Do you need to call 911? Or is there another crisis number that you can call a little outside of your community, who is still able to help? They should be able to help you.

Is your pdoc easy to get a hold of, where you have his or her cell phone number? Maybe your pdoc can direct you to the right person to talk to, but if you are feeling so bad that you need to go to the ER, it's better to stay safe. Having someone you trust there with you or talk to you, who can also get involved to help you, even if it means bringing you somewhere to be screened might be needed if you don't want to go alone or you need someone to talk to (an emergency contact especially). I definitely wouldn't wait to get help though. Sounds like you need something urgent.

I totally get it. I have had plenty of mixed episodes, and they are hell. Lately, I have some mixed symptoms "leaking through" my meds. My irritability is way high, I'm restless and anxious, but trying to cope. The heart racing is also something I am struggling with. When I am especially bad, I am super impulsive, self-destructive, depressed at the same time as manic, sometimes I hear things, the racing thoughts are constant, I can't calm down, I often get paranoid, and I get super distracted. Keep posting and reaching out for help. It often helps me feel better.