Do I Fall in the Bipolar Spectrum
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Q:  Do I Fall in the Bipolar Spectrum?

Dear Dr. Phelps,

I've been suspected of having generalized social anxiety, add, and atypical depression. I'm 23 and I had a major depressive episode when I was around 16.  Recently, I've researched the bipolar spectrum and think I may have something worse than cyclothymia but not as bad as bipolar II.

My mood cycles sometimes within the same day but I'm never in what I call my "up" phase for more than a day -- maybe two days on occasion.  My up phase is incredible.  It's almost like being asymptomatic -- no depression, limited social anxiety.  Life is a pleasure, and being up doesn't seem to get in the way of functioning but it doesn't last long enough to know for sure.  More of the time I'm somewhat down and socially anxious, but on occasion I get way down with about the same time frame as my "up" phase.  I go through about one noticeable mood fluctuation a week, and less noticeable within each day.  My most noteable problem with sleep is getting up in the morning -- getting me out of bed is all will power.

My response to anti-depressants (and some other drugs like adderall) has always been WOW! This is incredible, I hope this lasts, but it never does and I begin feeling worse.  And so I stop the drug cold turkey and feel really good again followed by really bad.  Zoloft had the biggest effect on my mood.  Lithium made me very depressed and irritable, depakote made my mood consistent but too far from happy.

I'm currently on moclobemide (RIMA) which seems to have accelerated my fluctuation in mood but it has been helpful with social anxiety.  I was considering stopping moclobemide and trying Lamictal instead?  What do you think of Lamictal for someone with my symptoms?  And do you think I fall in the bipolar spectrum?  Thanks for reading my words and considering my situation.


Dear Jon -- 
From the unsafe distance of having read only your letter, I would agree with your diagnostic assessment.  If you're right, lamotrigine could be an excellent idea; for your doctor's consideration, here's the handout I give patients for
that medication and other.  Check your thyroid status.  You know from experience what I recently heard from a bipolar expert: the opposite of mania is not necessarily depression, or only depresssion -- it's lack of confidence.  Unfortunately that has proved harder to "land in the middle" than mood, in my experience; so you might look down the road at a treatment program for social phobia (ironic you'd need it when you clearly don't, one day a month or so) if that's a major issue when mood and energy are no longer cycling.  

Dr. Phelps

Published September, 2001


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