[if you arrived here from a search engine and there is no "navigation" banner down the left side of the page, you'll need to go to the HOME PAGE to get anywhere easily within this very large program! (300 pages or so...)]
Mood Swings without "Manic" Episodes
(Reviewed and revised, October 2013)
My depression is really complicated. Have I come to the right place?
This site is for people with depression that doesnt get better with antidepressants or psychotherapy. Or who, even before such treatment, obviously dont have "depression" alone. Not everyone will find a fit here. There are several different kinds of complex depression. Only one of those kinds is discussed here. But if what you find on this site seems to fit your experience, I hope you will learn some useful things that may guide you to an effective treatment.
This site describes what for now well call "depression plus". In addition to depression, you might have extreme anxiety; or severe difficulty sleeping; or fits of anger over something minimal; or episodes of crying over something like a TV commercial. Or you may have noticed "mood swings": big changes in mood or energy for no clear reason.
There is an energy side of "depression plus" that can show up as anxiety (often severe), finally leading into attacks of panic. It can show up as episodes of rage. It can interrupt sleep so much people go night after night with 3 or 4 hours of broken sleep, and even that doesnt feel restful. People can find themselves thinking a lot, often thinking fast, or about lots of things at the same time, or thinking so much they cant even keep track of what theyre thinking about, and become confused!
Psychiatry finally put this very different kind of depression into the diagnosis rule book in 1994. Many mood experts had been talking about it for years prior to that. But as of 2013, diagnosis of this set of mood problems is still controversial in psychiatry. So the diagnosis is very frequently missed, or dismissed after it is considered, or un-done by a later psychiatrist or psychologist who goes strictly by the official diagnostic criteria.
It is a relative of manic-depressive disorder, even though people who have it do not have "manic" episodes as such. Instead, the manic energy shows up in all different ways, without any loss of contact with reality (not "going crazy"). Many people have figured out that they have a complicated depression that seems to keep changing, or cycle up and down, or keep returning. They even wonder if they might be "manic-depressive". But then they say to themselves "That cant be Ive never had a manic episode!"
But bipolar disorder, as it is now called, is much more complicated than this. If you have depression or anxiety that has not gone away with antidepressants or psychotherapy, or if you havent had those treatments but already recognize a cyclic energy part of your depression, you definitely need to learn about Bipolar II. It is not something anyone would want to have, but it is often very treatable.
This site seeks to serve as a single, "one-stop shopping" place for accurate, up-to-date information on versions of bipolar disorder that dont have typical "manic" episodes. The official names include Bipolar II, Bipolar Mixed State, Cyclothymia, "soft" bipolar disorder, and other variations. If you feel like you know nothing at all about bipolar disorder and want some basics, the Wikipedia page is pretty good, though it uses technical lingo than this site). But beware: most "bipolar disorder" webpages mention Bipolar II only briefly, which is very unfortunate, because the experience of Bipolar II is very different that that of Bipolar I.
A thorough discussion of the diagnosis and treatment of Bipolar II and similar non-manic versions of bipolar disorder is the purpose of this section of PsychEducation.org. The outline below shows what you'll find on the main Bipolar II pages here. Use the links in the left column to navigate (if there is no navigation bar on your left, go to the homepage, click on Mood Swings But Not Manic, and take the version for patients and families. The navigation bar will then appear on the left).