Mixed episodes have been a major feature of my bipolar 1 disorder. Or what would often happen was that I'd have an elated mania or a pure depression that would transition to the other "pole" in the form of a mixed episode, often doing so at the peak of the type of original episode. In my case, the right medications were crucial in easing the mixed episode. Sometimes I was lucky to reach baseline stable, but other times I'd switch to a more "pure" form of depression or mania. It depended on the medications. I have found that some medications are a bit better for handling mixed episodes than others. Some medications as part of my cocktail, were for me no-nos. I'm a little reluctant to declare what I believe are the "good medications" or bad ones for mixed episodes, because we're all different.

I do think that therapy and practice of coping skills/methods have been important adjuncts to the medications. I guess I've used ones for both depression and mania at the same time, as the medications do their work.