ABSTRACT
People with mood dysregulation have symptoms with core similarities. Their presentations are variations on a theme. The individuals presented in this chapter came to me with “depression,” discouraged by a poor response to multiple antidepressant medications. Some had other diagnoses such as eating disorder, anxiety, alcohol abuse and ADHD. Treatment failures were affecting their lives and relationships and, at times, their willingness to engage in further treatment. But all had dysphoria, which was never previously recognized. It was typically described as “depression” and/or “anxiety” whilst manifest in a state of activation characterized by irritability, restlessness and agitation. These activated/increased energy symptoms resembled the activated hypomania of bipolar disorders more than symptoms of any depressive disorder, but none of these individuals could be diagnosed with bipolar disorder. Perhaps the bipolar connection was in the genetic commonality between people with this symptom constellation and those with bipolar disorders, “an affective temperament” or genetic predisposition to a mood disorder. Each of these individuals, in fact, experienced significant relational stress that could account for development of mood dysregulation if genetically predisposed. Psychotherapy was an important part of the treatment response for those who embraced it. And for each one, mood stabilizers proved uniquely effective in mitigating symptoms of what they had previously described as “depression.” In each case, proper identification of their symptoms made a crucial difference in treatment outcome and was key to effective treatment.
