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Mixed Episode Bipolar Disorder: Symptoms, Causes, Treatment, Risks

Mixed Episode Bipolar Disorder

Mixed episode bipolar disorder is a form – or more precisely the description of a component of the relatively widespread brain illness called bipolar disorder. This mental disorder was previously known as dysphoric mania. People who are suffering from mixed bipolar disorder experience symptoms of both mania and depression at the same time.

Individuals who suffer from mixed episodes bipolar disorder can experience both manic and depressive phases in different ways: the mixed episodes in bipolar disorder can be experienced either simultaneously, or is so-called “rapid sequences”. Mixed episodes in bipolar disorder are so severe that they are capable of causing serious distress and strong impairments in people’s everyday life.

What is Bipolar Mixed Episode

A mixed episode in bipolar disorder is characterized by typical symptoms of manic episode and of major depressive episode that occur either simultaneously or in rapid sequences, nearly every day for at least seven days.

Who is at risk for mixed bipolar disorder?

No special group of people is particularly at risk for being affected by mixed bipolar disorder. Basically, mixed bipolar disorder can affect anyone of us at any time. Worldwide, 2.2% of the population is estimated to suffer from a bipolar disorder form.

Mixed episodes – or mixed mood episodes – are fairly common in people suffering from bipolar disorder type I. Up to three people in four who suffers from bipolar disorder type I are likely to experience mixed episodes in bipolar disorder.

People usually experience their first symptoms of bipolar disorder relatively early. This generally occurs when they are teenagers or when they are just out of their teens. Those people are at higher risk of developing mixed episodes. When they have developed mixed episodes, they are also at high risk to suffer from pure depressive or pure manic or hypomanic episodes in bipolar disorder. As a matter of facts, bipolar disorder type mostly occurs before a person reaches the age of 25.

Heredity also can play a role: people with a family history of bipolar disorder are consequently at higher risks to suffer from the disorder one day.

Mixed Episode Bipolar Disorder Symptoms

Symptoms of mixed episode in bipolar disorder include:

Manic phase – or bipolar mania or hypomania – of bipolar disorder

The signs and symptoms of the manic or hypomanic phase of the illness bipolar disorder usually include:

Mood Changes in bipolar disorder:
  • Feeling "high," or an overly happy or outgoing mood for a long period
  • Extreme irritation, agitation, feeling "jumpy" or "wired."
Behavioral Changes in bipolar disorder:
  • Having racing thoughts, fast speech, jumping from one idea to another, 
  • Being easily distracted
  • Increasing activities like taking on new projects, ventures
  • Being restless
  • Sleeping little
  • Having an unrealistic belief in one's abilities
  • Behaving impulsively and taking part in a lot of pleasurable, high-risk behaviors, such as impulsive sex, compulsive spending, and impulsive business investments
Depressive phase of bipolar disorder

The signs and symptoms of the depressive phase of the illness bipolar disorder usually include:

Mood Changes in bipolar disorder:
  • Prolonged period of feeling of worry or emptiness 
  • Loss of interest in activities once enjoyed (including sex)
Behavioral Changes in bipolar disorder:
  • Feeling tired or "slowed down"
  • Having problems concentrating, remembering, and making decisions
  • Being restless or irritable
  • Changing eating, sleeping, or other habits
  • Having thoughts of death and/or suicide, or attempting suicide
The fact that a person suffering from mixed episodes in bipolar disorder is capable of feeling depressed and manic at the same moment may sound illogical but is understandable when considering that we encounter here a form of brain or mental illness that resists all and any predictable patterns of behavior and/or feelings.

When a mixed episode in bipolar disorder is not treated professionally, it can last from a few days up to a few months. People suffering from mixed episodes in bipolar disorder can experience the recurrence of the symptoms of the disorder. In this case, recovery last longer than for episodes of pure depressive or pure manic or hypomanic episodes of bipolar disorder.

What Causes Mixed Episodes in Bipolar Disorder?

The exact cause for the emergence of mixed episodes in bipolar disorder is still unknown. However, a number of factors appear to be involved in triggering mixed episodes in bipolar episodes. Most people suffering from mixed episodes in bipolar disorder share several factors that may act together to either produce their bipolar disorder or increase the risk of getting affected by mixed episodes in bipolar disorder.

Biological differences may be responsible for causing mixed episodes in bipolar disorder

People suffering from mixed episodes in bipolar disorder seem to have some specific physical changes in their brains that scientists do not find in the brains of healthy people or of people affected by other types of mental disorder. The precise significance of these changed patterns is not yet ascertained but may eventually help identify causes.

