual, replaced the mixed episode diagnosis with a mixed-features specifier that clinicians now apply to episodes of depression, hypomania, or mania. The issue that some researchers took with the DSM-4 mixed episode diagnosis was that it required a person to meet the complete diagnostic criteria for a depressive episode, as well as the full criteria for a manic episode, for a week or longer. Simply put, you had to be experiencing ongoing full mania and full depression simultaneously, Dr. Marsh says. But in reality, a person may present mixed features but not necessarily check every single diagnostic box for both.
A Bipolar Disorder Mixed Episode Can Cause You To Feel Abnormally Restless And Can Be Chaotic As Well As Confusing Understanding What They Are Can Help You Make Choices To Prevent Them
A mixed episode occurs when the criteria for both a major depressive episode and a major manic episode happen at the same time. ICK!
Mixed mania has typical manic symptoms such as restlessness, agitation, rapid thoughts, and decreased need for sleep, but rather than euphoria, there is extreme pessimism, negativity, irritability and often suicidal thoughts. Such episodes are chaotic and confusing. This mania feels terrible!!!
I have bipolar II which means that I have hypomania. Its a sneaky mood swing and even with my daily management plan, I have trouble catching it at first. Originally, I only had euphoric mania, but started to have mixed episodes in my 40s.
During a mixed episode, I am abnormally restless and cant settle down. I will pace, drive for hours, sit down and stand up, pick at my fingernails, drive too fast, yell at people, wonder why the world is such an ugly place, hate my life and hate people as well.
These days, we tend to say dysphoric mania instead of a mixed episode. This makes sense as it is the opposite of euphoric mania.
My post Letter from a Dysphoric Manic Person lets you into the mind of someone in a mixed episode!
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What Causes Bipolar Disorder
Scientists dont yet know the exact cause of bipolar disorder.
But they do believe theres a strong genetic component. Bipolar disorder is considered one of the most heritable psychiatric conditions more than two-thirds of people with bipolar disorder have at least one close biological relative with the condition. However, just because you have a biological relative with bipolar disorder, doesnt necessarily mean youll also develop it.
Other factors that scientists think contribute to the development of bipolar disorder include:
- Changes in your brain: Researchers have identified subtle differences in the average size or activation of some brain structures in people with bipolar disorder. However, brain scans cant diagnose the condition.
- Environmental factors like trauma and stress: A stressful event, such as the death of a loved one, a serious illness, divorce or financial problems can trigger a manic or depressive episode. Because of this, stress and trauma may also play a role in the development of bipolar disorder.
Scientists are currently performing research to determine the relationship that these factors have in bipolar disorder, how they may help prevent its onset and what role they may play in its treatment.
What Are The Mixed Episodes In Bipolar Disorder
Mixed episodes are basically a combination of symptoms from both depression and mania. For example, you might feel really down and hopeless but at the same time have a ton of energy and be unable to concentrate or sleep. These episodes can be really confusing and frustrating, especially because its hard to know how to treat them.
There are two types of mixed episodes:
- Depressive mixed episodes: These are more common and tend to last longer than manic mixed episodes.
- Manic mixed episodes: These are less common but can be more severe.
If youre experiencing a mixed episode, its important to seek professional help. These episodes can be very difficult to manage on your own and often require medication and/or hospitalization.
Mixed episodes are fairly common in people with bipolar disorder, so if youre struggling, know that youre not alone. There are many resources and treatments available to help you get through this tough time.
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How Does It Impacts Life
When it comes to mixed bipolar, its hard to say how it will specifically impact someones life. Thats because the symptoms can vary so much from person to person. For some people, mixed bipolar may mean experiencing both manic and depressive episodes at the same time. Others may cycle rapidly between the two states.
What is known is that mixed bipolar can be very disruptive to a persons life. It can cause several problems that impact the quality of life. Some of these negative impacts include:
Symptoms Of Depression With Mixed Features
A depressive episode with mixed features will also involve three or more symptoms of mania or hypomania:
- increased talkativeness and rapid speech, often characterized by frequent or sudden shifts in topic
- extreme excitement or restlessness
- less of a need for sleep, or feeling rested after very little sleep
- impulsive behavior or lowered inhibitions
While the DSM-5 includes grandiosity and an elevated mood among the typical signs of a manic episode, suggests these symptoms show up less commonly in depressive episodes with mixed mania. Some people do still experience these symptoms, though.
During a mixed depressive episode:
- An emotional high or euphoric state of mind might conflict with extreme sadness or guilt.
- You could feel irritable or tearful, even while completely focused on a creative project you usually enjoy.
- Persistent feelings of emptiness or worthlessness can show up alongside increased energy or restless movement.
- You might start several projects but get sidetracked easily and fail to get much done.
The combination of rapid shifts between emotional states, impulsivity and distractibility, and racing thoughts can feel frightening and unpredictable. Symptoms of psychosis, such as delusions, hallucinations, and paranoia, can make this distress worse.
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Childhood Versus Adult Bipolar Mixed State
For adults with bipolar, its common to experience separate episodes of mania alternating with episodes of depression. For children with the disorder, their mixed state of mania and depression and rapid-cycling mood swings is more common. These mixed moods can also co-occur with disruptive behavior disorders as well. Also, when they experience the mania state its typically sprinkled more with agitation and irritability than with euphoria that adults are more apt to present with.
How Is Bipolar Disorder Treated
Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of the following therapies:
- Psychotherapy .
- Self-management strategies, like education and identifying the early symptoms of an episode or possible triggers of episodes.
- Helpful lifestyle habits, such as exercise, yoga and meditation. These can support, but not replace, treatment.
- Other therapies, such as electroconvulsive therapy in cases that are poorly responsive to medication or where rapid control of symptoms is necessary to prevent harm.
Bipolar disorder is a lifelong condition, so treatment is a lifelong commitment. It can sometimes take several months to years before you and your healthcare provider find a comprehensive treatment plan that works best for you. Although this can be discouraging, its important to continue treatment.
Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder dont have mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help manage these symptoms.
Again, even though it may be difficult to treat these conditions, its not impossible. Be sure to stay committed to finding a treatment plan that works for you.
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