The "Bottom Line" -- The Main Point of
If your depressions are complicated; if you have mood swings, but not
"mania", you can still be "bipolar enough" to need a
treatment that's more like the treatments we use in more easily recognized
Bipolar Disorder. You'll
read here about those forms which do not have "mania" to make them stand out or
easily recognizable, including Bipolar II. Depression is the main symptom, including especially
sleeping too much, extreme fatigue, and lack of motivation. What makes
bipolar depression different is the presence of something else as well.
that "something else" often does not look anything like mania.
"Hypomania", which you'll learn about here, can show up as huge
sleep changes, irritability, agitation/anxiety, and difficulty
And finally, some people can have some bipolarity without any
hypomania at all.
What happened to "manic-depressive" (now bipolar I)?
Somewhere along the way you probably learned about manic-depressive illness:
episodes of mania, and episodes of severe depression. Here are the symptoms of "mania"
- Mood much better than normal
- Rapid speech
- Little need for sleep
- Racing thoughts, trouble concentrating
- Continuous high energy
- Delusions (often grandiose, but including paranoid)
What happened to "manic-depressive"?
As our understanding of
bipolar disorder has grown, the naming system has changed as well.
Recently the concept of a "mixed state" of bipolar disorder, in which
manic symptoms and depressive symptoms are found at the same time,
was added. Obviously this changes the understanding of manic-depressive
illness from one in which the two mood states alternate, to one in
which they can co-occur! Things
are getting more complicated.
Psychiatry has a diagnostic "rule book" that lists the symptoms
people must have in order to meet the definition of a particular
"disorder", called the Diagnostic and Statistical Manual. The most
recent edition came out
in 1994, the
"Bipolar II" was added in this edition, although it was first described
as a pattern of mood change long before that. Technically Bipolar
II describes a pattern in which patients experience "hypomania" (to be
discussed in detail below), alternating with episodes of severe
However, one of the most
experienced professionals in this field, who has bipolar disorder
herself, has criticized even this advance as too limited:
"The clinical reality of manic-depressive illness is far more
lethal and infinitely more complex than the current psychiatric
nomenclature, bipolar disorder, would suggest. Cycles of fluctuating
moods and energy levels serve as a background to constantly changing
thoughts, behaviors, and feelings. The illness encompasses the extremes
of human experience. Thinking can range from florid psychosis, or
"madness," to patterns of unusually clear, fast and creative
associations, to retardation so profound that no meaningful mental
activity can occur. Behavior can be frenzied, expansive, bizarre, and
seductive, or it can be seclusive, sluggish, and dangerously suicidal.
Moods may swing erratically between euphoria and despair or irritability
and desperation. The rapid oscillations and combinations of such
extremes result in an intricately textured clinical picture." (Kay Jamison, Ph.D.)
will read below can be found in a recent
review by two mood experts, except that their version is written in
full medical jargon.
Even the International Society for Bipolar Disorders has advocated a
change in diagnostic procedure, moving beyond the DSM-IV, using what we've
learned since 1994 in the diagnostic process (Ghaemi
and colleagues; if you look closely you'll see that my name is on the
list of co-authors: I was honored to be invited to participate and write
for this 2008 update on bipolar diagnosis guidelines). Their
recommendations are very consistent with what you'll read below.
What is the official definition of
Technically, this is literally a "little" mania — the familiar symptoms but less so:
- Mood much better than normal
- Rapid speech
- Little need for sleep
- Racing thoughts, trouble concentrating
- Continuous high energy
You may have noticed that "delusions" have disappeared from the list: these are by definition not found in Bipolar II. A patient who has had the above symptoms repeatedly, without
having delusions, is much less likely to
ever lose contact with reality (including weird experiences like
auditory hallucinations, which are common in bipolar mania) than a
patient who has experienced delusions.
"Bipolar II" is technically the combination of hypomanic phases with separate phases of severe
depression If the depressive phases are only mild, the term
"cyclothymia" is used. Getting confused? I certainly was, until I began
to think of these variations as points on a continuous spectrum. I hope
the following discussion will impress you as simpler.
What is the "mood spectrum?"
(references updated 4/2008)
Until very recently, depression and "manic-depressive illness"
were understood as completely independent: a patient either had one or
the other. Now the two are seen by many mood specialists
as two extremes on a continuum, with variations found at all
between, as in the graph below (e.g. Ghaemi;
and Cassano; Akiskal
to name just a few important articles since 2001; and finally, my
ISBD review in 2008):
On the left, the "unipolar" extreme represents straightforward
depression with no complications. There are many forms of depression, of
course. For an overview, see the appendix: "What kinds of depression are
there?". The depressions discussed further below are of a more genetic, or "chemical" nature;
versus those of a more situational type, like losing a loved one.
