مقالات مفيدة باللغة الإنجليزية

The “Mental Tug-of-War” of Bipolar Mixed Episodes

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.

mental tug-of-war bipolar disorder mixed episodes mania depression suicidal thinking anger

“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 THATSERIOUSLY, 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.

Suicidal Tendencies

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.


مجرد أثر بقلم لمياء مقلد

تخطيت تلك الأحداث منذ سنوات.
أحداث كنت وقفت عندها طويلا ،توقف خلالها الزمن بالنسبه لى ، وذهبت فيها إلى حيث لا رجعة …
ظننت وقتها السوء فى كل شئ..
ومع ذلك كله كان هناك صوت يهمس لا لم تتوقف نهائيا،فقط بعض الوقت وسيعود كل شئ كما كان ..
ولن يضر أن تأخذ هدنه من تلك الحياه السخيفه لبعض الوقت.
وانقضى بعض الوقت و بعض آخر وربما بعض ثالث..
واستيقظت يوما على حلم ملأ كل كيانى، صَدقَته كل حواسى، حتى تملك قلبى
أصبح بمثابه القشه التى يتعلق بها الغريق
أخبرنى بأنه حان الوقت وانقشعت الغمه !
وعدت لأتنفس مره أخرى ،وعاهدت نفسى أن يكون أول هواء أتنفسه هواء البحر ليس لشئ إلا لأننى أعشقه!
وقررت وأنا اشم رائحه البحر وهواؤه المنعش واشاهد الشمس وهى تشرق ليوم جديد أننى سأتنفس فقط ما أحب ولن أفعل ابدا الا ما ترضاه نفسى ..
ستسألنى مر كأن لم يحدث؟
سأقول مر كأنه حدث!
مر وترك أثر .



مقالات مفيدة باللغة الإنجليزية

When you shut down your emotions

‘When you shut down emotion, you’re also affecting your immune system, your nervous system.

So the repression of emotion, which is a survival strategy, then becomes a source of physiological illness later on. ‘ -Gabor Mate ⁣

However, it’s not just your long-term health that can suffer if you suppress your negative emotions.

There have been numerous studies showing that when we ignore our emotions, we can experience short-term mental and physical reactions as well.⁣

Suppressing your emotions can lead to physical stress on your body.

What emotion is being suppressed does not matter, the effect is the same. ⁣

When it comes to regulating difficult emotions, there are two ways most people respond: they act out or they suppress.

If you act out with a strong emotion like anger, you will most likely create undesirable consequences in your relationships, your work, and even your play.

The ripple effects of acting out usually provoke more anger around you, which leads to more difficulty.

The consequences of suppressing those big emotions can be even more dangerous. ⁣

What many people aren’t aware of is that there’s another way to regulate our emotions: Feel the feeling in real time. ⁣

On one level, emotions are like energy waves, varying in shape and intensity, just like ocean waves.

Their nature is to arise and pass away pretty quickly, like all natural phenomena.⁣

Ironically, efforts to “talk yourself out of your emotions” often results in “increased rumination and perseveration.”

In other words, you will keep thinking about and holding onto those emotions you’re trying to avoid.⁣

Research into emotional regulation suggests that mindfulness-based interventions can be helpful.

Particularly focus on feeling the emotion and practicing forgiveness, compassion, and kindness at the same time. ⁣

#عيادة الجمعة

عيادة الجمعة…. أين أذهب إذا شككت أنك تعاني مرض نفسي؟

قبل أن تتوجه لطبيب الأمراض النفسية أو تشك في أنك مريض نفسي إذهب لطبيب العائله وأعرضه عليه المشكله

بعد أن تقوم بمحادثة طبيبك المعالج بخصوص حالتك النفسية وإسقاطاتها على حياتك اليومية، قد يوجه الطبيب إليك عدداً من الأسئلة التي تشكل جزءاً من استطلاع معد لتشخيص الاكتئاب.

يجدر التنويه بأن الاستطلاع هو عبارة عن جزء فقط من الوسائل والإجراءات الطبية التي بوسع الطبيب استخدامها لتشخيص الاكتئاب. لكن هذا الاستطلاع يزود الطبيب المعالج بمعلومات تخص حالتك النفسية، وقد يستعين الطبيب به للوصول إلى تشخيص مؤكد.

مثال على أحد أنواع هذه الاستطلاعات، هو استطلاع مؤلف من جزئين، وقد تبين بأنه يشكل وسيلة ناجعة وموثوقة لتشخيص الإصابة بالاكتئاب.

يطلب منك في هذا الاختبار، الإجابة على سؤالين:

  1. هل كنت قلقا بسبب شعورك بالحزن، الاكتئاب أو اليأس، خلال الشهر الفائت؟
  2. هل كنت قلقا بسبب قلة اهتمامك بنفسك أو بسبب فقدانك للمتعة أثناء قيامك بأمور كانت تثير اهتمامك أو تجعلك تشعر بالمتعة من قبل، خلال الشهر الفائت؟

الإجابة التي تعطيها لهذين السؤالين هي التي سوف تحدد الإجراءات التي على الطبيب اتخاذها. قد يوجه إليك الطبيب بعض الأسئلة الإضافية كي يؤكد تشخيصه بأنك مصاب بالاكتئاب. إذا لم تدل أجوبتك على أنك تعاني من الاكتئاب، قد يطلب الطبيب أن تعيد وصف الأعراض التي تعاني منها، كي يواصل البحث عن أسباب ظهور هذه الأعراض.

وقد أظهرت الأبحاث أن السؤالين اللذين ذكرا انفاً، خصوصاً عند إجراء اختبارات تشخيص وتقييم إضافيةً معهما، يشكلان وسيلة ممتازة لتشخيص معظم حالات مرض الاكتئاب النفسي السريري.

وثمة فحوصات أخرى يحتمل إجراؤها لإستبعاد المرض العضوي تشمل:

في عيادة الطبيب النفسي :

قد يستخدم الطبيب أساليب للتشخيص، الفحص والتقييم أيضاً لكي يحدد ما إذا كنت مصاباً بالاكتئاب، بما في ذلك:

  • استطلاع لتقييم الاكتئاب على اسم بيك (Beck Depression Inventory – BDI) وهو عبارة عن استطلاع ذاتي مؤلف من 21 سؤالا أمريكيا (متعدد احتمالات الإجابة)، وهو يقيم درجة خطورة الاكتئاب استناداً إلى الأحاسيس، العواطف والأعراض.
  • مقياس للتشخيص الذاتي على اسم تسونغ (Zung Self-Rating Depression Scale)، وهو عبارة عن استطلاع قصير يحدد درجة الاكتئاب، ابتداءً من الاكتئاب الخفيف وحتى الاكتئاب الشديد والحاد.
  • مقياس للتشخيص لدى مركز بحث الأمراض
  • Center for Epidemiologic Studies-Depression Scale – CES-D، وهو عبارة عن وسيلة تشخيص تتيح للمريض تقييم أحاسيسه، تصرفاته وتوقعاته بموجب أحداث الأسبوع الفائت.