Bipolar Mixed Disorder

Bipolar disorder is a mental illness that is characterized by alternating episodes of mania (out of control, euphoric moods) and depression. According to the National Institute of Mental Health, it affects just under 3 percent of the U.S. population. There are several different subtypes of manic depression, one of the more severe being mixed bipolar disorder. However, many patients who choose to receive treatment can greatly reduce the severity and frequency of troublesome symptoms.

Mixed Episodes

• Although all people with bipolar disorder suffer cycles of manic and depressive moods, bipolar mixed disorder is unique in that these moods can actually occur simultaneously or in rapid succession. For example, a person may have a very depressed mood in conjunction with irritability, racing thoughts, impulsiveness or increased energy. The combination of a depressed mood with a feeling of invincibility or impulsivity make those who have mixed episodes at a particularly high risk of suicide.

Depressive and Manic Symptoms

• Although some people with bipolar mixed disorder experience a combination of depressive and manic symptoms that occur at the same time, others rapidly cycle through periods of depression and periods of mania. These cycles can last anywhere from minutes or hours to months. Those with extremely rapid cycling may find themselves literally laughing one minute and crying hysterically the next. Symptoms of a depressive episode include lack of motivation and loss of interest in activities, feelings of worthlessness and hopelessness, fatigue or sleep problems and thoughts of suicide. During a manic episode, a person may experience a feeling of grandiosity (almost delusional), irritability, racing thoughts, impatience, impulsivity and extreme distractibility. In very severe cases, hallucinations and delusions may be present.

Prognosis

• The prognosis for patients who are diagnosed with bipolar mixed disorder varies greatly and is dependent on the severity of the symptoms and how long they have manifested. Early diagnosis and treatment increases the odds that treatment will be successful. When left untreated, the condition tends to worsen through the years. Additionally, during the time that a person with bipolar disorder is not being treated, he is likely to engage in behaviors that create stress for himself and within his or her social support system. Untreated bipolar mixed disorder is a high risk factor for suicide, but the risk drops substantially with treatment.

Treatment Plans

• The most effective treatment plans consist of a multifaceted approach that addresses social, physical, emotional and biological components of the disorder. The goals of treatment are to reduce the severity and frequency of symptoms and assist the patient in developing skills and supports for dealing with manic or depressive episodes as they do occur. A comprehensive treatment plan may include patient education, psychotherapy, mood-stabilizing medications and lifestyle changes.

Medications

• Because bipolar mixed disorder is a chronic condition, there is no cure, per se, and treatment must be maintained long term to keep symptoms under control. Commonly prescribed medications include antidepressants, mood stabilizers and antipsychotics. Each of these types of medication addresses different symptoms and should be chosen in consultation with a health care provider on a case-by-case basis. Generally, antidepressants are used to help eliminate depressive symptoms, while mood stabilizers keep moods level and attempt to prevent or slow cycling time. Antipsychotic medications primarily address manic symptoms and may also help those who are suffering from hallucinations or delusions.