*I've been awake for 36 hours. Studies show a lack of sleep or an inability of sleep may be a precursor to mania or depression. I will add studies/articles as I find them. According to my moodscope chart, I am in a depressive cycle. I felt manic last night...determined to see the sunrise. I've decided my best sleep pattern would be from 7am - 2pm. That would be 7 hours of sleep and I could see both the sunrise and the sunset. Is this logical thinking? I don't think so. But it makes sense to me at this moment. I believe I'm experiencing a Mixed State brought on by taking the generic, non-time released Seroquel XR. Tonight, if I don't feel sleepy, I will take a larger dose of the Seroquel. I don't know if my sharing this is helpful or not. I may go back to sharing information from other sources and discontinue sharing my own experiences. I'm not sure what I'm comfortable with at this time.
Mixed episodes of bipolar disorder are defined by symptoms of mania and depression that occur at the same time, or in rapid sequence.
- Mania in mixed episodes usually involves irritability, racing thoughts and speech, and overactivity or agitation.
- Depression in mixed bipolar disorder is similar to "regular" depression, with feelings of sadness, loss of interest in activities, low energy, feelings of guilt and worthlessness, and thoughts of suicide.
For example, a person in a mixed manic episode could be crying uncontrollably while announcing they have never felt better in their life. Or they could be exuberantly happy, only to suddenly collapse in misery. A short while later they might suddenly return to an ecstatic state.
Mixed manic episodes can last from days to weeks or sometimes months, if untreated. Mixed episodes may recur and recovery can be slower than during episodes of "pure" bipolar depression or "pure" mania or hypomania.
The most serious risk of mixed bipolar disorder is suicide. People with bipolar disorder are 10 to 20 times more likely to commit suicide than people without bipolar disorder. Tragically, 8% to 20% of people with bipolar disorder eventually lose their lives to suicide.
Evidence shows that during mixed episodes, people may be at even higher risk for suicide than people in episodes of bipolar depression.
Treatment reduces the likelihood of serious depression and suicide. Lithium in particular, taken long term, reduces the risk.
People with bipolar disorder are also at higher risk for substance abuse. Nearly 60% of people with bipolar disorder abuse drugs or alcohol. Substance abuse is associated with more severe or poorly controlled bipolar disorder.
What Are the Treatments for Mixed Episodes of Bipolar Disorder?Mixed manic episodes generally require treatment with medication. Unfortunately, mixed episodes are more difficult to control than other episode types of bipolar disorder. The main drugs used to treat mixed manic episodes are mood stabilizers and antipsychotics.
While lithium is often considered a gold standard treatment for mania, it is thought to be less effective when mania and depression occur simultaneously, as in a mixed episode. Lithium has been used for more than 60 years to treat bipolar disorder. It can take weeks to work fully, making it better for maintenance treatment than for acute manic episodes. Blood levels of lithium must be monitored to avoid side effects.
Depakote is an antiseizure medication that also levels out moods. It has a more rapid onset of action, and in some studies has been shown to be more effective than lithium for the treatment of mixed episodes. Depakote is also sometimes used "off-label" for prevention of mixed manic episodes.
Some other antiseizure drugs, such as Tegretol, are also effective mood stabilizers.
Many atypical antipsychotic drugs are effective, FDA-approved treatments for mixed episodes. These include Zyprexa, Abilify, risperidone, Seroquel, Geodon, and Saphris. Antipsychotic drugs are also sometimes used alone or in combination with mood stabilizers for preventive treatment.
Electroconvulsive Therapy (ECT)
Despite its frightening reputation, electroconvulsive therapy (ECT) is an effective treatment for mixed manic episodes. ECT can be helpful if medication fails or can't be used.
Treatment for Depression in Mixed Bipolar Disorder
Common antidepressants such as Prozac, Zoloft, and Paxil have been shown to worsen mania symptoms during mixed episodes without necessarily improving depressive symptoms. Most experts therefore advise against using antidepressants during mixed episodes. Mood stabilizers (particularly Depakote), as well as atypical antipsychotic drugs, are considered the first-line treatments for mixed episodes.
Mixed episodes of bipolar disorder often involve recurrences of mixed, manic, or depressed phases of illness. Therefore, it is usually recommended that medications be continued in an ongoing fashion to prevent relapses.
BIPOLAR AND SLEEP
What may surprise you is that reduced sleep isn't just a symptom of mania - a short night can actually precipitate manic and hypomanic episodes. Studies have found that 25 to 65 percent of bipolar patients who had a manic episode had experienced a social rhythm disruption prior to the episode. "Social rhythm disruption" is some disturbance in routine affecting the sleep/wake cycle; it can be as simple as staying up extra late to watch a movie on television or getting wrapped up in an interesting online chat session, or as serious as being unable to sleep due to a family member's serious illness or death. "For reasons we have yet to learn, people with bipolar disorder seem to have more delicate internal clock mechanisms," said Dr. Ellen Frank, co-author of one of the studies. And once a sleep-deprived person has gone into mania, if he then feels less need for sleep (parasomnia) and, by staying awake perhaps 20 or more hours a day, is actually contributing to making the mania worse.
Some scientists believe that the reason the incidence of bipolar disorder has risen in modern times is the development of bright artificial light. Once upon a time, most people's sleep/wake cycles were regulated by the sun. Artificial light changed all that, and made it more likely that people who have a genetic predisposition toward bipolar disorder would actually develop the condition.
Interestingly, 85% of patients with unipolar depression report that they suffer from insomnia, even though bipolar patients tend to experience hypersomnia - excessive sleeping - during depressive episodes. Hypersomnia is also a characteristic of Seasonal Affective Disorder - along with decreased quality of sleep, which is also found in depressive patients, whether insomniac or hypersomniac. This poor-quality sleep can, in turn, lead to fibromyalgia, a painful, nondegenerative muscle disorder. All these patients can benefit from good "sleep hygiene" - a disciplined regularizing of sleep/wake hours. Depressed patients and those with fibromyalgia are also often treated with antidepressants such as amitriptyline and trazodone, which have sedating effects.
Patients suffering from insomnia and hypersomnia are told to go to bed at the same time each day, and get up at the same time. Naps are forbidden. Insomniacs should not stay in bed if they can't sleep, but are to get up at the same time no matter how little sleep they have had. Hypersomniacs are advised to gradually reduce the amount of time spent sleeping to a normal amount by using an alarm clock.
Preliminary studies indicate that aggressive readjustment of the sleep/wake cycle may be of particular help for treatment-resistant rapid cycling bipolar disorder. Such therapy may begin by enforcing complete light and sound deprivation for as many as 14 hours per night, which can be gradually reduced once the patient's moods are seen to stabilize.
Doctors point out the need to involve the patient's family in the effort to regularize the sleep/wake cycle. Family members should be taught about the patient's vulnerability to changes in daily routine. After all, a husband's "Oh, honey, I know the party will last all night but can't we do it just this once?" could send "honey" straight into a manic episode. Family members also need to learn the signs of an episode's onset, whether manic, hypomanic or depressive, and be prepared to intervene before the mood swing becomes full-blown.
If you or a loved one suffer from any type of mood disorder, pay attention to the sleep/wake patterns of the person involved. If you identify insomnia, hypersomnia, poor-quality sleep and/or reduced need for sleep, this should be brought to your/your loved one's doctor's attention right away. Treating the sleep disorder is very likely to improve the mood disorder, too.