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
- Mild Depressive Episode
- Moderate Depressive Episode
- Major Depressive Episode (MDD if more than one episode.)
- Major Depressive Disorder No Cycling (I'm not refering to bikes;>)
- Major Depressive Disorder Mild Cycling
- Major Depressive Disorder Moderate Cycling
- Major Depressive Disorder Major Cycling
- BP II
- 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 agitation...so 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)...do 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?