Mixed state bipolar (a brief review)

The following article will address the issue of bipolar mixed state, a way in which bipolar affective disorder can manifest itself. 

Mixed state bipolar 

Mixed state bipolar refers to one of the possible variations of bipolar affective disorder, in which simultaneously, or very close in time, both depressive and manic symptoms appear. As we know, this disorder is an alteration of the functioning of mood changes, which can become severe and affect the patient to a great extent. 

Have you ever heard of bipolar affective disorder? It’s possible since, in the history of psychology and psychiatry, this disorder has been one of the most studied over time. The symptoms it presents can be very obvious, and that’s why they have caused so much interest and curiosity, as well as the need to be studied in order to find an appropriate treatment. 

What do you think of when you hear about a person with the bipolar affective disorder? You may be reminded of a person who has very rapid, sudden, or unexpected emotional changes. A person who can become sad and then easily become very happy. Such an image is more or less appropriate, and in this article, you will learn a little more about this, also to generate clarity about what it refers to.

This common idea that people with bipolar affective disorder move easily from one emotion to another is quite widespread in beliefs in general. However, we are still left with the question of how quickly or how long a person with this disorder can move from one emotional state to another. 

Will this happen in minutes? Maybe hours? Days? Well, in the context of bipolar mixed state, we will learn a little more, and we will know how to give an answer to these questions, at least a more precise and accurate one. 

Mixed state bipolar: changing mood 

There are several options when it comes to the changes in mood that can occur in the context of bipolar affective disorder.

One option is for people to have full-blown, single-pole episodes of the disorder, so they might spend weeks experiencing symptoms and discomfort characteristic of depression (we’ll discuss what these symptoms are below), or they might spend months with only manic symptoms. 

A few months or weeks later, they may have another episode of the same type, or they may have an episode with polarity symptoms. In both cases, the symptoms are extreme, that is, they are part of the most extreme point in a spectrum that we can draw in order to understand the mood and the state of mind. 

A third option is for patients to present mixed state bipolar, which is characterized by episodes containing both depressive and manic symptoms. Mood changes include both types of symptoms and can present as a collection of discomforts present at the same time. 

Under mixed state bipolar, people experience abrupt changes in mood, which are experienced as involuntary and almost uncontrollable. These are acute episodes of mania or depression, with symptoms of the opposite pole added in an “accessory” way, and whose presentation is simultaneous or alternating rapidly. 

Mixed state bipolar: depressive type symptoms 

The symptoms of depression that can occur in a bipolar mixed state episode are the same as those that characterize a “pure” depression or an episode with these types of symptoms. Among them are the following: 

• Low energy. This symptom is the most prototypical of depression since it corresponds to a decrease in the desire to be active. People are literally not strong enough to do any activity that they did and enjoyed in the past. They may want to stay in bed for very long periods of time, or their motivation to be active may decrease very strongly. The low energy, in addition to the signs that may be exhibited externally, also produces a very unpleasant internal experience, under which the person feels that no activity makes sense. “What’s the point…?”, they might ask themselves all the time, finding no reason to even explore any activity before. 
• On the other hand, in mixed state bipolar episodes, feelings of sadness may also occur, if there are depressive symptoms. In this case, the emotion of sadness is appearing in a dysfunctional way, with many negative consequences. As we know, sadness as an emotion is normal under certain circumstances and it is normal to present it from time to time. Let’s be honest, all of us at some point have felt sad, and some recent loss makes us feel terrible. When sadness becomes abnormal and becomes a symptom, it creates a deep sense of loss. Just imagine that you feel a constant loss, and you can hardly identify what is happening. It is as if this is happening without your permission or authorization. 
• On the other hand, we also find feelings of guilt and worthlessness. “I’m not good enough, I have no use or direction in my life,” might be a thought for a person with this symptom. Added to the sadness, he may feel that he is guilty, so, in generic terms. There may not be a specific situation that objectively generates such guilt. The person’s inner feeling is very unpleasant and this makes it difficult for him to relate to other people. If she feels that she has no value, that others will not find anything important in her, she may determine that it is better to remain isolated and alone. The misery is only hers… 
• Thoughts of suicide or self-harm. This is another common and very serious symptom that can be life-threatening. It is common for people to take their own lives in the context of depressive symptoms. These thoughts may occur suddenly, or as subtle ideas that take hold in the person’s mind. It is as if a dark, malignant black stain is spreading inside the person, coming closer and closer to seeing suicide as a viable option to take away the suffering to which they are exposed. 

