Mixed States - Extra Sucky Bipolar

by L.C.
(Penn State student from NY)

There has been so much in the media about bipolar disorder in the last few years that many lay people have become much more educated about the disease. Ask them about bipolar and they can often give a reasonable explanation that describes mood swings between mania and depression. More and more frequently these explanations will be sympathetic rather than stigmatizing and are likely to include a reference or two to some of their favorite celebrities :)

If only bipolar disorder was just a simple matter of "up" versus "down".

At my local DBSA support group, some members do describe their bipolar disorder in these terms. One of the regulars, an old friend who cycles pretty rapidly, will even joke about "ricocheting to the other pole".

However, some of us experience bipolar disorder in a different way and are prone to what the experts describe as mixed states.

Again, this is a description that appears to be somewhat self-explanatory. However, even people who have bipolar disorder themselves and who have done a lot of research into the illness are likely to have an overly simplistic understanding of mixed states.

Intuitively it seems straightforward - simultaneous experience of mania and depression. But isn't it paradoxical or oxymoronic to talk about being manic and depressed at the same time? Only if we limit ourselves to stereotypes of mania and depression.

Mania can be more than elation, grandiosity, expansiveness, and so forth. Likewise, depression can be far more complex than just feeling "sad" or "blue".

Sure it would be difficult to have an experience of feeling euphoric and down both at the same time.

More nuanced definitions of mania and depression explain how a mixed state is possible. For example, it is possible to imagine being simultaneously anxious and morose, or grumpy along with gloomy.

The experts have studied mixed states and describe these states using terms such as agitated depression or anxious mania.

Personally I suffer from mixed states - a particularly toxic cocktail of irritable-hostile depression. This poisonous combination has been identified as a sub-type in its own right, for example different to so-called agitated depression, and has been the subject of some excellent research.

It was found to be present in almost 60% of those with Bipolar II.

Other findings include:
- it is associated with a young age of onset

- it is associated with higher than average rates of major depression

- it correlates strongly with a family history of bipolar disorder

- more likely to be accompanied by Axis I disorders such as anxiety.

Also, mixed states overall occur more often in people with a history of substance abuse, especially alcoholism.

Treatment is mainly meds, including lithium, although research on its effectiveness is inconclusive. Abilify and Geodon are atypical antipsychotics recently FDA approved for bipolar mixed states.

I hate the person I am when hostile-irritable-depression overtakes me. I do take medication and it helps a little, but I suspect the real key to improvement lies in psychotherapy and psychoeducation.