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I’ve seen a lot of weird things flying through the internet lately about bipolar disorder so I thought I would try and address the issue. Bipolar disorder was formerly known as manic-depression, and is thought to affect as much as 3% of the US population. Recently there has been a lot of talk about “Bipolar II” but that is more difficult to define as the “mixed mood states” are more subjective and so I will leave them aside here.
In the classic “Bipolar I” there are episodes of mania and depression, but the diagnosis is based on at least one episode of mania. This is defined as an episode of abnormally elevated mood that lasts at least one week or that results in hospitalization, associated with at least three of the following, inflated self esteem or grandiosity, decreased need for sleep, more talkative than usual or pressured speech, and racing thoughts/flight of ideas, distractibility, increased goal directed activity/psychomotor agitation, excessive involvement in pleasurable activities with potentially negative consequences. If the mood is only irritable you need four of the above.
And that these symptoms cause impairment in social or work function and are not caused by drugs or alcohol.
Treatment of choice is lithium, although this drug has side effects and requires monitoring of blood levels. Other drugs pushed more recently include mood stabilizers (Depakote, tegratol, lamotrigine) and antipsychotics, although studies have not shown them to be better. They are mainly pushed as more convenient by drug companies since they are on patent and profitable (unlike lithium).
Many people live their lives without it becomely widely known that they have bipolar disorder. With proper treatment, manic episodes do not necessarily exhibit themselves.
I might add that the public’s view of bipolar disorder is not realistic. These people are not running down the street naked and screaming, and many are leaders in their communities. In addition there seems to be a disproportionate number of people who are highly creative artistically and musically. People with the diagnosis of bipolar disorder also try to hide it at whatever cost, knowing the stigma of society may have an affect on their personal lives and careers.
Note: this post was modified after the original post on September 29, 2010
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Thanks for this, Doug.
We watched an episode of “Doc Martin” last night, where a person with alleged bi-polar was acting more like a person with extreme paranoid schizophrenia. Geez…..
John MacManamy writes an excellent blog on bi-polar disorder. http://knowledgeisnecessity.blogspot.com/
Hi Gina!
[...] This post was mentioned on Twitter by Bipolar Love and Steve Austin, Doug Bremner. Doug Bremner said: The Truth About Bipolar Disorder. My Thoughts. | BYTTP http://bit.ly/9T5UCQ [...]
Thank you for this post. It describes bipolar disorder well in a nutshell, and also addresses the public’s misconceptions. I am always grateful for people who go write posts which might reduce stigma. Thank you again!
Chris
With all due respect, you really are off the mark.
I’m a mental health writer, advocate and bipolar. Here are a few of the “facts” you might want to check:
1. There is nothing “recent” about bipolar II. It is in the DSM-IV and widely diagnosed.
2. Mixed-mood states are also in the DSM-IV.
3. Drugs are not “pushed”, drugs are _used_ to treat a life-threatening illness where up to one-in-five commits suicide.
4. Lamotrigine is not an antipsychotic
5. It is ridiculous to suggest that drugs other than lithium are “mainly pushed as more convenient by drug companies since they are on patent and profitable” A _huge_ number of people _do_not_ respond to lithium or cannot tolerate the side effects. Other drugs are their _only_ option.
6. It is also ridiculous to suggest that with “proper treatment manic episodes do not exhibit themselves.” For a huge number of bipolars (about 25%) they will almost _never_ be in a place without some break-through episodes.
Really. If you’re going to write about a medical topic you could at least check your facts and site sources.
- Natasha
Fact check: When bipolar was first introduced as manic/depressive disorder in was thought to effect less than 1% of the population.
I would like to hear an argument against bipolar 1 & 2 being the most misdiagnosed and over-diagnosed disorder in America by far today.
Only in America do we label babies mentally ill with a bipolar label & drug them into a shortened life long misery, disability, and death masked in the name of medicine.
As for the whole bipolar 2 diagnosis; I’m quite sure if honest studies were ever funded (of course we know how that $ story goes) we would find that in the vast majority of cases, it was a drug induced/side effect disorder, and not a valid diagnostic mood disorder.
Of course those like Gina Pera and Natasha that yield their pseudo status and living from propagating false science, or running misinformation campaigns will tell you bipolar is just like cancer, heart disease, or diabetes.
I only ask that they prove their outrageous claims.
Doug, would you like to validate and prove the brain chemical imbalance theory here, or maybe show us the gene or series of genes that can concretely be used as diagnostic criteria/tool for bipolar supposed disease.
