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Being Manic And Depressed At The Same Time

Bipolar Disorder And Other Conditions

The Experience of a Mixed State in Bipolar Disorder or Being Manic and Depressive at The Same Time

Some bipolar disorder symptoms are similar to those of other illnesses, which can make it challenging for a health care provider to make a diagnosis. In addition, many people may have bipolar disorder along with another mental disorder or condition, such as an anxiety disorder, substance use disorder, or an eating disorder. People with bipolar disorder have an increased chance of having thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses.

Psychosis: Sometimes, a person with severe episodes of mania or depression may experience psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the persons extreme mood. For example:

  • People having psychotic symptoms during a manic episode may have the unrealistic belief that they are famous, have a lot of money, or have special powers.
  • People having psychotic symptoms during a depressive episode may falsely believe they are financially ruined and penniless, have committed a crime, or have an unrecognized serious illness.

As a result, people with bipolar disorder who also have psychotic symptoms are sometimes incorrectly diagnosed with schizophrenia. When people have symptoms of bipolar disorder and also experience periods of psychosis that are separate from mood episodes, the appropriate diagnosis may be schizoaffective disorder.

Anxiety: It is common for people with bipolar disorder to also have an anxiety disorder.

Who Gets Mixed Bipolar Episodes

Virtually anyone can develop bipolar disorder. About 2.5% of the U.S. population — nearly 6 million people — has some form of bipolar disorder.

Mixed episodes are common in people with bipolar disorder — half or more of people with bipolar disorder have at least some mania symptoms during a full episode of depression. Those who develop bipolar disorder at a younger age, particularly in adolescence, may be more likely to have mixed episodes. People who develop episodes with mixed features may also develop “pure” depressed or “pure” manic or hypomanic phases of bipolar illness. People who have episodes of major depression but not full episodes of mania or hypomania also can sometimes have low-grade mania symptoms. These are symptoms that are not severe or extensive enough to be classified as bipolar disorder. This is referred to as an episode of “mixed depression” or a unipolar depressive episode with mixed features.

Most people are in their teens or early 20s when symptoms from bipolar disorder first start. It is rare for bipolar disorder to develop for the first time after age 50. People who have an immediate family member with bipolar are at higher risk.

A Mixed Bipolar Episode Is When A Person Experiences Depressive Symptoms And Those Of A Mood Elevation At The Same Time

Dr. Marsh points out that bipolar is somewhat of a misnomer, because while there are two poles, theyre not necessarily experienced separately, she says. This can be a very hard concept to grasp for someone observing a patient who is having symptoms associated with both poles at the same time, and for the patients themselves.

With bipolar disorder in general, its actually quite common for a person to experience episodes that are mixed, Igor Galynker, M.D., associate chairman for research in the department of psychiatry at Mount Sinai Beth Israel, tells SELF.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders included specific diagnostic criteria for mixed episodes, Dr. Marsh says. But the DSM-5, the latest version of the manual, replaced the mixed episode diagnosis with a mixed-features specifier that clinicians now apply to episodes of depression, hypomania, or mania. The issue that some researchers took with the DSM-4 mixed episode diagnosis was that it required a person to meet the complete diagnostic criteria for a depressive episode, as well as the full criteria for a manic episode, for a week or longer. Simply put, you had to be experiencing ongoing full mania and full depression simultaneously, Dr. Marsh says. But in reality, a person may present mixed features but not necessarily check every single diagnostic box for both.

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What Can I Expect After Treatment

For most people, a good treatment program can stabilize severe moods and provide effective symptom relief. Treatment that is continual has proven more effective in preventing relapses. Those who also have a substance abuse problem may need more specialized treatment.

Last reviewed by a Cleveland Clinic medical professional on 01/27/2018.

References

Highs And Lows: Understanding Symptoms Of Manic Depression

Surprising Symptoms of Manic Depression

Depending on your age and the company you keep, you might not have heard much about manic depression lately. However, its still out there its just more commonly referred to as bipolar disorder these days.

While most of us hear quite a bit about bipolar disorder on advertisements or see representations of it in the media, its hard to know what the condition really feels like. This is particularly worrying if you think that you or someone that you care about might have it.

Generally, the symptoms of bipolar disorder are mood shifts between depressive episodes and manic episodes. But theres more to it than that. Lets take a closer look.

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Look After Your Physical Health Too

The state of physical health impacts mental health and vice versa. One of the most effective ways to alleviate the symptoms is to increase your physical activity. Exercising or just getting outdoors is a great way to relieve stress, shift your focus, and boost your mood. Its also important to get plenty of sleep, eat healthily, stay hydrated, and limit alcohol consumption.

What Are The Symptoms Of A Mixed Features Episode

Mixed episodes are defined by symptoms of mania and depression that occur at the same time or in rapid sequence without recovery in between..

