Bipolar Disorder

A newly published study says that having a bipolar parent increases the everyday level of a key stress hormone. This might seem like a no-brainer, but in fact the study results are more interesting than that. For one thing, they weren't looking at young children, but at offspring between the ages of 14 and 28, so many of the study participants were not actually living with the bipolar parent any more - yet the stress effect continued.

"Previous research has shown that children of parents with bipolar disorder are four times as likely to develop mood disorders as those from parents without the condition," said the senior author Dr. Mark Ellenbogen. "The goal of our study was to determine how this is happening."

They already knew that high levels of the stress hormone cortisol often occur in people who later develop bipolar disorder - and that high stress levels can contribute to developing BP. What they found out in this study is that people with a bipolar parent react to both low-level and high-level stress by producing more cortisol than those with the same stress level but no bipolar parent.

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For people who can't work because of their bipolar disorder, Social Security Disability payments can make an enormous difference. Though the application process isn't easy, and getting approval can take a long time (if it is approved at all), it's worth the effort to those who need that income.

But if after going through all that you find people you know looking down on you because you're "mooching off the government," as one person mentioned, what are you to do? Our forum members discussed the question of whether - and how - to tell people where your income comes from if you are on SSDI.

• Talking About Disability for a Mental Illness

Angela sent in this photo from Andalucia, Spain (Andalusia is the English spelling) that she says illustrates the balancing act she tries to do between mania and depression. I've placed it in the "Images of Depression" series because of its somber coloring.

• Andalucia - Balancing Bipolar

Submit your own image of depression
Submit your own image of mania or hypomania

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Jane has sent in a picture that, she says, is all about how bipolar hypomania affects her. When you read what she has to say about it, I think you'll agree that she is, as she says herself, "kooky."

• Jane's Shorn Head

Submit your own image of mania or hypomania
Submit your own image of depression

Next in the "Images of Bipolar Depression" series comes the photo "Unexpected Messenger." This poignant story from a woman who had lost her daughter in an auto accident will tug at your heart, as well as illustrating how a single moment can help a person cope with a depressive episode - this one coinciding with grief.

• Unexpected Messenger

Submit your own image of depression
Submit your own image of mania or hypomania

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I came across a wonderful article today by Hilary Smith called "Five Myths About a Bipolar Diagnosis." Smith, the author of Welcome to the Jungle: Everything You Ever Wanted to Know about Bipolar but Were Too Freaked Out to Ask, starts out with something that a lot of people don't realize: that having bipolar disorder doesn't necessarily mean you're either hypo/manic or depressed all the time. Periods of stability occur and can last a long time, especially when you and your doctor have found the right mix of medications.

Smith lists four other common myths and ends by saying people with bipolar disorder "can have happy, productive, meaningful, awesome lives. Yes, the awesomeness will be interspersed with periods of depression and mania, but that's just how they roll."

There are a lot of myths and misunderstandings out there - I call them "mythunderstandings." When I wrote about my own experience with a supervisor who apparently didn't even understand the concept of mental illness, I also asked you to send in your encounters with myths and stigma. Do you have a story to share? There's a link at the bottom of my article where you can submit it for publication.

I want to thank Hilary Smith for this wonderful article. I hope it gets read by lots and lots of people who have misconceptions about the lives of people who have bipolar.

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It's well known that atypical antipsychotics (AAPs) such as Zyprexa and Seroquel cause weight gain. The prescribing information for all AAPs contains warnings that blood sugar should be monitored because this weight gain can be associated with diabetes, particularly in people with existing risk factors.

I had those risk factors - diabetes is prevalent in my family history. From various psychiatric medications, including Seroquel, I gained a total of 80 pounds (to 205 pounds) and weighed 190 when I became concerned about my blood sugar and contacted my doctor. Sure enough, I had developed diabetes. The doctor started me on a medication called Metformin (glucophage). Within two months I dropped 10 pounds (though have now hit a plateau at 180, still 35-45 pounds over my goal weight).

A study was published in the Journal of Clinical Psychiatry looking at the effect of Metformin on weight, body measurements and insulin resistance in patients taking AAPs. Researchers reviewed 6 existing studies. They found that while there was no significant reduction in the risk of diabetes, Metformin significantly reduced weight, body mass index (BMI), waist circumference and insulin resistance compared to placebo.

They concluded that while more studies are needed, the "available data support consideration of this intervention in clinical practice."

