Different versions of an individual suffering from bipolar disorder.

Artwork by Taniya Pramanik

Different versions of an individual suffering from bipolar disorder.

Exploring the Complexities of Bipolar Mixed Episodes: Insights and Interventions

Medically reviewed by

Written by Parth Sharma

Bipolar disorder, previously known as Manic Depression, is a mental condition that is severely generalized and causes extreme mood swings in people. It includes emotional highs (known as mania or hypomania) and lows (known as depression). It has a high prevalence of people discontinuing the prescribed medicine mid-course, and there are many subtypes of Bipolar disorder to begin with. Only a licensed and trained psychiatrist/mental health professional is allowed to make a Bipolar disorder diagnosis.

What are Mixed Episodes in Bipolar Disorder?

Mixed Episodes in Bipolar Disorder refer to the presence of both high and low symptoms occurring at the same time or as part of a single episode. In most variations, moods alternate between the elevated and the depressed—both ends of the spectrum are experienced either simultaneously or in rapid sequence. This is also exclusive of mixed features of each state, i.e. someone may have a depressive episode with mixed features—of mania and depression—wherein the main symptoms are depressive, but the subclinical manic signs are also present.

Bipolar Mixed Episode Symptoms

Symptoms of Bipolar Mixed Episodes may vary, depending on the mood episode in question. Some of the more common ones include:

Mood Swings

Characterized by rapid change in mood, from happy to sad, from excited to nervous, from melancholic to upbeat—you name it. The shift in mood patterns is varied, which is something to look out for.

Irritability and Agitation

Characterized by a general irritability towards people and situations and/or accompanied by feelings of agitation and annoyance. One is irritable for no ‘apparent’ reason. 

Depressive Thoughts with High Energy

Characterized by thoughts that are tinted with sadness, irritability, and emptiness but are also accompanied by high-energy manic/happy thoughts as well. 

Racing Thoughts with High Energy

Characterized by thoughts that are moving rapidly from one to another, in rapid succession, with little or no active control over the flow of thought—also accompanied by high-energy/happy thoughts.

Mixed Emotional States

Characterized by a mood state which is both manic and depressive at the same time. One experiences feelings of mania as well as depression over a short period of time.

Sleep Disturbances

Characterized by imbalanced and irregular sleep cycles. Broken sleep on a regular basis is a common feature as well. 

Suicidal Ideation

Characterized by thoughts pertaining to, or ruminations about, the idea of suicide. 

Social Withdrawal or Overactivity

Characterized by withdrawing from social situations that one previously enjoyed or generally liked. This is also seen in the opposite extreme, wherein one tends to overindulge in socializing more than one would usually have. 

Inconsistent Performance

Characterized usually by a drop in performance and, over time, an inconsistent performance pattern—usually relating to school, work, or any kind of place where a sense of competency is expected. 

Increased Risk Taking Behavior

Characterized by a jump in the amount of risk one used to take in matters both large and small. Recklessness is also seen to be on the rise.

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Causes of Bipolar with Mixed Features

To this day, doctors are not 100% sure of what exactly causes Bipolar with Mixed Features—however, it is pretty universally understood that it is probably due to a combination of genes, neurochemical imbalances, brain structure and function, and the environment. 

Genetic Factors

Some doctors believe that there is an element of genetics involved. If you have a history of the disorder in the family, you are more likely to have it as well. It should be noted, though, that most people who have direct or indirect relatives with the disorder don’t automatically develop it either. 

Neurochemical Imbalances

More often than not, when there are certain neuroreceptors that are out of order or not functioning in the correct way, it may lead to an imbalance in the functioning of the brain, which may lead to the symptoms.  

Brain Structure and Function

Brain scans can’t detect the disorder, but research has shown minor differences in the size of the brain, as well as the activity that goes on. Traumatic head injuries and concussions are also linked to the development of the disorder. 

Environmental Triggers

Particularly stressful events, such as a death, may trigger such a disorder. Stress hormones and how they are handled also play a part in the symptoms. 

How is Bipolar Disorder with Mixed Features Diagnosed?

The only person who should be diagnosing someone is a practicing medical professional or a psychiatrist. However, if you or a loved one you know is experiencing some of the symptoms described, it wouldn’t do any harm for them to take a quick visit to the required professional. The steps are usually as follows:

Initial Assessment and Medical History 

Initially, there is a physical exam, which is performed—or lab tests. There is no blood test, or a scan that a doctor will take that can determine whether or not the disorder exists, but it's good to get other illnesses out of running—such as hyperthyroidism. 