  • Mania with mixed features usually involves irritability, high energy, racing thoughts and speech, and overactivity or agitation.
  • Depression during episodes with mixed features involves the same symptoms as in “regular” depression, with feelings of sadness, loss of interest in activities, low energy, feelings of guilt and worthlessness, and thoughts of suicide.

This may seem impossible. How can someone be manic and depressed at the same time? The high energy of mania with the despair of depression are not mutually exclusive symptoms, and their co-occurrence may be much more common than people realize.

For example, a person in an episode with mixed features could be crying uncontrollably while announcing they have never felt better in their life. Or they could be exuberantly happy, only to suddenly collapse in misery. A short while later they might suddenly return to an ecstatic state.

Mood episodes with mixed features can last from days to weeks or sometimes months if untreated. They may recur ,and recovery can be slower than during episodes of “pure” bipolar depression or “pure” mania or hypomania.

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Is Bipolar More Serious Than Depression

Both are serious mental illnesses than can affect a persons quality of life. And both can lead to serious consequences if left untreated, including suicide, self-harm, reckless behavior, and impairment at work, home, or school. Both bipolar disorder and major depressive disorder, however, can be treated to lessen the risk of these dangerous symptoms.

How Is Bipolar Disorder Treated

Bipolar Disorder – When we use Lithium

Treatment for bipolar disorder may include the use of mood stabilizers such as lithium. Certain anticonvulsants, antipsychotics, and benzodiazepines may also be used to stabilize mood. Sometimes antidepressants are given in combination with mood stabilizers to boost the depressed mood, although antidepressants are often not as effective as some mood stabilizers or certain atypical antipsychotics for treating depression in bipolar disorder.

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Who Experiences Bipolar Disorder

Bipolar disorder usually begins in older teens and young adults, with at least half of all cases appearing before age 25. Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder . Some studies have indicated that bipolar depression is genetically inherited, occurring more commonly within families.

While bipolar disorder occurs equally in women and men, women are more likely to meet criteria for bipolar II disorder. Women with bipolar disorder may switch moods more quickly this is called “rapid cycling.” Varying levels of sex hormones and activity of the thyroid gland in the neck, together with the tendency to be prescribed antidepressants, may contribute to the more rapid cycling seen in women. Women may also experience more periods of depression than men.

An estimated 60 percent of all people with bipolar disorder have drug or alcohol dependence. It has also been shown to occur frequently in people with seasonal depression and certain anxiety disorders, like post-traumatic stress disorder .

What Is A Mixed Episode

A mixed episode, in the context of bipolar disorder, is a mood state that involves both mania and depression symptoms. Still, mixed episodes are separated into two major categories: depression with mixed features and mania with mixed features.

To qualify as a depression with mixed features, you will meet the criteria for a major depressive episode and also experience three symptoms of mania or hypomania in the same period. To qualify as mania or hypomania with mixed features, you need to qualify for either mania or hypomania and have three symptoms of major depression.

Not only is it possible to experience mania and depression at the same time, but it may also even be relatively common. According to a 2015 paper, around 40% of bipolar disorder patients experience a mixed episode at some point in their lives. Since mixed symptoms are so common, it makes sense that a change in the DSM expanded the qualification of depression and mania to include mixed symptoms.

The fourth edition of the DSM had a caveat in the criteria for both major depressive episodes and manic episodes that said, The symptoms do not meet criteria for a mixed episode. In other words, if symptoms were mixed, they dont fall under the category of a major depressive or manic episode. Those words were dropped in the fifth edition, which means people that experience mixed episodes can still be diagnosed with bipolar I or bipolar II.

Written by: Joseph Raspolich

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Misdiagnosed: Is It Bipolar Disorder Or Major Depression

Major depressive disorder and bipolar disorder are two separate conditions you cant be diagnosed with both at the same time. But thats because diagnostic criteria for bipolar disorder II includes MDD.

Of course, it is possible to be misdiagnosed. It can sometimes be difficult to tell the difference between the two conditions, even for healthcare professionals.

Although the symptoms of depression are often fairly straightforward to spot, it can be more challenging to recognize the symptoms of mania, and particularly hypomania . Plus, someone may be more likely to seek help when experiencing depression than mania.

About 1320% of people who have MDD with mixed features will eventually meet diagnostic criteria for bipolar disorder I or II.

Misdiagnosis can also happen for other reasons. For example, depression with mixed features can look like depression with borderline personality disorder. Or depression combined with a substance use disorder can resemble hypomania or mania symptoms.

Receiving a misdiagnosis may set back a persons recovery, since depression and bipolar disorder are typically treated with different medications.

To figure out if you have MDD, bipolar disorder, or another condition altogether, a mental health professional must conduct a thorough evaluation to determine which best fits your symptoms.

Mania in bipolar disorder with mixed features may actually be more common than in bipolar disorder without this specifier.

Causes Of Manic Episodes

How to Beat a Manic Episode Before It Starts

Your brain works through a series of chemical messengers called neurotransmitters. There are two main classes of neurotransmitters, namely stimulants and depressants. When your brain chemistry shifts in favor of stimulants over depressants, it can trigger a manic episode.

