Mixed Episode (A guide)


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Page last updated: 14/11/2022

Mixed Episode

This article is a detailed overview of ‘mixed episode’ and discusses some pertinent aspects related to this disorder. Also, this article reveals possible symptoms, diagnostic aspects and possible treatments that offer insight into this problem.

Mixed episode‘ is a term used for bipolar disorder; and not a disorder itself. Bipolar disorder, which is also known as manic depressive illness, is a brain disorder that changes the mood, shifts energy, and activity levels. It also affects the ability to do daily tasks. 

Bipolar disorder is of four types, all affecting the mood, energy, and activity level. The disorder is defined by meeting the diagnostic criteria for a manic episode, which is minor and a significant episode of depression, that spans from a day to a full week.

What Does a Mixed Episode Feel Like?

When a person feels symptoms of depression, it is called a mixed bipolar episode. This kind of person may also have mood elevation along with depression; a person could have full mania and depression at the same time with the highest level.

A general misconception is that a person with this condition only experiences two kinds of extreme moods. One is very high mania, and the other is very low depression. In the beginning, people having bipolar disorder do not show symptoms that reflect bipolar disorder. These episodes are not always as simple as high or low. 

Many people with bipolar diagnosis feel mixed episodes, sometimes they have both kinds of disorder, and they may feel symptoms of mania along with symptoms of depression.

Bipolar Mixed Episodes

The duration of the bipolar mixed episode may vary from person to person. There is no definite answer for how long does a single cycle of mixed episode lasts. Furthermore, both the frequency and duration of cycles may vary from person to person. It might last for hours, sometimes days or weeks, and sometimes it spans over months.

A research in 1992 shows that among people having bipolar disorder, 35 percent of them may have only this cycle only one time in five years span. But one percent from the same group may have this cycle in about every three months. Although another study conducted in 2010, on people with bipolar disorder type one, suggested that mood episodes may last an average of 13 weeks.  

Some conditions enhance the symptoms of people having bipolar disorder. There is a need to understand these conditions, so one can avoid triggering those symptoms; it can minimize the occurrence of the number of cycles. 

For this purpose, a person should have a proper sleep, avoid the exchange of heated words with loved ones, stop taking alcohol or drugs, avoid certain medicines to minimize depression.

What is Rapid Cycling?

A person experiencing four or more cycles in a year, it is known as rapid cycling. But it is still not a fixed pattern for a person undergoing bipolar disorder because it could occur at any time. A person in an episode may feel depression, mania, and hypomania or mixed state condition in which depression and mania co-occur. 

A small number of people suffer rapid cycling; it is said to be a more severe form of bipolar disorder. This kind of condition harms one’s ability to function smoothly and also affects the quality of life.

Though rapid cycling is not a diagnosis, it is the number of occurrences of this illness. Both rapid cycling and bipolar disorder-I shares the same symptoms, only with a difference in the speed of occurrence of the symptoms. Symptoms of rapid cycling are the same as bipolar disorder; the only difference is the speed by which it occurs.

In some cases, rapid cycling makes the disease more serious; it happens more often in people with bipolar I disorder. But just 5% to 10% of people with bipolar disorder may fall victim to rapid cycling. There is no specific cause of the condition, but scientists have identified some common risk factors. 

Women are said to be more at risk than men; people who develop symptoms at their young age have more chances of rapid cycling. A person having a history of depression may have a risk factor of rapid cycling. Moreover, some studies show that if someone had used antidepressants for a long time, he might be a victim of it. Somebody malfunctions like thyroid may be a reason for rapid cycling.      

Mixed Episode (A guide)

Causes of Mixed Episode

So far, there are no specific known reasons or causes for mixed episodes or bipolar disorder. However, to cause this disease, there might be several factors behind which might cause it. 

  • Biological differences:

Most individuals with bipolar sickness tend to have physical changes in their brains. The implication of such changes is still unknown. However, sooner or later, they may help pinpoint causes.

  • Genetics: 

Genetics also plays a critical role in causing this disorder. Bipolar disorder is more common in those people who have a first-hand relative bearing the same problem, such as father, mother, or any siblings. Scientists are still trying to identify genes that probably be causing or involved in creating a bipolar sickness.

Risk Factors

Aspects that might escalate the danger of evolving bipolar sickness or may become a catalyst for the first mixed episode might be depending on these factors:

  • Having a first-hand relationship with someone with bipolar illnesses such as a father, mother or even siblings.
  • Phases of higher strain, trauma, anxiety, depression, such as from a particular incident, the death of a loved one or any tragic life-changing event.
  • Drug or alcohol misuse.

Symptoms of Mixed Episodes

There could be numerous varieties of mixed episodes and bipolar disorders. Sometimes they may include hypomania. Significant symptoms of mixed episodes can be analyzed due to several mood change cycles and unpredicted behaviors. These symptoms ultimately cause difficult situations in your routine life. 

  • Bipolar I disorder: You might get the primary symptom of a manic episode longer than usual ones. Or it might get followed by a stronger one – the hypomanic or disturbing episode (Psychosis).
  • Bipolar II disorder: You might get some severe depression period, and the episode might stay for a long while, or you might observe at least single hypomanic episode.
  • Cyclothymic disorder: You might have got many periods of mixed episodes or hypomania under teenage or in your childhood, which might have lasted for a two or one year time period.
  • Other types: Other significant types may include mixed episodes or correlated disorders by certain medical situations, the more likely a Cushing’s disease, multiple sclerosis, or stroke.  

