Depression & Anxiety Links |
| Home | Articles | Links | Medications |
| Treatment Currently bipolar disorder has not been cured although many psychiatrists and psychologists believe that it can be managed. The emphasis of treatment is on effective management of the long-term course of the illness, which can involve treatment of emergent symptoms. Treatment methods include pharmacological and psychological techniques. A variety of medications are used to treat bipolar disorder; most people with bipolar disorder require combinations of medications. Prognosis and the goals of long-term treatment A good prognosis results from good treatment which, in turn results from an accurate diagnosis. Because bipolar disorder continues to have a high rate of both underdiagnosis and misdiagnosis it is often difficult for individuals with the illness to receive timely and competent treatment. Bipolar disorder is a severely disabling medical condition. In fact, it is the sixth cause of disability in the world according to the World Health Organization. However, with appropriate treatment, many individuals with bipolar disorder can live full and satisfying lives. Persons with bipolar disorder are more likely to have periods of normal or near normal functioning between episodes. The prognosis for bipolar disorder is, in general, better than that for schizophrenia. However, many atypical antipsychotics, which were originally developed to treat schizophrenia, have also been shown to be effective in bipolar mania. Ultimately one's prognosis depends on many factors, which are, in fact, under the individual's control: the right medicines; the right dose of each; a very informed patient; a good working relationship with a competent medical doctor; a competent, supportive and warm therapist; a supportive family or significant other and a balanced lifestyle that includes exercise. One of the most important lifestyle changes is regular sleep and wake times, this cannot be stressed enough. There are obviously other factors that lead to a good prognosis, as well, such as being very aware of small changes in one's energy, mood, sleep and eating behaviors as well as having a plan in conjunction with one's doctor for how to manage subtle changes that might indicate the beginning of a mood swing. Some people find that keeping a log of their moods can assist them in predicting changes. The goals of long-term treatment are to help the individual achieve the highest level of functioning and to avoid relapse. Relapse Even when on medication, some people may still experience weaker episodes or have a complete manic or depressive episode. The following behaviors can lead to depressive or manic relapse: * Discontinuing or lowering one's dose of medication without consulting one's physician. * Being under- or over-medicated. Generally, taking a lower dosage of a mood stabilizer can lead to relapse into mania. Taking a lower dosage of an antidepressant, may cause the patient to relapse into depression, while higher doses can cause destabilization into mixed-states or mania. * Taking hard drugs – recreationally or not – such as cocaine, alcohol, amphetamines, or opiates. These can cause the condition to worsen. * An inconsistent sleep schedule can destabilize the illness. Too much sleep (possibly caused by medication) can lead to depression, while too little sleep can lead to mixed states or mania. * Excessive amounts of caffeine can cause destabilization of mood toward irritability, dysphoria, and mania. Anecdotal evidence seems to suggest that lower dosages of caffeine can have effects ranging from anti-depressant to mania-inducing. * Inadequate stress management and poor lifestyle choices. If unmedicated, excessive stress can cause the individual to relapse. Medication raises the stress threshold somewhat, but too much stress still causes relapse. Research findings Heritability or inheritance of the illness Bipolar disorder runs in families. More than two-thirds of people with bipolar disorder have at least one close relative with the disorder or with unipolar major depression, indicating that the disease has a genetic component. Studies seeking to identify the genetic basis of bipolar disorder indicate that susceptibility stems from multiple genes. Scientists are continuing their search for these genes using advanced genetic analytic methods and large samples of families affected by the illness. The researchers are hopeful that identification of susceptibility genes for bipolar disorder, and the brain proteins they code for, will make it possible to develop better treatments and preventive interventions targeted at the underlying illness process. Recent genetic research Bipolar disorder is considered to be a result of complex interactions between genes and environment. The monozygotic concordance rate for the disorder is 70%. This means that if a person has the disorder, an identical twin has a 70% likelihood of having the disorder as well. Dizygotic twins have a 23% concordance rate. These concordance rates are not universally replicated in the literature, recent studies have shown rates of around 40% for monozygotic and <10% for dizygotic twins (see Kieseppa, 2004 and Cardno, 1999 ). In 2003, a group of American and Canadian researchers published a paper that used gene linkage techniques to identify a mutation in the GRK3 gene as a possible cause of up to 10% of cases of bipolar disorder. This gene is associated with a kinase enzyme called G protein receptor kinase 3, which appears to be involved in dopamine metabolism, and may provide a possible target for new drugs for bipolar disorder. Current and ongoing research The following studies are ongoing and are recruiting