[coolibrarian]

Can someone please define "mixed episodes" for me? Thanks in advance.

[ArtleyWilkins]

I saw no one responded to your question so I'll give my experience with mixed episodes.

For me, the best description was a really agitated and severe depression. I think mixed episodes look different for different people. In my case, mixed episodes were times my depression was most severe coupled with the energy and agitation to act on that depression; thus, they were highly dangerous for me. Each and every time I was hospitalized, I was in a mixed episode and highly suicidal with the energy to act on it.

[Blueberrybook]

I've been stuck in one, thought I might be getting out but not yet just more of the same. I have racing thoughts, no self-esteem, doubt myself all the time, I need to do this, I need to do that, some hypersexuality, depressed about my weight and the number on the scale, I need to run to lose weight, I end up running 10 miles (think the length of the run is partly due to mania, around 4 miles of running helps with anxiety beyond that is just eating disorder stuff, also dissociation (like my life is a movie. or that I just am, but I'm not controlling my body but the depressed part of me likes the dissociation; the eating disorder loves the calorie burn). I hate my life, wish I would die in my sleep at night (passive suicidal thoughts, I was told). Some times sad, crying spells, sometimes mania & depression practically on top of each other. Probably you can see from this post what my days are like. If I start talking, I can't seem to filter it, and it is stream of consciousness talking that is not empathetic of others, and it's been my husband and daughter having to listen to that. A lot of the time, I talk & and add stuff in there like chores I did that were completely normal and no reason to talk about.

It's frustrating and it sucks. I have been this way since the end of March.

Though I have certainly experienced many many pure hypomanic, full blown manic, and depressive episodes, I have had my fair share of what most call "mixed episodes". In fact, mixed episodes were my very worst episodes of my life, and accounted for about seven of my 10 hospitalizations.

Many people are not fond of the DSM (Diagnostic and Statistical Manual of Mental Disorders), and some who liked the earlier versions of the DSM, don't like the current 5th edition. However, I think that the bipolar disorder section of the 5th edition is much improved. Though the term "mixed episode" continues today, and likely will into the future, the DSM-5 doesn't really use that term, like it's predecessor did. In fact, from my recollection, the term doesn't even appear in the 5th edition. Instead, it refers to " with mixed features" as a type of specifier to bipolar episode types. Some other specifiers include:

* with rapid cycling
* with anxious distress
* with catatonia
* with atypical features
* with seasonal pattern
...and a few more.

Why I bring up the DSM-5 is because it is the first time it has "officially" recognized mixed features with hypomania. I can tell you that many (maybe most) psychiatrists did recognize them with hypomania before the DSM-5, but often the label "mixed episode" was primarily assigned to people with bipolar type 1, and not bipolar type 2. So, according to the DSM-5, you can have the following:

- Depression with mixed features
- Hypomania with mixed features
or,
- Mania with mixed features

The choice of the above has to do with the primary episode type. That could mean the episode type with the most symptoms represented, or the episode type with the very worst symptoms represented. Given this, what we've known as "mixed episodes" can certainly look a little different for some people (or for certain episodes) than others. So if you ask me what my mixed episodes looked like, I'd say that they varied, though my very worst episodes (when I was hospitalized) happened to fit the "manic with mixed features" category more than not. I certainly feel that someone with a particularly severe "depression with mixed features" may also tend to end up in the hospital. But "hypomania with mixed features", though pretty rough, likely don't necessitate a psychiatric hospitalization. That's my understanding.

As an add-on, in terms of coding an episode for insurance purposes, there are also other specifiers relating to severity of the episode, whether psychotic features were present, or if the illness is in partial or full remission.

Maybe the above is not exactly what you were asking for, but I truly can't provide an answer other than for my worst or most common episodes that happened to have mixed features. My worst were pretty dangerous for me in terms of danger to myself or others (i.e. reckless driving), having behavior that seemed either scary bat **** crazy, psychotic, and so energized or agitated that people were stunned or severely concerned. Whether there was more clear depression represented or more clear mania (or a rapid fluctuation between extremes) varied.

Mine are: not sleeeping, suicidal, probably doing dumb things like self harming, sleeping around, reckless driving, sometimes drinking, extremely irritable, typically end with the police dragging me out of the woods or someone's backyard or off the side of the highway and having a fun ride in an ambulance.

[jaysmotogp]

For me a mixed is hypomania and severe depression mixing back and forth minute to minute, will very agitated nervous energy going the entire time. I always know its coming on because after either a hypo or "normal" period, i become very irritable for a couple days then the mixed starts

[MickeyCheeky]

Unfortunately I don't know the details, but I know it's usually a very stressful and potentially dangerous episode, coolibrarian. I think you need to be very careful when you're going through one. For more details, and to get help, I'd suggest to talk to your Pdoc about this. Please stay safe and take care of yourself. Sending many hugs to you

[Blueberrybook]

Originally Posted by jaysmotogp

For me a mixed is hypomania and severe depression mixing back and forth minute to minute, will very agitated nervous energy going the entire time. I always know its coming on because after either a hypo or "normal" period, i become very irritable for a couple days then the mixed starts

This is me too.

[~Christina]

Mixed for me is pure hell on earth.

I’m depressed yet hyper spastic and anger agitated to the max. Also make lousy decisions leaving a path of destruction in my wake that I have to fix and make amends for.

If I ever find myself getting into that phase I start taking heavy duty old school drugs like Haldol or Thorazine to help me get out of it as fast as possible

Mixed = hell on earth