JANE'S MHSP ARCHIVES: 1999

Bipolar Disorder (“Manic Depression”)

What Is Bipolar Disorder?

Bipolar disorder is also called Manic Depression. The term “manic depression” isn’t the preferred term because of the connotation society has imparted to the words “mania” and “manic”. The word “mania” has become vernacular (commonly used) and has lost the medical seriously warranted in this disorder. In fact, some patients are offended when stores advertise their “July Mania” sales because the patients believe these terms downplay the pain that bipolar disorder brings to their lives and loved ones.

Bipolar Disorder (sometimes abbreviated as BP or BPD) is a neurobiochemical disorder from which a person experiences extreme “highs” and “lows” in mental perception (mood). Physical manifestations of a “high” swing may be extremely rapid thoughts coursing through the person’s head which often does not make sense or the ability for the person to go without sleep or food for several days. Physical manifestation of a “low” state may be excessive sleeping (hypersomnia).

As with many disorders, there is a spectrum of these two poles of mood (hence “bi-polar”) from extreme to mild episodes depending on the individual. Some people can experience the farthest of the extremes of the mood swings and are therefore suffering from “Classical” or Type I bipolar disorder. Along the spectrum are several variations of bipolar disorder which are assigned types II to V (2-5).

To accurately diagnose the type of bipolar disorder an individual has, he or she must consult with a professional with experience in diagnosing and treating bipolar disorders. People who suffer from bipolar disorder have described their moods as an unpredictable yo-yo, or liken the experience as being on a perpetual roller coaster ride.

Patients who experience only the down cycle have Major depressive disorder (abbreviated MDD) or Depression – these patients have Unipolar (one pole of mood) depression.

Who Gets Bipolar Disorder?

Bipolar disorder is estimated to affect approximately 5% of the U.S. population (year 2000 estimate). Bipolar disorder does not discriminate, and affects people of all races and ages. Children as young as two years old have been observed to suffer from bipolar disorder. While many professionals accept that young children can suffer from bipolar disorder, this is still under diagnosed and often misdiagnosed as ADD/ADHD.

Bipolar disorder often has a genetic basis. Therefore, a physician will ask the patient if there were family members who had symptoms of bipolar disorder. Researchers are still identifying bipolar disorder-causing gene(s) and some progress has been made. A potential molecular target that may be altered in patients with bipolar disorder is a protein called Bcl-2. This protein protects neurons (brain cells) from dying and helps neurons regenerate. However the findings are preliminary and has theoretically rather than practical implications at this point. Bcl-2 also plays a role in many disease states including cancer (in this case, Bcl-2 is the culprit and protects cancer cells from dying).

What Triggers Bipolar Disorder?

The onset of bipolar disorder-related symptoms often appear in early adolescence, and young children have also been diagnosed with bipolar disorder.

Triggers are often “invisible”. Recognizing symptoms and potential triggers are important in managing bipolar disorder. A bipolar disorder episode may be triggered by diverse factors such as sleep, stress, diet, physical activity, and the person’s own lifestyle. Each person has a unique “threshold” (tolerance level to an emotional or physical stimulation) that responds differently to triggers.

In conjunction with a medication and/or therapy regimen, some have found it helpful to keep track of certain triggers so they can anticipate symptoms. For example, high sugar content in some individuals’ diet may increase the risk of mania and they can reduce dietary sugar intake. Other non-medical practices like meditation and acupuncture may complement medication and therapy. Exercise is a critical element to relieving emotional and physical stresses.

What are the symptoms of bipolar disorder?

A helpful way of thinking about bipolar disorder symptoms is to see the symptoms in a “spectrum” rather than discrete behaviors because you may miss mild episodes. Mild episodes that did not receive proper medical attention may escalate into more serious episodes. Below is a short list of “gauges” for your reference; the medically accepted criteria for diagnosing bipolar disorder, DSM-IV, includes a more comprehensive list of symptoms of mania and depression.