Situational depressions may respond well to time or therapy and not require "bipolar" thinking.
On the right, the "manic-depressive" extreme is defined by the
presence of manic episodes, just the kind that most people have seen or
heard of: full delusional mania.
But in between these extremes is a large area which some mood
includes more people than either extreme. In other words, it might
be the most
common form of bipolar disorder, this middle group.
Consider the following points A and B on this spectrum:
Point A on the continuum describes
people who have a complex depression but who still respond well to
antidepressant medication or psychotherapy.
B, however, there is some sort of threshold where these approaches
are no longer completely or continuously effective: either they don’t
work at all, offer only partial relief, or help for a while then "stop
working" (which may account for some or much of "Prozac poop-out",
now regarded as a "soft sign" of bipolar disorder, described
Until 1994 and the publication of the DSM-IV, there was no official name for all the variations between
B and the "manic-depressive" extreme.
It was as though these variations
did not exist. In the minds of
a few, they still don’t, including some psychiatrists who have not
adopted this new "spectrum" way of thinking about diagnosis.
itself does not describe this "spectrum" concept. In it, the entire span
blue and green is still "Major Depression", the same as the
violet end to your left. Only the orange and red zones are clearly
Light green and yellow is BP NOS, Bipolar Not
Otherwise Specified. That diagnosis means you have something that
like bipolar disorder but does not meet the criteria for BP II or
Isn't it simpler just to think of it as a continuum? That is much
reality. We see all sorts of variations in between these named
the graph above.
What do "bipolar variations" look like?
Warning: The following represents my clinical experience
taking referrals from primary care physicians. Most patients I see have
been on 3 or more antidepressants before I see them. This selects very
directly for "bipolar spectrum" patients. However, note that none of
these descriptions are found in the DSM, nor are they widely spoken of
by mood experts. This is my personal formulation based on
almost 15 years of full-time selection for such patients.
Roller coaster depression
Many people have forms of depression in which their symptoms
vary a lot with time: "crash" into depression, then up into doing fine
for a while, then "crash" again — sometimes for a reason, but often for
no clear reason at all.
They feel like they are on some sort of mood
"roller coaster". They wonder if they have "manic-depression".
people know someone or have heard of someone who had a "manic" episode:
decreased need for sleep, high energy, risky behaviors, or even
grandiose delusions (‘I can make millions with my ideas"; "I have a
mission in space"; "I’m
a special representative for God"). So they think "well, I can’t
have that — I’ve never had a manic episode".
However, the new view of bipolar disorder means it’s time to
reconsider that conclusion.
Hypomania doesn’t look or feel at all like
full delusional mania in some patients.
Sometimes there is just a clear
sense of something
cyclic going on. Some mood disorder experts consider depression that occurs
repeatedly to have a high likelihood of having a manic phase at some pointFawcett, especially if the first depression occurred before age twenty.Geller,
Rao These two
features--repeated recurrence, and early onset--are also included among the
bipolar "soft signs" below: not enough to make a diagnosis,
but suggestive, especially if they occur with several other such signs,
even if "hypomania" is not detectable at all.Ghaemi
Depression with profound anxiety
Many people live with anxiety so severe, their depression is not
the main problem. They seem to handle the periods of low energy, as
miserable as they are.
Often they sleep for 10, 12, even 14 hours a day
during those times. But the part they can’t handle is the anxiety: it
isn’t "good energy".
Many say they feel as though they just have too
much energy pent up inside their bodies.
They can’t sit still. They
pace. And worst of all, their minds "race" with thoughts that go over
and over the same thing to no purpose.
Or they fly from one idea to the
next so fast their thoughts become "unglued", and they can’t think their
way from A to C let alone A to Z.
When this is severe, people who enjoy books can find themselves
completely unable to read: they just go over and over the same
paragraph and it doesn’t "sink in". They will get some negative idea in
their head and go around and around with it until it completely
dominates their experience of the world. Usually these "high negative
energy" phases come along with severely disturbed sleep (see Depression
with Severe Insomnia, below). Thoughts about suicide are extremely
common and the risk may be high.Fawcett(b)
Depressive episodes with irritable episodes
Many people with depression go through phases in which even they
can recognize that their anger is completely out of proportion to the
circumstance that started it. They "blow up" over something trivial.
