What is mixed bipolar disorder?

It can be but this has mostly to do with symptom acuity. Think of most bipolar symptoms as being on a continuum from mild to severe. Those symptoms on the mild end of the continuum are much more manageable than those that are closer to severe. If we’re discussing someone with a mild degree of mixed symptoms, he or she will more likely find their symptoms to be manageable. But the further up we go on the severity continuum the more difficult it is for individuals to not be adversely impacted. More specifically, the adverse impact has to do with the combination of negative depressive experience with elevated energy and poor impulse control. Therefore someone in a mixed state who is highly irritable is more likely to lash out at others or potentially even become violent. Similarly an individual experiencing strong suicidal ideation, high energy and poor impulse control may be at high risk for dangerous suicidal behavior.

As paradoxical as it seems, people can have mania and depression at the same time. A mixed state refers to either the simultaneous occurrence of both states or very rapid fluctuation between them, on the order of hours. It can frequently be very difficult to distinguish depression from a mixed state. In a mixed state, someone may suffer from sadness and depression, but feel activated and agitated. They may have racing thoughts focused on worry and negative outcome. They may be unable to sleep but be up all night doing things, frequently compulsive organizing kinds of activities. Depression, hopelessness and impulsivity together can make the risk of suicide very high during mixed states. Though mixed state has been defined as having full mania and depression simultaneously, it is increasingly recognized that mania with a few symptoms of depression or depression with a few symptoms of mania is common. Antidepressants are frequently the culprit in causing a mixed state. Though depression may be the primary problem, mixed states are really more related to mania. In many cases, stopping an antidepressant and using a mood stabilizer may bring relief. This however should be done only under your doctor’s supervision.

Sheri Van Dijk

Some people who have bipolar disorder experience mixed episodes at times. This is not a specific type of bipolar disorder, but rather a type of episode that can be experienced by someone who has bipolar disorder.

The Diagnostic and Statistical Manual defines a mixed episode as a period of at least one week during which the criteria for both a manic episode and a major depressive episode are met. In a mixed episode, a person experiences rapidly changing moods such as sadness, anger, and extreme happiness, together with symptoms of depression (e.g. low mood, irritability, changes in sleeping habits or appetite, loss of interest in activities). The symptoms experienced in a mixed episode often include agitation, irregular appetite, difficulties with sleep and suicidal thoughts. You tend to have lots of energy, but you feel awful. Mixed episodes can be more difficult to identify because of hte wide array of symptoms involved, but proper treatment is essential.


Ms. Julie A. Fast
Mental Health
Here are the four main symptoms of bipolar disorder:
Mania         Depression        Anxiety                Psychosis
These main symptoms of bipolar can mix and match. 
Mania can be pure mania: It's a chemically elevated mood that is either full blown (WAY up there or ...hypomania- the  milder form of mania.)
Depression can be pure depression: Sadness, weepiness, hopelessness, lack of belief in self, etc.  
Psychosis: The psychosis is always attached to a mood swing in bipolar disorder- so if a person is psychotic they are either manic/psychotic or depressed/psychotic.
Anxiety: Ah yes, most of us have experienced anxiety! In bipolar, anxiety is always attached to a mood swing- so if a person is anxious, they are either manic/anxious or depressed/anxious.
What is mixed bipolar disorder?
It's a combination of mania and depression along with anxiety.
There can  be psychosis mixed in there as well. Strictly speaking: a mixed episode is a manic episode with elements of depression and anxiety- also known as a dysphoric manic episode or an agitated manic episode.
Oh wow, it's extremely uncomfortable to be in a mixed episode. I've often said it's like someone is trying to pull your organs out through your skin! While you are sweating and running down the street!
<p>Mixed bipolar disorder is a type of bipolar disorder where the episodes of depression, or excessive sadness, and mania, or excitement and irritability, occur simultaneously. During an episode of mixed bipolar disorder, a person may feel energized, restless, and agitated, but also extremely sad and hopeless. By definition, a mixed episode must last at least a week, meet the diagnostic criteria for both mania and depression, and not be caused by a medication or another condition. There is no permanent cure for mixed bipolar disorder, but treatment can help make the disorder more manageable.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.