Being in a Mixed Bipolar Episode

There is is something in Bipolar Disorder called a Mixed Episode. It's exactly what it sounds like essentially. When someone is in a mixed episode, they have symptoms of both a depressive and manic (or hypomanic) episode. The DSM categorizes a depressive episode as at least 5 of these 9, present nearly every day:

  1.  Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). 
  2. Decreased interest or pleasure in most activities, most of each day 
  3. Significant weight change (5%) or change in appetite 
  4. Change in sleep: Insomnia or hypersomnia 
  5. Change in activity: Psychomotor agitation
  6. Fatigue or loss of energy 
  7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt 
  8. Concentration: diminished ability to think or concentrate, or more indecisiveness 
  9. Suicidality: Thoughts of death or suicide, or has suicide plan 
Now combine this with a Manic episode and you have someone who is depressed but also has the energy and symptoms of mania, and sometimes you have a recipe for disaster (at least in my experiences).  For a manic episode, 3 or more of the following symptoms must be present:
  1. Inflated self-esteem or grandiosity  
  2. Decreased need for sleep (e.g., one feels rested after only 3 hours of sleep)
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or subjective experience that thoughts are racing
  5. Attention is easily drawn to unimportant or irrelevant items
  6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  7. Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
Separately, the episodes in and of themselves are difficult to manage. Together they exacerbate each other and make for the potential of being unstable. I tend to self-harm, have worsened eating disorder habits, spend money recklessly, be extremely social, and try to take on a bunch of projects when I'm like that to compensate for the depression I am feeling inside. The past few years, mixed episodes have been the most dangerous for me. Unfortunately, this is the state that I have been in for the past few weeks. I am hoping to get better and to get back to being stable and not at both extremes of the spectrum. I just have to be patient and put everything I can into recovery.

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