Bipolar Disorder

The old name was a bit more catchy…Manic Depressive Illness. It describes a group of  lifelong disorders characterised by episodic disturbances in mood, cognition, and behaviour.  Usually at  least one of these episodes involves an elevation of mood lasting three or more days where there is grand ideas, decreased sleep, talkativeness, racing thoughts, risk taking , overindulgence.  Typically ‘ a high’  is followed by a depressive slump  lasting up to three months or more.  But the course of these disorder is quite variable;  some people have two or more mood episodes a year others two to three mood episodes in a lifetime.

The condition has a high genetic loading the relative risk in first degree relatives is 5.8-7.9 compared to 2.8 schizophrenia and 2.1 depression.  Once again the genetics of bipolar disorder is complex involving a number of genes which lead to a hyperexciteable neuronal phenotype.

Studies suggest decreased neuronal functioning in the prefrontal cortex and limbic system possibly due to mitochondrial dysfunction. Its been suggested that  inflammation plays  a role. Lithium a key treatment for bipolar disorder appears to work by improving mitochondrial function and increasing Brain Derived Neurotrophic Factor (BDNF) necessary for neuronal growth.

Bipolar Disorder need to be distinguished from Borderline Personality Disorder. In Borderline Disorder there is rapid change of mood during the day mostly in relation to anxiety and anger level usually in relation to feeling let down by significant others.

Bipolar Disorder persons often present when depressed but if treated with antidepressants alone they tend to get have no effect or actually get worse on them.

Management

Lifestyle-  Needs  to follow Epicurian  traditions ie: moderation in all things particularly in regularity of sleep-wake cycle, non-abuse of alcohol.

Many Bipolar patients resist treatment because they feel treatment takes the “edginess and excitement ” out of their lives.

A Mediterranean  Style diet is best.  Fast food tends to heighten neural inflammation.

Flaxseed Oil  2  tabs per day can help reduce cycling of mood and reduce neural inflammation.

                   Phosphatidyl Choline 500mg is helpful during highs

                   SAMe  400mg  1/day  is helpful during depressive phase

Medication–  The main medications used are mood stabilisers which are either Lithium or  Anticonvulsant medications which calm neuronal excitability. Once stabilised the person stays on these medications indefinitely.

During ” highs”  an antipsychotic medication is added.

During  depressions an antidepressant medication is added. Often people remain of a low dose of antidepressant so that no time is lost in restarting the antidepressant anew with recurrences.

There is a significant risk to Bipolar Disorder with high divorce rates,  risk of legal infringments or physical injury  during highs, and suicide during depressions.

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