Bipolar Affective Disorder
Bipolar Affective DisorderBipolar affective disorder has been a mystery to scientists and physicians since the sixteenth century. The artist Vincent Van Gogh is the first documented case of the disorder, but since then, we have not learned much more about what causes the disease or even a cure for sufferers. The biggest hindrance to scientists is that there are so many symptoms, and they aren’t sure what the source is. Right now, approximately one percent of the population (three million people) in the United States is victim of the Bipolar disorder. “As of now, scientists have learned almost all that they know just from watching and interviewing their patients,” and although a cure is needed for sufferers to lead normal lives, no true cure has come along yet (Ramirez. 15).
Bipolar disorder typically most often begins during adolescence or early adulthood and continues throughout life. It is often not recognized as an illness and people who have it may suffer needlessly for years or even decades. This particular disorder is characterized by a variety of symptoms that can be broken into manic (excessive highs) and depressive (deep hopelessness) episodes with periods of normal mood in between. The manic episodes are characterized by discrete periods of: increased energy, activity, and restlessness; racing thoughts; rapid talking; excessive “high” or euphoric feelings; extreme irritability and distractibility; decreased need for sleep; unrealistic beliefs in one’s abilities and powers; uncharacteristically poor judgment; a
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sustained period of behavior that is different than usual; increased sexual drive; abuse of drugs (particularly cocaine, alcohol, and sleeping medications); provocative, intrusive, or aggressive behavior; and denial that anything is wrong (Griswald 7).
“Bipolar disorder is diagnosed if an episode of mania occurs whether depression has been diagnosed or not, but most commonly, individuals with manic episodes experience a period of depression” (Jamison 14). The depressive episodes are characterized by intense feelings of sadness and despair that can eventually grow into feelings of hopelessness and helplessness. Some of the symptoms of a depressive episode include: discrete periods of persistent sad, anxious, or empty feelings; mood swings; feelings of hopelessness or pessimism; feelings of guilt, worthlessness, or helplessness; loss of interest or pleasure in ordinary activities; decreased energy; a feeling of fatigue; difficulty concentrating, remembering, or making decisions; restlessness or irritability; sleep disturbances; loss of appetite and weight, or weight gain; chronic pain or other persistent bodily symptoms that are not caused by physical disease; anhedonia, psycomoter retardation; near inability to move; and thoughts of death or suicide (Griswald 8).
When both manic and depressive symptoms occur at the same time it is called a mixed episode. Those afflicted are at a special risk because there is a combination of hopelessness, agitation, and anxiety that makes them feel as if they “could jump out of their skin”(Ramirez 17). Up to 50% of all patients with mania have a mixture of depressed moods. Patients report feeling dysphoric, depressed, and unhappy; yet, they exhibit the energy associated with mania. Rapid cycling mania is another presentation of bipolar disorder. Mania may be present with four or more distinct episodes within a 12-month period. “There is now evidence to suggest that
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occasionally, rapid cycling may be a transient manifestation of the bipolar disorder” (Hochman 165).
It may be helpful to think of the various mood states in manic-depressive illness as a spectrum or continuous range. At one end is severe depression, which shades into moderate depression; then come mild and brief mood disturbances that many people call “the blues”; then normal mood; then hypomania (a mild form of mania); and then mania. Some people with untreated bipolar disorder have repeated depressions. In the other extreme, mania may be the
main problem and depression may occur only infrequently. In fact, symptoms of mania and depression may be mixed together in a single “mixed” bipolar state (Ramirez 17).
Many times bipolar patients report that the depressions are longer and increase in frequency as the individual ages. The stages of the bipolar disorder most often begin in patients between the ages of 18 and 24 years of age (Griswald 1), with a second peak in the mid-forties of women. Most individuals with the disorder experience their first mood episode in their 20’s. However, manic-depression quite often strikes teenagers and has been diagnosed in children under 12. A typical bipolar patient may experience eight to ten episodes in their lifetime. These episodes are life altering, and prohibit those afflicted with the disorder from leading normal lives. The National Depressive and Manic Depressive Association (MDMDA) has reported that the bipolar disorder can create substantial developmental delays, marital and family disruptions, occupational setbacks, and financial disasters (Griswald 1). Even more seriously, the risk of suicide among persons afflicted with bipolar illness is unrealistically high. In the past, as many as 1 in 5 people with the bipolar disorder have committed suicide in the United States. “This devastating disease causes disruptions of families, loss of jobs and millions of dollars in cost to
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society” (Fieve 58). Therefore, scientists are desperately searching for ways to alleviate symptoms, or even find a cure.
