Q: Bipolar Without the "Poles"?
I have never experienced a "pure" depression or a classic mania. I do not
really have mood swings. I have long periods where I am totally stable and
normal, and then every year or two I have an "episode" that lasts several
months. These episodes always occur in late spring or summer and are always
the same. My psychiatrist has used the terms mixed-state and dysphoric mania to
refer to them. Prior to seeing this psychiatrist I would have called it
depression because it is definitely a very negative experience and I get
suicidal, but now I see that it has a lot more in common with mania than
depression. I have a LOT of energy (but in an uncomfortable, unpleasant way),
feel like I don't need to sleep, and have obsessive, repeating thoughts.
Sometimes these thoughts get very irrational and I get even more fixated on
them, to the point of seriously screwing up my life -- and according to my doc,
those are delusions. My doc is not quite sure whether this is bipolar 1 (but,
it doesn't really have classic mania), bipolar 2 (but there's no real
depression, and there's some form of delusional thinking) or a kind of
recurrent depression (but besides suicidal thoughts, I have very few of the
typical depressive symptoms.) I guess labels don't matter too much as long as I
have found a treatment that works (Lamictal), but I still wonder about this. It
all sounds very bipolar to me, and my doc thinks so too, but is it possible to
be bipolar without the "poles"?
Yes, unfortunately "bipolar" is a very misleading name. Between 2- and
ten-percent of patients with Bipolar I will only have manic episodes, never
depressed episodes. And you're right, this does sound like having manic episodes
only, except they have a significant negative component mixed in there. In case
it doesn't arise in discussion with your psychiatrist, think about using a means
of blocking exposure to early morning light next spring (thick blinds or a sleep
mask, for example): somehow your body is interpreting the arrival of
spring/summer as a time for triggering this change. If you can keep your body
from concluding that it is spring (the rather sudden shift into much earlier
dawns is one of the main signals of this that our body uses to regulate our
biological clocks), this might be a way to limit the "push" into these states.
If it doesn't work, not much cost or risk, so worth thinking about with your
doctor. Good luck with all that.
Published November, 2007