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605458 tn?1539228808

Can anyone clarify mixed state?

I thought I knew, but I keep getting different definitions.

Yes, of course labels and jargon aren't the most important thing, but I am just the kind of person that needs to know the proper term for what I am experiencing in order to communicate clearly.

I have heard two different definitions of mixed state/episode. 1. Symptoms of mania and depression occurring at the SAME EXACT TIME 2. Mania and depression alternating rapidly

I had always understood that it was the symptoms of mania and depression happening simultaneously, not alternating rapidly. I thought alternating rapidly was rapid cycling, and in the case of it happening within days or 24 hrs, it was called ultra rapid cycling.

I sometimes experience what I call an overlap of mania and depression as I phase out of mania and go into a depression. In that state my thoughts are still racing, I am still physically restless, and I am not sleeping at all BUT the mood is dysphoric, negative, pessimistic, self-berating. I am experiencing manic and depressive symptoms at the same exact time. I was told this was a mixed state.

This year I experienced something new. For about 3 days I was flying high then plummeted into a depression for about 3 days. I did this over and over for months. I might have 1 day of normal in between each cycle. The moods were quite distinct as mania and depression. And there were even times when I would cycle within a 24hr period. I thought this was rapid cycling or ultra rapid cycling, but by someone else's definition this alternating is a mixed state, not rapid cycling.

I even had a miscommunication with my current pdoc because we weren't using the terms the same way.

HELP! It's driving me insane!!!!!!!!!!!!!!!! No pun intended.
16 Responses
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1192491 tn?1265031829
Okay, let me try this again.  Just because you are dx with Mixed States due to an episode, doesn't mean the next time or everytime you have an episode it will Mixed.  The next episode may be an episode of rapid cycling....I think this explains what I was trying to say in the previous message....I hope.
Helpful - 0
1192491 tn?1265031829
I have experienced what you described as being manic and then becoming depressed but still having rapid thoughts (black thoughts) and unable to sleep and sudden rages and my doctor diagnoised me as Mixed Episodes.  I also have had less severe episodes but with mania and depression cyclng several times a day and I assume this is rapid cycling.  So, I am guessing a person's episodes can go from mixed to rapid cycling off and on...in short I guess I am trying to say...it must be possible to have separate types of episodes with each episode and not alway the same type of episodes every time. ...did I make any sense???
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Avatar universal
this is what i do also..i can be in a mania state then in the same time frame be deppressed then mania again..and its a visics cycle..but it not rapids by the pdoc...i think theres so manny difft cases that the pdocs cant keep up with them all..and even some can be psychotic features as well.....so i think  i rapid in a 24 hr period..were a person who is rapid sevre would be like every 5 min or less..or no change constantly full blown physicotic episodes..theres just so much that they reakly know about each person.. and what meds there on if there stable or not..

great topic!!!!!!!!!
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750716 tn?1263734643
'Mixed State' is a horrible place to be.  For me, I become very agitated mentally and physically, feel completely powerless and desperate yet have an overwhelming feeling of anger at everyone and everything!  Tearfulness usually accompanies the anger which is a strange combination of emotions and adds to the feeling of desperation.

ILAD has put it in a nutshell...'feeling angry at the world'
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605458 tn?1539228808
Don't worry about it. When I have irritablity as a symptom I have to stay away from forums because I get all defensive, frustrated, and bent out of shape. I get all fixated on one point and argue it to death. So my posts at those times don't reflect what I'm really like.
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605458 tn?1539228808
Oh, my diagnosis is quite clear. I didn't mention hearing voices in my post. I mentioned thoughts, not voices. I also mentioned delusions when I am extremely depressed or extremely manic. But the diagnosis is quite clear as Bipolar 1. I know a lot about my diagnosis. I was just confused by another lay person's misinformation.

BUT during one particular manic episode I did 'overhear' conversations through walls that never took place.

Yes, I have a history of psychotic symptoms but only in the context of my mood episodes. None while I am in minor mood fluctuations or in normal mood.

I've been treated for the disorder and am quite read up on it for over 10 years. It was just this one fine point regarding mixed episodes and rapid cycling.

