Does This Imply BP II
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Q:  Does This Imply BP II

Early in my treatment for mental health, I have been diagnosed bipolar 2.  However, I was in a severe major depression for months which lead my psychiatrist to believe that I only suffer from major depression w/ psychotic features.  I went to a group home and got some treatment.  I've been in the group home for 3 years now.  Strange things happen.  When I'm out of a depression, I will have at least 4 nights in a year in which I won't sleep from 30-58 hours.  It just creeps up on me out of no where.  I don't feel tired at all until I get a sleep aid at the end of that cycle.  This current episode, I was on top of the world--setting up a support group, working at an animal shelter 5 days a week voluntartarily, cleaning more and more, real hyper, real jokey, feeling powerful because I had money, spending money, cheerful, etc.  Does this imply that I have bp II?


Dear Katie -- 
Let's see if we can come up with some other way to explain the symptoms you describe.  Caffeine, other drugs?  Thyroid ok? Otherwise, as you've obviously already learned, you're describing a classic set of manic symptoms.  So, if a person has classic manic symptoms, and depressive episodes, she/he has bipolar disorder (she might have something else too, but by definition she has bipolar disorder.  Which kind of bipolar disorder?  If symptoms fall short of disorganized thought or frank psychosis, that's bipolar II; in a fairly common variation the depression symptoms are much more prominent than the manic (technically hypomanic) ones, thus it is easy to call it "major depression, recurrent", unless the psychiatrist was to hear the story of the symptoms you just described.  

If she did, and still didn't call your illness bipolar, then she's probably one of those psychiatrists who doesn't like diagnosing bipolar disorder for some reason.  There are plenty of those psychiatrists and reasons.  Somebody could freak out and say Dr. Phelps, you've never even seen this patient, what are you doing offering a diagnosis?  Answer: I'm not offering you a diagnosis; I'm teaching you what the DSM-IV says about how a diagnosis of bipolar disorder is made.  You can make it, or you can review it with your psychiatrist, as somehow you're going to have to maneuver your way to treatment, which is when this "diagnosis" is really going to matter (i.e. whether the doc' agrees with you or not. A thoroughly referenced discussion of the diagnosis of bipolar II can be found on my website.)

Dr. Phelps

Published February, 2002



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