Brain chemistry may be responsible for causing mixed episodes in bipolar disorder

Neurotransmitters are brain chemicals that are responsible for the transmission of signals between the cells; they are often involved in a number of depression. Mixed episodes in bipolar disorder can be the result of an imbalance of human brain chemicals called neurotransmitters. An imbalance in neurotransmitters may trigger the symptoms of mixed episodes in bipolar disorder.

Hormones may be responsible for causing mixed episodes in bipolar disorder

Scientists strongly believe that imbalanced hormones also play a partial role in causing or triggering the symptoms of mixed episodes in bipolar disorder.

Genetics may be responsible for causing mixed episodes in bipolar disorder

People with a family history of bipolar disorder are principally predisposed to experiencing mixed episodes in bipolar disorder. A sibling or parent with the condition may be a cause to trigger symptoms of mixed episodes in bipolar disorder.

Environment may be responsible for causing mixed episodes in bipolar disorder

Environmental factors, such as any kind of stress, physical or sexual abuse, significant loss of a loved one, separation from a parent, or other traumatic experiences may play a particular role in causing or triggering symptoms of mixed episodes in bipolar disorder .

According to the Diagnostic and Statistical Manual of Mental Disorders, mixed episodes in bipolar disorder cannot be diagnosed as such if the person’s bipolar disorder has been caused by or is the result of a physical trauma – such as brain injuries and thyroid disorders – or of a side-effect resulting from alcohol or illegal drug consumption. However, these causes that exclude a patient to be diagnosed with mixed episodes in bipolar disorder may generate other types of bipolar disorder.

What are the risks of mixed episodes in bipolar disorder

Suicide is by far the most serious risk for the people that are diagnosed with mixed bipolar disorder. For a person suffering from mixed episodes in bipolar disorder, the combination of manic and depressive symptoms can be extremely dangerous. Basically, all people who experience mixed episodes in bipolar disorder are at higher risk for suicide, self-harm, and further psychiatric complications.

Who is at risk with mixed episodes in bipolar disorder

A person who experiences bipolar disorder is up to twenty times more susceptible of committing suicide than people who do not suffer from bipolar disorder. Sadly, up to one person in five suffering from bipolar disorder commits suicide.  People experiencing mixed episodes in bipolar disorder are at more increased risk for suicide – during the mixed episodes period – than people experiencing episodes of bipolar depression.

Appropriate professional treatment lowers significantly the probability of developing a severe depression and the risk of committing suicide. Taken over a long period, lithium has shown to be effective in reducing the risks associated with mixed episodes in bipolar disorder. For people suffering from mixed episodes in bipolar disorder, it is not uncommon for them to have to be hospitalized to receive adequate professional treatment.

Alcohol and drugs abuse are another important issue for patients who suffer from mixed episodes in bipolar disorder, as the disorder makes them very receptive for the consumption of alcohol and drugs. Any kind or form of substance abuse automatically leads to more severe and intensive bipolar disorder or is directly linked with poorly controlled bipolar disorder.

How are mixed manic episodes in bipolar disorder treated

Treatment for mixed manic episodes in bipolar disorder is typically based upon the administration of medication. Mixed episodes in bipolar disorder are much more difficult to diagnose and to keep under control than any other form of bipolar disorder. Considered a type of mania, mixed manic episodes in bipolar disorder are typically treated with mood stabilizers and antipsychotics. Usually recommended medications for the treatment of mixed episodes in bipolar disorder include:
  • Mood stabilizers, like lithium and some anti- seizure drugs
  • Anticonvulsants
  • Antipsychotics
  • Benzodiazepines
  • Electroconvulsive therapy (ECT)
Electroconvulsive therapy is an option for people whose symptoms could not be improved by other treatments, or if you are pregnant and cannot take appropriate medications.

Very often, different medications have to be tried before the genuine one is found.  A combination of medications can also be recommended by your doctor to enhance the positive results.

How are mixed depressive episodes in bipolar disorder treated

Mixed depressive episodes in bipolar disorder are basically difficult to treat. The reason for the difficulty can be explained straightforward: mixed mood very often do not respond to common antidepressants and they can worsen both the hypomanic and manic symptoms of the bipolar disorder.

Some experts therefore recommend the use of mood stabilizers or antipsychotics to combat and suppress the hypomanic symptoms of the bipolar disorder, knowing that antipsychotics usually require a period of up to two weeks to work.