“A variety of medications are used to treat the bipolar (manic-depressive) disorder, but even with optimal medication treatment, many people with manic-depressive disorder do not achieve full remission of symptoms” (Jamison 125). Lithium has been the primary treatment of bipolar disorder since its introduction in the 1960’s. Its main function is to stabilize the cycling characteristic of bipolar disorder. “In four controlled studies by F. K. Goodwin and K. R. Jamison, the overall response rate for bipolar subjects treated with Lithium was 78%” (Jamison 254). Lithium is also the primary drug used for long- term maintenance of bipolar disorder. In a majority of bipolar patients, it lessens the duration, frequency, and severity of the episodes of both mania and depression. Unfortunately, as many as 40% of bipolar patients are either unresponsive to lithium or cannot tolerate the side effects of: thirst, weight gain, nausea, diarrhea, and edema. “Patients who are unresponsive to lithium treatment are often those who experience dysphoric mania, mixed states, or rapid cycling bipolar disorder” (Kirchner 3100).
One of the problems associated with lithium is the fact that long-term lithium treatment has been associated with decreased thyroid functioning in patients with bipolar disorder. Preliminary evidence also suggest that hypothyroidism may actually lead to rapid cycling. Pregnant women experience another problem associated with the use of lithium. Its use during pregnancy has been associated with birth defects, particularly Epstein’s anomaly. “Based on current data, the risk of a child with Epstein’s anomaly being born to a mother who took lithium during her first trimester of pregnancy is approximately 1 in 8,000, or 2.5 times that of the general population” (Hochman 245).
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There are other effective treatments for bipolar disorder that are used in cases where the patients cannot tolerate lithium or have been unresponsive to it in the past. The American Psychiatric Association’s guidelines suggest the next line of treatment to be Anticonvulsant drugs such as Valproate and Carbamazepine. These drugs are useful as antimanic agents, especially in those patients with mixed states. Both of these medications can be used in combination with lithium or in combination with each other. Valproate is especially helpful for patients who are lithium noncompliant, experience rapid cycling, or have alcohol or drug abuse (Kirchner 3101).
Neuroleptics such as haloperidol or chlorpromazine have also been used to help stabilize manic patients who are highly agitated or psychotic. Use of these drugs is often necessary because the response to them is rapid, but there are risks involved in their use. Because of the often-severe side effects, Benzodiazepines are often used in their place. “Benzodiazepines can achieve the same results as Neuroleptics for most patients in terms of rapid control of agitation and excitement, without the severe side effects” (Fieve 55).
Psychotherapy, in combination with medication, often can provide additional benefit. One such treatment is outpatient group psychotherapy. Dr. John Graves, spokesperson for The National Depressive and Manic Depressive Association, has called attention to the value of support groups, and challenged mental health professionals to take a more serious look at group therapy for the bipolar population. Research shows that group participation may help increase lithium compliance, decrease denial regarding the illness, and increase awareness of both external and internal stress factors leading to manic and depressive episodes. “Group therapy for patients with bipolar disorders responds to the need for support and reinforcement of medication
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management, and the need for education and support for the interpersonal difficulties that arise during the course of the disorder” (Griswold 1347).
More than two-thirds of people with manic-depressive disorder have at least one close relative with the illness or with unipolar major depression, indicating that the disease has a heritable component. Studies seeking to identify the genetic basis of manic-depressive disorder indicate that susceptibility stems from multiple genes. Despite tremendous research efforts, however, the specific genes involved have not yet been conclusively identified. 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 manic-depressive 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 (Jamison 52).
In addition to the mentioned medical treatments of bipolar disorder, there are several other options available to bipolar patients, most of which are used in conjunction with medicine. But there is no assurance that these medical measures will cure the patient in time. The one fact of which we are painfully aware is that bipolar disorder severely undermines its’ victims ability to obtain and maintain social and occupational success. Because bipolar disorder has such debilitating symptoms, it is imperative that we remain attentive in the quest for explanations of its causes and treatment.