Bipolar facts

Bipolar Facts

Below are a number of frequently asked questions about Bipolar disorder, treatment of bipolar disorder, medications used in treatment etc.

What is Bipolar Disorder?

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder can be severe. They are different from the normal ups and downs that everyone goes through from time to time. Bipolar disorder symptoms can result in damaged relationships, poor job or school performance, and even suicide. But bipolar disorder can be treated, and people with this illness can lead full and productive lives.

Bipolar disorder often develops in a person’s late teens or early adult years. At least half of all cases start before age 25. Some people have their first symptoms during childhood, while others may develop symptoms late in life.

Bipolar disorder is not easy to spot when it starts. The symptoms may seem like separate problems, not recognized as parts of a larger problem. Some people suffer for years before they are properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person’s life.

What are the types of Bipolar Disorder?

There are several types of Bipolar Disorder:

Bipolar I: defined by manic episodes that last at least 7 days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, depressive episodes occur as well, typically lasting at least 2 weeks. Episodes of depression with mixed features (having depression and manic symptoms at the same time) are also possible. A person does not need to have had a depressive episode to be diagnosed with Bipolar I.

Bipolar II: defined by a pattern of depressive episodes and hypomanic episodes, but not the full-blown manic episodes described above. Depressive episodes in Bipolar II tend to be longer and more disabling than those in Bipolar I. A person needs to have experienced both hypomanic and depressive episodes to be diagnosed with Bipolar II.

Bipolar Disorder Not Otherwise Specified (BP-NOS): defined by symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.

Cyclothymia: defined by numerous periods of hypomanic symptoms as well numerous periods of depressive symptoms lasting for at least 2 years (1 year in children and adolescents). However, the symptoms do not meet the diagnostic requirements for a hypomanic episode and a depressive episode.

What are the symptoms of bipolar disorder?

Bipolar disorder is characterised by extreme mood swings that interfere with your everyday life. The mood swings can range from extreme highs (mania) to extreme lows (depression). Episodes of mania and depression can often last for weeks or even months.

Depression:
During a period of depression, your symptoms may include:

  • Feeling sad or hopeless
  • Unable to experience pleasure
  • Lacking energy
  • Difficulty concentrating and problems with memory
  • Loss of interest in everyday activities
  • Feelings of guilt and despair
  • Feelings of worthlessness or emptiness
  • Feeling pessimistic about everything
  • Significant self doubt
  • Experiencing delusions, hallucinations or experiencing illogical thinking
  • Lack of appetite or overeating
  • Difficulty sleeping (insomnia) or oversleeping (hypersomnia)
  • Early morning waking and being unable to go back to sleep
  • Suicidal thoughts or plans/recurring thoughts of death
  • Significant weight loss or gain
  • Difficulty with small tasks or making decisions

Mania (or hypomania):
The manic phase of bipolar disorder may include:

  • Sudden increase in energy
  • Feeling happy, elated or overjoyed
  • Rapid speech
  • Racing thoughts
  • Grandiosity
  • Decreased need for sleep
  • Full of new and great ideas that seem urgent and important
  • Goal oriented/fixated
  • Being easily distracted
  • Becoming easily iritated or agitated
  • Delusional thinking, hallucinations or irrational / illogical thinking
  • Decreased appetite
  • Increased sex drive
  • Engaging in activities that may have disasterous consequences such as spending large amounts of money on expensive and unaffordable items, making decisions or behaving in ways that others see as risky or harmful.

Patterns of depression and mania:
If you have bipolar disorder, you may have episodes of depression more regularly than you have episodes of mania. Or you may have mania more often than depression.

Between episodes of depression and mania, you may sometimes have periods of ‘normal’ mood. However, some people with bipolar disorder can repeatedly swing from a high to low phase quickly without having a ‘normal’ period in between. This is known as ‘rapid cycling’. Others may experience symptoms of both mania and depression at the same time. This is known as “mixed moods” or “mixed states”.

Depression self test

The Goldberg Depression Scale is a self-administered questionnaire designed to measure the severity of depressive thinking and behavior.

This tool IS NOT designed to diagnose any psychiatric disorder, nor is it intended to replace evaluation by a qualified psychiatrist. It is only intended to measure the severity of depressive symptoms, and thus to help the reader decide whether to seek a psychiatric evaluation.

Take the test…

Mania self test

The Goldberg Mania Scale is a self-administered questionnaire designed to measure the severity of manic thinking and behavior.

This tool IS NOT designed to diagnose any psychiatric disorder, nor is it intended to replace evaluation by a qualified psychiatrist. It is only intended to measure the severity of manic symptoms, and thus to help the reader decide whether to seek a psychiatric evaluation.

Take the test…

How does bipolar disorder affect someone over time?

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms.

Doctors usually diagnose mental disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

  • Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.
  • Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.
  • Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.
  • Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.2 Some people experience more than one episode in a week, or even within one day. Rapid cycling seems to be more common in people who have severe bipolar disorder and may be more common in people who have their first episode at a younger age. One study found that people with rapid cycling had their first episode about four years earlier, during mid to late teen years, than people without rapid cycling bipolar disorder. Rapid cycling affects more women than men.

Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared. Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.

Proper diagnosis and treatment helps people with bipolar disorder lead healthy and productive lives. In most cases, treatment can help reduce the frequency and severity of episodes.

What Illnesses often co-exist with Bipolar Disorder?

Substance abuse is very common among people with bipolar disorder, but the reasons for this link are unclear. Some people with bipolar disorder may try to treat their symptoms with alcohol or drugs. However, substance abuse may trigger or prolong bipolar symptoms, and the behavioral control problems associated with mania can result in a person drinking too much.

Anxiety disorders, such as post-traumatic stress disorder (PTSD) and social phobia, also co-occur often among people with bipolar disorder. Bipolar disorder also co-occurs with attention deficit hyperactivity disorder (ADHD), which has some symptoms that overlap with bipolar disorder, such as restlessness and being easily distracted.

People with bipolar disorder are also at higher risk for thyroid disease, migraine headaches, heart disease, diabetes, obesity, and other physical illnesses. These illnesses may cause symptoms of mania or depression. They may also result from treatment for bipolar disorder.

Other illnesses can make it hard to diagnose and treat bipolar disorder. People with bipolar disorder should monitor their physical and mental health. If a symptom does not get better with treatment, they should tell their doctor.

What are the risk factors for bipolar disorder?

While researchers don’t yet fully understand the exact cause of bipolar disorder, they have identified certain factors which may increase your risk of developing the disorder.

Family with the Disorder:
If you have a relative in your nuclear family with bipolar disorder, such as a parent or sibling, then you may be at higher risk for the mood disorder. Symptoms may first emerge during teenage years or early adulthood, with the average of onset being 25. One analysis of the literature found that children of parents with a severe mental illness had roughly a one-third chance of developing a severe mental illness by adulthood. Researchers have also found that the earlier age your parent is diagnosed with the disorder, the higher your risk is for also developing it.

However, we know that genetics isn’t the only factor. Studies of identical twins have shown that while bipolar disorder is very heritable, both twins will not always develop the disorder. This means that environmental factors can play a role as well in increasing or decreasing risk of developing the condition.

High Stress:
People who experience traumatic events are at higher risk for developing bipolar disorder. Childhood factors such as sexual or physical abuse, neglect, the death of a parent, or other traumatic events can increase the risk of bipolar disorder later in life. Highly stressful events such as losing a job, moving to a new place, or experiencing a death in the family can also trigger manic or depressive episodes. Lack of sleep can also increase risk of a manic episode.

