Bipolar Disorder is a condition in which a person undergoes dramatic changes in mood and energy, but at levels of severity that differ from mood changes, the average person goes through them. However, a common misconception about bipolar disorder is that a person with diagnosis only experiences two different moods: either really high (mania) or really low (depression) lows. People with bipolar disorder do not always experience symptoms called bipolar episodes. Besides, these episodes are not always as simple as high or low.
Many episodes that include individuals with a bipolar diagnostic experience are considered "mixed episodes, sometimes also described as " switching "episodes or manic / hypomanic or depressive episodes with mixed characteristics.A mixed episode signals that the person is experiencing both aspects of mania or hypomania and the symptoms of bipolar depression.
Before discussing mixed episodes, let's talk about a standard episode of mood elevation (mania or hypomania) versus a depressive episode
"Bipolar used to be known as manic depression and some people will still call it that, so it makes sense for me that many people associate this with only two types of moods, namely, mania and depression. "Wendy Marsh, MD, Director of the Special Clinic for Bipolar Disorders, and Profe ssorin at the Institute of Psychiatry at the University of Massachusetts Medical School, tells SELF.
Symptoms associated with an episode of bipolar depression include lower energy and / or activity levels, difficulty concentrating, loss of interest in things, and changes in appetite and sleep. "And to refer to yourself as an episode of depression, in addition to you have at least five of the other symptoms for two people to experience a gateway symptom either for a sad mood or for loss of interest in life weeks", says Dr. Marsh.
To classify an episode as mood enhancement – that is, mania or hypomania – you must show a prolonged, unusual, high-energy mood and have at least three additional symptoms of mood enhancement. including ( but not limited to ) a sense of euphoria, increased energy and / or self-esteem, running thoughts, reduced sleep and others. (If someone experiences hallucinations or psychosis, or is hospitalized as a result of manic symptoms, this is also considered mania.)
A mixed A bipolar episode is when a person experiences depressive symptoms and mood height at the same time.
Dr. Marsh points out that "bipolar" is a misnomer, "because there are two poles, but they are not necessarily experienced separately," she says. "This can be a very difficult concept for someone watching a patient who has both symptoms associated with both poles and for the patients themselves."
In bipolar disorder in general, this is very common for a patient to experience episodes that are mixed, Dr. Igor Galynker, Deputy Chairman of the Research Department in the Department of Psychiatry at Mount Sinai Beth Israel, told SELF. (Research data suggest that estimated 20 to 40 percent of people with bipolar individuals have mixed episodes.)
The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders ] ( DSM ) contained specific diagnostic criteria for mixed episodes. Marsh. DSM-5 The latest version of the manual, however, replaced the "mixed episode" diagnosis with a "mixed-features identifier" that physicians now apply to episodes of depression, hypomania or mania. The problem that some researchers adopted in diagnosing the mixed episode DSM-4 was that a person had to meet the full diagnostic criteria for a depressive episode as well as the full criteria for a manic episode for a patient week or longer. "Put simply, you had to experience persistent full mania and full depression at the same time." Marsh. In reality, however, a person may have mixed characteristics, but does not necessarily have to mark each individual diagnostic box for both.
According to the most recent edition of the DSM a bipolar episode may be clinically classified as having mixed characteristics if one person experiences a mood episode most of the time along with at least three symptoms of the opposite mood episode. For example, on five days you have a week-long manic episode with at least three symptoms of a depressive episode. A list of diagnostic symptoms for mania / hypomania and depression can be found here . It is worth noting that episodes with mixed features can occur in both bipolar I and II .
So what does a mixed episode look like?
This usually depends on which mood episode that is predominant – for example, do you have a manic / hypomanic episode with symptoms of depression or a depressive episode with symptoms of mania? In some cases, a person with mixed characteristics may be in full mania and depression at the same time. In other cases, a person may have all the symptoms of mania / hypomania and only a few depressive symptoms (or vice versa). "Bipolar is not a changing mood disorder, it's a mood disorder," says Dr. Bipolar. Galynker. "The mood can be anywhere."
Generally speaking, "This is a person who has really risen, their minds racing, they talk a mile a minute, they do not need that much sleep-elevation symptoms," Dr. Marsh. "But at the same time they feel sad and blue, they hit each other in the head, their self-esteem is low." Dr. Marsh also says that a person experiencing a mixed episode often thinks of escaping misery or even death. "Although they have no thoughts of suicide, they may ask questions like . What would happen if I died? What would happen to my children? "she describes. This can be especially dangerous for a person in a depressive episode of manic symptoms – they feel helpless and miserable and have the energy to respond to it.
At first, it seems that depression and mania are not perceived at the same time. "It's very difficult to conceptualize," says Dr. Marsh. "But if you hear that people express their own experiences with it, it will be much clearer."
For a person in a mixed episode, it can be one of the most distressing moods in which he finds himself.
Gracie The 30, who was diagnosed with Bipolar II in July 2018, tells SELF that her episodes are usually mixed. "In a minute you're full of energy, cleaning the house, feeling great about life, having great ideas, and getting your excitement back. Then the next one, [you’re] that is crying for no reason and over-emotional. So lost in life You do not know where you're going [or] How you feel, only that you do not feel well All have the feeling that they have not slept for weeks, irritated by everything and everything they believe, " describes her. "You want your partner to hug you and hold you and tell you that it will be alright, but at the same time the idea of someone touching you will make your skin crawl."
Joey, 41, who was diagnosed with Bipolar II in 2006, also experiences episodes with mixed characteristics. "Even if [I’m] is hypomanic, I still suffer because maniacal energy only drives depression," he says to SELF. "And I am even more aware that my depression prevents me from doing most of the things that my manic side strives for."
He describes periods of normal hypomania as a "small moment of clarity and relief" , [like] if you look through binoculars and finally focus it perfectly.
For Emma 20, mixed states are the most common. "I get extremely excited. I am very short with people. Even the smallest things can trigger my fear. When I'm in a mixed state, I can quickly zap because my mind and body are so confused. How can you be both manic and depressive at the same time? [It feels like] Your brain is not ready for it, "she tells SELF. (She was diagnosed with Bipolar II in April 2017.)
"That's how I could feel perfect for a minute. A few hours later, an SMS could go up in flames all day and I can not see anything good, "Emma continues. "And when I ask for help, it's as if my mind does not want it, and I turn to whoever I ask."
The treatment and treatment of bipolar disorders may vary greatly depending on the individual and their type, bipolar, as well as their episode patterns.
Whether or not you have bipolar I or II – and even if you are not sure whether your mood episodes have mixed characteristics – taking mood-stabilizing medications is the standard for treating bipolar disorder as a whole, says Dr. Marsh. "But there are many exceptions and caveats – for example, these drugs have side effects," she adds. "So there's a lot of discussion with the patient when the treatment is prescribed."
Dr. Galynker also points out that it can take several months to find the right combination of medications, and the most effective medications for a person can also change over time. "The disease is cyclical, and the same medications that may be effective at one point, such as the more depressive phase of their cycle, may not work in the more manic phase of their cycle or in a mixed-characteristic period," he explains. "That's why it's very important to learn the very subtle behavioral changes that a person shows in the early stages of their cycle."
For this reason, therapy is often helpful. "One of the ways in which therapy is useful for people with bipolar disorder is the aspect of psychoeducation. They are meant to teach people which first signs of a mood enhancement are there so that they can capture them in the present as quickly as possible and implement the necessary interventions, "says Marsh.