Author: Cassandra Stout
If you have bipolar disorder, it’s likely you’ve experienced some symptoms of mania while you’ve suffered depression, or vice versa, and believe me: it’s miserable.
This awful set of feelings is colloquially called a mixed episode or a mixed mood state, and they are common in people with bipolar disorder. Half or more of people with bipolar disorder deal with mixed episodes, and I am one of them.
Just because I suffer mixed episodes, however, doesn’t mean I don’t have “pure” episodes of depression or mania–I have those, too, and they are also detrimental to my mental, physical, and emotional health.
But there’s something about a mixed episode that’s just doubly bad.
Six days after the birth of my first child at 22, I suffered an intense mixed episode with psychotic features and committed myself to a mental hospital, where I earned a diagnosis of Bipolar Disorder I.
I was constantly on the move, hadn’t slept in a week, and ate very little food or drink other than chocolate milk. I made to-do lists of over 100 items each and filled up brand new journal in a few days. I spoke so rapidly that no one could understand me, and flitted from topic to topic like a hummingbird, frustrated and irritable.
These are all symptoms of–and in the case of the lack of sleep, precursors to–mania. But I also suffered symptoms of depression: I cried constantly, felt an overwhelming dread that awful things were happening to my newborn, and vacillated between absolute euphoria and crushing despair.
Any setback destroyed me. Something as simple as not being able to eat my condiment of choice on my meal was a cause for sobbing dejection. And I fixated on my feelings of guilt, anxiety, and low self-worth.
My mixed mood state nearly got the best of me. When I wasn’t bursting with energy, I was exhausted. Angry outbursts from me were common, and my mind raced so much, I couldn’t get to sleep easily.
Fortunately, I was given proper medication in the hospital that stabilized me. Since then, I’ve faithfully taken my meds at morning and night, and I haven’t yet experienced a mood episode that terrible again.
I have, however, suffered less intense mixed episodes since my stay in the hospital. The symptoms–irritability, inability to focus, vacillation between euphoria and despair–are similar.
But I don’t allow them to control me anymore.
3 Ways I Handle Mixed Mood States
I handle mixed mood states in the same way I handle “pure” manic episodes: once I realize what’s going on, I ensure I’m taking steps to get out of the mood state.
Here are three ways I do that:
- I prioritize sleep. With mania, I frequently don’t need sleep–or, at least, that’s the lie that my brain tells my body. When I’m in a manic or mixed mood episode, I need sleep even more so than when I’m not, so I practice good sleep hygiene and force myself to lie down with my eyes closed until I’m out. Taking a hot bath right before bed also helps. Sometimes medication is involved in my sleep, which brings me to my next point…
- I inform my treatment team about my current struggles. My treatment team–my therapist, psychiatrist, and yes, even my husband–needs to know I’m experiencing a mood episode before they can help me. First, I tell my husband, as he’s the closest to me and is most likely to be adversely affected by my mood episode. Next, if the mood episode is truly terrible and I need to adjust my medication, I phone my psychiatrist and take his advice. After that, I make an appointment with my therapist to process the issues that cropped up during the episode.
- I pare down my to-do list. One of my manifestations of mania is to be insanely productive. But the more I accomplish, the more wound up I get, and therefore I accomplish even more, getting more wound up… It’s a vicious cycle. So when I recognize that I’m manic, rather than riding the high and getting a ton done, I scale back on my to-do list. I force myself to slow down and only get done what is absolutely vital. Slowing my brain down and deliberately paying attention to detail helps me conquer a manic or mixed mood episode.
My experience with mixed mood states has been awful. They’re like a manic episode turned up to eleven with all the worst parts of depression bogging me down.
When I’m suffering a mixed mood episode, I’m irritable, euphoric, and despairing. I can’t focus and I can’t sleep easily.
But the way I handle those states is similar to the way I handle manic episodes: I prioritize sleep, let my treatment team know and take their advice, and pare down my to-do list.
If you find yourself in a mixed state, prioritize sleep. Force yourself to lie down and close your eyes; try to slow your brain down as much as you can so your thoughts don’t run away with you. And don’t forget to take your medication!
You can survive a mixed mood state and even thrive afterwards. I wish you well in your journey.
Freelance writer Cassandra Stout blogs at the award-winning Bipolar Parent, a comprehensive resource for parents with mental illnesses. Cassandra holds degrees from the University of Arizona in Creative Writing and Journalism, and aims to return to school for her Masters degree in Clinical Mental Health Counseling. A U.S. resident, she has been a judge for the Pacific Northwest Writers’ Association literary contest for ten years, where her memoir, Committed, recently placed as a finalist. She balances her literary work with raising her children, writing fanfiction, and managing her bipolar disorder.