Those close to them are very well aware of the problem, of course. Many
women can experience this as part of "PMS".
As their mood problems become more severe, they find themselves having
this kind of irritability during more and more of their cycle.
Similarly, when they get better with treatment, often the premenstrual
symptoms are the "last to go". Others can have this kind of cyclic
irritability without any relationship to hormonal cycles.
Many men with bipolar variations say they have problems with anger
Depression that doesn’t respond to antidepressants (or gets
worse, or "poops out")
Many people have repeated episodes of depression. Sometimes the
first several episodes respond fairly well to antidepressant medication,
but after a while the medications seem to "stop working". For others,
no antidepressant ever seems to work. And others find that some
antidepressants seem to make them feel terrible:
not just mild side effects, but severe reactions, especially severe
agitation. These people feel like they’re "going crazy". Usually at
this time they also
have very poor sleep. Many people have the odd experience of
feeling the depression actually improve with antidepressants, yet
overall —perhaps even months later —they somehow feel worse overall.
In most cases this "worse" is due to agitation, irritability, and
In some cases, an antidepressant works extremely well at first, then
The benefits usually last several weeks, often
months, and occasionally even years before this occurs. When this
occurs repeatedly with different antidepressants, that may mark a
"bipolar" disorder even when little else suggests the diagnosis.Sharma
Depression with periods of severe insomnia
Finally, there are people with depression whose most noticeable symptom is severe insomnia. These people can go for days
with 2-3 hours of sleep per night. Usually they fall asleep without
much delay, but wake up 2-4 hours later and the rest of the night, if
they get any more sleep at all, is broken into 15-60 minute segments of
very restless, almost "waking" sleep. Dreams can be vivid, almost real.
They finally get up feeling completely unrested. Note that this is not
"decreased need for sleep" (the Bipolar I pattern). These people want desperately to sleep better and are very frustrated.
Unofficial but evidence-based markers of Bipolar
You have probably figured it out by now: making a diagnosis of
bipolar disorder can be pretty tricky sometimes! You're about
to read a list of eleven more factors that have been associated with
bipolar disorder. None of these factors "clinches" the
diagnosis. They are suggestive of bipolarity, but not sufficient
to establish it. They are best regarded as markers which
suggest considering bipolar disorder as a possible explanation for
symptoms. They are not a scoring system, where you might think
"the more I have of these, the more likely it is that I have bipolar
disorder." That way of thinking about these factors has not
Here's the list of items which are found with bipolar disorder more
often than you would expect by chance alone. This list is adapted from
a landmark article by Drs. Ghaemi and Goodwin and Ko. (Drs. Goodwin
and Ghaemi are among the most respected authorities on bipolar diagnosis
in the world. This important article is online https://ww1.cpa-apc.org/Publications/Archives/CJP/2002/march/inReviewCadesDisease.asp).
- The patient has had repeated episodes of major depression (four
or more; seasonal shifts in mood are also common).
- The first episode of major depression occurred before age 25
(some experts say before age 20, a few before age 18; most likely, the
younger you were at the first episode, the more it is that bipolar
disorder, not "unipolar", was the basis for that episode).
- A first-degree relative (mother/father, brother/sister,
daughter/son) has a diagnosis of bipolar disorder.
- When not depressed, mood and energy are a bit higher than average,
all the time ("hyperthymic personality").
- When depressed, symptoms are "atypical":
extremely low energy and activity; excessive sleep (e.g. more than 10
hours a day); mood is highly reactive to the actions and reactions of
others; and (the weakest such sign) appetite is more likely to be
increased than decreased. Some experts think that carbohydrate
craving and night eating are variants of this appetite effect.
- Episodes of major depression are brief, e.g. less than 3
- The patient has had psychosis (loss of contact with reality) during an
episode of depression.
- The patient has had severe depression after giving birth to a child ("postpartum
- The patient has had hypomania or mania while taking an antidepressant (remember, severe
irritability, difficulty sleeping, and agitation may -- but do
not always -- qualify for "hypomania").
- The patient has had loss of response to an antidepressant (sometimes called
"Prozac Poop-out"): it worked well for a while then the
depression symptoms came back, usually within a few months.
- Three or more antidepressants have been tried, and none
There is a very radical idea buried in these 11 items, which we should
look at before going on, but you should be aware that this idea is likely
be dismissed with a "hmmmph" by many practicing
psychiatrists. The idea is this: Dr. Ghaemi and colleagues
propose that there might be a version of "bipolar
disorder" that does not have any mania at all, not even hypomania.
