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  1. #1

    Weathering the Extremes of Bipolar Disorder

    Weathering the Extremes of Bipolar Disorder
    Karen Barrow. ABC News. May 5/05
    Many people feel sluggish and down during the gray, cold months of winter but when spring begins, the whole world seems to burst with energy and life and moods seem to magically improve. However, for the 2 million American adults living with bipolar disorder, the change of seasons can mean a change in behavior; the highs are much higher and the lows, much lower. New evidence has shown that the changing of the seasons may drive some of these extremes.

    In a study published in April 2004 in the Journal of Affective Disorders, a team of scientists surveyed patients with various mood disorders, including depression and bipolar disorder. At the end of the year-long survey, it was found that individuals with bipolar disorder were much more likely to have mood fluctuations with the seasons than those from the depressed or normal populations.

    While the true impact of this study is yet to be seen, it may change our understanding of bipolar disorder, and ultimately the way it is treated. Karen Shin, MD, the head researcher of the study and resident in psychiatry at the Sunnybrook and Women's College Health Sciences Centre, University of Toronto, tells us about these new findings.

    What is bipolar disorder?
    Bipolar disorder is a type of mental illness. It's in the category of mood disorders. Patients with bipolar disorder suffer from both highs and lows in their mood. When you're high it's called a manic episode; people can feel euphoric and elated. It can lead to impairment in judgment and disruption in sleep and eating. Similarly, when people are depressed their mood drops. They feel quite down and sleeping, eating, social activities can also be disrupted.

    What causes bipolar disorder?
    We don't know any specific causes. We know there is a genetic component; there is an element of heredity and we believe that neurotransmitters in the brain are contributory, but we don't know the fine details of what causes it.

    What are the types of bipolar disorder?
    There is bipolar disorder type 1 and bipolar disorder type 2. For bipolar disorder type 1, patients suffer from a cluster of symptoms that together would be called a manic episode. That includes severe euphoria and elation and a severe impairment in functioning. People might become psychotic, become very grandiose and have hallucinations. They may or may not have a depressive episode.

    For bipolar disorder type 2, patients have what's called a hypomanic episode; it's an elevated mood, but not to the same severity of a bipolar disorder type 1 manic episode. Also, they will have had a depressive episode sometime in their life as well.

    What are the first signs of bipolar disorder?
    It's generally an early onset illness that usually appears in one's 20's. But it can happen across the lifespan. Someone who notices that they don't need to sleep at night, but they're still energized during the day [may have bipolar disorder.] They're not hungry. They're not bothering to eat. Family members or other people might notice that they're talking very quickly. Their thoughts might be racing and they become very distractible, these are things that you yourself might notice, but also people who know you well. People with bipolar disorder might start to feel overconfident and this is when it can lead to problems. This elation is related to the mania, like you're on top of the world and you can accomplish anything. This overconfidence can lead people to make poor decisions; start up their own business, clear out their bank account, go on shopping sprees or start gambling.

    Someone with bipolar disorder might first have an episode of depression and they might be labeled as someone with a major depressive disorder. Then, say, ten years into it, they get a manic episode and then you look back and say, "Oh, actually this person is bipolar and not just depressed." Then, treatment would have to be tailored because treatment for depression is obviously different. The problem is that patients with bipolar disorder, run into manic times and depressive times, and antidepressants, which are used to treat depression, can sometimes trigger a manic episode. So it's a very careful balance in deciding what treatment is required.

    What can trigger episodes?
    Life stresses can trigger an episode. And not taking medications will trigger an episode. Compliance can become an issue because it is a chronic illness. To prevent episodes, you need to be vigilant in taking your medications every day. It's hard for patients to continue that over decades, especially when they're feeling better. That's when you can run into some problems with people that stop medications on their own.

    But also disruptions in sleep, related to things such as seasonal changes, can perhaps trigger episodes.

    How does seasonality affect bipolar disorder?
    If you look across the general population, people might complain of differences in their mood and behaviors across the different seasons. Our study looked bipolar disorder patients and how they feel their moods and behaviors fluctuate across the changing seasons. And we found that they do experience significant difficulty. We measured their mood, sleep, social activity, weight, appetite and energy [over one year]. In our survey, bipolar disorder patients reported that these items would fluctuate according to the changing seasons. The spring and summer would be times when you're more likely to see patients with a manic episode whereas the depressive episodes are less likely during this time.

    Is this at all related to seasonal affective disorder?
    There is one line of thinking that it is related to seasonal affective disorder (SAD), [a condition in which people experience depression during the winter months which subsides in spring and summer] It's not known in either case what triggers the mood changes; its never been clearly described.

    What treatments are available to people with bipolar disorder?
    Mood stabilizers are the mainstay of treatment. With a mood stabilizer you want to prevent manic episodes and depressive episodes. There are several different mood stabilizers and they all have different side effects.

    Lithium, valproic acid and carbamazepine are common mood stabilizers. They require that your doctor constantly check to make sure that blood levels are proper. Lithium can cause some sedation and weight gain. It can cause dizziness and upset stomach. People might develop tremors. Valproic acid can also cause some sedation, some upset stomach.

    And then a class of antipsychotic medications is also available as mood stabilizers. Often people do complain that they cause some tiredness. Sometimes people get some muscle stiffness as well.

