Depression Disorder Quiz. What happened to "manic-depressive" (now bipolar I)?
Q.What happened to "manic-depressive"? As our understanding of bipolar disorder has grown, the nomenclature has changed as well. In recent years the concept of a "mixed state" of bipolar disorder, in which manic symptoms and depressive symptoms are found simultaneously, was added. Obviously this changes the conception of manic-depression from one in which the two mood states alternate, to one in which they can co-occur! Things were getting more complicated.
A.In the most recent Diagnostic and Statistical Manual (DSM-IV), "Bipolar II" was added. Technically Bipolar II describes a pattern in which patients experience "hypomania" (to be discussed in detail below), alternating with episodes of severe depression. This marked the formal recognition of another variation on how "highs" and "lows" could be experienced. However, one of the most experienced professionals in this field, who has bipolar disorder herself, has criticized even this advance as too limited and thus profoundly misleading: "The clinical reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings. The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or "madness," to patterns of unusually clear, fast and creative associations, to retardation so profound that no meaningful mental activity can occur. Behavior can be frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish, and dangerously suicidal. Moods may swing erratically between euphoria and despair or irritability and desperation. The rapid oscillations and combinations of such extremes result in an intricately textured clinical picture." depression Bipolar experts have recognized that this illness is much more complicated . Dr. Susan McElroy of the University of Cincinnati says that two "poles" of "bipolar" disorder are like axes of a graph depression and that any point on that graph is possible in the "mixed states" of bipolar disorder. Many people have forms of depression in which their symptoms vary a lot with time: "crash" into depression, then up into doing fine for a while, then "crash" again - sometimes for a reason, but often for no clear reason at all. They feel like they are on some sort of mood "roller coaster". They wonder if they have "manic-depression". But, most people know someone or have heard of someone who had a "manic" episode: decreased need for sleep, high energy, risky behaviors, or even grandiose delusions ('I can make millions with my ideas"; "I have a mission in space"; "I'm God"). So they think "well, I can't have that - I've never had a manic episode". However, the new view of bipolar disorder means it's time to reconsider that conclusion. Hypomania doesn't look or feel at all like full delusional mania in some patients. Sometimes there is just a clear sense of something cyclic going on. Some mood disorder experts consider recurrent depression to have a high likelihood of manifesting a manic phase at some pointFawcett, especially if the first depression occurred before age twenty.
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