Dictionary
a mental disorder characterized by episodes of mania and depression
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Wikipedia
DiseaseDisorder infobox
Name = Bipolar affective disorder
ICD10 = F31
ICD9 = 296
'' by artist Edvard Munch, who is now regarded as probably having suffered from bipolar disorder]]Bipolar disorder, originally called manic-depression, is a psychologypsychological condition that causes extreme shifts in mood. The term ''manic-depression'' is also now used by a relatively small number of mental health professionals to refer to the entire clinical spectrum of mood disorders that include both bipolar disorder and Clinical depressionunipolar depression. Most mental health professionals and patient advocate groups are trying to phase out the term ''manic-depression'' entirely.
General description - Bipolar disorder is a condition that causes extreme shifts in mood, energy, and functioning. In most populations it affects around 1% of the population. Men and women are equally likely to develop this often-disabling illness. The disorder typically emerges in adolescence or early adulthood and affects sufferers throughout their lifespan. Although traditionally thought of as an adult disorder, there is now recognition that children also suffer from bipolar disorder. There are no definite known causes. Scientists believe that bipolar disorder may be caused by a combination of biological and psychological factors. Most commonly the onset of this disorder can be linked to stressful life events. Cycles, or episodes, of depression, mania, or "mixed" manic and depressive symptoms typically recur and may become more frequent, often disrupting work, school, family, and social life. The "kindling" theory suggests that persons who are genetically prone toward bipolar disorder experience a series of stressful events, each of which lowers the threshold at which mood changes occur. Then at some point these mood changes occur spontaneously.refkindling The person then "becomes bipolar". This might explain why the cause of bipolar disorder is difficult to pinpoint but is somehow related to genetics and environment.There is a tendency to romanticize bipolar disorder, especially in artistic circles. Many artists, musicians, and writers have experienced its mood swings, and some credit the condition with their creativity. However, this disease ruins many lives, and it is associated with a greatly increased risk of suicide. Bipolar disorder manifests itself in numerous ways, most notably:Clinical depressionDepression: Symptoms include a persistent sad mood; loss of interest or pleasure in activities that were once enjoyed; significant changes in body weight; significant changes in appetite; difficulty sleeping or oversleeping; physical slowing or agitation; loss of energy; feelings of worthlessness or inappropriate guilt; difficulty thinking or concentrating; recurrent thoughts of self-harm, death or suicide.Mania: Abnormally and persistently elevated (high) mood and/or irritability accompanied by at least three of the following symptoms (four if the mood is merely irritable): overly inflated self-esteem; decreased need for sleep; increased talkativeness; racing thoughts; distractibility; increased goal-directed activity such as shopping; physical agitation; hypersexuality; excessive involvement in risky or unusual behaviors or activities. Mania is often divided diagnostically into two categories: *full-blown manic episodes, and *hypomania, a less severe form of mania. Hypomania is often not especially problematic for the patient, as he or she typically feels very energetic and in a very good mood. As such, hypomania is often unreported and undiagnosed (this is perhaps the biggest cause of incorrect diagnoses between unipolar and bipolar depression.) Some patients experience only hypomania; in others, hypomania progresses into a full manic state in which the patient has more and more trouble retaining control, and the symptoms become more problematic.Mixed state (psychology)Mixed state: Symptoms of mania and depression are present at the same time. The symptom picture frequently includes agitation, trouble sleeping, significant change in appetite, psychosis, and masochistic thinking. Depressed mood accompanies manic activation. Also known as dysphoric mania (from Greek ''dysphoria'': ''dys'', difficulty, ''phorós'', bearer). This is the form most often seen in children, though for some adult sufferers it indicates the onset of mood reversal.Especially early in the course of illness, the episodes may be separated by "normal" periods during which a person suffers few to no symptoms. When four or more episodes of illness occur within a 12-month period, the person is said to have bipolar disorder with rapid cycling, or simply rapid cycle. The rapid-cycling form is often considered more difficult to treat and may be more disabling for bipolar persons since the mood transitions are faster. An atypical form exists whereby, in addition to multiple large cycles within one year, the sufferer may also have unstable moods that can shift from hypomania to deep depression within hours, though some clinicians consider this to be a sign of concomitant borderline personality disorder.
