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.


It can be challenging for family and friends to be around the person with bipolar disorder. The person may feel embarrassed by the behaviors when they are in a manic state. Family and friends may refer to the person with this disorder as moody or unstable.

How is it treated?

To make an accurate diagnosis, the doctor will first rule out other mental and physical health complications such as thyroid challenges, borderline personality disorder, or schizophrenia. They will check to make sure it is not a neurological disorder, effects of current medications or recreational drugs (e.g., marijuana, crystal meth, or cocaine).


Treatment can include a combination of medications that include mood stabilizers and/or atypical psychotics. Antidepressants can make the symptoms worse for bipolar disorder. Once the person’s mood is stabled or while their mood is stabilizing, the doctor may refer them to a therapist to explore signs and symptoms that they are going into a manic, hypomanic or depressive state, and assist with developing healthy coping skills.


If someone has bipolar disorder, it is best to see a psychiatrist. If they have a current diagnosis and are looking for a therapist but unsure about traditional therapy, consider online therapy at BetterHelp where you can text, video chat, send audio messages, and call a licensed counselor.

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