Relationship With Mania and Hypomania

Hypomania and mania both share the same symptoms. Though they are not hugely different from one another, yet there is something that separates them both. And it is the intensity of occurrence. 

In other terms, mania is more intensified then hypomania. It could cause significant effects and more severe problems at school, college, and workplace or even on regular social activities. The primary relationship between the episodes of mania and hypomania is the following symptoms, where three or more than three symptoms could occur.

  • Unusually optimistic, nervous or wired
  • Improved activity, liveliness or anxiety
  • Overstated sense of safety and self-assurance (euphoria)
  • The reduced necessity for slumber
  • Uncommonly talkativeness
  • Random thoughts variation 
  • Distractibility
  • Poorly made decision

Symptoms of Mixed Episodes (in Minors)

Indications of bipolar illness can be challenging to recognize in progenies, kids, and teenagers. It is sometimes much harder to identify whether these are normal mood swings or the outcomes of pressure, pain, or signs of psychological problems other than bipolar sickness.

Children and youngsters may have separate depressing situations or manic or hypomanic occurrences, but the arrangement can differ from that of grown-ups with bipolar sickness. And moods can quickly change throughout the time of mixed episodes

Some kids might get mixed events and don’t even show the symptoms during the episodes. The most noticeable sign of bipolar sickness in youngsters and teenagers may include severe mood swings; that are both profoundly different from their usual mood swings. 


When bipolar sickness is left untreated by any negligence, it could cause severe health problems both physically and mentally. Bipolar illness could issue a significant impact on your life where the whole life cycle could get disturbed. 

You may have to face the following complications: 

  • Complications linked to drug and alcohol use
  • Thoughts of committing Suicide or even suicide attempts
  • The problematic situation related to Legal or economic aspect
  • Difficulties with different relationships
  • Lack of performance office work or social activities


Prevention of bipolar disorder is not always guaranteed because there is no specific treatment or cure. However, the remedy is possible if the patient comes as soon as they observe even the minor signs of bipolar illness.

Being treated well is highly dependent on the time duration of how early one would approach to the medical professional. There are very few approaches that might be helpful to prevent extraordinarily harmful and severe mixed episodes of bipolar illness.

  • Pay attention to threatening signs:

It is always to address the situation before it could become injurious. The same condition also applies to bipolar sickness. If you pay attention to the warning signs at the earliest, it will help you to keep the illness contained. 

You might also recognize the patterns for mixed episodes and what is causing them. You should consult your doctor as early as you can. Because bipolar, if left untreated, will become even more severe for your own physical and mental well-being.

  • Avoid Drugs and Alcohol Consumption:

 If you are experiencing bipolar disorder, try to avoid drugs and alcohol as it will make things worse. Excessive alcohol consumption and drug abuse cause more severe mixed episodes, which will lead to mania and hypomania.

  • Take your medications exactly as directed:

Escaping your proper treatment is not an option in bipolar sickness. To completely get cured, you should always maintain the period of your medication and should not dose yourself on your terms. Doing such an act might worsen the situation, and the symptoms may return with even higher intensity.

Some Helpful Resources

  1. The Bipolar Disorder Survival Guide
  2. Bipolar Disorder: A Guide for Patients and Families
  3. Yellow Tulips: one woman’s quest for hope and healing in the darkness of bipolar disorder
  4. OMG That’s Me!: Bipolar Disorder, Depression, Anxiety, Panic Attacks, and More
  5. Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner 


Individuals with bipolar sickness unusually don’t identify how much their mood-swings and uncertain behavior affects their lives and people around them. Which is why they don’t get the health treatment they desperately required.

If you are someone who is experiencing mixed episodes of bipolar disorder, you would have those moments where you would feel more productive and happy. Although, these moments don’t last long, and always lead to an emotional derailment. In the end, you would only feel depressed and weary – especially if you are having legal, relationship, or financial problems. 

If you have any signs of unhappiness or mania, you really should look for a doctor or other medical professional. Bipolar sickness doesn’t just get cured on its own. Being treated from a mental health professional with a vast understanding of bipolar illness may help you get your unusual mixed episodic symptoms contained.

Frequently Asked Questions:

Q1. Does a Bipolar person know when they are manic?

Not really. Although the pathology involves varying degrees of ‘insight’ but usually an episode of mania happens as an all encompassing pathological manifestation. When a person is in a manic stage of bipolar disorder, he feels a lot of energy in him, thinks himself a creative person. In that stage, a person having this episode may have very little sleep and maybe more active. 

Q2. What is a mixed episode?

A mixed episode is characterized by the presence of depression and mania, both. The duration could be for upto a week (on a daily basis). 

Q3. What is a mixed episode like?

A mixed episode happens to have symptoms of depression and elevated mood, simultaneously. 

Q4. Why is a mixed state dangerous?

Mixed episodes are considered dangerous and psychiatric emergencies because they have, both depressive and manic symptoms present. This duality in symptom profile doubles the suicidality (ideation, impulses and attempts). 

Q5. How long does bipolar mixed episode last?

The bipolar mixed episode may last for up to 13 weeks. 

Q6. Is being bipolar considered a disability?

Yes, bipolar disorder (with mixed episode or not) is considered a disability. However, how disabling it really is, depends on pathological profile of the patient and would vary from one to another. 


  1. Mixed Episode-Bipolar symptoms
  2. Mixed Episode Criteria
  3. What are mixed episodes?
  4. This is what a mixed bipolar episode feels like
  5. Mixed Episode symptoms