Clinical Interview and Symptom Analysis

Interviews are taken, and the particular case history is examined by the professional concerned. There are various types of Bipolar disorder, so narrowing it down to a particular type will also require symptom analysis.

Psychological Evaluations 

A psychiatrist will conduct assessments to determine whether or not the disorder exists. Assessments also determine which particular type of Bipolar disorder is to be narrowed down to. 

Differentiating from Other Disorders

At all points in time, each professional is narrowing it down by eliminating potential other options that show similar symptoms but are not the same—whether it is the doctor, psychologist, or psychiatrist. 

Monitoring Mood and Behaviour Patterns

General mood and behavior are also monitored. Family members are also brought in and consulted to get a better understanding of the situation from a third-person point of view. 

Effective Bipolar Mixed Episodes Treatments

Rapidly shifting moods are at the helm of emotional turmoil. However, there are proper treatment methods and techniques that one can apply to manage the symptoms effectively.


Medication is complex since it involves the treatment of both mania and depression. It usually involves a combination of mood stabilizers as well as antipsychotics. They are usually prescribed separately since the ‘mania’ is usually controlled by the mood stabilizers, and then antipsychotics are prescribed if they don’t work. 

Electroconvulsive Therapy (ECT)

The treatment involves sending an electric current through the brain, which causes a brief surge of electrical activity in the brain. It is aimed at relieving symptoms that are commonly seen with the disorder. 

Psychotherapy Approaches

Also known as talk therapy, this is helpful in working out the stress associated with the disorder. It helps to find out and address the issues the individual is facing. 

Cognitive Behavioural Therapy (CBT)

Focuses on helping the individual manage their thoughts, behavior, and perceptions. It is to help find healthy ways to approach and deal with problems. Problems of depression and manic states are addressed and talked through.

Dialectical Behaviour Therapy (DBT)

Focuses on people who experience emotions very intensely, wherein people are helped to come to the reality of their lives and their behaviors, as well as helping them to change their lives and behaviors. 

Family-Focused Therapy

Focuses on helping families to work through intense stress and emotions and also promotes problem-solving and conflict resolution. 

Interpersonal and Social Rhythm Therapy (IPSRT)

Focuses on minimizing family disputes and disruptions in daily social life, which can lead to further triggers for future episodes. 

Paving the Way Forward in Managing Bipolar Mixed Episodes with Cadabams

Therapy with a trained mental health professional may not necessarily resolve severe mood symptoms. Still, it can be substantially helpful when you live with diagnosed bipolar disorder. A therapist can help you identify and manage overwhelming emotions, abrupt mood changes, and thoughts of suicide, even when you’re unsure precisely what you’re feeling. It also offers a safe space to build coping skills and create a crisis plan for future mood episodes. Reach out to us at Cadabam's, where we offer these and many other such services. We are here for you.

If you are searching for a solution to your problem, Cadabam’s Rehabilitation Centre can help you with its team of specialized experts. We have been helping thousands of people live healthier and happier lives for 30+ years. We leverage evidence-based approaches and holistic treatment methods to help individuals effectively manage their Bipolar Mixed Episodes. Get in touch with us today. You can call us at +91 96111 94949.

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1. What are common symptoms of a Bipolar Mixed Episode?

Common symptoms include:

  1. feeling a mixture of high and low moods
  2. doing pleasurable activities while having depressive symptoms
  3. experiencing low mood with rapid speech/ racing thoughts
  4. experiencing elevated mood with suicidal ideation
  5. having a severe disturbance of appetite

2. How do Bipolar Mixed Episodes differ from other Bipolar Episodes?

Within Bipolar disorder, a person with mixed features can have either Mania (with mixed features), usually involving irritability, high energy, racing thoughts, and overactivity/ agitation or Depression (with mixed features) with feelings of sadness, loss of interest in activities, low energy, feelings of guilt and worthlessness, and thoughts of suicide and self-harm. 

3. Are mixed episodes normal in bipolar?

Mixed episodes are common in people with bipolar disorder; research suggests that half or more people with bipolar disorder have at least some mania symptoms during an entire episode of depression. 

4. Who Gets Mixed Bipolar Episodes?

Those who develop bipolar disorder at a younger age, especially in adolescence, are more likely to have mixed episodes. People who develop episodes with mixed features may also develop pure depressive, pure manic, or hypomanic phases of bipolar illness.

5. What types of therapies does Cadabams offer for Bipolar Mixed Episodes?

We are fully equipped in the following ways:

  • Psychotherapy
  • Medications like mood stabilizers, antipsychotic medication, Antidepressants, and Anti-anxiety medications.
  • Family-focused therapy
  • Psychoeducation
  • Interpersonal and Social Rhythm Therapy

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