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class="css-ifmqwy"></div></div><div class="css-4a7tih"><aside class="css-1wm8u43" data-testid="header-leaderboard" data-sticky="true"><div data-empty="true" class="css-1j2d96m"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="dlb1__slot" data-adbridg-ad-class="dlb1" data-ad="true" class="css-1jpwf16"></div></div></aside></div><aside data-testid="mobile-leaderboard" class="css-pdceuf"><div class="css-11egx89"><button class="icon-hl-close-thick css-1ik4tkj"></button><div data-empty="true" class="css-1fteite"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="mlb1__slot" data-adbridg-ad-class="mlb1" data-ad="true" class="css-bcus5s"></div></div></div></aside><div data-placement="subheader"></div><div><div class="css-m260rd"><div data-article-body="0" class="css-1h1rean css-fv6hqc"><div class="css-z468a2"><h1>What Is Bipolar Disorder with Mixed Features?</h1><div data-preamp="social-proof-lessons"></div><div data-testid="byline"><section data-testid="byline" class="css-hilgma"><div class="css-1q67gt9"><div class="css-xc63cd"><img src="//i0.wp.com/post.psychcentral.com/wp-content/uploads/2022/01/Jeffrey-Ditzell-New-Headshot-500x500-Bio.png?w=105&h=105" alt=""/></div></div><div><span><span>Medically reviewed by <a class="css-150s69f css-130mbve" href="https://www.psychcentral.com/reviewers/jeffrey-ditzell-do">Jeffrey Ditzell, DO</a></span></span> — <span><span><span><span>Written by <a class="css-150s69f css-130mbve" href="https://www.psychcentral.com/authors/crystal-raypole">Crystal Raypole</a></span></span></span></span> — <span> Updated on March 5, 2021</span></div></section></div><div><nav class="css-wp9hsz fontWeight" id="tab-bar-0" data-testid="tab-bar"><ul class="css-wy0i0w"><li class="css-1v4zg8b"><a href="#what-are-mixed-features" class="css-ek11fi">What are mixed features?</a></li><li class="css-1v4zg8b"><a href="#symptoms" class="css-ek11fi">Symptoms</a></li><li class="css-1v4zg8b"><a href="#treatment" class="css-ek11fi">Treatment</a></li><li class="css-1v4zg8b"><a href="#how-to-cope" class="css-ek11fi">How to cope</a></li><li class="css-1v4zg8b"><a href="#next-steps" class="css-ek11fi">Next steps</a></li></ul></nav><article class="article-body css-d2znx6 undefined"><div data-testid="tabbed-article-section" class="css-12va8w7"><span style="font-size:0;line-height:0"></span><span style="font-size:0;line-height:0"></span><div><div><p class="css-w2pt6r">Mood episodes, or extreme shifts in emotion that can last several days, are the key symptom of bipolar disorder. </p></div></div><div><p><a href="https://psychcentral.com/disorders/bipolar" class="content-link css-150s69f">Bipolar disorder</a> involves manic, depressive, or hypomanic episodes, but you could have more than one type of mood episode. The specific mood changes you experience depend on whether you have bipolar I, II, or <a href="https://psychcentral.com/disorders/cyclothymic-disorder-cyclothymia" class="content-link css-150s69f">cyclothymia</a>. </p></div><div><div data-preamp="serena-chatbot"></div></div><div><p>Mood episodes associated with bipolar disorder do fall into three general categories. Still, <a href="https://link.springer.com/article/10.1007%2Fs40263-015-0275-6" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">around 40%</a> of people living with bipolar disorder have a specific condition known as bipolar disorder with mixed features. </p></div><div><p>The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced “mixed features” as a specifier to replace the previous term, “mixed episodes.” <a class="content-link css-150s69f sl" href="https://psychcentral.com/bipolar/dysphoric-mania">Dysphoric mania</a> and mixed mania, other older terms for this condition, have mostly fallen out of common use.</p></div><div class="css-20w1gi"><aside class="css-0 css-0" data-testid="sticky-inline-ad" data-sticky="false"><div><div data-empty="true" class="css-1sq15os"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="inline2__slot" data-adbridg-ad-class="inline2__slot" data-ad="true" class="css-1t05dkn"></div></div></div></aside></div></div><div data-testid="tabbed-article-section" class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="what-are-mixed-features">What are mixed features in bipolar disorder?</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>If you have bipolar with mixed features, your mood episodes will have mixed symptoms. Here’s what this means, according to DSM-5 diagnostic criteria:</p></div><div><ul><li>During an episode of <a href="https://psychcentral.com/depression" class="content-link css-150s69f">depression</a>, you’ll have at least three symptoms of mania or hypomania. </li><li>During a <a href="https://psychcentral.com/disorders/manic-episode" class="content-link css-150s69f">manic</a> or <a href="https://psychcentral.com/disorders/hypomanic-episode-symptoms" class="content-link css-150s69f">hypomanic</a> episode, you’ll notice three or more symptoms of a depressive episode. </li></ul></div><div><p>This differs from other types of bipolar disorder, where episodes involve only one type of mood symptom. </p></div><div><p>You may not have mixed symptoms for the <a href="https://psychcentral.com/blog/how-long-is-a-typical-bipolar-episode#1" class="content-link css-150s69f">entire length of the episode</a>. Symptoms need only to last a <em>majority</em> of days during the episode. During a manic episode with mixed features that lasts a week, for example, you might have depression symptoms for 5 days, not the entire week. </p></div><div><p>Bipolar disorder with mixed features can be more severe than <a href="https://www.psychcentral.com/bipolar/difference-between-bipolar-disorder-1-and-2" class="content-link css-150s69f">bipolar I or II</a> without mixed features, since mood episodes tend to happen more frequently and last longer. </p></div><div><p>Symptoms might also be worse than typical bipolar symptoms and have more of an impact on your daily functioning. </p></div><div><p><a href="https://www.cambridge.org/core/journals/cns-spectrums/article/mixed-features-in-bipolar-disorder/7531CF5E9B9BD1FD84497A24C062C95E" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Research</a> has also linked mixed features to symptoms of psychosis, increased <a href="https://www.healthline.com/health/suicide-and-suicidal-behavior" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">suicide risk</a>, and substance use.</p></div><div><div id="widget_call_out_951edcb7-d644-4adb-a919-34036be343ff" class="css-ubcbi5"><span style="font-size:0;line-height:0"></span><div class="css-14hk5xp"><div class="css-xqvouu"><div class="css-slwzda"><p>If you or someone you know is considering suicide, you’re not alone. Help is available right now:</p><ul><li><strong>The 988 Suicide & Crisis Lifeline.</strong> Call or text the 988 Suicide and Crisis Lifeline at 988 or chat <a href="http://988lifeline.org/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">988Lifeline.org</a>.</li><li>Text “HOME” to the <a href="https://www.crisistextline.org/?gclid=EAIaIQobChMIsPDQrdXH5wIVBRx9Ch1YdQjIEAAYASAAEgJ_1_D_BwE" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Crisis Textline</a> at 741741.</li></ul><p>Not in the U.S.? Find a helpline in your country with <a href="https://www.befrienders.org/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Befrienders Worldwide</a>.</p></div></div></div><div class="css-1uwjw6e"><div></div><div></div></div></div></div><span class="css-zya54r"></span></div><div data-testid="tabbed-article-section" class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="symptoms">Symptoms of bipolar disorder with mixed features</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>Bipolar disorder can involve a <a href="https://psychcentral.com/bipolar/bipolar-disorder-symptoms" class="content-link css-150s69f">wide range of symptoms</a>. If you live with bipolar I disorder, you might have a very different experience from someone else living with the same condition. </p></div><div><p>A mixed features mood episode generally won’t show up in the same way as a mood episode without mixed features, and you may not have an equal combination of symptoms. In other words, more of your symptoms might fall into one category — mania, depression, hypomania — than the other.