Bipolar disorder, what used to be called manic depression, directly affects between 5 percent and 8 percent of the population. This is not a small group and, considering how disruptive bipolar disorder is to the lives of those who suffer from it, as well as those who live with and love them, it's a good thing we're making meaningful progress toward identifying the causes of and treatments for it.
A genetic basis
There is a strong genetic component in BD, since 50 percent of people with the syndrome have relatives with similar mood fluctuations. Among identical twins the concordance rate is between 60 percent and80 percent, among fraternal twins, only 20 percent. If both parents have the disorder, their child's chance of developing it is 75 percent.
But finding the genetic basis is not simple. No single gene appears to be the culprit. It probably involves combinations of genes or chromosomes in interaction. And this appears to vary from family to family.
There are two main patterns of BD. Bipolar I is the most familiar, typified by months-long periods of depression and mania separated by periods of normal mood.
Bipolar II is harder to diagnose because the manic phase is less pronounced and more easily denied or disguised, since it's less dramatic. This type of bipolar illness is often misdiagnosed as uni-polar depression and treated inappropriately.
Some people cycle faster between moods or, worst of all, endure a mixed state of agitated depression. It's not hard to imagine the torture involved in a hyperactive state of despondency. Suicide is a very real risk, especially with this symptom pattern.
A final group includes those with less obvious and dramatic mood swings who, while never losing their grip on reality, nevertheless cycle from despondency and lethargy to optimism and engagement, all for biological reasons.
Usually diagnosed in young adults, symptoms can appear much earlier. In fact, because BD in children resembles ADHD (hyperactivity, distractibility and impulsiveness), it is sometimes diagnosed as such.
The good news, apart from the progress being made in genetic research, is that BD is readily treatable with good success using the appropriate drugs. Mania and depression are associated with over-or under activity of neural responses in the brain, specifically in the frontal cortex, the amygdala and the hippocampus.
All of the drugs used to treat this condition affect neural transmission by norepinephrine, serotonin or both. The most common drug used is Lithium carbonate, often used in combination with an anticonvulsant like Depakote and Neurontin, not because of any fear of convulsions, but simply because these drugs have proven to be effective mood stabilizers.
Sometimes anti-convulsants are used alone or in combination with an antidepressant or tranquilizer given for immediate calming and removed soon after.
One of the most difficult challenges in treatment is getting the individual to take the medications.
Taken correctly, mood stabilizers can suppress mood swings, sometimes completely, for years. But they have side effects that can be unpleasant. Also, a manic patient may be hesitant to give up the euphoric state of boundless energy and creativity they feel when on the upswing. A depressed person often just doesn't care.
Both depression and mania are difficult for family members to live with. Consequently, bipolar patients tend to have strained relationships, which can make their lives even less stable.
For this reason, and also because a more closely regulated and planned life can help eliminate cyclical mood swings, family psychotherapy is indicated in addition to medication management.
Those interested in further information can call theDepression and Bipolar Support Alliance at (800) 826-3632) or visit the Web site www.dbsalliance.org.
Hugh R. Leavell has been a marriage and family therapist in Palm Beach County for 18 years. He offers free seminars on couples communication and conflict management. Call him at (561) 471-0067 or visit his Web site www.oneminutetherapist.com.