Does this mean everyone who has gained weight from taking one of the atypical antipsychotics should be put on Metformin? No, of course not. It does mean that those patients should be monitored by having blood glucose and insulin resistance measured periodically (possibly including A1c testing), BMI calculated, and weight and waist measurements recorded. Both your psychiatrist and primary care physician should know all your risk factors for diabetes.

I can't stress this enough. My diabetes was preventable. Yours might be, too.

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Bipolar 1 disorder with psychotic features and schizophrenia have psychosis in common, but there are no mood swings in schizophrenia. Add schizoaffective disorder - where there are mood swings and psychotic episodes but not at the same time, and it gets even more complicated.

It doesn't help that the news media frequently get it wrong. I saw a news report where a man was described as having "bipolar disorder and depression." What sense does that make? And more than once I have seen news stories that say someone suffered from "bipolar disorder and schizophrenia," which could be bipolar 1 disorder or schizoaffective disorder. Where are they getting these things?

A recent study looked at brain function in people with bipolar disorder or schizophrenia plus a control group with no mental illness. Participants performed tasks learning face/name pairs while magnetic resonance imaging (MRI) was carried out.

The MRI results were quite different in each group. Different areas of the brain showed decreased, impaired, or greater activation during various phases of the task between all three groups, and there were distinctive differences between participants with bipolar disorder and those with schizophrenia. The researchers concluded that "[t]he results demonstrate that these disorders can distinguished at a group level using non-invasive neuroimaging."

I hope this type of testing will be carried out including patients with schizoaffective disorder. Could such tests become diagnostic tools? There isn't enough data yet, but it's certainly something that will be studied in the future.

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Two weeks ago I introduced a new feature series, "Images of Depression" with my own photo of unopened mail, a picture that is representative of what happens to me during a depressive episode.

Have you run into the word "tetchy" before? If not, it has pretty much the same meaning as "crotchety," although the latter is generally applied to elderly people. If you're still clueless, you'll get the answer in the first of our reader images, "Tetchy Tree" by an artist using the name Maxminmean. The painting illuminates a complex state of mind that the artist experiences.

See the full picture and Maxminmean's description and commentary. You're invited to comment on the picture using this blog.

• Tetchy Tree

You have bipolar disorder, and so did your mother and her father, plus other relatives. You're worried about whether your child will inherit bipolar disorder. Will a specialized eye exam someday be able to help predict whether your child will develop BP? A 2010 study reported in the journal Biological Psychiatry suggests that this may be possible.

At the back of the eye is the retina, which contains two types of light sensors called rods and cones. Rods see black and white and are important for sight in low light conditions and for peripheral vision. Cones see color. Although researchers already knew that retinal anomalies were detected in people diagnosed with bipolar disorder and schizophrenia, the effects of the illness and use of medication for it made those findings no good for research purposes.

In this study, researchers examined the retinas of healthy young adults who were at high risk for developing BP or schizophrenia and compared them with a control group whose families did not have a history of those illnesses. They found that in the high risk group, the ability of light to activate the rods was significantly reduced. There was no difference in the cones' responses between the two groups.

The identification of a possible new biomarker for BP is exciting. The study's authors concluded that this particular response of the retina's rods may be an "early and specific biomarker of risk" that may help in future genetic testing and prevention research.

Does a diminished response of the rods lead to perceptual problems in BP and schizophrenia? It's possible. DNA quoted Dr. John Krystal, editor of Biological Psychiatry, as saying, "It is important to appreciate that for schizophrenia and bipolar disorder, as for colour-blindness or selective hearing loss, people who appear to perceive the world normally may actually have subtle but important problems with perception, which may contribute to other adaptive impairments." Do you think this relates to you?
~Marcia

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Neena, a reader at the About Bipolar Disorder Facebook page, asked this question:

"How do you get your family to understand? They won't even read anything about it. They think I rely on my meds, even though I tell them that they would not be able to live with me without my meds."

It's tough when family members refuse to educate themselves or listen. The resources here can be valuable - if the family members will at least listen or read the articles. Some of them are:

• How to Explain Bipolar Disorder to Others
• What Is Bipolar Disorder?
• When to Call the Psychiatrist
• How Family Can Help

But if they won't listen, won't read even if you print out and hand them the articles - what then? Many years ago a social worker told me, "If others always do the same thing in a given circumstance, you can't change their behavior - you can only change your own." I found this to be invaluable. So Neena, you might stop and look at what happens right before they give you this negative response. Is what you did something you do or say frequently? Is there another way to do or say it, or is it just unproductive to do it at all?