Manic episode (less severe in hypomania):

• * talking excessively and/or rapidly compared to usual character

• * decreased need to eat or sleep, even for a few days

• * exaggerated grandeur, “having plans to save the world”, “unifying religions”

• * extreme cases include hallucinations and severe paranoia

• depressive episode (overlaps with dysthymia):

• * excessive sleeping or prevalent insomnia – disruption in usual sleeping pattern

• * antisocial behavior and irritability

• * prolonged feelings of inexplicable sadness, worthlessness

Why Me?

Many people ask the “Why me” question when confronted with a serious challenge. The alternative question is “why not me?” I find people who ask “Why not me?” inspirational because they used a devastation as a source of strength and growth.

Even though society is becoming aware of the devastating effects mental illness has on an individual and the people surrounding that individual, we are still quick to judge that person as being weak in character or having an immoral personality, and after having justified to ourselves why this is a bad person, we go about our own business. This may be easier for society to accept than to take actions to help the mentally ill, which does take a tremendous investment in time, effort, and money (as with all worthy causes).

What Treatments are Available?

There are many “first-line” treatments available. Often, these medications alone can control both the manic symptoms and depressive symptoms. However, an antidepressant may be added if depression is not alleviated with the mood stabilizer alone. It is extremely dangerous for a person suffering from bipolar disorder to take an antidepressant alone, because this can induce mania in the person.

New medications and treatment methods are becoming available for bipolar disorder, to improve the symptoms and quality of life for patients.

Is there Hope?

Yes.

Bipolar disorder does not have a “cure” but it can be managed with education, therapy, and healthy lifestyle practices (exercise, proper diet, enough sleep).

As with cancer and diabetes, bipolar disorder requires a ‘regimen’ of medical, dietary, and behavioral management. People with mental illnesses can lead productive lives. The key is to seek help before something catastrophic happens to our moods.

There is Hope when we create it for ourselves.

When is alternative medicine an alternative?

Today we like to be in charge of our recovery, which may include self-medication or alternative therapies. I’m glad that consumers are beginning to take a proactive attitude toward educating themselves about the options available to them. However, I worry about desperation being taken advantage of by misleading advertising claims.

Health supplements and “natural” medicines (nutraceuticals) are manufactured by commercial ventures intent on profit – not unlike pharmaceutical companies – except these products are not regulated by the FDA. Since supplements are not regulated by the FDA, there are cases where the product does not contain active ingredients claimed by the label. Recent attention over serious and fatal adverse events from ephedrine (contained in various weight loss supplements) highlights the potential danger of herbal supplements. Please check out the Quackwatch Home Page, where you will find questionable claims from cancer treatments to psychotherapy.

I remembered as a child (and living in Taiwan), I would visit the corner apothecary. My mother relied on traditional Chinese herbal medicine for ailments. We treated those as medicine, taken according to the herbalist’s instructions. Even so, there are questionable benefits to some of the ingredients comprising these herbal remedies. The western society has assumed a role of self-medication, often with remedies promising to be natural and “safe”. I’m encouraged about being proactive in restoring our health, but I worry about not questioning the truth in most health-related claims.

We often don’t think of plants as potently medicinal. We may even decide, “it’s herbal – how bad can it be?” The strongest medicines have come from plants. Aspirin was first discovered from the bark of the yew tree (active compound: salicylate). Aspirin is used as an analgesic and even prophylaxis for coronary incidents because of blood-thinning properties – that’s strong stuff. The cancer drug, paclitaxel also comes from the bark of the pacific yew tree. Perhaps it is time to accept herbal remedies as strong medicines warranting the same precautions as medicines made in a lab. This means accepting that natural medicines can Heal but can also Harm.

To put things into perspective, a doctor once said “Poison ivy is completely natural, but I wouldn’t roll around naked in it.”

Food Connection: Can We Eat Ourselves Into Depression?

Can food be linked to depression? I don’t mean feeling bad about gaining weight because of a daily junk food habit. Rather, dietary habit and brain chemistry. You’re probably not new to the concepts of altering our dietary lifestyles to change the way we look and feel, although how diet and our feelings connect together may not be so clearly discussed. An article by Ron Hoggan (M.A) and James Braly (M.D) discussed the effect of diet on the depression profile of brain biochemistry.

