Why am I still depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder. Jim Phelps, M.D. McGraw-Hill, 2006.

Responding to the general absence of information for the lay public on the less acute forms of manic depressive illness, this book provides a helpful overview of the symptoms, course and diagnosis of these less well-known bipolar subtypes.  Written in ultra-basic, simple language, by Dr. Jim Phelps, the Corvallis, OR psychiatrist behind the incredibly useful website psycheducation.org, this work is designed to familiarize readers with the characteristics of Bipolar Disorder Type II.  But there is another, larger agenda here:  to present a different diagnostic viewpoint on bipolarity itself, one that emphasizes illness course, and specifically recurrence, as the hallmark of the illness.  This, in contrast to the current American schema, exemplified in DSM IV TR that sees episode polarity, specifically mania/hypomania, as the defining essence of the condition. Dr. Phelps explains in a clear, pain-staking and repetitive fashion the rationale for using recurrence as the defining standard, the implications this has for diagnosis (it vastly broadens the scope of the condition to include all other recurrent mood disorders such as recurrent depression, SAD, PMDD, etc…) and for treatment.  With regard to treatment, Dr. Phelps repeatedly emphasizes the hazards that can occur from both antidepressant monotherapy (using antidepressants alone without a mood stabilizer) and using antidepressants in combination with mood stabilizers.  My only quibble here is that this is presented as fact rather than the actual, active controversy that surrounds this issue today.  In my opinion, we are far from agreement on the appropriate role of antidepressants in the treatment of the bipolar depression.  This aside, Dr. Phelps should be commended for authoring a much-needed and easily understood treatise on the spectrum concept in manic depression.

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