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What is mixed mania or mixed states?

Dan, who has bipolar disorder, is depressed. He’s feeling sad and hopeless and has no energy. But sometimes, he’s agitated and gets angry at those around him. He’s not sleeping and he often feels very anxious. He’s miserable. He’s even begun to think that ending his life is the only way to rid himself of these terrible feelings.

Dan is experiencing what’s called mixed mania or mixed mood states, when depression and mania overlap.

Bipolar disorder symptoms are considered by many experts to occur along a continuum. But there are four areas of symptoms, says Igor Galynker, M.D., Director of the Family Center for Bipolar Disorder at Beth Israel Medical Center in Manhattan.

  1. Traditional mania: Symptoms include euphoria or irritability.
  2. Mixed mania: Symptoms of traditional mania, such as unstable mood and occasional euphoria, combined with symptoms of depression.
  3. Mixed mania with depression as the dominant state.
  4. Pure bipolar depression.

“Mixed mania episodes can co-exist or may switch within minutes,” says Dr. Galynker. The individual can have two, three or four of these sets of symptoms lasting for weeks or months. Mixed mania is sometimes referred to as rapid cycling.

The symptoms of mixed mania can be very confusing to individuals experiencing them. They may be most aware of their irritability and agitation. “I’ll feel great, for awhile,” says Dan, “then my mind races, I’m angry, then depressed. I’m exhausted all the time.”

Individuals experiencing mixed mania are at high risk of suicide, says Dr. Galynker. When they become very anxious, even panicky, with conflicting emotions, their logic becomes distorted. Along with their increased energy, they have a frantic sense of hopelessness. They feel trapped and desperate to be free of their pain.

Treatment with medications, perhaps combined with psychotherapy, can be very effective. Each doctor will choose the treatment they believe will be most effective for their patient. If the individual appears to be at risk of danger to him- or herself, a hospital might be the safest place for treatment.

To maintain mental wellness, individuals with bipolar disorder should learn to avoid and manage stress, eat a healthy diet and get regular exercise and pay special attention to getting adequate sleep.

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