</p></div><div><p>The combination of symptoms can lead to some clear contrasts and inconsistencies in your mood, speech, and behavior. Here’s what that can look like: </p></div><div><h3>Symptoms of mania with mixed features</h3></div><div><p>Your mood episode will meet the criteria for an episode of mania or hypomania, but you’ll also have at least three symptoms of depression:</p></div><div><ul><li>feelings of uneasiness or disconnection from reality</li><li>extreme sadness or tearfulness</li><li>a sense of emptiness, worthlessness, or guilt</li><li>energy loss and fatigue</li><li>lack of interest or enjoyment in your usual activities</li><li>moving and speaking more slowly than usual</li></ul></div><div><p>A mixed features episode won’t always involve the same euphoria or feelings of grandiosity that often accompanies mania. You won’t necessarily feel on top of the world or experience the same elevated self-confidence and self-esteem. </p></div><div><p>You’re more likely to notice rapid changes in mood, increased irritability, and difficulty controlling strong emotions. In addition:</p></div><div><ul><li>Your thoughts might race, or your speech might become very rapid, while you feel very low and slowed down in mind and body. </li><li>You might find yourself unable to stop smiling or laughing despite persistent feelings of guilt or thoughts of suicide. </li><li>Feelings of hopelessness or sadness might show up alongside physical restlessness, anxiety, or increased energy. </li></ul></div><div><h3>Symptoms of depression with mixed features</h3></div><div><p>A depressive episode with mixed features will also involve three or more symptoms of mania or hypomania:</p></div><div><ul><li>increased talkativeness and rapid speech, often characterized by frequent or sudden shifts in topic</li><li>extreme excitement or restlessness</li><li>increased energy </li><li>racing thoughts</li><li>greater distractibility</li><li>less of a need for sleep, or feeling rested after very little sleep</li><li>impulsive behavior or lowered inhibitions</li></ul></div><div><p>While the DSM-5 includes grandiosity and an elevated mood among the typical signs of a manic episode, <hl-trusted-source source="PubMed Central" rationale="Highly respected database from the National Institutes of Health"><a href="https://pubmed.ncbi.nlm.nih.gov/28031070/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">research</a></hl-trusted-source> suggests these symptoms show up less commonly in depressive episodes with mixed mania. Some people do still experience these symptoms, though. </p></div><div><p>During a mixed depressive episode: </p></div><div><ul><li>An emotional “high” or euphoric state of mind might conflict with extreme sadness or guilt. </li><li>You could feel irritable or tearful, even while completely focused on a creative project you usually enjoy.</li><li>Persistent feelings of emptiness or worthlessness can show up alongside increased energy or restless movement. </li><li>You might start several projects but get sidetracked easily and fail to get much done. </li></ul></div><div><p>The combination of rapid shifts between emotional states, impulsivity and distractibility, and racing thoughts can feel frightening and unpredictable. Symptoms of psychosis, such as delusions, hallucinations, and paranoia, can make this distress worse.</p></div><div class="css-20w1gi"><aside class="css-0 css-0" data-testid="sticky-inline-ad" data-sticky="false"><div><div data-empty="true" class="css-1sq15os"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="inline7__slot" data-adbridg-ad-class="inline7__slot" data-ad="true" class="css-1t05dkn"></div></div></div></aside></div></div><div data-testid="tabbed-article-section" class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="treatment">Treating bipolar disorder with mixed features </a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>Treatment for mood episodes without mixed features focuses on resolving either mania or depression symptoms — whichever you are experiencing at the time. </p></div><div><p>Treating mood episodes with mixed features, on the other hand, needs to address mania and depression at the same time. This can pose some challenges, since certain medical treatments may worsen some symptoms, sometimes without offering much relief from other symptoms. </p></div><div><p>Certain <a href="https://psychcentral.com/lib/antidepressant-medications" class="content-link css-150s69f">antidepressants</a>, for example, might intensify manic symptoms without relieving depression. Many people take lithium to treat manic episodes, but mood episodes with mixed features may not respond in the same way. </p></div><div><p>These mood episodes are often more resistant to treatment, so it may take some trial and error to find the most effective approach for your specific symptoms. The right treatment will help improve many of your symptoms without making others worse. </p></div><div><p>Treatment for bipolar disorder with mixed features typically involves <a href="https://psychcentral.com/bipolar/bipolar-disorder-treatment" class="content-link css-150s69f">medication</a>. Your doctor or psychiatrist may recommend one medication or a combination, such as:</p></div><div><ul><li>atypical antipsychotics (also called second-generation neuroleptics), such as aripiprazole and olanzapine</li><li>mood stabilizers, such as lithium, valproic acid, or divalproex</li><li>anticonvulsants, such as carbamazepine or lamotrigine</li></ul></div><div><p><hl-trusted-source source="PubMed Central" rationale="Highly respected database from the National Institutes of Health"><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299125/" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">Research</a></hl-trusted-source> also suggests <a href="https://psychcentral.com/lib/an-overview-of-electroconvulsive-therapy-ect#1" class="content-link css-150s69f">electroconvulsive therapy</a> as another potential treatment for bipolar disorder with mixed features. If you don’t see much improvement with medication alone, your mental health professional might also recommend ECT. </p></div><span class="css-zya54r"></span></div><div data-testid="tabbed-article-section" class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="how-to-cope">How to cope with mixed features</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>Experiencing both mania and depression at the same time can feel confusing or disorienting. </p></div><div><p>Coping with a mixed features mood episode can be difficult, particularly when you have a hard time identifying exactly how you feel. A rapidly shifting mood can create plenty of emotional turmoil, and frequent, intense suicidal thoughts aren’t uncommon. </p></div><div><p>The good news is that the right treatment and coping strategies can help people manage these symptoms effectively.</p></div><div><h3>Therapy</h3></div><div><p>Therapy with a trained mental health professional may not necessarily resolve severe mood symptoms, but it can be substantially beneficial when you live with bipolar disorder. </p></div><div><p>A therapist can help you begin to identify and <a href="https://psychcentral.com/blog/how-to-manage-emotions-more-effectively#1" class="content-link css-150s69f">manage overwhelming emotions</a>, abrupt mood changes, and thoughts of suicide, even when you’re unsure exactly what you’re feeling or what kind of help you need. </p></div><div><p>Therapy also offers a safe space to build coping skills and develop a crisis plan for future mood episodes. </p></div><div><p>A therapist can also offer support with recognizing and tracking <a href="https://psychcentral.com/blog/bipolar/2009/04/spotting-the-early-warning-signs-of-a-bipolar-mood-episode#1" class="content-link css-150s69f">early signs</a> of mood changes. When you catch a shifting mood early on, you can sometimes take steps to prevent an episode. </p></div><div><p>Bipolar disorder symptoms and mood episode cycles can change over time, so you might notice your treatment becomes less effective. Always let your therapist and the doctor who prescribed any medications know about new symptoms so that you can discuss more helpful treatments. </p></div><div><h3>Manage stress</h3></div><div><p><a href="https://psychcentral.com/blog/10-practical-ways-to-handle-stress#1" class="content-link css-150s69f">Stress</a> in your day-to-day life can sometimes trigger mood episodes. While it’s not always possible to prevent stress, having a few <a href="https://www.healthline.com/health/10-ways-to-relieve-stress" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">go-to coping strategies</a> in place can help you maintain a calmer mindset when challenges pop up. </p></div><div><p>Try these tips: </p></div><div><ul><li>Make time for regular relaxation. This might include a nature walk, a warm bath, aromatherapy, or low-key pleasures like reading or coloring.