Bipolar Disorder

The New York Times reports today that in the wake of serious budget problems, Alabama is debating plans to close its last four state hospitals for the mentally ill while retaining one for criminal suspects and one for geriatric patients.

Since the 1990s, says the Times reporter Robbie Brown, Alabama has already closed 10 other mental health treatment centers. In addition, financing for mental health services has been cut by 36%, and additional cuts of up to 25% are planned for 2013.

Brown adds, "Nearly all of the 524 other mentally ill patients will get treatment at group homes and community centers, which are less expensive and give them more freedom, state officials say."

Read More...

In the wake of Whitney Houston's sudden death by drowning on February 12, 2012, it's worth taking a look the life of her ex-husband, singer Bobby Brown.

The couple were married in 1992, but just the next year Bobby began to get into serious trouble with the law. Both Whitney and Bobby had drug problems and went through rehab. Bobby's career waned while hers accelerated.

Here's a biographical sketch of Bobby Brown, including a look at his bipolar behavior.

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The availability of psychiatric care took another hit Friday as Cedars-Sinai Medical Center in Los Angeles announced it is phasing out inpatient and outpatient care for the mentally ill. About 1,800 patients depend on Cedars-Sinai for outpatient counseling and medications. In addition, 51 acute-care beds will be lost.

At the bottom of the move is, as usual, finances. Cedars-Sinai says it will make $1.5 million in grants to local agencies to "ease the transition," but it won't ease anything for patients who will have a harder time finding treatment as funding keeps being cut to those same agencies, and they keep having to cut staff.

I received the following news release from Andy Behrman regarding a planned protest:

On Monday, February 13th, the National Alliance on Mental Illness/Los Angeles will gather to protest their outrage at Cedars-Sinai's decision to shut down both its in-patient and out-patient psychiatric care facilities. This will eliminate fifty-one beds that are critical to the community at a time when both city and county wide services are shrinking.

The purpose of OCCUPY CEDARS is not only Read More...

As I first reported in August, 2010, almost 3/4 of patients who were given intravenous ketamine in a small study had rapid relief from their treatment-resistant depression - the median time was just 40 minutes. This was a very small study, with 17 patients who received ketamine and 16 receiving placebo. But now formal clinical trials are being conducted to see whether ketamine, best known as the club drug "Special K," is safe and effective enough for use as an antidepressant.

However, it's important to know that:

• The average duration of relief was only a week, and

• Ketamine can have some strong psychological side effects.

In spite of the small group of patients in the original study, the results were strong enough to make headlines: 71% of those receiving ketamine had relief from depression, and only 1 in 16 of those receiving the placebo reported improvement. One in each group developed manic symptoms. Dissociative symptoms were the most common side effect and did not continue.

Read More...

Schizoaffective disorder is one of the least understood mental illnesses. Authorities differ on the description of the illness, and to make matters worse, the European and American definitions are quite a bit different.

In the US, patients with schizoaffective disorder have symptoms of both schizophrenia and bipolar disorder - but there is a lot more to it. Misdiagnosis is common, but fortunately, even when the condition isn't properly diagnosed, treatment may still be effective.

Read the best available information, what the problems in diagnosis are, and why treatment doesn't depend on the right diagnosis:

What Is Schizoaffective Disorder?.

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On our Main Forum, Drop-In Jane writes: "I was wondering, are any of you highly sensitive to noise? I'm moving, and part of the reason is that the walls here are paper-thin. I have a noisy neighbor who likes to have loud drinking parties until 4:00AM on the weekend.

"I'm too scared he'll 'Pacific Heights' me (retaliate) to call the cops. Seriously, i can hear them cough, sneeze and say the F-word over there. They holler when there's a touchdown, as well. I moved my bed into the living room just to get away from him. It's helped a lot for sleeping.

"I've been diagnosed with Chronic Post Traumatic Stress Disorder, so my sensitivity might come from that. I'm also bothered by noise on the bus, construction, alarms, loud music that i don't like and even raised voices. ...

"Going Bananas Because of Noise,

"Drop-In Jane."

The American Psychiatric Association is hard at work to produce the next version of the Diagnostic and Statistical Manual of Mental Disorders. One of the disorders that has changes proposed is Cyclothymia, a form of bipolar that comprises hypomanic episodes along with periods of depression that are not severe enough to meet the criteria for a major depressive episode.

