Dear Dr. Phelps:

My doctors hate to categorize their patients, saying that not everyone fits into a "neat little box".  However, when I press them about my diagnosis it changes from cyclothymia to BPII to BP NOS (I was diagnosed in Nov. 2000). I also am rapid cycling and have mixed states.  So at times I'm confused and not sure how to answer questions about my diagnosis when I'm in a support group setting.  The doctors say that the first step is accepting your diagnosis and I say, okay, but just tell me what it is!  

I would especially like more clarification between cyclothymia and BP NOS.  Which is a more severe form of BP?  I'm currently taking Seroquel at a low dose for sleep and just started Lamictal.  In the past I've tried Wellbutrin, Depakote and Celexa.  I also have always experienced depersonalization symptoms and this is as troubling, sometimes even more so, than the bipolar symptoms.  

Sincerely,
Kathryn

Dear Kathryn -- 
Your confusion is understandable, but I hope also simplifiable.  All these (cyclothymia, BPII, BP NOS, rapid cycling, mixed states) are all variations on a complex state that can look one way at one time and another way at another time, but they're all Bipolar Disorder.  They're all treated the same way.  They all have roughly the same prognosis, i.e. they don't go away with treatment, they just stay controlled (hopefully).  They all have roughly the same genetic risk, etc.  They're basically the same thing.  Well then why all the labels?  good question.  It's a historical holdover, largely; and a wish by researchers to subdivide a clearly heterogeneous disorder into smaller groups for research purposes.  So you could just call it Bipolar II and be done with the subdividing.  You could just call it Bipolar Disorder but there is a distinction from Bipolar I that's worth making, as the prognosis is different there (BPI includes psychosis,and tends to occur in more discrete, less continuous episodes).  Try my site, the "diagnosis" section, for a little history and the "spectrum" way of diagnosing.  

Dr. Phelps