Maybe you can explain the validity of the diagnostic criteria used with children/toddlers to derive a bipolar label?
For a moment I thought I had mistakenly entered the NAMI or CABF site, but instead I found this.
[...] The Truth About Bipolar Disorder | Before You Take That Pill [...]
We haven’t identified a single gene for most cancers, but that doesn’t mean they aren’t real disorders.
As for the percentage that 3 per cent probably includes bp2
I don’t think anyone has scanned people in manic episodes as it would be hard to do safely
@Natasha “advocate?” writing snitty comments is hardly making a good representation for bipolar disorder. See my response to the rest of your comments below:
“There is nothing “recent” about bipolar II.”
I said recently there has been discussion.
“Mixed-mood states are also in the DSM-IV… it is widely diagnosed”
I said I was going to lay it aside for now, I didn’t say I didn’t believe in the diagnosis. As for widely diagnosed, so is childhood bipolar disorder, that doesn’t mean I have to agree with the diagnosis.
“Drugs are not “pushed”, drugs are _used_ to treat a life-threatening illness where up to one-in-five commits suicide.”
the fact is the the makers of the epilepsy drug neurontin paid millions in fines for off label promotion of the drug for bipolar and other conditions. Second generation antipsychotics and other mood stabilizing agents were also pushed as safer and more convenient. Check your facts about the relative efficacy of these drugs compared to lithium before making off the cuff comments.
“Lamotrigine is not an antipsychotic”
you’re right, that was corrected
“It is ridiculous to suggest that drugs other than lithium are “mainly pushed as more convenient by drug companies since they are on patent and profitable” A _huge_ number of people _do_not_ respond to lithium or cannot tolerate the side effects. Other drugs are their _only_ option.”
Huge number? As far as I can tell the most common current practice is to go straight to antipsychoatics and/or epileptic drugs
“It is also ridiculous to suggest that with “proper treatment manic episodes do not exhibit themselves.” For a huge number of bipolars (about 25%) they will almost _never_ be in a place without some break-through episodes.”
Of course there is always the exception to that; there are always life events so I corrected that
Hi Doug,
Thanks for this post. After disclosing my BP disorder in the Seattle Weekly, my life has never been the same. I am unemployable, though I now have a degree and since moving to Texas, demonized not only by the mental health system but by regular doctors who do not want to have a Bipolar/PTSD patient.
I just read the Seattle papers and saw what is going on with Stafford Frey, what a crock!!! We all know the real story…..
@Angie yeah I heard about your case. And then idiots writing anonymously on the internet rant about “using bipolar as an excuse”? Give me a break.
Stan – um, propaganda of pseudo science? Really. Feel free to show me one example where I have done any such thing. And while I do write professionally on mental health topics that is not where the bulk of my income comes from.
Feel free to show me the gene that has produced elongated tendons in my body or the one that causes my lack of biopic depth perception. Oddly, those things are real and medically verifiable and yet, no gene is known…
For bipolar I guess you’ll just have to settle for brain scan evidence:
http://www.ncbi.nlm.nih.gov/pubmed/20837502
http://www.ncbi.nlm.nih.gov/pubmed/20712826
http://www.ncbi.nlm.nih.gov/pubmed/20071149
or some bipolar gene information:
http://www.ncbi.nlm.nih.gov/pubmed/20679588
http://www.ncbi.nlm.nih.gov/pubmed/20667171
There are tens if not hundreds of studies on both topics.
Doug – If you would like to see evidence regarding medication efficacy in bipolar disorder, here is an excellent reference: http://psycheducation.org/depression/meds/moodstabilizers.htm
The site is written by a doctor who is published, and specializes in bipolar. (His credentials are clearly listed on the site.)
Additionally, treatment of bipolar mania and treatment of bipolar depression are two different things. Lithium is quite effective in mania, but not so in depression. Quetiapine and the olanzapine-fluoxetine combination have been found to be the most effective: http://www.ncbi.nlm.nih.gov/pubmed/20814319
Additionally: “long-term fluoxetine monotherapy may provide superior relapse-prevention benefit relative to lithium monotherapy after recovery from bipolar II major depressive episode without an increase in hypomanic mood conversion episodes” http://www.ncbi.nlm.nih.gov/pubmed/20360317
And I could go on and on. Lithium is one treatment. It doesn’t mean it’s the best in every case.
Do drug companies do nasty things? Naturally. They not really my favorite people either.
And are the comments snitty? Probably. Misinformation does that to me.