The article cites examples of how what we eat and drink may affect how our brain neurotransmitter levels are balanced. As a result, our moods are affected. We are aware of how sugary foods energize us in short bursts, for which we pay later with sluggishness and lethargy. As our social pace accelerates, our dietary habits change. This means we are potentially seeing trends and relationships between food and mood that we may not have noticed before.

The Serotonin Connection

The authors cite how an important neurotransmitter, serotonin, becomes elevated in our brain after we eat. You may be familiar with medications that change serotonin levels in our brains: antidepressants in the class of SSRI or Selective Serotonin Re-uptake Inhibitors. SSRI medications prevent serotonin breakdown, thereby maintaining an elevated serotonin level in our brain. Theoretically, we may increase serotonin levels in the brain by eating a protein-rich meal followed by a dose of carbohydrates. This manipulates the levels of tryptophan (an amino acid used to make serotonin) and insulin (a hormone that regulates glucose uptake). The potential result is an increase in the amount of tryptophan transported to the brain.

Food Breakdown To Mind Breakdown

Some foods that are incompletely broken down to yield “morphine-like substances”. These substances can lead to depression. These foods include gluten and milk, although the exact break-down substances were not stated in the article. Based on this premise, we may be tempted to associate a “digestive tract” profile of a person to how vulnerable that person is to depression. If a person was unable to completely digest a certain food, this can lead to the accumulation of partially digested proteins. These partially digested proteins can act as depressants. This person’s depression can then be linked to his or her body’s sensitivity to certain foods.

In our fast-paced, highly stressful way of life, are we selecting foods that are causing us to become more prone to depression, bipolar disorder, or other mental illnesses? This hypothesis is intriguing, because it suggests a therapeutic potential for patients who have become resistant to conventional therapies.

Mind Over Matter or Matter over Mind

Reading this article has prompted a “chicken-or-the-egg” question: which triggers depression first, the mind or the body?

If your body is nutritionally deficient, it may build up chemicals that causes a neurochemical imbalance. If the neurochemical imbalance already exists and leads to craving for a certain kind of food, the imbalance may be activated and “fed” by these foods. Is it possible to suggest that it is “matter” directing the “mind” where food is concerned?

Stealing

First I began to hoard things that I was given. I had an impressive candy collection that I refused to eat; I found greater comfort in having the sweet pile where I knew it was safe and available if I needed to look at it. I didn’t think my stash was a problem until my aunt called and told my mom that an army of ants had happily found their treasure trove. For some reason , I didn’t feel upset at having lost something I had saved so carefully. I must have learned by then that people always lost what was dear to them.

I was in the first grade when I started stealing. I wasn’t a delinquent – in fact I was at the top of my class. One day I discovered that my mother’s cash registers held cash (she owned a business), so I took a buck or two to buy candy. I started taking more money from the register and I couldn’t stop stealing to buy possessions that could become a comfort to me.

I felt a satisfaction of pseudo-independence, when I could buy whatever I wanted. Candy, paper dolls, a shot at the video arcade games, color pencils. The funny thing was I gave these possessions away freely. I let classmates borrow the shiny new pack of colored pencils I had bought with my mother’s stolen money. For me, because these pencils never really *did* belong to me (since it wasn’t “my money”), I never feared losing them. When I gave them out, I didn’t care if the students might not return them.

One day my mom came to my school. She suspected I had been stealing, and came to speak with my teacher after class. Seeing a parent’s face peer into the window of my classroom gripped my throat with panic. After the class was dismissed I was called to the front of the room where my mother began talking with my teacher.

They began firing questions at me, asking me where I got the things I had, how I got the money to buy them, whom I took the money from etc… the inquisition seemed to go on forever and I felt sick to my stomach. Finally after they were finished, my mother took me home in a cab. My mother said nothing on the way home. When we got home, a lady who worked for my mom’s business greeted us, “hey! you’re back! where have you been?” and my mother answered “we were grilling her” and looked at me. I felt ashamed. I was a criminal and everyone knew it. My mother also told me that if she ever caught me stealing again, she’d use severe punishment. She told me even when she was very poor, she never stole and acted like the thief I was. I was a shame to her and to the family.

