We interrupt this blog to bring you a special report on a phenomenon that apparently affects only certain bipolar patients. It’s known familiarly as The Mixed Episode.
For the uninitiated, this is a combination of symptoms from both ‘poles’—mania and depression—and it is pure, unmitigated HELL. I was so screwed up during my recent dalliance with it that I didn’t know whether to pick my watch or wind my nose. I was running around the house, unable to stay still for more than a few seconds; I had the attention span of a flashcube; and I was cleaning everything that wasn’t red hot or nailed down. (Note: I DON’T CLEAN. My stay-at-home husband does most of it, and what he doesn’t get done…..doesn’t get done.)
OK, these behaviors usually give me the idea that I might—just might—be a wee bit manic. But then, I couldn’t stop crying either…..or thinking sad thoughts…..or feeling like there were worse things than death (namely, going on like THIS). There were several nights in a row when I just sat up in my bed and wept silently for hours on end, swinging one foot and rocking back and forth to try to comfort myself with the rhythmic movements, even as my mind raced and tumbled wildly like squirrels in a cage.
I was confused. I was manic. I was depressed. And I was terrified.
One night about two weeks in, I almost called the suicide hotline. Not that I really wanted to die, only that I wanted the pain to end, and I was half-afraid I wouldn’t be able to resist the temptation to gobble the 90 Ativan tabs I’d just gotten refilled. But I was even more afraid of that someone would call 911 and the police would show up at my door to take me to the hospital in handcuffs. So with the last of my resolve (and a promise to myself to call my doctor in the morning), I forced myself to lie still and try again to sleep.
This is a good time to have a psychiatrist who always returns my calls the same day, because he’s good like that. He also knows that I call him between visits only when I’m in big trouble, so it wasn’t more than about 20 minutes before he called me back.
“I’ve crashed and burned,” I sobbed into the phone, and went on to describe my collective symptoms in a manner that could probably best be described as tangential. When I finally finished, he told me that he didn’t see this as an uncontrolled mania since I was able to channel the energy constructively, a statement that instantly made me feel better. But once again I was puzzled: what about the crying jags? The catastrophic thinking? The overwhelming anxiety?
Long story short, what I was experiencing was the dreaded mixed-mood episode, which according to the books is a feature of Bipolar 1, which is NOT the kind I signed on for. Now, I’ve heard of people with BP 2 or even NOS being upgraded to BP 1 with the advent of a defining episode; this one may very well have been mine, even though we haven’t yet talked about changing the diagnosis. (There’s that damned OCD thing about getting hung up on numbers again. Will I ever learn??)
The good news is, doubling the dose of my antipsychotic took care of matters swiftly and relatively painlessly. The bad news is, I obviously NEED an antipsychotic for maintenance as well as acute mania, because not only did I get better, I’ve continued to improve to the point where I don’t feel bipolar at all anymore.
This is not an exaggeration—I haven’t been this healthy in YEARS. And for some reason, it doesn’t feel like a temporary respite from the hell of continuous mood episodes; this is a sense of well-being that I suspect is going to stick around for awhile. There is none of the urgency of hypomania, nor of the feverish drive to move and go and do (even though I have plenty of energy to do whatever I wish). What’s more, I’m coping well through an intensely stressful time due to the deterioration of my sister’s health to the point where I have to put her in an assisted living facility.
So I’m really, REALLY motivated to do what I have to do to stay well. That freaking mixed episode was more than just a blip on the radar screen—it’s as scary as anything I’ve ever been through, and if I never have another one, it’ll still be a day too soon.
bpnurse 
That sounds terrifying. As a BP II’er I believe I have had mixed state episodes only to a lesser degree. Mine have been more the depression but with it the racing thoughts that jump from one to the next that are common with my hypo-mania. However, in the mixed states they are not the grand idea of signing up for med school but rather the thought after thought of all the reasons I am utterly useless. I truly hope you stay in this new state of peace.
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You and me both, friend……been a long time coming. =)
I do think I’ll wind up with the Bipolar 1 designation eventually. My pdoc doesn’t even bother with the word ‘hypomania’ in reference to my highs…..he just calls it mania. And that is BP 1 by definition, which kinda sucks, but then, bipolar sucks anyway.
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Thanks for your eloquence, and I’m glad the meds are doing better. My official tag is bipolar 2, but I agree it’s a spectrum. I was only diagnosed 4 years ago after many years of being treated for “atypical” depression, and sites like yours are helping me learn to understand the weird energy that runs through me and how often I was acting out or making myself sick to damp down that energy.
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Thank you for your comments!
When I was much younger, I didn’t recognize what was happening to me, even though I’ve known SOMETHING was wrong with me since I was very small. I started self-medicating with alcohol while still in my mid-teens, and continued off and on till I was 33. I’ve been sober now for over 21 years, but continued to battle those ever-popular inner demons alone till I was finally diagnosed as bipolar in March 2012. And I’m still battling them, but at least they’ve learned to shut up for a little while. =)
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Yes the mixed episodes are horrible, was diagnosed in 1995 with bipolar, fibromyalgia, you name it. But haws just had 14 hr surgery yes 14 hr with 2 day in hospital relief..was on medicaid. So 2 days later, freaked out, was alone so I took alot of klonopin and went out side iin pj’s and laid in the field while it was lightly snowing and very cold. My dog had gotten killed the day before, and I laid where he was buried. After 2 hrs of staring at the sky,i determined it was not my time as i never even got sleepy. in those 2 hrs i screamed at the world and prayed to die, cried on and off but very heavy body heaving cry. That was biggest scariest mixed episode I ever had. Since then i have had at least one a yr but nothing in comparison. 18 yrs since first diagnosis but I know I was since i was a child but I was the good child as I did as I was told and their only complaint was I cried too easy and too much, never tried to find out why.
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That’s awful, Nan!! I’d had confusing mood swings before as well, but this recent one was the mother of all mixed episodes as far as I’m concerned—even worse than the one that brought me to a psychiatrist in the first place. I wouldn’t wish this on anybody.
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I have had similar. In a way it is good we can get those feelings out, but it is scary the danger we put ourselves in!
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You know, that saying that “it’s always darkest before the dawn” is so true. A mere few weeks ago I was in that awful hot mess, and today I’m healthy. What a change a month makes!
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