Posted by SLS on May 15, 2012, at 20:36:56
In reply to Re: Melancholic vs Atypical depression » SLS, posted by psychobot5000 on May 15, 2012, at 17:31:19
> Thought it worth mentioning the results of my followup research in case any others stumble on this thread. Bipolar V appears to be a speculative and unofficial diagnosis defined by the presence of relatives with bipolar disorder, all of which is fine. However, the rationale for its existence as a category, and for its treatment indications, appears not to be greater efficacy for mood stabilizers, but to avoid bringing out a latent manic phase, as in Bipolar IV. Thus, in someone such as myself, treated with standard antidepressants for many years without mania or hypomania or anything like it, there may not be a rationale for any Bipolar V classification, at least as the disorder is currently thought of (regardless of whether there's some cycling between better and worse unipolar depression, though if schizoid disorders have a similar etiology to bipolar, perhaps it might be worthwhile for a new patient with such relatives to stay aware of possible manias[?]).
Apparently, the DSM V is scheduled to have five categories of bipolar disorder. The authors chose to include drug-induced mania as part of a bipolar III diagnosis. I guess they couldn't find a justification for describing depression-only or mania-only bipolar disorders. It would be interesting to know what their reasons were for rejecting the Gerald Klerman model that was first published in 1987 (Psychiatric Annals 17: Jan. 1987). Perhaps the statistics didn't warrant it.
Bipolar I - Mania and Major Depression
Bipolar II - Hypomania and Major Depression
Bipolar III - Cyclothymia
Bipolar IV - Antidepressant Induced Hypo/mania
Bipolar V - Major Depression with a family history of Bipolar Disorder
Bipolar VI - Unipolar Mania
All in all, I don't see why the physiological pathology of the depressive phase of bipolar disorder can't remain dominant and be the only observed mood state of an individual. In other words, if a bipolar depressive episode can last for days, weeks, months, and years, why not decades? To me, it doesn't make sense that manic-depression, as envisaged by Emil Kraeplin, can't include a depression-only presentation. Perhaps the conceptualization of "bipolar" is too limiting to describe "manic-depression".
Some see things as they are and ask why.
I dream of things that never were and ask why not.
- George Bernard Shaw