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Mixed State in Bipolar Disorder

Childrens Health > Mixed State in Bipolar Disorder

The term mixed state refers to a period during which symptoms of mania and depression are simultaneously present. If you have, or know of someone with bipolar disorder you are likely familiar with the term. Bipolar disorder (also called manic-depressive illness) affects approximately one percent of Americans and is characterized by periods of depression, mania or mixed state. Episodes are often recurrent throughout a person’s lifetime and are separated by periods of wellness, during which few or no symptoms are present. Significant medical advances have led to treatment options that limit work/life disruptions. A small percentage of the population will experience chronic episodes that are not sufficiently relieved with medication or treatment to allow typical work/life activities.

Although it is important to understand the terminology related to any mental health diagnosis (because it allows for learning, discussion and research) it is even more important to externalize the diagnosis or separate the person from the “problem.” While labels or diagnoses can be important in terms of access to benefits and services, they can also be limiting in terms of recovery, self-concept and personal relationships.

It is useful here to discuss briefly the features of depression, mania and finally mixed state. As you read, again, please be mindful that labels can be heavy, and at all times the individual should be at the forefront of consideration.


Depression is much more than simply feeling blue. It is characterized by periods of extreme sadness, loss of interest in activities previously enjoyed, changes in appetite and sleep patterns, inappropriate feelings of guilt, unworthiness and hopelessness, lethargy and thoughts of death or suicide.

Depression is typically diagnosed when several symptoms are present. These symptoms are persistent and pervasive. Increased awareness and understanding of depression has led to an increase in diagnosis and treatment. Some might even say that we are now leaning toward excessive prescription treatment, driven, in part by pharmaceutical companies (it is further contended that behavioral and/or other types of therapy could achieve similar results).

In recent years, pharmaceutical companies and the media have “normalized” or removed much of the stigma from depression. Obviously, there are pros and cons to this shift (we will limit our concentration to the advantages for this discussion). On the plus side, those who are struggling with depression are more likely to reach out for and get the support they need. Also, support and information are now more widely accessible. Additionally, treatment is more accessible and affordable. It is not uncommon to hear water cooler discussions about therapists and/or antidepressant medications that co-workers or friends may be using. To date, bipolar disorder has not benefited from such a change in social consciousness. Consequently, it is the responsibility of mental health professionals and advocates to lead the charge that will turn the tide.


Most of us are less familiar with mania. Mania refers to a period during which a person experiences an unusually and persistently elevated mood. The high mood is accompanied by at least three other features such as physical agitation, excessive involvement in risky behaviors, overly high self-esteem, racing thoughts, difficulty concentrating, decreased need for sleep, and increased talkativeness. As with depression, mania should be understood as a treatable disorder experienced by a person rather than a fundamental or inseparable feature of a person’s make-up.

Mixed State

As stated earlier, mixed state refers to a period during which symptoms of mania and depression are simultaneously present. As you might imagine, this can be an extremely painful time. Compassion, rather than shaming, is critical. Symptoms may include difficulty sleeping, dark, pessimistic or suicidal thoughts, agitation and changes in appetite.

Bipolar disorder is most often diagnosed in late adolescence or early adulthood, although more early diagnosis does occur. Whether you or a friend or family member has been diagnosed, it is important to stay abreast of new research and treatment options. Information can invaluable for advocating for yourself or a loved one. There are a number of reliable sources of information and support groups for those directly and indirectly impacted by bipolar disorder.

Childrens Health > Mixed State in Bipolar Disorder