I can’t think of a snappier title for this blog, because mixed mood is where I am at and my brain feels scrambled. For four weeks now my functioning has been disturbed, my mood fluctuating but not actually euthymic (normal) at any point.”How are you?” my Care Coordinator asks, and all I can say is that I am “up and down”. When pressed I think harder and say that I am more up than down, but definitely with down bits stirred in. So – mixed?
It’s maddeningly difficult to get anyone to agree what a mixed affective state is and I have of course met different psychiatrists with different views. Is any bipolar mood state that has some features of the other pole necessarily mixed? Is it useful to separate out predominantly depressed mood with hypomanic features from a predominantly high episode with some features of depression? How do you know whether the swirling pool of emotions is a mixed state or in fact “ultradian” (incredibly rapid) cycling?
A “mixed affective state” use to be viewed as one of the four presentations of bipolar: bipolar I, bipolar 2, mixed affective state and rapid cycling (all boxes I have been put in at one point or another). When the DSM-5 came along it switched to the “mixed features” approach, so any major mood episode can be diagnosed as having mixed features as part of its makeup.
It’s all a bit of a mish-mash from a service user point of view, and when you are in the grip of swirling emotions being able to tease out and articulate what you think is going on can be very hard. Just as I have had to learn what hypomania means for me (depression’s pretty easy to identify), I have had to learn what mixed mood entails. It matters that I am able to to identify mixed mood. It matters a lot. I was in mixed mood both times I was hospitalised. I was in mixed mood the only time I took a major overdose. Here’s what I have pieced together in recent years.
If I don’t know what mood state I am in, but I am unwell or distressed, it’s probably mixed mood.
If my moods flutter and flicker rather than snapping smartly back and forth, it’s probably mixed mood rather than incredibly rapid cycling.
In mixed mood my thoughts are very “loud” with competing viewpoints vying for attention. I can be in two or even three minds about something, for example: I need to die; I want treatment because I don’t want to die; there is nothing wrong with me and I don’t need anything. One thought can immediately follow another so that I don’t know what I feel, want or believe any more, sometimes wanting multiple conflicting things in any given moment.
If I am tired, yet raring to go, that’s a sign I may be in a mixed state.
If I experience eight different emotions, ten, maybe even more, in the course of a day then I must be in mixed mood.
Today I have been irritable, angry, lethargic, agitated, sad, tearful, awed, elated, guilty, terrified, ashamed. I got up desperate to go out and shop (hypomania) but returned to bed feeling exhausted before I could go anywhere (depression). I went out in the end and spent too much money (hypomania). I was hypersensitive to noise at the shops and felt hostile towards other people who had the gall to get in my way (hypomania). When I came home I sat on the sofa and cried because a song was so beautiful (hypomania). Then I cried because I couldn’t cope with household tasks and I felt aweful about the money I had spent (depression).
I have given up for the day. The washing will have to stay wet in the machine until Tom gets home to deal with it. I have cancelled the gym class I was really looking forward to because I have no idea whatsoever whether a cardio workout to loud music will be beneficial or detrimental to my wellbeing. I will have a bath. I might take some diazepam. It’s all uncomfortably like implementing a crisis plan.
I am seeing my psychiatrist tomorrow and I am going to ask about a medication increase. The level of mood disturbance has been creeping up and up in the last four weeks and I’ve been having the same old paranoid thoughts about my tech being misused by dark forces and the same old feeling that I am being menaced by banana skins. I can’t take the risk that things will get any worse and anyway I am getting very, very tired of the big bipolar mixing bowl.