"Something is wrong with my mood"

Yesterday was Bipolar UK's third annual national bipolar awareness day. What Bipolar UK is concerned about is that people may have to wait an average of 13 years for diagnosis (see press release for the first bipolar awareness day in 2012).

On the same day, Anne Cooke tweeted to remind us of the BPS document Understanding bipolar disorder. I also received an email from the National Institute for Health and Care Excellence (NICE) with the publication details of the update for the Bipolar disorder clinical guideline (see full guideline).

Bipolar UK changed its name from the Manic Depression Fellowship in 2011. I wish it hadn't. Since the term manic-depression was changed to bipolar in DSM-III in 1980, the concept has become so broad that its validity must be in question (eg. see previous post). Some may want to question the validity of any psychiatric diagnosis (eg. see another previous post). However, I think there is some meaning in the original concept of manic-depression, which goes back to Emil Kraepelin. This condition was recognised previously, for example, by Falret in 1851 as la folie circulaire. Mania was a psychotic diagnosis and its lesser form, hypomania, was seen as an indication that a person could be on the verge of developing a full-blown mania. The change to bipolar has allowed the inclusion of non-psychotic presentations. In particular, bipolar II only requires episodes of hypomania. Asking people with depression whether they have had episodes of being 'high' may uncover non-clinical such episodes and may not be a very rigorous way of deciding whether someone has had true hypomania. Such people may well not have been psychotic.

Furthermore, recognising the continuity with normal mood variation has encouraged a 'softer' version of bipolar spectrum. Almost anyone with a history of mood swings or instability can be seen as being on the spectrum. It may be important to note that NICE emphasises that, "The clinical utility of these proposed ['softer'] diagnoses has yet to be established and there is currently no indication whether treatment is necessary or effective". We shouldn't be using mood stabilisers for bipolar spectrum.

After all, the development of mood stabilising medication must have been a factor in promoting the bipolar concept (see previous post). We may well look for simple solutions to our emotional problems. To quote from Goodwin & Malhi (2007), "Put simply, the term mood stabilizer sounds comforting and may reflect our fond and perhaps somewhat naive hopes." Mental tranquility may sound attractive when feeling volatile.

Strong feelings derive from one's circumstances. Abnormal emotional states are likely to arise from the difficult situations we find ourselves in. 'Peace of mind' may not always be that easy to find.