Saturday, January 10, 2009

Trick Question

Here's a question I used to pose to my audience when I was giving talks in 2006-2007:

Emil Kraepelin was the pioneering diagnostician who coined the term manic-depression back in the early twentieth century. These days, we use the term bipolar. Question: What was the term Kraepelin used to describe unipolar depression?

Answer: Manic-depression.

That's right - manic-depression. To Kraepelin, both illnesses were part of the same phenomenon, or more precisely the same recurring phenomenon. People cycled in and out of depression. Some just happened to cycle up to a higher level than others.

In the 1950s, Jules Angst and others separated out a class of individuals with CHRONIC depression. These are the true unipolars. They don't cycle. They stay in their depression, often year in and year out.

Those with RECURRENT depression, on the other hand, exhibit a similar pattern to those with bipolar. The leading researchers of the day were pretty much in agreement on this. Then along came the DSM-III of 1980, which completely got it wrong.

The DSM lumps chronic and recurrent depression together and separates out bipolar. The treatment implications are enormous. These so-called unipolars are treated the same, regardless of their depressions, and given antidepressants while the bipolars get mood stabilizers.

Thus, a large population of unipolars are being treated with meds that not only may not work, but may, in fact get them worse.

Jim Phelps MD describes this very well in his 2006 book, "Why Am I Still Depressed?" For the clinician view, check out Goodwin and Jamison's definitive text, "Manic-Depressive Illness." Fittingly, the subtitle reads: "Bipolar Disorder and Recurrent Depression."

In my talks, I was speaking to very smart people. Yet, of the thousands I wound up addressing, not one came up with a correct answer to my question. The DSM is propagating a myth, aided and abetted by modern psychiatriy. Patients and loved ones are paying in full measure for this mistake.

Further reading from mcmanweb: The True Meaning of Manic-Depression.

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