"On occasion, these periods of total despair would be made even worse by terrible agitation. My mind would race from subject to subject, but instead of being filled with...exuberance and cosmic thoughts...it would be drenched in awful sounds and images of decay and dying; dead bodies on the beach, charred remains of animals, toe-tagged corpses in morgues."
An Unquiet Mind
A Memoir of Moods and Madness
The DMSV IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition) recognizes only one form of mixed state in Bipolar Disorder, that of Depressive Mania. Many individuals who have suffered a mixed episode, and many psychiatrists would carry this farther. Although psychiatrists do not yet agree on the defining characteristics for this state, they have long recognized that the symptoms of mania and depression seem to co-exist in some patients.
As many as one hundred years ago the physician Kraepelin suggested his theory of mixed mood states. He believed that they arose when mood, ideation, and psychomotor activity were incongruent. When all three were decreased, depression occurred; when all three were elevated the result was mania. If one of the domains was contradictory however, (for example, low mood with excitement and acceleration of activity), the diagnosis would be depressive mania. Kraepelin identified six different mixed states, in addition to the two pure states of mania and depression.
Psychiatrists today recognize that there are more variations than Depressive Mania within the spectrum of mixed states, although the characteristics have not been defined, nor are these states official. Clinical experience has identified several different states that could be termed mixed states. These include Depressive Mania, Irritable Mania, Anxious Mania, Excited depression and Agitated Depression and others may exist.
To read more about mixed states, and studies done on them see Dr. Hagop S. Akisal M.D.'s article at MEDSCAPE. A free membership is required.
Individuals who have had episodes of pure depression or mania and then suffered the harrowing symptoms of a mixed episode know the difference. I once went through a mixed episode where I was deeply depressed...unable to eat, unable to move. At the same time my mind was racing a hundred miles an hour. I was suicidal, and if my speeding thoughts could have made my body move I would have been in extreme trouble.
Patients with mixed disorder are more likely to commit suicide than those with pure mania according studies done by Dr. Giulio Perugi, of the Institute of Clinical Psychiatry at the University of Pisa, Italy. He reported that mixed state patients had attempted suicide 14.7 per cent of the time compared to 0 per cent of the mania patients in his study.
The newer mood stabilizing medications such as Neurontin, Lamictal and Topamax are being used in the treatment of mixed states quite successfully, often in combination with others. The drug Zyprexa has also been indicated as a good treatment for mixed states.
An article in the Int Clin Psychopharmacology 2000 on July 15, 2000, by JC Soares reports that new medications are being investigated for the treatment of Bipolar Disorder, and particular for those patients with atypical or mixed episodes who tend to respond poorly to current medications.
Hopefully, these new medications will make a big difference for all who suffer from mixed episodes.