Why Am I Still Depressed? Recognizing and Managing the Ups and Downs of Bipolar II and Soft Bipolar Disorder

by James R. Phelps

Tried everything but still not feeling better?

If your depression keeps coming back or is even getting worse, then you may be suffering from bipolar II or “soft” bipolar disorder. Commonly misdiagnosed, these mood disorders are characterized by recurring bouts of depression along with anxiety, irritability, mood swings, sleep problems, or intrusive thoughts.

Why Am I Still Depressed? shows you how to identify if you have a nonmanic form of bipolar disorder and how to work with your doctor to safely and effectively treat it.

Author James R. Phelps, M.D., gives you the latest tools and knowledge so you

Understand the Mood Spectrum, a powerful new tool for diagnosisKnow all your treatment options, including mood-stabilizing medications and research-tested psychotherapiesExamine the potential hazards of taking antidepressant medicationsManage your condition with exercise and lifestyle changesHelp family and friends with this condition understand their diagnosis and find treatment

Genres: Nonfiction, Psychology, Mental Health, Self Help, Health, Mental Illness, Medical

317 pages, Kindle Edition

First published March 6, 2006

Reviews

[Meagen · Rating 5 out of 5]

This changed my life. I'm not exaggerating at all. Dr Phelps' website is the first thing that led me to consider bipolar disorder after having the diagnoses of depression, anxiety, and insomnia for seven years. Now on mood stabilizers, I've had good days for the first time in seven years. This summer I finally had a week at a time where I felt like a normal person, happy and confident and relaxed, feeling like I belong, able to participate in conversations, and so forth.

I AM SO GRATEFUL I READ THIS BOOK AND WEBSITE!!!!!!!!!!!!!!!!! It really changed my life. I could go on and on about it. I finally felt like someone understood MY depression. "Depression plus," he said some of his patients presented with. As soon as I read that phrase, I knew I had to read further. I'd never heard someone describe my experience so closely. I finally didn't feel like a freak anymore.

Dr Phelps' conversational tone, easy-to-understand explanations, dry humor, and linking hundreds of times to others' independent research meant that this book was accessible, understandable, and trustworthy.

If you've struggled with depression for more than a year, if you had postpartum depression, if your depression is coupled with anxiety or insomnia or irritability -- read this book. It may not apply to you, but it just might change your life.

[Vivian · Rating 4 out of 5]

Fantastic look into the issues, reality and treatment of Bipolar II. My doctor recommended I read it as part of my treatment. This book gives a straight up presentation of this mental illness and how to understand and manage having it. The nuts and bolts approach helps demystify it as well as provides a framework to manage and cope.

[Sheila · Rating 5 out of 5]

FANTASTIC book. Well-written; it came across as a knowledgable, trusted doctor talking to a patient. He also uses his website (http://www.psycheducation.org) as an extension of the book, with additional notes and updates. Invaluable.

earlier:
p.s. guess what I got diagnosed with? :)

[Ashley · Rating 4 out of 5]

I honestly cannot believe I read a book with this title- it just seems so...melodramatic? I don't know...kind of a weird title given the subject matter, in my opinion.

But I heard a few people talk about how it was a must-read in regards to bipolar, and since a lot of my other options have been feeling kind of played out, I figured it wouldn't hurt.

And it certainly didn't. But on the other hand, after 15 years of dealing with this, there was very, VERY little in here that came as any surprise/relief/etc.

Sleep has always been one of my biggest issues. I've always felt that my inner clock runs on a 30-ish hour schedule, instead of the normal 24 (er, rather, 25, as research seems to indicate)

I've had doctors hammer into me time and time and time again the importance of managing my sleep. I've been on 3-4 different sleep medications that don't seem to help- either not working at all, causing absolutely unbearable side effects (30hr migraines kind of suck), or work a little too well- leaving me totally out of it the next day.

But his chapter on sleep gave me a bit of hope. I've never given much thought to the whole light therapy thing...it always seemed a little weird to me for some reason, but I might give it a shot. Of course, that means spending more money on a potentially useless "treatment", but such is life. The thought of changing all of your lights to dimming lights made a LOT of sense to me, and I might look in to that...not sure how practical it would be, but I could imagine it making a big difference.

Aside from that, there was the chapter on exercise, which I imagine made everyone else groan and roll their eyes like it did me...but some of the statistics were pretty surprising...enough to make me want to try to implement it.


One part that I felt really resonated in an unexpected way was in section "Pay Yourself First" at the end of the chapter about exercise where he mentioned the importance of making stuff like exercise your top priority- over and above more "pressing"/immediate needs, because otherwise it will be something that you'll get to "tomorrow" for the rest of your life.

