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Bipolar Disorder: Finding the Light in the Dark

Affecting nearly one percent of the population of the United States, bipolar disorder has quickly become one of the leading forms of mental illness (Spearing). While advancements in medical science and technology have allowed researchers and physicians to understand its elements more clearly, the effects of bipolar disorder are tragic and often deadly. Often the negative results occur due to a lack of proper diagnosis: some seventy-five percent of bipolar cases go untreated (Spearing).

Through proper education and public awareness, this serious disease can be properly diagnosed, treated and possibly cured. Bipolar disorder, as defined by the Gale Encyclopedia of Medicine, is a mood disorder that causes a person to suffer extreme emotional changes and shifts in mood. Previously known as manic-depressive disorder, bipolar disorder causes alternate periods of mania and depression. To fully understand the effects of this disease, it is important to comprehend the meanings of mania and depression.

Merriam-Webster’s Dictionary defines mania as “excitement manifested by mental and physical hyperactivity, disorganization of behavior, and elevation of mood. ” Depression, on the other hand, is defined as “a psychiatric disorder characterized by an inability to concentrate, insomnia, loss of appetite, feelings of extreme sadness, guilt, helplessness and hopelessness, and thoughts of death. ” (Merriam-Webster). The combination of the two results in emotional chaos. Of all psychotic disorders, bipolar disorder is the most common, affecting between one and two million Americans (Spearing).

While it affects males and females equally, there are a few distinctions that can be made about those who do have it. Amongst men, early onset bipolar disorder is more frequent while there is higher rate of rapid cycling, mixed states, and cyclothymia in women (Wurztel 28-31). Also, according to one survey, an estimated 59% of bipolar patients experienced their first symptoms when they were children or adolescents (Harakas G2). Studies show that bipolar disorder occurs in 1% of all age groups (Bipolar Survivor).

Evanston Northwestern Hospital claims, “There is some indication that the incidence of bipolar disorder may be increasing. ” While it is important to understand that bipolar disorder is a disease separate from the numerous other types of mental illnesses, it is also necessary to differentiate between the four different types of the disorder. The first type, Bipolar I, is the most often discussed. People who suffer from this type of bipolar disorder experience extreme periods of mania coupled with depression (Bailey).

During the extreme times of mania, Bipolar I patients engage in activities that are exceptionally dangerous and eccentric yet they believe that their actions are normal. Such activities may include spending outrageous amounts of money, investing in business schemes without any research or knowledge of the investment, driving recklessly, and engaging in sexual promiscuity (Bipolar Survivor). Also, during advanced mania, all touch with reality is completely lost resulting in delusions and hallucinations (Bailey).

With this type of bipolar disorder, there seems to be an abundant amount of energy with almost a complete lack of sleep (Bailey). The second, and most common, type of bipolar disorder is known as Bipolar II. With this type, people experience recurrent bouts of depression without the psychotic episodes of mania. Unlike Bipolar I patients, they suffer from brief spells of hypomania during which they feel euphoric and have a great amount of self-confidence and energy (Bailey). While it may appear that hypomania is similar to general happiness, Dr.

Hagop S. Akiskal, a senior advisor at the National Institute of Mental Health, states that “hypomania is a recurrent condition; happiness is not” (qtd. in Fireman 1470). Generally, this type of bipolar disorder is the mildest form of the disease and is the easiest to treat. Medicated mania, or Bipolar III, is the third type of bipolar disorder. The main difference between this type and the others is that it is the direct result of drug treatment or electroconvulsive therapy for depression (Bailey).

Most times this occurs because the patient is misdiagnosed with clinical depression. This misdiagnosis results in the prescription of anti-depressants that inadvertently cause a manic episode (Bailey). The final classification of bipolar disorder is known as cyclothemia, or rapid cycling. This type is characterized by intense changes in mood occurring more frequently than what is typically expected in bipolar disorder (Bipolar Survivor). Often, a person with cyclothemia will experience periods of mania and depression within the same day or within hours.

They often begin projects or tasks with enthusiasm but become quickly uninterested in them. Dr. Milton S. Gasparis, a doctor who specializes in family mental health disorders, indicates that the majority of those who suffer from this type develop it over time as the result of difficulty in treating Bipolar I or Bipolar II. Diagnosing bipolar disorder is often difficult because the symptoms of the disease are often exhibited in several other illnesses (Harakas G2).