In the current edition of the DSM, the presence of mixed episodes during the first two years of illness rules out a diagnosis of Cyclothymia. In the proposed new version, this exclusion has been removed. If this revision stands, a diagnosis of Cyclothymia With Mixed Features would be possible. "With Mixed Features" is an example of a specifier.

Other specifiers that could be applied to Cyclothymia under the new diagnostic guidelines would be:

• With Rapid Cycling
• With Anxiety, mild to severe
• With Suicide Risk Severity
• With Seasonal Pattern, and
• With Postpartum Onset

Learn More About Cyclothymia

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Here's part 2 of Bipolar for Beginners, a series designed to walk you through the basic information about bipolar disorder. Lesson 1, Introducing Bipolar Disorder, started you out with the most basic information: an explanation of what bipolar is along with definitions of terms that are essential to understanding the illness. Lesson 1 also debunks some of the common myths.

Lesson 2 covers what's known about the genetic component of mental disorders, theories regarding the relationship between stress and genetic susceptibility, and types of stresses that could bring on a bipolar episode. In addition, this lesson takes a look at the inner workings of nerves in the brain that are thought to affect moods. Finally, there's the story of a court decision legally confirming that bipolar disorder is not "all in your head."

Keep learning: Causes of Bipolar Disorder

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The window between the therapeutic dose of lithium and the toxic dose is almost vanishingly small. Differences in physiology may mean that what's the proper dose for one person is toxic for another.

If you or someone you care for is taking lithium for bipolar disorder, it's essential to know not just the symptoms of lithium intoxication, but also what circumstances are most likely to lead to it.

Lithium poisoning is no joke. When it's properly and promptly treated, most people recover with no aftereffects. But if it's not treated, or if treatment is delayed too long, it can have permanent consequences or lead to death. Read this vital information on Lithium Toxicity.

Photo: wonderferret / Flickr

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Bipolar depression expresses itself in dozens of ways. One group of symptoms comes under the heading of emotional pain - the sadness, guilt feelings, helplessness and other feelings that contribute to the misery of depression.

These symptoms aren't unique to bipolar depression or major depressive disorder by any means. Take a look at how this cluster of symptoms fits into the overall diagnosis of a bipolar depressive episode:

Emotional Pain in Bipolar Depression

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A new review published today in The Lancet found that in addition to the known potential for causing weight gain, taking lithium may increase the activity of the thyroid and parathyroid glands. Because of the increased risk for hyperparathyroidism, it is now recommended that doctors check blood calcium levels, an indicator for parathyroid activity, before beginning lithium therapy and periodically while the patient is taking lithium.

Lithium is a first-line treatment for bipolar disorder and may be used as add-on treatment for major depression.

The review found that patients taking lithium gained more weight than those taking a placebo, but less than those taking Zyprexa (olanzapine).

For more information:

• Lithium Drug Profile
• Hyperparathyroidism
• Hyperthyroidism

_{Source:
McKnight, R, et al. Lithium toxicity profile: a systematic review and meta-analysis. The Lancet. 20 Jan 2012}

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You might need this information in a compact form that guides you through the basic information about bipolar disorder because you're newly diagnosed. You might need it because someone in your family has been diagnosed, or you've just learned that a friend, someone you're dating, or someone you work with is bipolar. You might even be writing a term paper on bipolar disorder. No matter what the reason, you want to learn about BP from the ground up - so I've put together one page that will guide you through the first steps to knowledge.

This will be a series of walk-through pages, and by the time you've gone through them all, you'll have a strong understanding of what bipolar disorder is, the symptoms, the moods, the complexities and more. Watch this blog for the next in the series!

Get Started: Introducing Bipolar Disorder

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When a friend of mine suggested maybe I was "conditioned to depression," it was a revelation to me. This is not using "conditioned" in the formal psychological sense, mind you. It's more like being annoyed at having to put a heavy coat on when the weather first gets cold, but after awhile, you don't think about it any more. You're used to doing it.

In a similar way, the habits of depression can become so much a part of your life that you become used to them. When you're moving from a stable mood - particular if it's a low-level stable mood as can occur in Bipolar II - into the first stages of a depressed mood, you don't recognize that something is changing, because that state and the habits that go with it are so familiar that you're conditioned to them.

