According to “Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications”, just discussing Bipolar Type I and Bipolar Type II does not adequately cover the mood spectrum!
Typically discussed: Depression, Bipolar I and Bipolar II
Depression
- Major Depressive Disorder is the most common and readily recognized mood disorder
Dysthymia
- a less severe but long-lasting form of depression
Double Depression
- a major depressive episode with poor inter-episode recovery (level of dysthymia), followed by another major depressive episode
Bipolar I
- Full-blown manic episodes or mixed episodes of mania plus depression, often followed by a depressive episode
Rapid Cycling
- When mania recurs at least 4 times a year
Bipolar II
- At least one hypomanic episode that follows a depressive episode
Cyclothymic disorder
- Mood swings not as severe as full mania and full depression, but still above boundaries of normal mood
This text lists quite a few forms of Bipolar Disorder.
Bipolar 1/4 (0.25)
- “Not quite bipolar”
- An unstable form of unipolar depression that responds rapidly but in an unsustained manner to antidepressants (“poop-out”)
- Can benefit from mood-stabilizing treatments added to robust antidepressant treatments
Bipolar 1/2 (0.5) & Schizoaffective Disorder
- Called also “Schizobipolar disorder”
- Is part of the debate about whether psychotic disorders are dichotomous from mood disorders
- Combining features of positive symptoms of psychosis with manic, hypomanic, or depressive episodes
- Can include treatments for both schizophrenia and bipolar disorder
Bipolar 1 1/2 (1.5)
- Protracted or recurrent hypomania without depression
- Will often develop a major depressive episode, changing to Bipolar II diagnosis
- May benefit from mood stabilizers
Bipolar II 1/2 (2.5)
- Cyclothymic who develop major depressive episodes
- Treatment with antidepressant monotherapy may increase mood cycling or even induce mania
Bipolar III (3.0)
- Develop a manic or hypomanic episode on an antidepressant
- Called “substance-induced mood disorder”, not bipolar disorder
- Can be used as a diagnosis until individual experiences a spontaneous manic or hypomanic episode while taking no drugs–> Bipolar I or II diagnosis
- May not be good candidate for antidepressant monotherapy
Bipolar III 1/2 (3.5)
- Type of Bipolar Disorder associated with substance abuse
- Drugs may be utilized to treat depressive episodes, but may also induce mania
Bipolar IV (4.0)
- Association of depressive episodes with a pre-existing hyperthymic temperament
- Are often sunny, optimistic, high-output, successful individuals with stable temperament for years and then suddenly collapse into a severe depression
- May respond best to mood stabilizers
Bipolar V (5.0)
- Depression with mixed hypomania (full expression of both depression and mania simultaneously)
- Requires mood stabilizer treatment, not antidepressant monotherapy
Bipolar VI (6.0)
- Bipolarity in the setting of dementia
- Can be treated with mood stabilizers and even atypical antipsychotics
There are MANY states of mood disorder within the bipolar spectrum beyond just Bipolar I and II disorders!
