What Is Bipolar Disorder With Mixed Features?


There are days I can function with little to no rest and function as if I slept for eight hours, but within a few minutes, hours, or days, I feel depressed and sometimes suicidal. I never know when my mood will change, and it is emotionally draining. A wave of being slightly upbeat or extremely irritable to being depressed; this referred to as mixed features or mixed states. It was confusing and frustrating when I noticed my first mixed episode.

What is a bipolar disorder with mixed episodes?

One mood typically dominates either mania or depression, but the person cycles between the two in a short period. I was depressed the majority of the time but had spurts of feeling good and having energy.


According to Very Well Mind, if a person is in a manic or hypomanic state with mixed features, they will have had a recent manic or hypomanic episode. But would also have experienced at least three symptoms of depression during the majority of the same time frame:

  • A persistent feeling of sadness or emptiness

  • A loss of interest or pleasure in activities you usually enjoy

  • Speaking or responding more slowly than is normal

  • Persistent fatigue and loss of energy

  • Having feelings of worthlessness or inappropriate guilt

  • Recurrent thoughts of death or suicide


If someone is depressed with mixed features, they will meet the full diagnostic criteria for a recent major depressive episode but will also have experienced at least three symptoms of mania or hypomania during the majority of the same time frame:

  • An excessively elevated and expansive mood state

  • Extremely irritability

  • Inflated self-esteem or grandiosity

  • An overly talkative state or feeling pressured to keep talking

  • Racing thoughts or flight of ideas

  • Increased energy with a focus on goal-oriented tasks

  • Unwarranted risk-taking (financial, physical, sexual, etc.)

  • A decreased need for sleep

Why is this a problem?

People with bipolar disorder are more likely to attempt suicide at a higher rate than people with only depression. They have worse symptoms and can have a difficult time finding an effective treatment. They are also at risk for experiencing psychosis --- a disconnection from reality and experience delusions and hallucinations.