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Mixed state bipolar disorder

Mixed state bipolar disorder is a type of mental illness that involves having extremely high and low moods. Unlike bipolar disorder type 1, which involves mood swings ranging from depression to mania, 'mixed state' bipolar disorder happens when you experience both states at the same time. For example, you may display manic behaviour while feeling low or depressed.


When the classic bipolar symptoms of mania and depression happen at the same time, it can make it harder for you to think straight, identify your needs or manage your emotions.

Classic bipolar symptoms of mania include:

  • Hyperactive, 'manic' behaviour
  • Fast, jumbled speech
  • A sense of euphoria
  • Acting inappropriately
  • Being over-friendly, rude or suggestive
  • Being easily irritated
  • Increased libido
  • Increased confidence and dangerous risk-taking
  • Loss of inhibitions
  • Substance abuse.

Classic symptoms of depression include:

  • Lack of energy or lethargy
  • Feeling upset, down or tearful
  • Inability to feel pleasure
  • Avoiding social interaction
  • A sense of shame, hopelessness or worthlessness
  • Lack of confidence and self esteem
  • Stress or tension.

Because mixed bipolar episodes may combine some or all of the symptoms listed above, they can be very challenging. You may experience more serious problems like:

  • Extreme difficulty sleeping
  • Extreme agitation
  • Appetite changes
  • Delusions and paranoia
  • Hallucinations or hearing voices
  • Psychotic thoughts
  • Self-harm
  • Suicidal thoughts and feelings.


If you or a loved one has symptoms of mixed state bipolar disorder, you should discuss it with your doctor. Statistics show that the first symptoms often occur a long time before people actually seek medical help. It’s thought that about a quarter of those with bipolar illness never seek medical help.

You may find it especially difficult to ask for help because you struggle with managing your thoughts and feelings. You may also be concerned about the stigma attached to mental illness. The best approach is to talk to your GP and be open about your problems and concerns. It may help to write some notes before your appointment and even take a family member or close friend with you.

You can only be diagnosed with mixed state bipolar disorder by a mental health specialist, so your GP may refer you to a psychiatrist for assessment. This may involve questions about your family history, and other health issues, to rule out things like thyroid disease that can cause some similar symptoms. Other questions will probably include:

  • What symptoms you have
  • How long you’ve had symptoms
  • How long episodes last
  • How often episodes happen
  • The effect of symptoms on your daily life.

Statistics show that diagnosis may take time and observation by your doctor. Symptoms can be vague and hard to pin down, so you may be asked to keep a diary to track your moods. Because diagnosis isn’t easy and is not always definitive, you may feel more comfortable with a second opinion.

WebMD Medical Reference

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