Frequency of Cycling
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Q:  Frequency of Cycling

In the interview of Jane Pauley she was describing her rapid cycling as occurring one or more times during one conversation.  I've always kinda thought that was what was happening but I've never heard it described by anyone else in that manner or even in a diagnostic manual.  Does it really happen that way?  Also, Jane said she was diagnosed as having Bipolar III which to my knowledge is not a DSM IV diagnosis.  Is that a legitimate diagnosis or just an easier way of describing hypomania that occurs as a result of taking SSRI's?

Dear Ms. S' -- 
Interesting.  Cycling occurring one or more times in a conversation?  You know there are psychiatrists out there who have trouble swallowing the idea of "ultradian cycling", a non-DSM term meaning more than one mood cycle within a day.  So to be sure there are people who would wonder if "within a conversation" could be truly a "bipolar" phenomenon.  

The description I like best of what it's like to have bipolar mood/energy instability is from Kay Jamison, Ph.D., who wrote, with Frederick Goodwin, the "bible", Bipolar Disorder, back in 1990; and who has bipolar disorder herself.  Here's how she describes the pace and quality of mood shifting: 

"The clinical reality of manic-depressive illness is far more lethal and infinitely more complex than the current psychiatric nomenclature, bipolar disorder, would suggest. Cycles of fluctuating moods and energy levels serve as a background to constantly changing thoughts, behaviors, and feelings. The illness encompasses the extremes of human experience. Thinking can range from florid psychosis, or "madness," to patterns of unusually clear, fast and creative associations, to retardation so profound that no meaningful mental activity can occur. Behavior can be frenzied, expansive, bizarre, and seductive, or it can be seclusive, sluggish, and dangerously suicidal. Moods may swing erratically between euphoria and despair or irritability and desperation. The rapid oscillations and combinations of such extremes result in an intricately textured clinical picture."

(Notice how I ducked the question. Deliberate.  How would one "really" know?  The alternative explanation is usually that a person who might experience such fluctuations has a personality disorder (a term I hate), primarily "borderline", and that's why they are so mercurial.  The distinction between bipolar and borderline gets pretty thin in most spots, as discussed in this essay on borderline and bipolar disorder

Secondly, is "Bipolar III" a legitimate diagnosis or just an easier way of describing hypomania that occurs as a result of taking SSRI's?  You're right that it describes hypomania occurring only in the context of an antidepressant, and that it is not an official DSM diagnosis.  But it is fairly widely recognized as a description, thus perhaps "legitimate"? 

Ms. Pauley's courageous public declaration of her bipolar disorder is worth being aware of, as she is one of the most high profile and current figures to risk breaking the stigma barrier.  Thanks for bringing it further attention. 

Dr. Phelps

Published December, 2004


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