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New perspectives on bipolar disease

April 09, 2002|BY NILES BERNICK

Harry was beside himself. After five years in a comfortable marriage, his wife Amanda started to act strangely. She would withdraw from everything for weeks at a time, just sitting in the dark and avoiding people.

Once she became so despondent that she tried to commit suicide by cutting her wrists. Then she would suddenly snap out of it and for several weeks would run around the house puttering, doing much but accomplishing little, talking incessantly, and sleeping only a few hours each night yet claiming to feel great.

Several times she went on wild shopping binges, running up huge bills. Her mood swings were extreme, from deep depression to bubbly elation with periods of normal mood in between. During her "up" or manic moods, she was irritable and couldn't get along with anyone. This strange cycle would repeat every month or two but the mood swings grew more intense each time. Harry didn't know what to do.

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Brian was a bright, active toddler, the pride of his parents. Brian was always a demanding child, but the time he reached his 10th birthday his behavior started to be a problem. Everything had to be done his way. He would have a tantrum when his routine was disrupted. One moment he would complain that he was useless and talk about death and dying, but in school the next day he would act as though he was better than any of his classmates. His rages grew more frequent and more intense, sometimes involving physical attacks on his mother and often resulting in a trail of broken furniture and dishes, torn clothes and books. Between the storms of violence were periods when he was sad and withdrawn. The cycles repeated several times a day and were becoming more frequent. His parents didn't feel comfortable going anywhere with him and couldn't leave him for fear that he would hurt himself or someone else.

A destructive disorder


What do Amanda and Brian have in common? They both have bipolar disorder, or what used to be called manic-depressive disorder. These two cases are fictional, but they typify the most common form of adult bipolar disorder and early-onset bipolar disorder in a child. The person with bipolar disorder can become severely impaired, destructive, and suicidal - unable to function in everyday life. While nearly everyone has times when they are a little depressed or a little "hyper," the mood swings of bipolar disorder are extreme and potentially dangerous. Misdiagnosis is common with this complex disorder. Mental health professionals sometimes fail to identify bipolar disorder in adults, who usually seek help only when they are depressed. Unless the doctor uncovers the manic moods as well, patients may appear to be suffering from simple depression and may not get the treatment they need. It is estimated that between 1 and 3 percent of U.S. adults may have bipolar disorder and most of these people are still undiagnosed and untreated. Until recently bipolar disorder was considered a disease of adults. In the early 1990s, however, physicians recognized that children could have this disorder. In Washington County alone, 36 percent of bipolar patients treated during 2001 under Medicaid were under 21, with the greatest number in the adolescent age range.

Causes and treatment of adult bipolar disorder


Frederick T. Goodwin, M.D., an expert on bipolar disorder at George Washington University School of Medicine, describes bipolar disorder as a neurobiological disorder that affects the physical and chemical structure of the brain. According to the "Harvard Medical School Family Health Guide," the brain contains billions of nerve cells called neurons that communicate with each other through the action of chemical messengers called neurotransmitters. Among the most critical of these neurotransmitters are norepinephrine, dopamine, gamma-aminobutyric acid and serotonin. The actions of these and other neurochemicals are the basis for everything the brain does, including thought, feeling, memory and sensation. Researchers think that in many emotional and behavioral disorders, people have too much or too little of particular neurotransmitters in critical brain areas. Genetics also probably plays a role. If one or both parents have bipolar disease, the risk of their children being affected is increased. What causes this brain disorder is unclear, but several drugs are used to restore balance and functioning. Different people respond to the same drug in different ways, however, and, over the course of treatment, drugs may gain or lose effectiveness. The challenge for psychiatrists is to prescribe the right drugs to keep the patient stabilized.

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