Author: Lisa MacDonald

There have been times when my mind felt like it was moving a thousand miles an hour while my emotions were sinking into darkness. My body was restless, yet my thoughts were filled with despair. I couldn’t sleep. My thoughts raced uncontrollably, and even the smallest stressor felt insurmountable.

This is what a bipolar mixed episode can feel like. 

Most of us have probably heard of manic and depressive episodes. Mania is often associated with high energy, racing thoughts, and impulsive behavior. Depression is often described as low mood, exhaustion, and a loss of interest in things we once enjoyed.

But mixed episodes are different.

While bipolar disorder is typically characterized by episodes of either mania or depression, people experiencing mixed episodes feel symptoms from both extremes at the same time. Instead of feeling only energized or only depressed, these emotions can collide in confusing and overwhelming ways.

Some potential symptoms of a bipolar mixed episode include:

My Story

Personally, I have experienced racing thoughts, irritability, increased energy, suicidal thoughts, suicide attempts, sleeplessness, auditory hallucinations, and risk-taking behaviors during mixed episodes. At times, the auditory hallucinations have been command hallucinations—voices telling me to hurt myself.

It feels like being filled with pent-up energy while constantly on edge. I’ve spent hours online researching ways to die. I’ve made decisions I normally never would, yet in those moments, I felt almost powerless to stop myself—even when I knew better.

During these times, even the smallest inconvenience can make me feel like I might explode with frustration. My thoughts move so quickly that I can’t keep up with them. And these racing thoughts aren’t positive or exciting—they can be disturbing and dark.

Over time, I’ve learned how important early treatment is for bipolar disorder. Recognizing warning signs early can help prevent an episode from becoming more severe.

One lesson I had to learn the hard way is the importance of honesty—being honest with others, and with myself, about how I’m feeling. Pretending everything is okay doesn’t make things better. Masking my symptoms only delayed getting the support I needed. If I’m not honest, how can anyone help me? And how can I help myself?

Being open about struggles can feel really scary, but bottling everything up doesn’t help. In my experience, honesty has been one of the most important steps toward stability and support.

Coping Skills

So what are some coping skills? What can we do to potentially prevent a future episode or reduce its severity?

Routine
People living with bipolar disorder often benefit from a consistent daily schedule and structure.

Sleep
Aim to go to bed and wake up at roughly the same time each day.

Exercise
Regular movement can help regulate mood. If exercise is new for you, start small and build gradually.

Nutrition and Hydration
Eating regularly and staying hydrated supports both physical and mental health.

Managing Stress
Stress can trigger mood episodes. Techniques like mindfulness meditation, deep breathing, progressive muscle relaxation, journaling, or engaging in enjoyable activities can help reduce stress.

Communication
Open communication with trusted people—such as loved ones, therapists, or doctors—can make a big difference.

Medication Adherence
Take medication exactly as prescribed, and avoid stopping without consulting your doctor—even if you feel better or think it isn’t helping.

Avoid Drugs and Alcohol
Substances can worsen mood episodes and make symptoms more severe. If you use substances, it’s important to talk with your doctor, as stopping suddenly can sometimes be dangerous.

Limit Caffeine
Caffeine can increase agitation, anxiety, and sleep problems.

Have a Crisis Plan
Keep resources such as crisis hotlines saved in your phone, and know when it’s time to seek emergency help.

Delay Major Decisions
During unstable mood states, it can help to postpone major life decisions until things feel more stable.

Everyone’s experience with bipolar disorder is different, and it’s important to work with a mental health professional to find a treatment plan that works best for you.

There Is Hope

Living with bipolar disorder can be complicated, but it doesn’t have to mean life is hopeless. With the right support, treatment, and self-awareness, it is possible to manage bipolar disorder and build a meaningful life.

If you’re struggling right now, please remember that you don’t have to face it alone. Reaching out for help is not a weakness—it’s a brave and important step toward healing.

Author Bio

Lisa MacDonald is a mental health advocate with lived experience of bipolar disorder. She is trained in peer support and previously served as a patient representative on the advisory committee for Peer Support Nova Scotia. Lisa now works as a Recreation Therapy Assistant in inpatient mental health, where she is passionate about supporting others in their recovery and reducing stigma.