Pendulum Resources, however, indicates that there are criteria that must be met in order to properly make the diagnosis of bipolar disorder. For a depressive episode, the person must exhibit at least five of the following symptoms during a two week period: depressed mood, loss of interest in all daily activities, significant weight loss or weight gain, insomnia or hypersomnia, fatigue, feelings of worthlessness or guilt, inability to think or concentrate, and recurrent thoughts of death (Pendulum Resources).

Three of the following symptoms must be exhibited in a period of one week: inflated self-esteem, decreased need for sleep, excessive talking, racing thoughts or increased amount of ideas, distractibility, increased goal-oriented activity, and excessive involvement in pleasurable activities (Pendulum Resources). The symptoms for both a depressive episode and a manic episode must cause a significant impairment in social, family, and occupational functions.

Finally, these symptoms must not be the direct result of a medical condition or medical treatment (Pendulum Resources). Until bipolar disorder is diagnosed, most people do not know what is wrong with them and they sometimes feel as if they should be “snapping out of it. ” They don’t realize that their problem is a real disease. Until the disorder is correctly diagnosed, little or no improvement can be made to the person’s condition (Gasparis). Until recently, a diagnosis of bipolar disorder in children was rarely made (McCredie A7).

Scott McCredie, who has done extensive research in childhood bipolar disorder, indicates that it is important to realize that a significant amount of children diagnosed with Attention Deficit Hyperactivity Disorder in fact are bipolar. Also, According to the American Academy of Child and Adolescent Psychiatry, up to one-third of children with depression may actually be experiencing the early onset of bipolar disorder. Bipolar children tend to experience extremely rapid mood swings, often cycling from mania to depression and back to mania several times a day (American Academy of Child and Adolescent Psychiatry).

Typically, they experience low arousal states in the mornings followed by increases in energy towards late afternoon or evening (McCredie A7). The following symptoms often characterize this cycling: anxiety, defiance of authority, hyperactivity, bedwetting, night terrors, delusions, hallucinations, and a belief in the ability to defy the laws of logic (American Academy of Child and Adolescent Psychiatry). Children suffering from bipolar disorder may become easily frustrated and throw temper tantrums that last until they are exhausted.

These children tend to be bossy and have trouble adjusting to new situations. Some children with bipolar disorder are extroverted and very charismatic while other children experience bouts of social phobia (McCredie A7). Because of the difficulty in diagnosing bipolar disorder in children, it often goes untreated for a period of ten years or more until it is more easily detectable in early adulthood (American Academy of Child and Adolescent Psychiatry). What exactly causes bipolar disorder? Most doctors believe that bipolar disorder is primarily biological rather than psychological.

A number of genes have been identified that may be related to the disorder. Bipolar disorder seems to run in families. Dr. John Nurnberger, a recognized authority and researcher on the disorder stated, “If a first-degree relative is affected with bipolar illness, one’s risk is 25 percent, as compared with about 7 percent in the general population. For a child with two affected parents, it’s 50 percent. If one’s identical twin is affected, the risk is about 65%” (Pendulum Resources). If you have a number of relatives with the bipolar disorder or depression, the chance may be greater (Bailey).

Medical research is also trying to find a connection between the illness and chemical deficits with the brain cells. Melissa Spearing, a researcher with the National Institute of Mental Health, suggests that bipolar disorder is most likely an inherited problem somehow related to a lack of stability in the transmission of nerve impulses in the brain due to chemical deficits. Serotonin is the most commonly believed deficient chemical followed by norephinephrine and dopamine. This biochemical imbalance makes those with bipolar disorder more susceptible to physical and emotional stress (Spearing).

Furthermore, Spearing indicates that researchers have discovered that chemical deficiencies in the brain cause certain types of physical symptoms related to the symptoms of bipolar disorder. Another possible cause may be related to the physical structure of the brain. Both magnetic resonance imaging (MRI) and positron emission tomographic (PET) scans show structural abnormalities called hyperintensities, referred to as unidentified bright objects (UBOs), in the brains of many manic-depressives (Pendulum Resources).

Many researchers indicate that these “bright spots” are closely related to, if not the direct cause of, bipolar disorder. This is indicative of a physiological cause of bipolar disorder (Pendulum Resources). Not only are there many possible causes of bipolar disorder, there are also many possible effects of the disease. Evanston Northwestern Healthcare suggests that bipolar disorder can cause development delays, marital and family problems, disturbances in occupational settings including job loss, and financial difficulties.

