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Mixed States... tell me your stories of dealing with them.


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I want to hear all about mixed states. What were they like for you? What did you do to stop them? What happened while they were happening? Everything and anything. Spare me no details. 

 

I am a little obsessed with this forum right now because this is the first place I have ever come that I can sit and ramble on about what happens to me in extreme detail without fear of scaring or worrying people I love. 

 

Anyway, this is my version of mixed episodes. I know it's long but it was a relief to get into a typed up post that someone with similar symptoms might see and respond to.

 

Bipolar a la saint alto...

 

When I first was diagnosed as bipolar my moods were much more defined. Pure mania, pure depression. It wasn't a good thing to have of course, but it was a bit easier to treat and I responded better to medication back then. The mixed states started about 4 years in and have increased a little every year. It has been 11 years now since my initial diagnosis and its has replaced those defined manias/depressions completely. These things don't respond well to any meds I take. I can usually treat them when they happen, but nothing has been effective in preventing them from happening in the first place. They hold my life in check until the day I can figure out some treatment that can do the prevention and the treating.

 

Mixed episodes are kinda everything at once, hence mixed. I can describe mixed episodes as being pulled by every emotional extreme in every direction all at the same time. It feels like your body is going to explode or implode or shatter or do all of those things. It simply is not made to handle feeling suicidal, euphorically happy, hysterically scared, viciously angry all at one time. During these mixed moods I am most likely to hurt myself or worse. This is because My mind will hand me any psychotic hallucination or delusion if it gives me an excuse to do that. It just needs what is happening to stop and to stop as quickly as it can make me stop it. They can feel like you are being torn apart from the inside. 

 

Maybe this are different for others but I can say that when I am in the throws of one, I can never know what I will do or what will happen. I usually curl up in a ball on the bed and not move for what feels like hours so that I can't act on my thoughts. It's so hard because my head tries to make me think I am in scenarios such being held against my will by my own family, or that people are coming to hurt me, and I often think my mind is being read by other people. They are going to report me for whatever reason and the government is going to arrest me and take me somewhere because of what it was thinking. Sometimes I believe these things, sometimes I can see through them.

 

Interaction with other people during a mixed state is not a good thing. When people talk to me, what comes of their mouths is very different from what they are really saying. My mind will reconstruct all their words in a way that might sufficiently frighten me into making it stop in some drastic manner. It is very confusing to people around me when this happens because I am responding to what they are saying in a bizarre and unrelated way. Most of the time I get through all this intact, but it's so tiring and i feel utterly exhausted for days afterwards. 

 

The way I can fight it is by taking 6-8 seroquel, curling up, and wait it out until the pills kick in. After that, the rest of the day is spent in a groggy haze of popping seroquel on the hour just to be sure I am safe. I reach the point where i can't even open my eyelids, but I can't quite sleep either. I am paralysed. I refer to this as "nuking" my mood state. I throw everything I've got at it and my husband brings me food and stuff. It's not like I need to do that every day, but often enough. I never exceed 800 mg though, I am smart enough to make sure doses aren't endangering me.

 

What's most terrifying about mixed states is that I have absolutely no build up or warning to indicate they will happen. Nothing what so ever. They hit me out of nowhere with the intensity of my earlier, well defined, mood episodes. Those used to take at the very least a few days to reach a high point and much much longer to dip to the lowest points. I don't have time frame anymore.

 

In between my mixed states I go into in a sort of mini-bipolar period. I become a dormant volcano of sorts, but a grumbling one. I am moody in a more defined way. It is a much more reasonable state to be in when it comes to keeping things stable. I do still get delusions in-between mixed states (no hallucinations), but they generally aren't destructive or dangerous. I can also catch them early on. This would be great, and easily controlled if things were that way in a dependable way. Unfortunately, since I can't predict what is going to happen and when serious mixed state will hit, I cannot really do much with my life. I get tastes of being functional-ish in tidbits, but its not to be trusted.

 

All in all, these moods are more frequent as the years go on and they really drain your strength to fight back. My mind is so exhausted.

/fin

 

Wow, that was freaky to write in a non-personal physical journal format.

 

now, tell me your experiences.

Edited by saintalto
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I'm a little concerned for you, taking Seroquel every hour. That's not good.

 

Mixed states for me=staying in bed so I can minimize the fallout on others, sad and low energy but agitated to the point of flipping out on anyone that dares to utter a word to me. Able to function sometimes, thinking I am okay, then I just lose it and think I am smarter than all those assholes. Too slow, stupid.

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What wj4 said. Unfortunately there is nothing I've found that I can do for them, other than to talk to my pdoc about med tweaks.  I try to keep to myself to minimize negative impact on others with my asshole-ishness.  Kind of hard to do though with kids underfoot every day.

