Bipolar disorder affects over 5.7 million adult Americans. The World Health Organization considers bipolar disorder the sixth leading cause of disability worldwide. In many cases, people with bipolar disorder cope with upwards of ten years of showing symptoms before they receive a diagnosis. One of the reasons for this discrepancy is because of bipolar mixed features. While it isn’t exceptionally rare, it does create some problems with diagnosis because this disease typically presents with either mania or depression. Here’s what you should know about a bipolar mixed episode and available treatment.

Phases of Bipolar

Bipolar disorder is typically characterized by alternating bouts of either mania or depression. One second, you feel on top of the world, and the next moment, you’re being crushed by it. In rarer cases, people with bipolar disorder may suffer psychosis involving hallucinations, delusions, and incoherent speech.

There are three types of bipolar disorder: bipolar I, bipolar II, and cyclothymia. Bipolar I features alternating episodes between depression and mania. Bipolar II goes even further with full-on major depressive disorder and hypomania. Those with cyclothymia suffer more mild symptoms but more frequent episodes.

Bipolar Mixed Features Symptoms

A person who has bipolar disorder with mixed features experiences symptoms of both mania and depression. The problem is that they both happen simultaneously, often overlapping with one another. It could also refer to someone who alternates between the two rapidly without any noticeable delay.

When you suffer from this kind of episode, you can feel mania symptoms such as an elevated mood with increased energy. At the same time, you may feel sad, hopeless, and lethargic. Bipolar disorder with mixed features makes treatment difficult for both the individual as well as their therapist. It can make your first diagnosis more difficult, as you present a combination of all the different symptoms of bipolar disorder at the same time. You may also not even think to pursue mental health treatment because the symptoms can often balance each other out.

Risks of Depression With Mixed Features

Depression with mixed features as a result of bipolar disorder brings many risks with it.
For one, the severity of the symptoms you experience will likely be heightened. The combination of mental health conditions could impair your daily functioning as well as cause cognitive problems. The entire situation could be even more confusing if you suffer from rapid cycling, which is where you quickly bounce between depression and mania.

There’s also the chance that untreated bipolar disorder could negatively affect your relationships. Social difficulties inevitably pop up when you can’t control your emotional state, and this may also lead to extreme self-treatment and even suicide. It all depends on the severity of your symptoms and how long they go undiagnosed and untreated.

When undergoing treatment, building a support network and setting realistic goals for yourself is crucial. Try to build an understanding of your symptoms so you can discuss them with your therapist and get the right kind of treatment.

Why a Bipolar Mixed Episode Occurs

Anyone can develop bipolar disorder due to a combination of genetics, stress, and childhood trauma. Mixed episodes are common in those with this disorder to some degree. However, many of these episodes happen when they’re transitioning from one state to the other.
Imbalances in neurotransmitters like serotonin and dopamine may also play a role.

Environmental factors and substance abuse can play a role in triggering episodes. Different treatments for bipolar disorder may also affect how often you have mixed episodes, though their severity may be lessened.

Treatment for Mixed Bipolar

The treatment options for a bipolar mixed episode are much the same as for other types of episodes. What’s important is that you and your psychiatrist understand what is causing these mixed episodes. It could be unnecessary stress in your life or one of your already prescribed medications causing side effects.

Mood Stabilizers

Both mania and depression have their own sets of medications meant to treat them. Lithium is often used to treat mania, while depression has options such as SSRIs. However, bipolar mixed features require mood stabilizers to control these mood swings. Valproic acid is an antiseizure medication that can also help balance out mood swings in bipolar disorder. It’s one of the main alternatives to lithium for those who suffer from mixed episodes. Carbamazepine is another anticonvulsant that has mood-stabilizing properties. If you suffer more from bipolar depression, then lamotrigine can also help. Your medical team will help you find the proper medications to address your needs.


A little-known symptom of bipolar disorder is that it can sometimes present itself as psychosis. Psychosis is when a person experiences an episode of severe mania or depression that comes with psychotic symptoms. These symptoms can include anything from delusions to hallucinations.

Leaving bipolar psychosis untreated endangers both the individual and everyone around them. As such, their physician may prescribe them antipsychotics to help treat it. Antipsychotics are often prescribed alongside other mood stabilizers. Your options include medications such as olanzapine, quetiapine, risperidone, and aripiprazole.

Seek Hands-On Treatment

Bipolar mixed features can make your life feel a lot more complicated than it should. However, there are many ways to treat and control these symptoms. You shouldn’t have to fear when your mood will inevitably turn.

Comprehensive Wellness Centers provide a safe mental health and substance abuse rehab space. Our mental health track includes both inpatient and outpatient programs, as well as specialized programs. Contact us today with any questions and verify your insurance to learn more about your options.