Substance Abuse:
People who abuse drugs or alcohol are also at risk for developing bipolar disorder. Substance use doesn’t cause the disorder, but it can make mood episodes worse or hasten the onset of symptoms. Sometimes medications can also trigger the onset of a manic or depressive episode. However, because substance use can trigger psychosis, a person may have to detox from substances before a doctor can give them a diagnosis of bipolar disorder.

Gender:
Bipolar disorder affects men and woman equally, but women are three times more likely to experience rapid cycling of mood episodes. They are also more likely to experience depressive and mixed episodes of the disorder compared to men.

Genetics.

Bipolar disorder tends to run in families, so researchers are looking for genes that may increase a person’s chance of developing the illness. Genes are the “building blocks” of heredity. They help control how the body and brain work and grow. Genes are contained inside a person’s cells that are passed down from parents to children.

Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop the illness, compared with children who do not have a family history of bipolar disorder. However, most children with a family history of bipolar disorder will not develop the illness.

Genetic research on bipolar disorder is being helped by advances in technology. This type of research is now much quicker and more far-reaching than in the past. One example is the launch of the Bipolar Disorder Phenome Database, funded in part by NIMH. Using the database, scientists will be able to link visible signs of the disorder with the genes that may influence them. So far, researchers using this database found that most people with bipolar disorder had: 

  • Missed work because of their illness
  • Other illnesses at the same time, especially alcohol and/or substance abuse and panic disorders
  • Been treated or hospitalized for bipolar disorder.
The researchers also identified certain traits that appeared to run in families, including:
  • History of psychiatric hospitalization
  • Co-occurring obsessive-compulsive disorder (OCD)
  • Age at first manic episode
  • Number and frequency of manic episodes.

Scientists continue to study these traits, which may help them find the genes that cause bipolar disorder some day.
But genes are not the only risk factor for bipolar disorder. Studies of identical twins have shown that the twin of a person with bipolar illness does not always develop the disorder. This is important because identical twins share all of the same genes. The study results suggest factors besides genes are also at work. Rather, it is likely that many different genes and a person’s environment are involved. However, scientists do not yet fully understand how these factors interact to cause bipolar disorder.

Brain Structure and Functioning.

Brain-imaging studies are helping scientists learn what happens in the brain of a person with bipolar disorder. Newer brain-imaging tools, such as functional magnetic resonance imaging (fMRI) and positron emission tomography (PET), allow researchers to take pictures of the living brain at work. These tools help scientists study the brain’s structure and activity.

Some imaging studies show how the brains of people with bipolar disorder may differ from the brains of healthy people or people with other mental disorders. For example, one study using MRI found that the pattern of brain development in children with bipolar disorder was similar to that in children with “multi-dimensional impairment,” a disorder that causes symptoms that overlap somewhat with bipolar disorder and schizophrenia. This suggests that the common pattern of brain development may be linked to general risk for unstable moods.

Learning more about these differences, along with information gained from genetic studies, helps scientists better understand bipolar disorder. Someday scientists may be able to predict which types of treatment will work most effectively. They may even find ways to prevent bipolar disorder.

Bipolar Disorder: Myths and Facts.

Myth: Bipolar disorder is a single identifiable disorder

Fact: Bipolar disorder is a diagnostic category describing a class of mood disorders where a person experiences episodes of mania (elevated mood), and depression (state of sadness) or mixed states (when symptoms of mania and depression occur simultaneously). In between these episodes, a person will be free of symptoms.

 

Myth: Bipolar disorder cannot be diagnosed as easily as physical illnesses

Fact: While there are no physical tests that can reveal the disorder, the diagnosis of bipolar illness is based on standard criteria. An accurate diagnosis of a bipolar illness is made by using the tools (or “psychiatric laboratory tests”) of a medical and psychiatric history, self-reported symptoms, observable behavior, input from friends and family, family medical history and specific psychiatric rating scales.

 

Myth: It is impossible to help someone with bipolar disorder

Fact: Bipolar disorder can be effectively treated and managed. More than 40% of bipolar patients can expect full and complete recovery while another 50% can expect a very marked reduction in their symptoms. Individuals can go into remissions during various periods of their life. Successful management depends on many factors including education about the illness, good communication with professionals involved in your care, a good support system (family and friends) and adhering to your treatment plan.

 

Myth: Bipolar Disorder is a figment of one’s imagination.

Fact: Bipolar disorder is a treatable brain disorder that is real and can cause a lot of suffering, especially if it is not well managed. Individuals cannot just snap out of it! Recovery takes time and hard work.

 

Myth: People who have bipolar disorder cannot work

Fact: Proper medical treatment and good support enables most people (more than 75%) with bipolar to work and be successful.

 

Myth: Bipolar disorder is caused by a personal weakness or character flaw

Fact: Bipolar disorder is a medical condition just like diabetes or any other health condition. People with bipolar disorder cannot “just pull themselves together” and get better. Treatment is necessary.

 

Myth: Children do not get bipolar disorder

Fact: Bipolar disorder can occur in children as young as age six. It is more likely to affect children of parents who have bipolar disorder. Children tend to have very fast mood swings between depression and mania many times during the day whereas adults tend to experience intense moods for weeks or months at a time.

 

Myth: If you have bipolar disorder, you are crazy all the time

Fact: Bipolar disorder is characterized by episodes of highs and lows. In most people, these episodes are separated by periods of stability. People may go for months, sometimes even years without an episode.

 

Myth: bipolar disorder is under control, people can stop their medications once

Fact: Bipolar disorder is an illness that most often requires people to continue taking medications, even if they are symptom free. Medication can act in a preventative way, helping people to avoid relapses. You should always consult with your doctor before stopping any medications.

 

Myth: Alcoholism and drug abuse can cause bipolar disorder

Fact: People with bipolar disorder are more likely to abuse alcohol or drugs but the drugs do not cause the disorder. People with bipolar disorder may use alcohol or street drugs to make themselves feel better (self medication)

 Author: Mood Disorders Association of BC

How is bipolar disorder treated?

Treatments for bipolar disorder aim to reduce the severity and frequency of the episodes of depression and mania so that a person can live life as normally as possible. The condition needs to be managed and treated long term.

If they are not treated, episodes of bipolar-related depression or mania can last for 6-12 months. On average, someone with bipolar disorder will have 5 or 6 episodes over a period of 20 years and without medication, relapse is more likely. However, with effective treatment, episodes usually improve within about 3 months.

Most people with bipolar disorder can be treated using a combination of different treatments. The treatment may include one or more of the following:

  • medicine to treat the main symptoms of depression and mania when they occur
  • medicine to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as ‘mood stabilisers’ and are taken every day, on a long-term basis
  • learning to recognise the triggers and signs of an episode of depression or mania
  • psychological treatment such as talking therapy to help deal with depression and to give you advice about how to improve your relationships and reflect on how you are thinking and behaving
  • lifestyle advice such as doing regular exercise, planning activities that you enjoy and that give you a sense of achievement, and advice on improving your diet and getting more sleep

Most people with bipolar disorder can receive most of their treatment without having to stay in hospital. However, treatment in hospital may be required if your symptoms are severe, or if you are being treated under the Mental Health Act applicable in your state or territory, because there is a danger that you will harm yourself or others. In some circumstances, you may be able to have treatment in a day hospital and return home at night.