If you aren't doing or saying anything that brings on this repeating negative behavior, are you always reacting the same way, and does that reaction feed into the negative cycle, and if so, can you change your reaction to something more positive?

I'm not saying it's easy. You have to examine each incident and look for similarities in your own behavior, then think about how you can change it.

If you have ideas for how Neena can get her family to understand her illness better, please leave a comment.

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Psychiatrist Dr. Peter Breggin is an outspoken critic of "biological" psychiatry - the use of psychiatric medications. As someone who knows the value of psychiatric drugs both personally and from this site's thousands of readers and community members, I seldom read Dr. Breggin's writings. Today I did read his blog entitled Our Psychiatric Civilization, I was surprised that I found a few grains of truth in what he had to say. However, his initial paragraph illustrating the "horrors" of psychiatric drugs is pure scare tactic:

[This week] I evaluated a malpractice case involving a woman on the West Coast whose family doctor from a decade earlier kept prescribing Prozac to her for ten years without ever seeing her again. When she ran into emotional difficulty, she called this doctor who simply raised the dose and added a new drug, still without seeing her for a decade. This woman, a respected professional and parent in her community, then landed in a hospital where her adverse drug reaction was mistaken for a mental illness, more psychiatric drugs were added, and she soon killed herself...

I'd be curious as to how this malpractice suit comes out. While certainly a doctor - especially one in family practice - ought to know better than to continue renewing prescriptions for a patient he or she hasn't seen in ten years, it's hard for me to imagine why anyone would continue taking a drug - for ten years - from a doctor she no longer visited. And then to call that same doctor for more assistance? Do any of you do that - renew prescriptions from a former doctor for more than the few months it usually takes to find a new one (for example, if you move, as I did 18 months ago). Or call up a former doctor after a few years about a new problem?

We know nothing about the circumstances except those that Dr. Breggin chose to present, which makes it impossible to evaluate the true situation. My criticism is of what he did write - putting all the blame on the medical and psychiatric profession when by any standard the woman herself, based on the information given, was extremely irresponsible herself. In addition, I don't think that this kind of situation happens frequently.

Depending on old prescriptions is dangerous. Not only do your personal circumstances and stresses change, but over time your body and mind can respond differently to medications you've been taking for some time. Some antipsychotics, for example, can have side effects that don't show up immediately but can be dangerous when they do. An example is tardive dyskinesia, which can also be a long-term side effect of other psychiatric drugs - including Prozac. Antipsychotics also may lead to extrapyramidal side effects.

Am I right or wrong that this is a rare situation? If you are depending on one or more old prescriptions from former doctors, be honest in your comments and tell why you are doing so. And then, please, do something about it right away.

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There's no question that religious beliefs can give people with serious mental disorders comfort and strength. You have only to look through message threads on my forums to find many members who feel their faith sustains them.

Yet at the same time, religious delusions, according to Dr. H.G. Koenig, occur in a third of all psychoses, and these can cause severe problems. "God doesn't want me to wear shoes" might only be an indicator - until the patient ends up with severe frostbite, when it has to be taken more seriously. "God wants me to kill my sister" is obviously cause for immediate action.

Interestingly, international studies have found that the US has the highest percentage of religious delusions, and that Christians have a much higher percentage than any other religion.

What does this mean for patients, and how does it affect doctors? For information in depth, read: Religious Factors in Bipolar Disorder

Image from a picture on Free Stock Photos.biz

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A reader says: "I was manic a few months back, and I had many weird and strange beliefs. One was it was the end of the world, another that the moon was going to fall, and another it was the rapture and Jesus was coming. I really believed in them all, and now since I'm back to earth and reality, I am really confused about everything I've been taught in church. Has anyone felt as I did, leading to confusion about what you've been taught?"

One of the possible symptoms of mania is increased religious zeal and/or involvement. One study of patients with schizophrenia found that 24% of the subjects had religious delusions, and those that did appeared to be more severely ill than those who did not. Another study found that one-third of patients with psychosis, including patients with bipolar disorder, had religious delusions. Still another concluded, "Religious delusion is among the central symptoms of severe psychotic disorders such as schizophrenia, schizoaffective, and bipolar disorder at the acute phase."

So if you've had a religious experience during mania, you're not alone. Did you, like the reader above, find yourself confused about your beliefs afterward?

Read more on religion and mental illness: The Bible Supports Mental Illness Treatment

_{Photo: Billy Frank Alexander}

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The next time someone gets on your case about letting things slide when you're depressed, perhaps showing him or her in a picture rather then trying to explain it in words will get your message across. In my current bipolar depressive episode, I've been letting mail pile up for a good six weeks.

