You’re down. Like, really down. You don’t feel sad. In fact, you don’t feel much of anything. You can’t seem to get going in the morning no matter how much coffee you drink. You haven’t filed your taxes yet this year. You’re not into music anymore. You scroll through Netflix for a half hour but can’t seem to find anything enticing. You’re not sleeping. You’ve been calling off work way too much because sometimes you just … can’t even. Sometimes the idea of suicide pops into your head as if you’ve remembered where you left a hundred dollar bill. An almost orgasmic light goes off in your head – “oh, yeah! There’s a way out! I can kill myself. Thank God I thought of that!” And lately, on your worst days, there is an obsessive loop that plays in your head for hours on end, forbidding all other thought: “I should just kill myself. I’m gonna kill myself. I’m fucking killing myself.” You’ve seen a few family doctors when you’ve fallen into a funk like this before and they’ve cycled you through Prozac, Celexa, and Lexapro but none of them ever seemed to do anything for you, so you’ve given up on asking for help.
But you don’t always feel this way. Sometimes you feel good. Like, really good. You make lists of albums to buy and movies to watch. You only sleep a couple of hours a night, but you’re not tired the next day. You check out fifteen library books at once. You flirt, exchange numbers, and sleep with strangers. You spend forty dollars you don’t have on scratch-off lottery tickets. You drink a little too much occasionally. You figure out what you finally want to be when you grow up and outline a detailed plan to get the right credentials. You feel a little out of control at times and sense that you’re not always exactly yourself. But, now that you’re running at full speed, at least you’re finally catching up on bills and housework, which is important because you know this “up” time won’t last. You’ve got a few weeks at most and maybe only a few days. And, even though the people close to you can tell you’re on the upswing once again, no one thinks you’re crazy. You’re not writing on the walls, after all. I mean, it’s not like you’re Bipolar or anything, right?
Unfortunately, experiences like this are all-too-common. And, tragically, they go on for far too long in many cases – decades even. Because the ups don’t escalate into a full-blown manic episode, it doesn’t occur to the patient or her family or friends that what’s going on is anything other than periodic depression from which she recovers at intervals. What none of them know, however, is that there is an entire spectrum of mood disorders and these are not the same as straight depression, or major depressive disorder, also called unipolar depression. At one end, is what we might think of as “classic bipolar.” This is the kind of illness that carries the manic episode as its hallmark symptom and is referred to more accurately as bipolar disorder – type I. At the other end of the spectrum is unipolar depression. But in between these two extremes are a range of mood disorders such as bipolar type II and cyclothymia. These are characterized by varying degrees of depression and episodes of what’s called “subthreshold mania,” a period of elevated mood that doesn’t rise to the level of a manic episode, which might be “hypomania” at the high end of that scale. Ironically, because mania results in hospitalization in a majority of cases, those who suffer from bipolar type I often receive an accurate diagnosis earlier in the course of their illness.
People who have a mood disorder somewhere in between the two poles tend to only seek help when they’re in the depressive phase and family doctors aren’t trained to look for symptoms outside the depression that might indicate an alternative diagnosis. They often prescribe SSRIs like Prozac, but not only do mood disorder patients typically fail to respond to these medicines, they can also trigger hypomania and are thus actually contraindicated in the treatment of these conditions. Fortunately, the spectrum concept of mood disorders is beginning to take hold in practitioner circles and there is more help than ever for those who may be falling through this diagnostic crack.
One excellent resource is the recently published book Bipolar, Not So Much by Dr. James Phelps. Phelps is a practicing psychiatrist who has written other books on this topic and hosts the website Psycheducation.org, which focuses on spectrum mood disorders. In this latest book, co-authored with Dr. Chris Aiken, he explores and explains what it means for patients to be somewhere on the spectrum between unipolar depression and bipolar type I. Four self-tests are included which can give the reader some idea of whether these diagnoses should be explored with her doctor and where she might fall on the mood disorder spectrum. The book has an emphasis on non-medication treatments, which Phelps writes was inspired by his patients’ reliance on those methods, but also includes extensive discussions of all the medicines available as treatment options as well. Of note is the attention paid in the book to lamotrigine, which goes by the trade name Lamictal. Although this drug, along with Lithium, is usually thought of as a “mood stabilizer,” it turns out that it actually has a very powerful antidepressant effect as well. The authors refer to it as a “mood-lifting stabilizer” and it is their preferred drug for treating spectrum mood disorders. Bipolar, Not So Much also addresses beneficial lifestyle changes for patients and gives advice for putting one’s life back together after either a hypomanic or severe depressive episode. The book is written in an engaging, informal style, and many readers will make quick work of it despite the fact that it is packed full of helpful information.
Interestingly, as Bipolar, Not So Much makes clear, in some ways, it doesn’t really matter where one falls on the spectrum of mood disorders. The lifestyle changes, non-medication treatments, and even the recommended drug regimen will probably will be the same for most patients. The important thing to understand is that you’re not just depressed, because that’s where the prescriptions for getting healthy begin to diverge.
If you’re suffering now, please understand you don’t have to feel the way you do. Talk with your family doctor about seeing a psychiatrist. Check out Psycheducation.org. Please call 1-800-273-8255 if you’re thinking of hurting yourself. Get help. Get better. It can be done and it’s worth the effort.
National Suicide Prevention Lifeline: 1-800-273-8255