Mixed Moods in Bipolar - The Most Dangerous Mood?

I talk about bi-polar disorder. As in, two poles - mania/hypomania and depression. The name is extremely descriptive.

But as it turns out, there is something in the middle (besides normalcy, whatever that is); it's called a mixed mood episode. Mixed moods possess distinct characteristics of both depression and mania. Mixed moods severely impair judgement and carry a significant risk of suicide.

What is a Mixed Mood?

According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) a mixed mood must meet both the criteria for both depression and mania, although the depression only has to be present for one week whereas for a standard major depressive episode symptoms must be present for two.

That means you must show four distinct manic symptoms and five depressive symptoms.

Well, in clinical practice this is rarely the case.

Mixed Mood Episodes in Reality

According to the DSM-IV-TR definition, mixed moods de facto only occur in bipolar 1 (as they contain mania). We know this isn't actually the case. Those of us living with bipolar 2 can tell you, we get mixed moods too. You don't have to be manic to be mixed.

Additionally, specifying three or more manic symptoms plus five or more depressive symptoms is extremely restrictive and subjective as some symptoms cross over from mania to depression. Insomnia can indicate mania or depression but obviously, in and of itself does not indicate a mixed mood.

New Criteria for Mixed Mood in the DSM

Now that the DSM is undergoing revision, there is an attempt to capture some of the issues seen in clinical reality and alter the current mixed mood definition. It's a step in the right direction.

How to Cope with Mixed Moods

The first thing to do is to recognize that you are having a mixed mood and to report it to your doctor as soon as possible. As I said, mixed moods carry an increased risk of suicide and that should not be taken lightly.

Your doctor may wish to change your medication at this time. For example, a newly-added antidepressant may be contributing to the mixed mood and your doctor may wish to discontinue it.

For reference, the following medications are FDA-approved for the treatment of mixed moods in bipolar disorder:

• Carbamazepine (Tegretol)
• Aripiprazole (Abilify)
• Ziprasidone (Geodon)
• Risperidone (Risperdal)
• Asenapine (Saphris)
• Olanzapine (Zyprexa)

These medications treat mania as well as mixed moods are currently considered a manifestation of mania; although doctors now recognize that, clinically, depression may be the predominant state rather than mania.

My recommendations?

Medication, yes. Doctor, yes. But also, try relaxation exercises. In my experience, mixed moods feel like they are ripping your body apart with serrated teeth and then pouring lemon juice all over you. They are highly unpleasant bits of business.

If you meditate - do it. If you do yoga - do that. If you normally don't do relaxation exercises then just sit quietly with your back against the wall and take deep breaths with your eyes closed. Focus on the rising and falling of your chest. Slow the breath. Feel the diaphragm expand and contract. Do this for as long as it takes to try to feel a bit more put together.

Mixed Mood Warning

But know this, mixed moods can severely impair judgement; so all the coping techniques in the world might not help you. The moment you feel like you're a danger to yourself or if you know that you cannot function in a mixed mood - get help. Mixed moods are dangerous; don't let them be the thing that bites you and never lets go.

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