Of course I stole again. I craved for comfort and power of buying things I wanted and keeping it “mine” and secret. And of course, I got caught (I was a very stupid thief or I wanted to get caught). My mother went ballistic. My mother made good on her promise and brought out pliers as I stood there horrified and waiting, never attempting to run away or struggle. I had always been obedient that way – I’d stand there and wait for what I deserved.

My mom opened the pliers up and cramped down on my thumb. She proceeded to the next finger. I was sobbing but remained standing for my punishment to end. My aunt pleaded with my mother, telling her “she’s just a little kid!” but my mother insisted that I needed to be taught a lesson.

When my mom went into my room and began to pack my clothes into a bag, I lost it. She said she was throwing me out. She grabbed me by the hand and led me down the stairs as I wailed in terror. Then she threw the bag out the door and shut the gate in my face. I stood there weeping, not sure which I felt more – the fear that now I would die or the embarrassment that curious walkers-by stared.

Eventually, I stopped crying, and went to my piano lesson as if nothing happened. I learned to continue or “keep up” as normally as I could no matter what had just happened. That night I did sleep in my own bed so I was allowed in the house again.

Growing up sad

I didn’t smiled much as a child or as a teenager. I feel as if I’ve been catching up on all the smiling that I didn’t do, now, as an adult. It’s a strange experience because I always thought that children had more reasons to smile more than adults – after all children had not learned much fear or mortality.

Someone had told me that I was empathic. I soaked up other people’s emotions like a sponge. I felt what they were feeling, and sometimes that kept me down for a long time. Since I was young I had been thinking about all the suffering in the world, and I wondered why this was so. As a child I was quiet and hardly spoke. I was obedient, thinking too much, and in my own world.

When I was in kindergarten I realized I had no one to turn to. My dad was always away for business so it was just my mom, my brother, and me. My brother was often sick as a child and required a lot of attention.

One day after kindergarten I had an accident. A big kid on a bicycle sped by as I was walking home with a buddy and hit me. The big kid hurriedly got back onto his bike and fled. I was bleeding from the knees where I fell hard on the gravel. My walking buddy was scared, but I was feeling more of something else than pain from the injury. I got up and brushed myself off. Then I started crying.

I couldn’t stop crying. I leaned against the nearby lamp post and cried. I still don’t understand why I cried so hard then, although I knew it was not from the pain of my knees. My walking buddy begged me to stop crying and that he would walk me home. I wouldn’t budge. I didn’t want to go home because that was not where I found comfort.

After a long time, I finally moved away from the lamp post. My walking buddy and I walked to where I lived. When my mother answered the door, my walking buddy told her I was hurt from the accident with a bicycle. I was grateful that my walking buddy did not abandon me and walked all the way home with me (we usually parted at the street corner where I would walk to my house and he would walk the other way to his house).

That wound slowly healed too.

Eggs

When I was maybe 5 years old, I had learned to bathe myself, and wash my own hair.

One evening I was getting ready to wash my hair, when I noticed that in the corner of the bathroom, on the tiled floor adjacent to the bathtub, was a pile of tiny black pebbles. I wasn’t sure what they were, so I called for my mother. She walked by the bathroom (the door was open) and took a look, and told me ‘those were cockroach eggs’.

Cockroach eggs? Cockroaches! I jumped back, disgusted and afraid. Images of tiny cockroaches squirming in the little black eggs immediately flashed into my head. My fear was apparent. My mother snapped saying ‘they’re just cockroach eggs!’ and then she told me to put my left foot on them.

I could hardly believe what I was hearing. Suppose I put my foot on them and crush the eggs, and thousands of tiny cockroaches swarm over my foot! I looked at my mother, in panic and unable to speak.

My mother demanded that I put my foot on the eggs. She was my mother and therefore she was to be obeyed, so I held my breath and put my foot on the little eggs and could feel the little pebbles underneath my left foot.

The eggs thankfully did not burst open as I had imagined. My mother seemed satisfied and left. I continued my shower, but I still remember how the roach eggs felt underneath my foot.