See if you recognize yourself: Are You Conditioned to Depression?

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In the December issue of the American Journal of Psychiatry is a report on a Dutch study regarding age of immigration and risk of future psychosis that has me scratching my head.

After gathering data for 7 years on immigrants who "made a first contact with a physician for a suspected psychotic disorder," the researchers looked at the age when those people migrated to the Netherlands. According to an article in the New York Times, they found that those who came from Suriname, the Netherlands Antilles, Turkey and Morocco, and who immigrated as infants and up to the age of four, had the highest incidence of psychosis in later life, Read More...

The Citizens Commission on Human Rights recently tweeted saying there is no genetic proof of mental illnesses. "Get the facts," they say, "about psychiatric diagnoses of mental illnesses. Learn about one of the biggest so-called medical scams in history."

The CCHR, which touts itself as being a "watchdog investigating and exposing psychiatric human rights violations," starts with the premise that psychiatry is evil and goes on from there. In this case, "getting the facts" turns out to mean "read three quotes from doctors." (One of these quotes starts out, "In fourty years...." Okay, I admit I automatically downgrade the credibility of anybody who can't even spell forty.)

In fact, there is plenty of evidence regarding the heritability of bipolar and other mental disorders. There is abundant proof specifically that there is genetic component to bipolar. Studies have shown, for example, that a child of parents who both have bipolar disorder has a 50-75% chance of developing bipolar as well - far beyond the norm.

Get the true information: The Heredity Factor in Bipolar Disorder

As for the CCHR's so-called information - this "Quick Fact" should be called a "Quack Fact."

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"Manic" comes from the ancient Greek word "mania" meaning madness - simple enough. "Depression" comes from the Latin "to press down" and, according to the Online Etymology Dictionary, was first used to describe a mood of dejection in the 15th century. Though the manic depressive condition was described millennia ago, the actual term "manic depression" came into being relatively recently, and "bipolar disorder" was suggested just 50 years later.

The change in name was an important step forward for both patients and those who treat them. Take a look at what happened:

Why Did Manic Depression Become Bipolar Disorder?

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The depressive side of bipolar disorder can express itself in many, many ways. One group of symptoms and behaviors comes under the heading of loss of energy and decreased activity. In this group are things like fatigue, lethargy, insomnia, hypersomnia and social withdrawal. Both the patient and his or her friends and family need to be able to recognize these symptoms. Some are easy to spot, while others are not.

In this article, I take a look at several ways the symptom group called "Changes in Activity or Energy Levels" can show up, with examples of each that will help you identify when a person with bipolar disorder is exhibiting these signs of depression.

Learn more about bipolar depression: Decreased Energy and Activity

Photo: Jason Nelms/Flickr

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Topamax is an anti-seizure and migraine medication, available at reduced cost as the generic topiramate, that is often prescribed as a mood stabilizer for bipolar disorder. Here is a profile of Topamax, including several major warnings, information about common side effects and use in pregnancy, and information on the subject that gets talked about most - whether it causes weight loss.

In-Depth Information: Topamax Drug Profile

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Depakote is a medication used to treat epilepsy and other seizure disorders, migraines, and bipolar disorder, where it acts as a mood stabilizer for people who have manic, hypomanic and mixed episodes. It is also sold as Depakene. Generic versions are sodium valproate, divalproex sodium and valproic acid.

Read about available forms of Depakote, major warnings, common side effects, precautions, important drug interactions and usage in pregnancy and nursing.

Depakote Drug Profile

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Hypomania may not have the most severe symptoms of mania, but it's still a serious condition that needs treatment. Many of the symptoms of the two conditions are the same and can have profound consequences. The most obvious examples of these are hypersexual behavior and out-of-control spending. Things like poor impulse control, speaking so fast you can't be understood, making commitments you can't keep because you feel so energetic now - all of these may change people's perceptions of you forever. Imagine using obscene language while you talk to everyone up to the bishop's wife at a church dinner - you can't see it's inappropriate, you think it's funny, but the damage done to your reputation might last for years or decades.

And here's something I'll bet you never thought about: people with Bipolar I Disorder can have hypomanic episodes, too. For these people, not every "up" episode is so severe as to qualify as mania.

