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Bipolar Disorder With Mixed Features: Causes, Symptoms, Risks, Treatment

Bipolar disorder can be a great challenge. Mood swings, or extreme shifts in emotion that might last for several days, are the prime symptoms of this disorder. Usually, Bipolar disorder involves depressive, manic, or hypomanic episodes. However, the specific changes in mood that are experienced by the patient depend on if one has bipolar I, II, or cyclothymia. Now, the condition is known as bipolar disorder with mixed features. Let us take a further look and know more about the condition.

Understanding Bipolar Disorder With Mixed Features:

Bipolar disorder with mixed features is believed to affect one-third to half of the patients having bipolar disorder.(1)

If you suffer from bipolar disorder with mixed features, you will be experiencing your mood with mixed symptoms. This is different from other types of bipolar disorder, which involve only single type of mood symptoms. One might not experience mixed symptoms all the time during the episode.

It must be mentioned that bipolar disorder with mixed features might be more severe than Bipolar I and bipolar II without mixed features. This is because such mood episodes would occur more frequently and might also last longer. The symptoms might also be worse as compared to general bipolar symptoms.

Research has also shown that these mixed features are linked with symptoms of psychosis, increased risk of substance abuse, and suicide.(2)

Causes Of Bipolar Disorder With Mixed Features:

Though there is no specific cause of bipolar disorder with mixed features, however, experts have put forward some of the potential causes.

It has been suspected by researchers that one factor of this condition could be a change in the functioning of hypothalamus (a part of the brain).(1) Such changes might result in sleep issues as reported by many bipolar patients. Sleep problems, problems in falling asleep or remaining asleep, might even affect the person’s ability to regulate mood.

Every individual with Bipolar shows depressive and manic symptoms to certain extent. However, different factors trigger mood changes in a different manner for each individual. More research is required to find out the exact causes of such changes in mood.

Some Symptoms Of Bipolar Disorder With Mixed Features

Let us here take a look at some symptoms of bipolar disorder with mixed features. Though the features might vary from person to person, some of the common symptoms include:

  • Mixed feeling of elevated and low moods.
  • Experiencing low mood with rapid and random speech
  • Doing pleasurable activities however still having depression
  • Experiencing disturbed sleep
  • Suicidal ideation
  • Experiencing a severe disruption of appetite.

Risks Involved With Bipolar Disorder With Mixed Features:

Risks are a part of life. And when it comes to risk associated with bipolar disorder with mixed features, they could be really serious. The most severe risk is suicide. It is found that patients with bipolar disorder are 10-20 times more likely to commit suicide than those without the disorder. It has also been found that during episodes with mixed features of bipolar, people might be at higher risk for suicide than those with only bipolar disorder.

One more risk associated with this condition is substance abuse. Around 60-% of people with bipolar disorder are involved with substance abuse like abuse drugs or alcohol.

Treatments for Bipolar Disorder With Mixed Features:

Bipolar disorder episodes with mixed features usually indicate a more severe condition, and also poor response to treatment.

A single medication cannot be used for treating bipolar disorder with mixed features. Generally a combnation of two or more medications will be prescribed by a mental health professional for treating the condition. According to a review of 2014, it has been mentioned that using one antidepressant for therapy is not recommended.(3)

Combination therapy for bipolar disorder with mixed features might include atypical antipsychotics, mood stabilizers, and electroconvulsive therapy or ECT. More severe cases would rquire ECT, sine medications will not be effective to resolve the symptoms. However, mild cases can be treated using atypical antipsychotics like olanzapine, risperidone, quetiapine, ziprasidone, lurasidone, etc. and mood stabilizers like lithium, lamotrigine, divalproex sodium, topiramate, gabapentin, etc.


It might take a long time to find the best treatment for bipolar disorder with mixed features, however, you should not lose hope. With appropriate treatment and lifestyle changes, one can manage mood episodes and reduce symptoms quite easily.


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Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:May 3, 2022

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