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Bipolar II: 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 doesn’t get better with antidepressants or psychotherapy. Or who, even before such treatment, obviously don’t 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 we’ll 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 doesn’t 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 can’t even keep track of what they’re 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 can’t be — I’ve 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 haven’t 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 don’t 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). 

Site Outline


  • Can I trust what I see here?
  • How do you decide what to trust?
  • No substitute for evaluations
  • Cautions


  • What happened to "manic-depressive" (now bipolar I)?
  • What are the official (DSM-IV) definitions of the "new" bipolar variations?
  • Anxious depression could be "bipolar"?!
  • What is the "depression spectrum?"
  • What do "bipolar variations" look like?
  • Soft signs which suggests but do not confirm the diagnosis
  • Anxious depression could be bipolar?
  • Can you be sure if you have it or not?


  • What are the basic principles of bipolar disorder treatment
         (includes information about non-medication approaches)
  • Which mood stabilizer should I start with?
  • Guidelines for lamotrigine, lithium, and valproate
  • Do I really have to stop my antidepressant?
  • How long should someone stay on these medications?
  • Can I really do this with my primary care doctor?
  • A "Dear Doctor" letter for your provider

After you have learn the basics about diagnosis, above, here are more details about specific issues.

Likewise, here are more details about treatment once you have seen the basic outline.