</li><li>Try <a href="https://www.healthline.com/health/grounding-techniques" target="_blank" rel="noopener noreferrer" class="content-link css-150s69f">grounding techniques</a>, such as deep breathing, when you find yourself in a stressful situation. Your favorite relaxing <a href="https://psychcentral.com/lib/the-power-of-music-to-reduce-stress#1" class="content-link css-150s69f">music</a> can help, too.</li><li>Consider <a href="https://psychcentral.com/blog/10-surprising-health-benefits-of-mindfulness-meditation" class="content-link css-150s69f">meditation</a> to boost your ability to recognize and let go of unwanted thoughts.</li><li>Many people find that practicing <a href="https://psychcentral.com/blog/new-to-mindfulness-how-to-get-started#1" class="content-link css-150s69f">mindfulness</a> can help them reduce stress. However, it’s useful to remember that mindfulness can be challenging for people who have experienced trauma.</li><li><a href="https://psychcentral.com/lib/progressive-muscle-relaxation" class="content-link css-150s69f">Progressive muscle relaxation</a> is another tool for relaxing your mind and body. This involves slowly tensing and relaxing each muscle to relieve psychological stress and physical tension throughout your body.</li><li>A daily journal can help you express upsetting or painful feelings, keep track of mood symptoms, and increase emotional awareness.</li><li>Turn to loved ones for emotional support and help brainstorm problem-solving strategies or positive distractions during times of stress.</li></ul></div><div><h3>Follow a regular schedule</h3></div><div><p>Since unpredictable or random daily routines can also lead to mood changes, <a href="https://psychcentral.com/lib/building-a-routine-when-you-have-bipolar-disorder#1" class="content-link css-150s69f">keeping your days structured</a> could help prevent mood episodes.</p></div><div><p>Consider creating a weekly schedule that outlines specific times for things like:</p></div><div><ul><li>work</li><li>exercise</li><li>relaxation and alone time</li><li>time with friends and romantic partners</li><li>meals</li><li>chores and errands</li><li>switching off devices before bed</li></ul></div><div><p>Choose a regular bedtime and wake time, and stick to these times as closely as possible, even on the weekends — a <a href="https://psychcentral.com/blog/bipolar-laid-bare/2016/04/5-sleep-problems-common-with-bipolar-disorder#1" class="content-link css-150s69f">regular sleep-wake schedule</a> can sometimes help prevent mood episodes. </p></div><div><h3>Take care of your health</h3></div><div><p>If you’ve heard of the mind-body connection, you’ll know physical and mental well-being are linked. </p></div><div><p>Good health can’t cure mental health conditions, but all the same, physical wellness can improve your outlook and boost resilience, giving you the emotional strength to manage life’s unpredictable aspects. </p></div><div><p>Try these <a href="https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt-2#1" class="content-link css-150s69f">self-care</a> strategies:</p></div><div><ul><li>Set aside 7–9 hours for sleep each night.</li><li>Eat balanced meals at regular times.</li><li>Stay hydrated.</li><li>Limit <a href="https://www.psychcentral.com/depression/caffeine-and-depression" class="content-link css-150s69f">caffeine</a>, alcohol, and other substance use, since they may prompt mood changes or make symptoms worse. </li><li>Try to get some <a href="https://psychcentral.com/blog/10-health-benefits-of-daily-exercise#1" class="content-link css-150s69f">exercise</a> each day. </li><li>Make time for your favorite hobbies. </li></ul></div><div class="css-20w1gi"><aside class="css-0 css-0" data-testid="sticky-inline-ad" data-sticky="false"><div><div data-empty="true" class="css-1sq15os"><div class="css-1hjaa0k"><span class="css-zya54r"></span></div><div id="inline12__slot" data-adbridg-ad-class="inline12__slot" data-ad="true" class="css-1t05dkn"></div></div></div></aside></div></div><div data-testid="tabbed-article-section" class="css-1avyp1d"><span style="font-size:0;line-height:0"></span><div><h2><div><a class="chartbeat-section" name="next-steps">What next?</a></div></h2></div><span style="font-size:0;line-height:0"></span><div><p>It can take some time to find the best treatment for bipolar disorder with mixed features, but don’t lose hope. Improvement <em>is </em>absolutely possible. </p></div><div><p>As you work with your care professional to find the right treatment, keep in mind that lifestyle changes can also help reduce symptoms and make it easier to manage mood episodes. </p></div></div></article><span class="css-zya54r"></span></div><p data-testid="last-medically-reviewed" class="css-1kir5of"><span> </span></p><div><div class="css-zvkybb css-796gpq"><div class="css-1xn3edc"><div aria-expanded="false" aria-controls="article-resources" class="css-1l48sh1" role="button"><p class="css-1dxissy"><span class="css-1p6d3md icon-hlvideo-minus"></span><span class="css-1p6d3md icon-hlvideo-plus"></span> <span class="css-1xdhyk6">17 sources</span><span class="sro">collapsed</span></p></div><div id="article-resources" role="region" class="css-1ugaz02"><ul class="css-1vedeqe"><li class="css-f6pdvi"><cite><span>American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 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(2020).</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.cdc.gov/violenceprevention/about/copingwith-stresstips.html">https://www.cdc.gov/violenceprevention/about/copingwith-stresstips.html</a></cite></li><li class="css-f6pdvi"><cite><span>Fagiolini A, et al. (2015). Diagnosis, epidemiology and management of mixed states in bipolar disorder.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://link.springer.com/article/10.1007%2Fs40263-015-0275-6">https://link.springer.com/article/10.1007%2Fs40263-015-0275-6</a></cite></li><li class="css-f6pdvi"><cite><span>Flight of ideas. (n.d.).</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://dictionary.apa.org/flight-of-ideas">https://dictionary.apa.org/flight-of-ideas</a></cite></li><li class="css-f6pdvi"><cite><span>Frigerio S, et al. (2020). The impact of caffeine consumption on clinical symptoms in patients with bipolar disorder: A systematic review.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://onlinelibrary.wiley.com/doi/10.1111/bdi.12990">https://onlinelibrary.wiley.com/doi/10.1111/bdi.12990</a></cite></li><li class="css-f6pdvi"><cite><span>Lemon JC, et al. (2013). Exploring the mind-body connection: Therapeutic practices and techniques.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.counseling.org/docs/default-source/vistas/exploring-the-mind-body-connection-therapeutic.pdf?sfvrsn=13">https://www.counseling.org/docs/default-source/vistas/exploring-the-mind-body-connection-therapeutic.pdf?sfvrsn=13</a></cite></li><li class="css-f6pdvi"><cite><span>Lim L, et al. (2003). Keeping your balance: Coping with bipolar disorder.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.cci.health.wa.gov.au/-/media/CCI/Consumer-Modules/Keeping-Your-Balance/Keeping-Your-Balance---07---Behavioural-Strategies-for-Preventing-Mania.pdf">https://www.cci.health.wa.gov.au/-/media/CCI/Consumer-Modules/Keeping-Your-Balance/Keeping-Your-Balance---07---Behavioural-Strategies-for-Preventing-Mania.pdf</a></cite></li><li class="css-f6pdvi"><cite><span>Muneer A. (2017). Mixed states in bipolar disorder: Etiology, pathogenesis and treatment.