I stopped sleeping. I stopped eating. I drank coffee all night, used a black marker to scribble poetry on the living room curtains, had riveting conversations with the moon about my own magnificence,

By Carin Meyer

Last Updated: 22 Jul 2023

A bipolar mixed episode is a uniquely confusing and agitating experience, but you can prevent this by recognizing the early signs of a coming episode.

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I sat at dusk, my arms around my knees, at the junction of a turbulent and muddy river and the slow, dark water of an ocean inlet. As I sat at the convergence of two vastly different and yet similar things, my mind, too, found itself at its own convergence. Somehow, two moods — vastly different and yet somehow similar — had merged into something terrifying, feverish, and inexplicably sad.

Hours earlier, when I was overflowing with love and grandiose dreams, I spent several hundred dollars on gourmet cookies and bouquets of roses and lilies to hand out to friends. Later, as day turned into evening, mania and depression blended together into the unique and startling pain of a bipolar mixed episode.

It was nearly two decades ago, and I held a notebook and pen in my lap on that muddy river’s shore. I wrote with a fury, as if I were actually in those swirling waters, uncontrolled and wild, and yet full of despair.

The racing thoughts soon turned to suicidal thinking, and as they grabbed at that all-too-familiar concept, the idea formed a rapid loop in my brain. The rest of my mind — where logic and reason resides — grew dark and unfamiliar as I became stuck in an obsessive circle of thought.

In the many years since my initial diagnosis with bipolar 1 disorder, I have tried to understand the nature of a bipolar mixed episode. Even today, after so many years of experiencing them, I still have trouble recognizing the difference between a mixed episode and my ultra-, ultra-rapid (ultradian) cycling.

For me, the mixed episode often comes after the quick ups-and-downs of the rapid cycling, when mania and depression merge into something particularly disconcerting and painful.

During the early years after my diagnosis, as the rapid cycling took over and then morphed into the longer mixed episodes, I would lose all sense of the normal cadence of human life.

I stopped sleeping. I stopped eating. I drank coffee all night, used a black marker to scribble poetry on the living room curtains, had riveting conversations with the moon about my own magnificence, and agonized on the linoleum floor in my kitchen.

For me, trying to describe a mixed episode to someone who has never experienced one has always been difficult. For others, it may be easier, or it may be even harder.

I have tried, weakly, to compare it to the feeling that results from being over-caffeinated and tired at the same time, when your body quivers with energy while you also feel completely exhausted.

I have thought of other analogies over the years, some vague and esoteric, others clearer and more obvious. I am a heavy stone in a hurricane. I am lightning in a black sky. And, I am a woman at the cloudy confluence of a raging river and a dark sea.

Some individuals who have bipolar mixed episodes experience euphoric mania and severe depression at the same time.

Throughout my life, I have also occasionally felt euphoric and depressed simultaneously, and when I have, it was even more confusing than my usual agitated, dysphoric manias.

I have sobbed while talking about how I was going to be a world-famous author. I have celebrated my own greatness — an ecstatic megalomaniac — by sorting and piling my writings all over my bed, papers flying, while still overwhelmed with feelings of hopelessness and sorrow.

Today, I can recognize the common features of most of my mixed episodes.

If I have a hypomanic “up”, then I usually know that I will crash into one of my agitated depressions.

During these mixed cycles, I feel frantic and hypersensitive, irrationally sad, and always terrified. My thoughts are negative, obsessive, and frequently paranoid.

But sometimes, I can also recognize that I am in the midst of a cycle, and that the toxic loop of my racing thoughts do not reflect reality.

While recognition is of paramount importance when trying to emerge from a mixed episode, prevention of the episode itself is even more important.

For me, this means, above all, that I keep a regular schedule. I must sleep, eat, and take my medication at the same time every day. As soon as that structure begins to unravel, or when stress breaks my rhythm, I may cycle — and for me that usually means I will have a mixed episode.

The agitated despair of a mixed episode may often feel unbearable, and it may feel like we are at the mercy of the rushing river in our minds. But there is hope in our ability to watch downstream, to be ready to recognize the early signs of a coming episode, and, ultimately, to prevent the mixed states by keeping a steady rhythm and daily structure in our everyday lives.

Carin Meyer is a lifelong Alaskan who works in public relations. Her academic writing has won numerous awards and her science writing and other articles have been published in university magazines, newspapers, and other media outlets. She has a blog at The Smartest Girl in the World. She enjoys writing essays about bipolar disorder and mental illness. Carin has drafted a book about bipolar disorder, The Smartest Girl in the World, for which she is currently seeking publication.