You are here

In the Thick of Mixed

Help us win Healthline's Best Health Blog of the Year! Vote for International Bipolar Foundation here

I can’t believe that I’m actually writing this in the middle of a mixed episode right now, or presenting mixed features of a bipolar episode, because for the most part when my mind races like this, I can’t even articulate a relevant thought let alone write a series of them. 

What are mixed features? To put this as simply as possible, I am currently experiencing heightened energy, lack of sleep, and racing thoughts as well as restlessness and agitation. All of these symptoms are combined with the typical depressive episodes of bipolar disorder. 

I’m not overly surprised that I am in fact experiencing all of this, it’s historically ‘my time’ to do so. When you look back on my history that has been so painstakingly detailed by my psychiatrists, my charts show my two major swings a year. I go up in the spring and go down in the fall, every single year. Basically you could chart the change of seasons by my major cycles. Typically I have a warning period; roughly three days where my moods start to shift and I notice an increase in agitation and decrease in sleep. For some reason the warning signs were not there this time. One day I was okay, the next I was considering going inpatient, and I have absolutely no idea what shifted to have me in such a significantly awful state. 

What is upsetting is that I have prepared myself for this for the past year in hopes that I could avoid it. I have dutifully attended mindfulness courses as well as CBT, taken my medications faithfully and participated in one-to-one therapy as well as group therapy. 

I know my triggers, and I have become a wizard when it comes to avoiding and handling them. The distressing part of this horrific disease is that while I continue to choose healthy paths and prepare for the inevitable, I cannot avoid it. I am an advocate, I counsel others on how to navigate the waters of mental illness, but as educated as I am, it doesn’t stop the disease from affecting me. 

I have numerous supports set in place at the moment. I just spent the last 72 hours in and out of sleep on my psychiatrist’s orders. I was prescribed a higher dose of sleep aids to help me through this. Sleep is so important when trying to regulate moods, and it has proven to be a big help for me time and time again. Unfortunately in a mixed state, sleep doesn’t come naturally for me, I do rely on medication for this that will eventually require me to wean off of.

My first line of defence when entering a mixed episode is to hit it with ‘emergency meds’ prescribed by psychiatrist, who is also a medication specialist. These are meds that I do not take routinely; they consist of what my psychiatrist and I have called a ‘mania preparedness kit’. In two days I will see her for a face-to-face for an appointment and if my symptoms haven’t ceased (they’re slowing now) we go from there. 

‘There’ would be an increase of medications in a supervised setting, which is a fancy way of saying that I would voluntarily admit myself to a psychiatric unit. I’m not afraid of admitting myself; I’ve done this before and have always come out stronger. The thing about mixed episodes is that they are the brutal ones for me. I get paranoid, restless and am plagued by thoughts of suicidal ideation. 

Mixed episodes are particularly brutal for me as they completely disrupt every aspect of my life. I am no longer able to function with my activities of daily living, instead I pace restlessly starting one project to stop in the middle and start another. Chaos and disorder accompany every single mixed episode, and the loss of control that I feel is terrifying. The only thing racing faster than my jittery body is my mind, and that becomes impossible to stop on my own. My thoughts are plagued with how I am a failure and how much better the world would be without me in it. During a mixed episode I become non-compliant very quickly. I lash out in anger and frustration at those who love and support me and I also have a terrible habit of trying to convince everyone to agree with my decisions to stop my medications. Thankfully, we’ve been here before and my supports are strong.

The silver lining in all of this is that while things aren’t great, I am completely aware of what’s going on. The tricky thing about me specifically when it comes to bipolar disorder is that when I cycle, I have a small window before I go non-compliant. After years of ups and downs I have learned that the best way for me to live a healthy and balanced life is to speak up. I am not ashamed of my illness or my symptoms. I work every single day to lead the healthiest life I can, and even when I do everything that I should, bipolar still has a few tricks that catch me unawares.

I have an amazing support system that I can lean on when times get tough. I know, logically, that my illness is amped. I have put so many safeguards into place that I am confident that this to shall pass. I’m going to be okay, even though this is a terrifying feeling; somewhere inside of me I know that this is going to be okay. I recognize that because I have worked so hard to live well, these episodes no longer have the control over me that they once did. 

