Is mixed bipolar disorder serious?

All forms of bipolar disorder are serious. However, mixed bipolar disorder appears to be one of the most dangerous forms of the disease. Suicide is a common threat in people who have bipolar disorder. People who have the disorder are most likely to commit suicide if they are experiencing a mixed episode, combining mania and depression, or during depressive episodes. Following your doctor's treatment plan can greatly reduce suicidal thoughts.

Mixed bipolar disorder is a condition in which there are severe episodes of major depression and what are referred to as mixed (or also dysphoric) manic episodes. In bipolar disorder, more common are “classic” manic episodes that have an elated, euphoric mood, grandiosity, and very unrealistic feelings of self-esteem (for example the belief that one is the smartest person in the world). Manic symptoms that are seen in both classis/euphoric mania and mixed mania are: rapid speech, hyperactivity (agitation), decreased need for sleep and sometimes-psychotic symptoms. Mixed mania, unfortunately, has the aforementioned symptoms, but rather than euphoria there is a severely depressed mood. Owing to the serious depression, suicide attempts are much more common in mixed mania than in classic mania.

With adolescents and adults suffering with bipolar disorder, 20% of their first manic episodes are of the mixed type. It has also been found that if bipolar disorder is not well managed (i.e. that there is not appropriate treatment and medication compliance) another 20% will ultimately start having mixed episodes. Thus this can be seen as one result of a worsening of the disorder, making it all the more important for people to make every effort to stay on medications.

Mixed mania is much more common in childhood-onset bipolar disorder.

Finally, usually mixed mania is more challenging to treat than classic mania. It often takes longer to resolve manic episodes. Many different types of medications are used to treat mixed mania, however, Depakote is felt to be the most efficacious drug. This is almost always prescribed along with one or two other bipolar medications (e.g. lithium, Seroquel etc.). All people with mixed mania should be treated immediately (in large part because of the risks of suicide) and most of the time hospitalization is required.