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A Spectrum Approach to Mood Disorders

A Spectrum Approach to Mood Disorders


A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar—Practical Management

by James Phelps, MD; New York:
WW Norton and Company; 2016
255 pages • $32.00 (hardcover)

In A Spectrum Approach to Mood Disorders, Dr. James Phelps bravely enters territory that academia has largely neglected—the nebulous region between full bipolar disorder and major depression. This is where so many of our patients live. The book is a must-read for any health professional involved in the treatment of affective illnesses, including psychiatrists, psychiatric nurse practitioners, psychologists, and therapists.

His previous book, Why Am I Still Depressed?, is a great source of information about bipolar II for professionals who wish to learn more and for patients who have bipolar II and soft bipolar.1 In A Spectrum Approach, he once again leads us to a greater understanding of the complexity of the bipolar disorders. The author’s website, Psycheducation.org, averages around 40,000 unique visitors each month. It is safe to assume that at one time or another, the majority of our patients with bipolar disorder have read Dr. Phelps’s work. He is perhaps one of the most widely read experts on bipolar disorder of our time.

The book is framed by a quote by Vieta and Suppes2 regarding bipolar disorders: “Dichotomies are useful for education, communication, and simplification. Unfortunately, simplicity is useful, but untrue; whereas complexity is true but useless.” Dr. Phelps renders the complexity of bipolar spectrum useful while making it simple enough to be true and understandable.

The author delves into the little-understood region between what is not fully bipolar and what is more than simple major depression. He gives us tools to understand and diagnose “mid-spectrum bipolar disorder.” He re-brands and puts under one “roof” what we have previously called soft bipolar—Akiskal’s bipolar II; IIa; bipolar III; bipolar IIIa; bipolar IV; or Fred Goodwin’s “highly recurrent depression.” By placing these disparate diagnostic schemata under one “roof” of bipolar spectrum illness, he simplifies the concept, rendering it far easier to understand and more useful. By doing so, Dr. Phelps also gives us new insights into bipolar spectrum.

To think of bipolar as a spectrum disorder is a satisfying fit into what we see in everyday practice and within Kraepelin’s original definition of manic depression.3 It allows both our patients and professionals involved in the treatment of these disorders a relatively easy way to understand the wide variety of symptoms that are disparate in nature yet are features of bipolar illnesses.

Perhaps one of the reasons so many clinicians are reluctant to diagnose bipolar II or mid-spectrum bipolar is the demoralizing effect of making a such a diagnosis.

The book provides useful tools to help diagnose and treat mid-spectrum bipolar disorders, with thoughtful discussions of how patients present in clinical settings. The author deftly explores the overlapping symptoms of mixed bipolar symptoms, anxiety disorders, borderline personality disorders, ADHD, and major depression.

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