Medicine

Several medicines are available to help stabilise mood swings. These include:

  • Lithium carbonate (often referred to as just ‘lithium’) is the medicine that is most commonly used to treat bipolar disorder. Lithium is a long-term method of treatment for episodes of mania, hypomania and depression. It is usually prescribed for a minimum of 6 months.
  • Anticonvulsant medicines include sodium valproate, carbamazepine and lamotrigine. These medicines are sometimes used to treat episodes of mania. Like lithium, they are long-term mood stabilisers.
  • Antipsychotic medicines include aripiprazole, olanzapine, quetiapine and risperidone. Antipsychotic medicines are sometimes prescribed to treat episodes of mania or hypomania. They may also be used as a long-term mood stabiliser.

If you are prescribed an antipsychotic medicine, you will need to have regular health checks (at least every 3 months but possibly more often), particularly if you have diabetes.

If you are already taking medicine for bipolar disorder and you develop depression, your doctor or specialist will check that you are taking the correct dose and, if necessary, will adjust it.

Episodes of depression in bipolar disorder can be treated in a similar way to clinical depression. This includes using antidepressant medication.

Never try to self-medicate or change medicines without your doctors knowledge. It is important to keep taking the medicines long-term, even if you’re feeling well.

Psychological treatment

Some people find psychological treatment helpful when used alongside medicine in between episodes of mania or depression. This may include:

  • psychoeducation to help you find out more about bipolar disorder
  • cognitive behavioural therapy (CBT), which is most useful when treating depression
  • family therapy, a type of psychotherapy that focuses on family relationships (such as marriage) and encourages everyone within the family or relationship to work together to improve mental health
  • Electroconvulsive therapy (ECT) can be used for people who are very unwell and who aren’t responding to other treatments

Medications.

Bipolar disorder can be diagnosed and medications prescribed by a GP. Usually, bipolar medications are prescribed by a psychiatrist. Not everyone responds to medications in the same way. Several different medications may need to be tried before the best course of treatment is found.

Keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events can help the doctor track and treat the illness most effectively. Sometimes this is called a daily life chart. If a person’s symptoms change or if side effects become serious, the doctor may switch or add other medications.

Some of the types of medications generally used to treat bipolar disorder are listed on the next page. Information on medications can change.

Mood stabilizing medications are usually the first choice to treat bipolar disorder. In general, people with bipolar disorder continue treatment with mood stabilizers for years. Except for lithium, many of these medications are anticonvulsants. Anticonvulsant medications are usually used to treat seizures, but they also help control moods. These medications are commonly used as mood stabilizers in bipolar disorder:

  • Lithium was the first mood-stabilizing medication approved in the 1970s for treatment of mania. It is often very effective in controlling symptoms of mania and preventing the recurrence of manic and depressive episodes.
  • Epilum (valproic acid) is a popular alternative to lithium for bipolar disorder. It is generally as effective as lithium for treating bipolar disorder. [Also see the section: “Should young women take valproic acid?”]

More recently, the anticonvulsant lamotrigine (also sold in Australia as: Lamictal, Elmendos, Lamitrin and Lamogine) has been used in the treatment of bipolar disorder.

  • Other anticonvulsant medications, including gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal) are sometimes prescribed. No large studies have shown that these medications are more effective than mood stabilizers.

People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional.

Lithium and Thyroid Function.

People with bipolar disorder often have thyroid gland problems. Lithium treatment may also cause low thyroid levels in some people. Low thyroid function, called hypothyroidism, has been associated with rapid cycling in some people with bipolar disorder, especially women.

Because too much or too little thyroid hormone can lead to mood and energy changes, it is important to have a doctor check thyroid levels carefully. A person with bipolar disorder may need to take thyroid medication, in addition to medications for bipolar disorder, to keep thyroid levels balanced.

Should Young Women Take Epilim?

Epilum (Valproic acid) may increase levels of testosterone (a male hormone) in teenage girls and lead to polycystic ovary syndrome (PCOS) in women who begin taking the medication before age 20. PCOS causes a woman’s eggs to develop into cysts, or fluid filled sacs that collect in the ovaries instead of being released by monthly periods. This condition can cause obesity, excess body hair, disruptions in the menstrual cycle, and other serious symptoms. Most of these symptoms will improve after stopping treatment with valproic acid. Young girls and women taking valproic acid should be monitored carefully by a doctor.

Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, these medications are taken with other medications. Atypical antipsychotic medications are called “atypical” to set them apart from earlier medications, which are called “conventional” or “first-generation” antipsychotics.

Olanzapine (Zyprexa), when given with an antidepressant medication, may help relieve symptoms of severe mania or psychosis. Olanzapine is also available in an injectable form, which quickly treats agitation associated with a manic or mixed episode. Olanzapine can be used for maintenance treatment of bipolar disorder as well, even when a person does not have psychotic symptoms. However, some studies show that people taking olanzapine may gain weight and have other side effects that can increase their risk for diabetes and heart disease. These side effects are more likely in people taking olanzapine when compared with people prescribed other atypical antipsychotics.

Aripiprazole (Abilify), like olanzapine, is approved for treatment of a manic or mixed episode. Aripiprazole is also used for maintenance treatment after a severe or sudden episode. As with olanzapine, aripiprazole also can be injected for urgent treatment of symptoms of manic or mixed episodes of bipolar disorder.

Quetiapine (Seroquel) relieves the symptoms of severe and sudden manic episodes. In that way, quetiapine is like almost all antipsychotics. In 2006, it became the first atypical antipsychotic to also receive FDA approval for the treatment of bipolar depressive episodes.

Risperidone (Risperdal) and ziprasidone (Geodon) are other atypical antipsychotics that may also be prescribed for controlling manic or mixed episodes.

 Antidepressant medications are sometimes used to treat symptoms of depression in bipolar disorder. People with bipolar disorder who take antidepressants often take a mood stabilizer too. Doctors usually require this because taking only an antidepressant can increase a person’s risk of switching to mania or hypomania, or of developing rapid cycling symptoms. To prevent this switch, doctors who prescribe antidepressants for treating bipolar disorder also usually require the person to take a mood-stabilizing medication at the same time.

Recently, a large-scale, NIMH-funded study showed that for many people, adding an antidepressant to a mood stabilizer is no more effective in treating the depression than using only a mood stabilizer.
Fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), and bupropion (Wellbutrin) are examples of antidepressants that may be prescribed to treat symptoms of bipolar depression.

Some medications are better at treating one type of bipolar symptoms than another. For example, lamotrigine (Lamictal) seems to be helpful in controlling depressive symptoms of bipolar disorder.

What are the Side Effects of these Medications?

Before starting a new medication, people with bipolar disorder should talk to their doctor about the possible risks and benefits.

The psychiatrist prescribing the medication or pharmacist can also answer questions about side effects. Over the last decade, treatments have improved, and some medications now have fewer or more tolerable side effects than earlier treatments. However, everyone responds differently to medications. In some cases, side effects may not appear until a person has taken a medication for some time.

If the person with bipolar disorder develops any severe side effects from a medication, he or she should talk to the doctor who prescribed it as soon as possible. The doctor may change the dose or prescribe a different medication. People being treated for bipolar disorder should not stop taking a medication without talking to a doctor first. Suddenly stopping a medication may lead to “rebound,” or worsening of bipolar disorder symptoms. Other uncomfortable or potentially dangerous withdrawal effects are also possible.

The Psychotropic Drug Advisory Service (PDAS) in Melbourne is an independent source for information on medicines used to treat mental illnesses and other drugs that affect the way we think, feel and behave. Service users include individuals, medical practitioners, health care professionals, mental health care support organisations and their staff, carers and consumers. Though predominantly telephone based, the service is also accessed via email and facsimile.