This is something I've run into with sleep. I make a million excuses as to why I can't work on my sleep TONIGHT (test/assignment due tomorrow, have to be up at 6am to be somewhere, etc etc) but unless I put my longterm health ahead of my short-term issues, it's never going to change. I have to be willing to risk being late on an assignment, or being "hung over" from the sleep meds in class, because I HAVE to start establishing that routine at some point, or else it'll never happen.

And there's never going to be a good time to do it. Life doesn't let up to let us take care of crap like this.


So yea. The book had a few interesting things, but for the most part I didn't find it overly useful. That being said, it was an incredibly light read (although that could also be due to my extensive familiarity with the issue...but overall the writing style was EXTREMELY accessible) and I could see how it would be a god-send for someone who was recently diagnosed or who knows absolutely nothing about it.

I definitely respect the author for his commitment to the issue. He made a ton of resources available for free on his website and is totally transparent about his biases at certain points in the book- his motives seem pretty pure and he comes across as being totally trustworthy.

Overall, it's an incredibly thorough book, but assuming you've been dealing with this for a while, don't get too excited over the prospects of finding anything ground-breaking.

If I were to rate solely on the value of the information I took from the book, I'd probably give it 2.5 stars. If I were to rate it solely on the quality of the content, I'd probably give it 4.5 or 5. So my gut is to give it 3.5 stars, but because I respect the work that went into it it's easy enough for me to bump it up to 4 stars, because I really, really believe this would be FANTASTIC for people who are totally new to dealing with the illness.

[Kim · Rating 5 out of 5]

First of all, ya gotta love an MD who uses his nickname ("Jim") on the title page. The author is down home, encourages skepticism, and really appears to know his stuff on bipolar issues. His website is very helpful. If anyone has any bipolar issues in the family, I'd strongly urge getting a copy of this book and reading it.

[Kim]

Good book. Very helpful. Best for anyone with mood disorder, especially if you're on the spectrum

really good mood disorder book. I learned a lot. Phelps is a great writer. Lots of resources included too! Thanks.

[Courtney · Rating 4 out of 5]

This book helped me understand and answered some questions after I was diagnosed with Bipolar/OCD. It was recommended to me by my psychiatrist and I in turn recommend it to anyone else given a similar diagnosis. Just remember to keep in mind that not all of it may be relevant to you.

[Max · Rating 4 out of 5]

I valued this book immensely for helping me better understand my own bipolar and increasing my confidence in my diagnosis. However, the writing quality and editing are half-assed. I really hope they fix this in future editions, as the book is worth it.

It richly covers topics on which I could find little information in the online resources I’ve read. Those topics include: a) the bipolar spectrum as an alternative to the DSM model for viewing this illness, b) the idea that many people not meeting the DSM criteria may still be bipolar, and c) the negative impacts of antidepressants in people with this disorder. The author is clearly an expert on these topics and I recommend this book to anyone who is frustrated by the DSM’s rigid diagnostic criteria.

On the other hand, I cannot remember a book that so distracted me with the poor quality of its writing and editing. The author uses a folksy/breezy style doubtlessly intended to be relatable, but which ultimately condescends to the reader and reduces the writing’s clarity and specificity. The book’s section and paragraph structures are disorganized with problems such paragraphs’ concluding sentences being located in other paragraphs, headings assigned to sections that do not contain the indicated topics, and others. There are numerous distracting digressions, sloppy analogies and mixed metaphors, and SO MUCH REPETITION that if all these problems were fixed, many of the book’s sections would be cut in length by half.

The overall result was that I read the book slower, with greater effort, foggier understanding, and considerably less enjoyment, that I might have otherwise.

I value this book for enhancing my understanding of bipolar. I also want to strongly encourage the author and his editors to clean up their acts in subsequent editions or any future books.

[Judy Ball · Rating 4 out of 5]

Folksy and readable, yet full of useful information from research and practice (his own). My doctor recommended Dr. Phelps' website; I read the book and have since been using the website as well. His practice of using the website to extend and update the material in the book is commendable. Phelps' discussion of the bipolar spectrum, limitations of DSM diagnostic criteria, and how they differ from real-world patients' experiences was especially useful. References to literature on affective instability, pros and cons of different treatment options were personally enlightening. With a bit more editing to eliminate some redundancies, I would have given it 5 stars.

It wasn't until I had received a diagnosis of bipolar II that I learned of Dr. Phelps' book. It wasn't until I read the book that I truly started to undertand the nature of my disease. I understood depression (or so I thought), but I was completely clueless about bipolar II.