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A lot of what you describe I can relate to. Your descriptions of being pulled apart from the inside are totally how it has felt for me. The one big mixed I had was terrible and it was how I ended up getting my dx. I had the pure manias and depressions for years but never really thought anything of it. But when this hit I could tell something was really wrong me so I sought out a therapist who sent me to a pdoc but I couldn't get in for months and but the time I did I was numbed out and severely depressed which I guess is better than hospitalized of something but yeah.

I know that this isn't an official dsm thing but I swear I have had mixed hypomanias as well. Rather a lot. They are not like the big bad mixed but it feels like that just I don't know less somehow. But still pretty awful. I guess like lots of people I don't feel like many of my highs or lows are pure anymore. They are sort of one big mess.

I love coming here too and being to talk about this stuff openly and honestly with people who get it and who won't freak out.

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I want to hear all about mixed states. What were they like for you? What did you do to stop them? What happened while they were happening? Everything and anything. Spare me no details.

I am a little obsessed with this forum right now because this is the first place I have ever come that I can sit and ramble on about what happens to me in extreme detail without fear of scaring or worrying people I love.

Anyway, this is my version of mixed episodes. I know it's long but it was a relief to get into a typed up post that someone with similar symptoms might see and respond to.

Bipolar a la saint alto...

When I first was diagnosed as bipolar my moods were much more defined. Pure mania, pure depression. It wasn't a good thing to have of course, but it was a bit easier to treat and I responded better to medication back then. The mixed states started about 4 years in and have increased a little every year. It has been 11 years now since my initial diagnosis and its has replaced those defined manias/depressions completely. These things don't respond well to any meds I take. I can usually treat them when they happen, but nothing has been effective in preventing them from happening in the first place. They hold my life in check until the day I can figure out some treatment that can do the prevention and the treating.

Mixed episodes are kinda everything at once, hence mixed. I can describe mixed episodes as being pulled by every emotional extreme in every direction all at the same time. It feels like your body is going to explode or implode or shatter or do all of those things. It simply is not made to handle feeling suicidal, euphorically happy, hysterically scared, viciously angry all at one time. During these mixed moods I am most likely to hurt myself or worse. This is because My mind will hand me any psychotic hallucination or delusion if it gives me an excuse to do that. It just needs what is happening to stop and to stop as quickly as it can make me stop it. They can feel like you are being torn apart from the inside.

Maybe this are different for others but I can say that when I am in the throws of one, I can never know what I will do or what will happen. I usually curl up in a ball on the bed and not move for what feels like hours so that I can't act on my thoughts. It's so hard because my head tries to make me think I am in scenarios such being held against my will by my own family, or that people are coming to hurt me, and I often think my mind is being read by other people. They are going to report me for whatever reason and the government is going to arrest me and take me somewhere because of what it was thinking. Sometimes I believe these things, sometimes I can see through them.

Interaction with other people during a mixed state is not a good thing. When people talk to me, what comes of their mouths is very different from what they are really saying. My mind will reconstruct all their words in a way that might sufficiently frighten me into making it stop in some drastic manner. It is very confusing to people around me when this happens because I am responding to what they are saying in a bizarre and unrelated way. Most of the time I get through all this intact, but it's so tiring and i feel utterly exhausted for days afterwards.

The way I can fight it is by taking 6-8 seroquel, curling up, and wait it out until the pills kick in. After that, the rest of the day is spent in a groggy haze of popping seroquel on the hour just to be sure I am safe. I reach the point where i can't even open my eyelids, but I can't quite sleep either. I am paralysed. I refer to this as "nuking" my mood state. I throw everything I've got at it and my husband brings me food and stuff. It's not like I need to do that every day, but often enough. I never exceed 800 mg though, I am smart enough to make sure doses aren't endangering me.

What's most terrifying about mixed states is that I have absolutely no build up or warning to indicate they will happen. Nothing what so ever. They hit me out of nowhere with the intensity of my earlier, well defined, mood episodes. Those used to take at the very least a few days to reach a high point and much much longer to dip to the lowest points. I don't have time frame anymore.

In between my mixed states I go into in a sort of mini-bipolar period. I become a dormant volcano of sorts, but a grumbling one. I am moody in a more defined way. It is a much more reasonable state to be in when it comes to keeping things stable. I do still get delusions in-between mixed states (no hallucinations), but they generally aren't destructive or dangerous. I can also catch them early on. This would be great, and easily controlled if things were that way in a dependable way. Unfortunately, since I can't predict what is going to happen and when serious mixed state will hit, I cannot really do much with my life. I get tastes of being functional-ish in tidbits, but its not to be trusted.