You can get through this, I promise you that. Don’t ever stop talking; don’t ever stop asking for help. A healthy and happy life is entirely possible; sometimes we have a few hiccups along the way.

To read more from Nicole, see her posts from IBPF here or visit her website at The Lithium Chronicles


Hi Nicole, this was a wonderful article to read, I have scitzoaffective disorder, and I can relate to almost all of what your experiencing. I have a greater awareness of my cycle and what is happening during a swing and try to take steps to avoid a full episode. Even though I am heavily medicated I still experience these symptoms. It is good to read someone else's experiences as it makes me feel less alone in this illness. Thanks!

You're very welcome, Mathew.

I'm so happy to read that you do have an awareness, it's still so surreal sometimes though isn't it?

All the best to you.


Thank you for sharing.

You're welcome, Angie.

Thank you for reading and commenting,

All the best

Thank you so much for writing this! I have been experiencing (very) rapidly cycling mixed episodes for the past three years since I was diagnosed, with the last two years being the worst. I look for posts or any personal stories about people who experience mixed episodes all the time and have found exactly zero up until now. My episodes are a lot like yours but I am angry all the time, with rage episodes which are horrible and completely out of my control. I have tried pretty much every medication that could possibly be helpful, but I either can't tolerate them or they don't work. That's a big struggle because I start a new episode always within a month of the last one ending and I am a single mom with a little girl who is very effected by my illness. I relate so much to your inability to focus...starting something, getting "lost," starting another, and never finishing anything. I also get stuck in places, like the grocery store for 6 hours, day after day, because as much as I know I want to leave and feel scared, I can't over-ride what my brain wants to do which is examine everything without focus so I am all over the place looking at everything that has no meaning for me.. Anyway, I really just wanted to thank you! I was feeling so crazy and incredibly alone. This was so helpful!

Hi Rachel

I get it, I really do. I've had the panic as well as the rage. Have you looked into DBT or CBT classes at all? Some people find mindfulness hokey, but it's done wonders for me, especially when i get set off in a place like the grocery store.

You're never alone


Just thank you for writing this... It makes me know I am not alone! Karen :)

Hi Karen,

You are never alone. I'm happy that the blog helps a bit.

All the best,

Thanks for sharing you up an downs ,I gave three sons ... Life Is hard, eve without suffering a eldest son suffers lots of ups an downs, it has been a very long road for us all he has know been diagnosed with bipolar, his dad also had it : the sad thing is, his dad commited suicide 6 years ago he was very unwell for many years
I worry constantly this is the path my son could take.

Hi Debbie
I am so sorry for your loss. Suicide is devastating to say the least. Keep an open dialogue with your son, I know how much that would scare you, but talking about things is so important, especially something as serious as what you've all been through.

All the best to you and yours,

Thank you for sharing I am currently going through the same thing,Bipolar mixed states no sleep,I am brunette with tiny amount of grey this week I was up at 2;00 am and wanted to dye my hair Platinum in a heightened state thank god I didnt got a little laugh with my shrink

Oh Claire, I've been there, mine was fire engine red, and I went through with it. Hang in there.

All the best


This exact thought occurred to me as well, I am a brunette with a little grey. I've been looking up platinum hair styles on Pinterest for the last two days until I showed my daughter what I wanted to do and she looked horrified. That is when I realized I might want to check in with my Doctor.
I am fully depressed, meaning I have every symptom but I also get super irritated and have rage outbursts as well. I am so very anxious. I wonder if it is a mixed episode or just bipolar depression with anxiety. Whatever it is, it is awful.

I am a 30 yr old man that struggles with rapid cycling and mixed episodes regularly. I have not been able to find that stable combination of meds that help. I have twin 3 yr olds and an 8 yr old. I have periods when I am so completely disorganized and unfocused that I lose myself. I can't ever seem to finish anything and it is infuriating. The constant racing thoughts and the complete inability to function without impacting my family negatively has driven me to the edge many times. I am Happy knowing that I am not alone and there are others that experience this. I do not have the option of sleeping meds as my 3 yr old son wakes up and terrorizes the house while I am asleep. I have been trying to cope an just the one med they give me to stabilize my moods. Lithium. I am not sure if it is effective or if it has made the cycling come more often. I don't crash as hard when I do crash, but it is a horrible feeling. Coping skills can only take me so far and I am tired of effecting others in a negative way. I am on my way back up now and I cant even seem to focus to get this typed and have jumped all over, I just want to thank you for sharing

As a clinician, thank you for writing this. I've been looking to educate myself and this was a great read and exactly what I was looking for!

