- Hi, I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today's video is about bipolar spectrum illness
and it's based on a viewer question from Sadaam,
and he says, Mam it's my fourth time
I have been asking that I have been diagnosed
with bipolar spectrum three years ago.
Now I'm 21.
I have read a lot but I'm still confused.
Will my diagnosis change to bipolar I or II in the future,
or will it remain as bipolar spectrum?
Please answer.
I'm in great worry.
Thanks for the question, Sadaam.
Now because Sadaam has asked other questions of me,
I know that he's from India, so I'm assuming that India
uses bipolar spectrum terminology.
The short answer is that here in the U.S.,
bipolar spectrum is not an official term.
However, it is debated by researchers and clinicians
as to whether bipolar disorder and depression
or unipolar depression really should be considered
one bipolar spectrum illness and not separate diagnoses.
This concept of bipolar spectrum dates back
to the early 1900s with Emil Kraepelin.
Kraepelin was a German psychiatrist and considered
the father of modern psychiatry.
He identified schizophrenia and manic depression,
which he termed manic depressive insanity.
This was defined in his book, Manic-depressive Insanity
and Paranoia, published in 1921,
and this is where we get the term manic depression,
which we also don't use as an official term anymore.
Manic depressive insanity was a recurring illness
of both depression and mania with or without the psychosis.
The key feature of the illness was the fact
that it was episodic, and the episodes come and go.
This is different from the other illnesses
we have in psychiatry.
With schizophrenia, the course of the illness
is that it comes and it stays.
The symptoms plateau to where it remains
at the same level for long periods,
and then over time you can have dips
where the illness gets worse.
People with anxiety can have waves of it,
where their anxiety is more intense and unmanageable,
and then it improves, but they still have
some degree of anxiety that's always there,
but it's just manageable.
You may even say or think about yourself,
this is just how I am.
Things just bother me more than other people.
With ADHD, the peak occurrence of this illness
is in childhood, and it can completely go away
or improve to the point where, like anxiety,
the symptoms are manageable, and many people
do continue to have symptoms as adults.
But depression and mania act differently.
You have these episodes where you can have
all of the symptoms that look like depression
or look like mania, and it's there for a while,
then it goes away.
And sometimes with depression, it can be there
for a long time, like years, but for the most part,
the nature of the mood disorders,
depression and mania, is that they come and they go.
And this is how Kraepelin conceptualized this illness
of manic depression.
The insanity part comes with the presence of psychosis
that can occur in either the manic or the depressive state.
I did a video talking about psychotic depression
that you can watch for more understanding
about that condition.
In 1980, the Third Edition of the Diagnostic
and Statistical Manual of Mental Disorders
was published, and manic-depressive insanity
was split into bipolar disorder and unipolar depression.
With this change, the key feature of the illness
became polarity rather than episodes,
so it was thought that the experience
of having opposite disordered mood states
is a separate phenomenon from having the same mood state
that repeats.
So repeating episodes of depression
was carved out as a separate illness
called major depression, and repeating episodes
of opposite poles of mania and depression
was then termed bipolar disorder.
Not everyone has accepted this change.
Some believe Kraepelin's original broader concept
of manic depression more accurately describes
what we see in practice.
Some researchers believe that there's more
to bipolar disorder than mania and depression,
and we should change the term to bipolar spectrum
to include other conditions like recurrent severe depression
with psychosis, depression mixed with mania, cyclothymia,
antidepressant induced mania,
anxious depression, atypical depression.
Atypical depression is a subtype of major depression
with certain features like increased appetite and sleep
as well as being able to transiently have a better mood
if something positive happens.
Usually with depression, having a good day
doesn't brighten up your mood.
In fact, one of the symptoms of depression is anhedonia.
Anhedonia is when you're not able to find joy or pleasure
in anything.
Now, there are some who go a little further
and believe that depression doesn't even happen
without mania, and this concept
is called the primacy of mania.
The saying is that mania is the fire
and depression is the ash.
This viewpoint is not as popular and not as accepted
as the view of mania and depression being grouped together
as a single bipolar spectrum illness.
So, there are people in the United States
who believe that we should change the terminology
to bipolar spectrum disorder to put it closer
to what Emil Kraepelin originally intended.
His concept is a broader illness
that includes episodes of mania and depression,
allowing people the manifest either mania or depression
at any time.
So getting back to Sadaam's question
of whether his bipolar spectrum diagnosis
would at some point convert to bipolar I or bipolar II.
Terminology-wise, no, it won't,
because bipolar I and bipolar II are terms
that are based on a different way of thinking
about the illness.
Since bipolar spectrum is more of an umbrella term
that includes having mania and depression,
it already includes bipolar I and bipolar II disorder.
So it's a terminology thing.
However, if the real question is,
will you start having manic episodes,
that's hard to predict.
Having a family member who's had a manic episode
increases the chance that at some point you will have one,
but it's still not guaranteed.
If you currently are having only depression,
maybe with a little anxiety mixed in,
you could continue to have depression
that returns without mania or hypomania ever happening.
So what does this issue
of bipolar spectrum mean practically?
It doesn't mean that if you've ever been depressed
you need to worry that you really have bipolar disorder.
Keep in mind that bipolar spectrum
or the original manic-depressive insanity
did include having recurring depressions
without a manic episode.
That's one of the ways that it could manifest.
If you have an anxious depression,
that anxiety or agitation with your depression
is different from mania.
With mania, you can have psychosis,
extreme impulsivity or poor judgment,
just to name a few of the symptoms,
and that's not the same as anxiety,
so you can continue to have anxiety
that never turns into mania.
But even if we did consider it a spectrum illness
where on one end you have depression alone
and on the other end you have depression and mania,
people can still remain at one end of the spectrum,
so you don't need to hold your breath
waiting to have a manic episode.
If you have a first-degree relative
with bipolar disorder, like a parent or a sibling,
then you do have a greater risk of manifesting
mania or hypomania at some point,
but it's still not a given.
So if you've only had depression and no mania,
we still treat you with an antidepressant first
until we see a reason to add a mood stabilizer.
Reasons to add a mood stabilizer
would be emerging mania or hypomania,
or if your depression did not adequately respond
to a mood stabilizer alone, and we call this
treatment-resistant depression.
The treatment for treatment-resistant depression
looks very similar to the treatment for bipolar disorder.
For more on what mania and hypomania look like,
watch this video that I did giving you
a very detailed explanation.
Also take a look at my depression and bipolar playlist,
which address some of the other things
that I have mentioned like cyclothymia
and treatment-resistant depression.
So there's a lot in my back catalog
that you can watch to get a better understanding
of some of these terms.
Thanks for watching.
See you next time.