Bipolar disorder is a mental health condition that involves symptoms of mania or depression. Some people may have mixed episodes, which include both types of symptoms occurring at the same time.

According to the National Institute of Mental Health, bipolar disorder affects around 2.8% of U.S. adults. The condition involves mood changes that can last for days or weeks. In some cases, these changes can be severe.

This article discusses what mixed episode bipolar disorder is in more detail. It explores its symptoms, causes, and diagnosis. Finally, it explains how doctors treat mixed episode bipolar disorder.

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Mixed episode bipolar disorder occurs when a person experiences symptoms of depression and mania at the same time.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a handbook mental health professionals use to diagnose mental health conditions.

It originally used the term “mixed episode” to refer to episodes of mania with those of depression. However, it has replaced this with the term “mixed features” in the latest edition of the DSM.

There are different types of bipolar disorder. Mixed episodes can typically occur in bipolar I disorder. This type of bipolar disorder involves experiencing manic episodes for at least a week. Episodes may require hospital care if symptoms are severe. Depressive symptoms or mixed episodes may also take place.

According to a 2018 review, researchers estimate 1% of the general population experiences symptoms of bipolar I disorder.

In addition, people with bipolar II disorder may also experience mixed features.

The National Institute of Mental Health states that people with bipolar disorder may have symptoms of mania, which can include racing thoughts, hyperactivity, and an increased appetite for food, drinking, or other pleasurable activities.

They may also have episodes of depressive symptoms, including:

  • sadness
  • anxiety
  • restlessness
  • lack of energy
  • difficulty concentrating
  • feeling hopeless
  • suicidal ideations

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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However, some people may have episodes with mixed features, meaning they may feel hopeless and energized at the same time.

A 2019 study notes that people with manic and mixed episodes of bipolar disorder may have a high chance of experiencing racing or crowded thoughts.

Read more about bipolar disorder.

The following may contribute to episodes of bipolar disorder:

  • Genetics: People with a close relative with bipolar disorder may also have an increased chance of developing the condition.
  • Environmental factors: Stressful situations can trigger symptoms of bipolar disorder, such as manic episodes. Substance misuse and head injuries may also trigger symptoms.
  • Brain structure: Evidence suggests that people with bipolar disorder may have different brain structures than people without bipolar disorder. According to a 2022 study, people who have frequent manic episodes have thinning in some structures of their prefrontal cortex.

Bipolar disorder symptoms most often begin during adolescence or early adulthood.

A healthcare professional may perform a physical exam to check whether the person has other health conditions. They may also provide a referral to a mental health professional who may carry out an assessment that asks about symptoms.

A mental health professional may follow certain criteria to help them reach a diagnosis of bipolar disorder with mixed features.

Mania or hypomania may be present with at least three of the following depressive symptoms:

  • depressed mood
  • fatigue
  • excessive guilt
  • anhedonia, which is the inability to feel pleasure
  • recurrent thoughts of death
  • a slowdown of mental or physical activities

Major depressive episodes may occur with at least three of the following symptoms, including:

  • reduced sleep
  • activities consisting of painful consequences
  • grandiosity
  • expansive mood
  • increased talkativeness
  • flight of ideas
  • indulgence in activities with a high potential for painful consequences
  • increased goal-directed activity

For a diagnosis, mixed features must be present on most days.

Risk factors

Conditions that may increase a person’s chance of developing depressive symptoms include:

The American Psychiatric Association states that depression can also run in families. For example, if an identical twin has depression, there is a 70% chance that the other will develop the condition.

Depressive symptoms also tend to occur in people who have frequent pessimistic thoughts.

The possible causes of mania may include genetic, social, and psychological factors, such as:

  • stress
  • childbirth
  • seasonal changes
  • financial problems

People concerned about symptoms or experience manic episodes while taking certain medications may consider talking with their doctor.

Treatment for mixed episode bipolar disorder may include medications, lifestyle strategies, and therapy.


A healthcare professional may prescribe more than one medication, such as mood stabilizers and atypical antipsychotics.

Mood stabilizers may treat acute mania or mixed episodes.

Atypical antipsychotic medications are used to treat acute psychosis. This is a serious condition that occurs when a person experiences hallucinations, delusions, or disorganized thinking.

One 2018 review notes that antipsychotics may be effective in treating symptoms of bipolar disorder.

Learn more about medications for bipolar disorder.

Lifestyle strategies

A 2021 review states the following lifestyle strategies may help reduce stress, which in turn may help relieve bipolar disorder symptoms:

  • exercising regularly
  • avoiding alcohol
  • quitting or avoiding smoking
  • following a food plan as instructed by a doctor


Mental health professionals may help people with bipolar disorder learn how to:

  • recognize the early signs of episodes
  • identify negative thoughts
  • regulate day-to-day routines
  • monitor activity levels
  • manage emotions

The following are some questions people frequently ask about mixed episode bipolar disorder.

What does a bipolar mixed episode feel like?

During a mixed episode, people may feel high and low at the same time. They may have symptoms of depression with manic episodes. People may develop agitation and irritability.

How long do bipolar mixed episodes last?

Mixed episodes may last for up to 2 weeks, and sometimes even longer.

People may experience symptoms every day, and these tend to be intense.

What is the difference between hypomania and mixed state?

Hypomania is a form of mania but is less severe and lasts for a few days. Some people can continue their routine, as it does not disrupt their activities. However, others may find hypomania difficult to manage.

Symptoms of hypomania may include irritability, high self-esteem, and increased sexual energy.

“Mixed state” refers to mixed episodes of bipolar disorder. These happen when a person experiences symptoms of mania and depression simultaneously.

Mixed episode bipolar disorder occurs when people experience symptoms of mania and depression at the same time.

These episodes may more likely affect people with bipolar disorder when stressed. People who have a close relative with mixed episode bipolar disorder have an increased chance of having the condition too.

Mental health professionals can help provide a diagnosis. They may also recommend treatment, such as medications, lifestyle strategies, and therapy.