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
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.