View Full Version : What are mixed episodes?

07-10-13, 08:33 AM
I'm not sure if I get them but then, I don't understand really what a mixed episode is supposed to be.

Now, I know that in mixed episodes you are supposed to have both depressive and hypomanic symptoms, e.g. you feel depressed but are irritable and overactive both mentally and physically. Does that mean that you are depressed but restless? Do you have the energy to do your work irrespective of being depressed or do you just move and think randomly and non productively? What about when you are not that depressed but just restless and irritable?

I'd love to hear personal experiences of mixed episodes. How do they feel to you?

07-12-13, 12:53 AM
I'm not sure if I have them but I've had a few strange episodes. I've been depressed but impulsive at once.

There was this one time when I was cycling so rapidly from depressed, paranoid, hypomanic (my 'ranty' mood), to usual happy hypomanic that I felt it all at once. My head was just racing and it felt awful. I couldn't do anything but sit there and then my emotions blunted from the intensity of it all.

It's hard to know for sure because I'm not feeling it now. I've been restless and irritable on/off for days/weeks.

I've been depressed and irritable and incredibly sarcastic. I call that low-grade depression. Functional depression. It feels like every little thing p***es you off, particularly people who dare to be in the same room with you. I get angry at people for no reason. If a piece of paper just so falls off the desk I go into a ranty rage.

I've had the overactive mind with depression. It feels awful. I think I have just cycled out of my low mood too. And I resisted telling this Windows pop up program to go f**king die, and threaten to buy a Mac if it does it again. I say that a lot.

I don't know how to explain it. It's like being depressed but still getting ideas to do things, or having an active mind. Depression on its own just slows down my mental processes and even motor skills. That can lead to irritable ranty thoughts. Ranting about people in my head.

I think they can come with different intensities. The one that was rapid cycling felt as one completely disabled me, but the above I explained I could be a bit productive. It's a type of passive aggressive mood. I'm not sure if that's the best description though.

07-15-13, 03:08 PM
A mixed episode is sometimes also called an "agitated depression" or "black mania", to further illustrate the combination of traditionally depressed symptoms with traditionally manic symptoms.

Symptoms that characterize depression include things like feeling sad, hopeless, empty, unmotivated, sometimes having suicidal thoughts, etc. Symptoms that characterize mania include things like not being able to sleep, impulsivity, agitation, recklessness, and sometimes psychosis. There are some symptoms that occur in both manic and depressive episodes, like increased anxiety, agitation (although the agitation is usually more "off the handle" in mania than depression), and sleep pattern disturbances (mania is usually a decrease in sleep with no perceived need for sleep and corresponding increased energy, whereas depressed sleep changes are usually either insomnia or sleeping too much). Psychosis can also be a feature of both severe major depression and mania.

Mixed episodes are generally considered the most dangerous mood state, because they often combine the suicidal thoughts of depression with the impulsivity and agitation of mania. You can see how that would be a disastrous combination. One of the "safeguards" of major depression is that often when people are so depressed that they want to kill themselves, they are also incapacitated to the point of being unable to motivate themselves to go through with it. During a mixed episode, that safeguard is often not present because of the agitation and impulsivity of the manic influence.

I have had a small handful of mixed episodes in my life thus far, and they are awful. For me the mixed episodes have included profound sadness, hopelessness, and emptiness, as well as impulsivity (not ADHD impulsivity, bipolar impulsivity), extreme anxiety and agitation, delusions/psychosis, self harm, and attempted suicide. It feels like having your brain torn in half, is the only way I can describe it. Very, very intense and confusing, especially if/when psychosis sets in.

They're different for everyone, but that has been my experience of them.

07-16-13, 01:01 AM
This link might be helpful.

That's me down to a t. I wish I could say I've only had a handful of mixed episodes. Brain being ripped in half is right. I just sit there with my fists beating my head and pretty soon I lose the ability to feel emotions. Must be an autistic safeguard for me.

I'm always an agitated sarcastic depressed thing, though I've gone maybe a couple of days without the slightest episode. Knock on wood. I usually think about suicide right away too unlike the slow progression towards it when I get depressed.

Lately though, I've been ok. I can't believe those few short days were actually PMDD. I was a mess last month. This month I was waiting for it to get worse. I'm grateful especially with all that I'm committed to do in the next couple of weeks. It just feels weird.

This morning I can't quite work out if it was seizures or mania or both. I wrote this in another bipolar group. Does it sound like a mixed episode?

"I was experiencing a lot of pain from well period pain. I put on some music and felt euphoric. Then I started to talk a lot of nonsense. I yelled out "I'm in so much pain I'm delirious!" Then I started laughing for a good ten minutes. Someone brought me promite on toast and I thought I was eating french toast. I just felt really weird so I didn't take any muscle relaxants because I was already hallucinating."

Would add I did have quite a lot of brief seizures.

I'm not sure if I was delusional. I've been a bit delusional lately. I'm not sure what it was about last night but it had something to do with the government.

07-18-13, 03:57 AM
I finally noticed it. Depression was triggered by a very personal long time issue and then someone p***ed me off so I got very ranty, and yeah, I'm both manic and depressed now.

I'm such a ranter right now. I'm so angry. And then I don't care. I sound delusional particularly when I say a bunch of stuff that no one can comprehend. Stuttery. Unmotivated in one area yet more motivated to do something else. Either distractions or self destructive things that offer a little short term relief.

I think I could type for days.

I can't sit still yet I don't want to move.

I don't appear to be as impulsive as I am when I'm feeling euphoric but I have been getting into a lot of arguments and not holding back.

Brief suicidal ideation but it's over now. Last night I had a lot of hallucinations too.

08-17-13, 04:36 AM
I'd love to hear personal experiences of mixed episodes. How do they feel to you?

It's the worst mood swing I've ever endured.

I feel this pain in my stomach, that stretches throughout my abdominal region. It's intense. Always there. Depression.

I also have racing thoughts, sometimes racing uncontrollably. I can't hardly focus. They're usually negative, filled with paranoia, detrimental "self-talk" (which I can't hardly control), delusions, ideas ideas ideas - but nothing good.

I have energy. Sometimes the energy is higher and at other times lower. Sometimes I feel fatigued. It's confusing. I feel anxious, irritable, and agitated. It's very uncomfortable.

Sometimes I go into a rage when things build up - or it just comes on suddenly and I burst. I've self-harmed before to help ease the pain/intense pressure of the racing thoughts and the intense rage I feel.

I can't sleep when I'm like this. I want to usually, to not feel the depression. - It's such a deep depression and my mind and gripping pain in my stomach and racing thoughts constantly remind me of it.

And all of these things happen simultaneously. Sometimes some symptoms are more intense at times then others, but they're usually all there. Although, the delusions don't occur the entire time, but throughout.

It feels like there's no escape from it. It sucks you in and takes the life out of you while at the same time "brings you to life" in the fullest extent - to make sure you feel utter misery, pain, hopelessness and despair.

It is agony to the greatest degree.

(Yes, I've recently gone through one - may and probably still am in one - which helped me to describe the experience. :) )

08-17-13, 11:04 AM

Such an excellent account of a mixed episode. Captures the intensity and physicality of the mood state very well. Thanks for sharing, Bella.

08-18-13, 05:13 AM
For me it's just extreme rapid cycling that's so fast every emotion gets experienced together. And the emotions are so intense I temporarily go numb.

Last night I was experiencing a 'gustatory migraine' and then had severe paranoia and a very sped up feeling in my head.

I couldn't sleep either.

It's no wonder I'm feeling sleepy now.