While bipolar disorder can cause significant problems to the lives of those surrounding a bipolar patient, the most horrifying effect is suicide. As noted in “Suicide Risk in Bipolar Disorder During Treatment with Lithium and Divalproex,” the Journal of the American Medical Association claims that suicide is 10 to 20 times more common among bipolar patients than society at large. It is estimated that as many 20 percent of those who suffer from bipolar disorder attempt suicide at some time in their lives (Fireman 1467).

Patients sometimes think that there is nothing wrong with them and therefore decide not to seek help. This is especially dangerous because the periods of depression go untreated and thus cause a patient to become further prone to suicidal tendencies (Pendulum). It is quite possible that those who decide to end their lives do so because it is their belief that death is a more desirable option than a lifetime of struggling with mental illness. It is also interesting to note that while most of the effects of bipolar disorder are negative, there is one positive effect that deserves mentioning.

In an article written by Dr. Thomas Stuttaford, Dr. Kay Redfield Jamison, professor of psychiatry at Johns Hopkins University School of Medicine states, “The incidence of bipolar disorder among creative people is 10 to 20 times greater than that of the general population” (qtd. in Stuttaford 8). Several recent studies, including Jamison’s own survey of 47 British writers and artists, support her hypothesis that creative individuals are especially subject to mood disorders and suicide (Stuttaford 8).

Stuttaford, an associate of Jamison, also notes that Jamison’s work suggests that periods of creative productivity are preceded by an elevated mood thereby suggesting that certain types of moods open up thought, allowing for greater creativity. Furthermore, a diagnosis of bipolar disorder does not necessarily indicate an inability to maintain a high-standing job position. An article written by Julia Lieblich in the Harvard Business Review stated, “In our consulting experience during the last decade, we have found manic depressive executives at the top of some of the most successful U. S. companies as chairmen, CEOs, and senior VPs.

They are also represented among the ranks of the United States’ most brilliant entrepreneurs. They are risk takers. They build empires. And they often become wealthy. High political office has always attracted its share of manic-depressive leaders, including Winston Churchill, Theodore Roosevelt, and Abraham Lincoln” (31). An inspiration to those who suffer from this debilitating disease may be the mentioning of some well-known writers and artists in the past that suffered from what we know today as bipolar disorder.

Vincent Van Gogh, Michaelangelo, Leo Tolstoy, Edgar Allen Poe, F. Scott Fitzgerald and Charles Dickens are just a few. Recent well-known sufferers include Patty Duke, Buzz Aldrin, Francis Ford Coppola, Carrie Fisher and Jean Claude Van Damme. The important concept to remember about these people is that this disorder did not stop them from attaining success in their lives (Stuttaford 8). With an understanding of what bipolar disorder is, including the different types and symptoms of the disease, treatment is more effective.

Fortunately, with the advancement of medical research and technology, there are several options available to help treat the illness. The first, and most widely used, treatment is the use of prescription medication. John McManamy, founder of Pendulum Resources, differentiates between three types of medication: antidepressants, mood stabilizers and antipsychotics. One of the most widely used prescription drugs is lithium. Lithium has been the primary treatment for bipolar disorder since the 1960s.

In a study done by Bruce Fireman, MA; Frederick K. Goodwin, MD; Enid M. Hunkeler, MA; Janelle Lee, MHA, DrPH; Dennis Revicki, PhD; and Gregory E. Simon, MD, 78% of bipolar patients treated with lithium had a positive response to the drug (Fireman 1470). The Journal of the American Medical Association indicates that the main function of lithium is to stabilize the emotional cycling experienced by suffers. It aids in the prevention of wild mood swings as well as in the prevention of suicide. Lithium is the primary drug used in long-term treatment of the disease because it is highly effective in lessening the duration, frequency, and severity of mania and depression (Fireman 1471).

Unfortunately, some 40 percent of bipolar patients are unresponsive to lithium or cannot tolerate its side effects, which include: thirst, weight gain, nausea, diarrhea and edema. Lithium has also been known to cause decreased functioning of the thyroid. This hypothyroidism in turn may cause rapid-cycling (Fireman 1473). Depression is treated with anti-depressants that are usually used with a mood stabilizer (Gasparis). During a personal interview, Dr. Milton S. Gasparis indicated that an anti-depressant without a mood stabilizer could cause you to go into a manic episode.