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299125">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299125</a></cite></li><li class="css-f6pdvi"><cite><span>Ng F, et al. (2007). 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Mixed features in bipolar disorder.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.cambridge.org/core/journals/cns-spectrums/article/mixed-features-in-bipolar-disorder/7531CF5E9B9BD1FD84497A24C062C95E">https://www.cambridge.org/core/journals/cns-spectrums/article/mixed-features-in-bipolar-disorder/7531CF5E9B9BD1FD84497A24C062C95E</a></cite></li><li class="css-f6pdvi"><cite><span>Sonne SC, et al. (2002). Bipolar disorder and alcoholism.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm">https://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm</a></cite></li><li class="css-f6pdvi"><cite><span>Swann AC, et al. (2013). Bipolar mixed states: An International Society for Bipolar Disorders Task Force report of symptom structure, course of illness, and diagnosis.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2012.12030301">https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2012.12030301</a></cite></li><li class="css-f6pdvi"><cite><span>Targum SD, et al. (2011). The complexity of "mixed" depression: A common clinical presentation.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140897">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140897</a></cite></li><li class="css-f6pdvi"><cite><span>Tohen M. (n.d.). Expert Q & A: Bipolar disorder.</span><br/><a class="css-150s69f css-138ocmy" target="_blank" rel="noopener noreferrer" href="https://www.psychiatry.org/patients-families/bipolar-disorders/expert-q-and-a">https://www.psychiatry.org/patients-families/bipolar-disorders/expert-q-and-a</a></cite></li></ul></div></div><div class="css-1wkzy2"><div class="css-1ytasfq"><div class="button-wrapper print"><a class="css-1uhtj6l print button icon icon-hl-print" target="_blank" title="Print this page"></a></div><div class="button-wrapper facebook"><a class="css-1uhtj6l facebook button icon icon-hl-facebook" href="https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fpsychcentral.com%2Fdisorders%2Fmixed-episode-symptoms%3Futm_medium%3Dsocial%26utm_source%3Dfacebook%26utm_campaign%3Dsocial-sharebar-referred-desktop" rel="noopener noreferrer nofollow" target="_blank" title="Share on Facebook"></a></div><div class="button-wrapper twitter"><a class="css-1uhtj6l twitter button icon icon-hl-twitter" 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</script><script src="https://rvo-cohesion.psychcentral.com/cohesion/cohesion-tpo.min.js?cDomain=psychcentral.com" async=""></script><link href="https://c.aps.amazon-adsystem.com" rel="preconnect" crossorigin="true"/><script src="https://c.aps.amazon-adsystem.com/apstag.js" async=""></script><script>module={};__NEXT_DATA__={"buildId":"12fc9c7f-a227-446a-8650-3aa918a6101b","props":{"ga":{"k1":"bipolar","k2":"mentalhealth","kmeta":"vraylar24bp","contentType":"Tabbed Article","author":"Crystal Raypole","articleType":"regular","sponsoredProgramId":"","articleId":"psy-13758","mainContentCategoryTags":"","publishedDate":"2021-02-02","updatedDate":"2024-11-05","medReviewer":"Jeffrey Ditzell, DO","category":"Uncategorized","subcategory":"","trackingTerms":"","ek1":"2b59d6da71c8e0","ekmeta":"3f42c7cc71c8e0cfe48176,","contentForm":"Non-Head Term","type":"healthfeature"},"lang":"en","data":{"k1":"bipolar","sideEffectsWidget":{},"livedExperience":{},"shareYourExperience":{},"drugSavingsData":null,"comments":[],"topComments":[],"id":"psy-13758","title":["What Is Bipolar Disorder with Mixed Features?"],"articleHistory":{"2016-05-17":{"updateReason":[],"authors":"John M. Grohol, Psy.D.","medicallyReviewedBy":"Scientific Advisory Board"},"2021-03-05":{"updateReason":[],"authors":"Crystal Raypole","editor":"Jamie Smith","copyEditor":"Douglas Backstrom","medicallyReviewedBy":"Jeffrey Ditzell, DO"}},"updateReason":[],"isFeature":false,"isPaidMedia":false,"isEditorialPaidMedia":false,"isTransactionalPaidMedia":false,"authors":[{"id":211,"name":{"display":"Crystal Raypole","first":"Crystal","last":"Raypole"},"link":"/authors/crystal-raypole","type":{"value":"author","label":"Author"},"nid":"","specialties":[],"guestTitle":"","bio":{"text":"\u003cp\u003eCrystal Raypole\u0026#8217;s work appears on Healthline, and she\u0026#8217;s previously worked as a writer and editor for GoodTherapy. Her interests include Japanese language and translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues. She hopes to someday write fiction — if she can stop reading fiction long enough to write more than a few chapters of anything.\u003c/p\u003e\n"},"avatar":{"title":"","width":400,"height":400,"src":"https://post.psychcentral.com/wp-content/uploads/sites/4/2021/04/CrystalRaypole.jpg"},"bioBlurb":{"nodes":["Crystal Raypole’s work appears on Healthline, and she’s previously worked as a writer and editor for GoodTherapy. Her interests include Japanese language and…"]}}],"medicalReviewers":[{"id":4948,"name":{"display":"Jeffrey Ditzell, DO","first":"Jeffrey","last":"Ditzell, DO"},"userLogin":"jditzell","links":{"website":"https://jeffditzellpsychiatry.com/","facebook":"https://www.facebook.com/drdpsychiatry","linkedin":"https://www.linkedin.com/company/dr-ditzell-psychiatry-pllc","twitter":"https://twitter.com/drdpsychiatry","instagram":"https://instagram.com/jeffditzellpsychiatry","tiktok":""},"link":"/reviewers/jeffrey-ditzell-do","type":{"value":"medical_reviewer","label":"Medical Advisor"},"nid":"164726","specialties":[],"guestTitle":"","bio":{"text":"\u003cp\u003e\u003c!-- wp:paragraph --\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis individual is no longer a medical reviewer in our network. The credentials and contact information reflected here may not be current.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-weight: 400;\"\u003eDr. Jeffrey Ditzell is an adult ADHD and general psychiatrist with a private practice in New York City. He has been the chief of an inpatient dual diagnosis unit, the lead attending in two psychiatric emergency rooms, and the lead physician of an assisted community treatment team. Additionally, Dr. Ditzell has served in the United States Army for more than 20 years, having attained the rank of lieutenant colonel.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli style=\"font-weight: 400;\" aria-level=\"1\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eDes Moines University College of Osteopathic Medicine, DO\u003c/span\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Accomplishments\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli style=\"font-weight: 400;\" aria-level=\"1\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eAwarded the Army Commendation Medal, having served as the Division Psychiatrist in Tikrit, Iraq, during deployment in 2005\u003c/span\u003e\u003c/li\u003e\n\u003cli style=\"font-weight: 400;\" aria-level=\"1\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eServed as medical officer for a community-based warrior transition unit at Rock Island Arsenal, assisting soldiers and their families in making the oftentimes difficult transition from overseas deployment to home\u003c/span\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003c!