The result so far isn't catastrophic, but it could be if I don't get moving on it faster than I have as of today. There are medical bills from a hospitalization in January in the backed-up mail, and it'll be April in two days.

• Full image and full story: Image of Depression: Unopened Mail
  You will also be able to submit your own images and your story of how it illustrates a facet of your bipolar depression.

If this could be you - you're certainly not alone.

One of the most important things I know about the mood stabilizer Lamictal, and its generic version lamotrigine, is that in either form, it TASTES TERRIBLE. Well, yes, that IS important, especially if you're one of those unlucky people who has trouble taking pills, but there's much more you need to know about this medication.

Top of the list of essential knowledge about lamotrigine is that it can cause a very dangerous rash, and what you should do if rash symptoms appear. Lucky for you, I have put together information on this topic and many others, including not just the basics but side effects, warnings, withdrawal and more:

• Lamictal and Lamotrigine - Comprehensive Information

By the way, one thing I found about the taste of Lamictal - tomato juice and other tomato-based drinks like V8 make the taste worse if you don't get the whole pill down in one try. At least the generic lamotrigine's shape is a bit easier to swallow than the brand.

I can just imagine some pharmaceutical researcher coming up with a new antipsychotic medication, some years ago, and saying, "Wait, this isn't like all the existing drugs for psychosis - we'll call it 'atypical.' How does that sound?"

Researcher #2 replies, "But then what do we call all the existing medications, then?" And Researcher #1 says, "Well, we'll have to call them 'typical,' I guess."

There's really nothing more to the name "typical" for these antipsychotic drugs than that: they were already around when the atypicals were being developed. "First generation" and "second generation" would have been a lot clearer and a lot more useful - and what the heck will they call third generation drugs, if and when they are developed?

Before I ever started looking into bipolar medications, I learned the name of one of these drugs from television. It was, er, typical for emergency room doctors to call out for Haldol to help subdue a refractory or otherwise overactive patient. (Nowadays they say "haloperidol," the generic name for Haldol, instead.) Occasionally medical shows mention Thorazine or Stelazine, but there are several others you probably have never heard of.

• Learn more about Typical Antipsychotics, as a group and individually, including their side effects.

I have had especially vivid dreams all my life. The most common are dreams where I'm walking through the new house I've moved into - I could describe to you in detail every room, all the furniture, all the people I meet. The other recurring theme in my dreams is falling, or fear of falling - often in an elevator where the floor begins to peel away from the walls and flap like a rubber mat. And in fact, people with bipolar disorder are more likely than others to experience exceptionally vivid dreams and nightmares. And although night terrors are much more common in children than adults, adults with bipolar are far more likely than other adults to experience these. Bipolar Disorder and Dreams takes a look at the phenomenon of vivid dreams in bipolar disorder. Nightmares and Night Terrors discusses these issues as they affect both children and adults with bipolar disorder.

Do you have especially vivid dreams, nightmares, or night terrors? Share your dream stories and read about others' bipolar dreams.

_{Photo: Daniel Mohorovic}

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One of our community members who goes by the colorful and descriptive name of Manic Carousel recently posted in our forum about being in a "mixed state." Crying one minute, energetic and focused an hour later, then spending a long time in bed, then recklessly shopping - she was miserable.

I have to be careful not to call this a "mixed episode" because only her doctor can diagnose that condition. Certainly, though, she's right that she's got symptoms of both hypomania and depression.

Others who replied to her post sympathized, some saying they knew just what she meant. One of those was a community member with the equally colorful nickname of Doo Lally Tap, who described the mixed state she'd recently been through with the conglomeration of feelings you saw up above.

Take a look at Manic Carousel's symptoms and activities in:

• Living in a Bipolar Mixed State

and see if you recognize the situation as something you have experienced or are going through now - not necessarily the exact same juxtaposition of symptoms, but the existence of both manic/hypomanic and depressive symptoms. Whenever you find yourself feeling and acting in such a disjointed way, it's a good idea to talk to your doctor about it.

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Prior to working here, my only experience with panic attacks came from a long-ago friend who "had" them at very convenient times - for her. Usually it was when she wanted me to do something I didn't want to do. (I got stuck with the most obnoxious cat I ever owned that way.) As you can imagine, this was a pretty negative introduction to the subject for me.

But over the years I've been at About Bipolar Disorder, I've learned the truth about panic disorder and just how serious and debilitating panic attacks are.