Information in depth: What Is Hypomania? How Is It Diagnosed?

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Dark and bright, smile and frown, laugh and cry, comedy and tragedy - the contrasts of human emotions have been staples of philosophy and poetry, literature and theater, throughout the history of mankind. And within those contrasts, "manic depression" was identified at least as far back as the 2nd century AD.

But bipolar disorder is more than manic depression. The spectrum of bipolar disorders encompasses a variety of symptoms that shade the range of moods between the two extremes.

From darkest black through shades of grey to muted tones and up to flamboyant scarlet, sapphire blue, royal purple and the other richest, most vivid colors, the forms and moods of bipolar disorder encompass the entire spectrum of light and of human experience.

And with that in mind, I've put together a comprehensive reference to the bipolar disorders - prose rather than poetry, I admit, but still a handy resource.

_{Photo: Stockbyte / Getty Images}

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From my friend Andy "Electroboy" Behrman comes a thoughtful and thought-provoking essay on the journey through life with bipolar disorder. Is there truly such a thing, he's been asked, as "recovery" from mental illness, or is apparent recovery just a matter of good coping skills? "After more than 20 years of ping-ponging between the two frightening emotional states of euphoric highs and desperate lows," Andy says, "I'm pretty sure I've come up with my answer to this challenging question."

Andy's been through it all, both before and after diagnosis. Uncontrolled mania resulted in his arrest for art forgery. Treatment resistance led him to electroconvulsive therapy. He went through years of experimenting with medications to get the best combination. And he's gone from male stripper to a volunteer at his children's school.

Now he's written - exclusively for About Bipolar Disorder - an extraordinary look into what "recovery" means and the relationship between "you" and "your mental illness." I found reading it extremely rewarding. I hope you do, too.

Mental Health Recovery - A Personal Perspective, by Andy Behrman

_{Photo Courtesy of Andy Behrman, by Dummit Photography}

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ShareCare has chosen the Top 10 Online Influencers making a difference in the world of depression, and I'm on their list. Since 1998 I've been working to help people who have bipolar disorder, including, of course, those who must cope with bipolar depression. I'm greatly honored to be recognized by ShareCare!

I'm also proud to be associated with the others on ShareCare's list, which includes Nancy Schimelpfenig of About.com's Depression website - congratulations, Nancy! - along with eight other bloggers and writers who all work as mental health advocates. ShareCare describes us as those who "who help millions of people cope with their depression every month."

Thank you to all my readers who have been listening, asking questions and sharing the answers this year. I owe this award to you.

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A massive Danish study that followed over 120,000 women who were born over a 40-year period has yielded interesting information: that the first appearance of any psychiatric illness after childbirth can ultimately result in a diagnosis of bipolar disorder. The study is "Psychiatric Disorders With Postpartum Onset: Possible Early Manifestations of Bipolar Affective Disorders" (abstract).

They began by following a large group of women beginning with the first time they had inpatient or outpatient treatment for any mental disorder except bipolar disorder, including 2,870 whose first psychiatric contact occurred within 12 months after giving birth. They found that after 15 years, 14% of the women whose first treatment was within 30 days after the birth of a child were later diagnosed with bipolar disorder, compared to just 4% of those whose first psychiatric treatment was not related to childbirth.

Other studies have already found that about episodes of postpartum psychosis, which can be a very serious condition, are strongly linked to bipolar disorder. The reverse is true as well - women already diagnosed with bipolar disorder have a higher risk than others of suffering from postpartum depression or psychosis.

More research is needed to establish the reasons for the connection between childbirth and a subsequent diagnosis of bipolar disorder, but this study and others make it clear that it's important for women to treatment for any unusual mental symptoms occurring within a year, and especially within a month, after a child is born.

Photo: Nasirkhan

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These two updated resource list the common to rare side effects of Paxil (generic paroxetine) and Xanax (generic alprazolam). The two articles also inform you about the symptoms of withdrawal and overdose for these drugs, and which side effects and symptoms mean you urgently need to contact a doctor.

Paxil is an antidepressant in the SSRI class, and Xanax is an anti-anxiety medication, one of the benzodiazepines.

• Paxil / Paroxetine Side Effects
• Xanax / Alprazolam Side Effects

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