“I don’t get it. The three antidepressants I’ve tried over the years work for a time, and the effect just peters-out. Am I hopelessly crazy? Misdiagnosed? Yikes!”
No, you aren’t “hopelessly crazy!” Misdiagnosed? Well, that’s a possibility. Perhaps you’re enduring something known as “soft bipolarity.”
Let’s roll-up our sleeves and learn about a cutting edge mood concept…
Bipolar Disorder (as it’s been known)
Were you to flip through the psychiatric diagnosis “good-book,” the DSM-IV-TR (name too long to bother sharing), you’d find diagnostic codes and criteria for bipolar disorder I and bipolar disorder II.
To cut to the chase, both feature major depressive episodes. And then there’s the matter of mania. In bipolar I it’s full blown – in bipolar II it’s a hypomania. In general, we’re talking…
- Inflated self-esteem/grandiosity
- Big-time decreased need for sleep
- Intense chattiness
- Racing thoughts
- High-risk behaviors
But, avoiding a ton of psychobabble, let’s just say a hypomanic presentation is much less prolific than its “full-blown” counterpart.
A “Mood Spectrum”
Now, it’s a fair question to ask – can bipolarity really be that tightly categorized?
Enter the well-researched thoughts and work of psychiatrists and psychologists such as Jim Phelps, MD.
Dr. Phelps proposes we consider mood as points along a continuum – a spectrum. And here’s how it looks (his diagram)…
To the far left, you’ll see “unipolar” – as in what’s traditionally viewed as depression, no degrees of mania associated. ‘Course, you can see the progression to “Bipolar I” – major depressive and manic episodes in all their glory – as you move to the right. By the way, “BP NOS” signifies bipolar disorder not otherwise specified.
And now to Phelps’ radicalism – Points A and B. He believes people who have a difficult depression, but respond well to antidepressants (ADs) and/or psychotherapy, typically find themselves at Point A.
But, according to Phelps, things get very interesting in the land of Point B. It’s in this neck of the woods that ADs and therapy don’t work too well, if at all. It’s here where one often experiences phenomena such as the infamous “Prozac Poop-Out.”
“Soft Signs (Markers) of Bipolarity”
Phelps assigns the term “soft signs of bipolarity” to the goings-on at Point B. And he presents these “markers” that may lead to a correct diagnosis and efficacious treatment regimen…
- Cycling depressive symptoms – with or without reason – that take one from “crashes” to mood stability.
- The depths of depression are somehow tolerated; however, the accompanying anxiety is unbearable. We’re talking an inability to remain still, a racing mind, lost attention and focus, assorted sleep issues, and suicidal thoughts.
- In the midst of depressive episodes, one’s anger – and its expression – is way over-the-top. And the individual is fully aware of it (as is everyone else).
- Depressive episodes don’t respond well to antidepressants. Fact is, one’s depression may actually get worse while using ADs. Or it could be that one’s first couple of major depressive episodes responded well to an AD – but that’s in the rear-view mirror. Finally, it may be about an AD having no impact at all – ever. Feelings of “going crazy” are common.
- Depressive episodes are accompanied by insomnia. For days an individual may get only 2-3 hours of sleep a night. And it’s more an issue of sustaining sleep, not its initiation.
- A history of 4+ major depressive episodes.
- The initial major depressive episode occurred before age 26.
- Mom, dad, brother, sis, son, daughter have been diagnosed with bipolar disorder.
- Mood and energy runs a bit higher than average when not depressed.
- One’s depression presents with these symptoms: extremely low energy and activity, excessive sleep, mood is reactive to the actions of others, and a ramped-up appetite (carb-cravings and night-eating may be a part of the picture).
- A history of post-partum onset depressive episodes.
- Mania or hypomania has been experienced while using an antidepressant.
- 3+ ADs have been tried, and none of them worked.
Again, these are “markers,” as opposed to tried and true diagnostic criteria. Remember, we’re dealing with a cutting-edge concept here.
But what’s most important is the fact that the presence of any of these “markers” calls for professional review. And that can lead to an entirely new approach to treatment – and relief.
Isn’t that Job 1?
Let’s Close
It’s outside-the-box thinkers like Dr. Jim Phelps who bring hope to those enduring a mood or anxiety disorder.
In this case it’s about challenging the stringent DSM-IV-TR criteria for bipolar disorder by suggesting mood presentations can be plotted along a spectrum. And that led to finding a bit of turf – rather a no man’s land – where many have fallen off the diagnostic and treatment map.
Are you showing “soft signs of bipolarity?” Armed with what you’ve learned, chat with your psychiatrist and therapist. And if either aren’t open-minded enough to consider it, find someone else.
Do yourself a favor – check-out Dr. Phelps’ website at psycheducation.org.
Would you like to read more chipur articles on the biology of the mood and anxiety disorders? Well, click right here. How ’bout the psychology of depression, anxiety, and bipolar disorder? Here ya’ go!
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