Many of our clients struggle with depression or anxiety, but a fair number suffer from both conditions. Faced with this particular mix of symptoms, therapists may apply lots of different diagnostic labels—PTSD, ADHD, generalized anxiety disorder, borderline personality disorder—but what’s often missed is another condition altogether, a subtle form of bipolar II, which can lead to years of debilitating mood swings that can make a person feel desperately out of control.

As a psychiatrist and therapist specializing in complex mood disorders, I know well how challenging it can be to diagnose subtle bipolar II, a condition in which severe depression alternates with episodes of higher energy that are less obvious than those in bipolar I. These other phases are difficult to identify as abnormal because mild hypomania is not all that different from having a really good day.

Treatment for bipolar disorders used to focus on medication, but like many other mood specialists, I’ve found that most clients don’t get the help they need with medication alone, or even with established therapy approaches in combination with medication. Instead, a combination of new, lesser-known therapies plus medications has been shown to produce substantial gains in mood stabilization and daily functioning.

Teasing Out the Problem

Maria, a 34-year-old high-school teacher, came in for her first appointment looking exhausted. She told me…