PDAS provides advice on:-

  • Treatment choice
  • Treatment response
  • Adverse effects of medications, as well as other psychoactive substances
  • Interactions between medications and other drugs
  • Specific information on the use of medications by special populations (e.g. children, adolescents, the elderly and women who are pregnant or breast feeding)

Side Effects – Mood Stabilizers.

Antidepressants are safe and popular, but some studies have suggested that they may have unintentional effects on some people, especially in adolescents and young adults. Possible side effects to look for are depression that gets worse, suicidal thinking or behavior, or any unusual changes in behavior such as trouble sleeping, agitation, or withdrawal from normal social situations. Families and caregivers should report any changes to the doctor. The following sections describe some common side effects of the different types of medications used to treat bipolar disorder.

 

Mood Stabilizers

In some cases, lithium can cause side effects such as:

  • Restlessness
  • Dry mouth
  • Bloating or indigestion
  • Acne
  • Unusual discomfort to cold temperatures
  • Joint or muscle pain
  • Brittle nails or hair.

Lithium also causes side effects not listed here. If extremely bothersome or unusual side effects occur, tell your doctor as soon as possible. If a person with bipolar disorder is being treated with lithium, it is important to make regular visits to the treating doctor. The doctor needs to check the levels of lithium in the person’s blood, as well as kidney and thyroid function.

These medications may also be linked with rare but serious side effects. Talk with the treating doctor or a pharmacist to make sure you understand signs of serious side effects for the medications you’re taking.

Common side effects of other mood stabilizing medications include:

  • Drowsiness
  • Dizziness
  • Headache
  • Diarrhea
  • Constipation
  • Heartburn
  • Mood swings
  • Stuffed or runny nose, or other cold-like symptoms.

 The Psychotropic Drug Advisory Service (PDAS) in Melbourne is an independent source for information on medicines used to treat mental illnesses and other drugs that affect the way we think, feel and behave. Service users include individuals, medical practitioners, health care professionals, mental health care support organisations and their staff, carers and consumers. Though predominantly telephone based, the service is also accessed via email and facsimile.

PDAS provides advice on:-

  • Treatment choice
  • Treatment response
  • Adverse effects of medications, as well as other psychoactive substances
  • Interactions between medications and other drugs
  • Specific information on the use of medications by special populations (e.g. children, adolescents, the elderly and women who are pregnant or breast feeding)

Side Effects – Atypical antipsychotics.

Some people have side effects when they start taking atypical antipsychotics. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include:

  • Drowsiness
  • Dizziness when changing positions
  • Blurred vision
  • Rapid heartbeat
  • Sensitivity to the sun
  • Skin rashes
  • Menstrual problems for women.

Atypical antipsychotic medications can cause major weight gain and changes in a person’s metabolism. This may increase a person’s risk of getting diabetes and high cholesterol. A person’s weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking these medications.

In rare cases, long-term use of atypical antipsychotic drugs may lead to a condition called tardive dyskinesia (TD). The condition causes muscle movements that commonly occur around the mouth. A person with TD cannot control these moments. TD can range from mild to severe, and it cannot always be cured. Some people with TD recover partially or fully after they stop taking the drug.

 The Psychotropic Drug Advisory Service (PDAS) in Melbourne is an independent source for information on medicines used to treat mental illnesses and other drugs that affect the way we think, feel and behave. Service users include individuals, medical practitioners, health care professionals, mental health care support organisations and their staff, carers and consumers. Though predominantly telephone based, the service is also accessed via email and facsimile.

PDAS provides advice on:-

  • Treatment choice
  • Treatment response
  • Adverse effects of medications, as well as other psychoactive substances
  • Interactions between medications and other drugs
  • Specific information on the use of medications by special populations (e.g. children, adolescents, the elderly and women who are pregnant or breast feeding)

Side Effects – Antidepressants.

The antidepressants most commonly prescribed for treating symptoms of bipolar disorder can also cause mild side effects that usually do not last long. These can include:

  • Headache, which usually goes away within a few days.
  • Nausea (feeling sick to your stomach), which usually goes away within a few days.
  • Sleep problems, such as sleeplessness or drowsiness. This may happen during the first few weeks but then go away. To help lessen these effects, sometimes the medication dose can be reduced, or the time of day it is taken can be changed.
  • Agitation (feeling jittery).
  • Sexual problems, which can affect both men and women. These include reduced sex drive and problems having and enjoying sex.

Some antidepressants are more likely to cause certain side effects than other types. Your doctor or pharmacist can answer questions about these medications. Any unusual reactions or side effects should be reported to a doctor immediately.
Should women who are pregnant or may become pregnant take medication for bipolar disorder?

Women with bipolar disorder who are pregnant or may become pregnant face special challenges. The mood stabilizing medications in use today can harm a developing fetus or nursing infant. But stopping medications, either suddenly or gradually, greatly increases the risk that bipolar symptoms will recur during pregnancy.

Scientists are not sure yet, but lithium is likely the preferred mood-stabilizing medication for pregnant women with bipolar disorder. However, lithium can lead to heart problems in the fetus. Women need to know that most bipolar medications are passed on through breast milk. Pregnant women and nursing mothers should talk to their doctors about the benefits and risks of all available treatments.

The Psychotropic Drug Advisory Service (PDAS) in Melbourne is an independent source for information on medicines used to treat mental illnesses and other drugs that affect the way we think, feel and behave. Service users include individuals, medical practitioners, health care professionals, mental health care support organisations and their staff, carers and consumers. Though predominantly telephone based, the service is also accessed via email and facsimile.

PDAS provides advice on:-

  • Treatment choice
  • Treatment response
  • Adverse effects of medications, as well as other psychoactive substances
  • Interactions between medications and other drugs
  • Specific information on the use of medications by special populations (e.g. children, adolescents, the elderly and women who are pregnant or breast feeding)

Psychotherapy.

In addition to medication, psychotherapy, or “talk” therapy, can be an effective treatment for bipolar disorder. It can provide support, education, and guidance to people with bipolar disorder and their families. Some psychotherapy treatments used to treat bipolar disorder include:

  • Cognitive behavioral therapy (CBT) helps people with bipolar disorder learn to change harmful or negative thought patterns and behaviors.
  • Family-focused therapy includes family members. It helps enhance family coping strategies, such as recognizing new episodes early and helping their loved one. This therapy also improves communication and problem-solving.
  • Interpersonal and social rhythm therapy helps people with bipolar disorder improve their relationships with others and manage their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes.
  • Psychoeducation teaches people with bipolar disorder about the illness and its treatment. This treatment helps people recognize signs of relapse so they can seek treatment early, before a full-blown episode occurs. Usually done in a group, psycho-education may also be helpful for family members and caregivers.

A psychologist, social worker, or counselor typically provides these therapies. This mental health professional often works with the psychiatrist to track progress. The number, frequency, and type of sessions should be based on the treatment needs of each person. As with medication, following the doctor’s instructions for any psychotherapy will provide the greatest benefit.

Other treatments.

  • Electroconvulsive Therapy (ECT) — For cases in which medication and/or psychotherapy does not work, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as “shock therapy,” once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe bipolar disorder who have not been able to feel better with other treatments.

Before ECT is administered, a patient takes a muscle relaxant and is put under brief anesthesia. He or she does not consciously feel the electrical impulse administered in ECT. On average, ECT treatments last from 30–90 seconds. People who have ECT usually recover after 5–15 minutes and are able to go home the same day.

Sometimes ECT is used for bipolar symptoms when other medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severely depressive, manic, or mixed episodes, but is generally not a first-line treatment.