I have tried Lamictal three times, at least. At low doses the double vision and poor coordination is so bad that I can't read, watch tv, drive, go down the stairs safely, and I have to walk around with one eye closed. The double vision makes me nauseaus. Lamictal is also very sedating for me. I really don't want this to get into a med discussion. I know my meds, which meds do what. My med history is complicated. I don't tolerate many, blah blah.
Helpful - 0
585414 tn?1288941302
Lamictal can at times worsen mania in higher doses so its helpful for many people and some can't tolerate it just like any other medication. It worked for me well for a long time. There are other options. You can look at the websites we have linked up to find out about all available options as regards mood stabilizers. You can find out and then speak to your psychiatrist. As for posting I wouldn't worry about what your psychiatrist said but I'd keep it in mind. If you are concerned about the response you'd get write it down on a piece of paper first and then look at it for a while and then think it over. Then you can have a better idea. I know that before I write letters as regards some of the advocacy I do I sometimes have other people look them over so they don't seem to contain my own emotions where they don't belong but just ideas that might work. Besides the guidelines it is a public forum so if you (applies to all of us including me) wouldn't want the general public to read it then you might not want to post it. If its your personal concerns you can always keep a journal entry here and set it to private. But as for the internet in general I do set a goal for myself (which is good for anyone) which is don't surf the web while manic because of the lack of good judgment and doing things like buying too many cd's. The internet is a complex place but discretion is usually the best judgment. That doesn't mean you should limit yourself completely. Be your own guide or speak to a talk therapist about it.
Helpful - 0
Avatar universal
Lamictal made me worse BTW...every med is different for everyone though
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Avatar universal
I may be coming off wrong and don't mean to be...every time I re-read posts, I think something, but then I get confused as to how to say it.  This is prob why my pdoc told me to NOT reply on any forums..but, I want help! And, at the same time, maybe I am helping.
Helpful - 0
Avatar universal
Hey girl,
Sorry about the pdoc situation.  You BOTH were Clearly NOT talking about the same thing.  This is what I am experiencing...BTW, I am thinking clearer now so hopefully I won't ramble too much ;)...PenelopeAnn, let's speak in our terms, shall we? I UNDERSTAND mixed state as well as rapid cycling.  I say that with the intention that it is understood (lol) NO ONE, AND,  I do mean NO ONE, will EVER be able to explain so an average person (let alone some one of our intelligence) could ever possibly understand what a living being with this illness to this extent of the illness (I like to refer to as blessing in a sick way, but hey, I always joked about being insane and having it documented...lol...my pdoc doesn't think it's funny, but I get away with some stuff and it makes me laugh..LOL..IMPORTANT!!  ..to finish earlier sentence....not only goes through, but lives on a minute to minute basis.

I am (obviously) still pretty manic.  At the same time, I do feel hurt and sad (I have to say it like that or I will ramble on to explain what I think you already are aware of) "depression". My rapid cycling is something I haven't thought to mention to my pdoc yet, as alot transpires in 45minutes, ya know!.  It's DIFFERENT, like you state.  Hmmm, it is SO DIFFICULT to stop the racing thoughts, but I do have a thought.  This is why I guess I did the UNTHINKABLE, or let me say, UNIMAGINABLE and I WROTE everything down when I went thru the really bad manic and depressive "simultaneous" episodes as well as the rapid cycling ones.  I have 20 journals and 680 pictures.  F*ck!  OK, back on track....****, it's so hard for me to concentrate right now..

Manic does NOT equal Euphoria!  I am not happy or "euphoric" so to speak at ALL. Depression does NOT equal I want to kill myself every day either. Mixed state is hard enough for docs to explain, then let's add extreme rapid cycling...WHEW!!!  LOL I will get majorly down in the dumps feeling, and then BAM, I am ok and I am gonna carry on...at the same time I am ok with that and am not...make sense???
Helpful - 0
574118 tn?1305135284
i agree with ILADVOCATE about mixed states. I am BP1 if i recall well how i got my severe mixed states. I started my first mania euphoric and extremely happy as i was on an AD. Then it became dysphoric, i was energetic but extremely angry i would shout like tigers break furniture and use my hands against my parents. I suppose this is the mixed state when depression comes with mania. Simply because the classical manai is euphoric and the classical depression you lose interest and energy. here you combine qualities both. So in my case the disphoric part came later after the euphoric part. Thanks to the seroquel which extinguishes it vgery rapidly. As IL said and heard it and read it lamictal is good for mixed states and rapid cycling too i.e. when they follow each other in any sequence. Usually BP shouldn't rely much on AD's because they aggravate these symptoms. They say that depakote works well with mixed states. Once you stabilize all these symptoms subside. So once you stabilize i.e. recover and its symptoms will automatically disappear
good luck
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585414 tn?1288941302
I would state that since you describe hearing voices that might be psychosis which can be another aspect of bipolar. Seroquel is antipsychotic. You could ask your psychiatrist what your diagnosis is, whether perhaps its bipolar with psychotic features. Unless you've had a bad experience with it there is no reason to avoid Lamictal. The side effect of a rare rash is extremely rare (1 in a thousand and goes down after 6 months) and not any reason to avoid it. I certainly wouldn't suggest a particular medication but I know Lamictal was helpful for me and there would be no reason to avoid it for sure.
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605458 tn?1539228808
Here's why terminology is important.

I was talking with my current pdoc. We were discussing my problem with the 3 days up, 3 days down. I have only been seeing her for about 5 months. She asks, "So what has helped in the past with the mixed episodes."

BIG problem. We aren't talking about the same thing & therefore may not be treating the same symptoms. I have told her I have not experienced this in the past. I HAVE said I have experienced mixed episodes in the past, and they weren't anything like what I have been experiencing recently. What I was experiencing was a some serious ultra rapid cycling.

