Sources: Diagnostic and Statistical Manual of Mental Disorders (DSM-5), American Psychiatric Association; The Minnesota Reports, University of Minnesota; “MMPI-2, MMPI-A, and Minnesota Reports: Research and Clinical Applications,” James N. Butcher, PhD; Bipolar Disorders: An International Journal of Psychiatry and Neurosciences
By JB Burrage Last Updated: 13 Aug 2020
Mixed episodes of mania and depression aren’t easy to spot, but when they hit, they’re among my most exhausting experiences. Not only did I learn how these mood episodes affect me, but I realized the risk they carry—and that is my biggest fear.
“Mood Episodes with Mixed Features,” aka Bipolar Mixed Episodes
Something that I don’t talk about often in public is mixed episodes. According to the DSM-5—the Diagnostic and Statistical Manual of Mental Disorders, which is the manual created by the American Psychiatric Association to outline the criteria for mental health conditions and treatment—these mood episodes are no longer considered distinct episodes on their own. Now they are considered a “specifier,” or a feature of another mood episode.
But, not being a medical professional, and for the sake of this writing—so I don’t confuse anyone or myself—I’ll use the phrase “mixed episodes.” Mixed episodes are yet another of what I call the “twisted” components of my bipolar disorder. I probably experience mixed and depressive episodes more often than full hypomanic or manic episodes. Not only that, it’s a part of my disorder that sometimes concerns me more than depression or mania. At least with depressive and manic episodes, I know distinctly what they are. Mixed episodes aren’t as easy to spot, but when they hit, they’re among my most exhausting experiences.
While I’ve heard of them before, the first time that I can recall being told that I have experienced mixed episodes was about eight years ago, when a psychiatrist had me take the Minnesota Multiphasic Personality Inventory (MMPI) and determined that I had traits of hypomania and “agitated depression.” Being the overly curious guy that I am, I looked it up and saw that it was one of two names for mixed episodes.
Like with almost everything else that I continue to learn about my bipolar disorder and the experiences of others, it was confusing but started to make sense. It explained why even during my depression that lasted from 2008 till around 2012 or so, excluding the almost half-year-long manic episode in 2011, I had moments when I would feel hyped and energetic, while also miserable and not wanting to get out of bed or see the world at the same time. My therapist at the time was very concerned about these episodes; she warned me that people experiencing mixed episodes were more prone to attempting and following through with suicidal thinking, so she paid close attention while lecturing me about taking my medication… I was notoriously noncompliant with my medication regimen back in those days and it showed.
The Exhaustion of Mental Illness … Amplified by Mixed Episodes
My personal experiences with these episodes, again, is that they are very exhausting. I can’t emphasize that enough. Mental illness is exhausting as it is, but I would say mixed episodes are just another beast altogether. It’s very conflicted for me, especially since these episodes are not as distinct and obvious as manic or depressed episodes are. One of the best ways I can define it is almost like a “mental tug-of-war.” Or perhaps imagine trying to mix gasoline with water and throwing a match into it. If either analogy didn’t make sense to you, you can now imagine the itch in my brain that it causes.
If you’ve followed any of my other blog posts, I’ve talked a lot about how difficult bipolar depressionis for me. I think I have written more about depression than mania, so I don’t have to tell you how it sucks the soul out of me—and for any of you who feel this way, too. But with these mixed episodes, I deal with a mix of symptoms.
My Symptoms of Mixed Episodes
- I’m extremely irritable.
- I’m extremely energetic.
- I don’t sleep.
- I feel like I want to crawl into a hole.
- Everything around me is nothing but darkness and sadness.
- I feel like I’m the show starter and the showstopper.
- I feel like I’m Superman.
- I hate my life.
- I can’t get out of bed.
- I feel like all of my life’s energy is being drained, and I’m walking around with a metal ball and chain.
- In the most extreme cases, I want to die.
I think you get the idea, so I don’t need to go any further. And these episodes can go on for days or even weeks. To be honest, I don’t think that I ever fully recover from them, because I always feel like I’m straddling the line between mania and depression, even on the days when I’m clearly fine and my moods are more in check.
Dealing with Mixed Episodes That Seem to Never End
So how do I deal with this? Sometimes, I don’t know how. Anyone who knows me knows that my go-to used to be to just try to drink it away. I HIGHLY DON’T RECOMMEND THAT. SERIOUSLY, JUST DON’T DO IT. At this point, I’m kind of trying to drill this into my head (“do as I say, not as I do” kind of thing), because when I tried to drink away the misery, it never ended up good. It either intensified my “mixed” symptoms or tilted the scale one way or the other. I try to handle it by doing the typical things that I would do in an episode: write, read something (no matter how big or small), watch funny videos, send stupid memes, listen to music, walk … whatever will take my mind off of things. But it’s not always that easy.
Efforts to Communicate and Connect with Others
I’m trying to get better at communicating these things—my struggles with bipolar and my mixed episodes—though it’s still not simple or natural. So, I try to talk with friends and I’m still trying to get therapy restarted. I’m compliant with my medicine regimen 99.5 percent of the time, but, to be honest, sometimes I feel like they don’t work when I’m experiencing mixed episodes. I could talk with my psychiatrist to change my dosages and medication, but I’m still fairly new with this current regimen, and it does work the majority of the time. One thing that concerns me with changing medication and dosages is that I hate the unknown variables. My first bipolar medication regimen had weird effects on me, and, because of that concern, I don’t want to adjust them at this time.
What bothers me the most is when I think about what my past therapist warned me about when it comes to mixed episodes and the risk of suicidal impulses. Again, being the overly curious guy that I am, I went back and did my research. I saw how real the likelihood was during mixed episodes. The risk for suicidality is greater during mixed episodes because you’re depressed but you’re also more likely to have the energy and drive to carry out your impulses and/or plans.
This scares the living daylight out of me. Because back when I was told about mixed episodes, agitated depressions, and all of these other new terms that I had to learn, I was always grappling with these kinds of thoughts. It’s something I don’t talk publicly about often, but it’s an ugly truth. I once told someone that I was more afraid of my own hand than anything else. Over the years, there have been some close calls.
I even had a complete, thought-out plan, right down to how I would be found. So, years ago, it was a very real situation for me. Finding out that having mixed episodes increased the chances of it actually happening brought not only another sense of fear but also a new sense of determination to beat this thing. I admit that it wasn’t right away. But, eventually, I realized that I’m not ready to go, and I have to do something to keep these impulses under control.
Choosing to Fight for Myself
It’s hard. But I’m trying. Every day I’m trying. So far, I’m winning.
If you take anything out of this story, I would hope that it’s this: with everything else that is part of this disorder, you’re not alone in this struggle. We’re all living through this together, no matter how it manifests itself. If you’re dealing with mixed episodes, I completely understand you and how it makes a very confusing thing even more confusing.
But because I don’t have the answers, I wonder how some of you deal with mixed episodes. What would you recommend, to me or others, to make them a little more manageable?
Because even though almost ten years ago, a name was given to my experiences and I deal with them frequently, it’s still very tiring and I don’t always know what to do.
Stay safe. Stay focused. Keep striving.