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Bipolar, Not So Much - A Review

Recurrent depression, treatment-resistant depression, depression with mixed features, cyclothymic disorder -- if your file at the doctor's office is coded for any of these, my heart goes out to you. Chances are you have taken a number of turns around the antidepressant not-so-merry-go-round. I call it "The Chemistry Experiment," and you are the test tube.


Chris Aiken and James Phelps have written the book for you. Bipolar, Not So Much: Understanding Your Mood Swings and Depression introduces the reader to the Bipolar Spectrum. No, they are not talking about the movie version of bipolar, throwing furniture out the window, driving the car into the river... They mean the vast ground between that and your basic depression. They mean depression - with something more.

The authors use a conversational style, speaking directly to the reader and skipping the jargon. They begin by explaining the spectrum. They don't ask the question the way the DSM frames it, Does this person have bipolar? Rather, their question is, How much bipolar does this person have?

Like this:



You won't find the spectrum in the DSM, the manual of diagnoses. The DSM’s symptom silos are designed to put you in one slot or another. The silos came into existence in the 1960s. The spectrum approach is much preferred by the acknowledged experts in bipolar, starting with Goodwin and Jamison who also prefer the name manic depression. But in the recent revision,there was huge resistance to making the change back to the earlier understanding of the disorder. Symptom lists with their precise cut off points seem so tidy and are easier to code. So they remain in the DSM-5, and people like Aiken and Phelps write books to try to inform people who don't know anything more about bipolar than the damn lists. But I digress...

Aiken and Phelps take the approach that you will get the best recovery if you know what is actually going on. So first they thoroughly ground the reader in the spectrum concept, and include the diagnostic and predictive instruments that all the docs can access, but usually don't take the time to use. Damn, I am digressing again...

Next they spend a lot of time on lifestyle changes and other nonpharmocological treatment measures. The thing is, the meds were all developed and work best for the folk on the far ends of that spectrum. Which you already know if you are somewhere in the middle, because they don’t work so well for you, which is how you became a Chemistry Experiment. 

Actually, even if you are clearly unipolar or clearly bipolar 1, Aiken and Phelps have good advice for you regarding sleep, diet, exercise, supplements, and the rest. You’re just going to do better if you don’t ask the meds to do all the work. Mood disorders are more complicated than that mythological chemical imbalance. 

The book's third section is a thorough listing and discussion of all the meds. They have their favorites which may be different from your doctor’s, because they don’t talk to drug reps nor read the ads. They read (and do) the research. Are you getting the sense that I have an agenda here?

Bipolar, Not So Much is the essential resource for for anybody who has depression and maybe something more. It is backed up by Phelp's excellent website PsychEducation.org. It is a humane book by humane doctors who listen and learn from their patients. What a concept, huh? Their dedication page tells the tale:


To our patients. You showed us what life is like in the mood spectrum, and we hope we got it right, or at least close, in this book.

flair from Facebook.com
book cover from Amazon.com
bipolar spectrum graphic from PsychEducation.com.

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