This treatment strategy is fairly similar to that recommended by many doctors for the treatment of bipolar disorder type II.  The primary objective is to stop the cycling – also called hypomania – and to control if the strategy has been capable of correcting the depression. In any case, the use of antidepressants is to be avoided or limited wherever possible.

People suffering from mixed episodes in bipolar disorder often have recurrent episodes and can experience either mixed, manic or depressed episodes of bipolar disorder.

Can mixed episodes in bipolar disorder be prevented

Nobody can guaranty yet the prevention of any mood disorder.  There is still no treatment available that is capable of preventing entirely the occurrence of mixed episode in bipolar disorder. 

The best that can be done in the meantime is to seek for professional help at the very first signs of any mental health disorder, as some episodes of hypomania and of depression can be prevented effectively in people who have started developing episodes of bipolar disorder.

Another important point consists in continuing taking regularly the prescribed medicines – as agreed with your doctor. This may be the best measure you can take personally to prevent the emergence of future mixed episodes in bipolar disorder.

General Questions about Mixed Episodes in Bipolar Disorder

What kind of questions can my doctor ask about my mixed episodes in bipolar disorder?

When you see your doctor for the very first time in connection with your symptoms of mixed episodes associated with bipolar disorder, he or she will ask you a number of questions that you may not be able to answer completely if you have not kept regularly a “My Mixed Episodes Diary” in which you have regularly and carefully put down:
  • When you have realized for the very first time that you might experience symptoms of mixed episodes of bipolar disorder.
  • A most precise description of your mood symptoms of depression, hypomania, and/or mania.
  • How long your mixed episodes of bipolar disorder have lasted.
  • Who, how and when somebody – at home or at work – has noticed that you might show typical symptoms of mixed episodes of bipolar disorder.
Your doctor will also want to know
  • If the mixed episodes that you have experienced have improved on their own or if you have taken some medications to treat your mixed episodes of bipolar disorder.
  • If you remember having ever experienced a “normal” mood?
  • How you would describe right now your mixed episodes of bipolar disorder.
  • If your personal needs for sleep or sex have changed significantly during the mixed episodes of bipolar disorder.
  • If your relationships, your productivity at work, or your home life have been affected by your mood swings associated with bipolar disorder.
  • If you do have or have had a parent or sibling with bipolar disorder.
  • If you regularly or now and then consume illegal drugs or alcohol

What causes mixed episodes in bipolar disorder?

Quite a number of factors may contribute to the emergence of mixed episodes in bipolar disorder. Most people who suffer from mixed episodes of bipolar disorder have a family history of some forms of bipolar disorder.

Moreover, some chemical imbalances in a person’s brain can be responsible for the emergence of episodes of depression and of mania.

Some people who experience a traumatic event can become so stressed that they develop mixed episodes of bipolar disorder.

In accordance with the Diagnostic and Statistical Manual of Mental Disorders, mixed episodes in bipolar disorder is not diagnosed as such if the disorder has been caused by any kind of physical trauma or by the consumption or abuse of drugs and alcohol. However, these causes may trigger other types of bipolar disorder.

The factors that can contribute to the emergence of mixed episodes bipolar disorder include:
  • Interrupting taking mood stabilizers after the first episode or, reducing deliberately the doses recommended by the doctor in order to easier manage the side effects.
  • Not treating one’s episodes at an early stage may result in developing mixed episodes in bipolar disorder. Some people suffering from bipolar disorder only seek treatment when the condition worsens.
  • Using only antidepressant medications or in combination with mood stabilizers.
  • Consuming illegal drugs – especially cocaine and/or methamphetamine – and alcohol.
  • Sleeping chronically not enough.
  • Underlying thyroid disease
People experiencing mixed episodes in bipolar disorder carry one of the greatest risks of committing suicide among people suffering from psychiatric illnesses. Therefore, all efforts and measures have to be taken to prevent and/or treat professionally mixed episodes in bipolar disorder.

Can mixed bipolar disorder cause other illnesses?

Obviously, quite a number of illnesses resulting from mixed episodes in bipolar disorder are caused by the different medicines that are administrated to treat a patient. For example, lithium – a usually recommended mood stabilizer – can also cause serious complications in pregnancies, such as deforming the fetal heart or generating complications in hyperthyroidism and kidney.

Further medications, such as antidepressants and antipsychotics can also affect dangerously an organ system. On the other side, anticonvulsants generally generate only mild side-effects like weight gain.

