Current Issues in Mental Health

Bipolar Disorder: Often Unrecognized and Untreated-But Help is Available

Acclaimed author Kay Redfield Jamison, who will be speaking in Easton March 21, 2007 is one of a number of famous people who have written about their struggles with, and eventual successful management of, their bipolar disorder. Art Buchwald even joked about being in a Bipolar Hall of Fame. Yet many people still suffer for many years before their bipolar disorder is diagnosed and treated. The other name for bipolar disorder, manic-depressive illness, makes clear that episodes of depression are part of the illness. Persons with bipolar illness also have episodes of mania or hypomania. The combination, if not diagnosed and treated effectively, can eventually have a devastating effect on an individual's life.

There are many reasons why bipolar illness is so often unrecognized and untreated.
One reason is the wide range of symptoms of mania.

Any one individual may have several, but not all, of the following signs and symptoms of mania: (bullet points and italicized phrases from the National Institute of Mental Health (NIMH) website www.nimh.nih.gov/publicat/bipolar.cfm).

• Increased energy, activity, and restlessness.
• Excessively high, overly good, euphoric mood.
• Extreme irritability.
• Distractibility, can't concentrate well.
• Little sleep.
• Unrealistic beliefs in one's abilities and powers.
• Poor judgment.
• Spending sprees.
• Increased sexual drive.
• Abuse of drugs, particularly cocaine, alcohol and sleeping medications.
• Provocative, intrusive, or aggressive behavior.
• Denial that anything is wrong.

In addition to the range of symptoms above, other clusters of symptoms have been identified as part of bipolar disorder. A mild to moderate level of mania is called "hypomania" in which the person feels good and the episode may be associated with good functioning and enhanced productivity…but without proper treatment hypomania can become severe mania or switch into depression.

Some individuals have a "mixed" bipolar state, in which symptoms of mania and depression occur together and often include agitation, trouble sleeping, significant change in appetite, psychosis and suicidal thinking. A person may have a hopeless mood and at the same time feeling extremely energized.

It is easy to understand that with such a variety of symptoms that bipolar disorder is often unrecognized, undiagnosed and untreated. This problem is heightened by the fact that bipolar disorder typically first develops in late adolescence or early adulthood. At these ages some of the mood swings and extremes in behavior that are characteristic of bipolar illness are often viewed as youthful excesses that will diminish with age. In mature adults, diagnosis is sometimes delayed by the co-existence of another disorder, such as alcoholism. One theory holds that the high percentage of overlap between those with bipolar disorder and alcohol or drug problems is due to "self-medication" by persons troubled by bipolar symptoms. Without treatment the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent and more severe manic and depressive episodes.

When the illness is diagnosed and effectively treated, people with bipolar disorder can lead healthy, productive and successful lives, as illustrated by the many well-known people who have done so. A critical first step is obtaining an accurate diagnosis. This is usually initiated or confirmed by a psychiatrist after a thorough evaluation and history-taking from the patient, and often from the family as well.

The most effective treatments for bipolar disorder are medications known as "mood stabilizers". Lithium and valproate (Depakote) are the most commonly used mood stabilizers, and are FDA approved for this purpose. Supplemental psychotherapy and other supportive programs have also been found to be helpful in bipolar disorder.

Anti-depressants are sometimes also prescribed to alleviate the depressive periods of bipolar disorder. However, research has shown that people with bipolar disorder are at risk of switching into mania or of developing rapid cycling during treatment with anti-depressant medication. Thus when a person with bipolar tendencies is treated for depression with anti-depressants, a mood stabilizing medication is generally also needed to be part of the medication regime to protect against this switch. Sometimes it is necessary to try several medication combinations to find the most effective one.

Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life. As is the case of all illnesses, it is usually beneficial for both the person with the illness and family members to learn as much as feasible about the illness and its treatments.

The eleven-page NIMH booklet Bipolar Disorder, from which all the quotes in italics above are taken, is available at www.nimh.nih.gov/publicat/bipolar.cfm. It contains more information and suggestions on how individuals and family members can get help with bipolar disorder.

A source of even more detailed information and practical advice is the 296-page book The Bipolar Survival Guide by David J Miklowitz, PhD, available at the Talbot County Library and from most booksellers.

A book often cited as one of the best-written descriptions of the experiences of bipolar disorder is the best-seller book An Unquiet Mind: A Memoir of Mood and Madness by Kay Redfield Jamison, in which she describes her own experience with mania and suicidal depression. Touched with Fire and Night Falls Fast: Understanding Suicide are other books written by Jamison. All are available at the Talbot County Library and from booksellers.

Kay Jamison is an example of a person who has achieved professional success and public acclaim after finding a way to manage her own bipolar disorder. Interested individuals will be able to hear Jamison in person when she appears at the Avalon in the evening of March 21, 2007 speaking on the topic: "Bipolar Disorder: a Personal and Professional Perspective".

Missed the Dr. Kay Redfield Jamison Event? No worries! Kay Jamison DVD's on Sale!
You can watch it on DVD for only $10 plus shipping. Contact Susan Sherman at 410.822.0444 or email her at ssherman@mhamdes.org to buy your copy today.

Written by Delphine Peck. She has written reviews of books and information sources about Mood Disorders for Smooth Sailing, the newsletter of the Depression and Affective Disorder Association (DRADA). Submitted under the direction of the Mental Health Association of Talbot County.

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