Mixed Features

Mixed features, formerly referred to as mixed mania, mixed episodes, or a mixed affective state, is now a clinical specifier used when an individual experiences symptoms of both poles — mania and depression — simultaneously. During these states, a person can shift between high and low symptoms very quickly, often within the same hour or day. This may manifest as feeling energized or having grandiose thoughts while simultaneously feeling sad, empty, or suicidal. Others describe feeling “agitated and switched on” while feeling deeply depressed. In a subsyndromal context, this often creates a “tired but wired” state that’s incredibly taxing, painful, and exhausting, even if individual symptoms don’t meet the full criteria for a formal manic or major depressive episode. By using this specifier, clinicians can acknowledge these overlapping subthreshold features that fall outside of a pure high or low.