volunteers: The Maudsley Bipolar Twin Study, based at the Institute of Psychiatry in London is conducting research about the genetic basis of bipolar disorder using twin methdology. Currently recruiting volunteers: identical and non-identical twins pairs where either one or both twins has a diagnosis of bipolar I or II. The MRC eMonitoring Project, another research study based at the Institute of Psychiatry and Newcastle Universities, is conducting novel research on electronic monitoring methodologies (electronic mood diaries and actigraphy) for tracking bipolar symptom fluctuations in Bipolar individuals who are interested in self-managing their condition. Medical imaging Researchers are using advanced brain imaging techniques to examine brain function and structure in people with bipolar disorder, particularly using the functional MRI and positron emission tomography. An important area of neuroimaging research focuses on identifying and characterizing networks of interconnected nerve cells in the brain, interactions among which form the basis for normal and abnormal behaviors. Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders and studies have found anatomical differences in areas such as the prefrontal cortex and hippocampus. Better understanding of the neural circuits involved in regulating mood states, and genetic factors such as the cadherin gene FAT linked to bipolar disorder, may influence the development of new and better treatments and may ultimately aid in early diagnosis and even a cure. Personality types or traits An evolving literature exists concerning the nature of personality and temperament in bipolar disorder patients, compared to major depressive disorder (unipolar) patients and non-sufferers. Such differences may be diagnostically relevant. Using MBTI continuum scores, bipolar patients were significantly more extroverted, intuitive and perceiving, and less introverted, sensing, and judging than were unipolar patients. This suggests that there might be a correlation between the Jungian extraverted intuiting process and bipolar disorder. Research into new treatments In late 2003, researchers at McLean Hospital found tentative evidence of improvements in mood during echo-planar magnetic resonance spectroscopic imaging (EP-MRSI), and attempts are being made to develop this into a form which can be evaluated as a possible treatment. NIMH has initiated a large-scale study at twenty sites across the U.S. to determine the most effective treatment strategies for people with bipolar disorder. This study, the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), will follow patients and document their treatment outcome for 5 to 8 years. For more information, visit the Clinical Trials page of the NIMH Web site. Transcranial magnetic stimulation is another fairly new technique being studied. Pharmaceutical research is extensive and ongoing, as seen at clinicaltrials.gov. Gene therapy and nanotechnology are two more areas of future development. Bipolar disorder and creativity The Starry Night painted by Vincent van Gogh in 1889 in the hospital for mentally disturbed people in St. Rémy de Provence. Van Gogh is considered to have been affected by bipolar disorder and this painting has high contrasts analogous to extreme bipolar highs and lows, and captures the vibrancy associated with mania. Van Gogh is considered to have been affected by bipolar disorder and this painting has high contrasts analogous to extreme bipolar highs and lows, and captures the vibrancy associated with mania. Many artists, musicians, and writers have experienced its mood swings, and some credit the condition for their creativity. Kay Redfield Jamison, who herself has bipolar disorder and is considered a leading expert on the disease, has written several books that explore this idea, including Touched with Fire. Research indicates that while mania may contribute to creativity (see Andreasen, 1988), hypomanic phases experienced in bipolar I, II and in cyclothymia appear to have the greatest contribution in creativity (see Richards, 1988). This is perhaps due to the distress and impairment associated with full-blown mania, which may be preceded by symptoms of hypomania (i.e. increased energy, confidence, activity) but soon spirals into a state much too debilitating to allow creative endeavor. Many famous people are believed to have been affected by bipolar disorder, based on evidence in their own writings and contemporaneous accounts by those who knew them. Bipolar disorder is found in disproportionate numbers in people with creative talent such as artists, musicians, authors, poets, and scientists, and it has been speculated that the mechanisms which cause the disorder may also spur creativity. Many historical figures gifted with creative talents commonly cited as bipolar were "diagnosed" after their deaths based on letters, correspondence or other material. Hypomanic phases of the illness allow for heightened concentration on activities and the manic phases allow for around-the-clock work with minimal need for sleep. Another theory is that the rapid thinking associated with mania generates a higher volume of ideas, and as well associations drawn between a wide range of seemingly unrelated information. The increased energy also allows for greater volume of production. See list of people believed to have been affected by bipolar disorder. Trivia * Bipolar disorder and its treatment with lithium dibromide is referenced to by Krusty the Klown in a Simpsons episode titled Midnight Rx. However, lithium bromide, the compound referred to, is rarely used to treat bipolar disorder. Instead, lithium carbonate is often used for the treatment of the illness. |