Bipolar Mixed Episodes

With Bipolar disorder, a mental illness, a mixed stat or a mixed episode is a condition during which symptoms of mania and depression occur simultaneously.  Some of the symptoms that are shown are agitation, anxiety, fatigue, guilt, impulsiveness, irritability, suicidal thoughts; there may be paranoia, pressured speech and rage. Other symptoms that may be seen are crying during a manic episode and racing thoughts during a depressive episode. One may also feel rage and at the same time have a flight of ideas. Mixed states are often the most dangerous period of mood disorders, during which makes a person more vulnerable to substance abuse, panic disorder, violence and can include suicide attempts.

Mixed episodes consist of a manic episode with depressive symptoms. Increased energy and some form of anger, from irritability to full blown rage, are the most common symptoms... Symptoms may also include auditory hallucinations, confusion, insomnia, persecutory delusions, racing thoughts, restlessness, and suicidal ideation. Alcohol, drug abuse, and some antidepressants can trigger a mixed state in certain individuals.

Treatment of mixed states is the use of mood stabilizers, which may include anticonvulsants or antipsychotics. Mood stabilizers work to reduce the manic symptoms that have the symptoms of depression that are in the mixed episode.

Treatment of a mixed episode is complicated by the presence of the depressive symptoms which do not respond to all medications.  Because the medication can trigger a manic episode there is speculation about whether or not antidepressants should be used to treat mixed episodes.

The prognosis is good when medication is combined and is more effective in controlling the manic symptoms which drives the cycle. Medication may also be combined with psychotherapy once the person is stabilized on medication.