They call it "bipolar spectrum disorder".
This is strange, you are saying to yourself. "I thought
bipolar disorder was distinguished from 'unipolar' depression by the
presence of some degree of hypomania. Don't you have to have some
hypomania in order to be bipolar? How could it be 'bi' - polar
if there is no other pole!?"
But Dr. Ghaemi and colleagues assert that there are versions of
depression that end up acting more like bipolar disorder, even
though there is no hypomania at all that we can detect (or, as in item #9,
only when an antidepressant has been used). These conditions
often do not respond well, in the long run, to antidepressant medications (which
"poop out" or actually start making things worse). They
respond better to the medications we routinely rely on in bipolar
disorder, the "mood stabilizers" you'll be introduced to in the
Treatment section of this website (including several non-medication
approaches). And these patients have other
folks in their family with bipolar disorder or something that looks rather
more like that (e.g. dramatic "mood swings", even if the person
never really gets ill enough to need treatment).
In Dr. Ghaemi's description, then, there are people whose depression
looks so "unipolar" that even a "fine-toothed comb"
approach to looking for hypomania will not identify it as part of the
"bipolar spectrum". According to Ghaemi and colleagues,
these people should be regarded as
"bipolar", in a sense, because of the way they will end
up responding to treatment. In other words, there is something in
these people which doesn't look like our old idea of bipolar disorder, or
even our newer idea of bipolar disorder (bipolar II, etc.), but will
still better describe their future (their prognosis) and the medications
that are most likely to help them. Remember that this is the very
purpose of "diagnosis", to describe the likely outcomes with and
without treatment, and to identify effective treatments. So, on that
basis, it seems reasonable to include these patients on the "bipolar
spectrum", like this:
The idea that someone can "have" bipolar disorder and yet not
have any hypomania at all is not widely understood. You probably would
get blank looks from most psychiatrists if you mention it, and frank
disbelief from nearly all primary care doctors, who don't have time to
read the literature on the diagnosis of bipolar disorder. So, if you
mention this idea to anyone, be prepared for some serious
resistance. As of 2005 the Harvard-associated
Mood Disorder program started using this approach to diagnosis. They call
it the Bipolarity
Other researchers are also beginning to use the
same framework of thought. For example, one research group just
reported that patients with migraine headaches are much more likely to
have these bipolar spectrum traits.Oedgaard
(Migraines are much more common in patients with unipolar and Bipolar
II than in Bipolar I, interestingly.Fasmer)
One recent summary article for primary care doctors, about bipolar
disorder, discusses these "soft signs" in considerable detail.Swann
The concept of a bipolar "spectrum" is supported by work from a
research group calling themselves the Spectrum Project.e.g.
Probably better not to raise this issue unless you have to, but if you must, cite the source. Here's that
article link again.Ghaemi
Dr. Ghaemi is the chairman of the committee on diagnosis for the
International Society for Bipolar Disorder. One of his two
co-authors is Dr. Frederick Goodwin, who wrote the "bible" of
bipolar disorder for our lifetime (Manic-Depressive Illness, with
Dr. Kay Jamison). These are highly respected researchers amongst
mood experts. Dr. Ghaemi emphasizes the need to rely on evidence in
all his papers on diagnosis and treatment and is very frequently cited by
other authors on this topic . But
he is certainly not the only such voice. If you haven't seen enough
references yet, here's another similar recent one, by other international
Anxious depression could be "bipolar"?!
Warning: leaving DSM-IV territory
The remainder of this "diagnosis" discussion cannot be found
in the DSM. I will repeatedly reference mood disorder experts, but many
of these views are controversial. You must evaluate for yourself the
validity of what follows.
Unfortunately, "hypomania" is quite a mis-naming. There are many patients whose "hypomanic" phases are an extreme and very negative experience. As noted above
by Dr. Jamison, mania can be negative as often as it is positive. The
"racing thoughts" can have a very negative focus, especially
self-criticism. The high energy can be experienced as a severe
agitation, to the point where people feel they must pace the floor for hours at a time. Sleep problems can show up as insomnia: an inability to sleep, rather than decreased need.