What happens in a person experiencing a mixed episode in bipolar disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a mixed episode in bipolar disorder is defined as a period of minimum seven days during which the settled criteria for both a manic episode and a major depressive episode are experienced. During such a period, people experience rapidly shifting moods like sadness, anger, and extreme happiness, together with symptoms of a manic and of a major depressive episode.

Very often, the symptoms that people usually experience in the course of a mixed episode in bipolar disorder also include agitation, insomnia, psychotic symptoms, and sadly enough, suicidal thoughts. Because of the wide range of symptoms usually involved, mixed episodes are significantly more difficult to diagnose.

However, providing promptly appropriate medical treatment is extremely important for people who suffer from mixed episodes in bipolar disorder, as the outcome is poorer for them than for people affected by other forms of bipolar disorder.

What should people with mixed episodes in bipolar disorder avoid?

Quite obviously, people suffering from mixed episodes in bipolar disorder should do their best to systematically avoid all situations and activities that might trigger an episode. For example, alcohol and drugs are known to increase the frequency and severity of mixed episodes; they can also be responsible for the triggering of stressful situations.

With appropriate medications and proper counseling, a person who suffers from mixed episodes in bipolar disorder can still enjoy most daily activities on a regular basis. Another very important point consists in continuing taking regularly the prescribed medicines – exactly as agreed with your doctor.

How can I manage my mixed episodes of bipolar disorder on a daily basis?

If you want to manage correctly your mixed episodes of bipolar disorder on a daily basis, you should make sure that you do not skip any of your counseling appointments and that you take all the medications very precisely as they were prescribed by your doctor. Medication and therapy for people with mixed episodes of bipolar disorder are often highly effective, provided that they are taken consistently.

Should you suffer from severe side effects that you judge excruciating, talk in full details to the doctor who prescribed the medicine. Based on your information, he or she will try to find a solution and possibly suggest another medication to easier combat your mixed episodes of bipolar disorder. Make sure that – under no circumstances – you stop taking the prescribed medication or reduce the dose without your doctor's knowledge. The resulting effects of such a decision could be dramatic.

Keeping a healthy diet and doing regular exercise can only be beneficial. It is also a good idea to keep a “My Mixed Episodes Diary” in which you can write down all relevant information about your mixed episodes of bipolar disorder, such as when what kind of symptoms occurred, how long they lasted, how they felt, what side effects you experienced, how you could sleep, etc.  This information will be both helpful and appreciated by your doctor.

Do your very best to avoid consuming drugs and alcohol; they can easily trigger the mixed episodes you are not keen to experience.

Do your utmost to live a healthy lifestyle and sleep a lot. Doing regularly exercise will help you better cope with your mixed episodes of bipolar disorder.

Keep away from all those people who might encourage you to take part in risky business or harmful situations, especially when you are experiencing a manic episode. Instead, search for people you can trust and who can give you the necessary support.

How does mixed episodes bipolar disorder affect the body?

Mixed episodes of bipolar disorder can cause serious negative changes to a person's sleeping and eating habits.

A high number of people suffering from mixed episodes of bipolar disorder develop suicidal thoughts that can lead to serious consequences and to self-harming.

Chronic pain can also cause serious discomfort in people experiencing mixed episodes of bipolar disorder.

Not to neglect are the severe side effects resulting from administrated medication to combat mixed episodes in bipolar disorder. These side effects can damage liver and kidney. However, the types of medications usually prescribed to treat mixed episodes in bipolar disorder do not cause such serious side effects. They are usually responsible for the person’s weight gain.

How common are mixed episodes in bipolar disorder?

Less than four percent of people in the United States suffer from the illness “bipolar disorder”.  Estimates do vary widely, but some evidence suggests that up to two in five people diagnosed with bipolar disorder do experience so-called mixed episode.

While some of these patients suffer from bipolar disorder type I – an illness characterized by severe mixed episodes – other patients are diagnosed with mixed episodes of bipolar disorder. A patient suffering from mixed episodes in bipolar disorder usually experiences symptoms of mania and of depression at the same time or in rapid succession. That person might therefore feel sad and hopeless, but also develop racing thoughts.

What increases my risk for mixed bipolar disorder?

Basically, a person with a family history of bipolar disorder is at higher risk of developing mixed episodes in bipolar disorder.

The very same applies for children and adolescents; their mixed episodes of bipolar disorder occur more frequently – compared with those affecting adults.

Experiencing stressful events can trigger episodes in some people. For certain people, undergoing very stressful events, such as the death of a loved one or a separation increase significantly the risk of developing mixed episodes in bipolar disorder.

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