Mixed States - an actually decent explanation

I've read every book on bipolar known to mankind, but I've never found what seemed like an adequate explanation of mixed states. Well, I found a book I actually hadn't read before, and it has at least a more detailed discussion of this. The book is Bipolar Disorder: Your Questions Answered by Neil Hunt. It is written for physicians, but is very readable. My apologies for this being so long, but I thought it might be interesting and maybe even helpful for some of us. So this is what he says about mixed states:

"The usual view of manic depression is of the two extremes of mood--very high and very low--which are seen as opposites. However, there is more in common between these states than it at first appears. Both states involve loss of sleep; overactivity is obvious in mania but it can also be present in depression in the form of agitation. The rushing thoughts of mania are apparent in speech but in depression the mind is often full of overwhelming negative thoughts going round and round that cannot be stopped. Both mood states lead to poor concentration, memory and distractibility. Psychosis can be evident in both states, though usually in different forms; disability is profound in both states when severe.

It is easier to understand "switching" when the similarities between the two states are appreciated. Many depressions are followed by mania and vice versa. This is often put down to the effect of the medication but in fact it is a basic part of the illness course and was apparent well before the treatments we currently use were available.

It is probably better to look on mania and depression as closely related states rather than opposites and that they have more in common with each other than with euthymia--normal mood. This makes the understanding of mixed states easier and the more you look for mixed states the more you will see them.

Mixed states are the combination of manic and depressive symptoms at the same time. Sometimes it is just the presence of depressive idea: feeling guilty and frightened in an otherwise clear manic state--dysphoric mania. For others the combination is so marked you cannot say in which state they are in."

There's more, but I thought the explanation of mania and depression being very similar rather than on opposite poles helped me understand my mixture of symptoms as much more comprehendible. I can see that blend of symptoms much more clearly.

Thank you. Your post is helpful.

My pdoc gave me a copy of this book - it's a good one, I agree! Mixed episodes are my most common mood state and I agree with the description.