Bipolar Mixed Episodes: Navigating the Unthinkable

Can mania and depression really coexist? In this episode, our hosts unravel the complexities of bipolar mixed episodes — where mania and depression collide in the same mind, often creating a personal hell for those experiencing it.
Gabe Howard, who lives with bipolar disorder, and Dr. Nicole Washington dive into the complexities of mixed episodes, highlighting that they’re far more than just mood changes. Bipolar mood episodes combine dangerous elements like high energy, impulsivity, and intense hopelessness.
They use vivid analogies, comparing it to mixing vodka and Red Bull — a chaotic blend where alcohol and caffeine each trigger distinct sensations but together create an entirely unpredictable and overwhelming effect. This can help listeners visualize the volatile nature of mixed episodes and why they are so challenging to manage.
Discover why mixed episodes carry a higher risk of suicide and why recognizing them matters. Tune in to learn how this evolving knowledge can lead to better diagnoses, treatment, and ultimately, better outcomes for those living with bipolar disorder.
“When someone is sitting in front of me and I'm trying to figure out, what is this? Is this mania? Is this a mixed episode? And I'll be completely honest with you, a lot of times, mixed episodes don't even come to the forefront of my mind. It's not something I usually say, oh, let me screen for whether this is a manic episode or a mixed episode. In all the chaos of the mania, sometimes the depression parts can get missed.” ~Dr. Nicole Washington 

To learn more -- or read the transcript -- please visit the official episode page.

Our Host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, "Mental Illness is an Asshole and other Observations," available from Amazon; signed copies are also available directly from the author.
To learn more about Gabe, or book him for your next event, please visit his website, gabehoward.com. You can also follow him on Instagram and TikTok at @askabipolar.

Our host, Dr. Nicole Washington, is a native of Baton Rouge, Louisiana, where she attended Southern University and A&M College. After receiving her BS degree, she moved to Tulsa, Oklahoma to enroll in the Oklahoma State University College of Osteopathic Medicine. She completed a residency in psychiatry at the University of Oklahoma in Tulsa. Since completing her residency training, Washington has spent most of her career caring for and being an advocate for those who are not typically consumers of mental health services, namely underserved communities, those with severe mental health conditions, and high performing professionals. Through her private practice, podcast, speaking, and writing, she seeks to provide education to decrease the stigma associated with psychiatric conditions. Find out more at DrNicolePsych.com.