Why can't people with bipolar 2 have mixed episodes?

I really think I'm experiencing a mixed episode but I have bipolar 2, not 1, and the online literature says it's only for bipolar 1.

My symptoms are...

Agitation, anxiety, anger/frustration, panicky feelings, inability to concentrate or focus, feeling out of control, feeling like I'm going to do something irresponsible.

I'm trying to reign in these symptoms. I have lorazepam, but I don't know if this is an appropriate time to take it. I only take it when I'm having extreme anxiety.

I see my Pdoc in about a week and I'm hoping to wrap my head around what the problem is so I can better articulate it to her.

well it sounds like you are doing a pretty good job articulating it here. I wouldn't get wrapped up in whether it is bipolar I or II. you may be presenting differently now than when you were first diagnosed. I don't even know which one I am, so I must be I since I have always had mixed cycles. just write everything down for pdoc next week so you don't forget anything. don't worry about it being concise. pdoc can sort it out. take care.

Bipolar can change over time. Some patients, myself included, get upgraded to BP 1 from BP-NOS or BP 2 due to a defining event that meets the DSM criteria for a manic or mixed episode.

It's funny, I obsessed over having a 'number' for a year, and then when I finally got assigned one it was no big deal. The diagnostic label is really only for billing purposes, anyway (I get charged more now than I did when I was BP-NOS because my case is considered 'complex'). Try not to get too hung up on whether you have 1 or 2, your doctor is treating the symptoms and not the diagnosis.

I had no idea bpII aren't supposed to have mixed episodes. I feel I have them. As unhealthy as a benzo is, it seems to help me - not always tho...

No, I'm pretty sure I'm bipolar 2 and do have mixed episodes. Don't take the "literature" too seriously. Take solemn science seriously.

I'm quite sure that I get mixed episodes sometimes - but if someone was to say I was BP1 I'd be telling them that that really isn't very accurate as I do not have mania! I have hypomania, and I think that as that's the biggest marker between bp1 and bp2.... BP2 thus fits me more accurately.

When unmedicated I have mixed episodes and cycling
I have paranoia that goes a little extreme to the point of a slight psychosis
But... I have never gone absolutely manic
never been hospitalized

I am bp2

Mixed Episode

The DSM-IV diagnosis of bipolar I disorder, mixed episode, requiring that the individual simultaneously meet full criteria for both mania and major depressive episode, has been removed from the DSM-5.

Instead, a new specifier, “with mixed features,” has been added, according to the APA, that can be applied to episodes of mania or hypomania when depressive features are present. It can also be applied to episodes of depression — such as in the context of major depressive disorder or bipolar disorder — when features of mania/hypomania are present.

DSM-5 Changes: Bipolar & Related Disorders | Psych Central Professional

so what then? I'm like, bipolar 1 1/2 lol! but seriously, that means I just got promoted to bp1?!

Maybe we are bp2 x (-0.5 / pi x 0 +1.889)

bipolar 1.8937654871

Thanks, I didn't know this!

This is not really good news, in my opinion. I wonder why they did that?

If I'm reading it correctly, I think it's great news.

It sounds like it means that you can have either bp1 or bp2 with "mixed features" and that they're going to pay more attention to when the mixed episodes are primarily a depression or primarily a (hypo)mania.

((For what it's worth, mine are primarily depression and sometimes those depressions will have a LOT of energy going on..))

I'm reading it to mean that manic episodes are no longer the defining criteria for bp1 and has been replaced by mixed episodes.

now I have to wonder, what DOES this really mean :\

This is from a different article. There are links to further information within the full article.

I'm glad for this change because the only reason I carry the bipolar 1 diagnosis is due to mixed episodes. I've always felt I really fit the criteria for bipolar 2 more closely with the exception of those mixed features.

Changes To Bipolar Disorder Treatment In The New DSM-5

Mixed episodes have also been eliminated. Instead of labeling an episode as mixed, the provider will now have the option to specify a manic or depressive episode with a certain specification, “with mixed features” attached to it. The goal is to pinpoint the predominant mood.
According to the DSM-V, a person must now exhibit changes in mood as well as energy to classify for bipolar disorder. For example, a person would have to be highly irritable and impulsive in addition to not having a need for sleep. Changing these criteria helps to separate bipolar disorders from other illnesses that may have similar symptoms. The intention is to cut down on misdiagnosis, resulting in more effective bipolar disorder treatment.
A bipolar 2 diagnosis can now include episodes with mixed features. According to past editions of the manual, a person who had mixed episodes would not be diagnosed with bipolar 2. This change has made it easier to put people in less severe categories than bipolar 1.
- See more at: Changes To Bipolar Disorder Treatment In The New DSM-5

Nice! Thank you for explaining that!

This isn't how I read it. I think it means that mixed episodes can happen in the context of both mania and hypomania. So, if you're BP II, you can get mixed episodes of depression and hypomania. If you're bipolar I, you could get mixed episodes with either hypo or full blown mania.

According to the DSM-V, a person must now exhibit changes in mood as well as energy to classify for bipolar disorder. For example, a person would have to be highly irritable and impulsive in addition to not having a need for sleep. Changing these criteria helps to separate bipolar disorders from other illnesses that may have similar symptoms. The intention is to cut down on misdiagnosis, resulting in more effective bipolar disorder treatment.

This seems like a positive step forward to me. In theory (with the old definition) a change in mood such as becoming very irritable alone could be considered hypomanic (though, in realty, this could indicate a great many different things) whereas now there has to be a constellation of symptoms in addition to that (i.e. excessive irritability *and* little sleep but tons of energy, etc.).

Thanks for posting this, I didn't know about the change.

I was diagnosed bp II and have mixed episodes. Most of my mood is mixed when I'm not feeling "normal".

Mine too, I hate it. A year ago it wasn't this mixed all the time. Even when I'm happy I want to kill myself because it's exhausting. But that is just ideation.

im bipolar 2, and a few month ago I know I was cycling, I tried to tell my psych, he just said it was stress, but a few yrs back, I went through a 6 month period where I did things that was not in my character of doing and I live in regret to everything today. I haven't had any other episodes since, but just the recent cycling.