Bipolar disorder: Family history, triggering situations combine to worsen symptoms | Mental Health

In the extreme, bipolar disorder — formerly known as manic-depression — encompasses moods that can range from extremely energized behavior to sad and hopeless periods.

“People are much more aware of mental health these days, but they don’t always understand it,” said Michael Dicharry, M.D., assistant professor of clinical psychiatry for LSU.

“The word bipolar is thrown around a lot, particularly with kids in college, who may be going through finals. But, lack of sleep and trouble concentrating may lead to yo-yo moods … this is to be expected considering the stress.”

True bipolar disorder, which involves a chemical imbalance in the brain, is typically diagnosed during adolescence or early adulthood.

During mania, people may experience delusions of grandeur, may jump from topic to topic while speaking, and often can’t stop talking in an uninterrupted stream of consciousness, which, says Dicharry, makes others very uncomfortable. Severe manic symptoms may require hospitalization.

Depressive episodes can include feeling restless, sleeping too much, trouble concentrating and a lack of interest in almost all activities. Extreme episodes can involve feelings of worthlessness and even thoughts of suicide. Extreme moods on either end of the manic-depressive spectrum can result in psychosis.

Healthcare providers base diagnoses on symptoms and family history, not brain imaging, although newer research has indicated that the brains of those with bipolar disorder may exhibit differences from those without the disorder.

There’s a genetic component as well, but genes don’t tell the whole story.

“In identical twins, the incidence is only 50%, which means it’s not entirely genetic, and may also come from other genes, as well,” Dicharry said.

“It can be environmental, as well. A study which looked at Syrian refugees who had fled to Scandinavia after relentless bombings in Aleppo indicated increased rates of psychosis because of exposure to constant trauma. So, stress can induce a variety of mental disorders, even psychosis.”

Anti-manic meds

Most treatments for bipolar disorder involve classes of drugs known as anti-manic agents, anticonvulsants and atypical antipsychotics, which change the activity in the brain and stabilize mood.

All of these medications may have unpleasant side effects for some patients. In particular, some people object to the way these drugs flatten out their personalities, removing the very highs and lows.

However, psychiatrists agree that it’s important to weigh those effects against dangerous behavior caused by the disorder.

“Manic episodes can ruin your life,” Dicharry said. “A financial analyst with bipolar disorder gave away his entire 401K to the homeless, then traveled across the country to marry Taylor Swift. This sort of behavior just isn’t sustainable.”

Bipolar disorder is a lifelong illness, so it’s important that patients learn to manage their symptoms. Psychotherapy is important, and along with cognitive behavioral therapy, this includes the newer IPRST therapy, an acronym for interpersonal and social rhythm therapy. It aims to minimize disruptions to daily routines and rhythms since these changes can lead to disrupted sleep and an unstable mood in some people.

Another treatment option for those who have not improved with therapy or medication is ECT, or electroconvulsive therapy, a brain stimulation therapy that can help relieve severe symptoms of bipolar disorder. A seizure is induced while the patient is asleep.

“Most patients see improvements after two or three sessions, and after 12 sessions are cured,” Dicharry said. “There are some who need maintenance sessions … actor Carrie Fisher, who has spoken about this in her books, had ECT from the 1980’s into her older age.”

One of the biggest problems with treating bipolar disorder is non-compliance on the part of patients with their prescribed medications. Some patients who come off of their prescribed meds use alcohol or other drugs to self-medicate. But that can lead to addiction, because these patients, genetically, are more susceptible.

SIDEBAR: BIPOLAR DISORDER AND SUBSTANCE ABUSE

Mental health disorders and substance abuse can go hand in hand.

“Mental health disorders and substance abuse can co-exist because of common genetic factors or common susceptibilities,” said Ben Springgate, MD, PhD, Professor and Chief of Community Population Medicine at LSU Health.

“Dual disorders are not uncommon. Basically, someone with a mental health disorder is looking for a way to feel better when they are in a state of disarray from their illness.

“All medications have side effects beyond their intended use. This can change how the neurotransmitters work in the brain, and may make those with bipolar disorder feel uncomfortable with themselves when using their prescriptions.

“Perhaps it’s hard to sleep, or recall a name. They often look for alternatives.”

Springgate says those with bipolar disorder should be screened for substance abuse, as self-medicating with alcohol and illegal drugs is one of the coping mechanisms.

Stressful, triggering situations should be avoided. Individual or group therapy can help prevent addiction, especially support groups with others who have similar diagnoses.

As with other mental illnesses, people with bipolar disorder may also suffer from other disorders like anxiety or depression, increasing tendencies to self-medicate.

“It’s important to remember these are health problems, not moral failings,” Springgate said. “But, using street drugs now comes with a special danger in that many are laced with Fentanyl, which can be deadly.

“This is why it’s so important to find the right medication for all mental health disorders, that come with the fewest side effects, and are tolerated by the patients using them.”

To find local treatment services in your area, call the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Referral Helpline at 1-800-662-HELP (4357).