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Mixed Bipolar Disorder

What Are Mixed Episodes in Bipolar Disorder?

Mixed episodes in bipolar disorder are a form of mental illness. In most forms of bipolar disorder, moods alternate between elevated and depressed over time. A person with mixed episodes experiences both mood "poles" -- mania and depression -- simultaneously or in rapid sequence.  Technically, mixed episodes are described only in people with bipolar I disorder (not bipolar II disorder), although this distinction is expected to change as the psychiatric diagnostic classification system is currently being revised.

Who Gets Mixed Bipolar Disorder?

Virtually anyone can develop bipolar disorder. About 2.5% of the U.S. population suffers from some form of bipolar disorder – nearly 6 million people.

Mixed episodes are common in people with bipolar I disorder. Estimates vary widely, but between 20% and 70% of people with bipolar disorder experience mixed episodes.

Those who develop bipolar disorder at a younger age, particularly in adolescence, may be more likely to have mixed episodes.  People who develop mixed episodes may also develop "pure" depressed or "pure" manic or hypomanic phases of bipolar illness.

Most people are in their teens or early 20s when symptoms from bipolar disorder first start. Nearly everyone with mixed episodes develop bipolar disorder before age 50. People who have an immediate family member with bipolar are at higher risk.

What Are the Symptoms of a Mixed Episode?

Mixed episodes of bipolar disorder are defined by symptoms of mania and depression that occur at the same time, or in rapid sequence.

  • Mania in mixed episodes usually involves irritability, racing thoughts and speech, and overactivity or agitation.
  • Depression in mixed bipolar disorder is similar to "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? Because mixed manic episodes are a form of mental illness, they defy any predictable pattern of feelings or behavior.

For example, a person in a mixed manic episode 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.

Mixed manic episodes can last from days to weeks or sometimes months, if untreated. Mixed episodes may recur and recovery can be slower than during episodes of "pure" bipolar depression or "pure" mania or hypomania.

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