Clifford Zeller MD

Bipolar Spectrum

The word bipolar has become overused lately both as a diagnosis and as an “explanation” for all kinds of problems and behaviors. Probably the common misusage of the word derives from confusing bipolar I disorder with the more subtle and complicated bipolar II spectrum disorder complex. In bipolar I disorder, individuals must have had it least one manic episode and for the term “manic-depressive” to be used, there has to have been a significant depressive episode as well. Actually the term ”manic-depressive” is out of date and no longer medically valid. It is vague, imprecise and carries associations to psychosis which is an entirely different and less common occurrence.

The Bipolar II Spectrum: However we now understand that there is a whole complex of mood disorders in which overstimulation is mixed with depression. Overstimulation includes anxiety symptoms but also irritability, anger, impulsivity, poor attention, sleep disruption, binge eating, and risk-taking behavior. Basically our behavioral control system can tend to vary between over activity and under activity. This can occur as a cycling between states which can be slow (years) or quick (hours). However more commonly there is a “mixed state” with combined sets of symptoms occurring together.

Sometimes positive parts of overstimulation include more energy, more confidence, and more sociability. However negatives can outweigh the positives including excessive spending, gambling hypersexuality, increased use of drugs and alcohol or difficulty in interpersonal relationships.

The biochemical foundations triggering the spectrum create exquisite sensitivity to medications which can be very helpful, but if prescribed in the wrong way can do more harm than good. Particularly, antidepressants which can be a foundation for treatment can also exacerbate the underlying biochemistry and so must be prescribed carefully or may be better replaced with other types of medications. Complementary approaches including changes in light, exercise, diet and sleep are very important. Psychotherapy to recognize triggers and warnings for mood shifts are fundamental as a treatment base.

For more information on this subject I recommend checking out www.psycheducation.org as a good educational starting point. Although I do not agree with all of the information or opinions on the site, I think it provides a good basic foundation of helpful educational material. It can become the basis of a good discussion and part of our ongoing collaboration.