Also, I have a YouTube video blog on bipolar, not a diary but on topics relating to bipolar and mental health. I was shocked when I looked at the profile of a subscriber, who also has a bipolar video blog, had mixed episode defined as what I define as ultra rapid cycling - the symptoms alternating, not occuring simultaneously. I'd like to know what I was talking about or at least know enough to say I am not certain.

Also, there is a possibility I am a little hypomanic because I always get wound up tight about words and terms and phrases when this happens.
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605458 tn?1539228808
I understand that dyphoric mania and agitated depression are also terms used when talking about mixed episodes.

I had a major manic episode. Then I had the mixed state/episode of the type where I was mentally and physically still racing and not sleeping at all, but my thoughts were "Only an evil person would think such things. You are evil. You should die and go back to hell." I was up walking the streets at night in my pajamas praying for my mind to just stop. It only went faster. I didn't sleep a wink for 2 weeks and became quite darkly delusional. One morning I woke up and couldn't move or think. I stayed that way for a year. That was the worst example of that type.
Then I get these ones that I also call mixed episodes. I am high as kite, euphoric beyond belief, but I am calm and quiet, on inisde looking out. And I am constantly thinking about death. It becomes magical and my brain convinces me there is something waiting for me on the other side. I almost committed suicide during one of these. The also occur sort of in between mania & depression.

Having manic symptoms for 3 days then depression for 3 days over and over only started this year. Sometimes I experienced the mixed as I phased from one mood to the next. In other words, it was the same thing as when my moods lasted months, just super condensed.

An increase in my Seroquel has helped. I'm trying to avoid Lamictal.
Helpful - 0
Avatar universal
I am so glad I came across your question.  I don't really have any answers, that I can be exact on, but I will try.  See, I am still going through my "who knows how long mania episode".  I do know that I had my first MAJOR manic episode and am now considered Bipolar 1.  I prefer to say it like this though...I am  ME  with Bipolar 1 Disorder. Forgive my reply if it doesn't make much sense. I am really trying hard to get my thoughts together here.

I am currently on 450mg lithium, 5mg zyprexa, 3mg xanax and 20mg Celexa. I haven't worked since April 24th and my pdoc will not approve me to go back yet.  Okay, I am going to cut myself off and get to the subject matter...I can go on and on...you understand! ;)

"I sometimes experience what I call an overlap of mania and depression as I phase out of mania and go into a depression. In that state my thoughts are still racing, I am still physically restless, and I am not sleeping at all"

I just differ bcz I don't feel like I am phasing out of mania.  Bcz of the new meds I am on, I just feel like an intelligent, pdoc abiding (means I take my meds) still quite manic, litlle ME with bipolar MANIA to a lesser degree that occassionally, every few hours or so, realizes what the heck has been going on with my family (very long story..basically they're in denial and they neglected me since I was 6...blah blah) and I get "depressed", then I get irritated, then I don't give a sh*t, then I feel mania kicking back up and start crafting or finally fishing a project I started 2 weeks ago...rinse and repeat...LOL  In a nutshell! I don't know what quite to call all this.

Like you stated though, do we need labels?  No, but I do understand the need to know what one has, diagnosis.  I'm like that too.  Now, maybe bcz I am still pretty manic, I accept that I have Bipolar 1 Disorder and that I am also extremely intelligent and gifted. they go "hand in hand" with each other.  Ying and Yang.  I wouldn't haVE IT ANY OTHER WAY THOUGH BECAUSE THIS IS A PART OF ME AND IT HELPS MAKE ME WHO i AM TODAY.  i KNOW i SOUND POSITIVE RIGHT NOW, IT CHANGES SO i AM GONNA HIT SEND.  nOT EVEN RE-READING IT.  iT'LL never GET SENT IF i DON'T.  tHANK YOU ALL FOR READING MY RAMBLING not NONSENSE.  wE ARE not alone!!!!!  i DID LOOK up and notice the cap thing..I am not re-typing this for obvious reasons...I didn't mean to do that...new keyboard (older puter)..LOL
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585414 tn?1288941302
The websites that are linked up should define it but I'll provide what information I know. Rapid cycling is going from manic to depression in an ultra short period of time. They don't overlap. "Mixed states" are complex. I didn't understand how a person could be manic or depressed at the same time either but before my current recovery I asked and found out that I experienced "agitated mixed states" (as does a family member who is about to start treatment for bipolar) where a person has the speeded up quality of mania but the down aspect of depression. It seems like you are "angry at the world". Dysphoric mania (which in me might be caused by other than mental criteria but is often part of bipolar) is where a person experiences depression but with manic aspects of it. Thus a person may seem "obsessed with death". I've found for me Lamictal was the best on rapid cycling and mixed states but each person was different. This is as much as I know without using clinical terminology but I gained my information from those websites posted as well as information I've read but you could look this up and speak to your psychiatrist more about it as they would know how to treat it.
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