The following is an excerpt from my upcoming memoir, BrainStorm: From Bruised to Blessed on the Bipolar Spectrum.

I have an anomaly in my DNA, an accident of genetics that I now know is Bipolar II or “soft bipolar.” Ninety percent of the time, Bipolar II is hard to diagnose or misdiagnosed as “standard depression.” It presents with the classic symptoms: exhaustion, negativity, hopelessness, loss of joy in life. But this diagnosis is the kiss of death for a bipolar brain like mine and that of millions of people in this country alone who are suffering from Bipolar II. Here’s why: The standard meds for depression—SSRIs (selective serotonin reuptake inhibitors) such as Prozac, Lexapro, Paxil, Zoloft—are poison to the bipolar brain. They actually make us sicker—more anxious, more psychotic, and more willing to act on suicidal thoughts. This was true for me. The depressions I’d suffered from, on and off for twenty-five years without medication, became dangerously worse when I was on Lexapro and Prozac.

What makes Bipolar II hard to diagnose is that people with it don’t show the classic signs of mania that is associated with BiPolar I, also known as manic-depressive disorder. Even though they are wired similarly and respond similarly to standard medications, they don’t have its insatiable highs. Classic signs of mania include needing only a few hours of sleep a night, going on spending sprees, having insatiable sexuality, and incessant speech. This pattern is so common that we use it colloquially to describe people. When you hear someone say, “That guy’s really manic,” you know it means he’s some combination of hyperactive and non-stop talking. If a fast-talking fidgeting person with “manic” behavior bounces from high speed in one phase to darkly depressed in another, we’re not surprised if they return from a psychiatrist with a diagnosis of bipolar and a scrip for lithium to treat it.

Although I’ve never had any of these classically manic symptoms, I’ve always had more energy than most people which made Bipolar II hard to diagnose. In high school I was awarded the Harvard Book Prize for the top scholar-athlete in my graduating class of five hundred. Harvard had been awarding these prizes in high schools around the country for years, but mine was the first they’d ever given to a female student. I got 800s on the SATs in math and earned As in calculus. I went to Brown University. As an undergrad, I biked to classes, studied four hours straight every night, and then headed to the pool for a one-mile swim followed by midnight drinks with my friends. I maintained a 4.0 in science, acing Physics and Organic Chemistry, and started as a rightwing in varsity field hockey in my freshman year. I had a blast in college, thriving on the athletic competition, the intellectual challenge, my feisty women friends, and a sense that nothing but success and accolades lay ahead for me.

Then, out of nowhere, a door slammed on my life. On the morning of my twenty-first birthday, I couldn’t get out of bed. I was suddenly immobilized. I was a senior in college. There was no precedent for this and there had been no warning. My legs were too heavy to raise from under the blankets. I did not want to see friends, did not want to get dressed, could barely get up to lug myself to class. (Not one to skip class, I did drag myself there.) That afternoon, my brothers and sister, all older than me, drove from Boston to surprise me on my birthday. The three of them hid under the covers of my double bed and gleefully yelled, “Surprise!” when I arrived back from class. 

Instead of delight, I felt terror and shame. I did not recognize myself in this state of flat affect combined with a sense of doom, and I didn’t want Martha, Bill, and Dan to see me like this.