All in all, these moods are more frequent as the years go on and they really drain your strength to fight back. My mind is so exhausted.

/fin

Wow, that was freaky to write in a non-personal physical journal format.

now, tell me your experiences.

I can relate to a lot of this, so I guess my pdoc got the dx right. Pie seem to have a few different levels of symptoms, though. What you are describing is the most intense stage for me. That may last a few days or a few weeks before it subsides into a milder depressed stated where I just wanna curl up in a dark corner and forget about everything. There might be a short break of normal, and Then the whole process starts over again. The very beginning feels like a mild version of what you described, then the mania and euphoria comes, perhaps—but not always—alternating with the other, or sometimes with a mild depressed state or almost normal even, and then at one point, POW! Hits me like a ton of bricks every time. Last one just me right before Christmas. I'm overdue, I guess. I'm hoping the meds, which I started earlier this month, will prevent the next big blowup/meltdown. Edited by Flash
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I'm a little concerned for you, taking Seroquel every hour. That's not good.

 

Mixed states for me=staying in bed so I can minimize the fallout on others, sad and low energy but agitated to the point of flipping out on anyone that dares to utter a word to me. Able to function sometimes, thinking I am okay, then I just lose it and think I am smarter than all those assholes. Too slow, stupid.

I never take over 800 mg a day, though. I am safe about it. 

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I can relate to a lot of this, so I guess my pdoc got the dx right. Pie seem to have a few different levels of symptoms, though. What you are describing is the most intense stage for me. That may last a few days or a few weeks before it subsides into a milder depressed stated where I just wanna curl up in a dark corner and forget about everything. There might be a short break of normal, and Then the whole process starts over again. The very beginning feels like a mild version of what you described, then the mania and euphoria comes, perhaps—but not always—alternating with the other, or sometimes with a mild depressed state or almost normal even, and then at one point, POW! Hits me like a ton of bricks every time. Last one just me right before Christmas. I'm overdue, I guess. I'm hoping the meds, which I started earlier this month, will prevent the next big blowup/meltdown.

 

 Have you tried lots and lots of seroquel at one time when a mixed state hits you? You should as your pdoc about it and see what they think. It might be good to put a "plan" together with your pdoc about what you do when a mixed state hits.

 

In my case, I took a really big, but safe, dose of seroquel out of desperation and asked my pdoc later about it because it worked as a last resort measure. I usually would always ask before doing, but I just didn't have time to inform her before hand as it was an emergency.

 

Anyway, she said it was okay to do what I did so long as I kept under 800mg. It's not a good solution permanently, of course, but it works enough to keep the clock ticking. You do have to set aside a few days to be super drugged up. I keep on 800 mg 2-3 days after a mixed state hits just to be safe. I spend the time laying in bed and watching movies that are really easy to follow (I can't comprehend anything complex because my memory is fried the entire time). My husband helps me with meals and stuff cause i can't really walk around easily. Maybe i'm just super sensitive to side effects though, could be better for you.

 

I wish I got euphoria so badly. Even in mild form, my symptoms always involve irritability and anger in one way or another. I had classic euphoria during a mania a few times when I was younger. 

 

I know it isn't a good thing to have euphoria, but d*mn it, if I'm going to have to go through all this anyway, even though I am completely faithful to meds and therapy, the bipolar gods could at throw in something enjoyable into the mix.

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A lot of what you describe I can relate to. Your descriptions of being pulled apart from the inside are totally how it has felt for me. The one big mixed I had was terrible and it was how I ended up getting my dx. I had the pure manias and depressions for years but never really thought anything of it. But when this hit I could tell something was really wrong me so I sought out a therapist who sent me to a pdoc but I couldn't get in for months and but the time I did I was numbed out and severely depressed which I guess is better than hospitalized of something but yeah.

I know that this isn't an official dsm thing but I swear I have had mixed hypomanias as well. Rather a lot. They are not like the big bad mixed but it feels like that just I don't know less somehow. But still pretty awful. I guess like lots of people I don't feel like many of my highs or lows are pure anymore. They are sort of one big mess.

I love coming here too and being to talk about this stuff openly and honestly with people who get it and who won't freak out.

It's so nice to just ramble on freely about the biggest secret of your life.

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What wj4 said. Unfortunately there is nothing I've found that I can do for them, other than to talk to my pdoc about med tweaks.  I try to keep to myself to minimize negative impact on others with my asshole-ishness.  Kind of hard to do though with kids underfoot every day.

