Welcome to Back from the Abyss. I'm Dr. Craig Hecock. If you haven't yet filled out the Back from the abyss listeners poll, please do so.

We've been getting a lot of helpful feedback, some interesting thoughts, some really kind and

lovely compliments. Thank you so much. And one of the things that's come up a bunch in the early

returns is that a lot of you are wanting some more many episodes with me

where I talk about clinical ideas or cases or just insights. So I thought I would do this

episode. It's going to be called Lessons and Insights in Clinical Pearls from 20 years of psychiatry.

I can't believe I've been doing psychiatry for 20 years.

So here we go.

In residency, we learned that there are basically two primary mood disorders.

Bipolar mood disorders and major depressive disorder or unipolar depression.

And the basic difference between those is that bipolar disorder has major depressive

episodes plus hypomania or mania, whereas unipolar depression or major depressive disorder has just major depressive

episodes.

But I think there's a fundamental flaw in even this construction, this noisology,

because if you look in the DSM what they define as a major depressive episode, they say

it can be characterized by hypersomnia,

oversleeping, or insomnia, lack of sleep, which makes no sense whatsoever. And I've talked

about this on the podcast before. Because if you think about it, hypersomnia is a shutdown of the nervous system. It's a it's a numbing, it's a

parasympathetic thing, it's a hibernating kind of thing, whereas insomnia is

activation, overactivation, sympathetic nervous system, trauma. So it seems that the whole primary mood structure of the DSM is built

on this faulty assertion. And more and more psychiatrists are starting to argue this. But I think it can

be really helpful for us to think about depression in a different way.

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