Q:  Bipolar Without the "Poles"?

I have never experienced a "pure" depression or a classic mania.  I do not really have mood swings.  I have long periods where I am totally stable and normal, and then every year or two I have an "episode" that lasts several months.  These episodes always occur in late spring or summer and are always the same.  My psychiatrist has used the terms mixed-state and dysphoric mania to refer to them.  Prior to seeing this psychiatrist I would have called it depression because it is definitely a very negative experience and I get suicidal, but now I see that it has a lot more in common with mania than depression. I have a LOT of energy (but in an uncomfortable, unpleasant way), feel like I don't need to sleep, and have obsessive, repeating thoughts.  Sometimes these thoughts get very irrational and I get even more fixated on them, to the point of seriously screwing up my life -- and according to my doc, those are delusions. My doc is not quite sure whether this is bipolar 1 (but, it doesn't really have classic mania), bipolar 2 (but there's no real depression, and there's some  form of delusional thinking) or a kind of recurrent depression (but besides suicidal thoughts, I have very few of the typical depressive symptoms.)  I guess labels don't matter too much as long as I have found a treatment that works (Lamictal), but I still wonder about this.  It all sounds very bipolar to me, and my doc thinks so too, but is it possible to be bipolar without the "poles"? 
 

Dear Jodie 
Yes, unfortunately "bipolar" is a very misleading name. Between 2- and ten-percent of patients with Bipolar I will only have manic episodes, never depressed episodes. And you're right, this does sound like having manic episodes only, except they have a significant negative component mixed in there. In case it doesn't arise in discussion with your psychiatrist, think about using a means of blocking exposure to early morning light next spring (thick blinds or a sleep mask, for example): somehow your body is interpreting the arrival of spring/summer as a time for triggering this change. If you can keep your body from concluding that it is spring (the rather sudden shift into much earlier dawns is one of the main signals of this that our body uses to regulate our biological clocks), this might be a way to limit the "push" into these states. If it doesn't work, not much cost or risk, so worth thinking about with your doctor. Good luck with all that. 

Dr.Phelps