Mixed Bipolar Disorder – Track your mood and medications for good!

mixed bipolar disorder

When we think of disease, we usually think of those that have affects on us that we can see. But we rarely think about those diseases that impact our minds. Mental illnesses are diseases, however what defines them can be blurry. Due to the nature of this ‘blurriness’, most of these mental health illnesses range within a ‘spectrum’, instead of set rules. Mixed bipolar disorder is one of the mental illnesses. It can be seen frequently in our daily life. We have heard of the term ‘depression’, but we rarely hear about ‘mania’. Depression and mania are considered to be on opposite poles of this spectrum. Hence the swings between these two poles are named ‘bipolar’. And when these swings happen suddenly and quickly, mixed bipolar is usually the diagnosis.


Mania is a condition when an individual feels or acts bouncing, happy or short-tempered. Consequently they experience less will to sleep and tend to make spontaneous choices with no fear over the effects. The severe form of manic episode or association with psychosis is mania, and the less severe form is hypomania.

Psychosis is an abnormal condition that results in determining what is real and what is not. During a manic episode, people with psychotic symptoms tend to have unrealistic grandiose beliefs. For example, being famous, having a lot of money, or having superpowers.

The key signs of this manic episode are,

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  1. hyperactivity, decreased want for sleep
  2. feeling very happy or too high for an extended period
  3. vulnerable for easy distraction
  4. speaking very loud and fast, usually with hurrying thoughts
  5. feeling extraordinarily restless or impulsive
  6. having overconfidence in your abilities
  7. engaging in precarious behavior, e.g. going on shopping sprees, having sudden sex, gambling with life savings


Depression is when an individual feels or expresses a negative stance over life. For example, they feel exhausted, crying and devoid of eye contact with others. They would have a low threshold to attempt self-harm or even suicide.

Opposite to the features of psychosis during a manic episode, people with psychotic symptoms during depression can imagine that they are bankrupt, involved in crime, or suffering from a severe unknown illness.

Key signs of depression from bipolar disorder are,

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  1. sad or hopeless feeling for long periods
  2. retraction from friends and family
  3. loss of interest in activities which you once enjoyed
  4. a significant change in appetite
  5. severe fatigue or lack of energy
  6. problems with concentration, memory and decision making
  7. thoughts or attempts of suicide, or having an obsession with death

The episodes of either mania or depression may last from days to weeks. Bipolar disorder is a combination of both – mania and depression. Hence, it got other names such as manic depression, bipolar affective disorder. In other names, the words manic and depressive is suffixed by disorder, illness and psychosis . It is featured by periods of depression and mania at varying times in a single individual. Meanwhile, health issues fall under anxiety disorders and substance abuse are seen to co-exist with bipolar disorder.

When talking about symptoms, the symptom tracker feature in the CareClinic app should be mentioned. While you encounter such symptoms, you can utilize this feature to record and maintain it as a symptom diary.

Varieties of Bipolar Diseases

Bipolar disease is classified into following categories. All involve occurrences of depression and mania to a point of time.

Bipolar I disorder

Bipolar I disorder can occur to virtually anyone. This is described by at least one manic episode. It may or may not be associated with psychotic components. Many have experienced one or more depressive episodes in all patients with mania. The hypomanic stage precedes the maniac stage. The symptoms appear mostly during teens or early 20s. However, the onset is before 50, for nearly everyone diagnosed. Higher risk of early occurrence is observed with a bipolar member in the immediate family.

Bipolar II disorder

Bipolar II disease is another bipolar spectrum disorder. It is characterized by at least one hypomanic episode and at least one episode of major depression. Most importantly, there should be completely no occurrence of any full manic episode. Since a complete manic episode is considered a diagnostic feature of BD-I, diagnosis for bipolar II disorder demands this rule to be fulfilled.

Cyclothymic disorder

This is not a common type. Cyclothymic disorder is momentary episodes of hypomanic symptoms. They alternate with brief bouts of depressive symptoms. These episodes do not prolong, similar to episodes in full hypomania or full depression.

What is Mixed State Bipolar Disorder?

The simultaneous existence of elevated and depressed symptoms occurs in people encountering an episode of mania or depression as a part of the episode. Moods swing between high and low over time are noticed in other forms of bipolar disorder. In contrast, mixed state bipolar is described as the occurrence of mania and depression at the same time or in an alternating sequence. A study conducted in 2015 reveals that around 40% of people with bipolar disorder experienced at least one mixed episode. (R)  Mixed state bipolar has other names such as bipolar mixed and bipolar mixed episode.

Risk factors

Chemical imbalance in the brain

Bipolar disorder is generally considered to be the result of chemical imbalances in the brain. The neurotransmitters are the chemicals accountable for controlling the brain’s functions. They are namely noradrenaline, dopamine and serotonin. Symptoms of bipolar disorder may develop consequently to an imbalance in one or more neurotransmitters’ levels.


