Balancing Bipolar Disorder

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Karen Renken was just 14, but she knew something was terribly wrong. “I was a straight-A student, and suddenly I started failing in school,” says Renken, now 45, of Long Island, N.Y.

At high school, she would go from enjoying a seemingly normal mood to throwing a tantrum in the hallway. Her teenage response to normal requests, such as her mother’s plea to pick up after herself, was dramatic. She would, she says, “shriek like a maniac.”

Renken was sent to a bipolar disorder more quickly. According to the National Institute of Mental Health, some 5 million American adults have the condition; this figure is far higher than the previous estimate of 2 million. More accurate diagnoses of bipolar disorder, as opposed to depression, may be part of the reason why.

“Our society has [become] more aware of psychiatric disorders in general,” says Michael Gitlin, MD, professor of psychiatry and director of the Clinic at the UCLA’s David Geffen School of Medicine. He says people may be more likely to seek treatment today, plus the definition of bipolar has broadened in the eyes of many doctors.

The “poles” in bipolar refer to the mood extremes — mania on one end, depression on the other — that distinguish this mental illness. But behavior isn’t always extreme, and many more doctors are now recognizing patients with episodes that are more subtle than the classic mania behavior, leading them to diagnose bipolar disorder rather than depression, Gitlin says.

Better Bipolar Treatments

Once a correct diagnosis is made, treatment can be highly effective. Medication and psychotherapy both help, Gitlin says. Research suggests that interpersonal and social rhythm therapy — where the focus is on improving interpersonal relationships and regularizing daily routines and sleep schedules to help prevent manic episodes — gets results. The number of medications available to treat bipolar disorder has increased in the past five years, with the overall goal being long-term stabilization of mood.

was the first mood stabilizer approved by the FDA, more than 35 years ago. The medication works by stabilizing or smoothing out moods, helping to prevent both extremes of depression and mania.

Anticonvulsants such as valproate (Depakote) or (Tegretol) also can help stabilize mood. Some doctors think these drugs are helpful for difficult-to-treat bipolar episodes.

Atypical antipsychotics (also called second-generation antipsychotics) such as aripiprazole (Abilify), clozapine (Clozaril), olanzapine (Zyprexa), (Seroquel), (Risperdal), and ziprasidone (Geodon) have also been tried as mood stabilizers when lithium or anticonvulsant medications do not work well for a particular patient.

Doctors may also prescribe antidepressants, but how to use them is a matter of debate. Some experts frown on them because, as Gitlin explains, they might lift mood too much, tipping the patient into a manic state. But others, including Gitlin, think that antidepressants can offer some benefits and that their use must be decided on a case-by-case basis. (Another wrinkle: The FDA recently issued a warning of an increased risk of dangerous behaviors among children and teens who took antidepressants.)

Treatment choices may change with time, depending on a person’s mood and episodes. But treatment itself must be long-term, say Gitlin and other experts.

These days, Karen Renken is a changed person. The combination of better medications and continued therapy, she says, has made all the difference. “I’m pretty happy with my life,” she says.

Questions to Ask Your Doctor About Bipolar Disorder

  • Could I have bipolar disorder or some other condition?
  • If I do, what treatment plan is best for me?
  • What else can I do to minimize my symptoms?
  • Where can I find resources and emotional support for my family and me?