Diagnostic criteria - Bipolar disorder takes two principal forms, neither of which requires plural "cycles". According to the Diagnostic and Statistical Manual of Mental DisordersDSM-IV-TR (p. 345), these two principal forms of Bipolar disorder are: Bipolar I disorder, the diagnosis of which requires over the entire course of the individual's life at least one manic (or mixed) state episode which is usually (though not always) accompanied by major depressive episodes. Bipolar II disorder, which over the course of the individual's life must involve at least one major Depressive episode and must be accompanied by at least one hypomanic episode. There must be no manic episodes. If there were manic episodes, the accurate diagnosis would be Bipolar I.Therefore, Bipolar disorder need not have both severe manic episodes and depressive episodes. In certain cases the sufferer has only episodes of mania. There need be no "cycles" of mania and depression.This is why certain contemporary psychiatrists avoid from the original name, manic depression, which suggests that all individuals have both mania and depression. It has nothing to do with the notion of equal distribution of cycles of mania and depression, since there need not be any cycles at all—in fact, even when there is one (or more) bout of both mania and depression over the course of an individual's life, the two episodes may be so unrelated to each other temporally and otherwise that this need not constitute a cycle. However, a significant portion of individuals with bipolar experience the classical alternating episodes (cycles) of mania and depression and therefore it is overstating the case to say that the classical alternation "rarely" occurs.The DSM-IV treats these bipolar disorders as variants of mood or affective disorders. Others types include Clinical depressionmajor depressive disorder and Dysthymiadysthymic disorder. Bipolar and other mood disorders may have no identifiable medical, traumatic or other external cause (exogenous) or may be due to a medical condition (endogenous). Current psychiatric view no longer labels mood episodes as endogenous or exogenous. The exceptions being a substance induced mood disorder or a mood disorder due to a general medical condition.In order for a person to be properly diagnosed with bipolar, the mood episodes cannot be due to external medication, drugs or treatment for depression.
Cycles in bipolar disorder - Emil Kraepelin included in his description of manic depression the phenomenon that episodes of acute illness, whether mania or depression, are usually punctuated by relatively symptom-free intervals during which the patient is able to function normally both at work and in social affairs.The cycles of bipolar disorder may be long or short, and the ups and downs may be of different magnitudes: for instance, a person suffering from bipolar disorder may suffer a protracted mild depression followed by a shorter and intense mania. The manic episodes typically include euphoria, tirelessness, and impulsiveness; the depressed periods may seem much worse following a manic period.Severe depression or mania may be accompanied by symptoms of psychosis. These symptoms include hallucinations (hearing, seeing, or otherwise sensing the presence of stimuli that are not there) and delusions (false personal beliefs that are not subject to reason or contradictory evidence and are not explained by a person's cultural concepts). Psychotic symptoms associated with bipolar disorder typically reflect the extreme mood state at the time.
Domains of bipolar disorder -
Mania - Researchers at Duke University have refined Kraepelin’s four classes of mania to include hypomania (featuring mainly euphoria), severe mania (including euphoria, grandiosity, sexual drive, irritability, volatility, psychosis, paranoia, and aggression), extreme mania (most of the displeasures, hardly any of the pleasures), and two forms of mixed mania (where depressive and manic symptoms collide). (See mcmanweb.com - Bipolar Disorder Part II.)
Hypomania - Hypomania is not necessarily a pathology, especially if not part of a cycle of mania or depression. Patients rarely, if ever, seek out a psychiatrist complaining of hypomania. Johns Hopkins psychologist John Gartner in The Hypomanic Edge contends that many of America’s greatest visionaries – including Christopher Columbus, Alexander Hamilton, Andrew Carnegie, Louis B Mayer, and Craig Venter (who mapped the human genome) owed their brilliance and drive (and eccentricities) to their hypomanic temperaments.“Mania lite,” however does carry a downside. Trisha Suppes of the University of Texas, Dallas points out that many hypomanic patients have symptoms of irritability (classic “road rage” cases). The DSM, at present, fails to recognize this fact of life. Hypomania can also signal the beginning of a more severe manic episode.Unfortunately, hypomania has not been well-researched, and much more work needs to be accomplished before psychiatrists can accurately diagnose and treat this overlooked aspect of bipolar disorder. (See mcmanweb.com - Hypomanic Nation.)
