by Harvey Widroe, M.D.
American Reporter Correspondent
August 1, 2007
ARE YOU BIPOLAR?
ORINDA, Calif. -- Because of increased media attention and pharmaceutical company advertising, more people than ever are coming now to see therapists or psychiatrists claiming they suffer from a bipolar illness.
For a fair number, the self-diagnosis is right on the money. And almost all of those with bipolar illness can benefit substantially from appropriate treatment.
Fred, a 52 year old married computer programmer, well-groomed and nicely dressed, sat just a few feet away from my desk. He had never seen a psychiatrist before. "I'm bipolar," was his response to my asking why he had come for treatment. He had recently read about bipolar illness in a magazine, and he realized the article was talking about him.
Bipolar disorder has enough subtypes to confuse anyone. One kind of bipolar disorder, known as Type I, not very long ago was called "manic depressive illness."
Fred thought he was a textbook case. He described long periods of depression characterized by marked apathy. In this phase of his illness he could barely get out of bed, and he tended to sleep ten or more hours a day. He faltered in basic self-care tasks like bathing, brushing his teeth, or getting dressed. He had little interest in anyone or anything. Although his life was miserable, he was not suicidal.
Depressive episodes in Type I bipolar illness can go on for many months, even as long as a year. Often people like Fred are misdiagnosed as suffering from pure depression, chronic fatigue, or work stress. The correct diagnosis may not be made for years until after the patient experiences a manic episode.
Unfortunately, those suffering from bipolar Type I depression do not easily respond to efforts at treatment, though over time they do improve, especially with aggressive treatment. When they finally recover from the depressive episode, their moods are stable. They function at a high level, experiencing normal variations of happiness or sadness, just like the rest of us. With continuing treatment, this normal state of affairs can go on indefinitely.
When a bipolar Type I patient experiences a manic episode, everyone around him knows it.
George had awakened with a jolt, as though he'd had an electric shock. He felt euphoric, and his thoughts raced in fifty different directions. Among them was the belief that he had been appointed by God to save the world. He began shouting at his wife and fled from the house. A few hours later his loud argumentative behavior led to his being arrested at the airport. He was transferred from police custody to a psychiatric hospital for treatment.
These manic episodes unpredictably appear overnight, like turning on a light switch. Even if untreated, the illness runs its course over a period of weeks, often leaving a patient's life in a shambles. However, if treated with mood-stabilizing medications early in the course of an episode, manic patients experience a significant degree of recovery in a period of days. While the severe symptoms can be controlled quickly, the impact of the manic episode is so shattering that it takes months for anyone to fully regain self confidence and self esteem.
Once Fred and George became symptom-free, they felt and acted normal.
Type II bipolar illness appears very different. The bipolar II patient has more frequent shifts in mood, often every few days or even several times a day. These mood shifts appear to be totally unrelated to anything going on in the patient's life. Type II bipolar illness may make it impossible for its victims to hold jobs, achieve academic or vocational success, or to maintain a healthy marriage.
Karen complained of her daily mood swings. How she could be very happy for a few hours, then abruptly and without cause shift to feeling depressed and tearful, angry and impulsive, and finally anguished and remorseful. It took little if anything to set off cascades of intense moods. She knew she was extra sensitive to perceived slights or minimal stress.
But why she suddenly felt giddy with joy and opted for a day-long shopping marathon, she couldn't explain. The kids could set her off for no reason other than acting like kids. Her poor husband wasn't perfect, but his minor imperfections at any given moment seemed like cause for divorce. He never knew which Karen was going to greet him: the cheerful exuberant wife or the wife who was irritable, explosive and depressed. She felt bad later about her outbursts, but still was unable to control her eruptions of intense feelings. Sometimes she wished she were dead, and occasionally thought of taking an over dose of pills or cutting her wrists, as she had once done in high school.
When she saw a tv show about bipolar illness, she thought she might be watching herself. Karen's psychotherapist didn't think much of the idea; the therapist explained that Karen's problems were a product of a stormy relationship with an emotionally volatile mother who "hadn't been there for her."
But when Karen didn't improve after almost a year of therapy, the frustrated therapist grudgingly gave in to the idea of Karen seeing a psychiatrist to evaluate the possibility of using medication.
When an antidepressant medication actually made Karen more agitated, she was reluctant to try anything else. But when she was prescribed a mood-stabilizing medication instead of an antidepressant, she experienced relief from ugly, intense feelings and achieved a sense of increased control of her actions.
Medication can help almost everyone with bipolar illness. Because there are a variety of medication possibilities, a psychiatrist should be consulted.
Lithium, once the only effective drug for the treatment of Type I bipolar disorder, does little for patients with Type II. The most helpful medications for the treatment of Type II bipolar patients are a group of mood stabilizing medications that were originally used to treat schizophrenia. Another class of mood stabilizers, initially developed to treat seizure disorders, may dampen mood swings in many patients suffering from Type II.
Patients with Type I depression respond to the aggressive use of energizing antidepressants, sometimes alone, sometimes in combination, or at other times with the addition of mood stabilizing medications. Occasionally antidepressants given without mood stabilizers can precipitate a sudden switch from a depressive to a manic state.
Type I manic patients benefit most quickly from large dosages of sedating mood-stabilizers, with decreases in dosage as the patient improves. Sometimes hospital care can be avoided altogether.
Bipolar illness cannot be definitively cured. But it can be controlled by the judicious use of medication. And patients suffering from bipolar illness may go on to lead more comfortable and more productive lives.
For Fred, George, Karen and the legion of others like them who have bipolar illness, the prospect for relief is now excellent. Harvey Widroe, a longtime practicing psychiatrist, is the author of the recently published, "The Smart Dieter's Guide to Cheating: Eat and Watch Pounds Melt Away," with Ron Kenner (Outskirts Press 2007).