My Story
The crisis team visited me at my sister’s house because I decided my family home was full of triggers. I was given a bed in a local psychiatric hospital for respite. Unfortunately, the mixed state continued and I argued with any nurse who spoke to me out of turn.
Interestingly, I still stand by most of my comments and feelings as a result, it’s just my illness exacerbated them to the point I couldn’t control them in a calm and more effective manner.
Treatment
Unfortunately, mixed states offer therapeutic challenges and are more difficult to control than a pure episode of mania or depression. The main drugs used to treat mixed states are mood stabilizers and antipsychotics.
Common antidepressants have been shown to worsen mania symptoms without necessarily improving depressive symptoms in mixed states. Most experts therefore advise against using antidepressants during episodes with mixed features.
What Helped Me?
- Telling a professional about my symptoms and concerns. For example, phoning a mental health helpline and the crisis team who visited me at home.
- Educating my family and setting boundaries to avoid triggers and hostile situations. For example, giving me personal space and being mindful of uncontrollable irritability.
- Receiving calm, patience and understanding. Asking family and friends to speak to me in a kind, low tone of voice.
- Including family support in meetings where you discuss treatment and progress with all consultants and nurses. It is here family can listen and be educated further about the severity of mixed states.
- Allowing respite in hospital. The body needs time to calm itself from its stimulated, high alert state.
- The prescription of benzodiazepines (sedatives). These are often required when symptoms reach such a peak that self-harm, aggression or suicide are concerns.
- Reviewing medication. For example, introducing new mood stabilizers and/or the decrease of anti-depressant use.
- The use of mood charts. These are helpful to monitor how often the mood is changing and when improvement is evident.
- Continual professional support throughout recovery. Counselors and other members of your health care team offer constant reassurance that things will get better, and recommend coping strategies to get through the difficult mixed state phase.
As outlined, mixed states are one of the most difficult and dangerous phases in bipolar, but may be unavoidable. For me, the only route of treatment is telling a professional because it can be hard for family to cope with.
Medication, sedatives, therapy and support is often the framework for progress. It is difficult, but I am living proof you can recover from mixed state episodes.