ECT may cause some short-term side effects, including confusion, disorientation, and memory loss. But these side effects typically clear soon after treatment. People with bipolar disorder should discuss possible benefits and risks of ECT with an experienced doctor.

  • Sleep Medications—People with bipolar disorder who have trouble sleeping usually sleep better after getting treatment for bipolar disorder. However, if sleeplessness does not improve, the doctor may suggest a change in medications. If the problems still continue, the doctor may prescribe sedatives or other sleep medications.

People with bipolar disorder should tell their doctor about all prescription drugs, over-the-counter medications, or supplements they are taking. Certain medications and supplements taken together may cause unwanted or gerous effects.

Herbal Supplements.

In general, there is not much research about herbal or natural supplements. Little is known about their effects on bipolar disorder. A herb called St. John’s wort (Hypericum perforatum), often marketed as a natural antidepressant, may cause a switch to mania in some people with bipolar disorder.

St. John’s wort can also make other medications less effective, including some antidepressant and anticonvulsant medications. Scientists are also researching omega-3 fatty acids (most commonly found in fish oil) to measure their usefulness for long-term treatment of bipolar disorder. Study results have been mixed. It is important to talk with a doctor before taking any herbal or natural supplements because of the serious risk of interactions with other medications.

Sleep Deprivation Triples Risk of Mental Illness.

New research suggests young people getting less than five hours sleep per night are tripling their chances of developing a mental illness. The George Institute for Global Health surveyed almost 20,000 Australians aged between 17 and 24 for the research.

Researchers found those sleeping fewer than five hours a night are three times more likely to become mentally ill than those sleeping for eight or nine hours. The results also linked sleep deprivation with cardiovascular disease and weight gain.

The study’s lead author, Professor Nick Glozier, says the average amount of sleep for a young adult is eight to nine hours a night. But he says that is decreasing, especially over the past decade.

“There’s a whole bunch of gadgets that kids and young adults now have in their bedrooms that they never used to have. ” he said.

“Yet of course they’ve got to get up and go to school or go to college or go to uni at exactly the same time. So there’s a group of them who are becoming more and more sleep-deprived.”

Professor Glozier says it is important to prevent mental health problems where possible.

“It’s those chronic mental health problems when you’re an adolescent or you’re a young adult, that lead on to the more important adult forms of the disorders, like major depressive disorder or bipolar disorder, ” he said.

“So if we can do something around that group of people when they’re beginning to become chronic, or preventing those chronic, persistent problems then we may have a really good target for an early intervention. “

Mood Charts.

A mood chart is a simple diary. You will use it to keep track of your mood changes, your daily feelings, the things that you do and the way that you sleep. It is quite an effective tool when put to good use. Here’s what to include in your mood chart for starters:

  1. The way that you feel that day, including any feeling changes. If you wake up in a great mood, record this. If later someone angers you, record this too.
  2. Your activities also need to be recorded. If you go to work, write it down. If you decide to spend the day in bed, this too needs to be recorded. Being able to track the things that you do will help you and your doctor to spot triggers and to spot oncoming severe mood swings.
  3. Sleep patterns are very important to the bipolar patient. You should track the changes that happen in your sleeping because it will trigger differences in your overall well being.
  4. Medications and side effects should also be considered daily. If you take your medication and in an hour feel like you need a nap, this should be recorded. It is very important to remember to include changes in your overall response, too. If you begin to have new side effects or ones that are worsened, this needs to be considered.
  5. Life changes and life events that are significant should be noted. Sometimes, the death of a loved one or the stresses at work can lead to mood changes that can be severe. Most days, you’ll record a normal day. Many times you won’t have a lot of details to incorporate into your mood chart. Other times, though, you may find the need to include many details.

There are a number of different types of charts on the market that can be quite useful to you. Select one that your doctor tells you is the right choice. It will ultimately provide you with the best record of how to manage your mood swings by keeping track of them. If you don’t want to do this on paper, you can make a virtual diary on a document that you keep on your computer too. To remember to do this tracking, simply take note of it the same time each day, perhaps after you eat a meal. Diarize it! You’ll be rewarded with the answers that you need for daily life management.

Can't sleep?

Nothing is more frustrating than not being able to sleep. Tossing and turning. Your mind is racing, going over everything that happened today. Night noises keep you awake. What can you do?

There ARE things you can do! Read on and learn some new tricks to sleep well.

These tips are also known as “Sleep Hygiene.”

  • Sleep only when sleepy. This reduces the time you are awake in bed.
  • If you can’t fall asleep within 20 minutes, get up and do something boring until you feel sleepy. Sit quietly in the dark or read the warranty on your refrigerator. Don’t expose yourself to bright light while you are up. The light gives cues to your brain that it is time to wake up.
  • Don’t take naps. This will ensure you are tired at bedtime. If you just can’t make it through the day without a nap, sleep less than one hour, before 3 pm.
  • Get up and go to bed the same time every day Even on weekends! When your sleep cycle has a regular rhythm, you will feel better.
  • Refrain from exercise at least 4 hours before bedtime. Regular exercise is recommended to help you sleep well, but the timing of the workout is important. Exercising in the morning or early afternoon will not interfere with sleep.
  • Develop sleep rituals. It is important to give your body cues that it is time to slow down and sleep. Listen to relaxing music, read something soothing for 15 minutes, have a cup of caffeine free tea, do relaxation exercises.
  • Only use your bed for sleeping. Refrain from using your bed to watch TV, pay bills, do work or reading. So when you go to bed your body knows it is time to sleep. Sex is the only exception.
  • Stay away from caffeine, nicotine and alcohol at least 4-6 hours before bed. Caffeine and nicotine are stimulants that interfere with your ability to fall asleep. Coffee, tea, cola, cocoa, chocolate and some prescription and non-prescription drugs contain caffeine. Cigarettes and some drugs contain nicotine. Alcohol may seem to help you sleep in the beginning as it slows brain activity, but you will end end up having fragmented sleep.
  • Have a light snack before bed. If your stomach is too empty, that can interfere with sleep. However, if you eat a heavy meal before bedtime, that can interfere as well. Dairy products and turkey contain tryptophan, which acts as a natural sleep inducer. Tryptophan is probably why a warm glass of milk is sometimes recommended.
  • Take a hot bath 90 minutes before bedtime A hot bath will raise your body temperature, but it is the drop in body temperature that may leave you feeling sleepy. Read about the study done on body temperature below. Trouble Sleeping? Chill Out! – A press release from the journal Sleep about the significance in body temperature before sleep
  • Make sure your bed and bedroom are quiet and comfortable. A hot room can be uncomfortable. A cooler room along with enough blankets to stay warm is recommended. If light in the early morning bothers you, get a blackout shade or wear a slumber mask. If noise bothers you, wear earplugs or get a “white noise” machine.
  • Use sunlight to set your biological clock. As soon as you get up in the morning, go outside and turn your face to the sun for 15 minutes.

Tackling Bipolar Disorder with Yoga Techniques.

Yoga techniques offer some simple breathing exercises that may help relieve panic, anxiety depression, and bipolar disorder, also known as manic depression, which is common and found in even young teenagers. Bipolar disorder is a genetic illness characterized by fluctuating feelings of delight and absolute depression.

