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What It's Like to Experience Mixed Episodes With Bipolar Disorder


I have bipolar I disorder with mixed episodes. This means I can have periods of time where I experience many of the “classic” signs of mania: The frenetic physical energy, the restlessness, the compulsive need to give voice to the torrent of thoughts flying through my head, resulting in pressured and sometimes near unintelligible rapid-speech, the reckless impulsivity in pleasurable activities, feeling grandiose like I have some kind of skills or powers that are greater than other people, etc. With mixed episodes (also known as dysphoric mania), I also get many of the symptoms of depression like dark feelings of hopelessness, a certain feeling of futility in fighting my illness, unrelenting irrational fears about my future and how living with bipolar disorder will affect that, thoughts of suicide, etc. The part where it gets terrifying is that, while my thoughts are bleak and black, they are also swirling with all the intensity of an F5 tornado. There is nowhere to hide. They blow the house down and shred every protective barrier I have in place away, leaving me completely vulnerable to the relentless onslaught of the flurry of racing thoughts and ideas. Psychosis is occasionally a player as well, and so paranoia can become an issue for me too.

They are terrifying. It’s like a fire hose of thoughts is pointed at me and I cannot move or shut it off. The thoughts are “loud” in a non-audible way, but in a way that is impossible to ignore. Sometimes I can’t focus on anything because so many things are running through my head at once. I am scared and I become terrified it won’t stop, or I won’t be able to endure it. I worry I am actually losing my mind.

I blast music in my car, in my ears, in my room, just to try to drown out half of the thoughts and slow down the stream. It helps sometimes. I don’t sleep much because the mania part doesn’t let me and because the thoughts keep me up late. I dream more during this period than at any other time because my brain won’t rest, even if I am sleeping. I can start a sentence off crying and be laughing by the end, the early tears still streaming down my cheeks. I am acutely aware of what I look like to people.

These are the episodes that can land me in the hospital. They are notoriously considered the most unsafe type of episodes for people with bipolar disorder because people have all of the warped depressive episode thinking, combined with the energy to follow through with the ideas. The increased impulsivity I experience in concert with the above is deeply problematic for me, so I will seek an admission if I see those things becoming a serious issue.

I want people to know what these feel like. Over the years, I have found myself frantically searching the web for others’ descriptions of their mixed episodes, and found material sadly lacking. There are clinical descriptions written by people who have clearly never experienced a mixed episode, but precious little written by anyone who has been through one.

You aren’t alone. We are all out here.

My favorite quote is from Carrie Fisher’s book and film “Postcards from the Edge,” when she is describing her semi-autobiographical character, Suzanne. It hit home for me and I relate to it so very much:

“She wanted to be tranquil, to be someone who took walks in the late-afternoon sun, listening to the birds and crickets and feeling the whole world breathe. Instead, she lived in her head like a madwoman locked in a tower, hearing the wind howling through her hair and waiting for someone to come and rescue her from feeling things so deeply that her bones burned. She had plenty of evidence that she had a good life. She just couldn’t feel the life she saw she had. It was though she had cancer of the perspective.” — Carrie Fisher

If you or someone you know needs help, visit our suicide prevention resources page.

If you need support right now, call the National Suicide Prevention Lifeline at 1-800-273-8255, the Trevor Project at 1-866-488-7386 or text “HOME” to 741-741. Head here for a list of crisis centers around the world.

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Thinkstock photo via misuma