- Natasha
Thanks for the insightful post, Doug. I’ll leave the arguments to the specialists and stick to what I know firsthand. Bipolar disorder is poorly understood by the general public and those who disclose often pay a high price forpublic ignorance and the fear it induces. And this is simply not right. With proper treatment and monitoring, people who have been correctly diagnosed as BP can have productive and happy lives. Let’s not add stigmatization to the challenges these people face every single day of their lives.
@Natasha You continue to throw out little snippets of misleading facts. First, I clearly stated that I was not discussing bipolar II, so your comments on that topic are not germane. I am also not interested in links to someone’s websites about their opinions. If you want to discuss this, show real studies. If you take a look at the website’s link to quetiapine, the psychiatrist – author states that he works for Astra Zeneca, the makers of quetiapine. I looked at some of the studies (most of which were conducted by the manufacturers) of atypical antipsychotics v lithium and I am not convinced that they have superior efficacy for relapse recurrence of all mood events (which is what is clinically germaine). Given the long-term consequences of atypical antipsychotics (diabetes, weight gain) not to mention how patients state that they make them *feel* if I had bipolar disorder (which I don’t) I don’t think there is much question about what I would take.
Second, lithium has been clearly shown to be superior to valproate for prevention of recurrence of mood episodes.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)61828-6/abstract
and to be superior to placebo for prevention of relapse.
http://ajp.psychiatryonline.org/cgi/content/abstract/161/2/217
and the other epileptic (so-called “mood stabilizers”) have not been shown to be superior to lithium
No one ever claimed that the first line treatment of a depressive episode is lithium. what I am talking about is chronic treatment (i.,e. prevention of episodes)
people always pull out “brain scan evidence” as proof of bipolar. Look, if it really was “evidence”, Bipolar would be handed to the neurologists like every other real brain disease. End of story.
(Wait, actually I’m not quite done. Is Bipolar a problem, regardless of whether or not it is an irrefutable MEDICAL problem? Sure. Is our current biopsychiatric paradigm getting us the results we want? NO! Was there a time in US History where we actually got BETTER results in terms of outcomes in “manic-depressive psychosis”? Yes. And hint: it was before drugs existed, and yes, even before the psychiatrists took over. Since psychiatry, outcomes have always sucked in Bipolar, and they are getting worse.
So I looked at the first three links, and quite frankly, I’m not convinced. First of all, brain scans are pretty flimsy evidence even in well-established REAL brain diseases like Cerebral Palsy, which I know from experience. You can always see the white matter damage in Cerebral Palsy, which is how it is diagnosed, but pervasive damage does not always equal a severe form of CP, and light damage does not equal a mild form.
Secondly, it would be much more impressive if they could use the results to blindly diagnose Bipolar disorder: ie – get 300 or so “scans” showing this so-called global density and pick out the bipolar brains from the non-bipolar brains. Since the researchers “know” the results beforehand, it biases the experiment.
And the effects of medication are hardly ever taken into consideration, though the first study says it controlled for Lithium use. It is very rare to find any person with Bipolar who is drug-naive. Since the stupid drug war people are so fond of saying you can see the effects of ecstasy usage (for example) SEVEN YEARS LATER in monkey brain scans, I find it hard to believe that these same researchers consistently fail to wonder how these legal drugs (which we call “medicines”) which also cross the blood-brain barrier, don’t somehow also affect the brain density.
As someone who has to figure out how to deal with having Bipolar 1 _and_ be a good mom _everyday_, I am quite offended by the comments to this post suggesting that Bipolar does not exist. It’s all well and good to question the powers that be, but don’t question the millions of people who suffer day in and day out from this illness. Trust me, to those of us who have to deal with it, it is quite real. If you are fortunate enough to not have this illness, don’t add insult to injury by questioning the rest of us.
Dear Lisa,
I ALSO have a Bipolar I diagnosis, and for what it’s worth, I’m a damn good mom. So am I allowed to question it, since I am “[un]fortunate enough to… [not] have this illness”?
I don’t question that it exists, but I DO question whether or not it is a proven disease. It would be more accurately described as a syndrome, because the proof that it is a medical problem is lacking.
It would be similar to this scenario: imagine if you go to an endocrinologist and say, “I’m constantly thirsty, losing a lot of weight, and peeing a lot” and the endocrinologist says, “Based on your description, you are suffering from diabetes. Here are some drugs that will make the thirst go away, keep your weight stable, and stop you from peeing a lot”
Symptoms do not equal disease. Treating the symptoms do not equal treating the disease.