Bipolar depression - People with bipolar disorder are depressed far more often than they are manic. According to the Stanley Foundation Bipolar Network, bipolar patients spend three times more days in depression than they do in mania. For bipolar II patients, a study by Hagop Akiskal of the University of California, San Diego revealed this population was depressed 37 times more than they were hypomanic.A 2003 study by Robert Hirschfeld of the University of Texas, Galveston found bipolar patients fared worse in their depressions than unipolar patients. (See mcmanweb.com - Bipolar Depression.)
Cognition - Numerous studies show that bipolar disorder affects a patient's ability to think and perform mental tasks, even in states of remission. Deborah Yurgelun-Todd of McLean Hospital in in Belmont, MassachusettsBelmont, Massachusetts has argued these deficits should be included as a core feature of bipolar disorder.By the same token, research by Kay Jamison of Johns Hopkins University and others have attributed high rates of creativity and productivity to individuals with bipolar disorder. (See mcmanweb.com - Brain Damage.)
The Mood Spectrum - Clinical depression and bipolar disorder are classified as separate illnesses, but psychiatry is increasingly viewing them as part of an overlapping spectrum that also includes anxiety and psychosis. In a 2003 study, Akiskal and Judd re-examined data from the landmark Epidemiological Catchment Area study from two decades before. The original study found that .08 percent of the population surveyed had experienced a lifetime manic episode (the diagnostic threshold for bipolar I) and .05 a hypomanic episode (the diagnostic threshold for bipolar II). But by tabulating survey responses to include criteria below the diagnostic radar, such as one or two symptoms over a short time period, the authors of the study recalculated the data to arrive at an additional 5.1 percent of the population, adding up to a total of 6.4 percent of the entire population who could conceivably be thought of as having bipolar disorder.There is also a case that clinical (unipolar) depression can be bipolar disorder waiting to happen. In a 2005 study, Jules Angst and his colleagues at Zurich University tracked 406 patients with major mood disorders over a 20-year period. Of 309 patients presenting with depression, 121 (39.2 percent) eventually manifested as bipolar (24.3 percent to bipolar I, 14.9 percent to bipolar II). In all, more than 50 percent of the study population turned out to have bipolar disorder. (See mcmanweb.com - The Mood Spectrum.)
Environmental factors affecting mood in bipolar disorder - In mid-2003, a twin study was published concerning environmental factors and bipolar disorder. The bipolar twin was found to be far more affected by changes in sunlight. Longer nights resulted in mood and sleep-length changes far greater than the healthy twin. Sunny days also did more to improve mood. In fact, natural light in general was found to have a profound positive effect upon the well-being of the bipolar twin.refHakk_2003 Paradoxically, in the 2004 publication of a study using Tel Aviv's public psychiatric hospitals, it was found that "Admission rates of bipolar depressed patients increase during spring/summer and correlate with maximal environmental temperature".refShap_2004 Unipolar depressed patient admission had no such correlation. High temperature points in the month, as well as high temperature months, were found to be correlated with depressive episodes in admissions.
Bipolar disorder and childbirth - For many women with depression or bipolar disorder, the postpartum period is a period of risk for developing illness. Episodes of bipolar disorder that follow childbirth are traditionally called ''Postpartum depressionpuerperal psychosis'' (PP). Ian Jones of the Department of Psychological Medicine in Cardiff is researching this area.
Dual diagnosis - Bipolar disorder is often complicated by co-occurring alcohol abusealcohol or substance abuse. Traditionally this has been viewed as an attempt by patients to self-medicate the condition. More recently, some have doubted if this is an entirely accurate description. Cannabis in particular can alleviate symptoms of depression and may also have a mood stabilizing component in bipolar disorders, but the random titration of drug abusers usually does do more harm than good. There is growing evidence, however, that carefully titrated dosage of delta-9-THC tincture, taken sublingually, may prove of some benefit when taken with other mood stabilizer medications. In some cases, the substance abuse seems to begin before the onset of bipolar disorder, which is difficult to reconcile with the idea of self-medication (at least initially). Nicotine addiction is very common in bipolar sufferers, and in the view of some, may be an active precursor to mature onset of both bipolar affective disorder and other forms of clinical depression in general.