I would recommend this book to anyone facing a bipolar II diagnosis or anyone who has a family member with such a diagnosis. I would also recommend it to primary care physicians and practicing psychiatrists everywhere. If more of them were familiar with Dr. Phelps' work, his website, and the research he cites, perhaps fewer of us would struggle for years with the wrong diagnosis and, consequently, the wrong medications. Thank you, Dr. Phelps!

[AmandaKaye · Rating 5 out of 5]

When my husband was diagnosed bipolar II over a year ago, I read every book in it that I found. I wish I had read this sooner, during that time. The information and explanations are incredibly helpful. My insight could have been better if I read this then.

[Peter Anderson]

I had never heard of Soft Bipolar before, so when I read this I was surprised to feel like I was reading about my life. We live in an amazing time with information and experts at our fingertips and Jim Phelps does a great job encouraging and teaching the interested learner. I recommend this book.

[Marilyn · Rating 5 out of 5]

This is one of the BEST books to read if you've been diagnosed with BP or wondering if you are. Excellent!!

[Bob Buehler · Rating 4 out of 5]

Looked through it for highlights, found some interesting tidbits. Geared toward helping the individual take charge of his/her own diagnosis, treatment and progress --always a good thing.

[Ines · Rating 4 out of 5]

This book is an excellent resource on the bipolar spectrum.

I'll start with the cons because there aren't many: The author spends a lot of time hammering in the argument that bipolar spectrum disorders are often misdiagnosed as unipolar depression. He goes on and on about this at length. But when it's time to discuss how to differentiate bipolar spectrum disorders from normal mood swings, he glosses over this in one very short, vague paragraph. This distinction is critical because this is where med compliance becomes an issue. I get that it's a blurred line and discussing it could be sticky. But not tackling this in more detail is an oversight.
I also would have liked more examples of mania vs. hypomania, and what mixed states look like. He covers it in terms of symptoms but some examples of how this might play out would have been helpful.

That aside, this is a wonderful book. It describes variations of bipolar disorder, and treatments (including medication and non-medical approaches). The author backs everything up with scientific research and references. He is honest about areas where he might have bias, and explicit on when he's speculating and sharing ideas that haven't been backed up yet. It's refreshing to see such honest writing. He also has a lot of compassion for people with mood disorders.

His discussion of atrophic and trophic factors linked to bipolar symptoms was fascinating. I've taken psychopharmacology classes but have never seen this discussed. It's more complex and interesting than just the serotonin deficiency model. Prevention of brain atrophy is an excellent reason to stay on medication. This was my favorite section of the book.

All in all this was an excellent book, written by a doctor who truly cares about his patients and the issue he specializes in. It's been helpful to me in understanding my symptoms, root cause, why the diagnosis has eluded me for so long, and treatment options and prognosis from here. Highly recommended.

[Karen · Rating 4 out of 5]

So, my psychiatrist made me start reading this before we made any changes to my medication regime, to see how much of it actually resonated with me. 87 highlights later, I'd say a lot has.

Useful information on how to recognize mood spectrum disorders when the mania isn't as evident, education on standard medications available and the pros and cons of each. Also a touch of what's actually going on in the brain chemistry and other things that can interact and affect mood swings.

I'm really glad she recommended it to me. The only downside is that the book constantly references the authors website with extra notes sorted chapter by chapter. Alas, this was published in 2006, and a lot has changed in Dr. Phelps world. The website is still a font of information but things are not necessarily where the book says they will be, and I don't think some of the patient cases he references are still contained there. Luckily the site does have a table of contents and is still an amazing resource.

Definitely recommend this as a "why does my brain do what it does" type read. Thanks Dr. Turner for assigning it to me!

[Jane · Rating 5 out of 5]

This was an excellent resource on the Mood Spectrum and “soft” bipolar disorder. A must read for anyone with Bipolar II - lots of practical tips and good information.

[Gabrielle · Rating 4 out of 5]

Much information is updated now on his website but still very informative, critical, accessible and what you probably won’t hear from many mental health specialists.

[Jacob Anderson · Rating 5 out of 5]

Legitimately life-changing. Coherent and cogent. Gave me so many answers with such robust reasoning/evidence.

[SN · Rating 5 out of 5]

This book is life changing.

Dr. Phelps explains in his 2014 book A Spectrum Approach To Mood Disorders: "Two hundred and 26 separate genes have been associated with Bipolar Disorder (Nurnberger al., 2014). Although these likely sort into a few major pathways...even 5 major Bipolar pathways, each with just 10 variations, would have 250 different combinations...It seems there are as many bipolar variations as there are patients: Each person has a different mix of depression and manic experiences."

This book further elaborates on his writings about the issues patients face when psychiatrists rely solely on rigid DSM criteria to diagnose. The DSM ignores these variations in experience and as such, many Bipolar patients live without a diagnosis - a diagnosis that can help explain the chronic challenges they have faced/continue to face, and more importantly, empower them to seek targeted treatment and support.