Recently I asked my Facebook community to tell me some of the things they needed to know more about regarding bipolar disorder. A number of them asked about dealing with their panic attacks. Since anxiety disorders are quite common in people with bipolar disorder, this isn't surprising.

Often called anxiety attacks, these sudden feelings of fear or terror, usually accompanied by physical symptoms such as having trouble breathing, are extremely debilitating. So I've scoured About.com for resources that will help people cope with panic attacks, from treating them to helping prevent them.

• Coping With Panic Attacks in Bipolar Disorder

If you're mildly depressed, or feel like you're coming out of a depression, there are plenty of ways to sabotage yourself. I've put together 6 ways you can make yourself feel worse with very little effort.

Okay, of course I'm not really saying you should do these things. The point is, you may already be doing some of them and not thinking about the effect these actions - or non-actions - are having on you.

So in hopes that awareness can increase your ability to avoid these behaviors, I offer you:

• Act Depressed and You'll Feel Depressed - 6 Ways to Increase Your Depression

Image adapted from a photo by o5con / Flickr

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A community member said she always thinks people are talking about her and laughing at her. She believes people are scheming against her. "They're out to get me!" Is this, she asked, part of having bipolar? Do others experience the same thing?

Yes, paranoia can be a symptom of bipolar disorder, either during mania (but not hypomania) or during depression. The experience is called having paranoid delusions. Here's a great deal of information about paranoid delusions:

What Is Paranoia?

If you do have bipolar, you know what angers you, so I hope this collection of ten infuriating but all too common things people say will be of use to you - show it to the offenders!

If you don't, but know someone who does, see if you're guilty. These are always counterproductive. Just two of the sayings listed are "Everybody has mood swings" and "You're psycho!" For each item in the list, I've explained what's wrong. Please take these lessons to heart!

Here's the list: 10 Infuriating Things NOT to Say to Someone With Bipolar

And what about other medical and health issues? There are both things not to say and things not to do. Running Guide Christine Luff has put together a powerful page from Health and Wellness sites here on About.com listing "Things Not to Say" on all sorts of issues: What Not to Say!

And take a look at Social Anxiety Disorders Guide Arlin Cuncic's comprehensive list of "10 Things Not to Do" for everything from weight loss and exercise to back pain, cancers, stress and a whole lot more:

10 Things to Stop Doing and Improve Your Health

Image: John Giustina / Getty Images

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The Diagnostic and Statistical Manual of Mental Disorders is just a book your psychiatrist has to have, right? Well, not so fast. That book sets the official criteria for diagnosing a mental illness AND gives the codes your doctor has to use to communicate with insurance companies and other medical and psychiatric personnel and facilities.

All medical conditions have codes, mental or physical. For example, when I was hospitalized for ischemic colitis, it wasn't enough for the hospital to tell the insurance company that's what I had - they had to transmit the proper code for my condition in order for my insurance to be activated. And the DSM is where the codes for mental illnesses are set.

One of the telling differences between the fourth edition - DSM-IV - and the new edition, the DSM-5, is that the definition of "mixed episodes" is gone, replaced by the designation "with mixed features," which can apply to depressive, manic, or hypomanic episodes. In the DSM-IV, the presence of mixed episodes ruled out a diagnosis of Bipolar II.

Changes like this are why you should care about the new DSM-5.

Photo: Dave Dugdale / Flickr

This is one of my most popular blogs ever, so it's time to bring it to everyone's attention again.

On the About Bipolar Disorder Facebook page, a fan named Laurie asked this question:

"I would like to know if anybody else engages in avoidance behavior by not doing things that NEED to be done but instead doing any and every or nothing else. My bedroom has been a mess for 2 months. What's up with that? I have 2 lousy bills to pay. I just don't pay them. Why?"

My own response was, "I find that if I have one job I dislike on my to-do list, I wind up not tackling the list at all. I used to have 'clean cat boxes' near the end of the list, and then I'd not get that far and forget. So I put it near the top of the list, and since it's an icky job, I still haven't started the list yet."

Fan Wendy said, "I am the same way. I just keep putting everything off until i have no choice but to deal with it then i get overwhelmed by it. "

Maureen's reply is, "Yes, its a bad habit of mine - I put them off until my anxiety forces me to do something. It's as if I am waiting for good old hypomania to visit and do it all for me, but my p-doc won't let me do that!"

Michelle commented, "Wow...you all need to stop talking about me. "

What about you?

Photo by Marcia Purse ©2013

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