The Bipolar Spectrum: Beyond Depression, Type I & Type II


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!


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Typically discussed: Depression, Bipolar I and Bipolar II



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  • Major Depressive Disorder is the most common and readily recognized mood disorder


  • 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


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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!

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