Bipolar disorder is an emotional disorder characterized by extreme, and nearly unpredictable, changes in mood. The depressed state leaves its victims feeling hopeless, alone, helpless, and in emotional turmoil. They lose interest in activities and other things they once loved. Lethargy often sets in and simply getting out of bed everyday is incredibly painful.

Mania is the complete opposite of the painful emptiness. While manic, a person has unreal amounts of energy. Their self-esteem and ego are inflated beyond the realm of reality. Delusions of grandeur can cause a person to believe in impossible things to the point where it disrupts their lives. Personalities change in manic people during these episodes. Sometimes people become elated and giddy. Other times, anger replaces giddiness. Violence and psychosis can accompany this state.

Hypomania is a less severe state of Bipolar disorder that can still cause disruptions in a person’s life. It has many of the same symptoms of mania, but to a lesser degree. Psychosis can accompany a hypomanic state, but not always. I have hypomania often and my version rarely gives way to an uplifted mood, but rather into an irrational anger over things that do not warrant it.

Then there is the MixedState. It’s a state of Bipolar disorder where a person suffers from both depressed and manic symptoms. That may sound like an oxymoron, but this state is only too real. (I am a frequent sufferer of mixed states when not on my medication.) During a mixed state a person will have the low mood and desire that accompanies depression. They still feel worthless, useless, and hopeless. They hate themselves and feel like the mood shall never pass. However, the energy from manic episodes is also present during a mixed state. A person will have the uncontainable energy and often the irrational anger, but because they are depressed, this irrational anger is turned inwards onto the person themselves.

Violence is known to accompany this state just as it accompanies the manic state, but because a person is turning the anger inwards, the violence is also turned inward as well. A mixed state is often considered the most dangerous time for a person with bipolar disorder. It is that this time when they feel as unhappy and hopeless as ever and have the energy to do something about it. A risk of suicide accompanies the mixed state and thus a person in this state needs to take special care to get it under control. That can feel next to impossible and very overwhelming.

This is one of the reasons that during commercials for anti-depressants, the announcer must warn that the medication can increase the risk of suicide in teens and young adults. (The risk is increased in most people of any age, but teens and young adults are more likely to have undiagnosed bipolar disorder rather than depression alone.) The increased risk occurs for two reasons. Firstly, because anti-depressants take time to take effect, they may lift the sense of lethargy before they cause a change to a person’s mood. Secondly, if a person does have bipolar disorder rather than depression, anti-depressants can bring about manic or hypomanic episodes. This risk is lowered when taken in conjunction with a mood stabilizer used to treat manic symptoms. (When I had my depakote level’s increased because of frequent mixed states, my moods began to level out. It’s wonderful to not feel like your mind is running in every direction possible.)

My conclusion is this: Mixed states can occur in people with regular manic and hypomanic episodes. They can be frightening when you feel so horrible, but also ready to leap out of your skin. The risk of suicide that accompanies them is higher than in any other state. Beware of the Mixed State. It is a terrible place to be.