Bipolar Disorder is typically characterized by extreme up and down mood swings. The various types of the disorder are distinguished by the pattern and severity of these highs and lows. And in Mixed Bipolar Disorder, the highs and lows may occur at the same time. The mood swings of Bipolar Disorder are called "episodes." While a person with "regular" Bipolar Disorder may alternate between elevated manic and depressed moods over a period of time, a person with Mixed Bipolar Disorder typically experiences simultaneous episodes of mania and depression. These mixed state episodes may appear as either: dysphoric mania, which is a manic episode with an unpleasant or depressed mood; or agitated depression, a depressive episode-including sadness, hopelessness and suicidal thoughts-with mania symptoms, such as anger and irritability. While symptoms vary according to the person, those with Mixed Bipolar Disorder have described the mixed state experience as "tired but wired," with racing thoughts that may be highly negative, and often exchanging laughter for crying in misery all in a matter of mere seconds. The result may be an extremely confusing and frightening state of mind that that can adversely affect a person's ability to carry out normal daily activities. It's also not uncommon that a mixed state episode may lead to substance abuse or suicide attempt. In some cases, mixed episodes may also be accompanied by psychotic symptoms that reflect the sufferer's extreme mood state, and may include hallucinations or delusional behavior. Some may require hospitalization for their own safety, or the safety of others. Approximately six million people in the U.S. suffer from some form of Bipolar Disorder, which typically begins in the late teens or early adulthood, and rarely starts after age 50. Having an immediate family member with the illness increases the risk. It's estimated that between 20 and 70 percent of Bipolar Disorder sufferers may experience mixed episodes, which are particularly likely when the illness begins during adolescence. Some experts attribute the occurrence of mixed states in children and teens to thyroid abnormalities. A diagnosis of Mixed Bipolar Disorder involves episodes of mania and depression that occur concurrently or in rapid succession, nearly every day for at least a one-week time period-and be severe enough to impair functioning. Left untreated, mixed episodes can continue for days, and even years. Rather than antidepressants, which may trigger manic episodes, medications for Mixed Bipolar Disorder typically include mood stabilizing drugs like Lithium, and antipsychotic drugs, such as Zyprexa. Additionally, Depakote, an anti-seizure drug, may help level mood and prevent mixed episodes. Electroconvulsive therapy MAY be helpful if medication isn't working as desired. Living with Mixed Bipolar Disorder can be challenging. But, with an effective treatment strategy including medication, therapy and healthy coping skills, sufferers can typically manage their symptoms. If you experience recurring symptoms of mania and depression at the same time, please see your doctor or mental health provider.