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What are Mixed Episodes?

Bipolar I Disorder and Mood Episodes

Bipolar I Disorder is a condition that causes unusual changes in mood, energy, and activity. Changes in mood can range from feeling elated and energetic to feeling sad and exhausted. These periods of extreme “highs” and “lows” are called “mood episodes,” which can range between manic (highs), depressive (lows), or mixed (highs and lows). The extreme behavioral shifts people with Bipolar I Disorder experience can often make it difficult for them to perform everyday tasks.

Having a Mixed Episode

People with Bipolar I Disorder can sometimes have a mood episode that features mania and depression at the same time. This is known as a “mixed episode.” People with Bipolar I Disorder can have a mixed episode and not even realize it, because its symptoms are unique. For example, a person experiencing a mixed episode may:

  • Feel overly irritable, while also feeling extremely tired
  • Feel unusually talkative, while also feeling exhausted
  • Experience racing thoughts, while also lacking energy
  • Shift rapidly from extreme sadness to extreme happiness, or vice versa
  • Laugh inexplicably, while revealing deep feelings of despair
  • Behave impulsively, while also feeling very sad
  • Do many activities at once, without enjoyment
  • Do activities that are normally fun, while also being irritable

Having a Mixed Episode

People with Bipolar I Disorder can sometimes have a mood episode that features mania and depression at the same time. This is known as a “mixed episode.” People with Bipolar I Disorder can have a mixed episode and not even realize it, because its symptoms are unique. For example, a person experiencing a mixed episode may:

  • Feel overly irritable, while also feeling extremely tired
  • Feel unusually talkative, while also feeling exhausted
  • Experience racing thoughts, while also lacking energy
  • Shift rapidly from extreme sadness to extreme happiness, or vice versa
  • Laugh inexplicably, while revealing deep feelings of despair
  • Behave impulsively, while also feeling very sad
  • Do many activities at once, without enjoyment
  • Do activities that are normally fun, while also being irritable

Knowing the symptoms of Bipolar I Disorder — and tracking your own symptoms over time — can help you to better understand and manage your episodes.

What are the Symptoms of Mixed Episodes?

It’s important to understand that people can experience many different symptoms of Bipolar I Disorder. Knowing the various symptoms can help you recognize your own symptoms, as well as help you and your healthcare provider manage any episodes you may experience.

While experiencing a manic episode, you may:

  • Feel energetic, excited, or unusually happy
  • Feel restless, irritable, or wired
  • Have racing thoughts, with difficulty concentrating
  • Indulge in impulsive behaviors, including sexual behavior
  • Have a heightened sense of self-importance
  • Abuse drugs, such as alcohol, sleeping medications, or cocaine
  • Exhibit provocative, intrusive, or aggressive behavior

While experiencing a depressive episode, you may:

  • Feel sad or empty
  • Feel restless or anxious
  • Have feelings of negativity
  • Have feelings of helplessness or worthlessness
  • Lose pleasure or interest in activities you once enjoyed, including sex
  • Have decreased energy, while feeling very tired
  • Become easily bothered or irritable
  • Have difficulty concentrating, remembering, or making decisions
  • Experience changes in appetite, with unintended weight loss or gain
  • Have bodily symptoms that are not caused by physical illness or injury
  • Have thoughts of death or suicide

Remember — taking the appropriate medication as prescribed by a healthcare provider is a key component of a successful bipolar disorder treatment. For information on an FDA-approved prescription medicine for the acute treatment of manic or mixed episodes of Bipolar I Disorder, click here.