Mixed Bipolar Disorder – Mixed Mood Episodes in Bipolar 1

Mixed Bipolar Disorder – Mixed Mood Episodes in Bipolar 1

Ask a Bipolar – What is a mixed mood in bipolar disorder?

As one of the Burble’s commenters mentioned, there seems to be a lack of good information on mixed moods available. After some Googling, I would tend to agree. While mixed mood episodes are pretty common for us bipolar folk, few people seem to be discussing it.

This is the beginning of a four-part series on mixed moods in bipolar disorder:

What is a Mixed Mood Episode?

By definition, a mixed mood in bipolar disorder is the presence of both depression and mania. According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), mixed moods are only present in bipolar disorder type 1 as mixed moods require the presence of mania.

Mixed mood episodes are (officially) found in bipolar disorder 1 and are characterized by:

  • Persons must meet both the criteria for mania and major depression; the depressive event is required to be present for 1 week only.
  • The mood disturbance results in marked disruption in social or vocation function.
  • The mood is not the result of substance abuse or a medical condition.

Mixed mood episodes are officially considered part of the manic phase of bipolar disorder.

What is Bipolar 1 Mania?

As a quick refresher, mania is a part of bipolar disorder type 1 and is diagnosed as the following:

Manic episodes are characterized by at least one week of profound mood disturbance, characterized by elation, irritability, or expansiveness. At least three of the following symptoms must also be present:

  • Grandiosity
  • Diminished need for sleep
  • Excessive talking or pressured speech
  • Racing thoughts or flight of ideas
  • Clear evidence of distractibility
  • Increased level of goal-focused activity at home, at work, or sexually
  • Excessive pleasurable activities, often with painful consequences

The mood disturbance is sufficient to cause impairment at work or danger to the patient or others. The mood is not the result of substance abuse or a medical condition.

(A more technical definition of mania/hypomania can be found in the next post. Mania and hypomania are diagnostically the same – the difference is in the degree of symptomology. Also in that mania may include hallucinations whereas hallucinations are not present in hypomania.)

What is a Major Depressive Episode?

Refresher two, a depressive mood (in bipolar 1 or bipolar 2) is diagnosed by the following:

For the same two weeks, the person experiences five or more of the following symptoms, with at least one of them being either a depressed mood or characterized by a loss of pleasure or interest:

Mixed Moods in Bipolar 1 Disorder

So, though a major depressive episode requires two weeks of symptoms, an official mixed mood only requires one week of depressed symptoms. While mania has a relatively low incidence of suicide, in mixed episodes the depressive phases increase the risk of suicide.

Mixed Moods in Bipolar 1Depressive Phases?

Seems so. There seems to be a general confusion between extremely rapid-cycling moods and mixed moods as outlined in the DSM. People in a mixed mood episode can either oscillate rapidly between severe mania and depression or they can experience the moods simultaneously, as outlined above.

What’s the difference between rapid cycling and mixed moods? From my research, it’s not clear that we understand the difference, but if I had to guess, I’d say psychiatric history probably separates the two.

What Do We Know About Mixed Moods in Bipolar Disorder?

Patients with a mixed mood in bipolar disorder type 1 often exhibit:

  • Marked irritability / aggression
  • Delusions and hallucinations consistent with either depression or mania or both
  • Dramatic oscillations between depression and euphoria
  • Severely impaired judgement and insight

Because mixed moods are technically considered part of mania, they are generally treated with lithium, an anticonvulsant or an antipsychotic. Antidepressants could make the mixed state worse. However, treating a mixed mood is difficult particularly if the person doesn’t fit into the textbook definition (and most don’t) and primarily have depressive symptoms.

Series on Mixed Moods in Bipolar Disorder

Stay tuned: Upcoming in this series:

Reference: Medscape Reference, Bipolar Affective Disorder Clinical Presentation


About Natasha Tracy

Natasha Tracy is an award-winning writer, speaker and consultant from the Pacific Northwest. She has been living with bipolar disorder for 18 years and has written more than 1000 articles on the subject.

Natasha’s New Book

Find more of Natasha’s work in her new book: Lost Marbles: Insights into My Life with Depression & Bipolar. Media inquiries can be emailed here.

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