A More Nuanced View of Hypomania

Dr. Phelps will discuss a view of bipolar disorder that is increasingly accepted among mood specialists: rather than “does he/she have bipolar disorder?”, the better question is “how bipolar is he?” or “ How much bipolarity does she have?” The yes/no approach to bipolar diagnosis that has dominated psychiatry for decades is finally giving way to a more nuanced concept of bipolarity. Depression is a common ingredient across the spectrum of mood disorders: but between Major Depression and clear-cut Bipolar Disorder, there are many people who clearly have something more than plain unipolar depression. They might have a family member with Bipolar I; or highly recurrent depressions; or an obvious post-partum depression; or, commonly, a very negative reaction to an antidepressants. But in the official rule-book of diagnosis, the DSM, they can’t have “Bipolar Disorder” unless they have had hypomania or mania. So, how subtle can hypomania be? How little can one have and still be “bipolar?” Does it matter, in terms of treatment? (For many people, you bet it does…).