Treatment of bipolar disorder - A variety of medications are used to treat bipolar disorder. Many people with bipolar disorder are on multiple medications, often between two and five. Some people with bipolar disorder add to or replace their Western medicineWestern medication with herbal or holistic options. But even with optimal medication treatment, many people with the illness have some residual symptoms. Symptom management is considered one of the only useful non-medication treatments of bipolar disorder. This treatment teaches how to lessen the severity of mood swings by recognizing and managing triggering symptoms or events.
Medication - There is no cure for bipolar disorder; however, medications can be used to manage bipolar symptoms. Medications called mood stabilizers can sometimes be used to prevent or mitigate manic or depressive episodes. Because mood stabilizers are generally more effective at treating mania than bipolar depression, periods of depression are sometimes also treated with antidepressants, although this carries a risk of inducing mania (especially when no mood stabilizer is also prescribed). In severe cases where the mania or the depression is severe enough to cause psychosis (and recently sometimes in less severe cases as well, although this remains controversial), antipsychotic drugs may also be used. (See the end of the article for an external resource on psychopharmacology.) Medications work differently in each person, and it takes considerable time to determine in any particular case whether a given drug is effective at all, since bipolar disorder is usually episodic, and patients may experience remissions and periods of normal functioning (which may last years) whether or not they receive treatment. Evaluation of patients is usually carried out using a "life chart" which graphs moods over a long period of time, ranging from weeks to years. It is also generally necessary to "titrate" the dosage of a drug, seeking to achieve the most effective treatment possible while minimizing side effects. Most mood stabilizers have common side effects which may range from inconvenient to having a major impact on quality of life; many also have potentially dangerous side effects which make medical monitoring of patients undergoing drug treatment vitally important. For details of particular drugs, see the section below. Often, a customized combination of medications are needed to stabilize moods.Compliance with medications can be a major problem, because some people becoming manic lose insight, or the awareness, of having an illness, and they therefore discontinue medications. Then they often suffer a manic episode and may suddenly find themselves initiating multiple projects often being scattered and ineffective, or may go on a spending spree or take a poorly planned trip landing them in an unfamiliar location without cash. The manic periods, euphoric as they may be, are often disastrous because of the impulsiveness and irrationality that comes with them. Depression does not respond instantaneously to resumed medication, typically taking 2–6 weeks to respond. Other reasons cited by individuals for discontinuing medication are side effects, expense, and the stigma of having a psychiatric disorder. In a relatively small number of cases stipulated by law (varying by locality but typically, according to the law, only when a patient poses a strong threat to himself or others), patients who do not agree with their psychiatric diagnosis and treatment can legally be required to have treatment without their consent. Throughout North America and the United Kingdom, involuntary treatment laws exist for bipolar disorder and other mental illnesses. While bipolar disorder can be one of the most severe and devastating medical conditions, fortunately many individuals with bipolar disorder can also live full and mostly happy lives with correct management of their condition. Compared to patients with schizophrenia, persons with bipolar disorder are more likely to have periods of normal functioning in the absence of medication. Although schizophrenic patients may have remissions with relatively high levels of functioning, schizophrenic patients tend to suffer some impairment during these intervals in contrast to persons with bipolar disorder who often appear completely healthy when they are between mood swings.