A major reason this book is so important is that it legitimatizes the experiences of Bipolar II patients; So often they have their daily struggles with the disorder dismissed as merely a "lighter" or "easier to deal with" form of Bipolar, in comparison to Bipolar I. Rarely are the huddles they have to face to live some semblance of a "normal" life recognized.
Dr Phelps explains, with data collected from JAMA's study Prospective Investigation of the Natural History of the Long-term Weekly Symptomatic Status of Bipolar II Disorder, that Bipolar II is just as difficult to cope with as Bipolar I, because the depression symptoms are typically more severe in Type II - as compared to Bipolar I, whose mania symptoms are typically more severe.

I appreciated the documentation of lesser known symptoms of Bipolar II Disorder as well as proper ways to zone in on Bipolar II during the diagnostic period, ruling out other possible causes of symptoms.
Part 2 of the book focuses solely on treatment options, their benefits and risks, and how to choose what is right for you.

Dr. Phelps has truly done the world an incredible service by sharing his expertise on Mood Disorders by publishing this (and other) books. Most of the information from these books can also be accessed for free on his website PsychEducation.org. He receives no outside funding from pharmaceutical companies to run his website, as he wishes to provide accurate information to patients instead of mere capitalist propaganda. He's truly an amazing man who very obviously cares about Bipolar II patients, and I cannot recommend this book more to patients, doctors or even those who are simply just interested in learning about the condition.

[Carissa · Rating 3 out of 5]

I skimmed through this book to read the topics that I was interested in, so I didn't read the whole thing cover to cover.

Antidepressants that aren't antidepressants
1. Exercise
2. Light and sleep shifts
3. Fish oil (evidence that these can affect mood is slowly racking up, but the best does is not yet established)
4. Psychotherapy

Watching sleep, light and darkness closely
The connection between sleep and mood stability is as yet unknown, but it has to do with your biological clock.
The retina registers the light and sends a signal up to your hypothalamus which controls your biological clock. Getting into a regular sleep pattern helps stabilize your mood. It is best to have a gradual slow down into bed. No tv or computer an hour before going to bed (perfect time to read!) Have a regular rise time, even on the weekends. You can use a dawn simulator to help wake up in the morning. It gradually brightens your bedside lamp over thirty to 45 minutes.
Regular rhythms in general help, such as when you eat, when you exercise, but sleep helped the most to maintain regularly.

Exercise
"... mood symptoms, if not treated, often lead eventually to brain shrinkage, particularly in regions associated with decision making (frontal lobes) and memory (hippocampus)."
Effective antidepressents increase the brain's growth factors and reverse this shrinkage---the same thing happens with exercise. "The director of the Bipolar Clinic associated with Harvard, Dr. Gary Sachs, says, 'Here's your exercise program: go to the door, look at your watch. Walk 7.5 minutes in any direction, then turn around and walk home. Do that five days a week at least.'"


So, I have some new things to try. I already knew that exercise is extremely beneficial, but I never made it apart of my day as much as I have now. I go 3x a week, though, for 20-30 minutes, trying to get my heart rate up and a good sweat. Still, walking every day may be a good shift for me as well. I am trying to change my sleep cycle, but that is more difficult. I am more awake at night, the daytime quiet and soft sun makes me very sleepy. I only let myself have a nap once a week, if that. Unfortunately the yoga technique of laying on the floor, with my butt against the wall and my legs straight up on the wall has been failing to keep me awake. I woke up the other day on the floor with obvious muscle strain from an awkward, uncomfortable position.

[Natasha Tracy · Rating 5 out of 5]

An amazing book, particularly for people with bipolar II or those who are diagnosed with major depression but suspect bipolar disorder.

This book sheds light on bipolar disorder in a way that other books don't and it's written in a way that anyone can understand. Dr. Phelps is an amazing resource and a trusted expert.

This is a must-read for people with bipolar II or those who think they may have bipolar.

[Lisa · Rating 4 out of 5]

The writing is atrociously chummy and folksy but the info is good and hard to find elsewhere.

[Saaammyd · Rating 4 out of 5]

Useful.

[Steven · Rating 4 out of 5]

For those who suffer from recurrent, cyclical depression, this is an important book to understand why anti-depressants stop working and your depression keeps coming back.

[Sorcha · Rating 4 out of 5]

Great reference book. Solid information about the basics of Bipolar Disorder and what you can do.

[Rebekah · Rating 3 out of 5]

People are healthier when they keep routines. Fancy that.

[Gen Superfish · Rating 3 out of 5]

Important to read for anyone with depression or Bipolar.

[Riley]

it was a good book and i learn alote