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More on Symptoms of "Soft" or Spectrum Bipolar Condition
(revised 4/2006)

You probably came here from the main page on the diagnosis of bipolar II.  If you didn't, you may wish to get there from the beginning, where a navigation bar will help you get around. 

The following is in very technical language, but even if you only understand about half of the lingo, you may recognize some of your symptoms.  I'd just link the page this came from but it's hard to find this section once you get there.  So, I've copied a big chunk of it below. However, if you are concerned that this Dr. Phelps guy you're reading is a one-of-a-kind psychiatrist, perhaps it would help to see the writing of another psychiatrist who seems to think in very similar ways.  He and I approach treatment a bit differently, you might notice, as I rely less on antidepressants and atypical antipsychotics than he does.  But diagnostically, we're about 90% in agreement. 

Here's the part I wanted you to see (brace yourself for the language; here's a link to the original, by Dr. Arnold Lieber) :

Presenting Symptoms

* Episodic mood instability - these patients manifest lifelong episodes of mood swings starting around adolescence. The mood shifts unpredictably among several distinct mood poles: brief depressions lasting hours to one or two days, brief euphorias, brief dysphoric or irritable episodes, brief paranoid episodes, episodes of rage or intense uncontrollable anger, episodic anxiety equivalents (panic attacks, phobias or obsessive ruminations ). This multiplicity of mood options begs the very issue of bipolarity. It appears that multipolar mood disorder might be a more accurate designation for the soft bipolar spectrum.

* Episodic atypical depression - bipolar depressions can manifest the entire gamut of endogenous, nonendogenous and/or atypical depressive symptomatology, and they are always recurrent over time . Soft bipolar depressions usually show atypical depressive features. Patients are mood responsive, which means that they respond to favorable circumstances with a temporary lifting of the mood that can last hours to a day or two before returning to the depressed state. Other symptoms may include eating too much, sleeping too much, feeling worse towards evening and intense tiredness or lethargy. Anxiety and its subtypes (phobias, panic attacks, OCD ) frequently co-exist with atypical depression , as does episodic mood instability. There are a number of atypical depressive subtypes that are distinguished by special features. Since they are often episodic and associated with mood instability, they should be viewed as part of the soft bipolar spectrum. Included are the following: seasonal affective disorder - winter-onset atypical depressions; premenstrual dysphoric disorder - atypical depression associated with irritability, mood swings and dysphoria which occurs a week to ten days on either side of the menstrual period; hysteroid dysphoria - atypical depression mainly in women with histrionic personality features, whose episodes are precipitated by romantic rejection; abulic depression - atypical depression with a deficit syndrome ( apathy, amotivation, lack of will power, lack of energy, lack of pleasure in life, emotional blunting ).

* Hypomania - hypomania is of two types, euphoric and dysphoric or irritable. It is also of two durations, episodic and protracted or characterologic. Bipolar spectrum patients usually show episodic dysphoric hypomania. Euphoric hypomania feels good and is sometimes productive, but dysphoric hypomania produces irritability, emotional discomfiture, impulsiveness, temper dyscontrol and impaired judgment. It tends to interfere with interpersonal relationships and to limit productivity at work. There is a sense of inner speeding combined with restless over activity and racing thoughts, which can lead to a state of desperation. The hypomania frequently alternates with episodes of depression, and mood instability is almost always present. Sometimes brief euphoric episodes are added to the mix. The triad of irritable episodes alternating with rage episodes and paranoid episodes is characteristic of dysphoric hypomania.

* Mixed states - mixed bipolar disorder [ the simultaneous occurrence of both depressive symptoms and mania/ hypomania ] and rapid cycling bipolar disorder [ the patient experiences frequent switches from depression to mania/ hypomania and back ] often produce diagnostic confusion for treaters and treatment resistance for patients. These mixed states are found in bipolar I, bipolar II and bipolar spectrum disorders. They are more common in women and are often associated with thyroid abnormalities, lack of response to lithium (the standard treatment for bipolar I disorder) and antidepressant-induced worsening of symptoms. Outpatient diagnosis of these conditions is difficult at best, even after a detailed history is obtained. Diagnosis of mixed states is most likely to be made by a skilled diagnostician after a patient fails to respond to outpatient treatment or becomes worse on antidepressant medications and is subsequently admitted to the hospital for closer observation. Misdiagnosis of these conditions is all too common, leading to delays in effective treatment and a higher risk of suicide.

If you've read this far, you might want to have a look at my book on bipolar II and soft bipolar disorder, which has 3 long chapters about what you just read -- JP.