Bipolar disorder is often lumped with other main mental illness, schizophrenia, but unlike this there are no changes in the brain tissue. Yoga techniques can help plan the brain and direct the energy swings to avenues that are more productive. Bipolar disorder is, as the name implies, a swinging mood from happy, giddy, and increased energy. A sufferer of this disorder will rapidly change their happy mood and follows a deep depression immediately. Some of the symptoms of this disorder are sleeplessness, weight loss, and if it develops far enough there can be visual and auditory delusion. Cell damage can cause if this energy is continued to build making the brain cells to disorganise. However, yoga techniques can be practiced in order to avoid the bipolar disorder, and the patient can lead an active and satisfying life.

Yoga techniques will help you to get in touch with your own body, makes you more aware of mood swings, and help you to remain calm. By practicing regular breathing exercises, yoga poses and being in the moment will help to control this bipolar disorder.

However, you can’t  ignore the importance of professional health and the correct medications because medical help is vital in lessening the risk of cellular damage if it’s left unchecked. Once the bipolar disorder patient has been analysed and medication is in progress, then they can concentrate on increasing the level of awareness to that extent that their body wants.

Yoga techniques are a great tool for reducing the mood swings and challenging your body mentally to slow down. Concentrating and practicing yoga poses, meditation, breathing exercises can help in reducing the anxiety and level the moods in your body. Taking medication is also essential to stabilize the energy in the brain cells. Exercises, removing the negative way of thinking and letting go of the strain that they have passed through are all-important in treating bipolar disorder.

It’s more important for a patient to be diagnosed as this disorder is occasionally treated just as depression and moreover the medication and treatment for depression is different from bi-polar disorder. The need for large amounts of medications for bipolar disorder can reduce by listening to your body, by practicing concentration and breathing techniques and following healthy eating patterns, which can help your body and lessen the damage to healthy organs.

One patient can be diagnosed with bipolar disorder, after 20 years, even if depression is being diagnosed and treated successfully. After practicing yoga techniques, breathing exercises and receiving therapy changed to a new medicine turned him around. The importance of meditation and breathing exercises can’t be stressed enough in treating patients with bi-polar disorder. Yoga techniques help in getting the stability of emotions that the body requires to generate a healthy and happier person.

Quitting Smoking Improves Mood.

Quitting smoking is certainly healthy for the body, but doctors and scientists haven’t been sure whether quitting makes people happier, especially since conventional wisdom says many smokers use cigarettes to ease anxiety and depression. In a new study, researchers tracked the symptoms of depression in people who were trying to quit and found that they were never happier than when they were being successful, for however long that was.Based on their results, the authors of the article published online in the journalNicotine & Tobacco Research recommend that smokers embrace quitting as a step toward improving mental as well as physical health, said Christopher Kahler, corresponding author and research professor of community health at the Warren Alpert Medical School of Brown University. Quitting is not, as some smokers may fear, a grim psychological sacrifice to be made for the sake of longevity. “The assumption has often been that people might smoke because it has antidepressant properties and that if they quit it might unmask a depressive episode,” said Kahler. “What’s surprising is that at the time when you measure smokers’ mood, even if they’ve only succeeded for a little while, they are already reporting less symptoms of depression.”

Moving mood Kahler and colleagues from Brown, The Miriam Hospital, and the University of Southern California studied a group of 236 men and women seeking to quit smoking, who also happened to be heavy social drinkers. They received nicotine patches and counseling on quitting and then agreed to a quit date; some also were given specific advice to reduce drinking. Participants took a standardized test of symptoms of depression a week before the quit date and then two, eight, 16, and 28 weeks after that date. All but 29 participants exhibited one of four different quitting behaviors: 99 subjects never abstained; 44 were only abstinent at the two-week assessment; 33 managed to remain smoke-free at the two- and eight-week checkups; 33 managed to stay off cigarettes for the entire study length.

The most illustrative – and somewhat tragic – subjects were the ones who only quit temporarily. Their moods were clearly brightest at the checkups when they were abstinent. After going back to smoking, their mood darkened, in some cases to higher levels of sadness than before. The strong correlation in time between increased happiness and abstinence is a tell-tale sign that the two go hand-in-hand, said Kahler, who is based at Brown’s Center for Alcohol and Addiction Studies (CAAS). Subjects who never quit remained the unhappiest of all throughout the study. The ones who quit and stuck with abstinence were the happiest to begin with and remained at the same strong level of happiness throughout. Kahler said he is confident that the results can be generalized to most people, even though the smokers in this study also drank at relatively high levels.

One reason is that the results correlate well with a study he did in 2002 of smokers who all had had past episodes of depression but who did not necessarily drink. Another is that the changes in happiness measured in this study did not correlate in time with a reduction in drinking, only with a reduction – and resumption – of smoking. Looking at the data, Kahler said, it is difficult to believe that smoking serves as an effective way to medicate negative feelings and depression, even if some people report using tobacco for that reason. In fact, he said, the opposite seems more likely – that quitting smoking eases depressive symptoms. “If they quit smoking their depressive symptoms go down and if they relapse, their mood goes back to where they were,” he said. “An effective antidepressant should look like that.”

In addition to Kahler, other authors on the study were Nichea Spillane of Brown’s CAAS, Andrew Busch of the Centers for Behavioral and Preventive Medicine at The Miriam Hospital and Brown, and Adam Leventhal of the Keck School of Medicine at USC. The National Institute on Drug Abuse funded the study.

Teenage Depression and Suicide - warning signs and prevention.

What are the Warning Signs and How can we Prevent It?

Bob Livingstone, LCSW – Dec 21st 2010

Teenage depression and suicide has been in the headlines lately. Suicide is the third largest cause of death for teenagers behind accidents and homicide. Studies have shown that for every completed suicide, there are twenty-five suicide attempts.

According to a ScienceDaily 2007 article; Following a decline of more than 28 percent, the suicide rate for 10- to-24-year-olds increased by 8 percent, the largest single-year rise in 15 years. Many teenagers who end up attempting suicide have clinical symptoms of depression. These symptoms are: Loss of interest in activities that used to be enjoyable, significant loss or gain in appetite, difficulty falling asleep or wanting to sleep all day, fatigue or loss of energy, feelings of worthlessness or guilt, withdrawal from family and friends, neglect of personal appearance or hygiene , sadness, irritability, or indifference and having trouble concentrating. Other signs that your child may be suicidal are: Drug or alcohol use or abuse, aggressive, destructive, or defiant behavior, poor school performance, hallucinations or unusual beliefs, risk taking behaviors, complains more frequently of boredom, does not respond as before to praise, states that she is thinking of killing herself, gives items away that she treasures, and writes suicide notes.

Teenage depression can be caused by genetic as well as environmental factors. There are two recent studies that we should all pay attention to concerning electronic use and diet. Too much time spent in front of the television or on computer games may seriously affect teens’ mental health, researchers found. The odds of developing depressive symptoms rose with each additional hour of exposure by a significant 8% for TV and 5% for overall electronic media, Brian A. Primack, M.D., of the University of Pittsburgh, and colleagues reported in the February issue of the Archives of General Psychiatry.

A research paper by Australia-based Telethon Institute for Child Health Research, published in the journal Preventive Medicine determined that there was a definite link between teenage depression and the consumption of fast/junk food. Teenagers may also be facing depression because of the intense pressure in their lives to get into the best college because the competition for the job market is so intense in 2009. They take classes to obtain high SAT scores. They not only have to achieve a 4.0 grade point average, but they have to participate in as many extra curricular activities as possible in order to gain admission to top schools.

Teenagers can be impulsive and not think through the possible consequences of their actions. If they feel rejected by their peers and feel devastated over a breakup with a girlfriend, they may become suicidal. They often feel extremely isolated during these periods and don’t reach out to those who can help them. The essence of being a teenager is suffering through mood swings.