Doug: one question…are you a practicing psychiatrist? just wondering, because not too many psychiatrists dose out Li any more.
The popular go-to drugs are Trileptal and Lamictal with an add-on Antipsychotic. Depakote has low patient efficacy ratings and Li kills the kidneys…
I’ve been in the psych wards for over a year now over hearing a LOT of doctor talking to patients and Li is rarely talked about as ‘first line’ mood stabilization.
Also, I’m pretty certain that ppl w the bp dx might disagree that no one around them ever knows they are bipolar if their symptoms are controlled w meds….face it moods are moods and no drug is a cure for bipolar, thus the med-tweaking that is a constant in these ppl’s lives.
I also am intrigued at this post, my first thought, is that it reads as a ‘expert witness’ statement for court….not a lot of fact and research etc…think about how long this post could be with a lot of information…
Also, the SPECT scans were written up in WIRED mag, when Dr Carlat volunteered to have one done in Newport Bch AMEN clinic a while back, and I’m pretty sure he doesn’t agreee w any scans being decisive resources for bipolar dx’ing.
Here’s the Carlat story
http://www.wired.com/medtech/health/magazine/16-06/mf_neurohacks?currentPage=all
Brain Scans as Mind Readers? Don’t Believe the Hype
Thanks for that, Stephany, it was a pretty funny article
DSM-IV-TR diagnoses exist – and are given – in order to guide treatment that can alleviate suffering. I don’t think anyone on this thread is suggesting that mental illnesses aren’t “real” – just that there *are* relevant distinctions between physical and mental illness in many cases. In my personal opinion this doesn’t mean that medication shouldn’t be prescribed (on the contrary) – just that we should see diagnosis for what it is: a guide for treatment, rather than an objective fact. Before the bipolar commenters eat my children – yes, we believe your symptoms are debilitating, and yes, we know your problems are genuine.
The most common issue in bipolar II diagnosis is that the label is often given to permit pharmacological treatment of people who “really” have a personality disorder. Because personality issues can produce a similar set of symptoms, the diagnosis isn’t *in*correct – it just misses the point.
For people whose mood problems are linked to low self-esteem, immature defenses, relationship problems resulting in lack of social support, self harm etc – what they really need is a lot of therapy and community support to enable them to build a better life.
But because these services aren’t available, don’t get immediate results, or pose too great a challenge to fragile patients – because a label like borderline personality is also stigmatizing, and may offend – because this isn’t the kind of treatment that makes drug companies money – treatment providers will default to Bipolar II, write a(n ineffective) prescription, and send a damaged, suffering individual back to their unhappy life to fend for him or herself.
I agree there’s a problem here. But it’s only partly big pharma.
@Elephant – Bingo. You got it.
I have a half day clinic a week but my views on lithium are held by others
http://ajp.psychiatryonline.org/cgi/content/full/167/2/216
this post was not meant to be comprehensive but to start a conversation
The Amen brain scan scam is a fraud
Yes, I was reporting in ‘from the trenches’ about Li use in patients in general via observation in several inpatient settings, it’s less popular to use now.
Also, many psychs are rx’ing Lamictal for bipolarII dx.
The view on Lithium is widely held, though not without debate. Have you read Moncrieff’s work on Lithium?
I’m still with you on that, though, as far as bipolar drugs go, it is at least as effective (and widely held to be more so) than other nonsense drugs. I hated it personally, but that doesn’t tell you anything about averages.
Yeah, I had to laugh at comments critical of this post – if you had to clarify every little everything said about bipolar, you’d need a book. It was good for a post.
And @Stephany, yeah, doesn’t surprise me about Lamictal at all… Since bipolar II is much more depressive, and Lamictal is the only drug I have seen with any efficacy in bipolar depression (I don’t think Lithium really works for bipolar depression, despite what is said in literature). Having said that, it really barely beats placebo.
Frankly, psychiatry really doesn’t have any ideas when it comes to Bipolar depression, which sucks because it’s much more a depressive disorder, even though it’s defined by mania
I have to agree with you on the “new drugs being pushed”. I was diagnosed Bipolar II and have had horrible reactions to the latest greatest drugs-gee they even have free samples-how nice? Not. But, can I get anyone to put me on a tiny tiny dose of Lithium? No way! They want to try every single new drug that ends up making me worse! It is money. Lithium is cheap. And, he docs don’t have to monitor you so closely on the new ones-until they meet me-canary in the coal mine. So, now I have to wait 2 weeks to see a specialist/I have no therapist. I don’t know the answers, but I do know once you get on some of these drugs you’ll never get off/that’s a fact from my experience. I’m so fed up. But, who’s going to listen to me? I’m mentally ill? UGH!