Bipolar disorder is related to genetics, as it appears to run in families. Not a single gene is accountable for bipolar disorder. A combination of genetic and environmental factors are believed to act as triggers. In other words, family members of a person diagnosed with bipolar disorder have an increased risk.


A traumatic experience or condition often causes symptoms of bipolar disorder. These types of life-altering events can cause episodes of depression at any time in a person’s life.

Examples of stressful triggers include

  • the break-up of a relationship
  • physical, sexual and emotional abuse
  • the death of a loved one
  • physical illness
  • sleep disturbances
  • devastating problems in daily life related to money, work or relationships


The symptoms of mania or depression are explained in the previous paragraphs under their respective headings. Tracking your mood variations described above will be a helpful tool in diagnosis. You can learn more about tracking moods and medications in the latter part of this article.

Lets say you feel that you or someone you love has signs or symptoms of any bipolar disorder described above. Then you should seek advice from the physician. If you experience extreme variations in your mood and it disturbs your daily routine, you should see your physician. Only a trained medical professional could diagnose the disease, and it is the first step towards a proper treatment to lead a symptom-free life to the fullest. In other words, you don’t have to hesitate to reach for medical attention.

No specific blood work or imaging technique like brain scans will be of use in diagnosis. Meanwhile, your physician might order a few other blood work to rule out the possibilities of other diseases. A most common blood test is for thyroid function tests to exclude hypothyroidism.


Once you have a diagnosis, your doctor will decide on a treatment program that works best for you. Treatment for bipolar disorder may include:

  • Medication
  • Non-medical approach
  • Substance abuse treatment
  • Electroconvulsive therapy
  • Meditation

No matter what the therapy you are following, you can keep your therapy updated by using the therapy feature offered by the CareClinic app.

Medication for bipolar disease

When you get the diagnosis saying that you have bipolar disease, you will require continuing treatment. Firstly, regular visits to a mental health professional will be essential, despite your feeling of ‘being fine.’ Secondly, regular medications play a vital role. Combination of medications along with conversations with the health professional, will be part of your treatment.

Initial treatments will focus on bringing your symptoms under control as quickly as possible, and once controlled, the maintenance phase would begin. The reason for a maintenance dose is the reduction of the risk of relapses. It also prevents minor mood swings from bursting into mania or depression.

Few types of medications are used to treat bipolar disorders. They includes a variety of mood stabilizers, anti-anxiety drugs and antidepressants. The prescription will contain a single drug or combination. It is depending on the treatment requirement planned by your health care professional. Judging the appropriate medication which works better for you will take some time. On the other hand, side effects of medications might mandate a change in drugs. But your physician will not change your drugs haphazardly. One drug will replace another, at one time. By replacing one, your physician can identify the medication that is effective for you.

However, explaining further about the drugs used for treatment is out of the scope of this article.

Why tracking your medication necessary?

People who suffer from chronic diseases, including mental illnesses, experience challenges in taking their medication. It may be any reason, for instance – complexity of the regimen, the patient’s forgetful mind, inability to remember the time, dose, drug, etc.

You should take the medications regularly, especially for mental illnesses, to keep the bursting mood swings under control.

CareClinic offers the feature for medication tracker and reminder in a single app itself. (R) In the CareClinic app, you can construct a care plan comprising any medication you are taking.

The medications list is already in the app, and all you need to do is enter the correct doses and frequencies as prescribed. You can set the reminders in the application. Consequently the calendar will show active, inactive and refill reminders as well.

CareClinic app also lets you monitor your medication adherence, medication frequency and additional health-related information. The best thing you can do after diagnosis with a new illness is adding it to your treatment plan. Mental disorders are not an exclusion to this practice. The prescribed medications you have will then be related to the symptoms you encounter.

The app will generate notes that include information you’ve tried about drug adherence, conditions, and multiple treatments. As a result, the therapy will build connections between your symptoms and medication.

Non-medical approach

Behavioral therapy

Behavioral therapy included all therapy types that treat mental health disorders by identifying and changing the potentially unhealthy behaviors. It focuses on the current problems and works on the solutions for them.

As this therapy involves knowing about yourself, a therapist would ask you many personal questions. Therefore, reaching out to a therapist with whom you would feel comfortable is the crucial step. You might visit a few therapists to find out the most convenient person for you. Following are the types of therapies falling under the umbrella term ‘behavioral therapy’.

Cognitive-behavioral therapy

Cognitive-behavioral therapy is a combination of behavioral therapy and cognitive therapy. The treatment goal is to understand the link between someone’s thoughts and beliefs and their influences in the actions and moods, focus on their problems, and work around a solution. Ultimately, the long-term goal is to make a person’s thinking and behavioral patterns healthier.

Cognitive-behavioral play therapy

It is commonly useful for children. Therapists observe the children during their play and learn about the child’s expresses. They focus on what is comfortable or uncomfortable for the child to express. The game could improve communication between the parents and the children and result in improved thinking and behavior of the children.

