What Is a Bipolar Mixed Episode?

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  • Written By: Lainie Petersen
  • Edited By: Melissa Wiley
  • Last Modified Date: 09 June 2018
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A bipolar mixed episode, sometimes called a mixed state, is a state in which an individual with bipolar disorder experiences the symptoms of depression and mania at the same time. Typically, this state must last for at least a week for an official diagnosis of a bipolar mixed episode to be made. In some cases, a mixed episode may cause a person with bipolar disorder to act out inappropriately, requiring medical attention and support. By being able to identify a bipolar mixed episode, clinicians, family members, and even those who have bipolar disorder may be able to blunt its effects with appropriate medication and treatment. Psychiatrists and other medical doctors may be able to modify a patient's medications during this time and may, in situations where an individual's behavior may point to possible suicide, recommend hospitalization.


Individuals with bipolar disorder, sometimes known as manic depression, typically experience an extreme range of emotions at various times. For example, someone with bipolar disorder may periodically become severely depressed. During this time, he may be extremely sluggish, irritable, and experience profound sadness. On the other hand, he may also experience periods of mania in which he may be full of energy, extremely excitable, and may even experience hallucinations or delusions of grandeur. For family members and friends, a bipolar mixed episode can be particularly frustrating and frightening, as their bipolar loved one may be demonstrating unfamiliar behavior uncharacteristic of either depression or mania. In such cases, family and friends may become fearful of the bipolar individual's behavior and may need to ask for outside help.

During a bipolar mixed episode, a bipolar person's behavior may become extremely unstable. This may be because her mental state is profoundly negative and she may feel incredibly worthless, sad, or angry and yet also be experiencing racing thoughts, delusions, and a lot of restless energy. Some mental health experts believe that an individual's risk of suicide increases during a bipolar mixed episode. This can happen because the individual may be experiencing a great deal of emotional pain and yet may also feel active enough to actually carry out a plan of suicide. As such, friends, family members, and therapists should be particularly aware of the signs of a suicide plan, which may include direct threats of suicide, an individual attempting to say goodbye to friends and family members by apologizing for past hurts or giving away prized possessions, or engaging in risky behaviors.



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