These mood swings may be overwhelming at times and negatively effect self-esteem and confidence. Some adolescents also have a negative view of their parent’s lifestyle. Their perception is that their parents are unhappy, materialistic and simply going through the motions. These teens are fearful that they are destined to repeat their parent’s dreary lives and this creates angst and despair.

What can we do to Prevent Teenage Suicide? First of all, determine if your child has any of the symptoms discussed above. If she does, attempt to talk honestly with her about your concerns; that she is showing distinct signs of depression and you are worried about her. Don’t judge her or get angry-this is the time to remain calm.

Be prepared to be shocked and frightened, but do your best not to react. Being calm, compassionate and firm may allow her to open up about what is bothering her. Seek out the name of a psychotherapist who has extensive experience working with teenagers. You can obtain referrals from your family physician, school counselor or friends who are also parents of teenagers. The psychotherapist needs to be willing to work with your family as well as your child.

If your child refuses to go to therapy, take him to the nearest hospital emergency room where he can be assessed for suicide risk. If he refuses to go with after you have tried to convince him by conversing with those he respects, you are left with no other choice but to call the police. This is an extreme measure, but one that could save your child’s life.

Before You Quit Antidepressants…

By Richard A. Friedman, M.D.

For the millions of people who take these drugs, and the doctors who prescribe them, this provocative claim had to be confusing, if not alarming. It contradicted literally hundreds of well-designed trials, not to mention considerable clinical experience, showing antidepressants to be effective for a wide array of depressed patients. But on close inspection, the new study does not stand up to that mountain of earlier evidence. To understand why, it helps to look at the way it was conducted. The study is a so-called meta-analysis — not a fresh clinical trial, but a combined analysis of previous studies. A common reason for doing this kind of analysis is to discover potential drug effects that might have been missed in smaller studies.

By aggregating the data from many studies, researchers gain the statistical power to detect broad patterns that may not have been evident before. But meta-analyses can be tricky. First, they are only as good as the smaller studies they analyze. And when there are hundreds of studies out there, how to decide which ones to include? For the recent analysis in the journal, the authors identified 23 studies (out of several hundred clinical trials) that met their criteria for inclusion. Of those 23, they could get access to data on only 6, with a total of 718 subjects. Three trials tested the antidepressantPaxil (a selective serotonin reuptake inhibitor, in the same class as Prozac) and three used an older drug, imipramine, in the class known as tricyclics.

That is not many studies if your goal is to answer a broad question about the efficacy of antidepressants as a class. Indeed, as Robert J. DeRubeis, a professor of psychology at theUniversity of Pennsylvania who is one of the new paper’s authors, told me, “Of course, we can’t know that these results generalize to other medications.” Admittedly, it is not easy to find studies that include large numbers of people with mild to moderate depression; most trials focus on severely ill patients.

But the authors of the new analysis gave themselves an additional handicap: they decided to exclude a whole class of studies, those that tried to correct for the so-called placebo response. Researchers argue all the time about which patients to include in a study. Antidepressant studies come to such different conclusions partly because patient characteristics vary so widely. Many patients with depression — as many as 50 percent, in some studies — get better with no drug at all, just a placebo pill and attentive treatment by a therapist. For that reason, researchers often design their studies to exclude such people, to determine whether the drugs are working independent of any placebo response. An analysis that eliminates such studies is bound to show a comparatively small average difference between drug treatment and placebo treatment. Not surprisingly, this is just what happened in the recent analysis.

But in randomized clinical trials that try to correct, or wash out, the placebo effect, patients with mild to moderate depression respond to antidepressants at rates nearly identical to patients with severe depression (who tend to have a much lower response to placebos). Another drawback of the study is that its conclusions are based on studies that included only two antidepressants — when there are 25 or so on the market. By contrast, when the Food and Drug Administration wanted to investigate the safety of antidepressants, it analyzed data from some 300 clinical trials, with nearly 80,000 patients, involving about a dozen antidepressants. Antidepressants are not interchangeable; studies show that a patient who fails to respond to one has about a 30 percent chance of responding to another.

Still, antidepressants are not panaceas, and their advocates have sometimes been overly optimistic about their efficacy. Only about 35 percent of depressed patients will achieve remission with the first antidepressant they receive. But with sequential treatments, most can expect to feel a lot better. And the real test of an antidepressant is not just whether it can lift someone out of depression; it is whether it can keep depression from returning.

For a vast majority of people with depression, the illness is chronic. Relapses and low-level symptoms between episodes are common. Scores of studies show that antidepressants are highly effective in preventing relapse; on average, the risk of relapse in patients who continue on an antidepressant is one-half to one-third of those who are switched to a placebo.

Every once in a while, a landmark study comes along and overturns everyone’s cherished ideas about a particular treatment. But the current study is not one of them. So it would be a shame if it discouraged depressed patients from taking antidepressants. Experts may disagree about what constitutes the best treatment for depression, and for whom. But there is no question that the safety and efficacy of antidepressants rest on solid scientific evidence.

Dr. Richard A. Friedman is a professor of psychiatry at Weill Cornell Medical College.
Published: January 11, 2010

9 Myths of Bipolar Disorder.

by John M. Grohol

Many myths surround bipolar disorder — what it is, what it means, and how it’s treated. Here’s to busting a few of the most common ones.

1. Bipolar disorder means I’m really “crazy.” While bipolar disorder is a serious mental disorder, it is no more serious than most other mental disorders. Having a mental disorder doesn’t mean you’re “crazy,” it just means you have a concern that is negatively impacting how you live your life. Left unaddressed, this concern can cause a person significant distress and problems in their relationships and life.

2. Bipolar disorder is a medical disease, just like diabetes. While some marketing propaganda might simplify bipolar disorder into a medical disease, bipolar disorder is not — according to our knowledge and science at this time — a medical disease. It is a complex disorder (called a mental disorder or mental illness ) that reflects its basis in psychological, social, and biological roots.

While it has significant neurobiological and genetic components, it is no more of a pure medical disease than ADHD or any other mental disorder. Treatment of bipolar disorder that focuses solely on its “medical” components often results in failure.

3. Manic depression is different than bipolar disorder. Manic depression is simply the old name for bipolar disorder. The name was changed to more accurately describe the type of mood disorder it is — someone who experiences swings between two poles of mood (or emotion). Those two poles are mania and depression.

I’ll have to be on medications for the rest of my life. While the default assumption by most mental health professionals is that most people with bipolar disorder will need to be on medications for the rest of your life, nobody can predict how exactly you, as an individual, will react to such medications or what the future holds for your specific needs.

So it is a myth to say that all people with bipolar disorder will absolutely be on medications for the rest of their lives. As many people age with this disorder, they find their swings between mania and depression lessen significantly, and the need for medication may decrease, and may even be discontinued without any harmful repercussions.

5. I’m feeling better since taking my medications, which means I probably don’t need them any more, right? Wrong. Once a person starts feeling better because of the medication, they often discontinue taking the medication, leading to an eventual relapse. This is a common problem in the treatment of bipolar disorder and is something professionals like to call “treatment compliance.”

This is just a fancy way of saying that a person needs to continue taking their medication as prescribed, no matter how good they may be feeling. It is perhaps one of the most insidious issues in the treatment of bipolar disorder, and leads many people to greater distress than if they just kept taking their medications.

6. There’s no need for psychotherapy in bipolar disorder. This varies from person to person (just as the need for taking medications does), but this is a myth insomuch that many people and professionals believe that psychotherapy doesn’t help much in the treatment of bipolar disorder.