(If you or a friend or doctor is skeptical about anxiety
as a "bipolar" symptom, try that link for more details and
Most of these people come to treatment
with a combination of agitation, anxiety and self-criticism — and they
can’t sleep well. Is this "anxiety?" Is this some mood variation? How
could you tell the difference? Is there a difference? What is really
going on chemically? Unfortunately, this is still almost completely
unknown. See the appendix "What’s the latest on
why?", which I will try to keep updated frequently, for the latest research about the cause of this illness.
Again, my opinion: you can’t easily distinguish "anxious
depression" from bipolar II in a mixed state. I doubt that there is a
distinction to be made, ultimately (when we know, hopefully
someday relatively soon, what the chemical basis for anxiety with
depression really is). For example there is nearly complete overlap
Generalized Anxiety Disorder and Bipolar II.
For now, the only way to tell is by how treatment turns out. Depression that is not
bipolar can get better and stay better: with time, or counseling, or
formal psychotherapy, or antidepressants. If you get better — great! If
you don’t, you may need this new understanding of mood disorders in
order to consider mood stabilizers medications, discussed in detail
below, as an option.
Meanwhile, at least one experienced mood researcher warns that
anxiety in someone who is depressed is associated with a high suicide
So although there is diagnostic confusion, there are tremendous stakes
involved. Approaching this situation with an open mind seems wise, given
What does Hypomania actually feel
It's true that hypomania is a milder version of mania -- just how mild,
you'll see in a moment. Mind you, Bipolar II is not a
milder version of Bipolar I, though it is very often described that
way, to my utter dismay.
The suicide rate in Bipolar II is the same
or higher than the rate for Bipolar I, for example.Dunner
So the BP II version is definitely not a "mild" illness. The
depression phases are as bad as in BP I, and often more common (that is,
they occur more frequently and represent a more dominant part of the
Nevertheless, hypomania can indeed by subtle, certainly by
comparison with full mania, as shown in this graph (from Smith
and Ghaemi). Here are the symptoms which people with clear-cut
hypomania actually experience -- and how often. For example, at the
bottom of the graph you see that nearly 100% of people with hypomania will
have an increase in their activity. By comparison, optimism is prominent
only about 70% of the time in hypomania.
As you can see, these "symptoms" are not clearly abnormal.
Everyone experiences these feelings from time to time. When they
are extreme; and when they show up over and over again in cycles of
mood/energy change; when they are accompanied by other signs of
bipolarity, such as phases of depression; that's when we should think of
this as "abnormal", or at least as warranting caution if someone
wants to treat those depressed phases with an antidepressant.
However, hypomania is not always positive. Just as manic
phases can be very negative (so-called "dysphoric mania"),
hypomania also can be very unpleasant. Here is an example of how hypomania
can change from a positive experience to a very negative one/
First, the positive phase:
Increased energy. A extraordinary feeling of happiness with myself and
the world. A very loving feeling towards the people I care about. An
uncommon ability to get things done. A huge burst of energy from the
moment I awaken until I go to bed. An expanded ability to multi-task. An
organizational acuity that is second to none. A willingness to engage with
people. A desire to spend more time with people I care about--and even
those I don't.
Then, the negative phase of hypomania (still pretty subtle):
I start feeling burned out. While I still have a lot of energy, I don't
have that "I love the world" feeling. If I've been playing my
Autoharp at my mother's assisted living facility, and jumping up and down
to help all the participants turn the pages and stay with me, I suddenly
feel that the staff should be more helpful in doing this.
... things don't just slide off my back. While I try not to
"snap" back at people, I am not always successful. I am
certainly less willing to ignore things that days or weeks earlier
wouldn't have bothered me at all.
I become far less happy, joyful, and kind. I dislike being criticized in
any which way.
How short can an episode of hypomania be?
Officially, the answer is "four days", according to the DSM.
But in real life, it's very clear that episodes can be shorter, and that's
agreed upon by nearly all mood experts I've ever heard. They might
disagree whether we should shorten the required duration in the DSM, as
that would "admit" a lot more people into the bipolar camp which
is already a controversial issue. But no one really seems to think that a
hypomanic episode lasting only 3 days instead of four is anything other
than hypomania; it just doesn't "meet criteria", that's
Indeed, a recent studyBauer
showed that episodes lasting as little as one day are common. So don't get
hung up on length of episodes as an issue if you're trying to figure out
if you "have bipolar disorder" or not. Remember, that's the
wrong question anyway... Instead, it's "how bipolar are you?" as
affirmed in a recent editorial Smith
in the British Journal of Psychiatry (one of the biggies...).
