NOS (Not Otherwise Specified)

I have actually felt good for the last couple of days.  This is highly unusual for me, but it's quite nice.  So my new diagnosis is Bipolar II--NOS, which is to say I have a not otherwise specified form of bipolar II.  According to Wikipedia, "Bipolar disorder NOS (Not Otherwise Specified) is a diagnosis for bipolar disorder (BD) when it does not fall within the other established sub-types^[1] Sub-types of bipolar are part of the bipolar spectrum."  Bipolar II disorder is a "softer" type of bipolar disorder.  In other words you don't cycle between extreme mania and depression.  Often you cycle between depression and hypomania, but you don't have to have a lot of cycling between the two to be considered bipolar.  Apparently you may have as few as 1 hypomanic episode and several depressive episodes to count as bipolar II or soft bipolar.  There's a really good book I read called "Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder" by Jim Phelps, MD.  He also has a great website at http://www.psycheducation.org/ in which he defines writes:  "Bipolar II is a version of Bipolar Disorder: depression is obvious but mild phases of high energy ("hypomania"), which can just look like anxiety and insomnia, are also present.  This doesn't look at all like "manic-depression", just big mood and energy swings. But Bipolar II can be as severe as other forms of Bipolar Disorder, maybe even more prone to suicide. Bipolar II is an "official" diagnosis in the Bipolar Disorders group." 

When I first talked to my psychiatrist about this (last entry I had about labels) my reaction to the idea was that it couldn't be right, because I never feel that hypomania.  However, after studying it for 2 weeks I'm beginning to realize that this diagnosis feels correct and plausible.  The best thing is that normal anti-depressants only are effective if you have uni-polar depression, but are ineffective for bipolar disorders.  In fact, one of the symptoms that led my doctor to diagnose me as such was that I've been on many different types of anti-depressants with little to moderate effectiveness.  Now I've been put on a medication specifically for bipolar II and I'm really hopeful.  I don't think my mood improvement has to do with starting the medication because you have to be titrated onto the medicine and I'm at a very low dose right now.  However, I wonder if I'm feeling so good because I finally have some hope.  I am not looking forward to having 6 weeks of medicine titration before I can find out if it will work.  But.  At least I have a timeline with my depression.  I've been so severely depressed for the last 2 years that I'm really ready to be done.  One way or another.

My symptoms, which by themselves are not singularly symptoms of "bipolarness," taken together are all part of the signs and symptoms that paint a bipolar II.  Some of these symptoms include:

• Multiple major depressive periods (I've had at least five in the last 25 years)
• Depression starting when I was in my teens
• Multiple anti-depressants not working or working for a short period of time
• Having a first order family member diagnosed with bipolar II (my sister has been diagnosed)  

These last couple of weeks have been very informative for me.  Plus I've started making some changes in my lifestyle.  Dr. Phelps writes about trying to find treatments with high success rates and low side-effects rates.  4 things he mentions are exercise, fish oil, light therapy, and plain old therapy.  I have been in therapy and continue to do so, but now I've started walking about 20 minutes every day, taking fish oil pills, and trying to use my mood light as often as I can.  This is the first time that I've read about exercise and am actually motivated to do it!  It's a huge accomplishment.  I don't know if these things have attributed to my better mood, we'll see how long it lasts.  But like I said earlier, I am hopeful.  And hope may be the best medicine yet.