Lithium salts - The use of lithium salts as a treatment of bipolar disorder was first discovered by Dr. John Cade.Lithium salts have long been used as a first-line treatment for bipolar disorder. In ancient times, doctors would send their mentally ill patients to drink from "alkali springs" as a treatment. They did not know it, but they were really prescribing lithium, which was present in high concentration in the waters. The therapeutic effect of lithium salts appears to be entirely due to the lithium ion, Li+. The two lithium salts used for bipolar therapy are lithium carbonate (mostly) and lithium citrate (sometimes). Approved for the treatment of acute mania in 1970 by the FDA, lithium has been an effective mood-stabilizing medication for many people with bipolar disorder. Lithium is also noted for reducing the risk of suiciderefbald_2003 . Although lithium is among the most effective mood stabilizers, most persons taking it experience side effects similar to the effects of ingesting too much table salt, such as high blood pressure, water retention, and constipation. Regular blood testing is required when taking lithium to determine the correct lithium levels since the therapeutic dose is close to the toxic dose. The mechanism of lithium salt treatment is believed to work as follows: some symptoms of bipolar disorder appear to be caused by the enzyme inositol monophosphatase (IMPase), an enzyme that splits inositol monophosphate into free inositol and phosphate. It is involved in signal transduction and is believed to create an imbalance in neurotransmitters in bipolar patients. The lithium ion is believed to produce a mood stabilizing effect by inhibiting IMPase by substituting for one of two magnesium ions in IMPase's active site, slowing down this enzyme.Lithium orotate is used as an alternative treatment to lithium carbonate by some sufferers of bipolar disorder, mainly because it is available without a doctor's prescription. It is sometimes sold as "organic lithium" by nutritionists, as well as under a wide variety of brand names. There seems to be little evidence for its use in clinical treatment in preference to lithium carbonate. Self-treatment without medical monitoring is potentially dangerous.
Anticonvulsant mood stabilizers - Anticonvulsant medications, particularly valproate and carbamazepine, have been used as alternatives or adjuncts to lithium in many cases. Valproate (Depakote and Depakene) was FDA approved for the treatment of acute mania in 1995, and is now considered by many to be the first line of therapy for bipolar disorder. It is preferable to lithium because its side effect profile seems to be less severe, compliance with the medication is better, and fewer breakthrough manic episodes occur. However, valproate is not as effective as lithium in preventing or managing depressive episodes, so patients taking valproate may also need an SSRI or other antidepressant as an adjunct medicinal therapy. Some research suggests that different combinations of lithium and anticonvulsants may be helpful. Newer anticonvulsant medications, including lamotrigine, gabapentin, and topiramate, have been studied to determine their efficacy as mood stabilizers in bipolar disorder. Lamotrigine is particularly promising, as there is evidence it acts as a mood stabilizer and particularly helps bipolar persons with severe depression. refLamot_1 Topiramate has not done well in clinical trials, which may be because it seems to help a few patients very much but most not at all. Unfortunately, there are several controlled studies that show that gabapentin is very effective for certain types of epilepsy and has a mild side effect profile but is ineffective for bipolar disorder. Nevertheless, many psychiatrists continue to prescribe topiramate and gabapentin for bipolar disorder, although this is becoming increasingly controversial. According to studies conducted in Finland in patients with epilepsy, valproate may increase testosterone levels in teenage girls and produce polycystic ovary syndrome in women who began taking the medication before age 20. Increased testosterone can lead to polycystic ovary syndrome with irregular or absent menses, obesity, and abnormal growth of hair. Therefore, young female patients taking valproate should be monitored carefully by a physician. It should be noted, however, that the therapeutic dose for a patient taking valproate for epilepsy is very different than the therapeutic dose of valproate for an individual with bipolar disorder.
Atypical antipsychotic drugs - In some cases, the newer atypical antipsychotic drugs such as risperidone, quetiapine, and olanzapine may help relieve severe or refractory symptoms of bipolar disorder and prevent recurrences of mania. Several of the atypical antipsychotic drugs are now FDA approved for treatment of bipolar mania. However, more research is needed to establish the safety and efficacy of atypical antipsychotics as long-term treatments for this disorder.Nonetheless, doctors are increasingly prescribing atypical antipsychotics as maintenance medication for bipolar—rather than using the medications as acute treatment. This practice is risky and not approved by the FDA. Furthermore, countless studies are revealing that atypical antipsychotics, and olanzapine (brand name Zyprexa) in particular, can cause serious metabolic changes leading to obesity, diabetes, and even premature death. These medications are very dangerous and should be used with extreme caution.
Omega-3 fatty acids - Omega-3 fatty acids are also used as an alternative or additional treatment for bipolar disorder. Omega-3 fatty acids are polyunsaturated fatty acids which can be found in wild salmon, flaxseed and walnuts. To receive a significant dose, however, omega-3 fatty acids must usually be taken in the form of a fish oil dietary supplementsupplement. It has been hypothesized that the therapeutic ingredient in omega-3 fatty acid preparations is eicosapentaenoic acid (EPA) and that supplements should be high in this compound to be beneficial.refepa
Psychotherapy - Certain types of psychotherapy or psychosocial interventions, in combination with medication or instead of medication, often can provide tremendous additional benefit. These include cognitive-behavioral therapy, interpersonal and social rhythm therapy, family systems therapy, and psychoeducation.