The asshole-ishness can be the worst because when you emerge on the other side back into a reasonably cohesive reality, there is a lot of explaining to do in regards to your behaviour. 

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i can't stop moving no matter what - but i am terrified to leave the house.  i pace until my legs hurt so bad i can't take it anymore.  then i sit in a chair and rock back and forth (i don't own a rocking chair).  i claw at my arms because i am filled with angry bees.  i cry uncontrollably.  i want to die.  i want to smash everything i can either lift or put my fist through.  everything in me is screaming, my thoughts are racing too much to concentrate on anything.  i am afraid of everything except the things i should be afraid of like hurting myself or others (not just random people, people i think "deserve it" at the time).  in the middle of it i can't articulate what's happening, i can just cry or yell.  it's obvious though to anybody who understands BP.  then there's the added insult that the mixed state usually follows feeling hypomanic and good - so i'm falling from a place where i thought i was pretty indestructable and i'm mad as hell and embarassed that i can't make it stop.  mixed states are the worst.

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i can't stop moving no matter what - but i am terrified to leave the house.  i pace until my legs hurt so bad i can't take it anymore.  then i sit in a chair and rock back and forth (i don't own a rocking chair).  i claw at my arms because i am filled with angry bees.  i cry uncontrollably.  i want to die.  i want to smash everything i can either lift or put my fist through.  everything in me is screaming, my thoughts are racing too much to concentrate on anything.  i am afraid of everything except the things i should be afraid of like hurting myself or others (not just random people, people i think "deserve it" at the time).  in the middle of it i can't articulate what's happening, i can just cry or yell.  it's obvious though to anybody who understands BP.  then there's the added insult that the mixed state usually follows feeling hypomanic and good - so i'm falling from a place where i thought i was pretty indestructable and i'm mad as hell and embarassed that i can't make it stop.  mixed states are the worst.

 

This ^^

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i can't stop moving no matter what - but i am terrified to leave the house.  i pace until my legs hurt so bad i can't take it anymore.  then i sit in a chair and rock back and forth (i don't own a rocking chair).  i claw at my arms because i am filled with angry bees.  i cry uncontrollably.  i want to die.  i want to smash everything i can either lift or put my fist through.  everything in me is screaming, my thoughts are racing too much to concentrate on anything.  i am afraid of everything except the things i should be afraid of like hurting myself or others (not just random people, people i think "deserve it" at the time).  in the middle of it i can't articulate what's happening, i can just cry or yell.  it's obvious though to anybody who understands BP.  then there's the added insult that the mixed state usually follows feeling hypomanic and good - so i'm falling from a place where i thought i was pretty indestructable and i'm mad as hell and embarassed that i can't make it stop.  mixed states are the worst.

Do you also feel happy though? I get these things you are talking about, but the bizarre part of it I find is that there is this thing in the back of me that is "enjoying" something. I will feel so miserable... but a place in my brain is "laughing" in this cruel, voyeuristic way. Like it's just pulled up a seat with a bowl of popcorn to watch a the greatest show on earth! And it's me who is laughing, i'm sure of it, because I don't hear it outside of my head.

 

Maybe it's because I don't get the enjoyable symptoms on their own anymore so instead of before, it's during... I dunno.

 

I know it doesn't seem to make sense, but does anyone out there feeling really "happy" during all this?

Edited by saintalto
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i don't get the happy so much.  i will laugh, make jokes that might seem inapropriate but certain things will strike me funny that aren't really funny to anyone else, probably too morbid.  that's as close to a good feeling as i get in that state.

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i can't stop moving no matter what - but i am terrified to leave the house.  i pace until my legs hurt so bad i can't take it anymore.  then i sit in a chair and rock back and forth (i don't own a rocking chair).  i claw at my arms because i am filled with angry bees.  i cry uncontrollably.  i want to die.  i want to smash everything i can either lift or put my fist through.  everything in me is screaming, my thoughts are racing too much to concentrate on anything.  i am afraid of everything except the things i should be afraid of like hurting myself or others (not just random people, people i think "deserve it" at the time).  in the middle of it i can't articulate what's happening, i can just cry or yell.  it's obvious though to anybody who understands BP.  then there's the added insult that the mixed state usually follows feeling hypomanic and good - so i'm falling from a place where i thought i was pretty indestructable and i'm mad as hell and embarassed that i can't make it stop.  mixed states are the worst.

Do you also feel happy though? I get these things you are talking about, but the bizarre part of it I find is that there is this thing in the back of me that is "enjoying" something. I will feel so miserable... but a place in my brain is "laughing" in this cruel, voyeuristic way. Like it's just pulled up a seat with a bowl of popcorn to watch a the greatest show on earth! And it's me who is laughing, i'm sure of it, because I don't hear it outside of my head.