Thank you for sharing! Such an honest and brilliant way of describing what it is like with this illness. Well written for sure!

I am hypomanic bipolar and I am going through this right now.

Hi im currently going through this right now. It's so annoying. Yoga and good old antipsychotics usually help me get through these but unfortunately this one is a little rougher. I feel like I've been clenching my jaw all day. It'll just build till full blown mania if I don't sleep soon. Anyways the point was thanks.

Thank you for this. I needed to know I was not alone. It is so frustrating to do all the things I'm supposed to do and still feel like I'm failing. So easy to think why take the meds if I'm going to get to this place anyway?
Sometimes commrodery in despair gives hope. Thank you.

You have just described what I have been through 3 times in the last 12 months, with the latest episode being the worst for me. I've experienced mixed moods for 10 years and can pretty much remember them all but cannot get the NHS to see it. They only see my EUPD diagnosis. Tomorrow marks 4 weeks since I survived an OD, I ended up in ICU. I am now fighting with my mental health team to get them to medicate me. What I experienced this time was so scary, I felt I had no control over anything.

I have lives for 49 years ashamed of my inability to control myself. I finally have a psychiatrist and am getting the help i need. It has been so hard and i want to be better. Thank you for giving me hope

Hi there, thank you for this article!

I've had Bipolar Type 1 since I was 17, although was only diagnosed 5 years ago. Strangely though, my bipolar appears to be changing as I age. Previously I've had 3-6 months of mania, followed by a year of depression then 6-7 years of "normality". Over the past 2 years my episodes have become mixed, with psychotic features which have been really difficult to deal with.

Any suggestions?

Thank you for your article. I'm in that in between place, where I have realized something is off and I am teetering a bit. Your article has reminded me to take a deep breath and start utilizing my action/safety plan. Wish me luck because I feel like the rollercoaster is just starting the climb.

Thanks Nicole. At the ripe old age of 63 I'm learning that I too have mixed state bipolar. Thankfully, most of the time my meds and other therapies and activities keep me quite stable. Looking back, I'm beginning to see a trend of going into a mixed state with insomnia, hyper alertness, racing and impulsive thoughts, feelings of failure and self hatred during the summer time. It makes me mad that I'm doing everything I can to stay well and yet I can still have these occasional flare ups for no reason I can see. I know enough to get help early and I'm lucky to have a supportive family and a great therapy team.

Thank you for writing this. I'm struggling now as my boyfriend (both in our early 30s) has just been diagnosed with mixed bipolar. I'm stuck trying to go back and re-think our history together, his actions and decisions, and everything else. It's not easy, but reading your experience helps me to understand a bit more what he may be feeling. Thank you.

I would also like to thank you. I am currently in a frustrating mixed state. I am 40 and have rapid cycling bipolar diagnosed at 22. My son is grown and I live a very regulated peaceful life. I pay close attention to my moods, my meds and my lifestyle and still struggle often. I take lithium daily and also have my go to kit to prevent mania. My depressions are severe and I use Ect when my other meds aren’t enough and I feel it becoming dangerous. I appreciate being able to read thoughtful conversations like this, especially during the difficult times. I feel the big picture conversation often lacks the hard truth that treatment of bipolar over an extended period is not a linear process. It requires many tools and an awareness, energy and willingness that Is exhausting for those trying to stay sane. Thank you for reminding us to persevere.

I can't tell if I'm going through a mix episodes because of the stupid drugs I am on and I'm going crazy and I had I can't stop pacing and thinking and I feel like under my skin is like rip it off or something and but at the same time I feel, I don't know. Can't deal with feeling both these things at once I want to feel comfort

Ty for this writing. I'm in the midst of a mixed episode and just trying to survive the day. I also think about going inpatient when I feel like this. I can't afford it. My insurance sucks, and I need to be here for my kids. I keep repeating: it will get better. It has 100% of the time.

Add new comment

PLEASE POST COMMENTS ONLY. If you are in need of an IBPF resource, please contact Aubrey @ If you are in crisis, please call 1-800-784-2433.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.