The above are typical symptoms that a person has when he or she has depression. So in a mixed-state bipolar episode, some or all of these symptoms might appear, combined with manic symptoms, which we’ll discuss below. 

Mixed state bipolar: the other pole of the spectrum, manic symptoms 

As we mentioned a moment ago, the bipolar affective disorder is characterized by extreme changes (between the two existing poles) in the mood. The “high” end of the mood is mania. Imagine that your joy has become abnormal, and you feel it extremely, intensely, and for a long time. 

Manic symptoms include the following: 

• High energy. Contrary to the symptom of depression, in this case, the disorder consists of an intense and abnormal increase in the energy level experienced by the person. What do you do if you have too much energy? Yes, exactly: be very active. The feeling of having a lot of energy often comes with the motivation or the urge to be extremely active, to carry out multiple activities, even under unusual circumstances. People with this symptom may want to be active at night when everyone else is sleeping, not sleep (they have too much energy!) or stay engaged in the same task for much longer than a person would normally expect. They may want to work more as if they are constantly challenged and their goals have multiplied instantly. 
• Feeling of accelerated thinking. This is another characteristic symptom of mania, and the way it can be evidenced is by observing the speed with which the person speaks. It is normal that there is an average speed, that we speak with certain pauses and that we allow the other person to take his turn in the conversation. In patients with this symptom, since their ideas are moving very quickly through their minds, they need to “get them out”, express them, with that same speed. They don’t want to wait, they just want to talk constantly and let us know every single thing that comes into their head. In the professional context, this is called “speech pressure”. It is an unavoidable need to speak without stopping. 
• On the other hand, there is also agitation and over-activity. Given all that energy level, ideas running wild, people perceive the world and themselves in an accelerated manner. “Everything’s going miles an hour,” I could mention one of these patients. It is common to find them spending more money, doing a lot of shopping, overcooking, doing cleaning jobs without stopping, etc. All of the above is part of the consequences of having an excess of energy and a sense of urgency to carry out many actions. To imagine this situation, you only need to think about movies when you increase the playback speed. The characters move so quickly that it is difficult to appreciate what they are saying. It’s more or less that kind of inner experience for people with manic symptoms. 

Usually, when there are manic symptoms, people feel very good about themselves. They are very optimistic, happy, and confident that they will be able to do whatever they set out to do. After all, they have plenty of energy! 

Mixed state bipolar: simultaneous symptoms

As mentioned, in the bipolar mixed state, symptoms of depression and mania coexist. Thus, the person may have excess energy and want to do many activities, but at the same time think that there is no point in doing anything and that their future is very dark. 

It may be, on the other hand, and although it may seem paradoxical. A person could be crying uncontrollably (as part of his depressive symptoms) and at the same time say that he feels very good and is happy, that he loves what is happening to him at that moment. 

Another example would be a person who feels guilty constantly for making family members uncomfortable by being overly active. That is, he couldn’t stop doing many things, but he feels guilty about it. 

Conclusion

Mixed state bipolar is one of the possible ways that the symptoms that are part of the bipolar affective disorder can occur. By alternating between a very low mood and a very high one, the person would exhibit behaviors and expressions that might even be absurd. 

It is important not to lose sight of the fact that this situation is, for the most part, beyond the patient’s control. And it is the treatment that will help them regain control of their mood and emotional reactions.

Frequently asked questions (FAQs) about mixed state bipolar

Recommended resources

1. The Bipolar Disorder Survival Guide, Third Edition: What You and Your Family Need to Know
2. Beautiful Chaos: A Life Worth Living with Bipolar (The Inspirational Series)
3. Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner

References

1. An update on the treatment of mixed bipolar states: What is new in 2013?
2. Mixed state and suicide: Is the effect of mixed state on suicidal behavior more than the sum of its parts?
3. Bipolar Disorders: Mixed States, Rapid Cycling and Atypical Forms