What does bipolar depression actually feel
Theoretically, bipolar depression is exactly the same as "unipolar"
or straight Major Depression. Theoretically, you can't distinguish between
the two, so you can't tell if someone has bipolar disorder just by looking
at their depressions.
But I think there is a different quality to the depressions that people
with bipolar disorder experience, because before they start feeling
sad and having difficulty experiencing pleasure from their usual
activities, they very often have problems with energy. To
emphasize this I'd just like you to look at this list of symptoms which
people with bipolar disorder said they have when they're just starting to
If you think "that's me!", careful: this does not mean you
have bipolar depressions. But it might help to see what people with
bipolar disorder have said about their experience. I don't hear about
these symptoms so much when people have a more purely "unipolar"
-- not bipolar -- depression.
Granted, people in this study also endorsed "loss of interest in
activities" and "feeling sad, wanting to cry" but these are
her typical symptoms in official "Major Depression". And low
energy can also be seen in Major Depression. But look at how prominent it
is in this study. I think that might be telling us something about the
nature of bipolar depression. Certainly matches what I hear from
Finally, the original intent of this list was to help people identify
symptoms that mark the beginning of another episode of depression. He
might find it useful in that respect also.
I hope it may now make sense to you to think of mood symptoms as
falling on a continuum between plain depression and "depression plus",
the far end of which is Bipolar I, with many variations falling in
If you are wondering whether what you've just read is
"mainstream" or "fringe" (that's a good thing to
wonder), you'll find the same "spectrum" concept coming from
the head of the Harvard Bipolar Clinic, in this 2005 interview: Sachs.
By contrast, another mood disorder expert has shown that bipolar disorder is
2008; here is a close
examination of his findings). He's certainly right, if one sticks to
the DSM rules (although his paper also shows a notable underdiagnosis rate
as well). And there are quite a few people getting this diagnosis who
might be better understood with a different diagnostic framework, like
Post-Traumatic Stress Disorder (PTSD). But in my view, one of the things
that can help you figure out what's going on is
to learn more about "bipolarity", as you have done here. You are
an important part of the diagnostic process.
Is there a test for bipolar disorder? Can you be sure if you have it or not?
This used to be simple. When "manic" only meant one thing
(classic mania) one could ask "have you ever had a manic episode?" and
many people knew what was being asked:
- Mood much better than normal
- Rapid speech
- Little need for sleep
- Racing thoughts, trouble concentrating
- Continuous high energy
- Loss of contact with reality (delusions)
As you now know afresh if you came from elsewhere), this list looks
for obvious mania. It misses all the complexity we have just discussed.
might be wanting is a "no way!" bipolar test. Something to provide
statement, like: "no, you don’t have it, or anything like it".
Or you might be looking for the opposite: "you definitely have
bipolar II". Sorry,
that is not possible, but please read on.
On other websites you'll find a test called the Mood Disorders Questionnaire (MDQ) which is
supposed to give you a "yes or no" answer. But
another test came along after the MDQ which is better suited to
looking for subtle versions of bipolar II.
it: if by this point on this website you're saying to yourself
"that's me!", which some people do, then you really don't need
some test to tell you that you should go ahead and consider
treatment. Or that the diagnostic basis for that treatment should
a consideration of bipolar II. On the other hand, if someone else
thinks you might have it, but
you don't think you do, is a test result going to make a difference to
you? If so, go ahead and take one of these tests.
Family or friends could "take the test", answering as if
they were you, on the basis of what they've seen you do or heard you
say. And then they could gently wonder out loud if perhaps
the test might mean something, who knows, no one can tell for sure, but
darn it sure seems like your life is a struggle sometimes, wow, what if
there was a tool out there that would make life a bit smoother sometimes,
not even necessarily a medication treatment, oh well, just thinking
about this, of course you'd want to decide for yourself, not for me to say
of course, etc. etc.
The people who are in a position to benefit from taking one of these
diagnostic tests are those who are wondering if a "bipolar" variation
might be worth
considering to explain their symptoms. Here's the
test I'd recommend for you, called the Bipolar Spectrum Diagnostic Scale.
It won't give you a yes-or-no answer. I hope by this point you
understand why that's a good thing. If after all that you still want to use a
"fine-toothed comb" to look for hypomanic/manic symptoms, as I
sometimes do when people are still wondering about the diagnosis after
learning all this, here is a 32-item checklist
Thank you for patiently reading all the way to this point. It's a
lot to swallow at once, isn't it? read more about diagnosis issues in the Diagnosis Details section, or go on to Treatment.