Electroconvulsive therapy - Electroconvulsive therapy is sometimes used to treat severe bipolar depression.See detailsElectroconvulsive therapy
Treatment issues - Nearly all bipolar treatment studies have involved treating patients in the acute (initial) mania stage, where overmedication is often justified in removing a patient from danger. Much less is known, however, about long-term treatment, where relapse prevention and full remission are the main treatment goals. Many psychiatrists assume “what got you well will keep you well,” but the reality is most patients require a number of changes to their medications “cocktail” before they find a combination that feels right. (See mcmanweb.com - Long Haul Bipolar Treatment.)Virtually nothing is known about treating hypomania. Conceivably patients in hypomania, if otherwise stable, could be treated with reduced medication doses, various forms of talking therapy, or relaxation exercises, but there are no studies to guide patients and psychiatrists.On one hand, mild hypomania may be a legitimate baseline for some patients. For others, hypomania may signal the beginning of a cycle into more severe mania, necessitating immediate intervention. (See mcmanweb.com - Treating Hypomania.)Until recently, depression was largely overlooked in bipolar disorder. The anticonvulsant medication, Lamictal (lamotrigine) has acquired “flavor of the month” status for treating bipolar depression. New clinical trials are finding that certain new-generation antipsychotics such as Zyprexa (olanzapine) and Seroquel (quetiapine) show some beneficial effect in treating bipolar depression. Lithium also has an antidepressant effect.Because there is a danger of antidepressant medications such as SSRIs switching bipolar patients into mania, these medications are used with caution, nearly always with an antimania agent. (See mcmanweb.com - Treating Bipolar Depression.}
Research findings -
Heritability - Bipolar disorder appears to run in families. The rate of suicide is higher in people who have bipolar disorder than in the general population. In fact, people with bipolar disorder are about twice as likely to commit suicide as those suffering from major depression (12% to 6%).The rate of prevalence of bipolar disorder is roughly equal in men and women. Lifetime risk of bipolar I disorder is often quoted as around 1%, but when bipolar II is included the true rate may be around 4%.refkess_prev 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 heritable 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. Relatives of persons with bipolar disorder also have an increased incidence of having unipolar depression.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.refBarr_2003
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. An important area of imaging 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. Better understanding of the neural circuits involved in regulating mood states may influence the development of new and better treatments, and may ultimately aid in diagnosis.
Personality types - 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 EP-MRSI imaging, and attempts are being made to develop this into a form which can be evaluated as a possible treatment.It has been hypothesized that bipolar disorder may be the result of poor membrane conduction in the brain and that one possible cause may be a deficiency in omega-3 fatty acids. Following an encouraging small-scale study conducted by Andrew Stoll at Harvard University's McLean Hospital, the Stanley Foundation is sponsoring research regarding the beneficial claims, and several large scale trials of treatment using omega-3 fatty acids are under way.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.In 2005 two double blind placebo controlled studies were underway at Harvard University and University of Calgary to determine if the trends noted in several open label trials using a mineral, vitamin and amino acid supplement called E.M. Power would continue to demonstrate effectiveness. In preliminary studies, as many as 70% of patients taking the supplements were free of symptoms after slowly having withdrawn from psychotropic medications.For immediate management of mania, left coloric vestibular stimulation has proven effective in dramatically and rapidly stopping mania for up to 24 hours. Currently there are only case reports, and there has been no organized research on use of the procedure for acute mania.Another avenue for treatment that has, at times been curative for resolving manic psychosis is by treating an underlying infections such as Lyme disease. Results in these cases suggest that the term bipolar disorder may not accurately represent the actual biological disorders which meet the DSM-IV requirement for a bipolar disorder. For an unknown number of patients, the problem may be a kind of immune mediated disorder provoked by Lyme disease (Toxoplasmosis, Bornea virus), or any or a number of other chronic infections, including something as common as the influenzaflu.
