What is a Mixed Episode?

A mixed episode is a psychiatric state where someone experiences symptoms of both mania and depression at the same time. Diagnostic manuals used to define diagnoses for psychiatric purposes, such as the Diagnostic and Statistical Manual Mental Disorders, published by the American Psychiatric Association, have very strict definitions for mixed episodes. Many people who experience states that are clearly mixed in nature are not diagnosed with mixed episodes because they don't fit within the narrow diagnostic criteria, and this can make treatment very challenging.

To be officially considered a mixed episode, a patient must experience major depression and mania simultaneously for at least a week. This state is most commonly seen in people with bipolar I, a psychiatric disorder characterized by periodic episodes of mania or depression. The mixed state can manifest in a number of different ways. People may have agitated depression or dysphoric mania, with racing thoughts, agitation, and extreme depression, including suicidal thoughts and a flat affect.

This combination of manic and depressive symptoms can be extremely dangerous. Patients experiencing mixed episodes are at increased risk for suicide, self harm, and other psychiatric complications. It is not uncommon for patients to require hospitalization for treatment. Self care and completion of daily tasks can become challenging and sometimes impossible. Patients may forget to eat and practice basic hygiene and they can become antisocial as they struggle with the conflicting thoughts that they are experiencing.

Medications designed to stabilize mood can be used in the treatment of a mixed episode. These medications must be prescribed with care because some patients can react poorly to certain drugs, experiencing more severe symptoms rather than an alleviation. Psychotherapy is beneficial for some patients once they are stabilized on medications and other treatments may be explored as well, depending on the specifics of a particular case.

Patients with a history of mental illness may be aware of the warning signs of a mixed episode and they may take steps to receive treatment before the symptoms become severe. In other cases, patients may not recognize the onset or they may not have experienced such episodes before, and thus are unprepared for them. It is very important for patients to receive treatment while they are experiencing mixed episodes because this state can be extremely dangerous. Even if a patient does not meet the diagnostic criteria because the state is too short or hypomania instead of mania is experienced, there are serious risks associated with the simultaneous experience of mania and depression in a mixed episode.