-- /wp:paragraph --\u003e\u003c/p\u003e\n"},"avatar":{"title":"","width":500,"height":500,"src":"https://post.psychcentral.com/wp-content/uploads/2022/01/Jeffrey-Ditzell-New-Headshot-500x500-Bio.png"},"bioBlurb":{"nodes":[" This individual is no longer a medical reviewer in our network. The credentials and contact information reflected here may not be current. Dr. Jeffrey Ditzell…"]}}],"editors":[{"role":"Editor","name":{"display":"Jamie Smith"}}],"pinterestImage":{"path":"https://media.post.rvohealth.io/wp-content/uploads/sites/4/2021/02/Female_Portrait_732x549-thumbnail.jpg"},"hideFeedback":false,"isMedicare":false,"isBlog":false,"publishSource":"wordpress","isAmpSupported":false,"categories":[{"name":"Uncategorized","slug":"uncategorized","link":"/uncategorized","children":[]}],"language":{"en":"https://psychcentral.com/disorders/mixed-episode-symptoms/","x-default":"https://psychcentral.com/disorders/mixed-episode-symptoms/","current":"en"},"lang":"en","links":[],"colorScheme":"default","isContentSeries":false,"brandCTAs":[],"clusterNavLinks":[],"clusterUrls":[],"clusterLinks":{},"pathingTilesData":{},"pathingCardsData":{},"inArticlePathingCardsData":[],"quantitativeTrustData":{},"isPrependRecipeH2":false,"recipes":[],"breadcrumbsV2":[],"hideTabs":false,"tabs":[{"id":"_noHeaderPrefixedContent","title":null,"header":null,"body":[{"tagName":"div","source":"\u003cp class=\"css-w2pt6r\"\u003eMood episodes, or extreme shifts in emotion that can last several days, are the key symptom of bipolar disorder. \u003c/p\u003e"},{"tagName":"p","source":"\u003ca href=\"https://psychcentral.com/disorders/bipolar\" class=\"content-link css-150s69f\"\u003eBipolar disorder\u003c/a\u003e involves manic, depressive, or hypomanic episodes, but you could have more than one type of mood episode. The specific mood changes you experience depend on whether you have bipolar I, II, or \u003ca href=\"https://psychcentral.com/disorders/cyclothymic-disorder-cyclothymia\" class=\"content-link css-150s69f\"\u003ecyclothymia\u003c/a\u003e. "},{"tagName":"div","attributes":{"data-preamp":"serena-chatbot"},"source":""},{"tagName":"p","source":"Mood episodes associated with bipolar disorder do fall into three general categories. Still, \u003ca href=\"https://link.springer.com/article/10.1007%2Fs40263-015-0275-6\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003earound 40%\u003c/a\u003e of people living with bipolar disorder have a specific condition known as bipolar disorder with mixed features. "},{"tagName":"p","source":"The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced “mixed features” as a specifier to replace the previous term, “mixed episodes.” \u003ca class=\"content-link css-150s69f sl\" href=\"https://psychcentral.com/bipolar/dysphoric-mania\"\u003eDysphoric mania\u003c/a\u003e and mixed mania, other older terms for this condition, have mostly fallen out of common use."}]},{"id":"what-are-mixed-features","title":"What are mixed features?","isCollapsable":false,"header":["What are mixed features in bipolar disorder?"],"body":[{"tagName":"p","source":"If you have bipolar with mixed features, your mood episodes will have mixed symptoms. Here’s what this means, according to DSM-5 diagnostic criteria:"},{"tagName":"ul","source":"\u003cli\u003eDuring an episode of \u003ca href=\"https://psychcentral.com/depression\" class=\"content-link css-150s69f\"\u003edepression\u003c/a\u003e, you’ll have at least three symptoms of mania or hypomania. \u003c/li\u003e\u003cli\u003eDuring a \u003ca href=\"https://psychcentral.com/disorders/manic-episode\" class=\"content-link css-150s69f\"\u003emanic\u003c/a\u003e or \u003ca href=\"https://psychcentral.com/disorders/hypomanic-episode-symptoms\" class=\"content-link css-150s69f\"\u003ehypomanic\u003c/a\u003e episode, you’ll notice three or more symptoms of a depressive episode. \u003c/li\u003e"},{"tagName":"p","source":"This differs from other types of bipolar disorder, where episodes involve only one type of mood symptom. "},{"tagName":"p","source":"You may not have mixed symptoms for the \u003ca href=\"https://psychcentral.com/blog/how-long-is-a-typical-bipolar-episode#1\" class=\"content-link css-150s69f\"\u003eentire length of the episode\u003c/a\u003e. Symptoms need only to last a \u003cem\u003emajority\u003c/em\u003e of days during the episode. During a manic episode with mixed features that lasts a week, for example, you might have depression symptoms for 5 days, not the entire week. "},{"tagName":"p","source":"Bipolar disorder with mixed features can be more severe than \u003ca href=\"https://www.psychcentral.com/bipolar/difference-between-bipolar-disorder-1-and-2\" class=\"content-link css-150s69f\"\u003ebipolar I or II\u003c/a\u003e without mixed features, since mood episodes tend to happen more frequently and last longer. "},{"tagName":"p","source":"Symptoms might also be worse than typical bipolar symptoms and have more of an impact on your daily functioning. "},{"tagName":"p","source":"\u003ca href=\"https://www.cambridge.org/core/journals/cns-spectrums/article/mixed-features-in-bipolar-disorder/7531CF5E9B9BD1FD84497A24C062C95E\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eResearch\u003c/a\u003e has also linked mixed features to symptoms of psychosis, increased \u003ca href=\"https://www.healthline.com/health/suicide-and-suicidal-behavior\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003esuicide risk\u003c/a\u003e, and substance use."},{"widget":{"widgetFormat":"widget-call-out","items":[{"isBullets":true,"list":true,"content":[{"tagName":"p","source":"If you or someone you know is considering suicide, you’re not alone. Help is available right now:"},{"tagName":"ul","source":"\u003cli\u003e\u003cstrong\u003eThe 988 Suicide \u0026 Crisis Lifeline.\u003c/strong\u003e Call or text the 988 Suicide and Crisis Lifeline at 988 or chat \u003ca href=\"http://988lifeline.org/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003e988Lifeline.org\u003c/a\u003e.\u003c/li\u003e\u003cli\u003eText “HOME” to the \u003ca href=\"https://www.crisistextline.org/?gclid=EAIaIQobChMIsPDQrdXH5wIVBRx9Ch1YdQjIEAAYASAAEgJ_1_D_BwE\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eCrisis Textline\u003c/a\u003e at 741741.\u003c/li\u003e"},{"tagName":"p","source":"Not in the U.S.? Find a helpline in your country with \u003ca href=\"https://www.befrienders.org/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eBefrienders Worldwide\u003c/a\u003e."}]}]},"brandPage":{}}]},{"id":"symptoms","title":"Symptoms","isCollapsable":false,"header":["Symptoms of bipolar disorder with mixed features"],"body":[{"tagName":"p","source":"Bipolar disorder can involve a \u003ca href=\"https://psychcentral.com/bipolar/bipolar-disorder-symptoms\" class=\"content-link css-150s69f\"\u003ewide range of symptoms\u003c/a\u003e. If you live with bipolar I disorder, you might have a very different experience from someone else living with the same condition. "},{"tagName":"p","source":"A mixed features mood episode generally won’t show up in the same way as a mood episode without mixed features, and you may not have an equal combination of symptoms. In other words, more of your symptoms might fall into one category — mania, depression, hypomania — than the other."},{"tagName":"p","source":"The combination of symptoms can lead to some clear contrasts and inconsistencies in your mood, speech, and behavior. Here’s what that can look like: "},{"tagName":"h3","source":"Symptoms of mania with mixed features"},{"tagName":"p","source":"Your mood episode will meet the criteria for an episode of mania or hypomania, but you’ll also have at least three symptoms of depression:"},{"tagName":"ul","source":"\u003cli\u003efeelings of uneasiness or disconnection from reality\u003c/li\u003e\u003cli\u003eextreme sadness or tearfulness\u003c/li\u003e\u003cli\u003ea sense of emptiness, worthlessness, or guilt\u003c/li\u003e\u003cli\u003eenergy loss and fatigue\u003c/li\u003e\u003cli\u003elack of interest or enjoyment in your usual activities\u003c/li\u003e\u003cli\u003emoving and speaking more slowly than usual\u003c/li\u003e"},{"tagName":"p","source":"A mixed features episode won’t always involve the same euphoria or feelings of grandiosity that often accompanies mania. You won’t necessarily feel on top of the world or experience the same elevated self-confidence and self-esteem. "},{"tagName":"p","source":"You’re more likely to notice rapid changes in mood, increased irritability, and difficulty controlling strong emotions. In addition:"},{"tagName":"ul","source":"\u003cli\u003eYour thoughts might race, or your speech might become very rapid, while you feel very low and slowed down in mind and body. \u003c/li\u003e\u003cli\u003eYou might find yourself unable to stop smiling or laughing despite persistent feelings of guilt or thoughts of suicide. \u003c/li\u003e\u003cli\u003eFeelings of hopelessness or sadness might show up alongside physical restlessness, anxiety, or increased energy. \u003c/li\u003e"},{"tagName":"h3","source":"Symptoms of depression with mixed features"},{"tagName":"p","source":"A depressive episode with mixed features will also involve three