Bipolar disorder, talent and famous people - 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 be related to those responsible for creativity in these persons. (Many of the historical creative talents commonly cited as bipolar were "diagnosed" retrospectively after their deaths and thus the diagnoses are unverifiable; however, in cases diagnosed in recent decades there does seem to be at least some correlation between bipolar disorder and creativity.) The possible explanation for this is that 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.See list of people believed to have been affected by bipolar disorder.
Sources - Material from public domain text copied from !http://www.nimh.nih.gov/public at/manic.cfm? which states: "All material in this fact sheet is in the public domain and may be copied or reproduced without permission from the Institute. Citation of the source is appreciated." bipolar.about.com - 1, psycheducation.org - 2, ? legalnewswatch.com - 3 and antidepressantsfacts.com - 4 Links and references showing that gabapentin (Neurontin) is an inappropriate and ineffective medication for bipolar disorder. psychlaws.org - Suicide rate of persons with bipolar disorder
References - #Notekindling bpinfo.net - Link and reference involving kindling theory#NoteHakk_2003 Hakkarainen R, et al. (2003). ncbi.nlm.nih.gov - Seasonal changes, sleep length and circadian preference among twins with bipolar disorder. ''BMC Psychiatry'' 3 (1), 6.#NoteShap_2004 Shapira A, et al. (2004). ncbi.nlm.nih.gov - Admission rates of bipolar depressed patients increase during spring/summer and correlate with maximal environmental temperature. ''Bipolar Disorder'' Feb;6 (1), 90–3.#Notebald_2003 Baldessarini RJ, et al. (2003). ncbi.nlm.nih.gov - Lithium treatment and suicide risk in major affective disorders: update and new findings. ''J Clin Psychiatry'' 64 (Suppl 5), 44–52.#NoteLamot_1 pslgroup.com - 1 and psycheducation.org - 2 Links and references showing the promise of lamotrigine (Lamictal) in the treatment of bipolar depression.#Noteepa Osher Y, Bersudsky Y, Belmaker RH. Omega-3 eicosapentaenoic acid in bipolar depression: report of a small open-label study. J Clin Psychiatry. 2005;66(6):726–9. PMID 15960565#Notekess_prev Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. PMID 15939837#NoteBarr_2003 Barrett TB, Hauger RL, Kennedy JL, Sadovnick AD, Remick RA, Keck PE, McElroy SL, Alexander M, Shaw SH, Kelsoe JR. nature.com - Evidence that a single nucleotide polymorphism in the promoter of the G protein receptor kinase 3 gene is associated with bipolar disorder. ''Mol Psychiatry.'' 2003 May;8(5):546–57.
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Websites
Pregnancy and Depression
A compilation of online resources about depression (and other mental illnesses) during pregnancy and breastfeeding. Focus is primarily on psychopharmacologic treatment. Most links are to high-quality, researched based information.
http://www.pregnancyanddepression.com/
A Bipolar Odyssey
A site that offers alternative perspectives of bipolar and other mental disorders and suggests, among other things, a role for nutrients and targeted intervention of specific risk factors such as chronic infections.
http://www.bipolarodyssey.com/
Recovery Through Art
A comprehensive website devoted to the art and writings of a bipolar mother. Insightful stories, poetry and valuable mental health links.
http://www.recoverythroughart.com/
Walkers in Darkness - Support for depression & bipolar
Walkers in Darkness is one of the oldest online support groups for bipolar and depressive disorders. The site features many interactive features, including live chat rooms; mailing lists; and discussion forums. Walkers also maintains an extensive directory and database of mental health and social service resources.
http://www.walkers.org/
Pendulum Resources
Information, articles, research, books, humor and links.
http://www.pendulum.org/
National Institute of Mental Health
Symptoms, diagnosis, and treatment of various mental illnesses. Included are brochures and information sheets, reports, press releases, fact sheets, and other educational materials.
http://www.nimh.nih.gov/
Mental Health Sanctuary
Online resource for patients, families and professionals in mental health. Articles, resources, chats, bulletin boards and support regarding a variety of mental health disorders.
http://www.mhsanctuary.com/
Internet Mental Health
The 52 most common mental disorders, medications, news, recovery stories, links.
http://www.mentalhealth.com/
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