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Mixed Episode

This is an episode where, for at least one week, a person has enough symptoms to meet the diagnostic criteria for both a Manic Episode and Major Depressive Episode according to the DSM-IV-TR. This may seem paradoxical, given that Mania and Major Depression are often considered to be opposite states.  

As an example, someone in a Mixed Episode might feel depressed but also irritable, find it difficult to experience any pleasure and yet feels a lot of nervous energy and be busy doing many activities at an accelerated pace. This person may have rapid thoughts that are mainly of depressed and morbid topics, such as ideas of low self-esteem and suicide, and may be speaking very quickly, concentrating poorly and sleeping poorly, though also feeling as if they do not need much sleep.  In this example, the person would have enough symtpoms to be diagnosed both with a Manic and a Major Depressive Episode.                 

Dysphoric Mania is considered a type of Mixed Episode by many experts [ref], although this category is not described in the current edition of the DSM-IV-TR.  Dysphoric Mania differs from a true Mixed Episode in that the person has enough manic symtpoms to be diagnosed with a Manic Episode, but has some, though not enough, depressive symptoms to meet full criteria for a Major Depressive Episode.

As a feature of a Mixed Episode, patients can experience psychosis and even catatonia, which adds to the severity of the episode. 

Of note, if the symptoms of a Mixed Episode are caused by a particular drug or medication, or are due to a general medical condition, then a diagnosis of a Mixed Episode is not made, though this person will still require medical attention. This is true even if the Mixed Episode was caused by an antidepressant, though clinically such cases are usually treated like regular Mixed Episodes [ref].

 

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Major Depressive Episode

Rapid Cycling