or more symptoms of mania or hypomania:"},{"tagName":"ul","source":"\u003cli\u003eincreased talkativeness and rapid speech, often characterized by frequent or sudden shifts in topic\u003c/li\u003e\u003cli\u003eextreme excitement or restlessness\u003c/li\u003e\u003cli\u003eincreased energy \u003c/li\u003e\u003cli\u003eracing thoughts\u003c/li\u003e\u003cli\u003egreater distractibility\u003c/li\u003e\u003cli\u003eless of a need for sleep, or feeling rested after very little sleep\u003c/li\u003e\u003cli\u003eimpulsive behavior or lowered inhibitions\u003c/li\u003e"},{"tagName":"p","source":"While the DSM-5 includes grandiosity and an elevated mood among the typical signs of a manic episode, \u003chl-trusted-source source=\"PubMed Central\" rationale=\"Highly respected database from the National Institutes of Health\"\u003e\u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/28031070/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eresearch\u003c/a\u003e\u003c/hl-trusted-source\u003e suggests these symptoms show up less commonly in depressive episodes with mixed mania. Some people do still experience these symptoms, though. "},{"tagName":"p","source":"During a mixed depressive episode: "},{"tagName":"ul","source":"\u003cli\u003eAn emotional “high” or euphoric state of mind might conflict with extreme sadness or guilt. \u003c/li\u003e\u003cli\u003eYou could feel irritable or tearful, even while completely focused on a creative project you usually enjoy.\u003c/li\u003e\u003cli\u003ePersistent feelings of emptiness or worthlessness can show up alongside increased energy or restless movement. \u003c/li\u003e\u003cli\u003eYou might start several projects but get sidetracked easily and fail to get much done. \u003c/li\u003e"},{"tagName":"p","source":"The combination of rapid shifts between emotional states, impulsivity and distractibility, and racing thoughts can feel frightening and unpredictable. Symptoms of psychosis, such as delusions, hallucinations, and paranoia, can make this distress worse."}]},{"id":"treatment","title":"Treatment","isCollapsable":false,"header":["Treating bipolar disorder with mixed features "],"body":[{"tagName":"p","source":"Treatment for mood episodes without mixed features focuses on resolving either mania or depression symptoms — whichever you are experiencing at the time. "},{"tagName":"p","source":"Treating mood episodes with mixed features, on the other hand, needs to address mania and depression at the same time. This can pose some challenges, since certain medical treatments may worsen some symptoms, sometimes without offering much relief from other symptoms. "},{"tagName":"p","source":"Certain \u003ca href=\"https://psychcentral.com/lib/antidepressant-medications\" class=\"content-link css-150s69f\"\u003eantidepressants\u003c/a\u003e, for example, might intensify manic symptoms without relieving depression. Many people take lithium to treat manic episodes, but mood episodes with mixed features may not respond in the same way. "},{"tagName":"p","source":"These mood episodes are often more resistant to treatment, so it may take some trial and error to find the most effective approach for your specific symptoms. The right treatment will help improve many of your symptoms without making others worse. "},{"tagName":"p","source":"Treatment for bipolar disorder with mixed features typically involves \u003ca href=\"https://psychcentral.com/bipolar/bipolar-disorder-treatment\" class=\"content-link css-150s69f\"\u003emedication\u003c/a\u003e. Your doctor or psychiatrist may recommend one medication or a combination, such as:"},{"tagName":"ul","source":"\u003cli\u003eatypical antipsychotics (also called second-generation neuroleptics), such as aripiprazole and olanzapine\u003c/li\u003e\u003cli\u003emood stabilizers, such as lithium, valproic acid, or divalproex\u003c/li\u003e\u003cli\u003eanticonvulsants, such as carbamazepine or lamotrigine\u003c/li\u003e"},{"tagName":"p","source":"\u003chl-trusted-source source=\"PubMed Central\" rationale=\"Highly respected database from the National Institutes of Health\"\u003e\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299125/\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003eResearch\u003c/a\u003e\u003c/hl-trusted-source\u003e also suggests \u003ca href=\"https://psychcentral.com/lib/an-overview-of-electroconvulsive-therapy-ect#1\" class=\"content-link css-150s69f\"\u003eelectroconvulsive therapy\u003c/a\u003e as another potential treatment for bipolar disorder with mixed features. If you don’t see much improvement with medication alone, your mental health professional might also recommend ECT. "}]},{"id":"how-to-cope","title":"How to cope","isCollapsable":false,"header":["How to cope with mixed features"],"body":[{"tagName":"p","source":"Experiencing both mania and depression at the same time can feel confusing or disorienting. "},{"tagName":"p","source":"Coping with a mixed features mood episode can be difficult, particularly when you have a hard time identifying exactly how you feel. A rapidly shifting mood can create plenty of emotional turmoil, and frequent, intense suicidal thoughts aren’t uncommon. "},{"tagName":"p","source":"The good news is that the right treatment and coping strategies can help people manage these symptoms effectively."},{"tagName":"h3","source":"Therapy"},{"tagName":"p","source":"Therapy with a trained mental health professional may not necessarily resolve severe mood symptoms, but it can be substantially beneficial when you live with bipolar disorder. "},{"tagName":"p","source":"A therapist can help you begin to identify and \u003ca href=\"https://psychcentral.com/blog/how-to-manage-emotions-more-effectively#1\" class=\"content-link css-150s69f\"\u003emanage overwhelming emotions\u003c/a\u003e, abrupt mood changes, and thoughts of suicide, even when you’re unsure exactly what you’re feeling or what kind of help you need. "},{"tagName":"p","source":"Therapy also offers a safe space to build coping skills and develop a crisis plan for future mood episodes. "},{"tagName":"p","source":"A therapist can also offer support with recognizing and tracking \u003ca href=\"https://psychcentral.com/blog/bipolar/2009/04/spotting-the-early-warning-signs-of-a-bipolar-mood-episode#1\" class=\"content-link css-150s69f\"\u003eearly signs\u003c/a\u003e of mood changes. When you catch a shifting mood early on, you can sometimes take steps to prevent an episode. "},{"tagName":"p","source":"Bipolar disorder symptoms and mood episode cycles can change over time, so you might notice your treatment becomes less effective. Always let your therapist and the doctor who prescribed any medications know about new symptoms so that you can discuss more helpful treatments. "},{"tagName":"h3","source":"Manage stress"},{"tagName":"p","source":"\u003ca href=\"https://psychcentral.com/blog/10-practical-ways-to-handle-stress#1\" class=\"content-link css-150s69f\"\u003eStress\u003c/a\u003e in your day-to-day life can sometimes trigger mood episodes. While it’s not always possible to prevent stress, having a few \u003ca href=\"https://www.healthline.com/health/10-ways-to-relieve-stress\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003ego-to coping strategies\u003c/a\u003e in place can help you maintain a calmer mindset when challenges pop up. "},{"tagName":"p","source":"Try these tips: "},{"tagName":"ul","source":"\u003cli\u003eMake time for regular relaxation. This might include a nature walk, a warm bath, aromatherapy, or low-key pleasures like reading or coloring.\u003c/li\u003e\u003cli\u003eTry \u003ca href=\"https://www.healthline.com/health/grounding-techniques\" target=\"_blank\" rel=\"noopener noreferrer\" class=\"content-link css-150s69f\"\u003egrounding techniques\u003c/a\u003e, such as deep breathing, when you find yourself in a stressful situation. Your favorite relaxing \u003ca href=\"https://psychcentral.com/lib/the-power-of-music-to-reduce-stress#1\" class=\"content-link css-150s69f\"\u003emusic\u003c/a\u003e can help, too.\u003c/li\u003e\u003cli\u003eConsider \u003ca href=\"https://psychcentral.com/blog/10-surprising-health-benefits-of-mindfulness-meditation\" class=\"content-link css-150s69f\"\u003emeditation\u003c/a\u003e to boost your ability to recognize and let go of unwanted thoughts.