This happens for some reasons that well discuss more deeply throughout the article. Conditions like bipolar disorder are the most common, though stress, substance use, and in some cases, seasonal change can also cause manic episodes.

If your healthcare provider determines that a mental health condition is causing your manic episodes, he or she may prescribe prescription medication. Most of these prescription medications work by balancing your brain chemistry to limit episodes or reduce their severity.

There are some things that you can do to help to manage manic episodes without medication, including diet and lifestyle changes. Some people also find that counseling or talk therapy helps them to recognize and manage their manic episodes.

However, if your manic episodes are caused by a mental health condition like bipolar disorder, these measures may not be enough on their own.

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What Are The Symptoms Of Mania

Symptoms of a manic episode

  • Having an abnormally high level of activity or energy.
  • Feeling extremely happy or excited even euphoric.
  • Not sleeping or only getting a few hours of sleep but still feeling rested.
  • Having an inflated self-esteem, thinking youre invincible.
  • Being more talkative than usual. Talking so much and so fast that others cant interrupt.
  • Having racing thoughts having lots of thoughts on lots of topics at the same time .
  • Being easily distracted by unimportant or unrelated things.
  • Being obsessed with and completely absorbed in an activity.
  • Displaying purposeless movements, such as pacing around your home or office or fidgeting when youre sitting.
  • Showing impulsive behavior that can lead to poor choices, such as buying sprees, reckless sex or foolish business investments.

Psychotic symptoms of a manic episode

  • Delusions. Delusions are false beliefs or ideas that are incorrect interpretations of information. An example is a person thinking that everyone they see is following them.
  • Hallucinations. Having a hallucination means you see, hear, taste, smell or feel things that arent really there. An example is a person hearing the voice of someone and talking to them when theyre not really there.

What Steps Can I Take To Better Cope With Or Manage My Mania

Although episodes of mania cant always be prevented, you can make a plan to better manage your symptoms and prevent them from getting worse when you feel a manic episode may be starting.

Some ideas to try during this time include:

  • Avoid stimulating activities and environment such as loud or busy places or bright places. Instead choose calm and relaxing activities and environments.
  • Stick to routines. Go to bed at a set time, even if youre not tired. Also, stick to the same times for eating meals, taking medications and exercising.
  • Limit the number of social contacts to keep you from getting too stimulated and excited.
  • Postpone making any major life decisions and big purchases.
  • Avoid people and situations that might tempt you to make poor or risky choices, such as taking recreational drugs or drinking alcohol.
  • Consider selecting someone to manage your finances during a manic episode.

If you ever have thoughts of harming yourself, tell family or friends, call you healthcare provider or contact the National Suicide Prevention Lifeline at 800-273- . Counselors are available 24/7.

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What Is A Major Depressive Episode

Major depression is a mood state thats characterized by low energy levels, low mood, and feelings of despair or hopelessness. Depression is one of the most common mental health issues in the United States after anxiety disorders.

When it comes to bipolar disorder, major depression is identified by a set of symptoms similar to a manic episode. The DSM outlines nine symptoms of depression, and you need to experience five or more of them for it to be considered a major depressive episode. The symptoms include:

In addition to experiencing at least five of these symptoms, one of them has to be the first or second symptom. A low mood and the loss of interest in activities are definitive symptoms of a major depressive episode.

What Are The Triggers Of Manic Episodes

What Are Mixed Episodes In Bipolar Disorder? | Mental Health 101 | Kati Morton

Manic episode triggers are unique to each person. Youll have to become a bit of a detective and monitor your mood and start to track how you feel before an episode and when it occurs. Ask family and close friends who you trust and have close contact with to help identify your triggers. As outside observers, they may notice changes from your usual behavior more easily than you do.

Knowing your triggers can help you prepare for an episode, lessen the effect of an episode or prevent it from happening at all.

Common triggers to be aware of include:

  • A highly stimulating situation or environment .
  • A major life change .
  • Lack of sleep.
  • Substance use, such as recreational drugs or alcohol.

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How Do Doctors Treat It

Although there’s no cure for bipolar disorder, treatment can help stabilize moods and help the person manage and control symptoms. Like other teens with long-lasting medical conditions , teens with bipolar disorder need to work closely with their doctors and other medical professionals to treat it.

This team of medical professionals, together with the teen and family, develop what is called a treatment plan. Teens with bipolar disorder will probably receive medication, such as a mood stabilizer, from a psychiatrist or other medical doctor. A psychologist or other type of counselor will provide counseling or psychotherapy for the teen and his or her family. Doctors will watch the symptoms closely and offer additional treatment advice if necessary.

Can Bipolar Turn Into Depression

While one disorder cannot evolve into or become another, its possible that someone diagnosed with depression experiences the symptoms of bipolar disorder later in life1, or that someone with bipolar is misdiagnosed initially with major depressive disorder, because of the similarity of the disorders symptoms.

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