System desensitization

Simply, it is classical conditioning. It is mainly used to treat phobias. Following training for relaxation, the patient will learn how to show a relaxation response instead of a fear response to a phobia. Subsequently, the intensity of fear the patient is exposed to will be raised so that the patient can practice and strengthen their learning.

Aversion therapy

Aversion therapy is an appropriate treatment for problems such as alcoholism, smoking and substance abuse. The goal is to train by coupling a desirable stimulus with an unpleasant memory. The discomfort from the unpleasant memory would prevent you from looking for the desirable stimulus.

Substance abuse treatment

If you have a problem with substance abuse, then recovery from addiction would be the main focus. Recovering from an addiction isn’t easy. A significant amount of determination, self-control and self-discipline is necessary to achieve and maintain long-term soberness. On the other hand substance abuse recovery needs strong relationships. Your network with others who can relate to your state will be helpful. Support from your family, friends and loved ones have positive influence during this time.

People suffering from substance abuse could also seek advice and support from exclusive helplines.

Acknowledging substance dependency is the first step toward recovery from the addiction. The next step is finding and enrolling in a treatment program that could help restore overall health and happiness. Most importantly, there is no single program to fix the dependency. Each individual has different character. Each individual needs a tailored plan. Hence, there are countless treatment options a person can choose from.

Electroconvulsive Therapy (ECT)

In some instances, medications and talk therapy fails. Frequently, the last resort of treatment for some mental illnesses, including bipolar disorders is Electroconvulsive therapy (ECT). During the treatment, electrical fluxes are sent through the brain to induce a seizure. It has been shown to help people.


As discussed above, the treatment for the bipolar disease is to control the mood swings. Meditation is an ancient technique. It helps to balance and minimize the ups and downs of mood. Meditation helps you better understand yourself. It can ease your mind and support you. Meditation makes you survive and ride the waves of the worries of daily life. It gives you more tolerant view of life. However, meditation is not a cure for bipolar disorder, but it could help you soothe your mood.

The type of meditation that recently became popular amongst the public is mindfulness mediation. It lets you focus on your thoughts and feelings. Focusing on them will help you be aware of distressing thoughts and feelings. By recognizing such negative thoughts, you will be enabled to separate from them rather than fix them.

How to track your mood?

You can’t manage what you don’t measure. Mood tracking is a technique to help people record their moods. It helps to identify their mood variations, usually in particular time intervals. Tracking moods is self-help for people suffering from mood disorders, including bipolar disorder. It is more useful especially in mixed state bipolar.

You track your mood as you watch for swings in your mood. You must know your moods, specifically when they reach heights in both extremes. The more you are aware of your moods, the more you can identify the events triggering the episodes; help arrive at an accurate diagnosis. Also, you can focus on the treatment plan.

Conventional mood charts and journals helped in mood tracking for a long period. Now, smartphone apps with technology advancements replaced them. CareClinic is your one-stop personal health app. It provides you with a simple mood tracker. Mood tracker makes tracking easy, and more effortless when it is a part of your daily activities.

The app maps your mood within few taps. The check-in function in the app lets you record your mood access in the symptom tracker. You just need to select the mood and enter the date of occurrence. Isn’t that simple?

You can read more about tracking your mood on our blog. (R)

Why is mood tracking important in bipolar disorders?

You can recognize patterns and triggers of negative moods, by connecting the moods associated with events that took place. Learning the trigger would help you devoid such situations lead to a severe episode in future.

Another advantage of tracking is you can make informed health decisions. The diary entry or check in feature in CareClinic app lets  you maintain a log of your symptoms, triggers and treatments. Since you establish the network of events, people and mood, you can create better communication and seek support when needed.

Ways to fix your low mood

Give yourself time to do stuff you like or try something new. So that you can fix when you feel low in your mood. Here are a handful of tips.

  • Pay attention to yourself, get a grooming session, or go swimming.
  • Motivating yourself – for example, training for a running game, preparing something new.
  • Have time to enjoy spending time in your yard, going for a stroll, or listening to some music.
  • Rest and recharge – schedule and take a break.
  • Tidy up your home, do a yoga class or use meditation to relieve your tension.
  • Help the situation – devote some of your time to a cause or assist a friend or neighbour, for instance.
  • See the sun and breeze on your skin here and now, enjoy the scents of your yard, sense the warmth of your coffee cup in your hands.
  • Engage and exchange interests, for example taking up a class in painting or language or joining a sports club.
  • Take a friend to the cinema, or maybe meet up for a snack.
  • Ask for assistance – contact a friend or family member to share your feelings.
  • Visit your GP or dial a helpline.

In conclusion, when it comes to health, CareClinic offers the best solution out there. It enables you to conquer your disease with ease.

CareClinic opens up your one-stop health record. Track your mood. Check in to record your symptoms and triggers. Analyse and recognize the patterns. Maintain therapy record. Set medication reminders. Recieve refill reminders.

Download the CareClinic app and begin monitoring your mood, medications, activities. Enjoy your life to the fullest.

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Mariano R Kanagaratnam