\u003c/li\u003e\u003cli\u003eMany people find that practicing \u003ca href=\"https://psychcentral.com/blog/new-to-mindfulness-how-to-get-started#1\" class=\"content-link css-150s69f\"\u003emindfulness\u003c/a\u003e can help them reduce stress. However, it’s useful to remember that mindfulness can be challenging for people who have experienced trauma.\u003c/li\u003e\u003cli\u003e\u003ca href=\"https://psychcentral.com/lib/progressive-muscle-relaxation\" class=\"content-link css-150s69f\"\u003eProgressive muscle relaxation\u003c/a\u003e is another tool for relaxing your mind and body. This involves slowly tensing and relaxing each muscle to relieve psychological stress and physical tension throughout your body.\u003c/li\u003e\u003cli\u003eA daily journal can help you express upsetting or painful feelings, keep track of mood symptoms, and increase emotional awareness.\u003c/li\u003e\u003cli\u003eTurn to loved ones for emotional support and help brainstorm problem-solving strategies or positive distractions during times of stress.\u003c/li\u003e"},{"tagName":"h3","source":"Follow a regular schedule"},{"tagName":"p","source":"Since unpredictable or random daily routines can also lead to mood changes, \u003ca href=\"https://psychcentral.com/lib/building-a-routine-when-you-have-bipolar-disorder#1\" class=\"content-link css-150s69f\"\u003ekeeping your days structured\u003c/a\u003e could help prevent mood episodes."},{"tagName":"p","source":"Consider creating a weekly schedule that outlines specific times for things like:"},{"tagName":"ul","source":"\u003cli\u003ework\u003c/li\u003e\u003cli\u003eexercise\u003c/li\u003e\u003cli\u003erelaxation and alone time\u003c/li\u003e\u003cli\u003etime with friends and romantic partners\u003c/li\u003e\u003cli\u003emeals\u003c/li\u003e\u003cli\u003echores and errands\u003c/li\u003e\u003cli\u003eswitching off devices before bed\u003c/li\u003e"},{"tagName":"p","source":"Choose a regular bedtime and wake time, and stick to these times as closely as possible, even on the weekends — a \u003ca href=\"https://psychcentral.com/blog/bipolar-laid-bare/2016/04/5-sleep-problems-common-with-bipolar-disorder#1\" class=\"content-link css-150s69f\"\u003eregular sleep-wake schedule\u003c/a\u003e can sometimes help prevent mood episodes. "},{"tagName":"h3","source":"Take care of your health"},{"tagName":"p","source":"If you’ve heard of the mind-body connection, you’ll know physical and mental well-being are linked. "},{"tagName":"p","source":"Good health can’t cure mental health conditions, but all the same, physical wellness can improve your outlook and boost resilience, giving you the emotional strength to manage life’s unpredictable aspects. "},{"tagName":"p","source":"Try these \u003ca href=\"https://psychcentral.com/blog/what-self-care-is-and-what-it-isnt-2#1\" class=\"content-link css-150s69f\"\u003eself-care\u003c/a\u003e strategies:"},{"tagName":"ul","source":"\u003cli\u003eSet aside 7–9 hours for sleep each night.\u003c/li\u003e\u003cli\u003eEat balanced meals at regular times.\u003c/li\u003e\u003cli\u003eStay hydrated.\u003c/li\u003e\u003cli\u003eLimit \u003ca href=\"https://www.psychcentral.com/depression/caffeine-and-depression\" class=\"content-link css-150s69f\"\u003ecaffeine\u003c/a\u003e, alcohol, and other substance use, since they may prompt mood changes or make symptoms worse. \u003c/li\u003e\u003cli\u003eTry to get some \u003ca href=\"https://psychcentral.com/blog/10-health-benefits-of-daily-exercise#1\" class=\"content-link css-150s69f\"\u003eexercise\u003c/a\u003e each day. \u003c/li\u003e\u003cli\u003eMake time for your favorite hobbies. \u003c/li\u003e"}]},{"id":"next-steps","title":"Next steps","isCollapsable":false,"header":["What next?"],"body":[{"tagName":"p","source":"It can take some time to find the best treatment for bipolar disorder with mixed features, but don’t lose hope. Improvement \u003cem\u003eis \u003c/em\u003eabsolutely possible. "},{"tagName":"p","source":"As you work with your care professional to find the right treatment, keep in mind that lifestyle changes can also help reduce symptoms and make it easier to manage mood episodes. "}]}],"hasAffiliateLinks":false,"affiliates":[],"isDisclaimer":false,"isOwnedAndOperatedPresent":false,"propsFor":{"articleResources":[{"title":{"tagName":"span","source":"American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association."}},{"displayLink":"nimh.nih.gov/health/publications/bipolar-disorder/index.shtml","link":"https://www.nimh.nih.gov/health/publications/bipolar-disorder/index.shtml","title":{"tagName":"span","source":"Bipolar disorder. (2018)."}},{"displayLink":"link.springer.com/article/10.1007/s11920-020-1137-6","link":"https://link.springer.com/article/10.1007/s11920-020-1137-6","title":{"tagName":"span","source":"Chakrabarty T, et al. (2020). Treatment of mixed features in bipolar disorder: An updated view."}},{"displayLink":"cdc.gov/violenceprevention/about/copingwith-stresstips.html","link":"https://www.cdc.gov/violenceprevention/about/copingwith-stresstips.html","title":{"tagName":"span","source":"Coping with stress. (2020)."}},{"displayLink":"link.springer.com/article/10.1007%2Fs40263-015-0275-6","link":"https://link.springer.com/article/10.1007%2Fs40263-015-0275-6","title":{"tagName":"span","source":"Fagiolini A, et al. (2015). Diagnosis, epidemiology and management of mixed states in bipolar disorder."}},{"displayLink":"dictionary.apa.org/flight-of-ideas","link":"https://dictionary.apa.org/flight-of-ideas","title":{"tagName":"span","source":"Flight of ideas. (n.d.)."}},{"displayLink":"onlinelibrary.wiley.com/doi/10.1111/bdi.12990","link":"https://onlinelibrary.wiley.com/doi/10.1111/bdi.12990","title":{"tagName":"span","source":"Frigerio S, et al. (2020). The impact of caffeine consumption on clinical symptoms in patients with bipolar disorder: A systematic review."}},{"displayLink":"counseling.org/docs/default-source/vistas/exploring-the-mind-body-connection-therapeutic.pdf?sfvrsn=13","link":"https://www.counseling.org/docs/default-source/vistas/exploring-the-mind-body-connection-therapeutic.pdf?sfvrsn=13","title":{"tagName":"span","source":"Lemon JC, et al. (2013). Exploring the mind-body connection: Therapeutic practices and techniques."}},{"displayLink":"cci.health.wa.gov.au/-/media/CCI/Consumer-Modules/Keeping-Your-Balance/Keeping-Your-Balance---07---Behavioural-Strategies-for-Preventing-Mania.pdf","link":"https://www.cci.health.wa.gov.au/-/media/CCI/Consumer-Modules/Keeping-Your-Balance/Keeping-Your-Balance---07---Behavioural-Strategies-for-Preventing-Mania.pdf","title":{"tagName":"span","source":"Lim L, et al. (2003). Keeping your balance: Coping with bipolar disorder."}},{"displayLink":"ncbi.nlm.nih.gov/pmc/articles/PMC5299125","link":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5299125","title":{"tagName":"span","source":"Muneer A. (2017). Mixed states in bipolar disorder: Etiology, pathogenesis and treatment."}},{"displayLink":"ncbi.nlm.nih.gov/pmc/articles/PMC2655087","link":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655087","title":{"tagName":"span","source":"Ng F, et al. (2007). The role of lamotrigine in the management of bipolar disorder."}},{"displayLink":"pubmed.ncbi.nlm.nih.gov/27618746","link":"https://pubmed.ncbi.nlm.nih.gov/27618746","title":{"tagName":"span","source":"Rosenblat JD, et al. (2017). Treatment of mixed features in bipolar disorder."}},{"displayLink":"cambridge.org/core/journals/cns-spectrums/article/mixed-features-in-bipolar-disorder/7531CF5E9B9BD1FD84497A24C062C95E","link":"https://www.cambridge.org/core/journals/cns-spectrums/article/mixed-features-in-bipolar-disorder/7531CF5E9B9BD1FD84497A24C062C95E","title":{"tagName":"span","source":"Sol\u0026eacute; E, et al. (2017). Mixed features in bipolar disorder."}},{"displayLink":"pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm","link":"https://pubs.niaaa.nih.gov/publications/arh26-2/103-108.htm","title":{"tagName":"span","source":"Sonne SC, et al. (2002). Bipolar disorder and alcoholism."