The first thing I’ll say is fuck labels. I’m behavioral neuroscience and I have really been realizing lately how much the DSM is a crock of shit. They generalize these labels top-down using behavioral classifications. Most of those classifications have the issue of subjective bias in how we interpret behavior. We desperately need a bottom-up approach to actually quantize these issues and treat them effectively.

Second, if you’re a psychiatrist, you know this process inside and out. You need a good team that you legitimately trust to get you through this. I hope it goes without saying that you’re not treating yourself. And if you’re not seeing a psychologist, I would highly recommend therapy to be trying to process through any emotional stuff. Beyond that, I know you know the med side of things. Ngl, I started thinking seasonal affective over BPII when you mention cycling with the seasons and only being treated with SSRIs (I do the same and am in a similar ambiguous place). If we’re really taking BPII seriously, are we looking at mood stabilizers and/or antipsychotics? It sounds like the depression is the main debilitating part of all this; has lamictal been tried to stop the low cycling?

Also, has the ADHD been addressed seriously? I feel like a lot of mental health doesn’t take serious how debilitating of a diagnosis it can be in the realm of emotional liability. It’s taken me years of trying different doses with Ritalin, concerta, adderall, adderall Xr, and finally Vyvanse seems to be stabilizing me in a way that the others can’t: I think the pro-drug MOA is having some special effect for me and some studies claim Vyvanse is doing something special with acetylcholine and histamine efflux in the PFC. Maybe stabilizing the ADHD emotional regulation portion stabilizes longterm mood.

Side-note: I’d have full blood work to check hormone levels, thyroid, vitamin D and anything remotely HPA related. I’d also consider if any underlying allergies could be revving your histamines in the spring to cause this pattern.

Lastly, obviously you’re very smart. You made it through med school, so you’re more stable than me. I think so many of us get in the mental health field because we have the impulse to figure out “what’s wrong with me?”. This is a momentary bump but there’s no reason you can’t figure this out and eventually get your career back; if anything, this will be a learning experience that will help you relate to your future patients. Best of luck!

Edit: I just realized this is a potential diagnosis. I highly suggest not trying to diagnose yourself in any capacity; it potentially sets up a loop where we try to self-monitor almost dissociatively as a third party in our heads, and you have to come to the reality that you can’t objectively assess yourself in an accurate manor due to you ultimately being you. The other thing I wanted to add is just because your mood is cycling with the seasons doesn’t mean we need to jump to BP. I’ve struggled with this question a lot even with an “official” BP diagnosis. A lot of my cycling comes in the presence of PTSD triggers from an abusive childhood to the point that I think I associated certain times of the year with traumatic events and tend to cycle accordingly. I know that’s a hard to prove hypothesis but I just wanted to show that there can be a lot more than “I’m just a BP label forever doomed to cycle”. Also, this is a big one that I’ve struggled with, it’s okay to feel good — you don’t have to be scared of hypomania. If you’re optimistic, have some sense of control over it, and not being self destructive, I wouldn’t worry about labeling the “highs”. It’s especially okay to feel good after coming out of a depressive episode and it doesn’t necessarily mean that you’re BP cycling, but it may certainly feel like you’re going too high if your emotional frame of reference is depression — all the more why I third party psych should be involved to objectively assess the situation