James Phelps’ new book, A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar—Practical Management, is written for professionals, not laymen. I have some familiarity with bipolar disorder and its causes, symptoms, and treatments. However, I am not a professional and this book often goes beyond my ability to comprehend. Dr. Phelps has been treating patients and studying and writing about mood disorders for over 25 years, but he makes assumptions that the reader has a higher level of experience or training, and it makes this book difficult for amateurs to fully appreciate.
The basic premise of Dr. Phelps’ book is that there is a broad spectrum of mood disorders, not a simple black and white diagnosis. A black and white diagnosis asks the question, “Is s/he bipolar?” and labels the patient accordingly. By contrast, evaluating a patient along a spectrum of severity acknowledges that there are several inbetween conclusions that can be made. The author suggests that 40% of disorders could be considered mid-spectrum. But even three categories is not enough. Picture instead the color spectrum to get an idea of how patients can be evaluated, with very slight differentiation between levels of diagnosis. The importance of this distinction is that treatment approaches can be more precisely applied by professionals who understand and value these distinctions.
The author addresses many topics using the spectrum approach. He describes the distinctions a patient experiences when diagnosed with depression, post-traumatic stress disorder (PTSD), attention deficit hyperactivity disorder (ADHD), bipolar disorder, or something else. As you would expect, there are situations when it may not be clear where to place a patient on the spectrum. In fact, patients can also move along the spectrum as their symptoms change.
Phelps also presents a wide range of treatment options, including light therapy, dawn simulators, psychotherapy, amber lenses, sleep, exercise, and social rhythms, and provides suggestions for achieving greater effectiveness. As expected, several of these might be used at once.
There is extensive discussion of prescription medicines. An entire chapter is devoted to lithium and its use for various patients. For mid-spectrum patients, low-dose lithium may have a positive effect, although he cautions against administering higher levels of lithium. He almost suggests that there should be different names for full- and low-dose lithium.
Phelps discusses anti-psychotics, differentiating between their best uses depending on the disorder. Mid-spectrum patients do not need anti-psychotics because they are not manic. He also describes anti-depressant use with different types of patients.
There are three helpful appendices discussing moral reasoning and bipolar disorder, and how different values may affect diagnoses; over diagnosis of bipolar disorder; and bipolar treatments that avoid medication. This is followed by a lengthy citation of references.
In reading A Spectrum Approach to Mood Disorders, I realized how unprepared I was to fully understand the information that Phelps presented. However, there are many in the field of psychotherapy and psychiatry, or other health fields, who might find his book a tremendous resource to help differentiate between cases of mood disorder or bipolar disorder. Dr. Phelps is a respected and highly-experienced physician. He presents a thorough and convincing explanation of the nuances of accepting that a broad spectrum of mood disorders does exist. Professionals who acknowledge this will be able to use Dr. Phelps’ book to provide patients with the focused, in-depth treatment they require.
A Spectrum Approach to Mood Disorders: Not Fully Bipolar But Not Unipolar—Practical Management
W.W. Norton & Company, June 2016
Hardcover, 272 pages