Some of the most common anti-depressants are Prozac, Paxil, Wellbutrin, and Effexor. Most of these medications increase the re-uptake of serotonin, a needed chemical in the brain (Gasparis). While antidepressants are used to treat the depressive episodes, mood stabilizers are used to control episodes of mania (Gasparis). Some of the more common mood stabilizers used to treat manic depression are Depakote, Tegretol, Trileptal, Neurontin, Topamax and Lamictal (McManamy). However, their exact functions within the brain are unknown. The use of these drugs in treating bipolar disorder was discovered accidentally.

They were first made available on the market as treatment for seizure disorders (Spearing). Often, bipolar patients cannot handle the side effects of these drugs and noncompliance, refusing to take medication as part of treatment, becomes a problem (Gasparis). Another type of prescription medication used to treat the manic episodes is antipsychotics. Similar to mood stabilizers, their use in treating bipolar disorder was also discovered by accident (Spearing). Antipsychotics work by binding to dopamine receptors in the brain and thus preventing over stimulation from dopamine, a neurotransmitter (Pendulum Resources).

A few examples of antipsychotics used today include Haldol, Clozaril, Zyprexa, Risperdal, Seroquel, Geodon, and Abillify (Gasparis). Because of the wide variety of prescription medications available today, it is easy for patients to find those medicines that are best suited for them with the minimal amount of side effects. A second approach to treating bipolar disorder is the use of psychotherapy. Psychotherapy usually begins with individual appointments with either a psychiatrist or a therapist.

Jane McAtee, a long time bipolar patient, states that more than likely, visits to a therapist will be several times within a month coupled with a routine monthly visit with a psychiatrist. The most important goal of this type of therapy is to allow the bipolar patient to feel comfortable enough to discuss his or her problem without fear of what the other person may be thinking (McAtee). Counseling sessions focus on learning how to plan and hold to a daily routine, adhering to prescribed medication doses, and working on relationship problems as they arise (McAtee).

According to Dr. John Graves, spokesperson of The National Depressive and Manic Depressive Association, psychotherapy may also involve group counseling sessions or support groups during which several people who suffer from bipolar disorder discuss their individual problems and treatments in hopes that others will be able to learn from their experiences (Pendulum Resources). Mary C. Wetzel states that “support groups for unipolar and bipolar illness offer a major source of help for patients and families, as attested by the expanding NDMDA and its network of nationwide chapters”(81).

Psychotherapy may also involve the use of behavior modification. With this form of treatment, the bipolar patient is taught to substitute positive thoughts for negative thoughts in response to cues that trigger symptoms of depression (Bipolar Survivor). This is an extremely difficult form of treatment because it requires the patient to put forth a great deal of effort in order for it to be effective. “Because CBT emphasizes the acquisition of emotional problem-solving skills, it is quite labor-intensive and requires that patients possess insight, motivation, and the capacity to concentrate.

This may limit its applicability to a more heterogeneous bipolar population” (Evanston Northwestern Healthcare). A final treatment used in fighting bipolar disorder is electro-convulsive shock therapy. This is the preferred method of treatment for extremely manic, pregnant patients as well as those patients who are homicidal, psychotic, catatonic, or severally suicidal (McManamy). A course of treatment usually consists of six to twelve treatments given three times a week for a month or less. The patient is given general anesthesia and a muscle relaxant.

When these have taken full effect, the patient’s brain is stimulated using electrodes placed at precise locations on the patient’s head, with a brief controlled series of electrical pulses (Pendulum Resources). This stimulus causes a seizure within the brain that lasts for approximately a minute. Because of the muscle relaxants and anesthesia, the patient’s body does not convulse and the patient feels no pain. The patient awakens after five to ten minutes, much as he or she would from minor surgery (Pendulum Resources). One study indicates that 78 percent of those treated with shock therapy showed remarkable signs of improvement (McManamy).

Bipolar disorder is a mental illness that affects not only the patients who suffer from it but also their family, friends, and co-workers. The most important thing to understand about the disorder, however, is that it is not the person’s fault that they feel the way that they do. Patience and a willingness to participate in treatment and therapy are keys in helping to overcome the problem. Finally, without proper knowledge of the disease itself, bipolar disorder will continue to be a widespread epidemic haunting the lives of millions of people.

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