}},{"displayLink":"ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2012.12030301","link":"https://ajp.psychiatryonline.org/doi/pdf/10.1176/appi.ajp.2012.12030301","title":{"tagName":"span","source":"Swann AC, et al. (2013). Bipolar mixed states: An International Society for Bipolar Disorders Task Force report of symptom structure, course of illness, and diagnosis."}},{"displayLink":"ncbi.nlm.nih.gov/pmc/articles/PMC3140897","link":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3140897","title":{"tagName":"span","source":"Targum SD, et al. (2011). The complexity of \u0026quot;mixed\u0026quot; depression: A common clinical presentation."}},{"displayLink":"psychiatry.org/patients-families/bipolar-disorders/expert-q-and-a","link":"https://www.psychiatry.org/patients-families/bipolar-disorders/expert-q-and-a","title":{"tagName":"span","source":"Tohen M. (n.d.). Expert Q \u0026amp; A: Bipolar disorder."}}],"byline":{"authors":[{"id":211,"name":{"display":"Crystal Raypole","first":"Crystal","last":"Raypole"},"link":"/authors/crystal-raypole","type":{"value":"author","label":"Author"},"nid":"","specialties":[],"guestTitle":"","bio":{"text":"\u003cp\u003eCrystal Raypole\u0026#8217;s work appears on Healthline, and she\u0026#8217;s previously worked as a writer and editor for GoodTherapy. Her interests include Japanese language and translation, cooking, natural sciences, sex positivity, and mental health. In particular, she’s committed to helping decrease stigma around mental health issues. She hopes to someday write fiction — if she can stop reading fiction long enough to write more than a few chapters of anything.\u003c/p\u003e\n"},"avatar":{"title":"","width":400,"height":400,"src":"https://post.psychcentral.com/wp-content/uploads/sites/4/2021/04/CrystalRaypole.jpg"}}],"medicalReviewers":[{"id":4948,"name":{"display":"Jeffrey Ditzell, DO","first":"Jeffrey","last":"Ditzell, DO"},"userLogin":"jditzell","links":{"website":"https://jeffditzellpsychiatry.com/","facebook":"https://www.facebook.com/drdpsychiatry","linkedin":"https://www.linkedin.com/company/dr-ditzell-psychiatry-pllc","twitter":"https://twitter.com/drdpsychiatry","instagram":"https://instagram.com/jeffditzellpsychiatry","tiktok":""},"link":"/reviewers/jeffrey-ditzell-do","type":{"value":"medical_reviewer","label":"Medical Advisor"},"nid":"164726","specialties":[],"guestTitle":"","bio":{"text":"\u003cp\u003e\u003c!-- wp:paragraph --\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThis individual is no longer a medical reviewer in our network. The credentials and contact information reflected here may not be current.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cspan style=\"font-weight: 400;\"\u003eDr. Jeffrey Ditzell is an adult ADHD and general psychiatrist with a private practice in New York City. He has been the chief of an inpatient dual diagnosis unit, the lead attending in two psychiatric emergency rooms, and the lead physician of an assisted community treatment team. Additionally, Dr. Ditzell has served in the United States Army for more than 20 years, having attained the rank of lieutenant colonel.\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEducation\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli style=\"font-weight: 400;\" aria-level=\"1\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eDes Moines University College of Osteopathic Medicine, DO\u003c/span\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eProfessional Accomplishments\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n\u003cli style=\"font-weight: 400;\" aria-level=\"1\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eAwarded the Army Commendation Medal, having served as the Division Psychiatrist in Tikrit, Iraq, during deployment in 2005\u003c/span\u003e\u003c/li\u003e\n\u003cli style=\"font-weight: 400;\" aria-level=\"1\"\u003e\u003cspan style=\"font-weight: 400;\"\u003eServed as medical officer for a community-based warrior transition unit at Rock Island Arsenal, assisting soldiers and their families in making the oftentimes difficult transition from overseas deployment to home\u003c/span\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003c!-- /wp:paragraph --\u003e\u003c/p\u003e\n"},"avatar":{"title":"","width":500,"height":500,"src":"https://post.psychcentral.com/wp-content/uploads/2022/01/Jeffrey-Ditzell-New-Headshot-500x500-Bio.png"}}],"id":"psy-13758","updateReason":[],"editor":"Jamie Smith","factCheckedBy":"","factCheckers":[],"articleHistory":{"2016-05-17":{"updateReason":[],"authors":"John M. Grohol, Psy.D.","medicallyReviewedBy":"Scientific Advisory Board"},"2021-03-05":{"updateReason":[],"authors":"Crystal Raypole","editor":"Jamie Smith","copyEditor":"Douglas Backstrom","medicallyReviewedBy":"Jeffrey Ditzell, DO"}},"articleDates":{"factChecked":{"date":null,"display":""},"medicallyReviewed":{"date":1614902400,"display":"March 5, 2021"},"published":{"date":1463462797,"display":"May 17, 2016"},"lastUpdates":{"date":1614902400,"display":"March 5, 2021"},"modified":{"date":1730837682,"display":"November 5, 2024"}},"type":"healthfeature","language":"en"},"isCorp":false,"isReference":false,"isPremiumVideo":false,"isStandaloneVideo":false,"isStandaloneRecipe":false,"schemaObj":{"@context":"https://schema.org","publisher":{"@type":"Organization","name":"Psych Central","logo":{"@type":"ImageObject","url":"https://images-prod.healthline.com/hlcmsresource/images/frontend-static/psychcentral-logo@2x.png"}},"@type":"MedicalWebPage","headline":"What Is Bipolar Disorder with Mixed Features?","description":"If you have symptoms of mania and depression at the same time, you might have bipolar disorder with mixed features. Learn more here.","keywords":"bipolar with mixed features","author":{"@type":"Person","name":"Crystal Raypole"},"lastReviewed":"2021-03-05T00:00:00Z","url":"https://psychcentral.com/disorders/mixed-episode-symptoms","datePublished":"2016-05-17T05:26:37Z","dateModified":"2021-03-05T00:00:00Z","articleSection":"Uncategorized","correction":{"@type":"CorrectionComment","text":"","datePublished":"2021-03-05"},"reviewedBy":"Jeffrey Ditzell, DO","thumbnail":["https://media.post.rvohealth.io/wp-content/uploads/sites/4/2021/02/Female_Portrait_732x549-thumbnail-732x549.jpg"]},"hero":{}}},"ampLibs":{},"scrollArticles":[{"title":["Coping with Bipolar Disorder: 5 Self-Help Strategies"],"text":["You can manage symptoms of bipolar disorder on your own, in addition to professional support. Here are some of the best self-care strategies."],"link":"/lib/self-help-strategies-for-bipolar-disorder","imageAlt":"Coping with Bipolar Disorder: 5 Self-Help Strategies","thumbnail":"https://media.post.rvohealth.io/wp-content/uploads/sites/4/2016/05/Female_Portrait_732x549-thumbnail-732x549.jpg","medicallyReviewedBy":{"reviewerName":"Alex Klein, PsyD","reviewerImage":{"path":"https://post.psychcentral.com/wp-content/uploads/2021/04/200x200_Alex_Klein_mug.png","width":200,"height":200,"altText":""}},"isNutrition":false,"authors":[{"id":4946,"name":{"display":"Sandra Silva","first":"Sandra","last":"Silva"},"userLogin":"ssilva","links":{"website":"","facebook":"","linkedin":"","twitter":"","instagram":"","tiktok":""},"link":"/authors/sandra-silva","type":{"value":"author","label":"Author"},"nid":"","specialties":[],"guestTitle":"","bio":{"text":"\u003cp\u003eSandra Silva is an editor who is highly committed to developing content that helps bridge the gap in healthcare access and information. Sandra has an academic background in psychology and a MSc in Social Psychology and Group Processes. She has worked as a staff writer, managing editor, and editorial consultant for different print and digital publications. Sandra is the recipient of the British Council’s International Technical Cooperation Training Award and Saman de Oro Award for her work with underrepresented youth. She is passionate about building a more empathetic and compassionate community, and, not less intensely, soccer.\u003c/p\u003e\n"},"avatar":{"title":"","width":400,"height":400,"src":"https://post.psychcentral.com/wp-content/uploads/sites/4/2021/02/Sandra-bio-photo.jpg"}}],"reviewedByHeader":"Medically reviewed by"},{"title":["Living with Bipolar Disorder: What to Expect"],"text":["A bipolar disorder diagnosis may change the course of your life, but it doesn’t mean you can’t do great things. 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