Mental health is a constant difficulty in my home. My wife suffers from depression and her son has bi-polar disorder.
Sounds like Natasha forgot to take her meds. Really, I think this is great information on what society thinks about Bi-polar. I dont think it is meant to subsitute for people who need their own mental evaluations. Thank you Dr. Bremner for helping us see that bi-polar should not be kept a secret. Also, Natasha said that even with medication the moods can not be hidden, well I get PMS and just plain moody sometimes, does that mean I can use bi-polar as an excuse??? Really? Just cause you have mood swings doesn’t mean you can not control bi-polar.
[...] if you’d like to have a look, tell me I’m wrong, or snitty, or perhaps lend a comment in support, go right [...]
The DSM does not have one ” disease” that is scientfically proven.No blood tests,CAT scans or X rays. Each one of the diseases is voted into existence by the Psychiatric industry. Please do your research beyond the mainstream. Find out about what options there are besides people telling you your stuck in the condition for the rest of your life. The things people feel are very real but saying they have a disease is not accurate.
One thing I would love to see would be people writing in without attacking each other. It’s fully possible to correct or challenge or question someone else’s comments without being adversarial. For example, I am easily offended by posts that suggest that Bipolar II is purely psychological, or doesn’t exist, or is most often a personality disorder misdiagnosed… I have exceptional interpersonal skills, very healthy relationships, and an outgoing personality (when not depressed). My symptoms are painful and chronic, and extremely treatment-resistant. I know literally dozens of professional therapists who would laugh at the notion of personality disorder – but easily recognize bipolar disorder. Too many people in my life have suggested I just need to get out more – or read some new book – and one person told me to “join the choir at church” and everything would be fine. I’ve had some frustrated, angry moments.
But. Each person in their post was trying to say something they found meaningful. And several didn’t really say quite what I thought they were saying at first. And frankly, I’d rather get along with people, and I find it really boring to read other people criticizing each other and not staying on topic. It seems to be a pretty common thing on forums and such these days. My heartfelt request: remember that people are just human beings like you. Let’s try to work together…?
Of course, I suppose someone will be mad at me for saying this…
Bipolar disorder is just the latest fraud fad epidemic to push the latest lethal poison drugs on patent with BIG PHARMA per Dr. David Healy, MANIA: A SHORT HISTORY OF BIPOLAR DISORDER and even Dr. Allen Francis, ed. of DSM IV no less!! He admits they made terrible mistakes in DSM IV which resulted in epidemics of autism, ADHD and bipolar. ALL of those working on so called mood disorders for the DSM IV and now DSM V have conflicts of interest with BIG PHARMA, typical of main stream psychiatry. Manic depressive illness used to be very rare and most people recovered within a short time to lead productive lives WITHOUT lethal poison drugs from psychiatry. This label was changed to bipolar when new drugs were invented to treat it and it skyrocketed into a bogus epidemic because as Dr. Insel says, psychiatrists have certain preferences as to what they know how to treat based on their prejudices rather than evidence based science. With the recycling of an old epileptic drug renamed Depakote and the need for new markets of lethal atypical antipsychotics on patent, the fad fraud bipolar epidemic exploded all the more with predations on babies and toddlers no less showing mainstream psychiatry has no conscience whatever! Also, one should read Robert Whitaker’s books ANATOMY OF AN EPIDEMIC and MAD IN AMERICA to see how these bogus life destroying stigmas and toxic drugs created an epidemic of drug induced “mental illness” and such far worse outcomes than no treatment, that there has been an astonishing rise in disability for us taxpayers to bear not only for this bogus, “toxic psychiatry” per Dr. Peter Breggin, one of the few psychiatrists with a conscience, but also for the millions made permanently disabled and on permanent Social Security disability thanks to this fraudulent epidemic. Comparing VOTED in stigmas for the junk science DSM to any medical illness it total deceit. There is no comparison per Dr. Fred Baughman, Neurologist, who calls all these so called mental illnesses including bipolar 100% FRAUD!
It’s also shocking to learn that those in third world countries suffering emotional/social distress and not preyed on with bogus stigmas and lethal drugs tend to recover and fare much better than those in the U.S. and other so called advanced countries. CAVEAT EMPTOR!!