What is a Mixed Episode? It's Complicated.

 Damn. That is the only word that comes to mind in trying to explain what this past few weeks has felt like inside my mind and my body. I have read about mixed episodes before, and had hundreds when I was undiagnosed and drinking, but those don't count. Living through one while sober, and after an extended period of stability, is honestly like being a yo-yo controlled by a demonic child, giggling at my pain. Or like a kid on a see-saw, only with a large bully on the other side jumping up and down, with you white knuckling, screaming, being thrown wildly up and crashing painfully back down, with no control, only begging for help. Let me try to define what a mixed episode is. 

    This itself is more complicated than I had hoped. The common definition seems to be this: experiencing symptoms of mania (or hypomania) and major depression at the same time or cycling between the two rapidly, often on the same day. From WebMD's article:

    The high energy of mania with the despair of depression are not mutually exclusive symptoms, and their co-occurrence may be much more common than people realize. 

    For example, a person in an episode with mixed features could be crying uncontrollably while announcing they have never felt better in their life. Or they could be exuberantly happy, only to suddenly collapse in misery. A short while later they might suddenly return to an ecstatic state.

   Mood episodes with mixed features can last from days to weeks or sometimes months if untreated.
 They  may recur ,and recovery can be slower than during episodes of "pure" bipolar depression or "pure" mania or hypomania.

     Welp, this seems exactly right based on the last few weeks. I may have said this to my loved ones recently, "I'm objectively happy, I love it here, things are going well"... while simultaneously battling back tears as to not reveal the inner depths in which my true agony lies. I have awoken with lightening energy, working out for hours, checking things off lists and planning to do more; only to be crushed by a tsunami of despair, hopelessness and even a trickle or two of suicidal ideation. Let me be clear, this is not normal for me anymore, especially when I am not working and can control my entire day. Hence the confusion, lack of confidence, and a helpless feeling that has seeped back into my seemingly faux-stable mind built on a house of cards. 

Also from WebMD:

     The most serious risk of mixed features during a manic or depressive episode is suicide. People with bipolar disorder are 10 to 20 times more likely to commit suicide than people without bipolar disorder. Tragically, as many as 10% to 15% of people with bipolar disorder eventually lose their lives to suicide.
    Evidence shows that during episodes with mixed features, people may be at even higher risk for suicide than people in episodes of bipolar depression.

Am I concerned? Yes, but not too much. The key difference is my support team, especially my girlfriend. Without this I would be very worried. I don't share this to make those who know me concerned, I share this so that if someone is reading it, they know they are not alone and that there is hope and help. That being said, this is the hardest thing I have been through in a long time. 

    Seriously, imagine thinking about how good today was. Close your eyes, picture a day where you got everything done you wanted to. You're in a new city with the person in the world you love the most and you finally feel like you are settled in. You're excited, understandably a little nervous still, but the world finally seems like your oyster; a fresh start, a city with everything, new possibilities every where you look. So, you start planning out tomorrow before you drift off to sleep. You're going find a new trail to run or bike in the morning and then it's on to finding your next job, which you are finally looking forward to and not nervous....
    Then, you wake up. You're beyond miserable. You had nightmares throughout the night, were up multiple times throughout the night calming yourself down, re-relaxing, trying not to look at your phone and fall back asleep while convincing yourself it was just, in fact, a dream and that your next one won't be so bad. You sleep 5-6 hours while in bed for 9. You're depressed, thinking you have nothing to add to society and nothing to live for. Nothing has changed from when you drifted off to sleep such a short time ago, yet every single fiber of your mind and body is now consumed by exhaustion, despair and depression. The worst part, you have absolutely NO IDEA why this is happening or if you did something wrong. 

    The answer? Nothing is wrong and nothing changed. You just live with bipolar and your brain is sick and needs time to recover. Okay, but I deal with this from time to time, why is this particular time so hard? 

    Because in this instance, later that day your energy and enthusiasm picks back up out of no where. You're flying, fun to be around, back to having ideas and creativity and back to being productive. That might last 4 hours, until the next day or maybe even for the next two days, allowing you to settle down a little again and believe that things are finally evening out. Nope, back down, deeper this time, leaving you even more confused and discouraged than before. 

    A lot of life is difficult living with bipolar. This might be the hardest. It is just one repetitive, yet wildly unpredictable cycle of powerful ups and devastating downs that you once thought you had control of. It makes no sense. BUT, THERE IS ALWAYS HOPE. 

    I don't know when this will end, but I know this, my battle with bipolar disorder and will to live are not linked to the other at this point. I have a purpose in life now, multiple actually. I feel the need to share my experience with others in the hopes that it helps in some small way. I know that through it all, I am still a great family member and partner on my best days and that I try as hard as I can on my worst days. This will get better again at some point, I will feel stability again at some point. This is why I always refer to my stability as "somewhat" or "kind of" or "in the moment". I never know how long it will last and try not to take it for granted. 

It took me two weeks just to write this, but I'm glad it did. It gave me more time, more perspective and more experience to share with others. Now, I just hope that stability returns sooner than later so I can get back to doing what I love. 

As always, thank you so much to those of you who read this! Please follow me on IG @benefits_of_bipolar and check out my YouTube channel. Please follow, like and share any of my content that you resonate with or that helps! 

Lee Formella


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