Thursday, February 12, 2009


First...thanks to all who commented on my post, "Am I the Only One?" Each of your responses were full of things I think are true in many ways. Very valuable comments.

I have wondered for a long time why the DSM IV does not take a different approach to Depression and Bipolar Disorder. Based on my experience of myself, and my listening to and reading about, other's stories I really believe the way Depression and Bipolar Disorders are categorized is incorrect.

It seems really clear to me that Depression and Bipolar are on a continuum of one illness; that they are not two seperate illnesses. Here is my proposal for the next DSM:

Depression --->Bipolar Continuum
  1. Mild Depressive Episode
  2. Dysthymia
  3. Moderate Depressive Episode
  4. Major Depressive Episode (MDD if more than one episode.)
  5. Major Depressive Disorder No Cycling (I'm not refering to bikes;>)
  6. Major Depressive Disorder Mild Cycling
  7. Major Depressive Disorder Moderate Cycling
  8. Major Depressive Disorder Major Cycling
  9. Cyclothymia
  10. BP II
  11. BP I

Then the descriptives...chronic, psychotic etc. Of course, I am a layperson and there could be things in between that I haven't thought of...but it seems like depression is connected more closely to BP Disorder than is currently described. It seems people who have had numerous episodes of depression may be more likely to begin cycling at some point. Maybe I'm wrong, but this has definitely been my experience.

When I was young I either cycled between wellness (for me hyperthymic...quite a bit higher/more irritable than the average mood...this definitely runs in my family) and depression. The depressive episodes fairly short and sometimes extremely short, changing from suicidal to extremely high in one day, or every few days.

As I became older the episodes began to get longer and longer, and more severe. They began to really affect my ability to do the things I wanted to do. Now my mood cycles are much worse going between feeling suicidal and going so high I get intense anxiety and I begin having difficulty functioning at either end of the scale. Do mood cycles increase both in length and strength as we age, or as we have more and longer depressions? Or did the medications I have taken kick me into some kind of cycling pattern?

It seems I never had the intensity of cycling before I began trying medication. So I wonder if some of the medications initiated some of my cycling? Or did years and years of not sleeping well kick me into my mood swings? Or are they psychological (vs. biological) I cycle up so high because I am pushing to get well and I have so much momentum that I somehow manage to push right past the well stage? What about how the world seems to change when I am high? I feel I can see the life force pumping through everything. The colours are intense and it is as if I can see things at the cellular level..intense and more beautiful than when I just feel okay.

Does it matter why? Does it matter "what" I experience? Does it need a label? What would happen if there were only experiences and no labels? What if my cycling were a gift? What if it weren't a gift, but I accepted it as one? Would I be well?


Anonymous said...

I've only found your blog recently and haven't had a chance to read over much so excuse me if I seem not to grasp the 'whole pictue'. What you describe are 'symtpoms' and an experience very similar to my own. As a teenager I was diagnosed as 'naughty, disorderly, faddy and anxious'. In my twenties I was depressed. By my thirties I was treated for major depression. At 37 I was eventually diagnosed bipolar 2 (I'm now 39 and it appears I have come to the end of the labelling).
I believe you are absolutely right in your analysis and much of what I've read recently concurs that the spectrum exists between unipolar depression and bipolar 1. Mosy depressives who do not 'recover' or go untreated eventually begin cycling and exhibiting bipolar symptoms. I have always had 'highs' (just as you describe) but like many, failed to report then for years. It was eventually my response to anti-depressants (induced mania and rapid cycling) that alerted suspicion at which point I was referred to a psych and within half an hour had the new diagnosis! I'm not sure the cycling or severity of mood gets worse over time. Perhaps the diagnosis has made me more aware of triggers and thus more capable of management. I also have more responsibilities (a child, for one) now so am more careful not to allow things to get out of control.
However, i sometines can't help wonder if bipolar isn't just the bin they ditch you in when all else fails. That way, they can give up on therapy and just shove the stabilisers at you!
Otherwise, I don't believe the labelling is of much use/importance. We are all unique.

Anonymous said...

Oh but I forgot to add - one thing I have noticed. The 'mixed episodes' seem to have got worse (that's feeling 'high' but depressed and extremely agitated, restless and sleepless at once). This could be from messing with medication (I've not managed to stick with anything so far!) or it could be a result of current life-stresses.
Whatever it is, they're most unwelcome!

Lisa said...

Ugh, cycling is such a b****! Labels or not, it is not pleasant.

Harriet said...

I think a lot of what is in the DSM is dependent on what insurance companies want. I'm a cynic, I know that.

I also don't understand why diagnoses like asperger's and autism are considered mental illnesses. The whole DSM is a mystery to me.

But I like your continuum theory, it makes a lot of sense. Too bad the writers of the DSM don't get patient input.

Aqua said...

LoopyKate: Thanks for the comment. It is good to know I am not the only one. I never even considered I was cycling until the cycles began being bizarre and more frequent...the highs were (and sometimes still are) what I lived for. That was when I completed and created amazing things.

Lisa Marie: I definately agree.

Harriet: When I first had to apply for disability my pdoc told me exactly what you said: Diagnosises are for insurance companies...amazing. Re: the autism/aspergers...I should have mentioned in my post my belief that the differentiation between mental and physical disorder should disappear. I believe depression and mania and everything in between are illnesses of the brain. Period. Regardless of whether there are psychological, as well as physiological causes. Things like heart disese have a psychological content as well...stress can make you more susceptible to heart disease. Strokes and diabetes, like depression have environmental contributors. Mental illnesses ARE physical. CBT works because changing your thought patterns changes the structure of your brain. Tyhe brain is physically changed by depression...that is a physical illness....I'm just ranting...but thanks for your thoughts.

Aqua said...

Oh yeah...this "continuum theory is not my own, but a culmination of all kinds of different things that I have read about depression being on a spectrum of disorders, rather than a different disorder.

It makes could even take it a step farther and have a spectrum between, depression, bipolar and schizophrenia. Some people have schizoaffective disorder...a mix of schizophrenia and a mood disorder so it is not difficult to see they may all be linked .

Handsome B. Wonderful said...

I heard it described as a rainbow that there are shades of illnesses that overlap not unlike the colors of the rainbow blending into each other.

For example, my diagnosis is bipolar plus some Schizophrenia symptoms. So I'm a good example of the blend of two disorders.

By the way, I've found (and my psychiatrist agrees) that the depression end of Bipolar is the hardest part to treat. The mania is the easier one to manage for me with meds. Still the mania isn't a cake walk in managing as many of you know.

Life said...


Thanks for visiting my blog :o) bit worried you recognice one of my pics, were you there when my OH came home & wondered why I was sat on the kitchen floor taking pictures!!!

I don't concentrate on labels, I find them confusing and distracting, I am me, have been me, I thought I'd grow out of it but have had to learn to live with it & improve what I can, that sounds so easy!!! I have never fitted any particular box though, maybe that is why