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Mixed Mood Episodes in Bipolar Disorder – What Are They? Disclaimer: Please talk to a licensed health professional if you suspect you are having similar symptoms described below The complexities of bipolar disorder are as nuanced as they are challenging, and few aspects of it are more perplexing than mixed mood episodes. These unique and intense states bring symptoms of both mania and depression simultaneously, creating an emotional paradox that can make life feel like a series of contradictions. One moment may be marked by an elevated mood paired with deep sadness, and in the next, high energy mixes with hopelessness. In this post, we explore the intricacies of mixed mood episodes—also called bipolar disorder with mixed features—including their symptoms, risk factors, and approaches to treatment. What Is a Mixed Mood Episode? Mixed mood episodes, also previously called “mixed states” or “mixed episodes,” are now referred to as “bipolar disorder with mixed features” in the DSM-5, the diagnostic manual used by mental health professionals. This update in terminology reflects a more refined understanding of bipolar disorder’s spectrum, recognizing that these episodes can occur in both bipolar I and bipolar II disorders. A mixed episode happens when someone experiences symptoms of both mania (or hypomania) and depression either at the same time or in rapid succession, with little or no recovery period in between. Mixed mood episodes can manifest as an intense internal conflict, where high energy coexists with sadness, or even lead to manic actions laced with depressive thoughts. These episodes are estimated to affect roughly 20-40% of people with bipolar disorder, highlighting their significant prevalence and the importance of addressing them with care. Symptoms of Mixed Mood Episodes Mixed mood episodes can vary widely in their presentation, often blending mania’s energizing elements with the despair and lethargy of depression. Common symptoms include: An unusual combination of elevated and low moods Engaging in pleasurable activities while feeling depressed Experiencing rapid, pressured speech alongside a low mood Having an elevated mood with intrusive, depressive thoughts or even suicidal ideation Poor sleep, often characterized by severe insomnia Significant changes in appetite, which can swing between loss and excess Irritability, agitation, and restlessness Feeling energized yet hopeless Racing thoughts mixed with sadness or grief These symptoms can create a volatile state, making it difficult for individuals to function in daily life. The erratic combination of mood and energy can lead to heightened risk-taking, extreme emotional swings, and significant distress. Diagnostic Criteria The DSM-5 has specific criteria for diagnosing mixed features in bipolar disorder. According to these guidelines, an individual must show: Three or more manic or hypomanic symptoms during a major depressive episode, or Three or more depressive symptoms during a manic or hypomanic episode. These criteria help mental health professionals identify mixed mood episodes more accurately. Diagnosing mixed features is complex, and the coexistence of such opposing moods can make it harder to discern the underlying bipolar disorder type, whether it’s bipolar I or bipolar II. Cyclothymic Disorder vs. Mixed Mood Episodes In our research, we found many similarities between cyclothymic disorder and mixed mood episodes and find it difficult for even health professionals to make the subtle call when deciding on the right diagnosis. Nonetheless, it is the sole prerogative of a physician to make the call. Here are some general characteristics to know the subtle differences:  Cyclothymic Disorder A distinct mood disorder characterized by chronic, fluctuating mood disturbances Involves periods of hypomanic symptoms alternating with periods of depressive symptoms that do not meet full criteria for major depressive episodes Symptoms must be present for at least 2 years (1 year in children and adolescents) Considered milder than bipolar I or II disorder, but can cause significant impairment May be a precursor to developing bipolar disorder in some cases Mixed Mood States in Bipolar Disorder A specific presentation within bipolar disorder (40%), not a separate diagnosis Involves simultaneous symptoms of both mania/hypomania and depression during a single mood episode Can occur in bipolar I, bipolar II, or major depressive disorder Again, characterized by rapid shifts between manic and depressive symptoms or the presence of symptoms from both poles at the same time Often associated with more severe symptoms and greater functional impairment compared to “pure” manic or depressive episodes While both conditions involve fluctuations in mood, cyclothymic disorder is a distinct, long-term pattern of mild mood swings, whereas mixed mood states represent a specific type of episode that can occur within the context of bipolar disorder or major depression. The symptoms in cyclothymic disorder are generally less severe than those seen in mixed episodes of bipolar disorder.  Conclusion Mixed mood episodes add a layer of complexity to bipolar disorder, blending high and low moods into a state that can feel overwhelming and unpredictable. These episodes remind us of the diversity of experiences within bipolar disorder and underscore the importance of personalized care and support like the one offered at BP Harmony. While the journey of managing mixed mood episodes is challenging, a combination of targeted treatments, understanding support, and self-awareness can help individuals navigate these episodes and regain stability.The path forward includes recognizing the signs, seeking specialized care, and building a support system that understands the unique needs of those affected by bipolar disorder with mixed features.

