Definition

• Bipolar disorder, also known as "manic depression," is a mental illness characterized by mood swings, including periods of euphoria, extreme irritability, delusions of grandeur and debilitating depressions, sometimes lasting for weeks or months. When a person experiences the moods of bipolarism simultaneously or in a rapidly cycling manner, the condition is known as "mixed bipolarism."
  
  

Symptoms

• Mixed bipolarism involves simultaneous or rapid cycling of extreme moods, including:
  
  *Mania--agitation, irritability, euphoria, delusions of grandeur, hyperactivity, sleeplessness, racing thoughts and a feeling of being divinely or supremely inspired; and
  *Depression--absolute loss of interest in activities that were once enjoyable, lethargy, fatigue, sleeping too much or not at all, feeling worthless, unloved or guilty for no apparent reason.
  
  While in the "mixed" state, a bipolar person may cry and feel euphoric at the same time or may shift from tears to emotional highs in seconds. They are often unpredictable and may become violent for no apparent reason. The use of drugs or alcohol may intensify this condition or may turn a typical depressive or manic state into a mixed presentation of the disorder. Mixed bipolar patients have an even greater risk of suicide than those with nonmixed states because they tend to be less rational in their thinking and are often exhausted from the effects of rapid cycling.
  
  

Treatment

• Mixed bipolar disorder is typically treated with a combination of mood-stabilizing drugs, antipsychotics and other forms of therapy. Because of the constantly shifting nature of the disease, it is more difficult to treat than common bipolarism, and finding the correct combination of medication can present a challenge.
  Lithium is the most-often prescribed mood stabilizer for patients with mixed bipolar disorder. Most effective at treating mania, it builds up slowly in the bloodstream and must be carefully monitored due to its potential toxicity. Side effects are common with the drug, and many patients are reluctant to remain on the medication due to a reported "flattening" effect they experience.
  Antiseizure medications such as Depakote and Tegretol are also commonly prescribed to treat mixed bipolar disorder. Because they take effect more quickly than Lithium, they are often prescribed when a patient is experiencing mania or mixed mania/depression.
  Antipsychotics such as Olanzapine are often used as a preventative when rapid cycling is anticipated.
  Other forms of therapy include electroconvulsive therapy and talk therapy, in conjunction with medication.
  Antidepressants can trigger manic episodes and should be prescribed with caution and used under close supervision, several weeks after beginning the Lithium treatment.
  
  

Risks

• The most serious risk of a patient with mixed bipolar disorder is suicide. Up to 20 percent of people with the disorder will commit suicide. Although medication can help ease their symptoms and balance out their moods, many patients discontinue their medications during "manic" phases of their illness.
  Substance abuse and other addictions and dangerous lifestyle choices, such as gambling and sexual promiscuity, are other risks associated with the disease. Many patients attempt to self-medicate with drugs, alcohol or sex, and when the rapid cycling leads them out of their mania and into depression, they may feel self-contempt and wish to harm themselves.
  
  

Who Gets It

• An estimated 6 million people in the United States are currently believed to suffer from bipolar disorder--roughly 2.5 percent of the total U.S population. Up to 70 percent of those that suffer from the disease report mixed episodes. People with family members that have the disease are more likely to suffer from it themselves, and those that have an immediate family member with bipolarism are the most likely to develop the disease.
  The illness usually presents itself in the late teens or early twenties, but it may not appear until later in life, sometimes before a person is 50 years old.