Mixed Bag

And now, here are a few hundred words about the single worst aspect of my particular brand of bipolar: the dreaded mixed mood episode.

I’ve been through only a handful of these things, but they are a complete mind-f**k and if I never have another, it’ll still be a day too soon. It’s like reliving the worst day of your life while your whole body is thrumming with nervous energy and every synapse in your brain is firing all at once, much like a fireworks show gone wrong…….and believe me, it’s brutal. Imagine sitting on your bathroom floor at 2 AM, unable to sleep, scrubbing the baseboards with Comet and an old toothbrush and sobbing hysterically as if your best friend had just died, and you’ll get a hazy picture of this hellish experience.

At no time have I ever been closer to total insanity than during a mixed episode, which is not officially a mixed episode anymore but something like “mania (0r depression) with mixed features”. Whatever the DSM-V calls it, though, it’s probably the most dangerous mood swing there is. Combining the despair of depression with the irrationality and energy of mania—to say nothing of the general confusion of being manic and depressed at the same time—is a recipe for disaster, and some statistics show that the majority of bipolar patients who attempt suicide, do so during a mixed mood state.

Not all bipolar patients experience this phenomenon, and indeed many go through their entire lives without ever encountering it. Interestingly, until recently it was thought that the mixed state could be found only in Bipolar 1; now doctors are diagnosing it in people with BP 2 and BP-NOS as well.

For those of us who do have to endure such episodes, the peril lies in not knowing whether we are manic or depressed—or both—at a given moment. There is no navigator inside our brains to guide us through these dangerous waters. During my most recent bout, I went through a week or so of pure torture trying to figure out what the hell was happening to me as I bounced off the walls while I was dying inside; in desperation, I finally called my p-doc and blubbered into the phone for the whole twenty-minute conversation.

I couldn’t figure out why I was cleaning everything in sight when I was so depressed that I begged my husband to put our snub-nosed .38 revolver where I couldn’t find it. Not that I would’ve actually used it on myself—I would NEVER leave such a mess for my loved ones to find—but even in my confusion I knew I was a threat to my own safety, and I wasn’t about to take any chances.

So I was both surprised and shocked when my doctor instructed me to double up on my antipsychotic, which I knew meant that he was treating me for mania, not depression. And as usual, he was spot on: within days, the thunder and lightning in my brain had subsided, and I was no longer crying like a baby while scouring everything that wasn’t red-hot or running for the hills. In fact, the treatment was so successful that the next six weeks or so were as stable and happy a time as I’ve ever had. (Too bad I had to go and get manic again when summer came on, but I’ve already told that story. ‘Nuff said.)

Whatever it’s called—“dysphoric mania”, “agitated depression”, or “Bipolar x with mixed features”—the mixed mood is surely the most challenging part of the bipolar experience, and those who don’t know the fear and pain associated with it are more fortunate than they realize……in fact, what they are is damned lucky.

Published by bpnurse

I'm a retired registered nurse and writer who also happens to be street-rat crazy, if the DSM-IV.....oops, 5---is to be believed. I was diagnosed with bipolar I disorder at the age of 55, and am still sorting through the ashes of the flaming garbage pile that my life had become. Here, I'll share the lumps and bumps of a late-life journey toward sanity.... along with some rants, gripes, sour grapes and good old-fashioned whining from time to time. It's not easy being bipolar in a unipolar world; let's figure it out together.

2 thoughts on “Mixed Bag

  1. Having been diagnosed as bipolar since 1995, i have had more than my fair share of mixed episodes. Almost all were treated with AP, sometimes a low dose of AD also. I agreed it is the worst of both worlds. I am happy to report these mixed episodes have been decreasing regularly for years now. I moved where i wanted back in 2008 and i do not recall any mixed episodes since moving. I did have a crash when both parents died within 4 mos of each other in 2010 but was not treated except for grief, and i got thru it.

    I wouldnot wish amixed episode on my worst enemy as it is hard for everyone. Dr, caregivers, patient..just not sure from hour to hour what to treat. I imagine a pharmo co developing a med for mixed episodes would corner the market.


    1. And they’d probably charge an arm, a leg, AND one’s first-born male child for it, because every bipolar patient who has these miserable episodes would want it!


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