Bipolar disorder is a complex set of conditions that can present in unique ways. All of them involve mood swings that can be mild or severe and last for various amounts of time. People with bipolar disorder have depressive episodes as well as manic or hypomanic episodes, which
are periods of heightened energy, altered mood and distress. The difference is that hypomanic episodes are less intense.
As we’ve learned more about the variations of bipolar disorder, its diagnostic criteria have changed. Bipolar 1, bipolar 2 and cyclothymic disorder are the three profiles of the most common mood patterns. In the earliest research on bipolar disorder, clinicians discussed the three groups of symptoms as distinct episodes. There was little to no room for overlap. Now we know that these symptoms can overlap, and they often do. In the DSM-5, this is known as bipolar disorder with mixed features.
Recent changes in the criteria for these mixed episodes have important implications for the diagnosis and treatment of bipolar disorder. This article outlines the current definition of bipolar disorder with mixed features. We’ll also shed some light on how it’s evolved and what this means for people with this condition.
What should I know about mixed features of bipolar disorder and mixed episodes?
In the DSM-IV, the term “mixed episode” was used to describe mood episodes that met the criteria for both manic and depressive episodes at the same time. This definition doesn’t account for overlap with hypomanic and subclinical depressive symptoms. It only applies to people with bipolar 1. About 40% of people with bipolar disorder have mixed episodes that fit this definition.
Now we understand that it’s common for people to experience lower levels of depression and hypomania in combination with each other. They can also come along with more pronounced depressive or manic episodes. In the DSM-5, the specifier “with mixed features” replaced the previous definition of mixed episodes. It includes episodes with different combinations of manic, depressive and hypomanic symptoms. This covers a much broader range of presentations.
What are some symptoms of bipolar episodes with mixed features?
A lot of different language has been used to describe the mood fluctuations people experience with bipolar disorder. Studies in the PubMed database have used terms like “mixed states,” “mixed episodes,” “switching” and “rapid cycling.” However, mood episodes featuring both depressive and manic or hypomanic symptoms haven’t been extensively studied.
The possible combinations of depressive, manic and hypomanic symptoms are limitless. But in general, mixed episodes may include the following:
- Feeling a mixture of high and low moods simultaneously
- Having depressive symptoms while still being able to enjoy some activities
- Experiencing both low mood and rapid speech
- Having suicidal ideation with an elevated mood
- Extreme sleep disturbances
- Severe appetite changes
What’s the significance for people with bipolar disorder?
The expansion of the criteria for mixed episodes means more clinicians will recognize them more often. It shows they’re important for the diagnosis and management of bipolar disorder. Researchers estimate that under these new criteria, people with bipolar disorder have a threefold risk of experiencing them. That doesn’t mean their risk level has changed at all. Rather, it shows that more people who have episodes with mixed features will get the treatment they need.
The presence of manic or hypomanic and depressive symptoms doesn’t always mean a person has bipolar disorder. However, bipolar disorder has been historically underdiagnosed. This is partly because hypomanic symptoms may go unrecognized or dismissed by clinicians. Now more clinicians will know that mixed episodes are more common and often more subtle than once thought. They’ll be able to recognize them and treat them sooner. People who show symptoms of mixed states should be monitored for later episodes and serious illness.
It can take time to narrow down the best treatment options for people who have mixed episodes. The most effective treatments include psychotherapy combined with atypical antipsychotics, newer anticonvulsants and electroconvulsive therapy.
How can Lightfully help me recover and manage future episodes with mixed features?
At Lightfully, we put our clients’ lives and well-being first rather than focusing on a list of symptoms. Each person receives a personalized treatment plan that’s tailored to their outlook and their needs. We take a multifaceted, forward-looking approach to identify interventions and practices for mental wellness as part of our clients’ overall well-being.
Our treatment programs for bipolar disorder are comprehensive and guided by the client’s progress. We home in on your experience of your mood episodes to help you develop a relationship with them that’s a bit more empowered, safe and nonjudgmental.
What’s next for you in your treatment journey? If you’re looking for an intensive treatment program, you’re welcome at Lightfully. Reach out to our Admissions Concierge Team and let’s talk.