 

Maybe it's because I don't get the enjoyable symptoms on their own anymore so instead of before, it's during... I dunno.

 

I know it doesn't seem to make sense, but does anyone out there feeling really "happy" during all this?

 

 

I don't exactly know what you mean by "happy".  I am gleeful, full of energy, willing to do whatever you want, but, at the same time would love to yell at you, break your stuff and run over your dog.

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I hate mixed states and have a hard time describing them. They feel like brain static. Like a Korean horror flick. Like a melty laughing clown face. Like harming myself because it's fun. Like a roller coaster right before I puke, but I'm still smiling but I'm not. Everyone here got it right, mine are similar to OPs. I am most likely to feel suicidal in one. I too take extra Seroquel.

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I can relate to a lot of this, so I guess my pdoc got the dx right. Pie seem to have a few different levels of symptoms, though. What you are describing is the most intense stage for me. That may last a few days or a few weeks before it subsides into a milder depressed stated where I just wanna curl up in a dark corner and forget about everything. There might be a short break of normal, and Then the whole process starts over again. The very beginning feels like a mild version of what you described, then the mania and euphoria comes, perhaps—but not always—alternating with the other, or sometimes with a mild depressed state or almost normal even, and then at one point, POW! Hits me like a ton of bricks every time. Last one just me right before Christmas. I'm overdue, I guess. I'm hoping the meds, which I started earlier this month, will prevent the next big blowup/meltdown.

 Have you tried lots and lots of seroquel at one time when a mixed state hits you? You should as your pdoc about it and see what they think. It might be good to put a "plan" together with your pdoc about what you do when a mixed state hits.

 

In my case, I took a really big, but safe, dose of seroquel out of desperation and asked my pdoc later about it because it worked as a last resort measure. I usually would always ask before doing, but I just didn't have time to inform her before hand as it was an emergency.

 

Anyway, she said it was okay to do what I did so long as I kept under 800mg. It's not a good solution permanently, of course, but it works enough to keep the clock ticking. You do have to set aside a few days to be super drugged up. I keep on 800 mg 2-3 days after a mixed state hits just to be safe. I spend the time laying in bed and watching movies that are really easy to follow (I can't comprehend anything complex because my memory is fried the entire time). My husband helps me with meals and stuff cause i can't really walk around easily. Maybe i'm just super sensitive to side effects though, could be better for you.

 

I wish I got euphoria so badly. Even in mild form, my symptoms always involve irritability and anger in one way or another. I had classic euphoria during a mania a few times when I was younger. 

 

I know it isn't a good thing to have euphoria, but d*mn it, if I'm going to have to go through all this anyway, even though I am completely faithful to meds and therapy, the bipolar gods could at throw in something enjoyable into the mix. I have zyprexa right now, although I saw pdoc today and might get seroquel, too. He wants me to take two zyprexa for several days to see how that works first. And then if blood work ok will up lithium again.

Sorry you don't get the euphoria. That's the only fun part ... Until it isn't. Of course you will eventually have to deal with aftermath of the cray cray. And sometimes you can make quite a mess of things. :(

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I have zyprexa right now, although I saw pdoc today and might get seroquel, too. He wants me to take two zyprexa for several days to see how that works first. And then if blood work ok will up lithium again.

Sorry you don't get the euphoria. That's the only fun part ... Until it isn't. Of course you will eventually have to deal with aftermath of the cray cray. And sometimes you can make quite a mess of things. :(

 

 

Yes, I get the mess issue. One of the few things i remember in an early euphoria/manic state was that I gave away almost everything I owned. I was left with two dresses in an empty closet. I really miss some of my old stuff, when I think about it sometimes, especially some of the heirlooms. Oh well. That is my old life, I'd rather have what I do now anyway. 

 

I am glad you saw your pdoc. What is zyprexa? I get confused because some meds have a different name here than they did where I came from.

 

Edited by saintalto
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Zyprexa is an atypical antipsychotic med.  It is in the same class with Seroquel.

 

Mixed states, for me, are depression mixed with agitation.  All I want to do is go to bed, but my mind is buzzing along.  It feels like the gears in my head are grinding against one another, almost making a screeching sound.  So, basically, I'm exhausted but I can't calm down.  

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What PR said, plus rage, and loss of impulse control.

 

I stop them with prn benzos and AAPs. I don't stay on AAPs for long afterwards, though; maybe two months when we have gotten everything under control. I usually ask if I can go off of it ("it" is risperidal) around then, and my pdoc has always been happy to keep me on fewer meds. Once I've stablized, it starts to irritate me for some reason.

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