According to a review , children may have greater chances of developing later bipolar disorder if they have a first-degree relative who has bipolar disorder and:. No single neurobiological risk factor has been found for bipolar disorder, but others may include:. However, if you experience a mixed episode during treatment, your care team can work on figuring out what might have caused it, then adjust any necessary medication or work with you on lifestyle behaviors.
Episodes with mixed features typically indicate a more serious condition, as well as poor response to treatment, according to the review mentioned earlier. No single medication is indicated for use in treating mixed features. Usually, a mental health professional will prescribe a combination of two or more medications, depending on your individual circumstances. In severe cases where medication is not effective, ECT may be effective very quickly and resolve symptoms. Mixed episodes can be especially serious because of the risk of suicide — the depression is there, as well as the energy to carry it out.
A mental health professional can help you better manage symptoms and can alter your treatment plan to help stabilize moods and reduce subsequent mood shifts. While more research is necessary to determine the underlying causes of mixed states and triggers, there are ways to manage the mixed episodes.
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List of Partners vendors. We tend to think of bipolar disorder as a disease characterized by alternating bouts of depression and mania. While it is true that some people with the disorder will experience a distinctive pendulum swing in moods, with clear highs and lows, more often than not the clinical picture will not be so obvious. In many cases, the depressive episodes may be the defining feature of the disease.
At other times, a person may experience a less severe form of mania known as hypomania in which the elevated mood may not be so apparent, especially to casual observers. More confusing yet is a condition known as bipolar disorder with mixed features in which a person will simultaneously experience depression and mania.
While this may seem contradictory—to have a manic and depressed state all at the same time—it is more common than you may think. Bipolar disorder with mixed features is a term used to describe either a manic state with depressive symptoms or a depressive state with manic symptoms. While the distinction may seem incidental, the two mood states are, in fact, clearly delineated in the Diagnostic and Statistical Manual of Mental Disorders DSM issued by the American Psychiatric Association.
The characteristics of a mood state are known as "specifiers," which add more detail to a diagnosis and help ensure that the most appropriate treatment is prescribed. While one mood state will typically predominate during a mixed episode, in their totality, the body of symptoms will be contradictory. An example might be someone in a hyperactive state who has feelings of deep guilt or remorse the latter feature being symptomatic of depression. People with bipolar disorder who experience mixed episodes might experience mania, hypomania, and depression symptoms at the same time.
Experiencing these different states at the same time makes this presentation of bipolar disorder challenging to treat. In this article, we explore the characteristics, diagnosis, and treatments of bipolar disorder with mixed states.
When bipolar disorder presents with mixed episodes, they are states that are familiar to most people with bipolar disorder and include depression, mania, and a milder form of mania known as hypomania.
Not everyone with bipolar I disorder will experience depression. However, people with mixed features experience mania and depression at the same time. This increases the risk of extreme behavior and means that the symptoms are generally more severe and longer-lasting than those in people who do not experience mixed episodes. Often, the clinical outcomes are worse because treatment for one element of bipolar disorder with mixed features, such as anti-depressants, will sometimes make the other, co-occurring element more severe.
A person experiencing these symptoms might become socially isolated and even experience physical pains and aches. A person with mixed features during bipolar disorder might appear to feel euphoric while crying or may experience a rush of thoughts while also in a state of lethargy. If another individual appears to be experiencing these mixed states, the risk of suicidal ideation or potential harm to another person is high.
The mixed features that constitute this state constitute a medical emergency. Understanding more about the way bipolar disorder with mixed episodes can feel might help people around the individual offer support. Susan Noonan, a physician and certified peer specialist and consultant at the Massachusetts General Hospital and McLean Hospital, gave MNT an account of her own experience of a mixed episode, as a person with bipolar disorder.
Fatigue is huge and sleep never comes, and I could be wide awake for 4 to 5 days straight. Sometimes I just walk and pace continuously, sometimes just sit in one place for hours. Medical researchers have not yet identified the causes of bipolar disorder and its presentations.
Some researchers have noted that genetic factors contribute to the development of bipolar disorder. A study , however, points out that many cases of bipolar disorder are isolated. The authors state that families in which several members live with bipolar disorder are rare. The authors also note that alcohol and drug dependence are potential nongenetic factors that could act as triggers for the mixed specifier of bipolar disorder. Other reports, such as this report in the journal Synapse , suggest that genetic factors influence the speed and severity of switching emotional states.
Most often, doctors will prescribe mood stabilizers, including newer anticonvulsant drugs, and atypical antipsychotic medications.
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