An interesting lecture from Nassir Ghaemi on the bipolar spectrum concept. According to him unipolar and bipolar used to both be encapsulated under the phrase “Manic Depression”. “Manic Depression” meant someone who either experienced severe depression or mania. “Bipolar disorder” is defined by an individual having both depression and mania/hypomania. The two phrases differ only by a conjunction….something I hadn’t paid attention to before. Additionally, according to Kraepelin, a well known historic authority on the topic, individuals displaying mixed states were more common than the ones who had more pure states of either depression or mania. This has been noted more recently by other researchers such as Benazzi who published a number of articles about people who experience mixed depression.
Prevalence of mixed depression, a combination of depression and manic or hypomanic symptoms, is high in patients with bipolar disorders. Controlled studies are needed to investigate treatment of mixed depression; antidepressants can worsen manic and hypomanic symptoms, and mood stabilising agents might be necessary
While my depression has been more chronic I have experienced periods of time when it lifted and I felt normal and productive. There has also been a pattern to some of these “remissions”. They often occurred during my menses and when ever I altered my sleep schedule to a minor degree. These remissions weren’t long enough by DSM standards to qualify for hypomania however as Ghaemi states, the threshold for hypomania is to a large degree arbitrary.
I have noticed as well that my depressions didn’t seem pure. They often included good amounts of irritability, insomnia, racing/crowded thoughts, hypersexuality, and a little grandiosity. Somewhat interestingly these symptoms tended to occur in the late evening to the early morning hours. This has been noted by some researchers who study ultra rapid cycling in children. Many clinicians would probably categorize my experience as someone who is experiencing a pronounced diurnal variation but I am reluctant to think that since diurnal variation usually means a slight remission of symptoms throughout the day without hypomanic-like symptoms.
Manic-depressive insanity in the sense here delimited is a very frequent disease. About 10 to 15 per cent, of the admissions in our hospital belong to it. The causes of the. malady we must seek, as it appears, essentially in morbid predisposition.– Kraepelin
Ghaemi’s perspective much like Kraepelin is based on the big picture of evidence and history, not mainly on image. At the moment the DSM-V seems to be ruled by people who are primarily concerned with the public’s image of them. They mainly don’t want to appear like they are over prescribing and over pathologizing normal behavior. The fact that bipolar is no longer grouped with major depression under Mood disorders is one example of their over reaction to anti-psychiatry.
As someone who has experienced chronic depression with a moderate severity, I am tired of hearing how my so called Dysthymia is defined as mild and at one time in the past, a personality issue. Bipolar disorder has been generally viewed as more incapacitating and more endogenous while unipolar depression is more neurotic. Ghaemi and Kraepelin’s theories make sense to me in light of my experience with depression. It has been for the most part, quite incapacitating, miserable and briefly quite pleasant.