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Mixed states may represent a mixture of different elements of depressed and manic conditions. The most common mixed states are depressive or anxious mania, excited depression, and depression with flight of ideas. Others were manic stupor, mania with poverty of thought, and inhibited mania. Treatment of mania would be predicted to improve the depressive symptoms. Drugs such as lithium and lamotrigine may have the advantage of treating or preventing the depressed phase of bipolar disorder with less risk of triggering secondary mania and may be particularly useful in depression with hypomania (DMI) (bipolar: BP-II) disorder. Bipolar disorder is associated with an increased risk of comorbid conditions, including personality disorder, alcohol or drug misuse, and anxiety states. For rapid cycling bipolar patients, depot antipsychotics such as haloperidol decanoate stabilize mood swings. The use of antidepressants in bipolar depression is controversial, because of the suspected risk of triggering mania.
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