I self-harm since I was 12. Mixed episodes are the worst indeed, but depressive/dysthimic ones are just as bad.

Besides what we think of when someone says "self-harm", I also have other self-harm mechs like substance abuse and binge eating or alcohol. If I don't cut or hurt myself I use these others types of self-harm.

Funny thing: it's very different for me when I misuse meds to induce sleep vs doing it to hurt myself.