Why Do People With Bipolar Disorder Sometimes Say Hurtful Things? “Where did that come from?!” This is a common expression I would hear during my recovery journey. Some small comment or noise would irritate me beyond control, and I would lose my temper and say hurtful things to the person who was unfortunate enough to be around me. Often it was a family member, and I would unearth disputes from the distant past, making them feel as if I had been harboring ill feelings for many years. So, if you are a husband thinking, “Why is my wife yelling at me” or thinking about someone else who unusually snapped at you, you should look at why it happened instead of jumping to conclusions.Let me begin by saying a lot is going on in situations like this. I mention in my book that both the person struggling with bipolar and the people in their life must proceed with a spirit of love and build healthy systems of communication. However, let me share with you from an insider’s perspective: for someone dealing with bipolar disorder, saying hurtful things is a lot more common than one might think.I begin with the position that after having your first manic or depressive episode, you stay unstable for some time. A person regains balance but can easily be tipped over. They can vacillate between two extremes constantly and can even experience both states at the same time! The cumbersome task of managing oneself with a new range of emotions as well as becoming really sensitive feels like one is learning how to operate in a brand-new world. I would explain to people that just like the world is new and scary for a child it was like that for me too. For that reason, I would ask people to grant me some space as “I learn how to walk again.” But what exactly imbalances a person with a bipolar diagnosis? Sleep Deprivation Insomnia is a salient characteristic of BPD. Think of how difficult your day is if you don’t get a good night’s rest. Now imagine not sleeping well for days, weeks, or even months in a row. Due to racing thoughts, feelings of euphoria, tense muscles, and other chronic symptoms, the person has immense difficulty falling asleep, staying asleep, and getting rest even if they do fall asleep. This kind of sleep deprivation leads to crankiness and plays a huge part in irritability. Now imagine dealing with the demands of life with such little sleep. Answers to questions like bipolar people mean the hurtful things they say don’t count if sleep deprivation is a factor for an erratic mood. Pain Poor sleep can also cause pain around the shoulders, neck, and head. It also does not allow for the vital organs such as the liver to detox during the night, which can cause internal pain in the body. This pain can make someone irritable. What’s most frustrating is that no one can see that the person is in pain; therefore, when the person snaps and says something hurtful, it comes as a complete surprise. Poor Diet People with bipolar disorder often have issues with their gut health. This is driven by eating highly processed foods and poor hydration, which greatly affect one’s mood. Indigestion, heartburn, nausea, constipation, and diarrhea can occur as well as lethargy, anxiety, and dizziness. All of this can make a terrible recipe for emotional outbursts. Trauma When a person is going through mania and depression, the nature of the state is extreme sadness, fear, anxiety, paranoia, anger, and euphoria. Often these feelings are not connected to any incident or memory, so the person searches for deeper wounds to attach the intense feelings. This could be turned into a whole article but essentially the person unearths traumas from the past (which is good in the long run to identify and address). When a person is inwardly going through such turmoil, they can likely improperly snap at others in a desperate attempt to call for help. Isolation Because the experience of bipolar is so internal, it is difficult to understand what the person is going through. The person feels that nobody understands what they are going through, and then they become isolated and bitter because of it. In this state, when someone checks in on them, they may lash out with an emotional response. Shame Mania is often attributed to poor decision making and depression is often associated with not performing at one’s best. Both of these foster shame in the individual and lead to further feelings of isolation. If someone tries to encourage them to forgive themselves there is a likelihood to get an emotional response because of the overwhelming feelings of grief due to losing a job, relationship, or even reputation. You may hear things like, “I feel like I can never show my face in public again.” Conclusion The unifying thread for all of these reasons is pain. Hence, the adage, “hurt people hurt people,” becomes applicable with a slight modification: hurting people hurt people. The temporary agony and turmoil of mania, depression, and everything in between drags the person into a state of misery. The person experiencing the symptoms does not wish to hurt people, but the severity of the symptoms and the difficulty of navigating a new world leads to verbal and even physical abuse. As a consequence, the cycle of pain festers the wounds within, further isolates the person, and traps them in the manic-depressive cycle. One question that people need answers for is, how to tell a bipolar person they hurt you? But This is a topic for another blog post. I will conclude this blog with two pieces of advice on how to move forward. Firstly, the person with bipolar must take ownership of identifying their triggers and learning how to navigate the world again while the person on the other end should show patience instead of arguing with a bipolar person. BP Harmony’s

Imran’s Bipolar Recovery Tips for Moms on Not Your Mama’s Podcast Exciting news! I recently was invited to the Not Your Mama’s Podcast as a guest, where I discussed strategies for supporting children with bipolar disorder. In this podcast, I covered essential tips focusing on sleep hygiene, nutrition, exercise, and building a robust support network. If you’re a mom seeking guidance on how to help your child manage bipolar disorder naturally, this episode is a must-listen! Tune in to the full episode and empower yourself with valuable insights. Thanks for being part of this supportive community!