    All of these side effects would be monitored by a physician and medication adjustments made to minimize the side effects and maximize the treating potential.

    Do you think the new information about seasonal affects on bipolar disorder might effect treatment?
    Bipolar disorder is a chronic illness with a high mortality rate; between 10 and 15 percent of patients commit suicide. This stresses the need for appropriate illness detection, care and treatment. Finding out that bipolar patients have more difficulty in certain times of the year, shows that it would be important to monitor their symptoms, sleep and activity levels [during the different seasons]. They might need a little bit more medication to stabilize them over certain period of time where things are a bit more tenuous. You might have to add medications to help them sleep a little bit more. But these are projected ideas, there is no standard method to deal with seasonal changes and bipolar disorder.

  2. Weathering the Extremes of Bipolar Disorder

    another reason we stop taking our meds is the frustration of the "med game" where the pdocs change the types and combos and doses. and also being on meds that don't work I know I get to the point of giving up.

  3. #3

    Weathering the Extremes of Bipolar Disorder

    The doctors aren't changing the medications and dosages on a mere whim, butterfly. They are presumably doing it to find the right combination to manage your symptoms. Yes, it can be frustrating and yes, it does take some patience.

    If you don't give up, you will in due course find something that works. If you do give up, you pretty much have a guarantee that you will continue to feel as low as you do now...

  4. #4
    Join Date
    Mar 2006
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    I live in a small town in North Dakota.
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    Re: Weathering the Extremes of Bipolar Disorder

    As far as medication goes, if I wasn't on my meds, I would be in the hospital. It is a part of my every day routine.You get used to it. Some of the side effects aren't the greatest. I was on Risperdal and gained weight. They took me off it. Lithium is my wonder drug. Seroquel helps me sleep. And Trileptal and Wellbutrin finish out balance I have with my illness. I would rather feel good, than be in my bed, shut out from the world. There are times when I have gone off my meds just because I felt good. In a few days, I could tell the difference. It wasn't pretty.

    I know when I am getting depressed. I don't eat or sleep. I go into seclusion. Nothing matters to me. I have learned how to address these signs. It gets easier every time.

    Mental illness is on my dad's side of the family. I have aunts, uncles, neices, and cousins who have some type of depression. I have a cousin who committed suicide a couple of years ago. She had everything. A nice house and a wonderful family. She didn't have to work out of the home. No one knew she was depressed. She never got to go anywhere. Her husband controlled her. Her mother just doesn't understand why such a beautiful wife and mother would commit suicide. I am sure there were signs, but they weren't recognized.

    When I am high I go on buying sprees for things I don't need. I bought a pickup a few years ago. It got repossessed. I used to gamble. I don't anymore. I deal blackjack to avoid that.

  5. #5
    Join Date
    Mar 2006
    Location
    I live in a small town in North Dakota.
    Posts
    22

    Re: Weathering the Extremes of Bipolar Disorder

    It has been awhile since I was here. I have had a real bad bout of depression. My son and I got back from Rochester the end of May. I did fine on the trip, but when we got back, I crashed. I haven't worked for a month. I got real sick last week. I couldn't keep anything down so I went to the doctor. My lithium level was high and that was probably causing my stomach problems. My doctor lessened my dose to 900 mg a day. She took me off the Trileptal and started me on Lamactil. I also take 200mg a day of Seroquel and Wellbutrin in the morning. I am just know starting to feel better.

    There was an ad the paper about a company doing research on bi-polar. They were experimenting with two medications. I don't know what they are called, but I am tempted to try them. My doctor told me if I do that, she can't treat me. So I am caught between a rock and a hard spot.

    It's almost three months since I filed for disability. I hope I hear soon either way. I am behind on my bills and trying to catch up is so hard unless I find a real good paying job. I started cleaning houses. I can be my own boss, and if I get sick, my daughter can help. I am trying to get a grant to open a bed and breakfast. I am sure it will take awhile. I will have to have a back-up plan for when I get sick.

  6. #6

    Re: Weathering the Extremes of Bipolar Disorder

    Sorry to hear about your struggles, Brenda. It can be difficult, especially with bipolar disorder, to get the right mix of medications, partly because the dosages required may change over the course of the year. I fully understand that your doctor at this point would NOT want to be messing around with experimental medications or experimental mixes - there are already enough factors to deal with.

  7. Re: Weathering the Extremes of Bipolar Disorder

    Brenda! It's so good to hear from you! I'm really sorry things have been so difficult for you, but I do hope you start to feel better soon, hon. Sounds like you've had a really tough time.

    I agree with Dr. Baxter. This is no time to try experimental medications. You need known medications and the help of your doctor to get things right for you. Just hang in there. You'll find the right medications and dosages with a bit of trial and error. That's the way it is, unfortunately. However, once you doctor gets the medications right things do get better. My daughter is bipolar and does really well now. It took awhile for her to get things right, but things are going very well for her now.

  8. #8

    Re: Weathering the Extremes of Bipolar Disorder

    Hi Brenda, welcome back to the forum, missed u around here.
    sorry you've had such a hard time lately, but i'm glad to hear you're starting to feel better now. long may it continue.

    best of luck with the grant.. let us know how it goes eh?

    best wishes for continued improvement.
    nsa

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