Psychotherapy can be very helpful and effective in the treatment of bipolar disorder, since medications alone can’t teach a person new coping skills or how to deal with feelings of an impending manic or depressive episode. Psychotherapy can help a person with bipolar disorder learn to live with the disorder in their lives without as much stress or upset. While many people with bipolar disorder forgo psychotherapy, it is usually a helpful treatment to consider when first diagnosed.

7. Atypical antipsychotics are only for schizophrenia. In the U.S. in 1990, a new class of medications was introduced called “atypical antipsychotics.” These newer medications are not used to treat only psychosis (such as that found in schizophrenia), but also a wider range of psychiatric symptoms.

One of their approved uses is in the treatment of bipolar disorder in adults. They may also be approved in short time for use in teenagers and children 10 years and older (although they are already sometimes prescribed by doctors for “off label use” in teens and children). So don’t let the name of the class of medications fool you — they treat far more than just psychosis.

8. Atypical antipsychotics have little to no side effects. Atypical antipsychotics are often the primary drug doctors use to treat bipolar disorder. In the U.S., the Food and Drug Administration has determined that such drugs are both safe and effective for this use. However, like all medications, atypical antipsychotics have their own set of risks and side effects.

These medications have a different side effect profile than the medications they replace. While initially marketed as a “better” side effect profile, research since 1990 has shown that the side effects they do produce in many people can be just as worrisome as older medications. Chief among the typical side effects are weight gain and metabolism problems, which can be precursors to type 2 diabetes, increased risk of stroke, and heart problems (including an increase in cardiac arrhythmias which can lead to sudden death).

9. I may just have depression. Bipolar disorder often mimics clinical depression, because one of the primary symptoms of bipolar disorder is clinical depression. Up to 25 percent of people who have bipolar disorder are initially misdiagnosed with depression. Why does this occur? Because many people first go to their primary doctor for a diagnosis, and primary doctors do not always ask enough questions to make the proper diagnosis.

This can occur with mental health professionals who also fail to probe enough when a person presents with clinical depression in their office. An incorrect initial diagnosis can lead to incorrect treatment, such as the prescription of antidepressants. Generally, antidepressants are not used in the treatment of bipolar disorder, and in fact, can make the disorder worse in the person. So if you’ve ever had an episode of increased energy for no particular reason (not because you just drank a litre of Coke), make sure you share that information with your mental health professional.

Bipolar Disorder does not increase the risk of violent crime.

A study from Sweden’s Karolinska Institutet suggests that bipolar disorder – or manic-depressive disorder – does not increase the risk of committing violent crime. Instead, the over-representation of individuals with bipolar disorder in violent crime statistics is almost entirely attributable to concurrent substance abuse.

The public debate on violent crime usually assumes that violence in the mentally ill is a direct result of the perpetrator’s illness. Previous research has also suggested that patients with bipolar disorder – also known as manic-depressive disorder – are more likely to behave violently. However, it has been unclear if the violence is due to the bipolar disorder per se, or caused by other aspects of the individual’s personality or lifestyle.

The new study, carried out by researchers at Karolinska Institutet and Oxford University, is presented in the scientific journal Archives of General Psychiatry. Researchers compared the rate of violent crime in over 3,700 patients with bipolar disorder cared for in Swedish hospitals between 1973 and 2004 with that of 37,000 control individuals from the general public. 21% of patients with bipolar disorder and a concurrent diagnosis of severe substance abuse (alcohol or illegal drugs) were convicted of violent crimes, compared to 5% of those with bipolar disorder but without substance abuse, and 3% among general public control individuals.

The differences remained when accounting for age, gender, immigrant background, socio-economic status, and whether the most recent presentation of the bipolar disorder was manic or depressed. “Interestingly, this concurs with our group’s previous findings in schizophrenia, another serious psychiatric disorder, which found that individuals with schizophrenia are not more violent than members of the general public, provided there is no substance abuse,” says professor Niklas Långström, head of the Centre for Violence Prevention at Karolinska Institutet, and one of the researchers behind the study.

According to the researchers, the findings support the need for initiatives to prevent, identify and treat substance abuse when fighting violent crime. Additionally, Långström hopes that the results will help challenge overly simplistic explanations of the causes of violent crime. “Unwarranted fear and stigmatisation of mental illness increases the alienation of people with psychiatric disorder and makes them less inclined to seek the care they need”, Långström comments.

Publication: Bipolar disorder and violent crime: new evidence from population-based longitudinal studies and systematic review. 2010.

Causes of Bipolar Disorder

Why do we get bipolar disorder?

There are a number of factors that are believed to cause bipolar disorder. They include:

  • genetics
  • environmental factors
  • physical illnesses

For some people, the onset of bipolar disorder is linked to a stressful life event.

Genetic factors 

Bipolar disorder is frequently inherited, with genetic factors accounting for approximately 80% of the cause of the condition. Bipolar disorder is the most likely psychiatric disorder to be passed down from family. If one parent has bipolar disorder, there’s a 10% chance that their child will develop the illness. If both parents have bipolar disorder, the likelihood of their child developing bipolar disorder rises to 40%.

However, just because one family member has the illness does not mean that other family members will develop bipolar disorder.

We still need more research to fully understand the role of genetics in development of bipolar disorder.

Stressful life events

The onset of bipolar disorder can sometimes be linked to stressful life events.

People with bipolar disorder can find it beneficial to learn ways of managing and reducing stress as emotional pressure can trigger relapse.

Seasonal factors

While not a direct cause, seasonal factors appear to play a role in the onset of bipolar disorder, with the chance of onset increasing in spring.

The rapid increase in hours of bright sunshine is thought to trigger depression and mania by affecting the pineal gland.

Physical illness

Physical illness by itself is not a cause of bipolar disorder, but in some instances can cause symptoms that could be confused with mania or hypomania.

Some medications (such as steroids) and certain illicit stimulant drugs can also cause manic and hypomanic symptoms.

Substances

Antidepressants can trigger manic or hypomanic episodes in some people. It’s important to report any unusual symptoms to your prescribing doctor while on these medications.

Certain substances can lead to a high that resembles mania. These include:

  • drugs like cocaine, ecstasy and amphetamines
  • medicine for hormonal problems like prednisone or other corticosteroids
  • very large amounts of caffeine.

Pregnancy and perinatal period
Bipolar disorder can begin during pregnancy or after the birth of a baby. This might be a first episode, or a continuation or relapse of the condition.

Women who have previously experienced bipolar disorder or who have a family history of the condition are at an increased risk of an episode at this time.

It’s important to be aware of the early warning signs, and for family and friends to be aware of these symptoms.

There are special considerations that need to be made in treating bipolar disorder in pregnant and breastfeeding women. Some medications may be harmful to the developing baby, and careful management by a psychiatrist and other medical staff is needed at this time.

Always talk to your GP or a mental health professional if you are planning a pregnancy, or are pregnant and are experiencing symptoms of bipolar disorder.

Ongoing care during pregnancy and after birth is very important.

What can we do to recover from bipolar disorder?

When our mood swings are taking over the way we function in everyday life, it’s important to get help.

There are effective treatments for bipolar disorder, from medications to psychological therapies and lifestyle changes.

There are also lots of things you can do to help yourself. Often it’s a combination of things that help us get better, such as:

  • a well-informed team of health professionals you feel comfortable talking to
  • the right medical and psychological therapies
  • a wellbeing plan to keep you on track
  • support from family and friends
  • keeping up regular sleep, exercise and healthy eating
  • learning to recognise warning signs and triggers for relapse.